Use of mechanical devices for distal hemoperfusion during balloon catheter coronary angioplasty.

PubMed

Heibig, J; Angelini, P; Leachman, D R; Beall, M M; Beall, A C

1988-01-01

Previous attempts to protect the dependent myocardium during balloon catheter coronary angioplasty in animals and humans have had generally unsatisfactory results. This paper summarizes the authors' experience in investigating commercially available mechanical pumps for distal coronary hemoperfusion during balloon angioplasty. Both roller and piston pumps can attain adequate distal perfusion without significant side effects in the majority of patients. Our goal was to suppress angina for at least 5 min to prolong balloon inflation in awake patients. Minor T-wave changes without concomitant angina pectoris can be expected when the distal coronary bed is perfused with hypothermic blood. Side branch occlusion by the inflated balloon prevents effective protection of the corresponding part of the dependent myocardium during distal hemoperfusion, which may result in persistent angina and ST-T changes uncorrected by increasing the hemoperfusion rate. Distal coronary diffuse spasm, rare and transient, was the only immediate complication of this procedure. It is suggested that intense local wall stimulation could occur with a higher flow rate (jet effect). Improved balloon catheter pressure/flow characteristics and on-line continuous mechanical pumps should soon make distal coronary hemoperfusion through balloon catheters an accepted clinical technique.

Artery balloon angioplasty and depression symptoms.

PubMed

Slovacek, Ladislav; Slovackova, Birgita

2011-06-01

Peripheral arterial occlusive disease (PAOD) as a chronic disease is associated with physical, psychological and social distress for elderly patients and their families. The study has three main aims: 1. to evaluate the occurrence and the relevance of depression symptoms in patients with PAOD, 2. to evaluate the effect of age and Fontaine stage of PAOD on relevance of depression in patients with PAOD, and 3. to evaluate the effect of artery balloon angioplasty (ABA) on occurence and relevance of depression symptoms. The study was prospective and longitudinal. Dates were obtained during year 2006. The total number of subjects with PAOD was 42 (28 males, 14 females). Thirty subjects with PAOD (20 male, 10 female) treated by ABA filled in Zung's scale 3-6 months after ABA (61%). The mean age of all subjects was 65.4 years (aged 45-79). The evaluation of occurrence and relevance of depression was performed with Czech version of Zung self-rating depression scale (ZSRS). The mean Zung self-rating depression score (ZSRDS) certifies the presence of signs of minimum or mildly depression in patients with PAOD. The results proved statistically significant dependence of depression on age and on Fontaine stage of PAOD. Also, the results proved that artery balloon angioplasty has a highly positive effect on occurrence and relevance of depression symptoms. The results had shown the existence of the association between PAOD, depression and ABA.

Cutting-Balloon Angioplasty in Transplant Renal Artery Stenosis as First-Line Treatment in the Early Postoperative Period

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ucar, Adem, E-mail: ucaradem@yahoo.com; Yahyayev, Aghakishi, E-mail: aghakishi@yahoo.com; Bakkaloglu, Huseyin, E-mail: drhuseyin@yahoo.com

2011-02-15

Percutaneous transluminal angioplasty has been successfully used for the treatment of transplant renal artery stenosis (RAS). Cutting-balloon angioplasty (CBA) is being used as a second option in pressure-resistant stenosis. It is thought that CBA is less traumatic and therefore restenosis occurs less frequently than in conventional angioplasty. This case report describes the unusual use of a cutting balloon in transplant RAS as a first option in the early postoperative period. Long-term follow-up data are also presented.

Meta-analysis of randomized trials of percutaneous transluminal coronary angioplasty versus atherectomy, cutting balloon atherotomy, or laser angioplasty.

PubMed

Bittl, John A; Chew, Derek P; Topol, Eric J; Kong, David F; Califf, Robert M

2004-03-17

We conducted a systematic overview (meta-analysis) of randomized trials of balloon angioplasty versus coronary atherectomy, laser angioplasty, or cutting balloon atherotomy to evaluate the effects of plaque modification during percutaneous coronary intervention. Several mechanical approaches have been developed that ablate or section atheromatous plaque during percutaneous coronary interventions to optimize acute results, minimize intimal injury, and reduce complications and restenosis. Sixteen trials (9,222 patients) constitute the randomized controlled experience with atherectomy, laser, or atherotomy versus balloon angioplasty with or without coronary stenting. Each trial tested the hypothesis that ablative therapy would result in better clinical or angiographic results than balloon dilation alone. Short-term death rates (<31 days) were not improved by the use of ablative procedures (0.3% vs. 0.4%, odds ratio [OR] 0.94 [95% confidence interval 0.46 to 1.92]), but periprocedural myocardial infarctions (4.4% vs. 2.5%, OR 1.83 [95% CI 1.43 to 2.34]) and major adverse cardiac events (5.1% vs. 3.3%, OR 1.54 [95% CI 1.25 to 1.89]) were increased. Angiographic restenosis rates (6,958 patients) were not improved with the ablative devices (38.9% vs. 37.4%, OR 1.06 [95% CI 0.97 to 1.17]). No reduction in revascularization rates (25.2% vs. 24.5%, OR 1.04 [95% CI 0.94 to 1.14]) or cumulative adverse cardiac events rates up to one year after treatment were seen with ablative devices (27.8% vs. 26.1%, OR 1.09 [95% CI 0.99 to 1.20]). The combined experience from randomized trials suggests that ablative devices failed to achieve predefined clinical and angiographic outcomes. This meta-analysis does not support the hypothesis that routine ablation or sectioning of atheromatous tissue is beneficial during percutaneous coronary interventions.

Utility of Adjunctive Procedures With Balloon Dilation of the Eustachian Tube.

PubMed

Ashry, Yehia; Kawai, Kosuke; Poe, Dennis

2017-12-01

To assess the role and effect of concomitant adjunctive procedures when combined with balloon dilation of the Eustachian tube (BDET), including a new technique for treating obstructive disease within the bony Eustachian tube (ET). Retrospective case series. Tertiary medical center. Adults with persistent (≥2 years): 1) OME or non-fixed TM retraction AND type B or C tympanogram OR 2) Consistent symptoms of barochallenge with flights or diving, all despite medical treatment for ≥6 weeks. Balloon dilation of the cartilaginous ET (BDET) was performed under general anesthesia using concomitant myringotomy with or without tube placement if indicated. Adjunctive turbinectomy, adenoidectomy, and/or tympanoplasty were used in selected cases. For suspected disease in the bony ET, an illuminated guidewire was used for probing and clearing the lumen. Outcome measures were tympanogram, otomicroscopy, ET mucosal inflammation score, Valsalva maneuver, and PTA audiometry. 67 ETs (48 patients) underwent BDET: 1) 30/67 balloon w/wo myringotomy, w/wo tube, 2) 20/67 plus adjunctive procedure or 3) 17/67 plus guidewire. Follow-up was ranging from 0.4 to 3.4 years (mean 1.3 year, SD = 0.7). Significant improvement occurred in 79%. There was no significant difference in the failure rate comparing balloon dilation with adjunctive procedures 5/20 (25%) or without adjunctive procedures; 4/30 p  = 0.45 (13%). Failure rate for BDET plus guide wire was 5/17 (29%) and resistance within the bony ET occurred in 8/17 (47%). Balloon dilation of the cartilaginous ET demonstrated significant improvement despite expansion of indications that necessitated the addition of adjunctive procedures. 4.

Utility of Adjunctive Procedures With Balloon Dilation of the Eustachian Tube

PubMed Central

Ashry, Yehia; Kawai, Kosuke

2017-01-01

Objective To assess the role and effect of concomitant adjunctive procedures when combined with balloon dilation of the Eustachian tube (BDET), including a new technique for treating obstructive disease within the bony Eustachian tube (ET). Study Design Retrospective case series. Setting Tertiary medical center. Subjects Adults with persistent (≥2 years): 1) OME or non‐fixed TM retraction AND type B or C tympanogram OR 2) Consistent symptoms of barochallenge with flights or diving, all despite medical treatment for ≥6 weeks. Methods Balloon dilation of the cartilaginous ET (BDET) was performed under general anesthesia using concomitant myringotomy with or without tube placement if indicated. Adjunctive turbinectomy, adenoidectomy, and/or tympanoplasty were used in selected cases. For suspected disease in the bony ET, an illuminated guidewire was used for probing and clearing the lumen. Outcome measures were tympanogram, otomicroscopy, ET mucosal inflammation score, Valsalva maneuver, and PTA audiometry. Results 67 ETs (48 patients) underwent BDET: 1) 30/67 balloon w/wo myringotomy, w/wo tube, 2) 20/67 plus adjunctive procedure or 3) 17/67 plus guidewire. Follow‐up was ranging from 0.4 to 3.4 years (mean 1.3 year, SD = 0.7). Significant improvement occurred in 79%. There was no significant difference in the failure rate comparing balloon dilation with adjunctive procedures 5/20 (25%) or without adjunctive procedures; 4/30 p = 0.45 (13%). Failure rate for BDET plus guide wire was 5/17 (29%) and resistance within the bony ET occurred in 8/17 (47%). Conclusion Balloon dilation of the cartilaginous ET demonstrated significant improvement despite expansion of indications that necessitated the addition of adjunctive procedures. Level of Evidence 4 PMID:29299505

Cutting balloon angioplasty of the popliteal and infrapopliteal vessels for symptomatic limb ischemia.

PubMed

Ansel, Gary M; Sample, Nancy S; Botti III, Charles F; Tracy, Amy J; Silver, Mitchell J; Marshall, Brian J; George, Barry S

2004-01-01

Options for lower limb percutaneous revascularization are limited especially for complex vessel obstruction. Cutting balloon angioplasty (CBA) has been described in the coronary literature as effective for complex disease. We analyzed our peripheral vascular database and report procedural outcomes along with the clinical success at a mean of 1-year follow-up in 73 patients with symptomatic lower limb ischemia undergoing CBA. CBA was successfully completed in all 73 patients (93 vessels; 100%) with predilation necessary in 4% of vessels. Severe intimal dissection or inadequate hemodynamic result necessitated in adjunctive stenting in 20%. There were no incidents of vessel perforation or surgical target vessel revascularization. One patient (1.5%) died during the periprocedural period due to renal failure. After mean follow-up of 1 year (6-21 months), 89.5% of threatened limbs were salvaged. CBA is a safe and feasible option for the treatment of popliteal and infrapopliteal vessels. Copyright 2004 Wiley-Liss, Inc.

Application of conjugated heparin-albumin microparticles with laser-balloon angioplasty: a potential method for reducing adverse biologic reactivity after angioplasty

NASA Astrophysics Data System (ADS)

Kundu, Sourav K.; McMath, Linda P.; Zaidan, Jonathan T.; Spears, J. Richard

1991-05-01

Laser-balloon angioplasty (LBA) may potentially be used for local application of pharmacologically active agents which will reduce thrombogenic and proliferative responses after the angioplasty. In this study, the feasibility of applying covalently conjugated heparin- albumin microparticles onto arterial luminal surface was demonstrated. The covalent linkages were formed by reaction with 1-ethyl-3-dimethyl-aminopropyl-carbodiimide (EDC), and the resultant conjugates were used for preparation of microparticles by employing standard emulsification and heat-crosslinking techniques. The heparin release rate from the microparticles was found to be dependent upon the degree of crosslinking. When a thin coagulum of a suspension of microparticles was formed with heat on a glass surface, the treated surface demonstrated resistance to clot formation in contact with non-anticoagulated blood. A suspension of the microparticles applied during laser-balloon angioplasty onto the luminal surface of dog carotid and femoral arteries showed persistence for up to one week without thrombus formation or occlusion of the vessel. Since the rate of biodegradation is primarily dictated by the extent of crosslinking, an optimal degree of thermal denaturation will permit longer persistence of the carrier while allowing adequate release of the entrapped pharmacologic agent. A variety of antithrombotic and antiinflammatory agents are being considered as candidate bioprotective materials for local application after angioplasty.

Clinical experience with the Monorail balloon catheter for coronary angioplasty.

PubMed

Finci, L; Meier, B; Roy, P; Steffenino, G; Rutishauser, W

1988-01-01

The Monorail balloon catheter is distinctly different from other current balloon catheters: the guidewire passes through the balloon itself, exits the catheter proximal to the balloon, and runs alongside its small shaft (3 French) through the guiding catheter. Monorail coronary angioplasty was attempted in 61 patients on 73 lesions with balloons from 2.0 to 3.7 mm. Angiographic success was obtained in 66 lesions (90%). For 15 lesions, balloon exchanges were needed. In three lesions, the Monorail balloon failed to cross the lesion, while a standard balloon succeeded; two lesions could not be crossed with any balloon. Vessel occlusion occurred in four patients: two had emergency surgery without infarct (one died suddenly 4 days later and one had a stroke 1 day later), one was recanalized with a standard balloon, and one had a myocardial infarct. Continuous infusion of urokinase was used until patient 3 in whom problems with the delivery system led to cardiocerebral air embolization (with complete recovery). No thrombotic complications were observed in the subsequent 58 patients with only a bolus of 10,000 U of heparin. The Monorail balloon facilitates contrast injections and balloon exchanges but appears more difficult to pass through tight lesions. Omission of the previously recommended infusion with a thrombolytic agent proved safe.

Balloon Angioplasty – The Legacy of Andreas Grüntzig, M.D. (1939–1985)

PubMed Central

Barton, Matthias; Grüntzig, Johannes; Husmann, Marc; Rösch, Josef

2014-01-01

In 1974, at the Medical Policlinic of the University of Zürich, German-born physician-scientist Andreas Grüntzig (1939–1985) for the first time applied a balloon-tipped catheter to re-open a severely stenosed femoral artery, a procedure, which he initially called “percutaneous transluminal dilatation”. Balloon angioplasty as a therapy of atherosclerotic vascular disease, for which Grüntzig and Charles T. Dotter (1920–1985) received a nomination for the Nobel Prize in Physiology or Medicine in 1978, became one of the most successful examples of translational medicine in the twentieth century. Known today as percutaneous transluminal angioplasty (PTA) in peripheral arteries or percutaneous transluminal coronary angioplasty (PTCA) or percutaneous coronary intervention (PCI) in coronary arteries, balloon angioplasty has become the method of choice to treat patients with acute myocardial infarction or occluded leg arteries. On the occasion of the 40th anniversary of balloon angioplasty, we summarize Grüntzig’s life and career in Germany, Switzerland, and the United States and also review the developments in vascular medicine from the 1890s to the 1980s, including Dotter’s first accidental angioplasty in 1963. The work of pioneers of catheterization, including Pedro L. Fariñas in Cuba, André F. Cournand in France, Werner Forssmann, Werner Porstmann and Eberhard Zeitler in Germany, António Egas Moniz and Reynaldo dos Santos in Portugal, Sven-Ivar Seldinger in Sweden, and Barney Brooks, Thomas J. Fogarty, Melvin P. Judkins, Richard K. Myler, Dickinson W. Richards, and F. Mason Sones in the United States, is discussed. We also present quotes by Grüntzig and excerpts from his unfinished autobiography, statements of Grüntzig’s former colleagues and contemporary witnesses, and have included hitherto unpublished historic photographs and links to archive recordings and historic materials. This year, on June 25, 2014, Andreas Grüntzig would have celebrated

Successful Treatment by Balloon Angioplasty Under Portography for Late-Onset Stenosis of Portal Vein After Cadaveric Liver Transplantation

PubMed Central

Shiba, Hiroaki; Sadaoka, Shunichi; Wakiyama, Shigeki; Ishida, Yuichi; Misawa, Takeyuki; Yanaga, Katsuhiko

2013-01-01

A 69-year-old woman, who underwent cadaveric liver transplantation for non-B, non-C liver cirrhosis with hepatocellular carcinoma in April 2009, was admitted to our hospital because of graft dysfunction. Enhanced computed tomography revealed stenosis of the left branch of the portal vein, obstruction of the right branch of the portal vein at porta hepatis, and esophagogastric varices. Balloon angioplasty of the left branch of the portal vein under transsuperior mesenteric venous portography was performed by minilaparotomy. After dilatation of the left branch of the portal vein, the narrow segment of the portal vein was dilated, which resulted in reduction of collateral circulation. At 7 days after balloon angioplasty, esophageal varices were improved. The patient made a satisfactory recovery, was discharged 8 days after balloon angioplasty, and remains well. PMID:24229043

Mid-infrared coronary laser angioplasty with multifiber catheters

NASA Astrophysics Data System (ADS)

White, Christopher J.; Ramee, Stephen R.; Collins, Tyrone J.

1993-06-01

Mid-infrared laser wavelengths offer advantages as a source for coronary angioplasty based upon the excellent fiberoptic transmission and the enhanced tissue absorption of these photons. We report the results of a pilot clinical trial of a Holmium:YAG (2.1 micrometers ) coronary laser angioplasty using a prototype (1.6 mm and 2.0 mm) multifiber catheters. Coronary laser angioplasty with or without adjunctive balloon angioplasty or directional atherectomy was performed in 14 patients with 17 coronary stenoses. Laser success was obtained in 13/14 (93%) patients and 16/17 (94%) lesions. Uncomplicated procedural success was achieved in 9/14 (64%) patients and 12/17 (71%) lesions. Our initial laser success rate was very encouraging using this prototype multifiber catheter with a holmium:YAG laser. However, our overall procedural success rate was disappointing, and not superior to that expected with conventional angioplasty alone. The holmium laser remains an attractive energy source for laser angioplasty, but its utility is limited by catheters which create inadequate channels for stand-alone laser angioplasty.

Concurrent Angioplasty Balloon Placement for Stent Delivery through Jugular Venous Bulb for Treating Cerebral Venous Sinus Stenosis. Technical Report.

PubMed

Qureshi, Adnan I; Khan, Asif A; Capistrant, Rachel; Qureshi, Mushtaq H; Xie, Kevin; Suri, M Fareed K

2016-10-01

To report upon technique of concurrent placement of angioplasty balloon at the internal jugular vein and sigmoid venous sinus junction to facilitate stent delivery in two patients in whom stent delivery past the jugular bulb was not possible. A 21-year-old woman and a 41-year-old woman with worsening headaches, visual obscuration or diplopia were treated for pseudotumor cerebri associated with transverse venous stenosis. Both patients had undergone primary angioplasty, which resulted in improvement in clinical symptoms followed by the recurrence of symptoms with restenosis at the site of angioplasty. After multiple attempts at stent delivery through jugular venous bulb were unsuccessful, a second guide catheter was placed in the ipsilateral internal jugular vein through contralateral femoral venous approach. A 6 mm × 20 mm (left) or 5 × 15 mm (right) angioplasty balloon was placed across the internal jugular vein and sigmoid sinus junction and partially inflated until the inflation and relative straightening of the junction was observed. In both patients, the internal jugular vein and sigmoid sinus junction was successfully traversed by the stent delivery system in a parallel alignment to inflated balloon. Balloon mounted stent was deployed at the site of restenosis with near complete resolution of lumen narrowing delivery and improvement in clinical symptoms. We report a technique for realignment and diameter change with concurrent placement and partial inflation of angioplasty balloon at the jugular venous bulb to facilitate stent delivery into the sigmoid and transverse venous sinuses in circumstances where multiple attempts at stent delivery are unsuccessful.

Efficacy of Local Molsidomine Delivery from a Hydrogel-Coated Angioplasty Balloon Catheter in the Atherosclerotic Porcine Model

DOE Office of Scientific and Technical Information (OSTI.GOV)

Rolland, Pierre H.; Mekkaoui, Choukri; Palassi, Maria

2003-02-15

Purpose: To evaluate the therapeutic effects of local molsidomine delivery via a hydrogel-coated angioplasty balloon catheter during overstretch angioplasty in atheroscleroticswine iliac vessels. Molsidomine is retained in the arterial wall after local delivery for more than 72 hr and is slowly metabolized intolinsidomine, releasing nitric oxide (NO). Methods: A hydrogel-coated angioplasty balloon catheter was used to both deliver drug locally (150 mg molsidomine or placebo in the contralateral vessel) and dilate iliac vessels in nine Pietrin pigs that had been on an atherogenic diet for 5 months. Animals were killed at 3 hr(n = 2), 24 hr (n = 3)more » and 3 months(n = 3) after treatment. Iliac arteries were examined for wall pulsatility, histomorphometry, cell proliferation and platelet aggregation. Results: No significant therapeutic effects were detected 3 hr after treatment. At 24 hr, wall pulsatility,thrombo resistance and vascular cell homeostasis were significantly restored in the molsidomine-treated versus placebo group. At 3 months,molsidomine inhibited restenotic lesion development, except in scarred areas of histologically detectable adventitial/medial dissection. Conclusion: Local delivery of concentrated molsidomine from a hydrogel-coated angioplasty balloon catheter resulted in early NO-dependent vasodilation/stress normalization and antithrombotic and antiproliferative effects. In the medium term, molsidomine inhibited restenosis in the absence of vessel dissection.« less

Angioplasty and stent placement - heart

MedlinePlus

PCI; Percutaneous coronary intervention; Balloon angioplasty; Coronary angioplasty; Coronary artery angioplasty; Percutaneous transluminal coronary angioplasty; Heart artery dilatation; Angina - stent placement; Acute coronary ...

Restenosis of the coronary stenotic lesions treated by holmium:YAG laser coronary angioplasty

NASA Astrophysics Data System (ADS)

Miyazaki, Shunichi; Nonogi, Hiroshi; Goto, Yoichi; Itoh, Akira; Ozono, Keizaburo; Daikoku, Satoshi; Haze, Kazuo

1994-07-01

Clinical efficacy of newly developed Holmium YAG laser coronary angioplasty (HLCA) was assessed for 30 patients with angina. There were 12 near left main trunk (LMT) lesions and 4 aorto- ostial lesions. Adjunctive balloon angioplasty was performed for 25 of 30 lesions. Delivered energy ranged from 1.5 to 2.5 watts/pulse and the total exposure time ranged from 6 to 55 seconds. External diameter of laser catheter was 1.5 mm for 13 lesions, 1.4 mm for 17 lesions, and 1.7 mm for 5 lesions. Laser success, defined as 20% reduction of stenotic ratio, was obtained in 21 of 30 (70%) and overall procedural success rate was 93%. There were 3 cases with acute coronary occlusions relieved by adjunctive balloon angioplasty and one coronary perforation without manifestation of cardiac tamponade. There were no large coronary dissection which involved more than 5 mm of the coronary artery. Follow up coronary angiography after 3 months showed restenosis in 14 of 27 patients (52%). Percent stenosis after lasering (56%) was similar to that at 3 months after (62%). HLCA is acutely effective treatment for lesions near LMT, because of low incidence of large coronary dissection. However, angiographical restenosis rate is high at 3 months after HLCA. This may be attributed to the relatively large residual stenosis after the procedure and vessel injury caused by shock wave.

Treatment of femoro-popliteal lesions with scoring and drug-coated balloon angioplasty: 12-month results of the DCB-Trak registry.

PubMed

Baumhäkel, Magnus; Chkhetia, Shalva; Kindermann, Michael

2018-01-01

Debulking strategies prior to drug-coated balloon (DCB) angioplasty were suggested to improve clinical results in femoro-popliteal lesions. Currently, there are no data regarding plaque modification with a scoring balloon with subsequent DCB-angioplasty. Recently published 6-month results of the DCB-Trak registry in patients treated with scoring-balloon angioplasty and DCB-angioplasty were promising without any safety concerns. Herein, we report the 12-month follow-up data. In a single center registry, 29 consecutive patients with 32 femoro-popliteal lesions were treated with a scoring-balloon (VascuTrak®) and a DCB subsequently. The primary endpoint was the clinically driven target lesion revascularization (TLR). Secondary endpoints were clinically driven target vessel revascularization (TVR), binary restenosis (peak systolic velocity ratio > 2.4), change in Rutherford classification and ankle-brachial-index (ABI). Safety endpoints were major cardiovascular events (cardiovascular death, myocardial infarction, stroke, death) and need for amputation. The procedure was successful in 29 lesions. There were no clinically driven TLRs after 12 months. Two patients required clinically driven TVR and one patient had a binary restenosis. ABI significantly increased after the procedure (0.87±0.24 to 1.04±0.18, P < 0.01) without a relevant change after 6 months (1.01±0.15, P < 0.05) or 12 months (1.01±0.20, P < 0.05). Rutherford classification improved in more than 90% of patients after 6 and 12 months. There was one major cardiovascular event at 6-month follow-up, but no amputations at 6- or 12-month follow-up. Vessel preparation with a scoring-balloon and subsequent DCB-angioplasty was safe and effective in patients with femoro-popliteal lesions. Further multicenter trials have to validate these results.

Paclitaxel-Eluting Balloon Versus Standard Balloon Angioplasty in In-Stent Restenosis of the Superficial Femoral and Proximal Popliteal Artery: 1-Year Results of the PACUBA Trial.

PubMed

Kinstner, Christian M; Lammer, Johannes; Willfort-Ehringer, Andrea; Matzek, Wolfgang; Gschwandtner, Michael; Javor, Domagoj; Funovics, Martin; Schoder, Maria; Koppensteiner, Renate; Loewe, Christian; Ristl, Robin; Wolf, Florian

2016-07-11

The hypothesis that paclitaxel-eluting balloon angioplasty provides higher 1-year patency rates in femoropopliteal artery in-stent restenosis compared with standard percutaneous transluminal angioplasty (PTA) was tested. Several trials have demonstrated that paclitaxel-eluting balloon angioplasty reduces late luminal loss in comparison with PTA. In a prospective, randomized, single-blind, dual-center study, 74 patients with symptomatic peripheral artery disease due to in-stent restenosis were treated with either paclitaxel-based drug-eluting balloon (DEB) angioplasty (n = 35) or standard PTA (n = 39). Clinical outcomes and patency rates were assessed at 1, 6, and 12 months. The mean lesion length was 17.3 ± 11.3 cm in the DEB group and 18.4 ± 8.8 cm in the PTA group. A single major complication (bleeding) was observed once (1.4%). The mean ankle-brachial index before endovascular treatment was 0.65 ± 0.16 in both groups and 0.79 ± 0.2 versus 0.84 ± 0.3 (p = 0.70, Student t test) in the DEB versus PTA group at 12 months. The 12-month primary patency rates were 40.7% (95% confidence interval [CI]: 0.26 to 0.64) versus 13.4% (95% CI: 0.05 to 0.36) (log-rank p = 0.02) in the DEB versus PTA group. The odds ratio for PTA over DEB angioplasty for experiencing an event was estimated at 2.8 (95% CI: 1.2 to 6.6). Freedom from clinically driven target lesion revascularization was 49.0% (95% CI: 0.32 to 0.75) versus 22.1% (95% CI: 0.10 to 0.48) (log-rank p = 0.11) in the DEB versus PTA group. Clinical improvement by ≥1 Rutherford-Becker category was 68.8% versus 54.5% (p = 0.87) in the DEB versus PTA group at 12 months. When treating peripheral artery disease in patients with in-stent restenosis in the femoropopliteal artery, paclitaxel-eluting balloon angioplasty provides significantly higher patency rates than standard PTA. (Paclitaxel Balloon Versus Standard Balloon in In-Stent Restenoses of the Superficial Femoral Artery [PACUBA I Trial] [PACUBA 1]; NCT

Primary Cutting Balloon Angioplasty for Treatment of Venous Stenoses in Native Hemodialysis Fistulas: Long-Term Results from Three Centers

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bhat, Rajesh; McBride, Kieran; Chakraverty, Sam

2007-11-15

Aim. To evaluate the technical success and patency rates following primary cutting balloon angioplasty for venous stenoses in native dialysis fistulas. Methods. Forty-one patients (26 men, 15 women; age range 26-82 years, average age 59 years) underwent 50 (repeat procedures in 9 patients) primary cutting balloon (PCB) angioplasty procedures in three institutions by three primary operators. The indication was primary stenosis in 21 patients, recurrent lesions in 15, and immature fistulas in 5. A PCB was used alone in 17 cases, but was followed by a larger standard balloon in 33 cases. Follow-up included ultrasound, flow analysis and urea reductionmore » ratio, and ranged from 2 to 30 months (mean 14 months). Results. The technical success rate was 98%. All procedures were relatively painless. Two PCBs burst and 4 leaked, but without causing any morbidity. Nineteen fistulas were still working at last follow-up. Primary patency rates at 6, 12, and 24 months using Kaplan-Meier analysis were 88%, 73%, and 34%, respectively, and the primary assisted patencies were 90%, 75%, and 50%, respectively. Conclusion. PCB angioplasty has high technical success and low complication rates. The long-term patency rates are favorable for PCB angioplasty and compare favorably with other series.« less

Angioplasty and stent - heart - discharge

MedlinePlus

Drug-eluting stents - discharge; PCI - discharge; Percutaneous coronary intervention - discharge; Balloon angioplasty - discharge; Coronary angioplasty - discharge; Coronary artery angioplasty - discharge; Cardiac ...

Can you score with balloons to enhance outcomes after drug coated balloon angioplasty? Insights from the Paris DCB Registry for in-stent restenosis.

PubMed

Merat, Benoît; Waliszewski, Matthias; Dillinger, Guillaume; Henry, Patrick; Sideris, Georgios

2018-06-01

The objective of this study was to assess the 12-month clinical outcomes in patients with drug-eluting stent in-stent restenosis (DES-ISR) who were either pre-dilated with non-compliant balloons (NCBA) and with additional scoring balloons (NCBA + SBA) prior to drug coated balloon (DCB) angioplasty. This monocentric, retrospective study included patients with DES-ISR who were routinely treated over a 2-year time span. Patients with stable angina and documented ischemia or selected forms of unstable angina due to a culprit DES-ISR lesion were analyzed. The primary endpoint was the clinically driven target-lesion revascularization (TLR) rate at 12 months. Secondary endpoints included post-interventional lumen gain and late lumen loss (LLL) at 6 months. The 12-month TLR rates in 124 patients who underwent either NCBA + SBA or NCBA only group were not different (17.3%, 9/52 vs 11.6%, 8/69, P = 0.371) and low as compared to other comparable studies. The use of SBA led to equally high post minimal lumen diameters (MLD) in both treatment arms (NCBA 2.21 ± 0.33 vs NCBA + SBA 2.18 ± 0.41, P = 0.868). We did not find a significant difference in late lumen loss (LLL) between both groups (0.50 ± 0.62 mm vs 0.40 ± 0.46 mm, P = 0.468). Scoring Balloon Angioplasty can safely and effectively prepare DES-ISR lesions to render them suitable for DCB angioplasty with acceptable TLR and MACE rates. © 2018, Wiley Periodicals, Inc.

[Reintervention with percutaneous balloon angioplasty in patients with congenital heart disease with left-sided obstructions].

PubMed

Márquez-González, Horacio; López-Gallegos, Diana; Pérez-Velázquez, Nataly Alejandra; Yáñez-Gutiérrez, Lucelli

2017-01-01

Left-sided cardiac obstructions represent 15% of congenital heart disease (CHD). The treatment in adults is surgical; however, balloon dilation by interventional catheterization can alleviate the symptoms in pediatric patients to allow them to reach the target height. The aim was to determine the survival and the factors associated with reintervention in patients with CHD with left-sided obstruction treated with balloon angioplasty. A cohort study was conducted in patients aged 4 to 17 years with left-sided heart obstruction (valvular stenosis [VS], supravalvular aortic stenosis [SAS], coarctation of the aorta [CA]) successfully treated with balloon angioplasty. The follow-up was of 10 years and the outcome variable was the restenosis with reintervention criteria. Pediatric stage at the time of the procedure, nutritional status, residual gradient, and presence of genetic syndromes were considered prognostic variables. For statistical analysis, measures of central tendency and dispersion were used. Chi squared was employed in qualitative variables and Kruskal-Wallis in quantitative variables. We had a total of 110 patients: 40% had CA, 35% VS, and 25% SAS. 39% required reintervention: 80% in SAS, 35% in CA, and 14% in VS. The intervention balloon is a stopgap measure that allows patients with left-sided obstructions to reach the target height.

Absence of Bacteria on Coronary Angioplasty Balloons from Unselected Patients: Results with Use of a High Sensitivity Polymerase Chain Reaction Assay

PubMed Central

Hansen, Gorm Mørk; Nilsson, Martin; Nielsen, Claus Henrik; Holmstrup, Palle; Helqvist, Steffen; Tolker-Nielsen, Tim; Givskov, Michael; Hansen, Peter Riis

2015-01-01

Periodontitis is a chronic, bacterially-induced inflammatory disease of the tooth-supporting tissues, which may result in transient bacteremia and a systemic inflammatory response. Periodontitis is associated with coronary artery disease independently of established cardiovascular risk factors, and translocation of bacteria from the oral cavity to the coronary arteries may play a role in the development of coronary artery disease. Very few studies have used angioplasty balloons for in vivo sampling from diseased coronary arteries, and with varying results. Therefore, the aim of this study was to assess if bacterial DNA from primarily oral bacteria could be detected on coronary angioplasty balloons by use of an optimized sampling process combined with an internally validated sensitive polymerase chain reaction (PCR) assay. Coronary angioplasty balloons and control samples from a total of 45 unselected patients with stable angina, unstable angina/non-ST elevation myocardial infarction, and ST-elevation myocardial infarction (n = 15 in each group) were collected and analyzed using a PCR assay with high sensitivity and specificity for 16S rRNA genes of the oral microbiome. Despite elimination of extraction and purification steps, and demonstration of sensitivity levels of 25–125 colony forming units (CFU), we did not detect bacterial DNA from any of the coronary angioplasty balloons. A subsequent questionnaire indicated that the prevalence of periodontitis in the study cohort was at least 39.5%. Although coronary angioplasty balloons are unlikely to be useful for detection of bacteria with current PCR techniques in unselected patients with coronary artery disease, more studies are warranted to determine the extent to which bacteria contribute to atherosclerosis and its clinical manifestations and whether the presence of bacteria in the arteries is a transient phenomenon. PMID:26695491

In vivo delivery and long-term tissue retention of nano-encapsulated sirolimus using a novel porous balloon angioplasty system.

PubMed

Granada, Juan F; Tellez, Armando; Baumbach, William R; Bingham, Brendan; Keng, Yen-Fang; Wessler, Jeffrey; Conditt, Gerard; McGregor, Jennifer; Stone, Gregg; Kaluza, Greg L; Leon, Martin B

2016-08-20

Among antirestenotic compounds, sirolimus displays a superior safety profile compared to paclitaxel, but its pharmacokinetic properties make it a challenging therapeutic candidate for single-time delivery. Herein we evaluate the feasibility of delivery, long-term retention and vascular effects of sirolimus nanoparticles delivered through a novel porous angioplasty balloon in normal porcine arteries and in a swine model of in-stent restenosis (ISR). Sirolimus nanoparticle formulation was delivered via porous balloon angioplasty to 753 coronary artery segments for pharmacokinetic studies and 26 segments for biological effect of sirolimus delivery in different clinical scenarios (de novo [n=8], ISR [n=6] and following stent implantation [n=12]). Sirolimus coronary artery concentrations were above the target therapeutic level of 1 ng/mg after 26 days, and were >100-fold higher in coronary artery treatment sites than in distal myocardium and remote tissues at all time points. At 28 days, reduction in percent stenosis in formulation-treated sites compared to balloon angioplasty treatment was noted in all three clinical scenarios, with the largest effect seen in the de novo study. Local coronary delivery of sirolimus nanoparticles in the porcine model using a novel porous balloon delivery system achieved therapeutic long-term intra-arterial drug levels without significant systemic residual exposure.

Use of monorail PTCA balloon catheter for local drug delivery.

PubMed

Trehan, Vijay; Nair, Girish M; Gupta, Mohit D

2007-01-01

We report the use of monorail coronary balloon as an infusion catheter to give bailout abciximab selectively into the site of stent thrombosis as an adjunct to plain old balloon angioplasty (POBA) in a patient of subacute stent thrombosis of the left anterior descending coronary artery. The balloon component (polyamide material) of the monorail balloon catheter was shaved off the catheter so that abciximab injected through the balloon port of the catheter exited out the shaft of the balloon catheter at the site from where the balloon material was shaved off. We believe that selective infusion with abciximab along with POBA established antegrade flow and relieved the patient's ischemia. In the absence of essential hardware to give intracoronary drugs in an emergency situation, one may employ our technique of infusion through a monorail balloon catheter after shaving the balloon component from the catheter.

'Postconditioning' the human heart: multiple balloon inflations during primary angioplasty may confer cardioprotection.

PubMed

Darling, Chad E; Solari, Patrick B; Smith, Craig S; Furman, Mark I; Przyklenk, Karin

2007-05-01

Growing evidence from experimental models suggests that relief of myocardial ischemia in a stuttering manner (i.e., 'postconditioning' [PostC] with brief cycles of reperfusion-reocclusion) limits infarct size. However, the potential clinical efficacy of PostC has, to date,been largely unexplored. Using a retrospective study design, our aim was to test the hypothesis that creatine kinase release (CK: clinical surrogate of infarct size) would be attenuated in ST-segment elevation myocardial infarction (STEMI) patients requiring multiple balloon inflations-deflations during primary angioplasty versus STEMI patients who received minimal balloon inflations and/or direct stenting. To investigate this concept, we reviewed the records of all STEMI patients with single vessel occlusion who presented to our institution from November 2004 - April 2006 for primary angioplasty. Exclusion criteria were: previous MI, cardiogenic shock, patients resuscitated from cardiac arrest, or pre-infarct angina. Patients were prospectively divided into two subsets: those receiving 1-3 balloon inflations (considered the minimum range to achieve patency and stent placement) versus those in whom 4 or more inflations were applied. Peak CK release was significantly lower in patients requiring > or =4 versus 1-3 inflations (1655 versus 2272 IU/L; p<0.05), an outcome consistent with the concept that relief of sustained ischemia in a stuttered manner (analogous to postconditioning) may evoke cardioprotection in the clinical setting.

Iliac artery angioplasty : technique and results.

PubMed

Brountzos, E N; Kelekis, D A

2004-10-01

Percutaneous angioplasty is widely used for the treatment of iliac artery occlusive disease. Access to the ipsi-lateral, or less commonly contralateral, common femoral artery is obtained under local anaesthesia; the lesion is crossed with a guidewire and dilated with an angioplasty balloon catheter. This technique yields excellent immediate results with very few complications. Stent placement is used in lesions not amenable to balloon angioplasty, in complications, and recurrences. Evidence suggests that balloon angioplasty is the procedure of choice for iliac artery occlusive lesions. Stent placement should be reserved for angioplasty failures. However, primary stent placement is indicated in total occlusions. Lesion morphology is an important determinant of immediate success and long-term patency. TASC lesions type A and B are best treated with angioplasty and stenting, while TASC lesions type C and D show better results with surgical treatment. The development of new stent designs may expand the indications of the percutaneous treatment.

Laser Angioplasty

NASA Technical Reports Server (NTRS)

1990-01-01

The principal method of dealing with coronary artery blockage is bypass surgery. A non-surgical alternative available to some patients is balloon angioplasty. For several years, medical researchers have been exploring another alternative that would help a wider circle of patients than the balloon treatment and entail less risk than bypass surgery. A research group is on the verge of an exciting development: laser angioplasty with a 'cool' type of laser, called an excimer laser, that does not damage blood vessel walls and offers non-surgical cleansing of clogged arteries with extraordinary precision. The system is the Dymer 200+ Excimer Laser Angioplasty System, developed by Advanced Intraventional Systems. Used in human clinical tests since 1987, the system is the first fully integrated 'cool' laser capable of generating the requisite laser energy and delivering the energy to target arteries. Thirteen research hospitals in the U.S. have purchased Dymer 200+ systems and used them in clinical trials in 121 peripheral and 555 coronary artery cases. The success rate in opening blocked coronary arteries is 85 percent, with fewer complications than in balloon angioplasty. Food and Drug Administration approval for the system is hoped for in the latter part of 1990. * Advanced Intraventional Systems became Spectranetics in 1994 and discontinued the product.

Critical appraisal of paclitaxel balloon angioplasty for femoral–popliteal arterial disease

PubMed Central

Herten, Monika; Torsello, Giovanni B; Schönefeld, Eva; Stahlhoff, Stefan

2016-01-01

Peripheral arterial disease, particularly critical limb ischemia, is an area with urgent need for optimized therapies because, to date, vascular interventions often have limited life spans. In spite of initial encouraging technical success after femoropopliteal percutaneous transluminal angioplasty or stenting, postprocedural restenosis remains the major problem. The challenging idea behind the drug-coated balloon (DCB) concept is the biological modification of the injury response after balloon dilatation. Antiproliferative drugs administered via DCBs or drug-eluting stents are able to suppress neointimal hyperplasia, the main cause of restenosis. This article reviews the results of DCB treatments of femoropopliteal and infrapopliteal lesions in comparison to standard angioplasty with uncoated balloons. A systematic literature search was performed in 1) medical journals (ie, MEDLINE), 2) international registers for clinical studies (ie, www.clinicaltrials.gov), and 3) abstracts of scientific sessions. Several controlled randomized trials with follow-up periods of up to 5 years demonstrated the efficacy of paclitaxel –DCB technology. However, calcified lesions seem to affect the efficacy of DCB. Combinations of preconditioning methods with DCBs showed promising results. Although the mechanical abrasion of calcium via atherectomy or laser ablation showed favorable periprocedural results, the long-term impact on restenosis and clinical outcome has to be demonstrated. Major advantages of the DCBs are the rapid delivery of drug at uniform concentrations with a single dose, their efficacy in areas wherein stents have been contraindicated until now (ie, bifurcation, ostial lesions), and in leaving no stent scaffold behind. Reinterventions are easier to perform because DCBs leave no metal behind. Various combinations of DCBs with other treatment modalities may prove to be viable options in future. The follow-up results of clinical studies will evaluate the long

Critical appraisal of paclitaxel balloon angioplasty for femoral-popliteal arterial disease.

PubMed

Herten, Monika; Torsello, Giovanni B; Schönefeld, Eva; Stahlhoff, Stefan

2016-01-01

Peripheral arterial disease, particularly critical limb ischemia, is an area with urgent need for optimized therapies because, to date, vascular interventions often have limited life spans. In spite of initial encouraging technical success after femoropopliteal percutaneous transluminal angioplasty or stenting, postprocedural restenosis remains the major problem. The challenging idea behind the drug-coated balloon (DCB) concept is the biological modification of the injury response after balloon dilatation. Antiproliferative drugs administered via DCBs or drug-eluting stents are able to suppress neointimal hyperplasia, the main cause of restenosis. This article reviews the results of DCB treatments of femoropopliteal and infrapopliteal lesions in comparison to standard angioplasty with uncoated balloons. A systematic literature search was performed in 1) medical journals (ie, MEDLINE), 2) international registers for clinical studies (ie, www.clinicaltrials.gov), and 3) abstracts of scientific sessions. Several controlled randomized trials with follow-up periods of up to 5 years demonstrated the efficacy of paclitaxel -DCB technology. However, calcified lesions seem to affect the efficacy of DCB. Combinations of preconditioning methods with DCBs showed promising results. Although the mechanical abrasion of calcium via atherectomy or laser ablation showed favorable periprocedural results, the long-term impact on restenosis and clinical outcome has to be demonstrated. Major advantages of the DCBs are the rapid delivery of drug at uniform concentrations with a single dose, their efficacy in areas wherein stents have been contraindicated until now (ie, bifurcation, ostial lesions), and in leaving no stent scaffold behind. Reinterventions are easier to perform because DCBs leave no metal behind. Various combinations of DCBs with other treatment modalities may prove to be viable options in future. The follow-up results of clinical studies will evaluate the long-term impact

Differential glomerular filtration rate in diagnosis of renovascular hypertension and follow-up of balloon angioplasty

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lamki, L.; Spence, J.D.; MacDonald, A.C.

Two hundred nine hypertensive patients with high stimulated plasma renin levels were screened for renovascular hypertension using Tc-99m DTPA renal scintigraphy. Differential glomerular filtration rate (Diff-GFR) was obtained by integrating the area under the background-subtracted renogram of each kidney between 1 and 3 minutes. 50 patients who also had undergone selective renal angiography were divided into four groups according to Diff-GFR contribution by one of the kidneys. If one kidney contributed 45-50% of total GFR, this was regarded as normal. A Diff-GFR of less than 45% was very considered to be very suggestive of renovascular hypertension in the appropriate clinicalmore » setting, while a Diff-GFR of less than 20% indicated that the renal artery might not be amenable to successful balloon angioplasty. Diff-GFR following balloon angioplasty closely reflected the early clinical response of the patients--and in some cases progressive Diff-GFR improvement was observed several months later. Diff-GFR as a scintigraphic criterion for renovascular hypertension has a sensitivity of 93%, specificity of 74%, and accuracy of 85%.« less

The SABRE Trial (Sirolimus Angioplasty Balloon for Coronary In-Stent Restenosis): Angiographic Results and 1-Year Clinical Outcomes.

PubMed

Verheye, Stefan; Vrolix, Mathias; Kumsars, Indulis; Erglis, Andrejs; Sondore, Dace; Agostoni, Pierfrancesco; Cornelis, Kristoff; Janssens, Luc; Maeng, Michael; Slagboom, Ton; Amoroso, Giovanni; Jensen, Lisette Okkels; Granada, Juan F; Stella, Pieter

2017-10-23

The aim of this first-in-human study was to assess the safety and effectiveness of the Virtue sirolimus-eluting balloon in a cohort of patients with in-stent restenosis (ISR). Angioplasty balloons coated with the cytotoxic drug paclitaxel have been widely used for ISR treatment. The Virtue angioplasty balloon (Caliber Therapeutics, New Hope, Pennsylvania) delivers sirolimus in a nanoencapsulated liquid formulation. This clinical trial is the first to examine a sirolimus-eluting balloon for ISR. In this prospective, single-arm feasibility study at 9 European centers, 50 ISR patients were treated with the Virtue balloon. Angiographic measurements at 6 months are reported, along with 12-month clinical follow-up. Procedural success in the intention-to-treat population was 100%. The primary safety endpoint was target lesion failure (TLF) (cardiac death, target vessel myocardial infarction, and clinically driven target lesion revascularization) assessed at 30 days (0%, n = 50). The primary performance endpoint was in-segment late lumen loss (LLL) at 6 months (0.31 ± 0.52 mm; n = 47). Secondary 6-month endpoints include binary restenosis (19.1%), diameter stenosis (30.3 ± 19.9%), and major adverse cardiac events (MACE) (10.2%, n = 49). In the 36-patient per-protocol population (excluding major protocol violations and previously stented ISR), LLL was 0.12 ± 0.33 mm at 6 months. Clinical outcomes at 1 year for the intention-to-treat group were 12.2% TLF and 14.3% MACE and for the per-protocol population were 2.8% TLF and 2.8% MACE. This first-in-human study showed excellent procedural success for the Virtue sirolimus-eluting angioplasty balloon, 6-month LLL rates in line with current stent-free ISR treatment options, and clinical outcomes that warrant further evaluation in dedicated randomized studies. Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Drug-Coated Balloon Angioplasty: A Novel Treatment for Pulmonary Artery In-Stent Stenosis in a Patient with Williams Syndrome.

PubMed

Cohen, Jennifer L; Glickstein, Julie S; Crystal, Matthew A

2017-12-01

A 20-month-old boy with Williams syndrome had undergone multiple surgical and catheter-based interventions for resistant peripheral pulmonary arterial stenoses with eventual bilateral stent placement and conventional balloon angioplasty. He persistently developed suprasystemic right ventricular (RV) pressure. Angioplasty with a drug-coated balloon (DCB) was performed for in-stent restenosis and to remodel his distal pulmonary vessels bilaterally. This resulted in immediate improvement in the in-stent stenosis and resultant decrease in RV pressure. Follow-up catheterization two months later continued to show long-lasting improvement in the in-stent stenosis. We hypothesize that the anti-proliferative effects of DCBs may be of benefit in the arteriopathy associated with Williams syndrome. We report this as a novel use of a DCB in the pulmonary arterial circulation in a patient with Williams syndrome.

[Drug-coated Balloon Angioplasty in Femoropopliteal Arteries - Is There a Class Effect?

PubMed

Teichgräber, Ulf Karl-Martin; Klumb, Christof

2017-10-01

Aim Percutaneous transluminal angioplasty (PTA) is a well-accepted method to re-establish patency in stenotic and reoccluded vessels. One tool to improve results may be to use paclitaxel drug-coated balloon (DCB) catheters. This systematic review investigates whether there is a class effect among different DCBs. Methods The primary endpoint was "Freedom from Target Lesion Revascularisation" (FfTLR) after 12 months. A systematic literature search was performed in PubMed and risk of bias was assessed of the included trials. Efficacy of DCB vs. POBA (plain old balloon angioplasty) in binary outcomes was investigated with relative risks and number needed to treat (NNT). Results Ten trials including 1835 patients and investigating six different DCB were identified. A high risk of bias was found in these studies. There was a lower Late Lumen Loss at six months and a higher FfTLR and primary patency at one year after DCB-treatment. However, results varied greatly with NNTs ranging from three to thirty-three. Overall, there were no differences in ABI- and Rutherford-Outcome as well as incidence of adverse events. Conclusion Tested DCBs were able to improve PTA results at one year. There were large differences in efficacy between different DCB. A class effect cannot be confirmed yet. There is a risk of overestimating the effect of DCBs due to the high risk of bias in the included trials. Georg Thieme Verlag KG Stuttgart · New York.

A prosthesis for banding the main pulmonary artery, capable of serial dilatation by balloon angioplasty.

PubMed

Vince, D J; Culham, J A

1989-03-01

A prosthesis constructed with a fatigued steel helix encased in a silicone rubber shield was used to band the main pulmonary artery in 10 dogs. After a mean duration of 138 days the banded site was dilated with a 20 mm diameter angioplasty catheter. This dilatation produced a mean increase of 44.3% in the cross-sectional area. A further mean increase of 2.2% in the cross-sectional area was measured 137 days after the dilatation. In five uncomplicated experiments a second dilatation was performed with a 23 mm diameter angioplasty catheter after a mean interval of 140 days. The second dilatation produced a further 21% increase in the cross-sectional area. In the five experiments in which two dilatations were performed, there was a total increase in the mean cross-sectional area of 94% produced 273 days after banding. This prosthesis maintains banding of the main pulmonary artery and can be serially dilated by balloon angioplasty.

Rupture of the Renal Artery After Cutting Balloon Angioplasty in a Young Woman With Fibromuscular Dysplasia

DOE Office of Scientific and Technical Information (OSTI.GOV)

Oguzkurt, Levent, E-mail: loguzkurt@yahoo.com; Tercan, Fahri; Gulcan, Oner

2005-04-15

A 24-year-old woman with uncontrollable high blood pressure for 3 months had significant stenosis of the left renal artery caused by fibromuscular dysplasia (FMD). The lesion was resistant to percutaneous transluminal angioplasty at 18 atm with a semicompliant balloon. Angioplasy with a 6 x 10 mm cutting balloon (CB) caused rupture of the artery. Low-pressure balloon inflation decreased but did not stop the leak. An attempt to place a stent-graft (Jostent; Jomed, Rangendingen, Germany) failed, and a bare, 6-mm balloon-expandable stent (Express SD; Boston Scientific, MN) was deployed to seal the leak, which had decreased considerably after long-duration balloon inflation.more » The bleeding continued, and the patient underwent emergent surgical revascularization of the renal artery with successful placement of a 6-mm polytetrafluoroethylene bypass graft. CBs should be used very carefully in the treatment of renal artery stenosis, particularly in patients with FMD.« less

Cost-Effectiveness of Endovascular Femoropopliteal Intervention Using Drug-Coated Balloons Versus Standard Percutaneous Transluminal Angioplasty: Results From the IN.PACT SFA II Trial.

PubMed

Salisbury, Adam C; Li, Haiyan; Vilain, Katherine R; Jaff, Michael R; Schneider, Peter A; Laird, John R; Cohen, David J

2016-11-28

The aim of this study was to evaluate the cost-effectiveness of drug-coated balloon (DCB) angioplasty versus standard percutaneous transluminal angioplasty (PTA). Recent trials have reported lower rates of target lesion revascularization with DCB angioplasty versus standard PTA. However, the cost-effectiveness of DCB angioplasty is unknown. A prospective economic study was performed alongside the IN.PACT SFA II (IN.PACT Admiral Drug-Coated Balloon vs. Standard Balloon Angioplasty for the Treatment of Superficial Femoral Artery [SFA] and Proximal Popliteal Artery [PPA]) trial, which randomized 181 patients with femoropopliteal disease to the IN.PACT DCB versus standard PTA. Resource use data were collected over 2-year follow-up, and costs were assigned using resource-based accounting and billing data. Health utilities were assessed using the EuroQol 5-dimensions questionnaire. Cost-effectiveness was assessed as cost per quality-adjusted life-year (QALY) gained using a decision-analytic model on the basis of empirical data from the trial assuming identical long-term mortality. Initial costs were $1,129 per patient higher with DCB angioplasty than standard PTA, driven by higher costs for the DCB itself. Between discharge and 24 months, target limb-related costs were $1,212 per patient lower with DCB angioplasty such that discounted 2-year costs were similar for the 2 groups ($11,277 vs. $11,359, p = 0.97), whereas QALYs tended to be greater among patients treated with DCBs (1.53 ± 0.44 vs. 1.47 ± 0.42, p = 0.40). The probability that DCB angioplasty is cost-effective compared with standard PTA was 70% using a threshold of $50,000 per QALY gained and 79% at a threshold of $150,000 per QALY gained. For patients with femoropopliteal disease, DCB angioplasty is associated with better 2-year outcomes and similar target limb-related costs compared with standard PTA. Formal cost-effectiveness analysis on the basis of these results suggests that use of the DCB angioplasty

Retrieval of impacted broken balloon by balloon inflation in guiding catheter.

PubMed

Mehta, Vimal; Pandit, Bhagya Narayan; Yusuf, Jamal; Mukhopadhyay, Saibal; Trehan, Vijay; Tyagi, Sanjay

2014-07-01

Broken catheter fragment in a coronary artery during percutaneous coronary angioplasty is a rare complication. It can result in serious problems as a result of thrombus formation and embolization of broken fragment. We report an unusual complication of a broken balloon catheter during angioplasty, which was successfully retrieved by balloon inflation in guiding catheter technique.

[Coronary angioplasty with the Monorail system via 6 French diagnostic catheters].

PubMed

Villavicencio, R; González, H; López, J; Zavala, E; Ban Hayashi, E B; Gaspar, J; Gil, M; Martínez Ríos, M A

1994-01-01

We studied the use of "Monorail" system with Express (Scimed) balloon catheters for coronary angioplasty through 6 French (F) "high-flow" diagnostic catheters (Novoste, USCI). Prospectively, from July 1992 to January 1993, angioplasty of 31 lesions in 24 patients was attempted (1.3 lesions/procedure). Twenty procedures were of a single lesion and four were multi-vessel angioplasty. Fourteen lesions were in the left anterior descending or in its branches, 10 in the left circumflex or in its branches, 6 in the right coronary artery, and one in the distal anastomosis of an internal mammary artery graft. Thirteen lesions (42%) were type A, 17 (55%) type B and one (3%) type C. Balloon sizes varied between 2.0 and 3.5 mm. Twenty-nine lesions could be successfully dilated (93.5%); two cases were unsuccessful due to an acute occlusion in one and residual stenosis of more than 50% in the other. For only one case, another balloon catheter different from the "Monorail" system was necessary to complete a multi-vessel angioplasty. Coronary visualization and manipulation of the balloon through the tip of the diagnostic catheter were satisfactory in all cases, except with the 3.5 mm balloon catheter. Coronary angioplasty with "Monorail" system balloon catheters through 6 F "high-flow" diagnostic catheters is feasible and provides a high success rate in simple and moderately complex selected lesions, including multivessel angioplasty with advantages of smaller artery punction and the feasibility of performing coronary angioplasty with the same catheter used for diagnostic angiography.

Results from the Tack Optimized Balloon Angioplasty (TOBA) study demonstrate the benefits of minimal metal implants for dissection repair after angioplasty.

PubMed

Bosiers, Marc; Scheinert, Dierk; Hendriks, Jeroen M H; Wissgott, Christian; Peeters, Patrick; Zeller, Thomas; Brodmann, Marianne; Staffa, Robert

2016-07-01

The mechanism of angioplasty is disruption of atherosclerotic plaque, which often results in dissections. Dissection after percutaneous transluminal angioplasty (PTA) remains a significant clinical problem and untreated may cause acute occlusion or later restenosis. Stents are used to manage dissections, which is often followed by in-stent restenosis and occasionally stent fracture. Tack (Intact Vascular, Wayne, Pa) implants have minimal metal and low radial force and are specifically designed for dissection repair. This study evaluated Tack implants for treatment of dissections resulting from standard balloon PTA for femoral-popliteal arterial disease. Twelve-month outcomes after Tack treatment of post-PTA dissections are described. This prospective, single-arm study evaluated patients with ischemia (Rutherford clinical category 2-4) caused by lesions of the superficial femoral and popliteal arteries. Patients were treated with standard balloon angioplasty, and post-PTA dissections were treated with Tacks. The primary end points were core laboratory-adjudicated device technical success, defined as the ability of the Tack implants to resolve post-PTA dissection, and device safety, defined as the absence of new-onset major adverse events. Patients were followed up to 12 months after implantation. Tacks were used in 130 patients with post-PTA dissections (74.0% ≥ grade C). Technical success was achieved in 128 (98.5%) patients with no major adverse events at 30 days. The 12-month patency was 76.4%, and freedom from target lesion revascularization was 89.5%. Significant improvement from baseline was observed in Rutherford clinical category (82.8% with grade ≤1) and ankle-brachial index (0.68 ± 0.18 to 0.94 ± 0.15; P < .0001). Tack implant treatment of post-PTA dissection was safe, produced reasonable patency, and resulted in low rates of target lesion revascularization. Tack treatment represents a new, minimal metal paradigm for dissection repair that can

Laser angioplasty for cardiovascular disease

NASA Astrophysics Data System (ADS)

Okada, Masayoshi

2005-07-01

Recently, endovascular interventions such as balloon angioplasty, atherectomy and the stenting method, except for conventional surgery have been clinically employed for the patients with atheromatous plaques of the peripheral- and the coronary arteries, because the number of patients with arteriosclerosis is now increasing in the worldwide. Among these procedures, restenoses after endovascular interventions have been remarkably disclosed in 20-40 % of the patients who underwent percutaneous coronary interventions. Thus, there are still some problems in keeping long-term patency by means of endovascular techniques such as balloon angioplasty and atherectomy (1, 2). For reduction of these problems , laser angioplasty using Argon laser was applied experimentally and clinically. Based on excellent experimental studies, laser was employed for 115 patients with stenotic ,or obstructive lesions occluding more thasn 75 % of the peripheral and the coronary arteries angiographycally.

Multicentre randomised controlled trial of the clinical and cost-effectiveness of a bypass-surgery-first versus a balloon-angioplasty-first revascularisation strategy for severe limb ischaemia due to infrainguinal disease. The Bypass versus Angioplasty in Severe Ischaemia of the Leg (BASIL) trial.

PubMed

Bradbury, A W; Adam, D J; Bell, J; Forbes, J F; Fowkes, F G R; Gillespie, I; Raab, G; Ruckley, C V

2010-03-01

To compare a 'bypass-surgery-first' with a 'balloon-angioplasty-first' revascularisation strategy in patients with severe limb ischaemia (SLI) due to infrainguinal disease requiring immediate/early revascularisation. A stratified randomised controlled trial. A Delphi consensus study of vascular surgeons' and interventional radiologists' views on SLI treatment was performed before the trial. Twenty-seven UK hospitals. Patients presenting with SLI as the result of infrainguinal atherosclerosis and who, in the opinion of the responsible consultant vascular surgeon and interventional radiologist, required and were suitable for both surgery and angioplasty. Patients were randomised to either 'bypass-surgery-first' or 'balloon-angioplasty-first' revascularisation strategies. The primary end point was amputation-free survival (AFS); secondary end points were overall survival (OS), health-related quality of life (HRQoL) and cost-effective use of hospital resources. AFS at 1 and 3 years was not significantly different for surgery and angioplasty. Interim analysis showed that surgery was associated with significantly lower immediate failure, higher 30-day morbidity and lower 12-month reintervention rates than angioplasty; 30-day mortality was similar. Beyond 2 years from randomisation, hazard ratios (HRs) were significantly reduced for both AFS (adjusted HR 0.37; 95% CI 0.17 to 0.77; p = 0.008) and OS (HR 0.34; 95% CI 0.17 to 0.71; p = 0.004) for surgery relative to angioplasty. By 2008 all but four patients had been followed for 3 years, some for over 7 years: 250 (56%) were dead, 168 (38%) were alive without amputation and 30 (7%) were alive with amputation. Considering the follow-up period as a whole, AFS and OS did not differ between treatments but for patients surviving beyond 2 years from randomisation, bypass was associated with reduced HRs for AFS (HR 0.85; 95% CI 0.50 to 1.07; p = 0.108) and OS (HR 0.61; 95% CI 0.50 to 0.75; p = 0.009), equating to an increase in

Suppressive activities and mechanisms of ugonin J on vascular smooth muscle cells and balloon angioplasty-induced neointimal hyperplasia.

PubMed

Pan, Chun-Hsu; Li, Pei-Chuan; Chien, Yi-Chung; Yeh, Wan-Ting; Liaw, Chih-Chuang; Sheu, Ming-Jyh; Wu, Chieh-Hsi

2018-02-01

Neointimal hyperplasia (or restenosis) is primarily attributed to excessive proliferation and migration of vascular smooth muscle cells (VSMCs). In this study, we investigated the inhibitory effects and mechanisms of ugonin J on VSMC proliferation and migration as well as neointimal formation. Cell viability and the cell-cycle distribution were, respectively, analyzed using an MTT assay and flow cytometry. Cell migration was examined using a wound-healing analysis and a transwell assay. Protein expressions and gelatinase activities were, respectively, measured using Western blot and gelatin zymography. Balloon angioplasty-induced neointimal formation was induced in a rat carotid artery model and then examined using immunohistochemical staining. Ugonin J induced cell-cycle arrest at the G 0 /G 1 phase and apoptosis to inhibit VSMC growth. Ugonin J also exhibited marked suppressive activity on VSMC migration. Ugonin J significantly reduced activations of focal adhesion kinase, phosphoinositide 3-kinase, v-akt murine thymoma viral oncogene homolog 1, and extracellular signal-regulated kinase 1/2 proteins. Moreover, ugonin J obviously reduced expressions and activity levels of matrix metalloproteinase-2 and matrix metalloproteinase-9. In vivo data indicated that ugonin J prevented balloon angioplasty-induced neointimal hyperplasia. Our study suggested that ugonin J has the potential for application in the prevention of balloon injury-induced neointimal formation. Copyright © 2017 John Wiley & Sons, Ltd.

[The usefullness of percutaneous transluminal balloon angioplasty in the management of budd-Chiari syndrome].

PubMed

Kim, Se Hwan; Yu, Kyung Sool; Baek, Seung Min; Lee, Seung Yup; Kim, Hyun Su; Tak, Won Young; Kweon, Young Oh; Kim, Sung Kook; Choi, Yong Hwan; Chung, Joon Mo

2002-06-01

Membranous obstruction is the most common cause of Budd-Chiari syndrome in Orientals. Recently, percutaneous transluminal balloon angioplasty (PTBA) has been successfully applied as a treatment of membranous obstruction. We evaluated etiologies and clinical manifestations in our cases and the usefulness of PTBA. Twelve cases of Budd-Chiari syndrome were analyzed. 50.3 years was the average age of the cases (ranging from 37 to 67 years). Major symptoms or signs were superficial collateral vessels on the chest or the abdomen in 6 cases, ascites in 3, abdominal pain in 4, hepatomegaly in 4, splenomegaly in 3, melena or hematemesis in 2, and leg edema in 2. Upper gastrointestinal endoscopy showed esophageal varices in 6 cases and two of these 6 cases had gastric varices. Of 8 cases with liver cirrhosis, 4 were classified as Child-Pugh class A and 4 as B. Four patients with cirrhosis had concurrent hepatocellular carcinoma including 1 patient who was HBs Ag positive. Etiologies were membranous obstruction in 11 cases and protein C deficiency in 1 case. The main site of obstruction was IVC in 8 and hepatic vein in 4. PTBA was successfully performed in 8 cases of membranous obstruction. During the mean follow-up period of 27.6 months (12-40 months), there were no reobstructions except in 2 cases. The most common cause of Budd-Chiari syndrome in our cases was membranous obstruction of IVC. Percutaneous transluminal balloon angioplasty is a very useful treatment method.

Cutting Balloon Angioplasty of Bilateral Renal Artery Stenosis Due to Takayasu Arteritis in a 5-Year-Old Child with Midterm Follow-Up

DOE Office of Scientific and Technical Information (OSTI.GOV)

Gumus, Burcak, E-mail: burcakgumus73@yahoo.com; Cevik, Halime; Vuran, Can

The aim of this report is to demonstrate the successful endovascular treatment of bilateral renal artery stenosis due to Takayasu arteritis by cutting balloon angioplasty in a 5-year-old child with mid-term follow-up.

Angioplasty balloon catheters used for distraction of the ankle joint.

PubMed

Sartoretti, C; Sartoretti-Schefer, S; Duff, C; Buchmann, P

1996-02-01

Arthroscopy of the ankle joint is now routinely performed in diagnostic and therapeutic interventions but is still a demanding and difficult operative procedure in this very small and tight joint. Arthroscopy can be facilitated by a sufficient distraction that gives a better overview of the joint space. However, it is still a matter of debate how to obtain the adequate distraction. Distention by manual strength as well as by the help of a technical device have been proposed. We report our experience with distraction of the ankle joint by the help of one or two intraarticularily located and secondarily insufflated angioplasty balloon catheters that are routinely used in interventional radiology. These special catheters allow a careful and controlled distention of the joint with a fixed space of distraction and, according to our limited experience, without any morbidity.

Trial of a Paclitaxel-Coated Balloon for Femoropopliteal Artery Disease.

PubMed

Rosenfield, Kenneth; Jaff, Michael R; White, Christopher J; Rocha-Singh, Krishna; Mena-Hurtado, Carlos; Metzger, D Christopher; Brodmann, Marianne; Pilger, Ernst; Zeller, Thomas; Krishnan, Prakash; Gammon, Roger; Müller-Hülsbeck, Stefan; Nehler, Mark R; Benenati, James F; Scheinert, Dierk

2015-07-09

The treatment of peripheral artery disease with percutaneous transluminal angioplasty is limited by the occurrence of vessel recoil and restenosis. Drug-coated angioplasty balloons deliver antiproliferative agents directly to the artery, potentially improving vessel patency by reducing restenosis. In this single-blind, randomized trial conducted at 54 sites, we assigned, in a 2:1 ratio, 476 patients with symptomatic intermittent claudication or ischemic pain while at rest and angiographically significant atherosclerotic lesions to angioplasty with a paclitaxel-coated balloon or to standard angioplasty. The primary efficacy end point was primary patency of the target lesion at 12 months (defined as freedom from binary restenosis or from the need for target-lesion revascularization). The primary safety end point was a composite of freedom from perioperative death from any cause and freedom at 12 months from limb-related death (i.e., death from a medical complication related to a limb), amputation, and reintervention. The two groups were well matched at baseline; 42.9% of the patients had diabetes, and 34.7% were current smokers. At 12 months, the rate of primary patency among patients who had undergone angioplasty with the drug-coated balloon was superior to that among patients who had undergone conventional angioplasty (65.2% vs. 52.6%, P=0.02). The proportion of patients free from primary safety events was 83.9% with the drug-coated balloon and 79.0% with standard angioplasty (P=0.005 for noninferiority). There were no significant between-group differences in functional outcomes or in the rates of death, amputation, thrombosis, or reintervention. Among patients with symptomatic femoropopliteal peripheral artery disease, percutaneous transluminal angioplasty with a paclitaxel-coated balloon resulted in a rate of primary patency at 12 months that was higher than the rate with angioplasty with a standard balloon. The drug-coated balloon was noninferior to the standard

Renal artery stenosis in children: therapeutic percutaneous balloon and stent angioplasty.

PubMed

Colyer, Jessica H; Ratnayaka, Kanishka; Slack, Michael C; Kanter, Joshua P

2014-06-01

Renal artery stenosis (RAS) accounts for 10 % of cases of systemic hypertension in children. Initial management involves anti-hypertensive therapy. Percutaneous interventions are documented for the treatment of RAS in the adult population. In children, case reports suggest benefit. This is a retrospective analysis of consecutive patients referred for catheterization for RAS between 2002 and 2010 at a single institution. Recorded variables included: age, weight, systemic blood pressure, minimal luminal diameter, interventional devices, antihypertensive medications, contrast volume, and complications. Twelve patients (median age 8.2, IQR 6-12.4 years); median weight 42.8 kg, IQR: 25-47.4 kg) were referred for renal artery catheterization and underwent percutaneous intervention. Overall, minimal luminal diameter (MLD) increased by 1.2 ± 0.9 mm for all patients (p < 0.05) and by 1.3 ± 0.9 mm for post-renal transplant patients (p < 0.05). Only stent angioplasty patients demonstrated significant improved blood pressure (p < 0.05). One patient had stent thrombosis requiring re-intervention with repeat balloon angioplasty. This retrospective analysis suggests that percutaneous intervention might play a role in the management of RAS, with an improvement in MLD in children with RAS. Transcatheter intervention is technically feasible with low morbidity. A prospective, longitudinal study is warranted to compare standard medical therapy with percutaneous interventions.

High-speed coronary rotational angioplasty with the rotablator

NASA Astrophysics Data System (ADS)

Zacca, Nadim M.; Kleiman, Neal S.; Asimacopoulos, P. J.

1992-08-01

Percutaneous mechanical rotational ablation with the rotablator can be used effectively as a stand alone treatment for coronary arterial lesions, including those with angiographic morphology considered unfavorable for balloon angioplasty (eccentric, at bends, bifurcating, calcified, ulcerated, completely occluded_, as well as for balloon angioplasty procedure failures. The use of single rather than multiple burrs without balloon assistance, the use of fewer passes and of the nitroglycerine infusion through the rotablator catheter have considerably shortened the time necessary to complete a rotational atherectomy. Further, the apparently infrequent occurrence of post procedure abrupt closure makes this technique attractive in the clinical management of patients with complex coronary artery lesions.

Percutaneous Transluminal Cerebral Angioplasty and Stenting in Acute Vertebrobasilar Ischemic Stroke

PubMed Central

Nistri, M.; Mangiafico, S.; Cellerini, M.; Villa, G.; Mennonna, P.; Ammannati, F.; Giordano, G. P.

2002-01-01

Summary Reports of cerebral transluminal angioplasty and stenting in patients with vertebrobasilar ischemic stroke are scanty. Herein we report on the use of “monorail” coronary balloon angioplasty and stent balloon mounted catheters in two patients with acute vertebrobasilar ischemic stroke, focussing on the differences and possible advantages of the “monorail” technique in comparison with the “over-the-wire” technique. In both patients, the clinical picture was characterized by progressive brainstem symptoms followed by acute loss of consciousness related to an atherothrombotic occlusion and subocclusion of the dominant intracranial vertebral artery, respectively. In one patient, superselective thrombolytic therapy and balloon angioplasty resulted in a dissection flap at the vertebrobasilar junction. The latter was treated by successful deployment of a coronary stent. In the other patient, the subocclusive lesion was directly treated by angioplasty and stenting without thrombolytic therapy. The clinical outcome was poor for one patient (“locked in” syndrome) while the other had a complete clinical recovery. In acute atherothrombotic vertebrobasilar stroke transluminal cerebral angioplasty and stenting may be successfully performed allowing vessel recanalization. PMID:20594522

Restenosis after hot-tip laser-balloon angioplasty: histologic evaluation of the samples removed by Simpson atherectomy

NASA Astrophysics Data System (ADS)

Barbieri, Enrico; Tanganelli, Pietro; Taddei, Giuseppe; Perbellini, Antonio; Attino, Vito; Destro, Gianni; Zardini, Piero

1991-05-01

Laser balloon angioplasty has been used in recent years to treat peripheral artery disease. Despite a primary success the technique is plagued by a high restenosis rate. Directional atherectomy was performed in a small group of patients affected by primitive stenosis or restenosis after an invasive procedure. Light microscopy, immunohistochemistry, and transmission electron microscopy have identified the cellular component of intimal hyperplasia as smooth muscle cells in an active synthetic phenotype. The arterial healing process after invasive procedures seems to develop similarly independently of the device employed.

Morphological differences in coronary arteries following rotational atherectomy versus balloon angioplasty: ultrasound and angioscopic observations

NASA Astrophysics Data System (ADS)

Bass, Theodore A.; Gilmore, Paul S.; White, Christopher J.; Chami, Youssef G.; Kircher, Barbara J.; Conetta, Donald A.

1993-09-01

Percutaneous transluminal coronary rotational atherectomy (PTCRA) is an exciting new device to recannulate obstructed coronary arteries. This device works as a high speed `drill,' selectively cutting hard atherosclerotic plaque while preferentially sparing the softer, less diseased vascular luminal surface. At speeds as high as 200,000 rpm the plaque is pulverized into small particles easily handled by the circulatory system with no untoward clinical sequela. Balloon angioplasty does not remove atherosclerotic plaque. It dilates the vessel by mechanically stretching, compressing and splitting the plaque and vessel lining. We compare morphological and surface luminal characteristics of vessels post PTCRA to vessels post PTCA.

Application of CO laser for laser balloon angioplasty

NASA Astrophysics Data System (ADS)

Miyamoto, Akira; Sakurada, Masami; Mizuno, Kyoichi; Kurita, Akira; Nakamura, Haruo; Suda, Akira; Arai, Tsunenori; Kikuchi, Makoto

1990-07-01

CO laser may be efficient for thermal fusion of intima of arterial wall without adventitial tissue damage because of high tissue absorption. To investigate the efficacy of CO laser as a laser bam for laser balloon angioplasty (LBA). CO laser was irradiated to aortic tissue through 3Oim polyethylene membrane and tissue temperature was measured by a thermistor. At 2Owatt/cm2 200joules/cm2 continuous laser exposure (CE), tissue temperature was above 100°C within a depth of 1mm and rapidly decreased to 60 °C or below between 2 and 3mm in depth. Moreover, adventitial temperature could be decreased by changing duty ratio (exposure duration/interval) of intermittent laser exposure (IE) despite of the same laser energy. Light microscopy showed high degree of medial coagulation necrosis in CE, however thermal coagulation was observed only at the surface of intima of aortic tissue in IE at duty ratio 1 / 2. These findings suggested CO laser could coagulate intimal layer with less deep thermal damage compared to Nd- YAG laser and that IE was better for superficial welding than CE at the same energy. We concluded that CO laser might be more efficient as a laser beam for LBA than Nd-YAG laser.

Orbital atherectomy as an adjunct to debulk difficult calcified lesions prior to mesenteric artery stenting.

PubMed

Manunga, Jesse M; Oderich, Gustavo S

2012-08-01

To describe a technique in which percutaneous orbital atherectomy is used to debulk heavily calcified superior mesenteric artery (SMA) occlusions as an adjunct in patients undergoing angioplasty and stenting. The technique is demonstrated in a 62-year-old woman with a replaced right hepatic artery originating from an SMA occluded by densely calcified lesions. Via a left transbrachial approach, a 7-F MPA guide catheter was used to engage the ostium of the SMA, which was crossed using a catheter and guidewire. The calcified lesion was debulked using the 2-mm Diamondback 360° orbital atherectomy system. The wire was exchanged for a 0.014-inch filter wire and 0.018-inch guidewire. Using a 2-guidewire technique, the SMA was stented with a self-expanding stent for the distal lesion that crossed side branches and a balloon-expandable stent at the ostium. A 0.014-inch guidewire was placed into the replaced hepatic artery through a cell of the self-expanding stent, followed by deployment of a small balloon-expandable stent to address the residual lesion. The use of orbital atherectomy to debulk occluded and heavily calcified SMA lesions may optimize the technical results with angioplasty and stenting.

Incidence and Predictors of reCurrent Restenosis After Drug-coated Balloon Angioplasty for Restenosis of a drUg-eluting Stent: The ICARUS Cooperation.

PubMed

Cassese, Salvatore; Xu, Bo; Habara, Seiji; Rittger, Harald; Byrne, Robert A; Waliszewski, Matthias; Pérez-Vizcayno, María José; Gao, Runlin; Kastrati, Adnan; Alfonso, Fernando

2017-09-12

The incidence and predictors of recurrent restenosis after drug-coated balloon (DCB) angioplasty for drug-eluting stent (DES) restenosis remain poorly studied. We sought to evaluate the incidence and predictors of recurrent restenosis among participants in randomized controlled trials receiving DCB angioplasty for DES restenosis. The clinical and lesion data of individuals enrolled in 6 randomized controlled trials of DCB angioplasty for DES restenosis were pooled. All patients included in this report were assigned to receive paclitaxel-coated balloon angioplasty with the SeQuent Please DCB (B Braun, Melsungen, Germany). The current analysis focused on participants with available follow-up angiography at 6 to 9 months. The incidence of recurrent restenosis, defined as diameter restenosis ≥ 50% in the in-segment area at follow-up angiography, and its clinical and angiographic predictors were evaluated. A total of 546 patients were combined in a single dataset. Angiographic follow-up at 6 to 9 months was available for 484 patients (88.6%) with 518 treated lesions. Recurrent restenosis was detected in 101 (20.8%) patients. On multivariable analysis, lesion length (OR, 1.58; 95%CI, 1.10-2.26; P=.012 for 5mm increase) and vessel size (OR, 1.42; 95%, 1.12-1.79; P=.003 for 0.5mm reduction) were independently associated with recurrent restenosis. In the largest cohort to date of individuals with angiographic surveillance after DCB angioplasty for DES restenosis, we demonstrated that recurrent restenosis occurs in approximately 1 out of 5 patients. Predictors of recurrent restenosis are increased lesion length and small vessel size. Copyright © 2017 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

Cerebral intolerance during flow arrested carotid angioplasty.

PubMed

St Louis, Myron; Park, Brian D; Dahn, Michael; Bozeman, Patricia

2012-01-01

The use of flow arrest as a means of providing cerebral protection during carotid angioplasty offers the advantages of improved efficiency of debris removal and the ability to provide protection under unfavorable (tortuous) anatomic circumstances. However, in contrast to the filtration methods of cerebral protection, this modality requires complete interruption of antegrade carotid artery flow during balloon angioplasty and stent deployment. We report our experience with 9 patients undergoing carotid angioplasty with the Mo.Ma device, which utilizes common and external carotid artery balloon occlusion during the angioplasty procedure. We assessed the clinical outcomes and intraprocedural hemodynamic data. The average duration of carotid occlusion was 8.3 minutes. Of the 9 patients, 2 patients (22%) experienced cerebral intolerance. No stroke occurred in this patient cohort. There appeared to be a poor relationship between procedure intolerance and the presence of significant contralateral stenosis or low carotid back pressure. Furthermore, the incidence of postangioplasty hypotension was not clearly related to cerebral intolerance. Carotid angioplasty with stenting can be safely conducted with flow arrest as an alternative to filter-type cerebral protection devices. However, because cerebral intolerance is not an infrequent occurrence with this approach, clinicians must be cognizant of management strategies for transient cerebral intolerance.

Endovascular Treatment of Haemodialysis Arteriovenous Fistula with Drug-Coated Balloon Angioplasty: A Single-Centre Study.

PubMed

Lučev, Jernej; Breznik, Silva; Dinevski, Dejan; Ekart, Robert; Rupreht, Mitja

2018-06-01

To evaluate the effect of percutaneous transluminal angioplasty (PTA) on haemodialysis fistulas utilising drug-coated balloons with plain balloon vessel preparation (DCB). In the study group, 31 patients (16 men; mean age 62.8 ± 17.2 years) with failing arteriovenous fistulas were treated, with DCB, and compared with a control group (31 patients; 15 men; mean age 67.0 ± 8.44 years), in which only plain balloon PTA was performed. All stenoses were dilated with regular PTA balloons. After achieving haemodynamic success (< 30% residual stenosis), drug-coated balloons were used for drug administration in the study group. The follow-up intervals were 6, 12 and 24 months. Target lesion primary patency, primary assisted patency and secondary patency were compared. The statistical significance was set at 0.05. Target lesion primary patency was compared in both groups and was significantly higher in the study group (DCB) at 6 months (90.3 vs. 61.3%; p = 0.016), 12 months (77.4 vs. 29%; p = 0.0004) as well as 24 months (45.2 vs. 16.1%; p = 0.026). Kaplan-Meier survival curves also showed a significant difference for target lesion primary patency (534.2 vs. 315.7 days; p = 0.0004). There were no significant differences in target lesion primary assisted patency and in secondary patency. However, only 38.7% of patients in the study group were treated twice or more versus 80.6% in the control group (p = 0.002). DCB increases target lesion primary patency during the first 24 months and decreases the rate of reinterventions.

Initial experience with the Europass: a new ultra-low profile monorail balloon catheter.

PubMed

Zimarino, M; Corcos, T; Favereau, X; Tamburino, C; Toussaint, M; Spaulding, C; Guérin, Y

1994-09-01

One of the causes for percutaneous transluminal coronary angioplasty (PTCA) failure is the inability to cross the lesion with the balloon catheter after guidewire positioning. The Europass coronary angioplasty catheter is a monorail Duralyn balloon catheter developed to enhance lesion crossability and to overcome this limitation. This system was evaluated in 50 patients in which target lesions were chronic total coronary occlusions (12 cases) or stenoses that could not be reached or crossed by other new monorail balloon catheters. Overall procedural success was obtained in 49/50 patients (98%), using a single Europass balloon catheter in 46/50 patients (92%), with no in-hospital complications. Its low profile, small distal shaft, and excellent trackability allowed successful angioplasty in cases where other catheters failed. This balloon catheter represents a significant advance in angioplasty technology and can be considered as a first-choice device for a safe and expeditious single-operator procedure.

[SICI-GISE position paper on drug-coated balloon use in the coronary district].

PubMed

Cortese, Bernardo; Sgueglia, Gregory A; Berti, Sergio; Biondi-Zoccai, Giuseppe; Colombo, Antonio; Limbruno, Ugo; Bedogni, Francesco; Cremonesi, Alberto

2013-10-01

Drug-coated balloons are a new tool for the treatment of patients with coronary artery disease. The main feature of this technology is a rapid and homogeneous transfer of an antiproliferative drug (paclitaxel) to the vessel wall just at the time of balloon inflation, when neointimal proliferation, in response to angioplasty, is the highest. Moreover, drug-coated balloons share adjunctive advantages over stents: the absence of permanent scaffold and polymer, the respect of the original coronary anatomy, and limited inflammatory stimuli, thereby allowing for short-term dual antiplatelet therapy. At present, a variety of devices are available in the market, with limited scientific data for the vast majority of them. Thus, the Italian Society of Interventional Cardiology (SICI-GISE) decided to coordinate the efforts of a group of renowned experts in this field, in order to produce a position paper on the correct use of drug-coated balloons in all settings of coronary artery disease, giving a class of indication to each one, based on clinical evidence. This position paper represents a quick reference for operators, investigators and manufacturers to promote the understanding and the correct use of the drug-coated balloon technology in everyday clinical practice.

Coronary angioplasty with second generation Monorail catheters.

PubMed

Pande, A K; Meier, B; Urban, P; Villavicencio, R; de la Serna, F; Moles, V

1991-07-01

The Monorail system (Schneider) consists of a balloon catheter in which the guidewire passes through the balloon itself, exits the catheter proximal to the balloon, and runs alongside its small shaft (3 French) through the length of the guiding catheter. It offers distinct advantages over conventional systems of coronary angioplasty. It facilitates contrast injections and permits rapid balloon exchanges. This system was used for coronary angioplasty in 273 unselected consecutive patients (age 59 +/- 10, mean 35 to 73 years). There were 216 patients (84%) undergoing single-vessel and 57 patients (16%) with multi-vessel coronary angioplasty. A total of 335 coronary stenoses were dilated, which included 35 total occlusions. The size of balloon used ranged from 2.0 to 4.25 mm (3.0 +/- 0.5 mm) and the severity of stenosis was 85 +/- 11%. Technical success was defined as a residual stenosis of less than 50% as determined angiographically. Clinical success was defined as technical success, and absence of a major inhospital complication defined as absence of myocardial infarction, lack of need for coronary arterial bypass surgery, and survival. The Monorail system was technically successful in 294/300 stenotic lesions (98%). It was clinically successful for 281 lesions (94%). Of the 35 total occlusions, technical success was obtained in 25 (71%). The residual stenosis of successful cases was 26 +/- 21%. The Monorail system was also successful in 5 patients with stenosis of more than 90% in whom conventional systems failed. The complications included acute occlusion causing acute myocardial infarction in 13 cases (5%), emergency coronary arterial bypass surgery in 1 patient (0.4%), and death in 4 patients (1.5%).(ABSTRACT TRUNCATED AT 250 WORDS)

Peripheral Applications of Drug-Coated Balloons: Past, Present and Future

DOE Office of Scientific and Technical Information (OSTI.GOV)

Krokidis, Miltiadis, E-mail: mkrokidis@hotmail.com; Spiliopoulos, Stavros, E-mail: stavspiliop@upatras.gr; Katsanos, Konstantinos, E-mail: katsanos@med.upatras.gr

2013-04-15

Drug-coated balloon (DCB) technologies represent the latest and hottest development in the field of endovascular treatment of peripheral arterial disease. Initial experience with paclitaxel-coated balloon use in the femoral artery has demonstrated lower mid-term restenosis and superior mid-term clinical outcomes in terms of improved wound healing and reduced repeat angioplasty rates compared with standard balloon angioplasty. Many companies are presently developing and/or improving DCB catheters and therefore ongoing, technical improvements of the already existing platforms, new drugs, and innovative carriers are expected. The ongoing basic research studies and various multicenter randomized, controlled trials that are currently in progress will offermore » valuable scientific insights regarding the long-term effectiveness and other crucial issues, such as efficacy in various vascular beds, optimal balloon dosage, and post angioplasty antiplatelet therapy. Future applications of these devices also could include in-stent restenosis, anastomotic stenosis of surgical bypass, and benign stenoses of the central venous system. The authors envision that DCB angioplasty will evolve to a major paradigm shift in the endovascular treatment of occlusive vascular diseases.« less

Laser balloon angioplasty: effect of tissue temperature on weld strength of human postmortem intima-media separations.

PubMed

Jenkins, R D; Sinclair, I N; Anand, R; Kalil, A G; Schoen, F J; Spears, J R

1988-01-01

Dehiscence of portions of atheromatous plaques fractured during percutaneous transluminal coronary angioplasty may contribute to both abrupt reclosure and gradual restenosis. Laser balloon angioplasty has been shown to be effective in welding human plaque-arterial wall separations in vitro by heating tissues with a Nd:YAG laser during balloon inflation. To define the potentially useful therapeutic range of tissue temperature required to achieve thermal welds, 220 1-cm diameter discs of human postmortem atheromatous aortic tissue, the intimal plaque of which had been separated from the media, were exposed to 3-25 watts of Nd:YAG laser radiation delivered over a 12-mm2 nominal spot size for 20 seconds via a 400-micron core optical fiber. As measured with a thermistor, adventitial temperature reflected the temperature at the plaque-media junction to within 10 degrees C. The degree of tissue temperature elevation was related to delivered energy, while effective tissue penetration increased to maximum depth of 3 mm at the highest power density. Strength of tissue welds was defined as the force required to shear opposing layers of welded segments. Adventitial tissue temperatures below 80 degrees C were not associated with appreciable welds, while equilibrium temperatures between 95 degrees C and 140 degrees C were consistently associated with effective mean weld strengths, which increased linearly from 25 to 110 g, respectively. Temperatures greater than 150 degrees C were associated with rapid tissue dehydration and charring. These data suggest that the therapeutic range of tissue temperature that provides effective thermal fusion of intima-media separations is broad and that the depth and degree of thermal coagulation can be controlled by manipulation of laser energy delivery.

Simulation of balloon angioplasty in residually stressed blood vessels-Application of a gradient-enhanced fibre damage model.

PubMed

Polindara, César; Waffenschmidt, Tobias; Menzel, Andreas

2016-08-16

In this contribution we study the balloon angioplasty in a residually stressed artery by means of a non-local gradient-enhanced fibre damage model. The balloon angioplasty is a common surgical intervention used to extend or reopen narrowed blood vessels in order to restore the continuous blood flow in, for instance, atherosclerotic arteries. Inelastic, i.e. predominantly damage-related and elastoplastic processes are induced in the artery during its inflation resulting in an irreversible deformation. As a beneficial consequence, provided that the inelastic deformations do not exceed a specific limit, higher deformations can be obtained within the same pressure level and a continuous blood flow can be guaranteed. In order to study the mechanical response of the artery in this scenario, we make use of the non-local gradient-enhanced model proposed in Waffenschmidt et al. (2014). In this contribution, we extend this model to make use of an incompressible format in connection with a Q1Q1P0 finite element implementation. The residual stresses in the artery are also taken into account following the framework presented in Waffenschmidt (2015). From the results it becomes apparent that, when the artery is subjected to radial stresses beyond the physiological range, damage evolution is triggered in the collagen fibres. The impact of the residual stresses on the structural response and on the circumferential stress distribution along the thickness of the arterial wall is also studied. It is observed that the residual stresses have a beneficial effect on the mechanical response of the arterial wall. Copyright © 2016 Elsevier Ltd. All rights reserved.

Adventitial nab-rapamycin injection reduces porcine femoral artery luminal stenosis induced by balloon angioplasty via inhibition of medial proliferation and adventitial inflammation.

PubMed

Gasper, Warren J; Jimenez, Cynthia A; Walker, Joy; Conte, Michael S; Seward, Kirk; Owens, Christopher D

2013-12-01

Endovascular interventions on peripheral arteries are limited by high rates of restenosis. Our hypothesis was that adventitial injection of rapamycin nanoparticles would be safe and reduce luminal stenosis in a porcine femoral artery balloon angioplasty model. Eighteen juvenile male crossbred swine were included. Single-injury (40%-60% femoral artery balloon overstretch injury; n=2) and double-injury models (endothelial denudation injury 2 weeks before a 20%-30% overstretch injury; n=2) were compared. The double-injury model produced significantly more luminal stenosis at 28 days, P=0.002, and no difference in medial fibrosis or inflammation. Four pigs were randomized to the double-injury model and adventitial injection of saline (n=2) or 500 μg of nanoparticle albumin-bound rapamycin (nab-rapamycin; n=2) with an endovascular microinfusion catheter. There was 100% procedural success and no difference in endothelial regeneration. At 28 days, nab-rapamycin led to significant reductions in luminal stenosis, 17% (interquartile range, 12%-35%) versus 10% (interquartile range, 8.3%-14%), P=0.001, medial cell proliferation, P<0.001, and fibrosis, P<0.001. There were significantly fewer adventitial leukocytes at 3 days, P<0.001, but no difference at 28 days. Pharmacokinetic analysis (single-injury model) found rapamycin concentrations 1500× higher in perivascular tissues than in blood at 1 hour. Perivascular rapamycin persisted ≥8 days and was not detectable at 28 days. Adventitial nab-rapamycin injection was safe and significantly reduced luminal stenosis in a porcine femoral artery balloon angioplasty model. Observed reductions in early adventitial leukocyte infiltration and late medial cell proliferation and fibrosis suggest an immunosuppressive and antiproliferative mechanism. An intraluminal microinfusion catheter for adventitial injection represents an alternative to stent- or balloon-based local drug delivery.

Cool excimer laser-assisted angioplasty (CELA) and tibial balloon angioplasty (TBA) in management of infragenicular arterial occlusion in critical lower limb ischemia (CLI).

PubMed

Sultan, Sherif; Tawfick, Wael; Hynes, Niamh

2013-04-01

We aim to compare cool excimer laser-assisted angioplasty (CELA) versus tibial balloon angioplasty (TBA) in patients with critical limb ischemia (CLI) with tibial artery occlusive disease. The primary end point is sustained clinical improvement (SCI) and amputation-free survival (AFS). The secondary end points are binary restenosis, target extremity revascularization (TER), and cost-effectiveness. From June 2005 to October 2010, 1506 patients were referred with peripheral vascular disease and 572 with CLI. A total of 80 patients underwent 89 endovascular revascularizations (EVRs) for tibial occlusions, 47 using TBA and 42 using CELA. All patients were Rutherford category 4 to 6. Three-year SCI was enhanced with CELA (81%) compared to TBA (63.8%; P = .013). Three-year AFS significantly improved with CELA (95.2%) versus TBA (89.4%; P = .0165). Three-year freedom from TER was significantly improved with CELA (92.9%) versus 78.7% TBA (P = .026). Three-year freedom from MACE was comparable in both the groups (P = .455). Patients with CELA had significantly improved quality time without symptoms of disease or toxicity of treatment (Q-TWiST) at 3 years (10.5 months; P = .048) with incremental cost of €2073.19 per quality-adjusted life year gained. Tibial EVR provides exceptional outcome in CLI. The CELA has superior SCI, AFS, and freedom from TER, with improved Q-TWiST and cost-effectiveness.

Comparison of orbital atherectomy plus balloon angioplasty vs. balloon angioplasty alone in patients with critical limb ischemia: results of the CALCIUM 360 randomized pilot trial.

PubMed

Shammas, Nicolas W; Lam, Russell; Mustapha, Jihad; Ellichman, Jonathan; Aggarwala, Gaurav; Rivera, Ernesto; Niazi, Khusrow; Balar, Nilesh

2012-08-01

To evaluate the role of orbital atherectomy in calcified infrapopliteal arteries in patients with critical limb ischemia compared to balloon angioplasty (BA) alone. A randomized multicenter study was undertaken to evaluate short and 1-year outcomes in 50 patients (32 men; mean age 71 years, range 40-90) with confirmed calcified lesions using 1∶1 randomization to the Diamondback 360° Orbital Atherectomy System followed by BA vs. BA alone. All patients had severe (≥50% stenosis) peripheral artery disease (Rutherford classification 4-6) in the popliteal, tibial, and/or peroneal arteries. The primary endpoint was defined as restoration of a normal lumen (residual stenosis ≤30%) with no bailout stenting or dissection types C through F. Scheduled follow-up visits were conducted according to a common protocol at 1, 6, and 12 months. Procedural success was 93.1% (27/29 lesions) for atherectomy + BA patients and 82.4% (28/34 lesions) for BA alone (p = 0.27). Bailout stenting was needed in 2 (6.9%) of the 29 atherectomy + BA lesions and in 5 (14.3%) of the 35 BA-treated lesions (p = 0.44). At 1 year, there were no amputations in either group related to the index procedure. Estimates for freedom from target vessel revascularization and all-cause mortality were 93.3% and 100% in the atherectomy + BA group vs. 80.0% (p = 0.14) and 68.4% (p = 0.01) in the BA group, respectively. Proportional hazard models evaluating survival time vs. status of residual stenosis determined a hazard ratio for major adverse events of 5.6 for patients with an acute post-procedure residual stenosis >30% (p = 0.01). Debulking with orbital atherectomy appeared to increase the chance of reaching a desirable angioplasty result, with less acute need for bailout stenting and a higher procedure success. A negative association between procedure success and risk of serious adverse outcomes should encourage larger confirmatory studies.

Drug-coated balloon angioplasty for de novo small vessel disease including chronic total occlusion and bifurcation in real-world clinical practice.

PubMed

Onishi, Takayuki; Onishi, Yuko; Kobayashi, Isshi; Umezawa, Shigeo; Niwa, Akihiro

2018-06-18

The aim of this study is to validate the efficacy of drug-coated balloons (DCBs) for real-world de novo small vessel diseases including chronic total occlusion and bifurcation. DCB angioplasty has been reported to be effective in the treatment of de novo small vessel disease. However, the number of reports that have focused on complex lesions is limited. This observational study comprised consecutive patients who underwent DCB angioplasty for de novo small vessel disease with a reference diameter of less than 2.5 mm by visual estimation. Outcome parameters included late lumen loss, restenosis rate, and major adverse cardiac events, such as cardiac death, non-fatal myocardial infarction, and target lesion revascularization (TLR). Fifty-two patients underwent DCB angioplasty for 59 lesions with a reference vessel diameter of 1.93 ± 0.63 mm. Thirty-eight of the lesions (69%) were classified as type B2/C, including chronic total occlusions (20%) and bifurcations (33%). At the 8-month follow-up, late lumen loss was - 0.01 ± 0.44 mm with a restenosis rate of 20%. No cardiac deaths or myocardial infarctions were reported and only 5 (9%) angiographically driven TLRs were reported. DCB angioplasty offered an acceptable 8-month lumen patency and a stable clinical outcome for real-world complex de novo coronary diseases.

Atherectomy offers no benefits over balloon angioplasty in tibial interventions for critical limb ischemia.

PubMed

Todd, Kevin E; Ahanchi, Sadaf S; Maurer, Christian A; Kim, Jung H; Chipman, Candice R; Panneton, Jean M

2013-10-01

Endovascular adjuncts, like atherectomy, were developed to improve outcomes of endovascular arterial interventions. The true impact of atherectomy on endovascular outcomes remains to be determined, and little data exist on the influence of atherectomy on tibial interventions. Our study compares early and late outcomes of tibial intervention with angioplasty vs atherectomy-assisted interventions. We completed a retrospective review of all tibial interventions between 2008 and 2010. Outcomes were analyzed using single and multivariate analysis, Cox regression, and Kaplan-Meier curves. Primary outcomes were primary, primary assisted, and secondary patency rates, as well as limb salvage and survival rates. Over a 2-year period, 480 tibial interventions were completed for 421 patients. Eighty-seven percent (n = 418) of interventions were performed for critical limb ischemia (CLI) and 13% (n = 62) for claudication. The CLI cohort of 418 interventions was analyzed. These patients had a mean age of 71 years with a mean follow-up time of 16 ± 15 months (range, 0-59 months). Of the 418 interventions, 339 underwent percutaneous transluminal angioplasty (PTA): 333 PTA alone, six PTA + stent. The remaining 79 interventions received atherectomy: 33 laser, 13 directional, and 33 orbital either alone or in conjunction with PTA (11 atherectomy only, 68 atherectomy + PTA). The groups did not differ significantly in terms of demographics, risk factors, or technical success. The atherectomy group had more TASC B lesions (54% vs 38%; P = .013), while the PTA-alone group had more TASC D lesions (25% vs 13%; P = .004). TASC A and C lesions did not differ significantly between the groups. No significant differences existed with respect to the early (30-day) outcomes of loss of patency (11% vs 13%; P = .699), complications (8% vs 13%; P = .292), or major amputation (17% vs 13%; P = .344) in the PTA-alone group vs the atherectomy-assisted group. Kaplan-Meier analysis revealed no difference

Directional Atherectomy With Antirestenotic Therapy vs Drug-Coated Balloon Angioplasty Alone for Isolated Popliteal Artery Lesions.

PubMed

Stavroulakis, Konstantinos; Schwindt, Arne; Torsello, Giovanni; Stachmann, Arne; Hericks, Christiane; Bosiers, Michel J; Beropoulis, Efthymios; Stahlhoff, Stefan; Bisdas, Theodosios

2017-04-01

To report a single-center study comparing drug-coated balloon (DCB) angioplasty vs directional atherectomy with antirestenotic therapy (DAART) for isolated lesions of the popliteal artery. Seventy-two patients were treated with either DCB angioplasty alone (n=31) or with DAART (n=41) for isolated popliteal artery stenotic disease between October 2009 and December 2015. The majority of patients presented with lifestyle-limiting claudication (74% vs 86%, respectively). Vessel calcification (29% vs 29%, respectively), mean lesion length (47 vs 42 mm, respectively), and number of runoff vessels were comparable between the groups. The primary outcome measure was primary patency; secondary outcomes were technical success (<30% residual stenosis or bailout stenting), secondary patency, and freedom from clinically driven target lesion revascularization (TLR). The technical success rate following DCB was 84% vs 93% (p=0.24) after DAART. The 12-month primary patency rate was significantly higher in the DAART group (65% vs 82%; hazard ratio 2.64, 95% confidence interval 1.09 to 6.37, p=0.021), while freedom from TLR did not differ between the 2 treatment strategies (82% vs 94%, p=0.072). Secondary patency at 12 months was identical for both groups (96% vs 96%). Although not statistically significant, bailout stenting was more common after DCB angioplasty (16% vs 5% for DAART, p=0.13) and aneurysmal degeneration of the popliteal artery was seen more often after DAART (7% vs 0% for DCB alone, p=0.25). Popliteal artery injury was observed in 2 patients treated using DAART (5% vs 0% for DCB alone, p=0.5), whereas distal embolization rates were comparable between the groups (3% for DCB alone vs 5% for DAART, p=0.99). In this study, the use of DAART was associated with a higher primary patency rate compared with DCB angioplasty for isolated popliteal lesions. Nonetheless, both treatment options were associated with excellent 12-month secondary patency. Aneurysmal degeneration of

Effect of ketamine pretreatment for anaesthesia in patients undergoing percutaneous transluminal balloon angioplasty with continuous remifentanil infusion

PubMed Central

Jun, Na Hyung; Shim, Jae Kwang; Choi, Yong Sun; An, Seung Ho

2011-01-01

Background An appropriate level of sedation and pharmacological assist are essential during percutaneous transluminal balloon angioplasty (PTA). Ketamine provides good analgesia while preserving airway patency, ventilation, and cardiovascular stability with an opioid sparing effect suggesting that it would be ideal in combination with remifentanil and midazolam in spontaneously breathing patients. We evaluated the effect of a small dose of ketamine added to midazolam and remifentanil on analgesia/sedation for PTA procedures. Methods Sixty-four patients receiving PTA were enrolled. The Control group received midazolam 1.0 mg i.v. and continuous infusion of remifentanil 0.05 µg/kg/min. The Ketamine group received, in addition, an intravenous bolus of 0.5 mg/kg ketamine. Patients' haemodynamic data were monitored before remifentanil infusion, 5 min after remifentanil infusion, at 1, 3, 5, 30 min after incision, and at admission to the recovery room. Verbal numerical rating scales (VNRS) and sedation [OAA/S (Observer's Assessment of Alertness/Sedation)] scores were also recorded. Results The VNRS values at 1, 3, and 5 min after incision and OAA/S scores at 5 min after remifentanil infusion, and 1, 3, and 5 min after incision were lower in the Ketamine group than in the Control group. In the Control group, the VNRS value at 1 min after incision significantly increased and OAA/S values at 3, 5, and 30 min after incision significantly decreased compared to baseline values, while there were no significant changes in the ketamine group. Conclusions A small dose of ketamine as an adjunct sedative to the combination of midazolam and remifentanil produced a better quality of sedation and analgesia than without ketamine and provided stable respiration without cardiopulmonary deterioration. PMID:22110884

The Crataegus extract WS 1442 inhibits balloon catheter-induced intimal hyperplasia in the rat carotid artery by directly influencing PDGFR-beta.

PubMed

Fürst, Robert; Zirrgiebel, Ute; Totzke, Frank; Zahler, Stefan; Vollmar, Angelika M; Koch, Egon

2010-08-01

Effective systemic drugs against restenosis upon percutaneous transluminal coronary angioplasty (PTCA) are largely lacking. Polyphenols have been suggested to ameliorate post-angioplasty restenosis. Hawthorn (Crataegus spp.) extracts, which are among the most frequently used herbal medicinal products against mild forms of congestive heart failure, contain polyphenols, but have not been investigated in this context. We aimed to assess the potential of the hawthorn extract WS 1442 to prevent balloon catheter-induced intimal hyperplasia and to elucidate the underlying mechanisms. We analyzed the effects of WS 1442 on serum-induced vascular smooth muscle cell (VSMC) and endothelial cell (EC) growth and migration, growth factor-induced proliferation, growth factor receptor activity, and neointima formation in the rat carotid artery model. WS 1442 (100 microg/ml) decreased VSMC migration by 38% and proliferation by 44%, whereas EC migration and proliferation were unaltered. The extract inhibited VSMC DNA synthesis induced by platelet-derived growth factor (PDGF) (IC(50): 47 microg/ml), but not that of basic fibroblast growth factor (bFGF) and epidermal growth factor (EGF). Along this line, WS 1442 blocked recombinant human PDGF receptor (PDGFR)-beta kinase activity (IC(50): 1.4 microg/ml) and decreased PDGFR-beta activation and extracellular signal-regulated kinase (ERK) activation in VSMCs. In rats, orally administered WS 1442 significantly reduced neointima formation after balloon catheter dilatation of the carotid artery. WS 1442 inhibits migration and proliferation of VSMCs, but not of ECs, and reduces balloon catheter-evoked neointima formation probably through inhibition of PDGFR-beta. Thus, the present study suggests a novel adjunct pharmacological strategy to prevent angioplasty-related restenosis. Copyright 2010 Elsevier Ireland Ltd. All rights reserved.

Monorail Piccolino catheter: a new rapid exchange/ultralow profile coronary angioplasty system.

PubMed

Mooney, M R; Douglas, J S; Mooney, J F; Madison, J D; Brandenburg, R O; Fernald, R; Van Tassel, R A

1990-06-01

The Monorail Piccolino coronary angioplasty balloon catheter (MBC) was evaluated on 118 patients at two centers. Technical success was achieved in 110 patients (93%). Time for catheter exchange and total fluoroscopy time were significantly lower for the Monorail catheter than with standard equipment (exchange time 97 vs. 170 seconds P less than .05 and fluoroscopy time 17 vs. 88 seconds P less than .001). The advantages of rapid exchange and the ability of utilize 2 Monorail balloon catheters through one 9F guiding catheter for simultaneous inflations allowed for maximal flexibility in treating patients with bifurcation lesions. The double wire approach utilizing one Monorail balloon catheter with a 7F guiding catheter was also technically successful. The Monorail Piccolino balloon catheter has unique features that allow for greater ease of operator use, rapid catheter exchange, and optimal angiographic visualization. It is felt that this catheter design provides distinct advantages over standard angioplasty equipment.

Endovascular techniques in limb salvage: cutting, cryo, brachy, and drug-eluting balloons.

PubMed

Davies, Mark G; Anaya-Ayala, Javier E

2013-04-01

The complex pathophysiology response to injury of the lower-extremity arteries has prompted the development of several unique balloon technologies to overcome initial technical failures and short-term intimal hyperplasia. Cryoplasty alters the cellular and mechanical properties of the vessel wall during angioplasty. Cutting balloons incise the wall, preventing elastic recoil and allowing expansion of the lumen at a lower pressure, thus limiting barotrauma. Drug-eluting balloons actively transfer inhibitory compounds to the wall during the initial therapy, while brachytherapy balloons allow for localized delivery of radiation to inhibit the proliferative response seen after angioplasty. These platforms provide unique means to enhance immediate and short-term results and also reduce stent usage in the lower extremity.

Cost-effectiveness analysis of orbital atherectomy plus balloon angioplasty vs balloon angioplasty alone in subjects with calcified femoropopliteal lesions

PubMed Central

Weinstock, Barry; Dattilo, Raymond; Diage, Tiffini

2014-01-01

Introduction As cost considerations become increasingly critical when selecting optimal endovascular treatment strategies, a cost-benefit analysis was conducted comparing the Diamondback 360°® Orbital Atherectomy System (OAS) (Cardiovascular Systems, Inc., St Paul, MN, USA) and balloon angioplasty (BA) vs BA alone for treatment of calcified femoropopliteal lesions. Patients and methods The clinical outcomes from COMPLIANCE 360°, a prospective, multicenter, randomized study comparing OAS+BA vs BA alone for treatment of calcified femoropopliteal lesions, were correlated with cost data and previously published quality of life data. Site of service, hospital charges, and associated medical resource utilization were obtained from Uniform Billing statements for index treatments and associated revascularizations out to 1 year. Hospital costs were estimated using hospital-specific, procedure-specific cost-to-charge ratios. Length of stay and procedural data were collected from participating study sites. Results Twenty-five subjects with 38 lesions and 25 subjects with 27 lesions were randomized to the OAS+BA and BA-alone groups, respectively. Mean hospital charges (US$51,755 vs US$39,922) and estimated hospital costs (US$15,100 vs US$11,016) were higher for OAS+BA compared with BA alone (not statistically significant). Stent utilization was statistically significantly higher with BA-alone treatment for all subjects (1.1 vs 0.1, P=0.001) and in the subset of subjects with one lesion (1.0 vs 0.1, P<0.00001). There was a significant difference in cost for single-lesion versus multiple-lesion treatment. Using costs and quality-adjusted life years (QALYs) for the single-lesion cohort, the 1-year incremental cost of OAS+BA vs BA alone was US$549, and incremental QALY was 0.16. This results in an incremental cost-effectiveness ratio of US$3,441, well below the US$50,000 threshold. Conclusion One-year index procedure cost and cost-effectiveness were comparable for OAS+BA vs BA

Cost-effectiveness analysis of orbital atherectomy plus balloon angioplasty vs balloon angioplasty alone in subjects with calcified femoropopliteal lesions.

PubMed

Weinstock, Barry; Dattilo, Raymond; Diage, Tiffini

2014-01-01

As cost considerations become increasingly critical when selecting optimal endovascular treatment strategies, a cost-benefit analysis was conducted comparing the Diamondback 360°® Orbital Atherectomy System (OAS) (Cardiovascular Systems, Inc., St Paul, MN, USA) and balloon angioplasty (BA) vs BA alone for treatment of calcified femoropopliteal lesions. The clinical outcomes from COMPLIANCE 360°, a prospective, multicenter, randomized study comparing OAS+BA vs BA alone for treatment of calcified femoropopliteal lesions, were correlated with cost data and previously published quality of life data. Site of service, hospital charges, and associated medical resource utilization were obtained from Uniform Billing statements for index treatments and associated revascularizations out to 1 year. Hospital costs were estimated using hospital-specific, procedure-specific cost-to-charge ratios. Length of stay and procedural data were collected from participating study sites. Twenty-five subjects with 38 lesions and 25 subjects with 27 lesions were randomized to the OAS+BA and BA-alone groups, respectively. Mean hospital charges (US$51,755 vs US$39,922) and estimated hospital costs (US$15,100 vs US$11,016) were higher for OAS+BA compared with BA alone (not statistically significant). Stent utilization was statistically significantly higher with BA-alone treatment for all subjects (1.1 vs 0.1, P=0.001) and in the subset of subjects with one lesion (1.0 vs 0.1, P<0.00001). There was a significant difference in cost for single-lesion versus multiple-lesion treatment. Using costs and quality-adjusted life years (QALYs) for the single-lesion cohort, the 1-year incremental cost of OAS+BA vs BA alone was US$549, and incremental QALY was 0.16. This results in an incremental cost-effectiveness ratio of US$3,441, well below the US$50,000 threshold. One-year index procedure cost and cost-effectiveness were comparable for OAS+BA vs BA alone. This study provides compelling cost

A Novel Arterial Constitutive Model in a Commercial Finite Element Package: Application to Balloon Angioplasty

PubMed Central

Zhao, Xuefeng; Liu, Yi; Zhang, Wei; Wang, Cong; Kassab, Ghassan S.

2011-01-01

Recently, a novel linearized constitutive model with a new strain measure that absorbs the material nonlinearity was validated for arteries. In this study, the linearized arterial stress-strain relationship is implemented into a finite element method package ANSYS, via the user subroutine USERMAT. The reference configuration is chosen to be the closed cylindrical tube (no-load state) rather than the open sector (zero-stress state). The residual strain is taken into account by analytic calculation and the incompressibility condition is enforced with Lagrange penalty method. Axisymmetric finite element analyses are conducted to demonstrate potential applications of this approach in a complex boundary value problem where angioplasty balloon interacts with the vessel wall. The model predictions of transmural circumferential and compressive radial stress distributions were also validated against an exponential-type Fung model, and the mean error was found to be within 6%. PMID:21689665

Pravastatin and endothelium dependent vasomotion after coronary angioplasty: the PREFACE trial

PubMed Central

Mulder, H; Schalij, M; Kauer, B; Visser, R; van Dijkman, P R M; Jukema, J; Zwinderman, A; Bruschke, A

2001-01-01

OBJECTIVE—To test the hypothesis that the 3-hydroxy-3-methylglutaryl coenzyme-A reductase inhibitor pravastatin ameliorates endothelium mediated responses of dilated coronary segments: the PREFACE (pravastatin related effects following angioplasty on coronary endothelium) trial.
DESIGN—A double blind, randomised, placebo controlled, multicentre study.
SETTING—Four hospitals in the Netherlands.
PATIENTS—63 non-smoking, non-hypercholesterolaemic patients scheduled for elective balloon angioplasty (pravastatin 34, placebo 29).
INTERVENTIONS—The effects of three months of pravastatin treatment (40 mg daily) on endothelium dependent vasomotor function were studied. Balloon angioplasty was undertaken one month after randomisation, and coronary vasomotor function tests using acetylcholine were performed two months after balloon angioplasty. The angiograms were analysed quantitatively.
MAIN OUTCOME MEASURES—The efficacy measure was the acetylcholine induced change in mean arterial diameter, determined in the dilated segment and in an angiographically normal segment of an adjacent non-manipulated coronary artery.
RESULTS—Increasing acetylcholine doses produced vasoconstriction in the dilated segments (p = 0.004) but not in the normal segments. Pravastatin did not affect the vascular response to acetylcholine in either the dilated segments (p = 0.09) or the non-dilated sites. Endothelium dependent vasomotion in normal segments was correlated with that in dilated segments (r = 0.47, p < 0.001). There were fewer procedure related events in the pravastatin group than in the placebo group (p < 0.05).
CONCLUSIONS—Endothelium dependent vasomotion in normal segments is correlated with that in dilated segments. A significant beneficial effect of pravastatin on endothelial function could not be shown, but in the dilated segments there was a trend towards a beneficial treatment effect in the pravastatin group.


Keywords: angioplasty

Pravastatin and endothelium dependent vasomotion after coronary angioplasty: the PREFACE trial.

PubMed

Mulder, H J; Schalij, M J; Kauer, B; Visser, R F; van Dijkman, P R; Jukema, J W; Zwinderman, A H; Bruschke, A V

2001-11-01

To test the hypothesis that the 3-hydroxy-3-methylglutaryl coenzyme-A reductase inhibitor pravastatin ameliorates endothelium mediated responses of dilated coronary segments: the PREFACE (pravastatin related effects following angioplasty on coronary endothelium) trial. A double blind, randomised, placebo controlled, multicentre study. Four hospitals in the Netherlands. 63 non-smoking, non-hypercholesterolaemic patients scheduled for elective balloon angioplasty (pravastatin 34, placebo 29). The effects of three months of pravastatin treatment (40 mg daily) on endothelium dependent vasomotor function were studied. Balloon angioplasty was undertaken one month after randomisation, and coronary vasomotor function tests using acetylcholine were performed two months after balloon angioplasty. The angiograms were analysed quantitatively. The efficacy measure was the acetylcholine induced change in mean arterial diameter, determined in the dilated segment and in an angiographically normal segment of an adjacent non-manipulated coronary artery. Increasing acetylcholine doses produced vasoconstriction in the dilated segments (p = 0.004) but not in the normal segments. Pravastatin did not affect the vascular response to acetylcholine in either the dilated segments (p = 0.09) or the non-dilated sites. Endothelium dependent vasomotion in normal segments was correlated with that in dilated segments (r = 0.47, p < 0.001). There were fewer procedure related events in the pravastatin group than in the placebo group (p < 0.05). Endothelium dependent vasomotion in normal segments is correlated with that in dilated segments. A significant beneficial effect of pravastatin on endothelial function could not be shown, but in the dilated segments there was a trend towards a beneficial treatment effect in the pravastatin group.

Use of a wire extender during neuroprotected vertebral artery angioplasty and stenting.

PubMed

Lesley, Walter S; Kumar, Ravi; Rangaswamy, Rajesh

2010-09-01

The off-label use of an extender wire during vertebral artery stenting and angioplasty with or with neuroprotection has not been previously reported. Retrospective, single-patient, technical report. After monorail balloon angioplasty was performed on a proximal left vertebral artery stenosis, the 190 cm long Accunet neuroprotection filter device was not long enough for delivery of an over-the-wire stent. After mating a 145 cm long, 0.014 inch extension wire to the filter device, a balloon-mounted Liberté stent was implanted with good angiographic and clinical results. The off-label use of an extender wire permits successful over-the-wire stenting on a monorail neuroprotection device for vertebral artery endosurgery.

Primary angioplasty for infarction due to isolated right ventricular artery occlusion.

PubMed

Chahal, Anwar A; Kim, Min-Young; Borg, Alexander N; Al-Najjar, Yahya

2014-11-26

We report an unusual case of an isolated right ventricular infarction with haemodynamic compromise caused by spontaneous isolated proximal occlusion of the right ventricular branch of the right coronary artery (RCA), successfully treated by balloon angioplasty. A 58-year-old gentleman presented with epigastric pain radiating into both arms. Electrocardiograph with right ventricular leads confirmed ST elevation in V4R and a diagnosis of isolated right ventricular infarction was made. Urgent primary percutaneous intervention was performed which revealed occlusion of the right ventricular branch of the RCA. During the procedure, the patient's blood pressure dropped to 80/40 mmHg, and echocardiography showed impaired right ventricular systolic function. Despite aggressive fluid resuscitation, the patient remained hypotensive, continued to have chest pain and persistent electrocardiograph changes, and hence balloon angioplasty was performed on the proximal right ventricular branch which restored flow to the vessel and revealed a severe ostial stenosis. This was treated with further balloon angioplasty which restored TIMI 3 flow with resolution of patient's symptoms. Repeat echocardiography showed complete resolution of the ST-elevation in leads V4R and V5R and partial resolution in V1. Subsequent dobutamine-stress echocardiography at 4 wk showed good left and right ventricular contractions. The patient was discharged after a 3-d in-patient stay without any complications.

[Coronary transluminal angioplasty and determination of the intracoronary gradient with a new monorail system].

PubMed

Freitas, A D; Medina, A; Bethencourt, A; Coello, I; Hernández, E; Peraza, C; Melian, F; Jiménez, F; Laraudogoitia, E; Goicolea, J

1989-10-01

To evaluate the results obtained in coronary angioplasty using the new very low profile monorail catheter. A retrospective study to define the causes and frequency of successful and unsuccessful coronary angioplasty on proximal and distal lesions located in the three coronary vessels. Patients referred to the Hemodynamic Unit for coronary angioplasty. Coronary angioplasty was performed in 106 patients with cardiac ischemic disease (stable angina, unstable angina and myocardial infarction after thrombolytic therapy). To perform coronary angioplasty using a monorail system, including dilatation of vessels (angioplasty) and to measure the intracoronary gradient. A high success rate was achieved (92%) independent of vessel dilated or of the position of the stenosis. There was a lower success rate in complex lesions. In this study, this newly modified system for coronary angioplasty with balloon catheter and monorail pressure catheter gave a very high performance.

The NICE recommendation for drug-coated balloons and its global impact.

PubMed

Eccleshall, Simon; Waliszewski, M

2015-06-01

The clinical efficacy and safety of drug-coated balloon (DCB) angioplasty in patients with coronary in-stent restenosis (ISR) has been demonstrated. The objective of this article is to provide comparative cost efficacy data for DCB angioplasty in various countries based on the original methodology of the Medical Technologies Evaluation Programme (MTEP) at the National Institute for Health and Clinical Excellence (NICE) in 2010. Published and unpublished Health Technology Assessment (HTA) reports were evaluated for comparison in selected countries. Furthermore, a systematic review of economic evaluations of DCB angioplasty versus standard treatments (uncoated balloon angioplasty or drug-eluting stent implantations) was conducted. National cost efficacy data were evaluated using Markov state transition models which were adapted to fit each country's device and procedure related costs. The clinical input for adverse events was defined with two relevant trials for in-stent restenosis of bare metal stents (BMS-ISR) and of drug-eluting stents (DES-ISR). In the UK, Germany, Switzerland, South Africa, Japan and Brazil, DCB angioplasty is cost-effective when compared with drug-eluting stents to treat either BMS-ISR or DES-ISR. DCB angioplasty ought to be the preferred treatment option for patients with BMS-ISR and DES-ISR from the payers' point of view. © The Author(s), 2015.

Cutting Balloon Angioplasty (CBA) for the Treatment of Renal Artery Fibromuscular Dysplasia (FMD) in Six Patients: 5-Year Long-Term Results

DOE Office of Scientific and Technical Information (OSTI.GOV)

Cotroneo, Antonio Raffaele; Amoroso, Luigi; Giammarino, Alberto

PurposeTo evaluate long-term outcomes in terms of hypertension control, recurrent stenosis, and reinterventions from patients who underwent cutting balloon angioplasty (CBA) for symptomatic renal artery fibromuscular dysplasia (FMD).Materials and MethodsFrom 2011, six consecutive renal artery FMD women underwent CBA for poorly controlled hypertension, despite antihypertensive therapy. Follow-up consisted of blood pressure monitoring and duplex ultrasonography at 1, 6, and 12 months and thereafter annually for 5 years.ResultsAll treatments were technically successful. Recurrence of hypertension was found in two patients within 12 months, and reinterventions were performed using CBA.ConclusionResults show the efficacy of CBA for renal artery FMD.

Drug-Coated Balloon vs. Conventional Balloon Angioplasty in Dialysis Patients With Symptomatic Femoropopliteal Disease　- A Matched Comparison.

PubMed

Chou, Hsin-Hua; Huang, Hsuan-Li; Hsieh, Chien-An; Jang, Shih-Jung; Tzeng, I-Shiang; Ko, Yu-Lin

2018-04-26

Recent randomized trials have shown the treatment benefits of use of a drug-coated balloon (DCB) over conventional percutaneous transluminal angioplasty (PTA) in patients with femoropopliteal disease. However, the effectiveness and safety of DCB for dialysis patients remain unclear.Methods and Results:Consecutive dialysis patients, who underwent PTA or DCB for femoropopliteal disease, were assessed retrospectively via 2:1 propensity score matching. Effectiveness and safety endpoints, including binary restenosis, clinically driven target lesion revascularization (CD-TLR), amputations, major adverse cardiac events (MACE), and deaths, were compared between groups. A total of 278 dialysis patients with 339 limbs were eligible for matching: 84 limbs from 77 patients treated with PTA and 46 limbs from 37 patients treated with DCB were compared after matching. Baseline patient and lesion characteristics were not different between groups. Patients treated with DCB had significantly higher rates of freedom from binary restenosis (52.4% vs. 18.6%, P<0.001) and CD-TLR (56.4% vs. 25.9%, P=0.001) at 2 years compared with patients treated with PTA. Both groups had similar outcomes for amputation, MACE, and death. Cox proportional analysis showed that treatment with DCB was independently associated with a reduction of binary restenosis (hazard ratio [HR] 0.368, P=0.001) and CD-TLR (HR 0.390, P=0.004). This study suggested superior 2-year outcomes using DCB compared with PTA and similar safety profiles in dialysis patients with femoropopliteal disease.

Combined Directional Atherectomy and Drug-Eluting Balloon Angioplasty for Isolated Popliteal Artery Lesions in Patients With Peripheral Artery Disease.

PubMed

Stavroulakis, Konstantinos; Bisdas, Theodosios; Torsello, Giovanni; Stachmann, Arne; Schwindt, Arne

2015-12-01

To evaluate the midterm results of combined directional atherectomy (DA) and drug-eluting balloon (DEB) angioplasty for atherosclerotic lesions of the popliteal artery. In a single-arm, prospective study, 21 patients (mean age 63±16 years; 16 men) with isolated popliteal artery lesions were enrolled and underwent treatment with combined DA and DEB angioplasty under filter protection between October 2009 and February 2014. The majority (18, 86%) presented with lifestyle-limiting intermittent claudication and 3 with critical limb ischemia. Fifteen (71%) target sites were de novo lesions; 4 were occlusions. The main outcome was primary patency; secondary outcomes were technical success, secondary patency, and early and midterm morbidity and mortality. The TurboHawk atherectomy device was used in 15 (71%) patients and the SilverHawk peripheral plaque excision system in the remaining 6 patients. The In.Pact Admiral/Pacific DEB was used in the majority of cases (15, 71%). The technical success rate was 90% (n=19). One flow-limiting dissection was treated with bailout stenting. Complications included a perforation of the popliteal artery and 2 puncture site hematomas; there was no distal embolic event. The mean follow-up was 18±12 months. Two restenoses were retreated successfully. Kaplan-Meier estimates of primary patency at 12 and 18 months were 95% and 90%, respectively; the secondary patency was 100%. One (5%) patient died in follow-up. None of the patients had an amputation. In this prospective single-arm study, the combined therapy of DA and DEB angioplasty for popliteal artery lesions showed promising midterm performance. The combination of DA and DEB may, in highly selected patients, overcome the challenges presented by the mobility of the knee joint. © The Author(s) 2015.

Number of Blades-up Runs Using JetStream XC Atherectomy for Optimal Tissue Debulking in Patients with Femoropopliteal Artery In-Stent Restenosis.

PubMed

Shammas, Nicolas W; Shammas, Gail A; Aasen, Nicole; Jarvis, Gary

2015-12-01

Rotational atherectomy with the use of the JetStream XC device is indicated for treatment of infrainguinal arterial obstructive disease. The number of blades-up (BU) runs needed for optimal tissue debulking in femoropopliteal in-stent restenosis (ISR) is unknown. In the present series, 6 patients (15 lesions) were treated for femoropopliteal ISR with the JetStream XC device. Minimal luminal diameter or percent stenosis improved significantly from baseline after 2 BU runs, but no further gain was seen between 2 and 4 BU runs (P > .05). However, adjunctive balloon angioplasty reduced percent stenosis significantly following BU runs. In conclusion, the JetStream XC device achieved optimal acute angiographic results in treating femoropopliteal ISR following 2 BU runs and adjunctive balloon angioplasty. Copyright © 2015 SIR. Published by Elsevier Inc. All rights reserved.

Acute results, complications, and effect of lesion characteristics on outcome with the solid-state, pulsed-wave, mid-infrared laser angioplasty system: final multicenter registry report. Holmium:YAG Laser Multicenter Investigators.

PubMed

Topaz, O; McIvor, M; Stone, G W; Krucoff, M W; Perin, E C; Foschi, A E; Sutton, J; Nair, R; deMarchena, E

1998-01-01

The solid-state, mid-infrared holmium:YAG laser (2.1 microm wavelength) is a relatively new percutaneous device that has recently been evaluated in a multicenter study. Because of its unique wavelength and photoacoustic effects on atherosclerotic plaques, this laser may be useful in treatment of symptomatic patients with coronary artery disease. This study sought to evaluate the safety and efficacy of mid-infrared laser angioplasty in the treatment of coronary artery lesions. Laser angioplasty was performed on 2,038 atherosclerotic lesions in 1,862 consecutive patients with a mean age of 61 +/- 11 years. Clinical indications included unstable angina (69%), stable angina (20%), acute infarction (6%), and positive exercise test (5%). Complex lesion morphology included eccentricity (62%), thrombus (30%), total occlusion (27%), long lesions (14%), and saphenous vein grafts (11%). This laser catheter alone successfully reduced stenosis (>20%) in 87% of lesions. With adjunct balloon angioplasty, 93% procedural success was achieved. The presence of thrombus within the target lesion was a predictor of procedural success (OR = 2.0 [95% confidence interval 2.0, 4.0], P = .04). Bifurcation lesions (OR = 0.5 [95% confidence interval 0.2, 1.0], P = .05) and severe tortuosity of the treated vessel (OR = 0.4 [95% confidence interval 0.2, 0.9], P = .02) were identified as significant predictors of decreased laser success. Calcium within the lesion was associated with reduced procedural success (OR = 0.57 [95% confidence interval 0.34, 0.97], P = .03), and calcified lesions required significantly more energy pulses than noncalcified lesions (119 +/- 91 pulses vs. 101 +/- 86 pulses, respectively, P = .0002). Complications included in-hospital bypass surgery 2.5%, Q-wave myocardial infarction 1.2%, and death 0.8%. Perforation occurred in 2.2% of patients; major dissection in 5.8% of patients, and spasm in 12% of patients. No predictor of major complications was identified. Six

The Relationship Between Neutrophil–Lymphocyte Ratio and Primary Patency of Percutaneous Transluminal Angioplasty in Hemodialysis Arteriovenous Fistula Stenosis When Using Conventional and Drug-Eluting Balloons

DOE Office of Scientific and Technical Information (OSTI.GOV)

Çildağ, Mehmet Burak, E-mail: mbcildag@yahoo.com; Çildağ, Songül, E-mail: songulcildag@yahoo.com; Köseoğlu, Ömer Faruk Kutsi, E-mail: kutsikoseoglu@yahoo.com

ObjectiveThe aim of this study is to investigate the potential association of neutrophil–lymphocyte ratio (NLR) between primary patency of percutaneous transluminal angioplasty (PTA) in hemodialysis arteriovenous fistula stenosis and type (Conventional and Drug-Eluting) of balloons used in PTA.Material-MethodThis retrospective study consists of 78 patients with significant arteriovenous fistulas stenosis who were treated with PTA by using Drug-Eluting Balloon (DEB) (n = 29) or Conventional Balloon (CB) (n = 49). NLR was calculated from preinterventional blood samples. All patients were classified into two groups. Group A; primary patency <12 months (43/78), Group B; primary patency ≥12 months (35/78). Cox regression analysis and Kaplan–Meier method were used to determine respectivelymore » independent factors affecting the primary patency and to compare the primary patency for the two balloon types.ResultsNLR ratio and balloon type of the two groups were significantly different (p = 0.002, p = 0.010). The cut-off value of NLR was 3.18 for determination of primary patency, with sensitivity of 81.4 % and specificity of 51.4 %. Primary patency rates between PTA with DEB and CB displayed statistically significant differences (p < 0.05). The cut-off value was 3.28 for determination of 12-month primary patency with the conventional balloon group; sensitivity was 81.8 % and specificity was 81.3 %. There was no statistical relation between NLR levels and the drug-eluting balloon group in 12-month primary patency (p = 0.927).ConclusionIncreased level of NLR may be a risk factor in the development of early AVF restenosis after successful PTA. Preferring Drug-Eluting Balloon at an increased level of NLR can be beneficial to prolong patency.« less

Peripheral laser assisted angioplasty: results, complications and follow-up.

PubMed

Owen, E R; Moussa, S A; Lewis, J D; Wilkins, R A

1990-04-01

Detailed results including complications and ultimate outcome of 24 laser assisted angioplasties in 22 patients are presented. Despite the enthusiasm expressed in other published reports, we remain sceptical of the value of laser using a 1.5 mm 'hot-tip' probe for assisting angioplasty of peripheral occlusions. The tendency for this type of probe to damage the vessel wall and in so doing prohibit the use of subsequent balloon dilatation is a major problem. In this small series the long-term patency was not improved compared with conventional angioplasty. We have established the relative safety of this laser technique and further advances in probe design may lead to greater success in crossing long lesions. Long-term maintenance of patency in these diseased arteries will need further advances in technique and assessment preferably by a controlled trial.

[Coronary angioplasty simultaneous with the "kissing" technique in a bifurcation lesion: use of a guidewire, and 2 monorail systems of rapid interchange].

PubMed

Escudero, X

1996-01-01

Coronary branch occlusion complicating percutaneous coronary angioplasty has been recognized in certain bifurcation lesions. The utilization of double angioplasty systems simultaneously has been called "kissing" because the image of contact between balloons, and has been utilized as an alternative to protect the jeopardized branch or prevent snowplow lesion of the principal artery. The technological advance with the use of wide lumen catheters and low profile dilation balloons make the application of this technique possible in those type of lesions using a single guiding catheter. The present paper describes one case treated with this technique using conventional angioplasty systems in a complex bifurcating lesion of the circumflex artery. Some technical considerations about the procedure are made.

Percutaneous Angioplasty of Portal Vein Stenosis that Complicates Liver Transplantation: The Mid-Term Therapeutic Results

PubMed Central

Park, Kwang Bo; Do, Young Soo; Shin, Sung Wook; Cho, Sung Gi; Choo, In-Wook

2005-01-01

Objective We wanted to valuate the mid-term therapeutic results of percutaneous transhepatic balloon angioplasty for portal vein stenosis after liver transplantation. Materials and Methods From May 1996 to Feb 2005, 420 patients underwent liver transplantation. Percutaneous transhepatic angioplasty of the portal vein was attempted in six patients. The patients presented with the clinical signs and symptoms of portal venous hypertension or they were identified by surveillance doppler ultrasonography. The preangioplasty and postangioplasty pressure gradients were recorded. The therapeutic results were monitored by the follow up of the clinical symptoms, the laboratory values, CT and ultrasonography. Results The overall technical success rate was 100%. The clinical success rate was 83% (5/6). A total of eight sessions of balloon angioplasty were performed in six patients. The mean pressure gradient decreased from 14.5 mmHg to 2.8 mmHg before and after treatment, respectively. The follow up periods ranged from three months to 64 months (mean period; 32 months). Portal venous patency was maintained in all six patients until the final follow up. Combined hepatic venous stenosis was seen in one patient who was treated with stent placement. One patient showed puncture tract bleeding, and this patient was treated with coil embolization of the right portal puncture tract via the left transhepatic portal venous approach. Conclusion Percutaneous transhepatic balloon angioplasty is an effective treatment for the portal vein stenosis that occurs after liver transplantation, and our results showed good mid-term patency with using this technique. PMID:16145291

Randomized Comparison of Paclitaxel-Eluting Balloon and Stenting Versus Plain Balloon Plus Stenting Versus Directional Atherectomy for Femoral Artery Disease (ISAR-STATH).

PubMed

Ott, Ilka; Cassese, Salvatore; Groha, Philipp; Steppich, Birgit; Hadamitzky, Martin; Ibrahim, Tareq; Kufner, Sebastian; Dewitz, Karl; Hiendlmayer, Regina; Laugwitz, Karl-Ludwig; Schunkert, Heribert; Kastrati, Adnan; Fusaro, Massimiliano

2017-06-06

Atherosclerosis in the superficial femoral artery is common in patients suffering from peripheral artery disease. Paclitaxel-eluting balloon (PEB) angioplasty, stenting, and directional atherectomy (DA) have provided new options for the treatment of superficial femoral artery disease; however, the comparative efficacy of these interventional strategies remains uncertain. One hundred and fifty-five patients with symptomatic peripheral artery disease due to de novo superficial femoral artery stenotic or occlusive lesions were randomized to treatment with plain balloon angioplasty (BA) followed by PEB angioplasty and stenting (n=48), BA and stenting (n=52), or DA with distal protection and bailout stenting (n=55). The primary end point of the study was percentage diameter stenosis after 6 months measured by angiography. Other end points included target lesion revascularization, thrombosis, ipsilateral amputation, binary restenosis, and all-cause mortality at 6 and 24 months. Baseline and lesion characteristics were comparable in all groups with a mean lesion length of 65.9±46.8 mm and 56% total occlusions. At 6 months angiography, the percent diameter stenosis was significantly lower in patients treated by PEB angioplasty and stenting (34±31%) as compared with BA angioplasty and stenting (56±29%, P =0.009) or DA (55±29%, P =0.007). Similarly, binary restenosis was significantly lower after treatment with PEB and stenting as compared with BA and stenting or DA. Clinical follow-up at 24 months revealed a lower risk for target lesion revascularization after PEB angioplasty and stenting as compared with BA and stenting or DA. We found no difference in terms of target lesion thrombosis and mortality among groups, and no patient underwent amputation. Treatment of de novo superficial femoral artery lesions with PEB angioplasty and stenting is superior to BA angioplasty and stenting or DA in terms of angiographic diameter stenosis at 6 months and target lesion

Recanalisation of Chronically Occluded Remote Superficial Femoral Artery Endarterectomy Through Angioplasty for Limb Salvage

DOE Office of Scientific and Technical Information (OSTI.GOV)

Husainy, Mohammad Ali, E-mail: m.husainy@nhs.net; Slim, Hani; Rashid, Hisham

2017-02-15

We report a novel application of balloon angioplasty to recanalise a chronically occluded remote endarterectomy superficial femoral artery. This patient previously had two occluded surgical bypass grafts in an attempt to revascularise the limb and presented with critical limb ischaemia and necrotic foot ulcerations. Following the angioplasty, the patient showed significant improvement in rest pain and healing of the ulcerations. This technique may be useful for limb salvage in patients where surgical options have been exhausted.

Properties of nylon 12 balloons after thermal and liquid carbon dioxide treatments.

PubMed

Ro, Andrew J; Davé, Vipul

2013-03-01

Critical design attributes of angioplasty balloons include the following: tear resistance, high burst pressures, controlled compliance, and high fatigue. Balloons must have tear resistance and high burst pressures because a calcified stenosis can be hard and nominal pressures of up to 16 atm can be used to expand the balloon. The inflated balloon diameter must be a function of the inflation pressure, thus compliance is predictable and controlled. Reliable compliance is necessary to prevent damage to vessel walls, which may be caused by over-inflation. Balloons are often inflated multiple times in a clinical setting and they must be highly resistant to fatigue. These design attributes are dependent on the mechanical properties and polymer morphology of the balloon. The effects of residual stresses on shrinkage, crystallite orientation, balloon compliance, and mechanical properties were studied for angioplasty nylon 12 balloons. Residual stresses of these balloons were relieved by oven heat treatment and liquid CO2 exposure. Residual stresses were measured by quantifying shrinkage at 80 °C of excised balloon samples using a dynamic mechanical analyzer. Shrinkage was lower after oven heat treatment and liquid CO2 exposure compared to the as-received balloons, in the axial and radial directions. As-received, oven heat treated, and liquid CO2-exposed balloon samples exhibited similar thermal properties (T(g), T(m), X(t)). Crystallite orientation was not observed in the balloon cylindrical body using X-ray scattering and polarized light microscopy, which may be due to balloon fabrication conditions. Significant differences were not observed between the stress-strain curves, balloon compliance, and average burst pressures of the as-received, oven heat treated, and liquid CO2-exposed balloons. Copyright © 2012 Elsevier B.V. All rights reserved.

Restoration of Failed Renal Graft Function After Successful Angioplasty of Pressure-Resistant Renal Artery Stenosis Using a Cutting Balloon: A Case Report

DOE Office of Scientific and Technical Information (OSTI.GOV)

Peregrin, J. H., E-mail: jape@medicon.c; Buergelova, M.

2009-05-15

This study is the report of a 37-year-old male with a transplanted kidney from a 3.5-year-old donor: the graft had two arteries transplanted with an aortic patch to an external iliac artery. Four months after transplantation, the graft function deteriorated, together with the development of hypertension. Stenosis of both graft arteries was detected and the patient was referred for angioplasty. The angiographic result was suboptimal, nevertheless, the graft function improved and was more or less stable (serum creatinine, 160-200 {mu}mol/l) for 4 years, along with persistently difficult-to-control hypertension. Five years after transplantation, the graft function deteriorated again and severe graftmore » artery restenosis was detected. The restenosis did not respond to dilatation, graft function failed, hypertension decompensated, and left ventricular failure developed. The patient required dialysis. A cutting balloon angioplasty opened the artery, and kidney function was restored after a few days: the serum creatinine level dropped to 140-160 {mu}mol/l, and the glomerular filtration rate (creatinine clearance) to 0.65 ml/min/1.73 m{sup 2}. The graft function has now been stable for more than 2 years, however, the hypertension is still difficult to control.« less

Evaluation of a Dedicated Balloon Catheter for Infrapopliteal Difficult Calcified Lesions in Diabetic Patients With Critical Limb Ischemia

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lupattelli, Tommaso, E-mail: tommasolupattelli@hotmail.com

2011-02-15

The purpose of this study was to assess the technical performance and immediate procedural outcome of a new balloon catheter in the treatment of calcified lesions in infrapopliteal arterial disease. Sixty-one patients (81 vessels) with infrapopliteal arterial disease were evaluated. Seventy-four of the 81 treated vessels had total occlusions. The ReeKross 18 peripheral transluminal angioplasty catheter (ClearStream, Wexford, Ireland) is an 0.018-inch guidewire system with 4F sheath compatibility and a rigid shaft intended for enhanced pushability. Only technical procedural outcomes were recorded. In 37 of 61 patients (50 infrapopliteal severely stenosed or occluded vessels), an attempt with a standard balloonmore » was made before the ReeKross 18 was used. In 24 patients, the ReeKross 18 was used as the primary catheter in 23 cases involving crural arteries and in 8 cases involving the foot. The ReeKross 18 crossed the lesion in 55 of 59 (93.2%) patients and 72 of 77 (94.5%) vessels, respectively. Postdilatation results for the 51 patients (64 target lesions) in whom ReeKross 18 balloon dilation was achieved showed <30% residual stenosis in all but 4 patients (5 lesions). Of the patients treated with the ReeKross 18 as the primary catheter, the technical success rate (no adjunctive treatment/stent) was obtained in 20 of 24 (83.3%) patients (27 of 31 [87.1%] target lesions). In the treatment of difficult calcified lesions, the choice of a high-pushability angioplasty catheter, such as the ReeKross 18, warrants consideration.« less

Changing the strategy of balloon pulmonary angioplasty resulted in a reduced complication rate in patients with chronic thromboembolic pulmonary hypertension. A single-centre European experience.

PubMed

Kurzyna, Marcin; Darocha, Szymon; Pietura, Radosław; Pietrasik, Arkadiusz; Norwa, Justyna; Mańczak, Rafał; Wieteska, Maria; Biederman, Andrzej; Matsubara, Hiromi; Torbicki, Adam

2017-01-01

To assess the safety and efficacy of a refined balloon pulmonary angioplasty (BPA) strategy in patients with chronic thromboembolic pulmonary hypertension (CTEPH). There were 157 BPA sessions performed in 56 CTEPH patients (47 non-operable, nine after pulmonary endarterectomy; aged 58.6 ± 17.9 years; 28 females) with severely impaired pulmonary haemodynamics (mean pulmonary artery pressure [mPAP]: 51.3 ± 12.2 mm Hg, pulmonary vascular resistance [PVR]: 10.1 ± 3.9 Wood Units). The first 50 sessions aimed to recanalise chronic occlusions and prevent reocclusion with aggressive anticoagulation. The next 107 sessions aimed to relieve "web" and "ring" lesions using reduced tip load guidewires and less intensive anticoagulation. There was significant reduction in haemoptysis (22% vs. 7%, p = 0.01), vessel injury (30% vs. 13%, p = 0.01), and reperfusion pulmonary injuries (22% vs. 4%, p = 0.01) after changing the BPA strategy. Mortality at 14 days was also reduced (6% vs. 0%; p = 0.05). The cumulative survival rate was 94.6% at 24 months after the first BPA, which was more favourable than medically treated historic controls. In the 31 patients with > 3 BPA sessions, there was significant reduction of PVR (10.3 ± 3.7 vs. 5.9 ± 2.8 Wood Units; p = 0.01), mPAP (50.7 ± 10.8 vs. 35.6 ± 9.3 mm Hg; p = 0.01) and improvement in World Health Organisation functional class (3.19 ± 0.48 vs. 1.97 ± 0.80; p < 0.001). Balloon pulmonary angioplasty improves haemodynamics and outcome but requires refined strategy to limit early complication rate.

Laser welding of balloon catheters

NASA Astrophysics Data System (ADS)

Flanagan, Aidan J.

2003-03-01

The balloon catheter is one of the principal instruments of non-invasive vascular surgery. It is used most commonly for angioplasty (and in recent years for delivering stents) at a multitude of different sites in the body from small arteries in the heart to the bilary duct. It is composed of a polymer balloon that is attached to a polymer shaft at two points called the distal and proximal bonds. The diverse utility of balloon catheters means a large range of component sizes and materials are used during production; this leads to a complexity of bonding methods and technology. The proximal and distal bonds have been conventionally made using cyanoacrylate or UV curing glue, however with performance requirements of bond strength, flexibility, profile, and manufacturing costs these bonds are increasingly being made by welding using laser, RF, and Hot Jaw methods. This paper describes laser welding of distal and proximal balloon bonds and details beam delivery, bonding mechanisms, bond shaping, laser types, and wavelength choice.

The added benefits and efficacy of atherectomy in the lower limb.

PubMed

VAN DEN Berg, Jos C

2016-08-01

Atherectomy has been used as an adjunct therapy for balloon angioplasty and/or stent placement in the superficial femoral artery for many years, but has never gained global popularity in the treatment of peripheral arterial disease, most probably related to the conflicting results as published in the literature. Novel techniques that have been developed over the past years are yielding promising results in the infrainguinal region. This paper will describe the added benefits of atherectomy as compared to plain old balloon angioplasty and bail-out bare-metal stenting, both in the treatment of primary lesions of the superficial femoral artery as well as in cases of in-stent restenosis.

Below-the-ankle Angioplasty and Stenting for Limb Salvage: Anatomical Considerations and Long-term Outcomes

DOE Office of Scientific and Technical Information (OSTI.GOV)

Katsanos, Konstantinos, E-mail: katsanos@med.upatras.gr; Diamantopoulos, Athanasios; Spiliopoulos, Stavros

2013-08-01

PurposeTo report the long-term angiographic and clinical results in a series of below-the-ankle (BTA) angioplasty procedures and to present some biomechanical issues related to the unique anatomical geometry of the ankle.MethodsWe performed a retrospective analysis of BTA angioplasty procedures. Clinical end points included technical success, patient mortality, salvage of the treated foot, and repeat target lesion revascularization. Imaging end points included primary patency, binary restenosis of the target lesion at the 50 % threshold, and stent integrity (stent fracture, deformation, or collapse). Univariate subgroup analysis was performed.ResultsIn total, 40 limbs in 37 patients (age 73.5 {+-} 8.2 years) with criticalmore » limb ischemia were included and 42 inframalleolar lesions (4.2 {+-} 1.4 cm) were analyzed. Technical success was achieved in 95.2 % (40 of 42). Provisional stent placement was performed in 45.2 % (19 of 42). Two patients died, and two major amputations occurred up to 3 years. At 1 year, overall primary vessel patency was 50.4 {+-} 9.1 %, lesion binary restenosis rate was 64.1 {+-} 8.3 %, and repeat intervention-free survival was 93.6 {+-} 4.3 % according to life table analysis of all treated lesions. Pairwise subgroup analysis showed that BTA self-expanding stents were associated with significantly higher restenosis and poorer primary patency compared to plain balloon angioplasty or sirolimus-eluting balloon-expandable stents. Significant deformation and/or fracture of balloon-expandable stents placed BTA were identified in five of 11. Dynamic imaging showed that the dorsalis pedis artery is kinked during foot dorsiflexion, whereas the distal posterior tibial artery is kinked during plantar flexion of the foot.ConclusionBTA angioplasty for critical limb ischemia treatment is safe and feasible with satisfactory long-term results. BTA stent placement must be reserved for bailout indications.« less

Fracture, inflation and floatation embolisation of PTCA balloon.

PubMed

O'Neill, Louisa; Sowbhaga, Vinay; Owens, Patrick

2015-01-09

This case outlines an unusual complication of coronary intervention, the likely mechanisms leading to this and possible retrieval options. It is the first case to the best of our knowledge reporting this complication. A 78-year-old Caucasian man underwent coronary stenting. During the procedure kinking and subsequent fracture of a non-compliant percutaneous transluminal coronary angioplasty (PTCA) balloon occurred. Injection of contrast down the guide to opacify the coronary arteries resulted in 'inflation' of the balloon with air, and embolisation of the inflated balloon into the proximal left anterior descending artery. The embolised balloon was retrieved by removal of the guide catheter and wire as a unit. The patient had a good angiographic outcome. This case highlights risks associated with usage of kinked balloons catheters, and describes for the first time to our knowledge, the inflation of a PTCA balloon with air from its shaft within the catheter, causing 'floatation' embolisation into the coronary artery. 2015 BMJ Publishing Group Ltd.

Fracture, inflation and floatation embolisation of PTCA balloon

PubMed Central

O'Neill, Louisa; Sowbhaga, Vinay; Owens, Patrick

2015-01-01

This case outlines an unusual complication of coronary intervention, the likely mechanisms leading to this and possible retrieval options. It is the first case to the best of our knowledge reporting this complication. A 78-year-old Caucasian man underwent coronary stenting. During the procedure kinking and subsequent fracture of a non-compliant percutaneous transluminal coronary angioplasty (PTCA) balloon occurred. Injection of contrast down the guide to opacify the coronary arteries resulted in ‘inflation’ of the balloon with air, and embolisation of the inflated balloon into the proximal left anterior descending artery. The embolised balloon was retrieved by removal of the guide catheter and wire as a unit. The patient had a good angiographic outcome. This case highlights risks associated with usage of kinked balloons catheters, and describes for the first time to our knowledge, the inflation of a PTCA balloon with air from its shaft within the catheter, causing ‘floatation’ embolisation into the coronary artery. PMID:25576524

Systemic Embolic Complications of Pulmonary Vein Angioplasty in Children.

PubMed

Esch, Jesse J; Porras, Diego; Bergersen, Lisa; Jenkins, Kathy J; Marshall, Audrey C

2015-10-01

Pulmonary vein stenosis (PVS) carries significant morbidity and mortality for affected children, and its management often requires multiple angioplasty procedures. PVS angioplasty can be complicated by systemic embolic events such as stroke, but incidence and risk factors are poorly understood. We reviewed pediatric catheterizations involving PVS angioplasty and/or stent placement performed at Boston Children's Hospital between July 2005 and February 2014. A total of 406 cases were performed in 144 distinct patients. Patients underwent a median of two catheterizations, at median age 1 year and weight 6.9 kg. Eleven (2.7 %) catheterizations were complicated by clinically apparent systemic embolic events, comprising 10 strokes (one with associated hepatic embolism) and 1 renal infarct. Prevalence of clinically evident stroke among this cohort was 7.6 %. Using a prior (uncomplicated) catheterization to allow each patient to serve as their own control, we sought to identify potentially modifiable risk factors for systemic embolic events. Although this analysis was limited by low power, complicated and uncomplicated angioplasties did not appear to differ in case time, contrast dose, anticoagulation management, use of cutting balloons, number of catheter exchanges, or size of long sheath used. Significant non-embolic adverse events were common, occurring in 25 % of catheterizations. Systemic embolism appears to complicate PVS angioplasty at a rate much higher than that described for other congenital catheterizations. This risk may be inherent to the procedure rather than related to any modifiable or operator-dependent factors.

Endovascular Management of the Popliteal Artery: Comparison of Atherectomy and Angioplasty

PubMed Central

Semaan, Elie; Hamburg, Naomi; Nasr, Wael; Shaw, Palma; Eberhardt, Robert; Woodson, Jonathan; Doros, Gheorghe; Rybin, Denis; Farber, Alik

2013-01-01

Purpose Symptomatic atherosclerotic disease of the popliteal artery presents challenges for endovascular therapy. We evaluated the technical success, complications and midterm outcomes of atherectomy and angioplasty involving the popliteal segment. Methods We conducted a retrospective review of outcomes of popliteal artery intervention using atherectomy or angioplasty performed between 2003 and 2008. Results A total of 56 patients (36% women, age 72.8±12.2 years, 77% critical limb ischemia) underwent popliteal atherectomy (n=18) or angioplasty (n=38). These patients had similar clinical characteristics, TASC/TASC II classification, mean lesion length, and run-off scores. We observed a trend toward higher rates of technical success defined as <30% residual stenosis after atherectomy compared to angioplasty (94% vs. 71%, p=0.08). While angioplasty was associated with a higher frequency of arterial dissection (23% vs. 0%, p=0.003), atherectomy was associated with a higher rate of thromboembolic events (22% vs 0%, p=0.01). Adjunctive stenting was used more frequently following angioplasty compared to atherectomy (45% vs. 6%, p=0.005). Thrombolysis was used to treat embolization in 4 patients in the atherectomy group. The improvement in the ankle-brachial index was similar between the two treatment groups. Primary patency of the popliteal artery at 3, 6, and 12 months was 94%, 88%, and 75% in the atherectomy group and 89%, 82%, and 73% in the angioplasty group (p=NS). There were no significant differences in limb salvage and freedom from reintervention at 1 year between the atherectomy and angioplasty groups. Conclusions Our experience with popliteal artery endovascular therapy indicates a distinct pattern of procedural complications with atherectomy compared to angioplasty but similar midterm patency, limb salvage and freedom from intervention. PMID:19942598

Stent placement vs. balloon angioplasty for popliteal artery treatment: two-year results of a prospective, multicenter, randomized trial.

PubMed

Rastan, Aljoscha; Krankenberg, Hans; Baumgartner, Iris; Blessing, Erwin; Müller-Hülsbeck, Stefan; Pilger, Ernst; Scheinert, Dierk; Lammer, Johannes; Beschorner, Ulrich; Noory, Elias; Neumann, Franz-Josef; Zeller, Thomas

2015-02-01

To investigate the 2-year technical and clinical results of primary nitinol stent placement in comparison with percutaneous transluminal angioplasty (PTA) in the treatment of de novo lesions of the popliteal artery. The ETAP study (Endovascular Treatment of Atherosclerotic Popliteal Artery Lesions: balloon angioplasty vs. primary stenting; www.ClinicalTrials.gov identifier NCT00712309) is a prospective, randomized trial that enrolled 246 patients (158 men; mean age 72 years) who were randomly assigned to receive a nitinol stent (n=119) or PTA (n=127) for lesions averaging 42.3 mm in length. The results of the primary study endpoint were published. Secondary outcome measures and endpoints included primary patency (freedom from duplex-detected target lesion restenosis), target lesion revascularization (TLR), secondary patency, changes in ankle-brachial index and Rutherford class, and event-free survival (freedom from target limb amputation, TLR, myocardial infarction, and death). In total, 183 patients (89 stent and 94 PTA) were available for the 2-year analysis. The primary patency rate was significantly higher in the stent group (64.2%) than in the PTA group (31.3%, p=0.0001). TLR rates were 22.4% and 59.5%, respectively (p=0.0001). When provisional stent placement in the PTA arm was not considered as TLR and loss in patency, the differences prevailed between the study groups but were not significant (64.2% vs. 56.1% for primary patency, respectively; p=0.44). A significant improvement in ABI and Rutherford category was observed at 2 years in both groups. In treatment of obstructive popliteal artery lesions, provisional stenting reveals equivalent patency in comparison to primary stenting. However, the 2-year results of this trial suggest the possibility of a shift toward higher patency rates in favor of primary stenting. © The Author(s) 2015.

Endovascular Stenting for Restenosis of the Intracranial Vertebrobasilar Artery After Balloon Angioplasty: Two Case Reports and Review of the Literature

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kiyosue, Hiro, E-mail: hkiyosue@oita-med.ac.jp; Okahara, Mika; Yamashita, Masanori

Percutaneous transluminal balloon angioplasty (PTA) has been used in the treatment of critical stenosis of the intracranial vertebrobasilar artery (VBA). PTA of the intracranial VBA carries the risk of fatal complications such as arterial dissection or acute occlusion as well as postoperative restenosis. The estimated risk of periprocedural complications and restenosis were approximately 20% and 27%. The use of recently developed stents could prevent these problems of PTA. We present two cases of restenosis of the intracranial VBA after PTA which stenoses were successfully retreated with endovascular stenting using flexible coronary stents without any complications. Neither restenosis nor other recurrentmore » symptoms were observed during the 4- and 6-month follow-up period. Reviewing the literature of 33 cases and our 2 cases, the overall complication rates related to stenting and restenosis were 5.6% and 7.8%. Endovascular stenting for the treatment of intracranial VBA can reduce the risk of arterial dissection and restenosis.« less

Short term results of percutaneous transluminal coronary angioplasty with the monorail technique: experience in the first 1000 patients.

PubMed

de Feyter, P J; Serruys, P W; van den Brand, M; Suryapranata, H; Beatt, K

1990-04-01

The monorail technique allows monitoring of all steps of the coronary angioplasty procedure by high quality coronary angiography; easy, rapid, and safe recrossing and redilatation of the lesion if necessary; and stepwise dilatation of a stenosis with sequential increase of size of balloons. Transstenotic pressure differences cannot, however, be measured through the narrow shaft of the standard monorail balloon catheter. The monorail technique was used in 1014 patients (820 men, 194 women; mean age 57.8 years (range 24 to 84]. The indication for coronary angioplasty was stable angina in 52%, unstable angina in 40%, and acute myocardial infarction in 8%. Single vessel coronary angioplasty was attempted in 78%, multilesion coronary angioplasty in 11%, and multivessel coronary angioplasty in 11%. Angiographic success (reduction of stenosis to less than 50% of the luminal diameter) of all attempted lesions was achieved in 93%. The technique was clinically successful--that is, angiographic success of all attempted lesions, no occurrence of a major complication (death, myocardial infarction, acute bypass surgery), and improvement of symptoms--in 92% and partially successful in 1.3%. The clinical success rates were similar for stable angina (91%) and unstable angina (94%), but were somewhat lower for acute myocardial infarction (88%). Failure without major complication occurred in 3.4% of the patients. Failure with a major complication occurred in 3.3% (death 0.3%, myocardial infarction 2.4%, and acute bypass surgery 2.3%). The total major complication rate was higher in unstable angina (4.2%) than in stable angina (3.0%). These results indicate that the monorail technique can be applied safely and effectively for coronary angioplasty of patients with stable angina, unstable angina, and acute myocardial infarction.

Adjunctive stent use during endovascular intervention to the femoropopliteal artery with drug coated balloons: Insights from the XLPAD registry.

PubMed

Kokkinidis, Damianos G; Jeon-Slaughter, Haekyung; Khalili, Houman; Brilakis, Emmanouil S; Shammas, Nicolas W; Banerjee, Subhash; Armstrong, Ehrin J

2018-06-01

With growing use of drug-coated balloons (DCB) for femoropopliteal (FP) artery interventions, there is limited information on rates of real-world adjunctive stent use and its association with short and long-term outcomes. We report on 225 DCB treated FP lesions in 224 patients from the Excellence in Peripheral Artery Disease (XLPAD) registry (NCT01904851) between 2014 and 2016. Cochran-Mantel-Haenszel and Wilcoxon rank sum statistics were used to compare stented (planned or 'bail-out') versus non-stented DCB treated lesions. Stents were implanted in 31% of FP DCB interventions. Among the 70 stents implanted, 46% were for 'bail-out' indications and 54% were planned. Lesions treated with stents were longer (mean 150 mm vs 100 mm; p < 0.001) and less likely to be in-stent restenosis lesions (10% vs 28%; p=0.003). Stenting was significantly more frequent in complex FP lesions, including chronic total occlusions (66% vs 34%; p < 0.001). For bail-out stenting, interwoven nitinol stents were the most common type (50%) followed by drug-eluting stents (34%) and bare-metal stents (22%). There were no differences in peri-procedural complication rates or 12-month target limb revascularization rates (18.6% vs 11.6%; p=0.162) or 12-month amputation rates (11.4% vs 11%; p=0.92) between lesions where adjunctive stenting was used versus lesions without adjunctive stenting, respectively. In conclusion, in a contemporary 'real-world' adjudicated multicenter US registry, adjunctive stenting was necessary in nearly a third of the lesions, primarily for the treatment of more complex FP lesions, with similar short and intermediate-term clinical outcomes compared with non-stented lesions.

High-grade, non-flow-limiting dissections do not negatively impact long-term outcome after paclitaxel-coated balloon angioplasty: an additional analysis from the THUNDER study.

PubMed

Tepe, Gunnar; Zeller, Thomas; Schnorr, Beatrix; Claussen, Claus D; Beschorner, Ulrich; Brechtel, Klaus; Scheller, Bruno; Speck, Ulrich

2013-12-01

To investigate the impact of using paclitaxel-coated balloons (PCB) on outcome after post-angioplasty dissection in femoropopliteal arteries. The angiograms obtained in the THUNDER study (ClinicalTrials.gov identifier NCT00156624) were analyzed to compare degrees of dissection and angiographic parameters between the control (uncoated balloons, n=43) and treatment (PCBs, n=43) groups before and after the intervention and at 6-month follow-up. Furthermore, target lesion revascularizations (TLR) were documented up to 2 years. In each group, 24 (56%) patients had a dissection after the intervention. At the 6-month follow-up, patients with dissection of any grade after treatment with PCBs had significantly less late lumen loss (0.4 mm) than patients with dissection after treatment with uncoated balloons (1.9 mm, p=0.001) and a lower degree of stenosis (20% vs. 51%, respectively; p=0.003). Patients with severe dissection (grades C, D, or E) especially seemed to benefit from the PCBs, with late lumen loss of 0.4 mm vs. 2.4 mm for controls (p=0.05). The binary restenosis rate was also markedly lower in the PCB group (20%) than in the uncoated group (55%, p=0.02). In the 2-year follow-up, TLR was performed in 56% of patients in the control group compared to 10% of patients in the PCB group (p=0.002). The results of this subgroup analysis suggest that patients with dissection following treatment with a paclitaxel-coated balloon have a very acceptable outcome and stent implantation is not necessary as long as the dissection does not result in acute flow limitation.

Differences in optical coherence tomographic findings and clinical outcomes between excimer laser and cutting balloon angioplasty for focal in-stent restenosis lesions.

PubMed

Nishino, Masami; Lee, Yasuharu; Nakamura, Daisuke; Yoshimura, Takahiro; Taniike, Masayuki; Makino, Nobuhiko; Kato, Hiroyasu; Egami, Yasuyuki; Shutta, Ryu; Tanouchi, Jun; Yamada, Yoshio

2012-10-01

In-stent restenosis (ISR), especially focal ISR, after percutaneous coronary intervention (PCI) remains one of the major clinical problems in the drug-eluting stent (DES) era. Several reports have revealed that excimer laser coronary angioplasty (ELCA) is useful for ISR; however, detailed findings after ELCA are unknown. Therefore, we investigated the condition of the neointima after ELCA for ISR with optical coherence tomography (OCT) and compared the OCT findings and clinical outcome between ELCA and cutting-balloon angioplasty (CBA). Twenty-one consecutive patients with focal ISR who underwent ELCA or CBA were enrolled. All patients underwent 12- to 15-month follow-up coronary angiography. OCT was performed immediately after successful PCI to evaluate the neointimal condition in the ISR lesion. We compared the following OCT parameters between ELCA and CBA groups: maximal thickness of remaining in-stent neointima (MTN), number of tears, minimum lumen dimension (MLD), and minimum lumen area (MLA). We also evaluated clinical outcomes, including target vessel revascularization, acute myocardial infarction, death, and stent thrombosis. MLA in the ELCA group (n = 10) was significantly larger than in the CBA group, and number of tears in the ELCA group was significantly lower than in the CBA group. A trend was shown toward lower TLR with ELCA versus CBA (10.0% vs 45.5%). OCT immediately after ELCA for ISR lesions revealed larger lumen area and smaller number of tears compared with CBA, which may support favorable effects of ELCA for focal ISR.

The efficacy and safety of drug-eluting balloons for the treatment of in-stent restenosis as compared with drug-eluting stents and with conventional balloon angioplasty

PubMed Central

Oh, Pyung Chun; Suh, Soon Yong; Kang, Woong Chol; Lee, Kyounghoon; Han, Seung Hwan; Ahn, Taehoon; Shin, Eak Kyun

2016-01-01

Background/Aims: Treatment of coronary in-stent restenosis (ISR) is still associated with a high incidence of recurrence. We aimed to compare the efficacy and safety of drug-eluting balloons (DEB) for the treatment of ISR as compared with conventional balloon angioplasty (BA) and drug-eluting stents (DES). Methods: Between January 2006 and May 2012 a total of 177 patients (188 lesions, 64.1 ± 11.7 years old) who underwent percutaneous coronary intervention for ISR were retrospectively enrolled. Clinical outcomes were compared between patients treated with DEB (n = 58, 32.8%), conventional BA (n = 65, 36.7%), or DES (n = 54, 30.5%). The primary end point was a major adverse cardiac event (MACE), defined as a composite of cardiac death, myocardial infarction, and target lesion revascularization(TLR). Results: Baseline characteristics were not different except for a history of previous MI, which was more frequent in patients treated by conventional BA or DES than in patients treated by DEB (40.0% vs. 48.1% vs. 17.2%, respectively, p = 0.002). The total incidences of MACEs were 10.7%, 7.4%, and 15.4% in patients treated by DEB, DES, or conventional BA, respectively (p > 0.05). TLR was more frequent in patients treated by conventional BA than in patients treated by DEB or DES, but this was not statistically significant (10.8% vs. 6.9% vs. 3.7%, p > 0.05 between all group pairs, respectively). Conclusions: This study showed that percutaneous coronary intervention using DEB might be a feasible alternative to conventional BA or DES implantation for treatment of coronary ISR. Further large-scaled, randomized study assessing long-term clinical and angiographic outcomes will be needed. PMID:26951915

Limb-shaking transient ischemic attack masquerading as lumbar radiculopathy from pericallosal artery stenosis treated successfully with intracranial angioplasty and stenting.

PubMed

Kalia, Junaid; Wolfe, Thomas; Zaidat, Osama O

2010-03-01

The pericallosal artery is rarely associated with intracranial atherosclerotic disease and, until recently, was usually not amenable to endovascular therapy with balloon angioplasty and stenting. We present an elderly patient with postural left leg-shaking episodes secondary to pericallosal artery stenosis, which was treated initially with primary intracranial balloon angioplasty, and subsequently, angioplasty and stenting as a result of recurrent stenosis. Both procedures were preformed without complications, and the patient remained free of symptoms on 6-month follow-up. This case demonstrates unique clinical and neuroendovascular aspects; the isolated postural leg-shaking transient ischemic attacks, initially mistaken for radiculopathy and local joint etiology, were found later to be cerebrovascular ischemic in origin. Moreover, the correlation between the findings of computed tomography perfusion and angiography localized the lesion into the medial frontal lobe and pericallosal artery territory. In addition, the technical aspect provides insight into the current state of neuroendovascular techniques, addressing the difficulty of access into very small and distal intracranial arteries affected by stenosis. Copyright 2010 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Economic appraisal of the angioplasty procedures performed in 2004 in a high-volume diagnostic and interventional cardiology unit.

PubMed

Manari, Antonio; Costa, Elena; Scivales, Alessandro; Ponzi, Patrizia; Di Stasi, Francesca; Guiducci, Vincenzo; Pignatelli, Gianluca; Giacometti, Paola

2007-10-01

Growing interest in the use of drug-eluting stents (DESs) in coronary angioplasty has prompted the Healthcare Agency of the Emilia Romagna Region to draw up recommendations for their appropriate clinical use in high-risk patients. Since the adoption of any new technology necessitates economic appraisal, we analysed the resource consumption of the various types of angioplasty procedures and the impact on the budget of a cardiology department. A retrospective economic appraisal was carried out on the coronary angioplasty procedures performed in 2004 in the Department of Interventional Cardiology of Reggio Emilia. On the basis of the principles of activity-based costing, detailed hospital costs were estimated for each procedure and compared with the relevant diagnosis-related group (DRG) reimbursement. In 2004, the Reggio Emilia hospital performed 806 angioplasty procedures for a total expenditure of euro 5,176,268. These were 93 plain old balloon angioplasty procedures (euro 487,329), 401 procedures with bare-metal stents (euro 2,380,071), 249 procedures with DESs (euro 1,827,386) and 63 mixed procedures (euro 481,480). Reimbursements amounted to euro 5,816,748 (11% from plain old balloon angioplasty, 50% from bare-metal stent, 31% from DES and 8% from mixed procedures) with a positive margin of about euro 680,480 between costs incurred and reimbursements obtained, even if the reimbursement for DES and mixed procedures was not covering all the incurred costs. Analysis of the case-mix of procedures revealed that an overall positive margin between costs and DRG reimbursements was achieved. It therefore emerges that adherence to the indications of the Healthcare Agency of the Emilia Romagna Region for the appropriate clinical use of DESs is economically sustainable from the hospital enterprise point of view, although the DRG reimbursements are not able to differentiate among resource consumptions owing to the adoption of innovative technologies.

Short term results of percutaneous transluminal coronary angioplasty with the monorail technique: experience in the first 1000 patients.

PubMed Central

de Feyter, P J; Serruys, P W; van den Brand, M; Suryapranata, H; Beatt, K

1990-01-01

The monorail technique allows monitoring of all steps of the coronary angioplasty procedure by high quality coronary angiography; easy, rapid, and safe recrossing and redilatation of the lesion if necessary; and stepwise dilatation of a stenosis with sequential increase of size of balloons. Transstenotic pressure differences cannot, however, be measured through the narrow shaft of the standard monorail balloon catheter. The monorail technique was used in 1014 patients (820 men, 194 women; mean age 57.8 years (range 24 to 84]. The indication for coronary angioplasty was stable angina in 52%, unstable angina in 40%, and acute myocardial infarction in 8%. Single vessel coronary angioplasty was attempted in 78%, multilesion coronary angioplasty in 11%, and multivessel coronary angioplasty in 11%. Angiographic success (reduction of stenosis to less than 50% of the luminal diameter) of all attempted lesions was achieved in 93%. The technique was clinically successful--that is, angiographic success of all attempted lesions, no occurrence of a major complication (death, myocardial infarction, acute bypass surgery), and improvement of symptoms--in 92% and partially successful in 1.3%. The clinical success rates were similar for stable angina (91%) and unstable angina (94%), but were somewhat lower for acute myocardial infarction (88%). Failure without major complication occurred in 3.4% of the patients. Failure with a major complication occurred in 3.3% (death 0.3%, myocardial infarction 2.4%, and acute bypass surgery 2.3%). The total major complication rate was higher in unstable angina (4.2%) than in stable angina (3.0%). These results indicate that the monorail technique can be applied safely and effectively for coronary angioplasty of patients with stable angina, unstable angina, and acute myocardial infarction. Images PMID:2337500

Coronary venous retroperfusion support during high risk angioplasty in patients with unstable angina: preliminary experience.

PubMed

Costantini, C; Sampaolesi, A; Serra, C M; Pacheco, G; Neuburger, J; Conci, E; Haendchen, R V

1991-07-01

Synchronized coronary venous retroperfusion was used during coronary balloon angioplasty to support the ischemic myocardium of 20 patients with unstable angina and anatomy at high risk of a coronary event. Hemodynamics and left ventricular function were the major end points of the study. Coronary venous catheterization and retroperfusion were successfully performed in 15 patients. The target vessel was an unprotected left main artery in 2, left anterior descending artery in 10, left circumflex coronary artery in 1 and right coronary artery in 2 patients. A nonsupported balloon inflation (mean 44 +/- 13 s) was compared with a later retroperfusion-supported inflation (mean 145 +/- 21 s). Right anterior oblique left ventriculograms, aortic blood pressure, pulmonary artery pressure and thermodilution cardiac output were obtained before and during peak untreated and treated balloon inflations and on completion of angioplasty. All patients had either a baseline left ventricular ejection fraction less than 0.40 or greater than 40% of contracting myocardium estimated to be at risk for severe ischemia during angioplasty. The cardiac (liters/min per m2) and stroke work (g.m/m2) indexes decreased from mean baseline values of 2.5 +/- 0.52 and 52 +/- 15 to 1.7 +/- 0.47 and 27 +/- 12 (mean +/- SD), respectively, during nonsupported balloon inflations but decreased only to 2.1 +/- 0.52 (p less than 0.01 vs. nonsupported) and to 36 +/- 14 (p = 0.01 vs. nonsupported), respectively, during retroperfusion-supported inflations. Ejection fraction (n = 8) decreased from a baseline value of 55 +/- 13% to 27 +/- 7.3% during nonsupported inflations but only to 39 +/- 10% during retroperfusion-supported inflations (p = 0.01 vs. nonsupported). Regional wall motion (area change) in the ischemic (target) region was reduced from a baseline value of 49 +/- 17% to 11 +/- 16% during nonsupported inflations but only to 27 +/- 15% during retroperfusion-supported inflations (p less than 0.01 vs

Feasibility of real-time magnetic resonance-guided angioplasty and stenting of renal arteries in vitro and in Swine, using a new polyetheretherketone-based magnetic resonance-compatible guidewire.

PubMed

Kos, Sebastian; Huegli, Rolf; Hofmann, Eugen; Quick, Harald H; Kuehl, Hilmar; Aker, Stephanie; Kaiser, Gernot M; Borm, Paul J; Jacob, Augustinus L; Bilecen, Deniz

2009-04-01

Demonstrate the usability of a new polyetheretherketone (PEEK)-based MR-compatible guidewire for renal artery catheterization, angioplasty, and stenting under MR-guidance using MR-visible markers, in vitro and in vivo. The new 0.035'' guidewire with fiber-reinforced PEEK core, a soft tip, and a hydrophilic coating was used. Paramagnetic markings were coated on the wire and nonbraided catheters for passive visualization. Bending stiffness of the guidewire was compared with available hydrophilic guidewires (Terumo Glidewire Stiff and Standard). A human aortic silicon phantom and 2 pigs were used. The study was animal care and use approved by the committee. Under MR-guidance, renal arteries were catheterized, balloon angioplasty was performed, and balloon expandable renal artery stents were deployed in vivo. Post mortem autopsy was performed. Guidewire visibility, pushability, steerability, and device-support capabilities of the marked guidewire were qualitatively assessed. Procedure times were recorded. Bending stiffness of the new PEEK-based wire was comparable with Standard Glidewire. In vitro and in vivo guidewire guidance, catheter configuration, renal artery catheterization, and balloon angioplasty were successful. In pigs, stent deployments were successful in both renal arteries. Autopsy revealed acceptable stent positioning. Guidewire visibility through applied markers was acceptable. Steerability, pushability, and device support were good in vitro and in vivo. The PEEK-based guide allows percutaneous MR-guided renal artery angioplasty and stenting with sufficient visibility, good steerability, pushability, and device support.

Drug-Coated Balloon Versus Standard Percutaneous Transluminal Angioplasty for the Treatment of Superficial Femoral and Popliteal Peripheral Artery Disease

PubMed Central

Tepe, Gunnar; Schneider, Peter; Brodmann, Marianne; Krishnan, Prakash; Micari, Antonio; Metzger, Christopher; Scheinert, Dierk; Zeller, Thomas; Cohen, David J.; Snead, David B.; Alexander, Beaux; Landini, Mario; Jaff, Michael R.

2015-01-01

Background— Drug-coated balloons (DCBs) have shown promise in improving the outcomes for patients with peripheral artery disease. We compared a paclitaxel-coated balloon with percutaneous transluminal angioplasty (PTA) for the treatment of symptomatic superficial femoral and popliteal artery disease. Methods and Results— The IN.PACT SFA Trial is a prospective, multicenter, single-blinded, randomized trial in which 331 patients with intermittent claudication or ischemic rest pain attributable to superficial femoral and popliteal peripheral artery disease were randomly assigned in a 2:1 ratio to treatment with DCB or PTA. The primary efficacy end point was primary patency, defined as freedom from restenosis or clinically driven target lesion revascularization at 12 months. Baseline characteristics were similar between the 2 groups. Mean lesion length and the percentage of total occlusions for the DCB and PTA arms were 8.94±4.89 and 8.81±5.12 cm (P=0.82) and 25.8% and 19.5% (P=0.22), respectively. DCB resulted in higher primary patency versus PTA (82.2% versus 52.4%; P<0.001). The rate of clinically driven target lesion revascularization was 2.4% in the DCB arm in comparison with 20.6% in the PTA arm (P<0.001). There was a low rate of vessel thrombosis in both arms (1.4% after DCB and 3.7% after PTA [P=0.10]). There were no device- or procedure-related deaths and no major amputations. Conclusions— In this prospective, multicenter, randomized trial, DCB was superior to PTA and had a favorable safety profile for the treatment of patients with symptomatic femoropopliteal peripheral artery disease. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique Identifiers: NCT01175850 and NCT01566461. PMID:25472980

Intracarotid abciximab injection to abort impending ischemic stroke during carotid angioplasty.

PubMed

Ho, D S; Wang, Y; Chui, M; Wang, Y; Ho, S L; Cheung, R T

2001-01-01

Abciximab, a platelet glycoprotein IIb/IIIa receptor antagonist, prevents ischemic complications during percutaneous transluminal coronary angioplasty and was recently shown to open occluded vessels in patients with acute myocardial infarction when used alone or in combination with other thrombolytic agents. In an animal model of arterial thrombosis, abciximab was found to be safe and effective for the prevention of carotid artery thrombosis. However, the safety and efficacy of abciximab in the treatment of acute ischemic cerebrovascular events is unknown at present. We describe 3 patients who experienced ischemic cerebrovascular events with symptoms involving the middle cerebral artery territory while undergoing percutaneous angioplasty and stenting to their internal carotid arteries. Abciximab was administered to each patient within 10 min of symptom onset as a bolus (0.25 mg/kg) into the ipsilateral common carotid artery followed by continuous intravenous infusion (9 microg/min) for 12 h. All patients' symptoms resolved completely (by 25 min, 40 min and 5 h, respectively) with no further neurological complications. Our preliminary observation suggests that abciximab may improve neurological outcome following middle cerebral artery ischemic events associated with carotid angioplasty and stenting. Large prospective studies are warranted to establish the safety and efficacy of abciximab in acute ischemic stroke, either as a primary treatment modality or an adjunct to carotid angioplasty and stenting. Copyright 2001 S. Karger AG, Basel.

[Pressure-volume recording of PTCA catheters with balloons of lower and higher compliance].

PubMed

Werner, C; Bloss, P; Kiessling, D; Patzschke, H; Unverdorben, M; Vallbracht, C

1999-11-01

In this report, the results of complementary studies of pressure-volume (p-V) measurements on balloon catheters with balloons of low (LC) and high compliance (HC) used for percutaneous transluminal coronary angioplasty are discussed. The measurements were performed with balloons unconfined in air (free dilatation) and also confined in different shells. In the case of rigid shells, a surprisingly high self-expansion of the catheters was found. Although this self-expansion does not contribute to the radial dilatation, it cannot be neglected, but must be taken into account when the success of balloon dilatation is determined on the basis of measured p-V curves. The investigations performed using wrapped shells clearly show the different dilatation properties of LC and HC balloons. The results provide important information on the feasibility of controlled balloon dilatation on the basis of p-V measurements performed on-line during PTCA.

Autogenic training reduces anxiety after coronary angioplasty: a randomized clinical trial.

PubMed

Kanji, N; White, A R; Ernst, E

2004-03-01

Autogenic training (AT) is a method of autosuggestion with some potential for reducing anxiety. This study tests whether AT lowers anxiety levels experienced by patients undergoing coronary angioplasty. Fifty-nine patients were randomly assigned to receive regular AT or no such therapy as an adjunct to standard care for 5 months. The primary outcome measure was State Anxiety at 2 months. Qualitative information was generated by face-to-face interviews. State Anxiety showed a significant intergroup difference both at 2 and 5 months. This finding was corroborated by secondary outcome measures, for example, quality of life, and by qualitative information about patients' experiences. The results do not allow us to determine whether the observed effects are specific to AT or of a nonspecific nature. Our results suggest that AT may have a role in reducing anxiety of patients undergoing coronary angioplasty.

Novel use of cutting balloon to treat subintimal hematomas during chronic total occlusion interventions.

PubMed

Vo, Minh N; Brilakis, Emmanouil S; Grantham, J Aaron

2018-01-01

Contemporary chronic total occlusion (CTO) percutaneous coronary interventional (PCI) techniques are increasingly dependent upon dissection and reentry techniques (DARTs) especially for long occluded lesions. DARTs can result in compressive hematomas during CTO interventions and traditional treatment with balloon angioplasty and/or coronary stenting are often suboptimal and may extend the hematoma distally. We describe the novel use of a cutting balloon to "express" these compressive hematomas and restore antegrade coronary blood flow. © 2017 Wiley Periodicals, Inc.

TW-01, a piperazinedione-derived compound, inhibits Ras-mediated cell proliferation and angioplasty-induced vascular restenosis

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lin, Chao-Feng

Purpose: Vascular smooth muscle cell (VSMC) proliferation plays a critical role in the pathogenesis of atherosclerosis and restenosis. This study investigated piperazinedione derived compound TW-01-mediated inhibitory effects on VSMC proliferation and intimal hyperplasia. Methods: Cell proliferation was determined using [{sup 3}H]-thymidine incorporation and MTT assay; cell cycle distribution was measured using flow cytometry; proteins and mRNA expression were determined using western blotting and RT-PCR analyses; DNA binding activity of nuclear factor-κB (NF-κB), as measured using enzyme-linked immunosorbent assays (ELISA); in vivo effects of TW-01 were determined using balloon angioplasty in the rat. Results: TW-01 significantly inhibited cell proliferation. At themore » concentrations used, no cytotoxic effects were observed. Three predominant signaling pathways were inhibited by TW-01: (a) extracellular signal-regulated kinase (ERK)1/2 mitogen-activated protein kinase (MAPK) activation and its downstream effectors of c-fos, c-jun, and c-myc; (b) DNA binding activity of nuclear factor-κB (NF-κB); and, (c) Akt/protein kinase B (PKB) and cell cycle progression. Furthermore, TW-01 also inhibited Ras activation, a shared upstream event of each of these signaling cascades. In vascular injury studies, oral administration of TW-01 significantly suppressed intimal hyperplasia induced by balloon angioplasty. Conclusion: The present study suggests that TW-01 might be a potential candidate for atherosclerosis treatment. - Highlights: • TW-01significantly inhibits vascular smooth muscle cell proliferation. • TW-01 inhibits ERK, Akt and Ras pathway and DNA binding activity of NF-κB. • TW-01 significantly suppresses intimal hyperplasia induced by balloon angioplasty. • TW-01 might be a potential candidate for atherosclerosis treatment.« less

Spontaneous Coronary Dissection: "Live Flash" Optical Coherence Tomography Guided Angioplasty.

PubMed

Bento, Angela Pimenta; Fernandes, Renato Gil Dos Santos Pinto; Neves, David Cintra Henriques Silva; Patrício, Lino Manuel Ribeiro; de Aguiar, José Eduardo Chambel

2016-01-01

Optical Coherence tomography (OCT) is a light-based imaging modality which shows tremendous potential in the setting of coronary imaging. Spontaneous coronary artery dissection (SCAD) is an infrequent cause of acute coronary syndrome (ACS). The diagnosis of SCAD is made mainly with invasive coronary angiography, although adjunctive imaging modalities such as computed tomography angiography, IVUS, and OCT may increase the diagnostic yield. The authors describe a clinical case of a young woman admitted with the diagnosis of ACS. The ACS was caused by SCAD detected in the coronary angiography and the angioplasty was guided by OCT. OCT use in the setting of SCAD has been already described and the true innovation in this case was this unique use of OCT. The guidance of angioplasty with live and short images was very useful as it allowed clearly identifying the position of the guidewires at any given moment without the use of prohibitive amounts of contrast.

A perspective of percutaneous transluminal angioplasty.

PubMed

Stanson, A W

1983-01-01

PTA is a relatively new procedure which is still evolving. More technical improvements are needed. Stiffer balloon plastics and devices to measure arterial wall compliance during balloon inflation are predicted to lead to better long-term success rates. Increasing case numbers provide greater expertise and subsequent refinements in performance and case selection. These factors will lead to improved statistics. Other features of overall patient care must be considered also. The procedure is easy for patients to tolerate, and they can return to activities and work in three or four days. The overall cost is much cheaper than surgery, even at a conservative success rate of 65 percent. There is minimal risk and morbidity, and virtually no mortality. PTA can be repeated if the lesion recurs. Severe complications are rare and almost always surgically treatable. If PTA fails to achieve success, a traditional surgical procedure can be performed. Percutaneous transluminal angioplasty is an important therapeutic alternative to traditional medical and surgical treatment for occlusive arterial disease. It can save legs, veins, time, and money. We need to refine and accurately record the use of this procedure. Total cooperation among clinicians, surgeons, and radiologists is essential for proper utilization of PTA.

Successful management of grade III coronary perforation after percutaneous angioplasty in a high-risk patient: a case report.

PubMed

Coloma Araniya, Ricardo; Beas, Renato; Maticorena-Quevedo, Jesús; Anduaga-Beramendi, Alexander; Pastrana Castillo, Marco Antonio

2016-03-03

Coronary perforation is a rare complication in patients undergoing percutaneous coronary angioplasty. The mortality of this complication varies depending on factors related to the patient and the procedure performed, reaching 44% in patients with Ellis type III perforation. We report the case of an 81 year old male with multiple cardiovascular risk factors, who underwent percutaneous angioplasty for unstable angina management. The patient developed grade III coronary perforation in the anterior descending artery, which was successfully managed with balloon inflation to 6 atmospheres for 10 minutes twice in the affected area, with an interval of 5 minutes between each dilatation. The patient improved and was discharged.

Early and late effects of coumarin therapy started before percutaneous coronary intervention: Clinical, angiographic and cost-effective outcome of the Balloon Angioplasty and Anticoagulation Study (BAAS).

PubMed

Ten Berg, J M; Kelder, J C; Suttorp, M J; Mast, E G; Bal, E T; Ernst, J M P G; Plokker, H W M

2002-05-01

Coronary angioplasty frequently creates a thrombogenic surface with subsequent mural thrombosis that may lead to acute complications and possibly stimulates the development of restenosis. Whether coumarins can prevent these complications is unclear. In the Balloon Angioplasty and Anticoagulation Study (BAAS), the effect of coumarins started before the procedure on early and late outcome was studied. Patients were randomised to aspirin only or to aspirin plus coumarins. Half of the patients were randomised to undergo six-month angiographic follow-up. Study medication was started one week before coronary angioplasty and the target international normalised ratio (INR) was 2.1-4.8 during angioplasty and six-month follow-up. 'Optimal' anticoagulation was defined as an INR in the target range for at least 70% of the follow-up time. In addition, cost-effectiveness of coumarin treatment was measured. At one year death, myocardial infarction, target-lesion revascularisation and stroke were observed in 14.3% of the 530 patients randomised to aspirin plus coumarin versus in 20.3% of the 528 patients randomised to aspirin alone (relative risk 0.71; 95% CI 0.54-0.93). The incidence of major bleedings and false aneurysms during hospitalisation was 3.2% and 1.0%, respectively, (relative risk 3.39; 95% CI 1.26-9.11). Optimal anticoagulation was an independent predictor of late thrombotic events (relative risk, 0.33; 95% CI, 0.19-0.57). Quantitative coronary analysis was performed of 301 lesions in the ASA group and of 297 lesions in the coumarin group. At six months, the minimal luminal diameter was similar in the ASA and coumarin group. However, optimal anticoagulation was an independent predictor of angiographic outcome at six months. Optimal anticoagulation led to a 0.21 mm (95% CI: 0.05-0.37) larger MLD as compared with suboptimal anticoagulation whereas aspirin use led to a 0.12 mm (95% CI -0.28-0.04) smaller MLD. When including all costs, the savings associated with coumarin

Ultrasound-Guided Angioplasty of Dysfunctional Vascular Access for Haemodialysis. The Pros and Cons

DOE Office of Scientific and Technical Information (OSTI.GOV)

García-Medina, J., E-mail: josegmedina57@gmail.com; García-Alfonso, J. J., E-mail: juanjozarandieta@gmail.com

PurposeTo describe the benefits and the disadvantages of angioplasty in dialysis fistulas using only ultrasound guidance.Materials and MethodsThis is a prospective study in 132 failing or non-maturing arteriovenous accesses that underwent 189 ultrasound-guided balloon angioplasties. The technical success was defined as non-use of X-ray fluoroscopy during the procedure.Results127 procedures (67%) were successfully completed without fluoroscopy. Most failures were due to difficulty to traverse aneurismal segments, as well as anastomotic stenoses. Including initial failures, the primary patency rates at 6, 12 months and 2 years were 75 ± 3, 41 ± 3 and 14 ± 2%, respectively.ConclusionEndovascular repair of the dysfunctional vascular access for haemodialysis under ultrasound guidance ismore » feasible and safe in roughly two-thirds of cases.« less

Spontaneous Coronary Dissection: “Live Flash” Optical Coherence Tomography Guided Angioplasty

PubMed Central

Bento, Angela Pimenta; Fernandes, Renato Gil dos Santos Pinto; Neves, David Cintra Henriques Silva; Patrício, Lino Manuel Ribeiro; de Aguiar, José Eduardo Chambel

2016-01-01

Optical Coherence tomography (OCT) is a light-based imaging modality which shows tremendous potential in the setting of coronary imaging. Spontaneous coronary artery dissection (SCAD) is an infrequent cause of acute coronary syndrome (ACS). The diagnosis of SCAD is made mainly with invasive coronary angiography, although adjunctive imaging modalities such as computed tomography angiography, IVUS, and OCT may increase the diagnostic yield. The authors describe a clinical case of a young woman admitted with the diagnosis of ACS. The ACS was caused by SCAD detected in the coronary angiography and the angioplasty was guided by OCT. OCT use in the setting of SCAD has been already described and the true innovation in this case was this unique use of OCT. The guidance of angioplasty with live and short images was very useful as it allowed clearly identifying the position of the guidewires at any given moment without the use of prohibitive amounts of contrast. PMID:26989520

Economic evaluation of drug-eluting stents in coronary angioplasty.

PubMed

Santos, Ricardo; Pereira, Hélder

2005-11-01

Coronary angioplasty has revolutionized the treatment of coronary artery disease, from the first balloon angioplasty to the current era of drug-eluting stents (DES), which were developed to eliminate the bare metal stent's (BMS) Achilles' heel, restenosis. DES have an extremely low restenosis rate but are significantly more expensive and need more prolonged dual antiplatelet therapy. Restenosis has a generally benign prognosis and is not associated with higher mortality or major adverse cardiovascular events, which has limited the penetration of DES, whose only advantage is the reduction of restenosis. Economic evaluation of DES is therefore of paramount importance for assessing their appropriate use. In randomized trials in which they are compared with BMS, economic evaluation is advantageous for DES, with good cost-effectiveness ratios for both cost per quality-adjusted life year (QALY) and cost per revascularization avoided. However, these trials have two major limitations--the angiographic follow-up protocol and selection of patients with lower risk--and so their results do not accurately reflect reality. Other studies with unselected populations and cost-effectiveness models show that there is an economic advantage in the use of DES in groups with higher risk of restenosis, but not for the whole population undergoing angioplasty. Use of DES will be more appropriate if we can identify populations with a higher likelihood of restenosis, because these are the patients that will benefit most from their use and in whom they will be economically advantageous.

Novel application of a balloon-anchoring technique for the realignment of a prolapsed pipeline embolization device: a technical report.

PubMed

Crowley, R Webster; Abla, Adib A; Ducruet, Andrew F; McDougall, Cameron G; Albuquerque, Felipe C

2014-07-01

Flow-diverting stents represent a substantial advancement in the treatment of cerebral aneurysms. They can, however, be associated with unique complications that may require management through adjunctive techniques. To present a technical report of a salvage technique used to realign a prolapsed Pipeline Embolization Device (PED) during the treatment of a giant internal carotid artery (ICA) aneurysm. A patient in his late 70s with an incidental giant supraclinoid ICA aneurysm presented for endovascular consideration. Treatment was planned using the PED. Following placement of the device there were two focal areas of incomplete expansion and balloon angioplasty was performed. This manipulation resulted in foreshortening of the distal aspect of the PED which caused the device to prolapse into the aneurysm. After multiple unsuccessful attempts to regain distal access, a salvage technique was attempted in which a balloon was inflated in the middle cerebral artery and, by applying traction, the PED was realigned with the parent artery. After the PED was realigned, direct distal catheter access was achieved and a second Pipeline device was deployed, successfully covering the aneurysm neck with resultant flow stasis. The patient had no postoperative issues and was discharged 2 days later without deficit. The balloon-anchoring technique was successfully used to realign a PED that had prolapsed into a giant ICA aneurysm. This maneuver prevented potentially disastrous complications and allowed the satisfactory completion of the aneurysm embolization. This represents a useful salvage technique that should be considered when encountering a prolapsed stent. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Correlation of leukocyte adhesiveness, adhesion molecule expression and leukocyte-induced contraction following balloon angioplasty

PubMed Central

Kennedy, Simon; McPhaden, Allan R; Wadsworth, Roger M; Wainwright, Cherry L

2000-01-01

The aim of this study was to examine the changes in leukocyte adhesion and leukocyte-induced contraction in balloon-injured rabbit subclavian artery and to correlate these changes with vessel morphology and expression of adhesion molecules on the injured arteries.Rabbits were anaesthetized and their left subclavian arteries were injured by balloon inflation and withdrawal followed by sacrifice at 2, 24, 48 h or 8 days after injury. The left and right subclavian arteries were removed and leukocytes were isolated from autologous rabbit blood. Leukocyte-induced contraction was measured in 5-HT precontracted artery rings and leukocyte adhesion was measured using 51Cr-labelled leukocytes. Immunocytochemistry using paraffin-embedded tissue was employed to detect changes in the expression of adhesion molecules on injured arteries.Autologous leukocytes caused a contraction of rabbit subclavian artery rings, which was prevented by L-NAME (10−3 M). Balloon-induced injury abolished the contractile response to leukocytes, which correlated with loss of carbachol-induced relaxationBalloon injury markedly enhanced the adhesiveness of the subclavian artery for leukocytes, most notably at 24 and 48 h after injury (1.7 and 1.8 fold respectively). Increased leukocyte adhesion at these two time points correlated with an upregulation of E-selectin, P-selectin and VCAM-1 expression on the remaining endothelium of the injured artery.Vessel morphology revealed that balloon inflation had induced an infiltration of inflammatory cells into the vessel wall, the greatest increase being seen at 24 h after injury.It is concluded that an increase in the expression of E-selectin, P-selectin and VCAM-1 following balloon-induced injury leads to enhanced leukocyte adhesion and migration into the injured vessel. PMID:10781003

[Effect of nattokinase on restenosis after percutaneous transluminal angioplasty of the abdominal artery in rabbits].

PubMed

Gong, Min; Lin, Huan-bing; Wang, Qian; Xu, Jiang-ping

2008-08-01

To investigate the effect of nattokinase on intimal hyperplasia in rabbit abdominal artery after balloon injury and explore a novel strategy for the preventing restenosis after percutaneous transluminal angioplasty. Fifty-six New Zealand rabbits were randomly divided into 7 groups, namely the solvent control group, model group, natto extract lavage group, refined nattokinse lavage group, intravenous refined nattokinse injection group, clopidogrel group and clopidogrel-aspirin group. Balloon injury was induced by inserting the catheter through the femoral artery into the thoracic aorta of the rabbits. The platelet counts were notad and platelet aggregation was observed, and the abdominal artery was taken for pathological analysis. The expressions of MMP-2 and -9 in the abdominal artery were detected immunohistochemically. There was no significant difference in the platelet counts, platelet aggregation rate or MMP-2 and -9 expression between the model group and the nattokinse-treated groups (P>0.05). The stenosis index in each nattokinse-treated group was significantly greater and the neointimal proliferation index smaller than that of the model group (P<0.01 or 0.05). Nattokinse can inhibit restenosis of rabbit abdominal artery after percutaneous transluminal angioplasty, which is independent of its actions on the platelet or MMP-2 and -9 expressions.

Balloon Pulmonary Angioplasty for Inoperable Patients With Chronic Thromboembolic Pulmonary Hypertension. Observational Study in a Referral Unit.

PubMed

Velázquez, Maite; Albarrán, Agustín; Hernández, Ignacio; López-Gude, M Jesús; Sarnago, Fernando; Martín, Roberto; Arribas, Fernando; Escribano, Pilar

2018-05-29

Balloon pulmonary angioplasty (BPA) for inoperable chronic thromboembolic pulmonary hypertension (CTEPH) is becoming widely accepted. Procedural refinement has reduced complications. Our primary objective was to analyze the results and complications of the first national BPA program. Observational, prospective series that included all consecutive BPA procedures in inoperable CTEPH patients between May 2013 and February 2017 performed at a single institution. We analyzed clinical and hemodynamic improvement, reperfusion pulmonary edema, and mortality. We performed 156 BPA sessions in 46 patients. Pulmonary vascular resistance was reduced by 44% (10.1 ± 4.9 vs 5.6 ± 2.2 WU; P < .001) and mean pulmonary arterial pressure by 23.6% (49.5 ± 12 vs 37.8 ± 9mmHg; P < .001); cardiac index rose by 17.1% (2.3 vs 2.7 L/min/m 2 ; P = .002), N-terminal pro-B-type natriuretic peptide levels were reduced by 79.2% (1233 ± 1327 vs 255.5 ± 318 pg/dL; P < .001) and the 6-minute walk test distance improved by 74 meters (394 vs 468 m; P = .001). Reperfusion pulmonary edema developed after 9 interventions (5.8%) and 1 patient died (mortality 2.1%). Due to its current refinement, BPA has become a safe and effective treatment for inoperable CTEPH that improves hemodynamics, functional status, and biomarkers with a low rate of severe periprocedural complications and mortality. Copyright © 2018 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

Medical Therapy Versus Balloon Angioplasty for CTEPH: A Systematic Review and Meta-Analysis.

PubMed

Phan, Kevin; Jo, Helen E; Xu, Joshua; Lau, Edmund M

2018-01-01

A significant number of chronic thromboembolic pulmonary hypertension (CTEPH) patients will have an inoperable disease. Medical therapy and balloon pulmonary angioplasty (BPA) have provided alternate therapeutic options for patients with inoperable CTEPH, although there are a limited number of published studies examining the outcomes. Thus, our study aims to evaluate and compare the efficacy of medical therapy and BPA in patients with inoperable CTEPH. An electronic search of six databases was performed and the search results were screened against established criteria for inclusion into this study. Data was extracted and meta-analytical techniques were used to analyse the data. Pooled data from RCTs revealed that medical therapy, compared with a placebo, was associated with a significant improvement of at least one functional class (p=0.038). With regards to pulmonary haemodynamics, medical therapy also resulted in a significant reduction in both mean pulmonary arterial pressure (mPAP) (p=0.002) and pulmonary vascular resistance (PVR) (p<0.001). From the included observational studies, the 6-minute walk distance (6MWD) significantly increased following medical therapy by an average of 22.8% (p<0.001). The pooled improvement in 6MWD was found to be significantly higher in the BPA group when compared to medical therapy for CTEPH (p=0.001). Pooled data from available observational studies of medical therapy or BPA all demonstrated significant improvements in mPAP and PVR for pre versus post intervention comparisons. The improvement in mPAP (p=0.002) and PVR (p=0.002) were significantly greater for BPA intervention when compared to medical therapy. High-quality evidence supports the use of targeted medical therapy in improving haemodynamics in patients with inoperable CTEPH. There is only moderate-quality evidence from observational studies supporting the efficacy of BPA in improving both haemodynamics and exercise capacity. Further RCTs and prospective observational

Laser Atherectomy for Treatment of Femoropopliteal In-Stent Restenosis.

PubMed

Armstrong, Ehrin J; Thiruvoipati, Thejasvi; Tanganyika, Kundai; Singh, Gagan D; Laird, John R

2015-08-01

To investigate if laser atherectomy with adjunctive balloon angioplasty can improve endovascular treatment outcomes for femoropopliteal in-stent restenosis (ISR). A dual center study included 135 symptomatic patients (mean age 71 years; 76 men) who underwent endovascular treatment of femoropopliteal ISR between 2006 and 2013. Of these, 54 (40%) were treated with laser atherectomy and the remaining 81 patients with balloon angioplasty alone. Angiographic images were reviewed for lesion morphology and characteristics, TransAtlantic InterSociety Consensus (TASC) II classification, and distal runoff. Class I ISR was defined as focal lesions ≤50 mm, class II ISR as lesions >50 mm, and class III ISR as stent total occlusion. Recurrent ISR was determined by a peak systolic velocity ratio >2.4 by duplex ultrasound. Patients treated with laser atherectomy had longer mean ISR lesion length (222 vs 114 mm, p<0.001) and more class III ISR (69% vs 20%, p=0.001). There was no association between laser atherectomy and rates of recurrent restenosis or occlusion for patients with class I/II ISR, but there was a significantly lower rate of target lesion revascularization at 2 years among patients treated with laser atherectomy (14% vs 44%, p=0.05). In comparison, patients with class III ISR treated with laser atherectomy had lower rates of recurrent restenosis at 1 year (54% vs 91%, p=0.05) and 2 years (69% vs 100%, p=0.05). Patients with class III ISR treated with laser atherectomy also had lower rates of recurrent in-stent occlusion at 2-year follow-up (33% vs 71%, p=0.04). When used to treat complex ISR, including in-stent occlusions, laser atherectomy with adjunctive balloon angioplasty may be associated with improved patency. © The Author(s) 2015.

Effect of Balloon Pulmonary Angioplasty on Respiratory Function in Patients With Chronic Thromboembolic Pulmonary Hypertension.

PubMed

Akizuki, Mina; Serizawa, Naoki; Ueno, Atsuko; Adachi, Taku; Hagiwara, Nobuhisa

2017-03-01

Balloon pulmonary angioplasty (BPA) in chronic thromboembolic pulmonary hypertension (CTEPH) improves hemodynamics and exercise capacity. However, its effect on respiratory function is unclear. Our objective was to investigate the effect of BPA on respiratory function. We enrolled patients with inoperable CTEPH who underwent BPA primarily in lower lobe arteries (first series) and upper and middle lobe arteries (second series). We compared changes in hemodynamics and respiratory function between different BPA fields. Sixty-two BPA sessions were performed in 13 consecutive patients. Mean pulmonary arterial pressure and pulmonary vascular resistance significantly improved from 44 ± 8 to 23 ± 5 mm Hg and 818 ± 383 to 311 ± 117 dyne/s/cm -5 . The percent predicted diffusion capacity of lung for carbon monoxide (Dlco) decreased after BPA in the lower lung field (from 60% ± 8% to 54% ± 8%) with no recovery. Percent Dlco increased after BPA in the upper middle lung field (from 53% ± 6% to 58% ± 6%) and continued to improve during the follow-up (from 58% ± 6% to 64% ± 11%). The ventilation/Co 2 production (V˙e/V˙co 2 ) slope significantly improved after BPA in the lower lung field (from 51 ± 13 to 41 ± 8) and continued to improve during the follow-up (from 41 ± 8 to 35 ± 7); however, the V˙e/V˙co 2 slope remained unchanged after BPA in the upper/middle lung field. Changes in % Dlco and the V˙e/V˙co 2 slope differed significantly between lower and upper/middle lung fields. The effect of BPA on respiratory function in patients with CTEPH differed depending on the lung field. Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

Remodelling of the Superior Caval Vein After Angioplasty in an Infant with Superior Caval Vein Syndrome

DOE Office of Scientific and Technical Information (OSTI.GOV)

Mert, Murat; Saltik, Levent; Gunay, Ilhan

2004-08-15

An 8-month old girl was presented with superior caval vein syndrome early after cardiac surgery. Angiography showed severe stenosis of the superior caval vein with 50 mmHg pressure gradient. Following balloon angioplasty, the pressure gradient was reduced to 7 mmHg with some residual stenosis of the superior caval vein. When the patient was reevaluated 5 months after the procedure, angiography revealed a normal diameter of the superior caval vein without a pressure gradient.

Immediate and late clinical and angiographic outcomes after GFX coronary stenting: is high-pressure balloon dilatation necessary?

PubMed

Park, S W; Hong, M K; Lee, C W; Kim, J J; Park, H K; Cho, G Y; Kang, D H; Song, J K; Park, S J

2000-08-01

The GFX stent is a balloon-expandable stent made of sinusoidal element of stainless steel. The adjunct high-pressure balloon dilatations were usually recommended in routine stenting procedure. The aim of this study was to evaluate the immediate and long-term clinical and angiographic outcomes and to investigate the necessity of high-pressure balloon dilatation during GFX stenting. In all, 172 consecutive patients underwent single 12 or 18 mm GFX stent implantation in 188 native coronary lesions. Two types of stenting technique were used: (1) stent size of a final stent-to-artery ratio of 1:1 (inflation pressure > 10 atm, high-pressure group), and (2) stent size of 0.5 mm bigger than reference vessel (inflation pressure < or = 10 atm, low-pressure group). The adjunct high-pressure balloon dilatations were performed only in cases of suboptimal results. The adjunct high-pressure balloon dilatation was required in 11 of 83 lesions (13%) in the high-pressure group and in 7 of 105 lesions (7%) in the low-pressure group (p = 0.203). Procedural success rate was 100%. There were no significant differences of in-hospital and long-term clinical events between the two groups. The overall angiographic restenosis rate was 17.7%; 18.4% in the high-pressure group and 17.1% in the low-pressure group (p = 0.991). The GFX stent is a safe and effective device with a high procedural success rate and favorable late clinical outcome for treatment of native coronary artery disease. Further randomized trials may be needed to compare stenting techniques in GFX stent implantation.

Efficacy of stent angioplasty for symptomatic stenoses of the proximal vertebral artery.

PubMed

Weber, W; Mayer, T E; Henkes, H; Kis, B; Hamann, G F; Holtmannspoetter, M; Brueckmann, H; Kuehne, D

2005-11-01

To evaluate the safety and efficacy of stent angioplasty in the treatment of symptomatic arteriosclerotic stenoses of the proximal vertebral artery (VA). Thirty-eight symptomatic stenoses of the vertebral origin were treated with flexible balloon-expandable coronary stents. Angiographic and clinical follow-up examinations were obtained in 26 patients at a mean of 11 months. The immediate post-procedural angiographic results showed no residual stenosis in 33 vessels and mild residual stenoses in five vessels. Periprocedurally, there were two asymptomatic technical complications and one TIA. During follow-up re-stenosis could be detected in 10 cases (36%), and vessel occlusions in two patients. Two stents were broken. One of the restenosis caused a TIA within the follow-up period. Flexible balloon-expandable coronary stents proved to be save and effective in preventing vertebrobasilar stroke but were incapable to preserve the proximal vertebral artery lumen. For the VA origine an adequate stent, self-expanding, bioresorbable, or drug-eluting has to be found.

Technical and Clinical Results After Percutaneous Angioplasty in Nonmedial Fibromuscular Dysplasia: Outcome After Endovascular Management of Unifocal Renal Artery Stenoses in 30 Patients

DOE Office of Scientific and Technical Information (OSTI.GOV)

Barrier, Pierre, E-mail: p.barrier@gmail.com; Julien, Auriol; Guillaume, Canevet

2010-04-15

Although percutaneous transluminal renal angioplasty (PTRA) is associated with excellent results in medial fibromuscular dysplasia (FMD), the clinical and technical outcome in the less common nonmedial subtype of FMD is not clearly known. Angiographic PTRA results and clinical follow-up were documented, to report technical and clinical results in 30 patients with unifocal, nonmedial dysplastic stenoses. Balloon angioplasty was technically successful in only 65% of the lesions. Additional stenting, performed after PTRA failure in six patients, increased the initial technical success rate to 82%. Stenting was used in another lesion after restenosis, and long-term patency was achieved in only three ofmore » the seven stented lesions. Frequent restenoses and unusual complications were observed during follow-up. Stent fracture occurred in two cases. Overall, long-term clinical and technical successes were sustained in 70 and 76%, respectively. We conclude that nonmedial, unifocal renal artery dysplastic stenoses do not share the excellent prognosis of the medial type and that stenting should be avoided. Therefore, surgery should be considered in lesions remaining unresponsive to balloon dilatation, after a second PTRA attempt.« less

Benefits of Balloon-Dilatable Bilateral Pulmonary Artery Banding in Patients With Hypoplastic Left Heart Syndrome and Other Complex Cardiac Anomalies.

PubMed

Kise, Hiroaki; Suzuki, Shoji; Hoshiai, Minako; Toda, Takako; Koizumi, Keiichi; Hasebe, Yohei; Kono, Yosuke; Honda, Yoshihiro; Kaga, Shigeaki; Sugita, Kanji

2015-12-01

The purpose of this study was to evaluate the potential of balloon-dilatable bilateral pulmonary artery banding (b-PAB) and its impact on the configuration of the pulmonary artery (PA). We have previously used balloon-dilatable b-PAB as first-stage palliation for patients with hypoplastic left heart syndrome (HLHS) and other complex cardiac anomalies. Two pliable tapes were placed around each branch of the PA and tightened with 7-0 polypropylene sutures in a manner that allowed for the subsequent adjustment of PA diameters. We retrospectively examined the adjustability of PA diameters by balloon dilation and the need for surgical PA angioplasty at later stages. From January 2010 to October 2013, we performed b-PAB in 8 patients, including 3 borderline cases between biventricular repair (BVR) and univentricular repair (UVR). The b-PAB procedures were performed at a median age of 6.5 days (range, 2-10 days). Balloon dilations were performed in 10 lesions in 4 patients. All of the procedures were performed safely. Two patients reached definite BVR. The remaining 6 patients underwent open palliative procedures with univentricular physiologies that resulted in 2 deaths unrelated to the initial b-PAB. In all but 1 of the patients, the PA configuration was properly maintained and did not require surgical pulmonary angioplasty. Balloon-dilatable b-PAB can be performed safely and prevents PA distortion at later stages. This technique should be considered for patients with complex cardiac anomalies if uncertainty exists regarding the optimal surgical strategy (BVR or UVR) in early infancy. © 2015, Wiley Periodicals, Inc.

Angioplasty - Multiple Languages

MedlinePlus

... Heart Angioplasty - العربية (Arabic) Bilingual PDF Health Information Translations Bosnian (bosanski) Expand Section Heart Cath and Heart Angioplasty - bosanski (Bosnian) Bilingual PDF Health Information Translations Chinese, Simplified (Mandarin dialect) (简体中文) Expand Section Heart ...

Angioplasty of femoral-popliteal arteries with drug-coated balloons: 5-year follow-up of the THUNDER trial.

PubMed

Tepe, Gunnar; Schnorr, Beatrix; Albrecht, Thomas; Brechtel, Klaus; Claussen, Claus D; Scheller, Bruno; Speck, Ulrich; Zeller, Thomas

2015-01-01

The purpose of this study was to evaluate the 5-year follow-up (FU) data of the THUNDER (Local Taxan With Short Time Contact for Reduction of Restenosis in Distal Arteries). The THUNDER trial was the first study to investigate the treatment of femoropopliteal arteries with a paclitaxel-coated balloon (PCB). In 154 patients, femoropopliteal arteries were treated with PCB, with angioplasty with paclitaxel in contrast medium, or no paclitaxel (control). The primary endpoint was 6-month late lumen loss (LLL). Secondary endpoints included freedom from target lesion revascularization (TLR), binary restenosis rate, and amputation. The 5-year FU compares outcomes in patients treated with PCB and control subjects. Additionally, LLL at 6 months and TLR up to 5-year FU were analyzed in terms of sex and lesion length. Over the 5-year period, the cumulative number of patients with TLR remained significantly lower in the PCB group (21%) than in the control group (56%, p = 0.0005). In the small group of patients with angiographic and duplex sonographic follow-up, PCB was associated with a lower rate of binary restenosis (17% vs. 54%; p = 0.04). No signs of aneurysm formation or constrictive fibrosis were detected. Whereas LLL at 6-month FU did not differ between men and women in the PCB group, the TLR rate was lower in men than in women at 5-year FU. A benefit of PCB treatment in terms of LLL and TLR was seen independent of lesion length. The reduced TLR rate following PCB treatment was maintained over the 5-year FU period. No signs of drug-related local vessel abnormalities were detected. (Thunder Trial-Local Taxan With Short Time Contact for Reduction of Restenosis in Distal Arteries [THUNDER]; NCT00156624). Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Improvement in Quality of Life and Hemodynamics in Chronic Thromboembolic Pulmonary Hypertension Treated With Balloon Pulmonary Angioplasty.

PubMed

Darocha, Szymon; Pietura, Radosław; Pietrasik, Arkadiusz; Norwa, Justyna; Dobosiewicz, Anna; Piłka, Michał; Florczyk, Michał; Biederman, Andrzej; Torbicki, Adam; Kurzyna, Marcin

2017-03-24

The effect of balloon pulmonary angioplasty (BPA) on improvement in functional and hemodynamic parameters in chronic thromboembolic pulmonary hypertension (CTEPH) is known, but the quality of life (QoL) of patients treated with BPA has never been studied before.Methods and Results:Twenty-five patients with inoperable or persistent CTEPH were enrolled in the study and filled out the 36-item Short Form (SF-36v2) questionnaire twice: prior to commencement of BPA treatment and after ≥3 BPA sessions. In addition WHO functional class, distance on the 6-min walk test (6MWT) and hemodynamic parameters such as right atrial pressure (RAP), mean pulmonary artery pressure (mPAP), cardiac index (CI) and pulmonary vascular resistance (PVR) were assessed. QoL improved significantly in all domains, except for physical pain. Improvement in RAP (10.5±3.4 vs. 6.2±2.2 mmHg; P<0.05), mPAP (51.7±10.6 vs. 35.0±9.1 mmHg; P<0.05), CI (2.2±0.5 vs. 2.5±0.4 L/min·m 2 ; P=0.04), PVR (10.4±3.9 vs. 5.5±2.2 Wood units; P<0.05), functional class (96% vs. 20% in WHO class III and IV, P<0.05) and improvement in 6MWT distance (323±135 vs. 410±109 m; P<0.05) was observed. The only significant correlation was between the mental component summary score of QoL after completion of treatment and percentage improvement in the 6MWT (-0.404, P<0.05). Alongside improvement in functional and hemodynamic parameters, BPA also provides significant improvement in QoL.

Vascular occlusion with a balloon-expandable stent occluder.

PubMed

Moss, J G; Laborde, J C; Clem, M C; Rivera, F J; Encarnacion, C E; Meyer, K B; Palmaz, J C

1994-05-01

To evaluate the effectiveness of a new vascular occlusion device. The device was created by coating a balloon-expandable stent with a silicone sleeve that tapers to a blind-ended nozzle at its leading end. Once crimp-mounted on an angioplasty balloon catheter, the device is introduced over a guide wire through a small end hole in the nozzle. The device was tested for stability and occlusive ability. No migration was measured over a pulsatile pulse range of 50-300 mm Hg, and mean flow rate in the occluded vessel was reduced from 443 mL/min +/- 99 (standard deviation) to 1.9 mL/min +/- 2.7. Subsequently, 12 arteries were occluded in three dogs, and immediate vascular occlusion was achieved in all vessels. An arteriovenous fistula was created in another six dogs and was successfully occluded with the device. Follow-up arteriography at 3 months demonstrated persistent occlusion with no migration of the device. This new occlusive device offers immediate vascular occlusion with excellent stability.

The protective effect of bergamot oil extract on lecitine-like oxyLDL receptor-1 expression in balloon injury-related neointima formation.

PubMed

Mollace, Vincenzo; Ragusa, Salvatore; Sacco, Iolanda; Muscoli, Carolina; Sculco, Francesca; Visalli, Valeria; Palma, Ernesto; Muscoli, Saverio; Mondello, Luigi; Dugo, Paola; Rotiroti, Domenicantonio; Romeo, Francesco

2008-06-01

Lectin-like oxyLDL receptor-1 (LOX-1) has recently been suggested to be involved in smooth muscle cell (SMC) proliferation and neointima formation in injured blood vessels. This study evaluates the effect of the nonvolatile fraction (NVF), the antioxidant component of bergamot essential oil (BEO), on LOX-1 expression and free radical generation in a model of rat angioplasty. Common carotid arteries injured by balloon angioplasty were removed after 14 days for histopathological, biochemical, and immunohistochemical studies. Balloon injury led to a significant restenosis with SMC proliferation and neointima formation, accompanied by increased expression of LOX-1 receptor, malondialdehyde and superoxide formation, and nitrotyrosine staining. Pretreatment of rats with BEO-NVF reduced the neointima proliferation together with free radical formation and LOX-1 expression in a dose-dependent manner. These results suggest that natural antioxidants may be relevant in the treatment of vascular disorders in which proliferation of SMCs and oxyLDL-related endothelial cell dysfunction are involved.

[Successful correction with stent-graft of coronary artery rupture after angioplasty].

PubMed

Demin, V V

2003-01-01

Rupture and perforation of coronary arteries complicate in average 0.5% of radiosurgical coronary interventions and often are accompanied by serious consequences and high mortality. According to-type of coronary perforation different methods of correction are used, ranging from conservative measures to urgent cardiosurgical interventions. Coronary stent-grafts with 'sandwich' type of construction ore composed from two metal stents and PTFE layer between them. Development of such stents enabled effective radioguided endovascular repair of coronary ruptures. The paper presents the first Russian experience of stout-graft implantation for coronary artery rupture occurred during direct stenting of proximal anterior descending artery and balloon angioplasty in distal segment. The rupture occurred probably because of wall fragility between affected segment and muscular bridge. Stent-graft JoStent 16 mm in length connected with 3-mm balloon was implanted with subsequent complete restitution of blood flow, resolution of pain syndrome and ECG normalization. Echocardiography in operative theatre and one day after surgery showed no intrapericardial fluid. Stent-graft devices for urgent implantation in cases of coronary rupture must be included into obligatory equipment of radiosurgical facilities.

12-Month Results From the First-in-Human Randomized Study of the Ranger Paclitaxel-Coated Balloon for Femoropopliteal Treatment.

PubMed

Steiner, Sabine; Willfort-Ehringer, Andrea; Sievert, Horst; Geist, Volker; Lichtenberg, Michael; Del Giudice, Costantino; Sauguet, Antoine; Diaz-Cartelle, Juan; Marx, Claudia; Ströbel, Armin; Schult, Ingolf; Scheinert, Dierk

2018-05-28

The authors sought to evaluate the performance of the Ranger paclitaxel-coated balloon versus uncoated balloon angioplasty for femoropopliteal lesions at 12 months. Drug-coated balloons (DCBs) are a promising endovascular treatment option for peripheral artery disease of the femoropopliteal segment, and each unique device requires dedicated clinical study. The prospective, randomized RANGER SFA (Comparison of the Ranger™ Paclitaxel-Coated PTA Balloon Catheter and Uncoated PTA Balloons in Femoropopliteal Arteries) study (NCT02013193) enrolled 105 patients with symptomatic lower limb ischemia (Rutherford category 2 to 4) and stenotic lesions in the nonstented femoropopliteal segment at 10 European centers. Seventy-one patients (mean age 68 ± 8 years, n = 53 men) were enrolled in the Ranger DCB arm, and 34 patients (mean age 67 ± 9 years, n = 23 men) were assigned to the control group. Twelve-month analysis included patency, safety, and clinical outcomes and quality-of-life assessments. The DCB group had a greater primary patency rate at 12 months (Kaplan-Meier estimate 86.4% vs. 56.5%), with a significantly longer time to patency failure (log-rank p < 0.001). The estimated freedom from target lesion revascularization rate was 91.2% in the DCB group and 69.9% in the control group at 12 months, with a significantly longer time to reintervention (p = 0.010). No target limb amputations or device-related deaths occurred in either group. Twelve-month results show that patency was maintained longer after Ranger DCB treatment than after conventional balloon angioplasty, and this result was associated with a low revascularization rate and good clinical outcomes. Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.

Fibrin Sheath Angioplasty: A Technique to Prevent Superior Vena Cava Stenosis Secondary to Dialysis Catheters

PubMed Central

Hacker, Robert I.; Garcia, Lorena De Marco; Chawla, Ankur; Panetta, Thomas F.

2012-01-01

Fibrin sheaths are a heterogeneous matrix of cells and debris that form around catheters and are a known cause of central venous stenosis and catheter failure. A total of 50 cases of central venous catheter fibrin sheath angioplasty (FSA) after catheter removal or exchange are presented. A retrospective review of an outpatient office database identified 70 eligible patients over a 19-month period. After informed consent was obtained, the dialysis catheter exiting the skin was clamped, amputated, and a wire was inserted. The catheter was then removed and a 9-French sheath was inserted into the superior vena cava, a venogram was performed. If a fibrin sheath was present, angioplasty was performed using an 8 × 4 or 10 × 4 balloon along the entire length of the fibrin sheath. A completion venogram was performed to document obliteration of the sheath. During the study, 50 patients were diagnosed with a fibrin sheath, and 43 had no pre-existing central venous stenosis. After FSA, 39 of the 43 patient's (91%) central systems remained patent without the need for subsequent interventions; 3 patients (7%) developed subclavian stenoses requiring repeat angioplasty and stenting; 1 patent (2.3%) developed an occlusion requiring a reintervention. Seven patients with prior central stenosis required multiple angioplasties; five required stenting of their central lesions. Every patient had follow-up fistulograms to document long-term patency. We propose that FSA is a prudent and safe procedure that may help reduce the risk of central venous stenosis from fibrin sheaths due to central venous catheters. PMID:23997555

[Imprints of coronary plaque particles in the PTCA balloon surface during the dilatation processing].

PubMed

Werner, D; Behrend, D; Schmitz, K P; Urbaszek, W

1995-05-01

Seventy-six PTCA-balloons after coronary angioplasty were studied for superficial changes using scanning electron microscopy (SEM) after fixing in glutardialdehyde. Coronary plaque particles were identified on the balloon surface in 52 cases (68%). Twelve new and unused balloons were subjected to the same chemical treatment and SEM showed no imprints. The average length of the longest imprinted plaques was 128 +/- 201 microns and the average number of plaque particles per balloon was 4.9 +/- 2.7. The maximal dilatation pressure and the number of dilatations showed no influence on the impregnation of plaque particles. However, longer plaque imprints tended to occur under low dilatation pressure. Imprints of plaque particles were significantly higher in patients with low cholesterol (p = 0.0001) and low triglycerides (p = 0.0016). No correlation was seen between imprint length and lipid levels. Similarly, the different balloon materials (polyethylene, polyolefincopolymer) showed no significant differences with regard to plaque occurrence. The PTCA-balloons, plaque particles and six coronary plaques obtained after endatherectomy were subjected to energy dispersive x-ray analysis (EDX) under SEM as EDX reveals qualitative and quantitative information about the structural elements. Highly significant differences in calcium, sodium, phosphorus and silicon contents (p = 0.0000) between plaque particles and balloon surface were observed, owing to the absence of these in balloon material. Thus EDX offers additional advantages over SEM in that it clearly differentiates deformed balloon surface, plaque particle, and retained contrast medium. Plaque particles can be recovered from balloon surfaces after PTCA. Depending upon their size, they could lead to coronary spasm or microembolic phenomenon.

Balloon augmented Onyx embolization utilizing a dual lumen balloon catheter: utility in the treatment of a variety of head and neck lesions.

PubMed

Spiotta, Alejandro M; Miranpuri, Amrendra S; Vargas, Jan; Magarick, Jordan; Turner, Raymond D; Turk, Aquilla S; Chaudry, M Imran

2014-09-01

Endovascular embolization for tumors and vascular malformations has emerged as an important preoperative adjunct prior to resection. We describe the advantages of utilizing a recently released dual lumen balloon catheter for ethylene vinyl alcohol copolymer, also known as Onyx (ev3, Irvine, California, USA), embolization for a variety of head and neck pathologies. A retrospective review of all cases utilizing the Scepter C balloon catheter (MicroVention Inc, Tustin, California, USA) for use in balloon augmented embolization was performed over a 4 month period from October 2012 to February 2013 at the Medical University of South Carolina, Charleston, South Carolina, USA. Charts and angiographic images were reviewed. Representative cases involving diverse pathologies are summarized and illustrate the observed advantages of balloon augmented Onyx embolization with a dual lumen balloon catheter. Balloon augmented Onyx embolization utilizing a novel dual lumen balloon catheter was employed to treat both ruptured and unruptured arteriovenous malformations, intracranial dural arteriovenous fistulae, intracranial neoplasms, carotid body tumors, a thyroid mass, and an extracranial arteriovenous fistula. The dual lumen balloon catheter has several advantages for use with Onyx embolization over older devices, including more efficient proximal plug formation and enhanced navigability for placement deep within the pedicles. The balloon augmented Onyx embolization technique represents a valuable tool to add to the armamentarium of the neurointerventionalist to address a variety of head and neck lesions. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Angioplasty and stent placement - carotid artery

MedlinePlus

... medlineplus.gov/ency/article/002953.htm Angioplasty and stent placement - carotid artery To use the sharing features ... to remove plaque buildup ( endarterectomy ) Carotid angioplasty with stent placement Description Carotid angioplasty and stenting (CAS) is ...

Effects of supramaximal balloon dilatation pressures on adult cricoid and tracheal cartilage: A cadaveric study.

PubMed

Durvasula, Venkata S P B; Shalin, Sara C; Tulunay-Ugur, Ozlem E; Suen, James Y; Richter, Gresham T

2018-06-01

Cricoid fracture is a serious concern for balloon dilatation in airway stenosis. Furthermore, there are no studies examining tracheal rupture in balloon dilatation of stenotic segments. The aim of this study was to evaluate the effect of supramaximal pressures of balloons on the cricoid and tracheal rings. Prospective cadaveric study. Seven cadaveric laryngotracheal complexes of normal adults with intact cricothyroid membranes were acquired. Noncompliant vascular angioplasty balloons (BARD-VIDA) were used for dilatation. The subglottis and trachea were subjected to supramaximal dilatation pressures graduated to nominal burst pressure (NBP) and, if necessary, rated burst pressure (RBP). Larger-diameter balloons, starting from 18 mm size to 24 mm, were used. Dilatations were maintained for 3 minutes. The cricoid ring was disrupted by larger-diameter balloons (22 mm and 24 mm) even at lower pressures (less than NBP) in six cases. Tracheal cartilages were very distensible, and external examination after supramaximal dilatation (24 mm close to RBP) revealed no obvious cartilage fractures or trachealis tears. Histopathological examination revealed sloughing of mucosa in the areas corresponding to balloon placement, but no microfractures or disruption of the perichondrium of tracheal ring cartilages. These results indicate that the cricoid is vulnerable to injury from larger balloons even at lower dilatation pressures. The tracheal cartilages and the membranous wall of the trachea remained resilient to supramaximal dilatation and larger balloons. NA. Laryngoscope, 128:1304-1309, 2018. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

Improvement in the electrocardiograms associated with right ventricular hypertrophy after balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension.

PubMed

Nishiyama, Takahiko; Takatsuki, Seiji; Kawakami, Takashi; Katsumata, Yoshinori; Kimura, Takehiro; Kataoka, Masaharu; Tsuruta, Hikaru; Itabashi, Yuji; Murata, Mitsushige; Yuasa, Shinsuke; Aizawa, Yoshiyasu; Fukuda, Keiichi

2018-06-01

Balloon pulmonary angioplasty (BPA) is a treatment option for patients with chronic thromboembolic pulmonary hypertension (CTEPH). In 60 patients with CTEPH, we examined the hemodynamic data before and after BPA. In addition, the sequential ECG findings for right ventricular hypertrophy (RVH) were assessed. The mean pulmonary arterial pressure (mPAP) decreased from 38 ± 11 to 20 ± 4 mm Hg (p < 0.05). The ROC analysis showed that the S waves in V5, R waves in V1 + S waves in V5, S waves in I, and QRS axis were significant predictors of an mPAP ≧ 30 mm Hg (AUC > 0.75, p < 0.01). The predictive values for the mPAP before the BPA were the S and R waves in lead V6, and P waves in lead II (33.417 + 0.078 × P in II - 0.10 × R in V6 + 0.012 × S in V6). The change in the mPAP (ΔmPAP) correlated with the change in the amplitudes of the ECGs: ΔS wave in lead I (R = 0.544, p < 0.001), ΔR in V1 + S in V5 (R = 0.476, p < 0.001), and ΔP wave in II (R = 0.511, p < 0.001). At 6 months of follow-up, the improvement in an R in V1 + S in V5 of ≧10 mm implied a better functional status. BPA therapy reduced the pulmonary arterial pressure in patients with CTEPH and was associated with an improvement in the ECG findings related to RVH.

Coadjuvant Treatment of Vasospasm in Ruptured Unsecured Cerebral Aneurysms with Aggressive Angioplasty, Intra-Arterial Nimodipine, and Aneurysm Embolization.

PubMed

Chen, Ching-Chang; Yi-Chou Wang, Alvin; Chen, Chun-Ting; Hsieh, Po-Chuan

2018-05-16

Vasospasm is a major cause of morbidity and mortality in patients after aneurysmal subarachnoid hemorrhage. Early treatment of ruptured aneurysms is advocated; delayed intervention complicates the treatment strategy leading to significant vasospasm and poor prognosis. We report an endovascular protocol for occlusion of the unsecured aneurysm and angioplasty for vasospasm in a single session. Between January 2011 and May 2017, among 660 patients with aneurysmal subarachnoid hemorrhage, 24 patients with significant vasospasm and unsecured ruptured cerebral aneurysm were reviewed. Continuous nimodipine drip through a pressure line of the guiding catheter was set up. Aggressive angioplasty with a compliant balloon catheter either before or after embolization of the aneurysm in the major branches of vasospastic territory was performed. The goal was complete embolization of the aneurysm. Of 24 patients, 17 had ischemic symptoms at presentation, and the average delay from aneurysm rupture to presentation was 7.58 days. Angioplasty and nimodipine drip were performed on all patients. Severity of vasospasm was significantly reduced, and outcome improved in each patient. Two patients required a second angioplasty. In 20 patients, embolization of aneurysms was achieved without any aneurysmal sac or residual neck. Clinical outcome was good recovery (modified Rankin Scale score 0-2) in 23 patients (95.8%) and moderate disability in 1 patient (modified Rankin Scale score 3). Aggressive endovascular treatment of patients with unsecured ruptured cerebral aneurysm and associated vasospasm is safe and effective. Copyright © 2018 Elsevier Inc. All rights reserved.

PTA of supra-aortic arteries with temporary balloon occlusion to avoid distal embolism.

PubMed

Koike, T; Minakawa, T; Abe, H; Takeuchi, S; Sasaki, O; Nishimaki, K; Tanaka, R

1992-03-01

Percutaneous transluminal angioplasty (PTA) was carried out in eight patients with cervical arterial stenosis; six in the subclavian and brachiocephalic arteries (5 with subclavian steal syndrome), one in the common carotid artery, and one in both the brachiocephalic and common carotid arteries (with subclavian steal syndrome). The PTA balloon catheters were introduced via the femoral artery in seven and brachial artery in one. To prevent distal embolization through the vertebral and internal carotid arteries, the blood flow in these vessels was temporarily occluded with a balloon catheter. The dilation of the stenotic areas was generally satisfactory. Antegrade blood flow was promptly obtained in the vertebral artery even in patients with subclavian steal syndrome. In all patients, the clinical symptoms improved. Two patients underwent repeat PTA because of restenosis.

Aggressive plaque modification with rotational atherectomy and cutting balloon for optimal stent expansion in calcified lesions

PubMed Central

Tang, Zhe; Bai, Jing; Su, Shao-Ping; Lee, Pui-Wai; Peng, Liang; Zhang, Tao; Sun, Ting; Nong, Jing-Guo; Li, Tian-De; Wang, Yu

2016-01-01

Objective To evaluate the factors affecting optimal stent expansion in calcified lesions treated by aggressive plaque modification with rotational atherectomy (RA) and a cutting balloon (CB). Methods From January 2014 to May 2015, 92 patients with moderate to severe coronary calcified lesions underwent rotational atherectomy and intravascular ultrasound imaging at Chinese PLA General Hospital (Beijing, China) were included in this study. They were divided into a rotational artherectomy combined with cutting balloon (RACB) group (46 patients treated with RA followed by CB angioplasty) and an RA group (46 patients treated with RA followed by plain balloon angioplasty). Another 40 patients with similar severity of their calcified lesions treated with plain old balloon angioplasty (POBA) were demographically matched to the other groups and defined as the POBA group. All patients received a drug-eluting stent after plaque preparation. Lumen diameter and lumen diameter stenosis (LDS) were measured by quantitative coronary angiography at baseline, after RA, after dilatation, and after stenting. Optimal stent expansion was defined as the final LDS < 10%. Results The initial and post-RA LDS values were similar among the three groups. However, after dilatation, the LDS significantly decreased in the RACB group (from 54.5% ± 8.9% to 36.1% ± 7.1%) but only moderately decreased (from 55.7% ± 7.8% to 46.9% ± 9.4%) in the RA group (time × group, P < 0.001). After stenting, there was a higher rate of optimal stent expansion in the RACB group (71.7% in the RACB group, 54.5% in the RA group, and 15% in the POBA group, P < 0.001), and the final LDS was significantly diminished in the RACB group compared to the other two groups (6.0% ± 2.3%, 10.8% ± 3.3%, 12.7% ± 2.1%, P < 0.001). Moreover, an LDS ≤ 40% after plaque preparation (OR = 2.994, 95% CI: 1.297–6.911) was associated with optimal stent expansion, which also had a positive correlation with the appearance of a

Bypass versus Angioplasty in Severe Ischaemia of the Leg (BASIL) trial: An intention-to-treat analysis of amputation-free and overall survival in patients randomized to a bypass surgery-first or a balloon angioplasty-first revascularization strategy.

PubMed

Bradbury, Andrew W; Adam, Donald J; Bell, Jocelyn; Forbes, John F; Fowkes, F Gerry R; Gillespie, Ian; Ruckley, Charles Vaughan; Raab, Gillian M

2010-05-01

A 2005 interim analysis of the Bypass versus Angioplasty in Severe Ischaemia of the Leg (BASIL) trial showed that in patients with severe lower limb ischemia (SLI; rest pain, ulceration, gangrene) due to infrainguinal disease, bypass surgery (BSX)-first and balloon angioplasty (BAP)-first revascularization strategies led to similar short-term clinical outcomes, although BSX was about one-third more expensive and morbidity was higher. We have monitored patients for a further 2.5 years and now report a final intention-to-treat (ITT) analysis of amputation-free survival (AFS) and overall survival (OS). Of 452 enrolled patients in 27 United Kingdom hospitals, 228 were randomized to a BSX-first and 224 to a BAP-first revascularization strategy. All patients were monitored for 3 years and more than half for >5 years. At the end of follow-up, 250 patients were dead (56%), 168 (38%) were alive without amputation, and 30 (7%) were alive with amputation. Four were lost to follow-up. AFS and OS did not differ between randomized treatments during the follow-up. For those patients surviving 2 years from randomization, however, BSX-first revascularization was associated with a reduced hazard ratio (HR) for subsequent AFS of 0.85 (95% confidence interval [CI], 0.5-1.07; P = .108) and for subsequent OS of 0.61 (95% CI, 0.50-0.75; P = .009) in an adjusted, time-dependent Cox proportional hazards model. For those patients who survived for 2 years after randomization, initial randomization to a BSX-first revascularization strategy was associated with an increase in subsequent restricted mean overall survival of 7.3 months (95% CI, 1.2-13.4 months, P = .02) and an increase in restricted mean AFS of 5.9 months (95% CI, 0.2-12.0 months, P = .06) during the subsequent mean follow-up of 3.1 years (range, 1-5.7 years). Overall, there was no significant difference in AFS or OS between the two strategies. However, for those patients who survived for at least 2 years after randomization, a

Drug‐coated balloons for de novo lesions in small coronary arteries: rationale and design of BASKET‐SMALL 2

PubMed Central

Gilgen, Nicole; Farah, Ahmed; Scheller, Bruno; Ohlow, Marc‐Alexander; Mangner, Norman; Weilenmann, Daniel; Wöhrle, Jochen; Jamshidi, Peiman; Leibundgut, Gregor; Möbius‐Winkler, Sven; Zweiker, Robert; Krackhardt, Florian; Butter, Christian; Bruch, Leonhard; Kaiser, Christoph; Hoffmann, Andreas; Rickenbacher, Peter; Mueller, Christian; Stephan, Frank‐Peter; Coslovsky, Michael

2018-01-01

The treatment of coronary small vessel disease (SVD) remains an unresolved issue. Drug‐eluting stents (DES) have limited efficacy due to increased rates of instent‐restenosis, mainly caused by late lumen loss. Drug‐coated balloons (DCB) are a promising technique because native vessels remain structurally unchanged. Basel Stent Kosten‐Effektivitäts Trial: Drug‐Coated Balloons vs. Drug‐Eluting Stents in Small Vessel Interventions (BASKET‐SMALL 2) is a multicenter, randomized, controlled, noninferiority trial of DCB vs DES in native SVD for clinical endpoints. Seven hundred fifty‐eight patients with de novo lesions in vessels <3 mm in diameter and an indication for percutaneous coronary intervention such as stable angina pectoris, silent ischemia, or acute coronary syndromes are randomized 1:1 to angioplasty with DCB vs implantation of a DES after successful initial balloon angioplasty. The primary endpoint is the combination of cardiac death, nonfatal myocardial infarction, and target‐vessel revascularization up to 1 year. Secondary endpoints include stent thrombosis, Bleeding Academic Research Consortium (BARC) type 3 to 5 bleeding, and long‐term outcome up to 3 years. Based on clinical endpoints after 1 year, we plan to assess the noninferiority of DCB compared to DES in patients undergoing primary percutaneous coronary intervention for SVD. Results will be available in the second half of 2018. This study will compare DCB and DES regarding long‐term safety and efficacy for the treatment of SVD in a large all‐comer population. PMID:29527709

DOE Office of Scientific and Technical Information (OSTI.GOV)

Gosling, J.; Nayeemuddin, M.; Cowling, M.

Here, a case of Paget-Schroetter Syndrome in a 25-year-old guitar player is reported. After thrombolysis, conventional angioplasty failed to dilate the underlying subclavian stenosis both before and after first-rib excision with scalenus anterior and medius division. For the third attempt at angioplasty, a cutting balloon was used, which immediately produced a good result. Venography at 4-year follow-up showed no restenosis and no functional deficit. This case report demonstrates that cutting-balloon angioplasty may be considered when conventional balloon fails and may have greater durability than conventional balloon angioplasty in the treatment of Paget-Schroetter syndrome.

One Year Primary Patency of Infrapopliteal Angioplasty Using Drug- Eluting Balloons: Single Center Experience at King Hussein Medical Center

PubMed Central

Haddad, Sizeph Edward; Shishani, Jan Mohammad; Qtaish, Izzeddin; Rawashdeh, Mohammad Abdelmajeed; Qtaishat, Belal Saleh

2017-01-01

Objective: Conventional percutaneous transluminal angioplasty (PTA) for long lesions in the below-the-knee (BTK) arteries in patients presenting with critical limb ischemia (CLI) has high restenosis rates at 1 year. Our goal is to evaluate whether paclitaxel drug-eluting balloons (DEB) have higher 1 year primary patency rates compared to conventional PTA. Methods: This is a single-center, prospective, randomized trial that was conducted from June 2013 to December 2015. The aim of the study was to compare 1 year primary patency rates of DEB and PTA in BTK arteries in CLI patients. Inclusion criteria were patients presenting with CLI (Rutherford class 4 or greater), stenosis or occlusion ≥30 mm of at least one tibial artery, and agreement to 12-month evaluation. Exclusion criteria were life expectancy <1 year, allergy to paclitaxel, and contraindication to combined antiplatelet treatment. Follow-up was performed by clinical assessment, ankle brachial pressure index, Doppler ultrasound imaging, and conventional angiogram if indicated. Primary end point was 1 year primary patency, and secondary end points were target lesion revascularization (TLR) and major amputation. Statistical analysis was performed using Fischer's exact test. Results: Ninety-three patients with 106 lesions in the BTK arteries were enrolled in this study. One year primary patency was achieved in 26 (65%) and seven (17%) in the DEB and PTA groups (P = 0.006), respectively. TLR was performed in nine lesions (23%) and 29 lesions (71%) in DEB and PTA groups (P = 0.009), respectively. Major amputations occurred in one limb (2%) and two limbs (4%) in DEB and PTA groups (P = 0.6), respectively. Conclusion: Paclitaxel DEB has significantly higher 1 year primary patency rate associated with significantly less TLR than conventional PTA, following endovascular recanalization of BTK arteries in patients presenting with CLI. PMID:28852581

Temporary Percutaneous Aortic Balloon Occlusion to Enhance Fluid Resuscitation Prior to Definitive Embolization of Post-Traumatic Liver Hemorrhage

DOE Office of Scientific and Technical Information (OSTI.GOV)

Matsuoka, Shin; Uchiyama, Katsuhiro; Shima, Hideki

2001-07-15

We successfully stabilized severe hemorrhagic shock following traumatic liver injury by percutaneous transcarotid supraceliac aortic occlusion with a 5 Fr balloon catheter. Then we were able to perform transfemoral embolization therapy of the hepatic arterial bleeding source. Transient aortic occlusion using a balloon catheter appears to be a useful adjunct in select cases where stabilization of the patient is necessary to allow successful selective embolization of the bleeding source.

Transradial primary angioplasty and stenting in Indian patients with acute myocardial infarction: acute results and 6-month follow-up.

PubMed

Ranjan, Alok; Patel, Tejas M; Shah, Sanjay C; Malhotra, Hemant; Patel, Rajni; Vayada, Nishith; Pothiwala, Rasesh; Fonseca, Keith; Tanwar, Narendra S

2005-01-01

Coronary angioplasty and stent implantation is effective as primary intervention in acute myocardial infarction. Because of fewer puncture site complications and improved patient comfort, transradial access has been increasingly used as an alternative to transfemoral access for percutaneous coronary interventions. We studied 103 patients (94 men, 9 women: mean age 52.5 +/- 11.96 years) with a diagnosis of acute myocardial infarction (<12 hours after onset), who underwent primary percutaneous coronary intervention. Transradial access was used in all patients with a normal Allen's test and transfemoral access was used additionally only if intra-aortic balloon counterpulsation was required. Follow-up duration was 6 months. Transradial access was successfully achieved in all patients. Radial artery cannulation took <2 min in more than 85% patients. During percutaneous coronary intervention, cannulation to balloon inflation times and total procedure times were 11.3 +/- 5.2 min and 19.9 +/- 10.8 min, respectively. Stents were implanted in 99 (96.1%) patients andplain balloon angioplastywas performed in 3.9%. The primary success rate was 98.1%, with no major bleeding complications. Total length of hospitalization averaged 2.4 +/- 0.8 days. In-hospital major adverse clinical events rate was 5.9%. Six-month clinical follow-up was achieved for 84 (86.6%) patients. Six (7.1%) patients died during follow-up. Follow-up coronary angiography was performed in 22 (26.2%) patients. After 6 months, 7 patients required revascularizationof the target lesion. The rate of survival without myocardial infarction, bypass surgery or repeat coronary angioplasty was 88.5% at 6 months. Transradial access may represent a safe and feasible technique for performing primary percutaneous coronary intervention with good acute results and without major bleeding complications.

Balloon-occluded Retrograde Transvenous Obliteration (BRTO): Technique and Intraprocedural Imaging

PubMed Central

Sabri, Saher S.; Saad, Wael E. A.

2011-01-01

Balloon-occluded retrograde transvenous obliteration (BRTO) is an endovascular technique used as a therapeutic adjunct or alternative to transjugular intrahepatic shunts (TIPS) in the management of gastric varices. Occlusion balloons are strategically placed to modulate flow within the gastrorenal or gastrocaval shunt to allow stagnation of the sclerosant material within the gastric varix. The approach and complexity of the procedure depends on the anatomic classification of inflow and outflow veins of the varix. Ethanolamine oleate has been described as the main sclerosant used in this procedure. Recently, foam sclerosants have gained popularity as alternative embolization agents, which provide the advantage of better variceal wall contact and potentially less dose of sclerosant. PMID:22942548

Temporary Arterial Balloon Occlusion as an Adjunct to Yttrium-90 Radioembolization

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hagspiel, Klaus D., E-mail: kdh2n@virginia.edu; Nambiar, Ashwin, E-mail: uvashwin@gmail.com; Hagspiel, Lauren M., E-mail: lmh4gg@virginia.edu

2013-06-15

Purpose. This study was designed to describe the technique of arterial occlusion using a temporary occlusion balloon system as an alternative to coil occlusion during Yttrium-90 radioembolization of hepatic tumors. Methods. Review of charts, angiography, and follow-up imaging studies of consecutive patients undergoing oncological embolization procedures in which a HyperForm system (ev3 Neurovascular, Irvine, CA) was used. Intraprocedural target vessel occlusion and patency of the target vessel on follow-up were recorded. Clinical data and Bremsstrahlung scans were reviewed for evidence of nontarget embolization. Results. Four radioembolization procedures were performed in three patients (all female, age 48-54 (mean 52) years). Fivemore » arteries were temporarily occluded (three gastroduodenal arteries, one right gastric artery, and one cystic artery). All radioembolization procedures were successfully completed. Follow-up imaging (either digital subtraction angiography (DSA) or computed tomography angiography (CTA)) was available for all patients between 28-454 (mean 183) days following the procedure, demonstrating all five vessels to be patent. No clinical or imaging evidence for nontarget embolization was found. Conclusions. Temporary balloon occlusion of small and medium-sized arteries during radioembolization allows safe therapy with preserved postprocedural vessel patency on early and midterm follow-up.« less

Longitudinal outcomes after tibioperoneal angioplasty alone compared to tibial stenting and atherectomy for critical limb ischemia.

PubMed

Reynolds, Shaun; Galiñanes, Edgar Luis; Dombrovskiy, Viktor Y; Vogel, Todd R

2013-10-01

There are limited data available evaluating longitudinal outcomes after tibioperoneal angioplasty (TA) alone compared to adjunctive tibial procedures including stenting and atherectomy. Using the Centers for Medicare & Medicaid Services inpatient claims (2005-2007), patients evaluated TA only, TA plus stent placement (TA + S), and TA plus atherectomy (TA + A). A total of 2080 patients with critical limb ischemia underwent percutaneous tibioperoneal intervention for the indication of ulceration. Procedures included TA (56.3%), TA + S (16.2%), and TA + A (27.5%). Rates of amputation were not statistically different between the groups at 30, 90, and 365 days after the intervention. Mean total hospital charges were TA ($35,867), TA + A ($41,698; P = .0004), and TA + S ($51,040; P < .0001). Patients undergoing TA alone compared to concomitant stenting or atherectomy for ulceration demonstrated no improvement in limb salvage. Future analysis of adjunctive tibioperoneal interventions is essential to temper cost, as they fail to improve long-term limb salvage.

Iatrogenic left main coronary artery dissection due to pin-hole balloon rupture: Not to be panicked….

PubMed

Jeyakumaran, Balakumaran; Raj, Ajay; Pandit, Bhagya Narayan; Kumar, Tarun; Deora, Surender

2015-12-01

Iatrogenic left main coronary artery (LMCA) dissection is a rare complication and may have devastating consequences if not immediately intervened. The management includes urgent revascularization mostly with percutaneous coronary intervention (PCI) with bail-out stenting and rarely requires coronary artery bypass graft (CABG) surgery. In clinically and hemodynamically stable patients, a conservative approach may be preferred. Here, we present a rare case of iatrogenic retrograde LMCA dissection due to pin-hole rupture of angioplasty balloon that was managed conservatively.

Drug-coated balloons for de novo lesions in small coronary arteries: rationale and design of BASKET-SMALL 2.

PubMed

Gilgen, Nicole; Farah, Ahmed; Scheller, Bruno; Ohlow, Marc-Alexander; Mangner, Norman; Weilenmann, Daniel; Wöhrle, Jochen; Jamshidi, Peiman; Leibundgut, Gregor; Möbius-Winkler, Sven; Zweiker, Robert; Krackhardt, Florian; Butter, Christian; Bruch, Leonhard; Kaiser, Christoph; Hoffmann, Andreas; Rickenbacher, Peter; Mueller, Christian; Stephan, Frank-Peter; Coslovsky, Michael; Jeger, Raban

2018-05-01

The treatment of coronary small vessel disease (SVD) remains an unresolved issue. Drug-eluting stents (DES) have limited efficacy due to increased rates of instent-restenosis, mainly caused by late lumen loss. Drug-coated balloons (DCB) are a promising technique because native vessels remain structurally unchanged. Basel Stent Kosten-Effektivitäts Trial: Drug-Coated Balloons vs. Drug-Eluting Stents in Small Vessel Interventions (BASKET-SMALL 2) is a multicenter, randomized, controlled, noninferiority trial of DCB vs DES in native SVD for clinical endpoints. Seven hundred fifty-eight patients with de novo lesions in vessels <3 mm in diameter and an indication for percutaneous coronary intervention such as stable angina pectoris, silent ischemia, or acute coronary syndromes are randomized 1:1 to angioplasty with DCB vs implantation of a DES after successful initial balloon angioplasty. The primary endpoint is the combination of cardiac death, nonfatal myocardial infarction, and target-vessel revascularization up to 1 year. Secondary endpoints include stent thrombosis, Bleeding Academic Research Consortium (BARC) type 3 to 5 bleeding, and long-term outcome up to 3 years. Based on clinical endpoints after 1 year, we plan to assess the noninferiority of DCB compared to DES in patients undergoing primary percutaneous coronary intervention for SVD. Results will be available in the second half of 2018. This study will compare DCB and DES regarding long-term safety and efficacy for the treatment of SVD in a large all-comer population. © 2018 The Authors. Clinical Cardiology published by Wiley Periodicals, Inc.

Application of new balloon catheters in the treatment of congenital heart defects

PubMed Central

Fiszer, Roland; Szkutnik, Małgorzata; Smerdziński, Sebastian; Chodór, Beata; Białkowski, Jacek

2016-01-01

Introduction Balloon angioplasty (BAP) and aortic or pulmonary balloon valvuloplasty (BAV, BPV) are well-established treatment options in congenital heart defects. Recently, significant technological progress has been made and new catheters have been implemented in clinical practice. Aim To analyze the results of BAP, BAV and BPV with the new balloon catheter Valver and its second generation Valver II, which the company Balton (Poland) launched and developed. These catheters have not been clinically evaluated yet. Material and methods We performed 64 interventions with Valver I and Valver II. With Valver I the following procedures were performed: 17 BPV (including 9 in tetralogy of Fallot – TOF), 10 BAV and 27 BAP in coarctations of the aorta (CoA) – including 9 native and 18 after surgery. With Valver II ten interventions were done – 3 BPV, 2 pulmonary supravalvular BAP (after switch operations), 2 BAP of recoarctations and 3 other BAP. Age of the patients ranged from a few days to 40 years. Results All procedures were completed successfully, without rupture of any balloon catheters. The pressure gradient drop was statistically significant in all groups: BPV in isolated pulmonary valvular stenosis 28.1 mm Hg (mean), BPV in TOF 18.7 mm Hg, BAV 32.8 mm Hg, BAP in native CoA 15.4 mm Hg and in recoarctations 18.6 mm Hg. In 3 cases during rapid deflation of Valver I, wrinkles of the balloons made it impossible to insert the whole balloon into the vascular sheath (all were removed surgically from the groin). No such complication occured with Valver II. Conclusions Valver balloon catheters are an effective treatment modality in different valvular and vascular stenoses. PMID:27625686

[Baloon angioplasty with stent implantation in recoarctation of the aorta: an attractive alternative].

PubMed

Saliba, Z; Aggoun, Y; Iserin, L; Massih, T A; Bonnet, D; Acar, P; Mousseaux, E; Sidi, D; Kachaner, J; Bonhoeffer, P

2001-05-01

The results of transcatheter balloon angioplasty in teenagers and adults with aortic recoarctation are uncertain. Therefore, there is a current trend to prefer a more complex procedure including the implantation of a stent. This study deals with 8 patients aged 7 to 25.3 years (median: 15 years), weighing 20 to 68 kg. (median: 57) and having undergone resection of an aortic coarctation during infancy (24 days to 4 years). All had their lower limb pulses diminished or abolished, elevated blood pressure at rest (and at exercise in the 5 tested patients), and left ventricular hypertrophy. MRI documented the lesion and helped to select seven patients whose stenosis was short and remote enough from the origin of the main aortic collateral. In one case, the decision to stent was taken as an emergent measure to treat an aortic dissection which appeared shortly after balloon dilatation. The effectiveness of the procedure was immediate in all patients with a 50% increase in diameter of the dilated area, total relief of the gradient, drop to normal values of the blood pressure. These good results persisted at follow-up (3-24 months) in 6 patients, with moderate hypertensive rebounds in the last 2. There were 2 technical problems (premature burst of the balloon, asymmetrical inflation of the stent like an "Eiffel Tower") that could finally be overcome and should no longer occur with the new specially designed so-called "BIB" balloons. Would long term follow-up confirm these early results, one should conclude that this method offers an attractive, safe and effective option to surgery for adolescents and adults with late recoarctation of the aorta.

Energy efficiency and pulmonary artery flow after balloon pulmonary angioplasty for inoperable, chronic thromboembolic pulmonary hypertension: Analysis by phase-contrast MRI.

PubMed

Nagao, Michinobu; Yamasaki, Yuzo; Abe, Kohtaro; Hosokawa, Kazuya; Kawanami, Satoshi; Kamitani, Takeshi; Yamanouchi, Torahiko; Yabuuchi, Hidetake; Fukushima, Kenji; Honda, Hiroshi

2017-02-01

The aims of this study were to propose a new quantitative method for pulmonary artery (PA) flow energetics using phase-contrast magnetic resonance imaging (PC-MRI), and to investigate how balloon pulmonary angioplasty (BPA) impacts energetics in chronic thromboembolic pulmonary hypertension (CTEPH). PC-MRI at 3-Teslar and with a flow sensitive gradient echo was used to examine energetics prior to and following BPA for 24 CTEPH patients. Stroke volume (m; ml) and mean velocity (V; mm/s) for the main pulmonary artery (PA), right PA, and left PA were calculated from a time-flow curve derived from PC-MRI. Based on the Bernoulli principle, PA energy was identified as 1/2mV 2 (μj/kg), and energy loss was defined as the following equation "energy loss=main PA energy-(rt. PA energy+lt. PA energy)". Right PA energy was significantly greater post-BPA than pre-BPA (61±55 vs. 32±40μj/kg). There was no difference in main PA and left PA energies. Energy loss was significantly decreased post-BPA (18±97μj/kg) than pre-BPA (79±125μj/kg). An optimal cutoff of left PA energy of 45μj/kg pre-BPA can be used to predict patients with mPAP≥30mmHg after BPA, with an area under the curve of 0.91, 78% sensitivity, and 92% specificity. Analysis of PA energetics using phase-contrast MRI demonstrates that BPA improves energy loss in CTEPH. In addition, BPA responses can be predicted by PA energy status pre-treatment. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Emergency coronary angioplasty with stenting using Cordis® diagnostic coronary catheters when there is difficulty in engaging guide catheters and bench evaluation of diagnostic and guide catheters.

PubMed

Arokiaraj, Mark Christopher

2018-02-01

Difficulty in engaging with guide catheters is not uncommon in acute emergencies. We aimed to evaluate the use of Cordis ® INFINITI diagnostic catheters to perform angioplasty in patients in whom the coronaries cannot be engaged using standard guide catheters. In 34 cases of acute coronary syndrome, when difficulty in engagement with two standard guide catheters was encountered with reasonable manipulations, angioplasty was performed using diagnostic catheters. In total, 40 stents were placed by this technique. Pushability and trackability, distal tip flexion and three-point bending tests were performed to evaluate the performance of the guide and diagnostic catheters. Angioplasty was performed easily in a setting where it would have been very difficult to perform. Coronary dissection occurred in one patient, treated by a stent. The stent and dilatation balloons were easily passed through the diagnostic catheters. Pressure tracings were clearly preserved with certain stent delivery systems, and at angioplasty, although there was slightly reduced opacification of the respective artery, the coronary anatomy was sufficiently visualized to perform angioplasty. No periprocedural target lesion complications were seen in any cases. Pushability and trackability tests showed good force transmission along a tortuous path with diagnostic catheters, and balanced force-displacement curves from three-point bending tests and distal tip softness tests. Angioplasty with stenting can be performed safely through 6F Cordis ® infiniti diagnostic catheters when difficulty in engaging guide catheters is encountered. Copyright © 2018 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

Pharmacokinetic Evaluation of Two Paclitaxel-Coated Balloons with Different Drug Load in a Short-Term Porcine Study

DOE Office of Scientific and Technical Information (OSTI.GOV)

Abadal, J. M., E-mail: jmabadal@yahoo.es; Vazquez, Esther, E-mail: esva9999@gmail.com; Morales, Miguel, E-mail: miguel.moralesg@gmail.com

PurposeThe aim of the study was to evaluate the pharmacokinetics and tissue absorption of 2 paclitaxel (PTX) drug-coated balloons (DCB) using different drug loads in a porcine-injured iliac artery model.Materials and MethodsTwenty-eight pigs were randomized into 2 groups. In group B1, angioplasty was performed with a 1.0 µg/mm{sup 2} DCB with PTX and in group B3, with a 3.0 µg/mm{sup 2} DCB with PTX. An overstretched model of the iliac artery was used for angioplasty under fluoroscopy. Blood and vessel wall PTX were measured with liquid-chromatography mass spectrometry at 1, 5, 30 min, 1, 7, and 28 days. Remaining drug in the balloon wasmore » analyzed.ResultsMean PTX in blood was significantly higher in the group B3 0.269 ± 0.085 µg/ml compared with the B1 0.218 ± 0.085 µg/ml; p = 0.01. Peak blood PTX concentration was detected at 1 min, and PTX was undetectable 24 h post-angioplasty. There were no statistically significant differences in the mean arterial wall concentration from the treated iliac artery between group-B1 (15.24 ± 21.29 ng/mg) and B3 (15.68 ± 16.33 ng/mg), or in the PTX wall concentration measured at different time points. Mean remaining drug in assayed balloons was lower for group-B1 and represented 8 % of the initial dose.ConclusionsBlood PTX was higher when using 3.0 µg/mm{sup 2} DCB, with a peak drug concentration at 1-min, although the drug was undetectable at 24 h, independently of the loading dose. This study demonstrates no difference in arterial wall uptake of a low dose DCB (1.0 µg/mm{sup 2}), when compared to a common dose DCB (3.0 µg/mm{sup 2}) suggesting that the dose of drug in the DCB could be reduced obtaining a similar clinical effect.« less

Drug-coated balloon treatment of coronary artery disease: a position paper of the Italian Society of Interventional Cardiology.

PubMed

Cortese, Bernardo; Berti, Sergio; Biondi-Zoccai, Giuseppe; Colombo, Antonio; Limbruno, Ugo; Bedogni, Francesco; Cremonesi, Alberto; Silva, Pedro Leon; Sgueglia, Gregory A

2014-02-15

Drug-coated balloons are a new tool for the treatment of patients with coronary artery disease. The main feature of this technology is a rapid and homogenous transfer of an antiproliferative drug (paclitaxel) to the vessel wall just at the time of balloon inflation, when neointimal proliferation, in response to angioplasty, is the highest. Moreover, drug-coated balloons share adjuntive advantages over stents: the absence of permanent scaffold and polymer, the respect of the original coronary anatomy, and limited inflammatory stimuli, thereby allowing for short-term dual antiplatelet therapy. To this day, a lot of devices are available in the market, with limited scientific data for the vast majority of them. Thus, the Italian scientific society of interventional cardiologists GISE decided to coordinate the efforts of a group of reknown experts on the field, in order to obtain a Position Paper on the correct use of drug-coated balloons in all the settings of coronary artery disease, giving a class of indication to each one, based on the clinical evidence. This Position Paper represents a quick reference for operators, investigators, and manufactures to promote the understanding and the correct use of the drug-coated balloon technology in everyday clinical practice. Copyright © 2013 Wiley Periodicals, Inc.

Balloon pulmonary angioplasty relieves haemodynamic stress towards untreated-side pulmonary vasculature and improves its resistance in patients with chronic thromboembolic pulmonary hypertension.

PubMed

Hosokawa, Kazuya; Abe, Kohtaro; Horimoto, Koshin; Yamasaki, Yuzo; Nagao, Michinobu; Tsutsui, Hiroyuki

2018-04-20

Chronic thromboembolic pulmonary hypertension (CTEPH) is characterised by organised thrombotic obliteration of major vessels and small-vessel arteriopathy in the non-thrombosed vessels. The aim of this study was to investigate the impact of balloon pulmonary angioplasty (BPA) on the non-BPA-side pulmonary vasculature in patients with CTEPH. This study explored the outcomes of 20 unilateral BPA sessions in 13 CTEPH patients. We measured the pulmonary vascular resistance (PVR), pulmonary artery (PA) flow in the BPA-side and non-BPA-side lungs, respectively, using phase contrast MRI and cardiac catheterisation. The interval from BPA to the follow-up evaluation was 92.8±52.0 days. A single session of BPA decreased mean PA pressure from 37.4±6.2 to 30.9±6.5 mmHg (p<0.001). In the BPA side, BPA increased the PA flow from 1.58±0.65 to 1.95±0.62 L/min (p=0.001) and decreased the PVR from 27.3±27.4 to 14.4±9.0 Wood units (p=0.004). In contrast, it decreased both the non-BPA-side PA flow from 2.25±0.64 to 1.90±0.23 L/min (p=0.008) and the non-BPA-side PVR from 14.8±6.6 to 12.8±3.9 Wood units (p=0.01). BPA could relieve haemodynamic stress towards the non-BPA-side vasculature and decrease its PVR in patients with CTEPH, suggesting that it can suppress or regress the progression of the small-vessel arteriopathy in non-BPA-side vasculature, presumably due to haemodynamic unloading.

Impact of Balloon Pulmonary Angioplasty on Hemodynamics and Clinical Outcomes in Patients with Chronic Thromboembolic Pulmonary Hypertension: the Initial Korean Experience.

PubMed

Kwon, Woochan; Yang, Jeong Hoon; Park, Taek Kyu; Chang, Sung A; Jung, Dong Seop; Cho, Young Seok; Kim, Sung Mok; Kim, Tae Jung; Park, Hye Yoon; Choi, Seung Hyuk; Kim, Duk Kyung

2018-01-22

The treatment of choice for chronic thromboembolic pulmonary hypertension (CTEPH) is pulmonary endarterectomy (PEA). However, not all patients are eligible for PEA, and some patients experience recurrence of pulmonary hypertension even after PEA. Patients who underwent balloon pulmonary angioplasty (BPA) between December 2015 and April 2017 were enrolled from the Samsung Medical Center CTEPH registry. Enrolled patients underwent right heart catheterization, echocardiography, and 6-minute walk distance (6MWD) at baseline, 4 and 24 weeks after their first BPA session. We compared clinical and hemodynamic parameters at the baseline and last BPA session. Fifty-two BPA sessions were performed in 15 patients, six of whom had a history of PEA. BPA resulted in improvements in World Health Organization (WHO) functional class (2.9 ± 0.8 to 1.7 ± 0.6, P = 0.002), 6MWD (387.0 ± 86.4 to 453.4 ± 64.8 m, P = 0.01), tricuspid annular plane systolic excursion (14.1 ± 3.6 to 15.6 ± 4.3 mm, P = 0.03) and hemodynamics, including a decline in mean pulmonary artery pressure (41.1 ± 13.1 to 32.1 ± 9.5 mmHg, P < 0.001) and in pulmonary vascular resistance (607.4 ± 452.3 to 406.7 ± 265.4 dyne.sec.cm⁻⁵, P = 0.01) but not in cardiac index (2.94 ± 0.79 to 2.96 ± 0.93 L/min/m², P = 0.92). Six cases of complications were recorded, including two cases of reperfusion injury. BPA might be a safe and effective treatment strategy for both inoperable CTEPH patients and patients with residual pulmonary hypertension after PEA. © 2018 The Korean Academy of Medical Sciences.

Peripheral Atherectomy: Applications and Techniques.

PubMed

Mittleider, Derek; Russell, Erich

2016-06-01

Peripheral atherectomy is a class of procedures that is rapidly increasing in volume. Multiple classes of devices exist, and newer variants are added to the market annually. The devices see wide application for de novo lesions, in-stent restenosis, and adjunctive therapy for drug-coated balloons. The body of evidence supporting atherectomy is less robust than for many other peripheral therapies. The frequency and severity of complications from atherectomy can be significant compared with angioplasty and stenting, and familiarity with preventative and bailout techniques is essential for the interventionalist. Copyright © 2016 Elsevier Inc. All rights reserved.

Early and Long-Term Results of Subclavian Angioplasty in Aortoarteritis (Takayasu Disease): Comparison with Atherosclerosis

DOE Office of Scientific and Technical Information (OSTI.GOV)

Tyagi, Sanjay; Verma, Puneet K.; Gambhir, Daljeet S.

1998-05-15

Purpose: To compare the early andlong-term outcomes of subclavian artery angioplasty in patients with aortoarteritis and atherosclerosis. Methods: Sixty-one subclavian artery angioplasties were performed in 55 consecutive patients with aortoarteritis (n= 32) and atherosclerosis (n= 23) between 1986 and 1995. An arch aortogram followed by a selective subclavian artery angiogram was done to profile the site and extent of the lesion, its relation to the vertebral artery, and the distal circulation. Percutaneous transluminal angioplasty (PTA) was performed via the femoral route for 56 stenotic lesions and 5 total occlusions. Results: PTA was successful in 52 (92.8%) stenotic lesions and 3more » (60%) total occlusions. Three patients (5.4%) had complications, that could be effectively managed nonsurgically. Compared with atherosclerosis, patients with aortoarteritis were younger (27.4 {+-} 9.3 years vs 54.5 {+-} 10.5 years; p < 0.001), more often female (75% vs 17.4%; p < 0.001), gangrene was uncommon (0% vs 17.4%; p < 0.05), and diffuse involvement was seen more often (43.8% vs 4.4%; p < 0.001). The luminal diameter stenoses were similar before PTA (88.6 {+-} 9.7% vs 89.0 {+-} 9.1%; p= NS). Higher balloon inflation pressure was required to dilate the lesions of aortoarteritis (9.9 {+-} 4.6 ATM vs 5.5 {+-} 1.0 ATM; p < 0.001). This group had more residual stenosis (15.5 {+-} 12.4% vs 8.3 {+-} 9.4%; p < 0.05) after PTA. There were no neurological sequelae, even in PTA of prevertebral lesions. On 3-120 months (mean 43.3 {+-} 28.9 months) follow-up of 40 patients, restenosis was more often observed in patients with aortoarteritis, particularly in those with diffuse arterial narrowing. These lesions could be effectively redilated. Clinical symptoms showed marked improvement after successful angioplasty. Conclusion: Subclavian PTA is safe and can be performed as effectively in aortoarteritis as in atherosclerosis, with good long-term results. Long-term follow-up shows that

Efficacy and safety of balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension guided by cone-beam computed tomography and electrocardiogram-gated area detector computed tomography.

PubMed

Ogo, Takeshi; Fukuda, Tetsuya; Tsuji, Akihiro; Fukui, Shigefumi; Ueda, Jin; Sanda, Yoshihiro; Morita, Yoshiaki; Asano, Ryotaro; Konagai, Nao; Yasuda, Satoshi

2017-04-01

Chronic thromboembolic pulmonary hypertension (CTEPH) is a disease characterized by chronic obstructive thrombus and pulmonary hypertension. Balloon pulmonary angioplasty (BPA), an emerging alternative catheter-based treatment for inoperable patients with CTEPH, has not yet been standardised, especially for lesion assessment in distal pulmonary arteries. Recent advancement in computed tomography enables distal CTEPH lesions to be visualized. We retrospectively studied 80 consecutive patients with inoperable CTEPH who received BPA guided by cone-beam computed tomography (CT) (CBCT) or electrocardiogram (ECG)-gated area detector CT (ADCT) for target lesion assessment. We collected clinical and hemodynamic data, including procedural complications, before BPA and at 3 months and 1year after BPA. Three hundred eight-five BPA sessions (4.8 sessions/patient) were performed for the lesions of subsegmental arteries (1155 lesions), segmental arteries (738 lesions), and lobar arteries (4 lesions) identified by CBCT or ECG-gated ADCT. Significant improvements in the symptoms, 6-min walk distance, brain natriuretic peptide level, exercise capacity, and haemodynamics were observed 3 months and 1year after BPA. No cases of death or cardiogenic shock with a low rate of severe wire perforation (0.3%) and severe reperfusion oedema (0.3%) were observed. BPA guided by CBCT or ECG-gated ADCT is effective and remarkably safe in patients with CTEPH . These new advanced CT techniques may be useful in pre-BPA target lesion assessment. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Simultaneous Antegrade-Retrograde Subintimal Revascularization of a Femoropopliteal Chronic Total Occlusion by a Reentry Device-Facilitated Puncture of a Retrogradely Inserted Balloon.

PubMed

Goltz, Jan Peter; Anton, Susanne; Wiedner, Marcus; Barkhausen, Jörg; Stahlberg, Erik

2017-08-01

To report a rendezvous technique for subintimal revascularization of a chronic total occlusion (CTO) of the superficial femoral artery (SFA). This maneuver is appropriate after failure to cross a long SFA CTO via intra- and subintimal approaches from the ipsilateral femoral as well as retrograde posterior tibial artery (PTA) access sites. After predilation of the subintimal space from the femoral access, a reentry device was placed at the level of the first popliteal artery segment. A balloon was delivered via the retrograde PTA access and inflated at the corresponding level of the reentry device. The balloon was punctured with the needle of the reentry device under fluoroscopic control, and a 0.014-inch guidewire was placed within the punctured balloon. The balloon and the antegrade guidewire were retracted from the retrograde access while the guidewire was gently pushed from the femoral site. Conventional balloon angioplasty of the SFA occlusion was performed via the femoral access, followed by overlapping stent-graft implantation. Complete revascularization of the CTO was documented. In selected cases a transfemoral reentry device-assisted puncture of a retrogradely inserted balloon within the subintimal space may facilitate a rendezvous and revascularization if standard techniques to cross long CTOs have failed.

Extracranial carotid angioplasty and stenting. Initial results and short-term follow-up.

PubMed

Vozzi, C R; Rodriguez, A O; Paolantonio, D; Smith, J A; Wholey, M H

1997-01-01

Carotid percutaneous transluminal angioplasty, with or without stent implantation, is becoming another therapeutic option for carotid revascularization. To evaluate the feasibility and effectiveness of the technique, from October of 1995 to March of 1997, we performed 24 percutaneous transluminal angioplasty procedures in 22 patients with severe extracranial carotid artery stenosis. Three common carotid and 21 internal carotid arteries were treated, and 19 procedures included stent implantation using nonarticulated PALMAZ stents (P154 and P204). Twelve patients were asymptomatic and 10 patients were symptomatic; 2 of the symptomatic patients had complete obstruction of the internal carotid artery that was successfully recanalized. Technical and angiographic success was achieved in 23 of 24 procedures, with the carotid artery obstruction diminishing from 85.6% +/- 8.5% to 5.7% +/- 3.2% (P < 0.001). Average stenosis length was 12.5 +/- 3.1 mm, and mean time of carotid occlusion during balloon inflation was 11.5 +/- 2.5 seconds. Three patients experienced transitory seizures during the procedure prior to dilation, 1 patient had a minor stroke with complete recovery within 72 hours, and 1 patient had a major stroke and died 45 days after the procedure. Clinical follow-up was achieved in all patients (mean, 10.5 +/- 7.2 months) and angiographic follow-up in 16 patients (mean, 6.3 +/- 1.2 months). The results obtained in this initial experience provide adequate support to continue further evaluation of this new therapeutic strategy.

Laser driven short-term thermal angioplasty: enhancement of drug delivery performance by heating with tension

NASA Astrophysics Data System (ADS)

Suganuma, Kao; Homma, Rie; Shimazaki, Natsumi; Ogawa, Emiyu; Arai, Tsunenori

2017-02-01

To enhance drug delivery performance of drug eluting balloon (DEB) against re-stenosis, we have proposed a heating drug delivery during balloon dilatation using our laser driven short-term thermal angioplasty which may realize to suppress surrounding thermal injury. We studied an influence of vessel dilatation parameters on the heating drug delivery. These parameters were classified into two different forces, that is, circumferential tension and inter-luminal pressure. We think these parameters were not able to determine only by balloon pressure. The circumferential tension with 0-30 mN/mm2 was added to a porcine carotid artery using an automatic stage. Various temperature solutions with 37, and 70°C of hydrophobic fluorescent Rhodamine B with 3 μg/ml in concentration were dropped on pig carotid wall. We measured a defined drug delivery amount as well as delivery depth by a microscopic fluorescence measurement on the cross section of the solution delivered vessel. In the case of 37°C, we found the intima surface drug amount with 7 mN/mm2 was increased as 10-20 times as other tension cases. On the other hand, at 70°C, we found the optimum tension with 30 mN/mm2. We found the drug delivery enhancement might be related to the change of super microscopic surface structure of the vessel. We predict that the collagen thermal denaturation of the vessel wall might play important role to the drug delivery.

Ten years single-centre experience with intra-aortic balloon pump.

PubMed

Vandenplas, Guy; Bové, Thierry; Caes, Frank; Van Belleghem, Yves; François, Katrien; De Somer, Filip; Taeymans, Yves; Van Nooten, Guido

2011-12-01

The objective of this study was to investigate the patient characteristics and outcomes in 1406 patients undergoing intra-aortic balloon pump (IABP) counterpulsation. Between 1998 and 2008, 1406 consecutive patients were recorded in a prospective database. Based on the main clinical indication for IABP use, we defined 3 groups: group A, 630 cases of coronary ischaemia or infarction without serious left ventricular (LV) dysfunction; group B, 466 patients with left ventricular failure or cardiogenic shock; group C, 310 patients where IABP was used for miscellaneous procedures such as weaning from cardiopulmonary bypass or during high-risk angioplasty or surgery. Global mortality was 28% (n = 390), with a significant difference between group A (15%, n = 95) and group B (41%, n = 191) (P < 0.001). Mortality in group C was 34% (n = 104). Most insertions were done in the catheterization laboratory (n = 943) with subsequent mortality of 23% whereas 199 balloons were inserted in the operation room with 34% mortality. 170 balloons inserted in the intensive care unit resulted in 46% mortality (P < 0.001). Major IABP-induced complications were 6.8% with no statistical differences between the three groups. Advanced age, left ventricular failure and low BMI were identified as prognostic risk factors for early mortality. IABP deployed at an early clinical stage yields the best results, especially for acute coronary patients with preserved LV function whereas LV failure and late insertion result in worse outcome.

Efficacy of Intrauterine Bakri Balloon Tamponade in Cesarean Section for Placenta Previa Patients.

PubMed

Cho, Hee Young; Park, Yong Won; Kim, Young Han; Jung, Inkyung; Kwon, Ja-Young

2015-01-01

The aims of this study were to analyze the predictive factors for the use of intrauterine balloon insertion and to evaluate the efficacy and factors affecting failure of uterine tamponade with a Bakri balloon during cesarean section for abnormal placentation. We reviewed the medical records of 137 patients who underwent elective cesarean section for placenta previa between July 2009 and March 2014. Cesarean section and Bakri balloon insertion were performed by a single qualified surgeon. The Bakri balloon was applied when blood loss during cesarean delivery exceeded 1,000 mL. Sixty-four patients (46.7%) required uterine balloon tamponade during cesarean section due to postpartum bleeding from the lower uterine segment, of whom 50 (78.1%) had placenta previa totalis. The overall success rate was 75% (48/64) for placenta previa patients. Previous cesarean section history, anterior placenta, peripartum platelet count, and disseminated intravascular coagulopathy all significantly differed according to balloon success or failure (all p<0.05). The drainage amount over 1 hour was 500 mL (20-1200 mL) in the balloon failure group and 60 mL (5-500 mL) in the balloon success group (p<0.01). Intrauterine tamponade with a Bakri balloon is an adequate adjunct management for postpartum hemorrhage following cesarean section for placenta previa to preserve the uterus. This method is simple to apply, non-invasive, and inexpensive. However, possible factors related to failure of Bakri balloon tamponade for placenta previa patients such as prior cesarean section history, anterior placentation, thrombocytopenia, presence of DIC at the time of catheter insertion, and catheter drainage volume more than 500 mL within 1 hour of catheter placement should be recognized, and the next-line management should be prepared in advance.

Efficacy of Intrauterine Bakri Balloon Tamponade in Cesarean Section for Placenta Previa Patients

PubMed Central

Cho, Hee Young; Park, Yong Won; Kim, Young Han; Jung, Inkyung; Kwon, Ja-Young

2015-01-01

Purpose The aims of this study were to analyze the predictive factors for the use of intrauterine balloon insertion and to evaluate the efficacy and factors affecting failure of uterine tamponade with a Bakri balloon during cesarean section for abnormal placentation. Methods We reviewed the medical records of 137 patients who underwent elective cesarean section for placenta previa between July 2009 and March 2014. Cesarean section and Bakri balloon insertion were performed by a single qualified surgeon. The Bakri balloon was applied when blood loss during cesarean delivery exceeded 1,000 mL. Results Sixty-four patients (46.7%) required uterine balloon tamponade during cesarean section due to postpartum bleeding from the lower uterine segment, of whom 50 (78.1%) had placenta previa totalis. The overall success rate was 75% (48/64) for placenta previa patients. Previous cesarean section history, anterior placenta, peripartum platelet count, and disseminated intravascular coagulopathy all significantly differed according to balloon success or failure (all p<0.05). The drainage amount over 1 hour was 500 mL (20–1200 mL) in the balloon failure group and 60 mL (5–500 mL) in the balloon success group (p<0.01). Conclusion Intrauterine tamponade with a Bakri balloon is an adequate adjunct management for postpartum hemorrhage following cesarean section for placenta previa to preserve the uterus. This method is simple to apply, non-invasive, and inexpensive. However, possible factors related to failure of Bakri balloon tamponade for placenta previa patients such as prior cesarean section history, anterior placentation, thrombocytopenia, presence of DIC at the time of catheter insertion, and catheter drainage volume more than 500 mL within 1 hour of catheter placement should be recognized, and the next-line management should be prepared in advance. PMID:26263014

Importance of Adjunct Delivery Techniques to Optimize Deployment Success of Distal Protection Filters During Vein Graft Intervention.

PubMed

Kaliyadan, Antony G; Chawla, Harnish; Fischman, David L; Ruggiero, Nicholas; Gannon, Michael; Walinsky, Paul; Savage, Michael P

2017-02-01

This study assessed the impact of adjunct delivery techniques on the deployment success of distal protection filters in saphenous vein grafts (SVGs). Despite their proven clinical benefit, distal protection devices are underutilized in SVG interventions. Deployment of distal protection filters can be technically challenging in the presence of complex anatomy. Techniques that facilitate the delivery success of these devices could potentially improve clinical outcomes and promote greater use of distal protection. Outcomes of 105 consecutive SVG interventions with attempted use of a FilterWire distal protection device (Boston Scientific) were reviewed. In patients in whom filter delivery initially failed, the success of attempted redeployment using adjunct delivery techniques was assessed. Two strategies were utilized sequentially: (1) a 0.014" moderate-stiffness hydrophilic guidewire was placed first to function as a parallel buddy wire to support subsequent FilterWire crossing; and (2) if the buddy-wire approach failed, predilation with a 2.0 mm balloon at low pressure was performed followed by reattempted filter delivery. The study population consisted of 80 men and 25 women aged 73 ± 10 years. Mean SVG age was 14 ± 6 years. Complex disease (American College of Cardiology/American Heart Association class B2 or C) was present in 92%. Initial delivery of the FilterWire was successful in 82/105 patients (78.1%). Of the 23 patients with initial failed delivery, 8 (35%) had successful deployment with a buddy wire alone, 7 (30%) had successful deployment with balloon predilation plus buddy wire, 4 (17%) had failed reattempt at deployment despite adjunct maneuvers, and in 4 (17%) no additional attempts at deployment were made at the operator's discretion. Deployment failure was reduced from 21.9% initially to 7.6% after use of adjunct delivery techniques (P<.01). No adverse events were observed with these measures. Deployment of distal protection devices can be

Magnetic Particle / Magnetic Resonance Imaging: In-Vitro MPI-Guided Real Time Catheter Tracking and 4D Angioplasty Using a Road Map and Blood Pool Tracer Approach.

PubMed

Salamon, Johannes; Hofmann, Martin; Jung, Caroline; Kaul, Michael Gerhard; Werner, Franziska; Them, Kolja; Reimer, Rudolph; Nielsen, Peter; Vom Scheidt, Annika; Adam, Gerhard; Knopp, Tobias; Ittrich, Harald

2016-01-01

In-vitro evaluation of the feasibility of 4D real time tracking of endovascular devices and stenosis treatment with a magnetic particle imaging (MPI) / magnetic resonance imaging (MRI) road map approach and an MPI-guided approach using a blood pool tracer. A guide wire and angioplasty-catheter were labeled with a thin layer of magnetic lacquer. For real time MPI a custom made software framework was developed. A stenotic vessel phantom filled with saline or superparamagnetic iron oxide nanoparticles (MM4) was equipped with bimodal fiducial markers for co-registration in preclinical 7T MRI and MPI. In-vitro angioplasty was performed inflating the balloon with saline or MM4. MPI data were acquired using a field of view of 37.3×37.3×18.6 mm3 and a frame rate of 46 volumes/sec. Analysis of the magnetic lacquer-marks on the devices were performed with electron microscopy, atomic absorption spectrometry and micro-computed tomography. Magnetic marks allowed for MPI/MRI guidance of interventional devices. Bimodal fiducial markers enable MPI/MRI image fusion for MRI based roadmapping. MRI roadmapping and the blood pool tracer approach facilitate MPI real time monitoring of in-vitro angioplasty. Successful angioplasty was verified with MPI and MRI. Magnetic marks consist of micrometer sized ferromagnetic plates mainly composed of iron and iron oxide. 4D real time MP imaging, tracking and guiding of endovascular instruments and in-vitro angioplasty is feasible. In addition to an approach that requires a blood pool tracer, MRI based roadmapping might emerge as a promising tool for radiation free 4D MPI-guided interventions.

Percutaneous Transluminal Angioplasty of Hepatic Artery Stenosis in Patients After Orthotopic Liver Transplantation: Mid-term Results

DOE Office of Scientific and Technical Information (OSTI.GOV)

Jarmila, Lastovickova, E-mail: jala@ikem.cz; Jan, Peregrin

2011-12-15

Purpose: This study was designed to present our experience with percutaneous treatment of hepatic artery stenosis in orthotopic liver transplant patients and to evaluate the efficacy, technical outcomes, and mid-term clinical results of the procedure. Methods: Twenty-two percutaneous transluminal angioplasties (PTAs) were performed in 19 liver transplant recipients at our institution between 1998 and 2010. Stents were placed into the hepatic/celiac artery in 16 PTAs, but balloon dilatation alone was performed in 6 because of the anatomical condition of the vessel. PTA/stenting was indicated in 17 patients because of elevated liver enzymes; 2 patients were asymptomatic. The objective of treatingmore » stenosis was prevention of long-term complications, including thrombosis. Results: Technical success was achieved in all patients. There was only one complication: dissection of the treated artery without any subsequent adverse effects. In all patients, elevated liver enzyme levels improved after treatment. No restenosis was observed in any patient during a mean follow-up of 2.6 years (1 month to 5.5 years). Conclusions: Percutaneous angioplasty/stent placement is a safe method for the treatment of hepatic artery stenosis after orthotopic liver transplantation, with a high technical success rate and promising mid-term results.« less

Intravascular ultrasound evaluation of JETSTREAM atherectomy removal of superficial calcium in peripheral arteries.

PubMed

Maehara, Akiko; Mintz, Gary S; Shimshak, Thomas M; Ricotta, Joseph J; Ramaiah, Venkatesh; Foster, Malcolm T; Davis, Thomas P; Gray, William A

2015-05-01

Endovascular treatment of calcified femoral-popliteal disease is challenging. We sought to evaluate the mechanism of lumen gain when using the JETSTREAM Atherectomy System to treat calcified peripheral artery lesions. The JETSTREAM Calcium Study was a prospective, single-arm, multicentre study to evaluate the JETSTREAM Atherectomy System for severely calcified femoral-popliteal artery lesions, i.e., patients with claudication and lesions with superficial calcium >90° and >5 mm in length as determined by intravascular ultrasound (IVUS). The 2.1 mm catheter was used in this study without distal protection. Fifty-five patients underwent angiographic screening: 26 (45%) met IVUS inclusion criteria. Angiographic calcium was moderate in eight cases and severe in 14, with no available data for four cases. Visual diameter stenosis was 86±9% pre-treatment, 37±13% post atherectomy, and 10±6% post adjunctive treatment (adjunctive PTA+stenting in eight and adjunct PTA alone in 16). IVUS showed lumen area increased from 6.6±3.7 mm2 to 10.0±3.6 mm2 (p=0.001): calcium reduction was responsible for 86±23% of the lumen increase. Although the superficial calcium arc did not change (151±70° to 146±71°, p=0.83), the arc of reverberation increased (23±20° to 65±40°, p=0.006), indicating device-related modification of calcium. Adjunctive balloon angioplasty was performed in 62% of the lesions, and stent implantation in 31%. In 11 cases with adjunctive balloon dilation, the MLA increased from 7.1 (6.4, 7.8) mm2 post atherectomy to 11.9 (10.3, 13.5) mm2 post balloon (p<0.001) without flow-limiting dissection. No major adverse events occurred up to 30 days post procedure in either the study group or the patients who were excluded from the analysis. The JETSTREAM Atherectomy System increased lumen dimensions in moderately or severely calcified femoral-popliteal lesions by removing superficial calcium without major complications.

The role of brachytherapy and Cutting Balloon angioplasty in the current treatment of stent restenosis.

PubMed

Bonan, Raoul

2004-09-01

The Gamma I, START and INHIBIT trials conclusively demonstrate the feasibility, safety and efficacy of intracoronary radiation as the treatment of choice for stent restenosis. Further reports confirm this finding and extend the indications. Vascular brachytherapy should be made available for all patients with diffuse stent restenosis. Specific devices such as cutting balloons may improve the procedure but does not seem to have an impact alone on the evolution.

Renal Branch Artery Occlusion in a 13-Year-Old Hypertensive Girl: Initial Treatment and Treatment of Recurrent Stenosis by Balloon Angioplasty

DOE Office of Scientific and Technical Information (OSTI.GOV)

Konez, Orhan; Burrows, Patricia E.; Harmon, William E.

2001-09-15

A 13-year-old girl who recently developed hypertension was diagnosed to have an occluded right renal branch artery and was treated successfully with percutaneous transluminal angioplasty (PTA). To our knowledge, PTA has not been reported as a treatment for totally occluded renal branch arteries, and there is no data available regarding the success rate and possible complications.

High dose rate brachytherapy for prevention of restenosis after percutaneous transluminal coronary angioplasty: Preliminary dosimetric tests of a new source presentation

DOE Office of Scientific and Technical Information (OSTI.GOV)

Popowski, Y.; Rouzaud, M.; Kurtz, J.M.

1995-08-30

Balloon dilatation of coronary artery stenosis has become a standard treatment of atherosclerotic heart disease. Restenosis due to excessive intimal cell proliferation, which subsequently occurs in 20-50% of patients, represents one of the major clinical problems in contemporary cardiology, and no satisfactory method for its prevention has thus far been found. Because modest doses of radiation have proved effective in preventing certain types of abnormal cellular proliferation resulting from surgical trauma, and brachytherapy has already been used successfully after dilatation of peripheral arteries, development of a radioactive source suitable for coronary artery applications would be of great interest. Doses obtainedmore » at the surface of the balloon, for a 2-min exposure for the 0.26 mm wire (balloon inflated with air) and the 0.15 mm wire (air or contrast), were 56.5 Gy, 17.8 Gy, 5.4 Gy, respectively. As expected for a beta emitter, the fall-off in dose as a function of depth was rapid. External irradiation from the beta source was negligible. Our experiments indicate that the dose rates attainable at the surface of the angioplasty balloon using this technique allow the doses necessary for the inhibition of intimal cell proliferation to be reached within a relatively short period of time. The thin yttrium-90 wires are very easy to handle, and their mechanical and radioactive properties are well suited to the requirements of the catheterization procedure. 16 refs., 4 figs., 1 tab.« less

Post-marketing surveillance in the published medical and grey literature for percutaneous transluminal coronary angioplasty catheters: a systematic review.

PubMed

Polisena, Julie; Forster, Alan J; Cimon, Karen; Rabb, Danielle

2013-10-10

Post-marketing surveillance (PMS) may identify rare serious incidents or adverse events due to the long-term use of a medical device, which was not captured in the pre-market process. Percutaneous transluminal coronary angioplasty (PTCA) is a non-surgical procedure that uses a balloon-tipped catheter to enlarge a narrowed artery. In 2011, 1,942 adverse event reports related to the use of PTCA catheters were submitted to the FDA by the manufacturers, an increase from the 883 reported in 2008. The primary research objective is to conduct a systematic review of the published and grey literature published between 2007 and 2012 for the frequency of incidents, adverse events and malfunctions associated with the use of PTCA catheters in patients with coronary artery disease (CAD). Grey literature has not been commercially published. We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials and PubMed for medical literature on PMS for PTCA catheters in patients with CAD published between January 2007 and July 2012. We also searched the grey literature. This review included 11 studies. The in-hospital adverse events reported were individual cases of myocardial infarction and hematoma. In studies of patients with coronary perforation, more patients with balloon angioplasty were identified compared with patients who required stenting. Our systematic review illustrates that the volume and quality of PMS studies associated with the use of PTCA catheters in patients with CAD are low in the published and grey literature, and may not be useful sources of information for decisions on safety. In most studies, the objectives were not to monitor the long-term safety of the use of PTCA catheters in clinical practice. Future studies can explore the strengths and limitations of PMS databases administered by regulatory authorities.

The use of balloon-expandable metallic stents in the treatment of pediatric tracheomalacia and bronchomalacia.

PubMed

Furman, R H; Backer, C L; Dunham, M E; Donaldson, J; Mavroudis, C; Holinger, L D

1999-02-01

To evaluate the use of balloon-expandable metallic stents in the treatment of children with tracheomalacia and bronchomalacia in whom conventional therapy has failed. Retrospective case series. Tertiary pediatric otolaryngology and cardiothoracic surgery referral center. Six patients were identified as having undergone bronchoscopic placement of metallic balloon-expandable stents between 1994 and 1997. The age at stent placement, prior surgical interventions, and indications for and sites of stent placement were noted. Also, the complications related to stent placement and the current airway status of the patients were reviewed. Twelve balloon-expandable metallic angioplasty stents (Palmaz; Johnson & Johnson Interventional Systems Co, Warren, NJ) were placed bronchoscopically in 6 patients. Six stents were placed in the lower trachea, and 6 were placed in the main bronchi. The stents were balloon expanded under fluoroscopic guidance. Discontinuation of mechanical ventilation. The age at stent placement ranged from 1.5 to 38 months (mean age at placement, 10 months). The indications for stent placement were (1) tracheomalacia or bronchomalacia, (2) pericardial patch or slide tracheoplasty failure, and (3) bronchomalacia caused by tetralogy of Fallot and large pulmonary arteries. The primary complication of stent placement was postoperative granulation tissue formation. One patient required the removal of 2 tracheal stents because of granulation tissue formation. There were 2 deaths in the series, 1 possibly related to stent placement. Four of the 6 patients were weaned from mechanical ventilation, and 3 experienced prolonged relief of airway obstruction. Metallic balloon-expandable stents are effective in relieving lower tracheomalacia and bronchomalacia in select patients. Only patients in whom conventional therapy has failed should be considered for stent placement.

Reporting standards for angioplasty and stent-assisted angioplasty for intracranial atherosclerosis.

PubMed

Schumacher, H Christian; Meyers, Philip M; Higashida, Randall T; Derdeyn, Colin P; Lavine, Sean D; Nesbit, Gary M; Sacks, David; Rasmussen, Peter; Wechsler, Lawrence R

2010-12-01

Intracranial cerebral atherosclerosis causes ischemic stroke in a significant number of patients. Technological advances over the past 10 years have enabled endovascular treatment of intracranial atherosclerotic stenosis. The number of patients treated with angioplasty or stent-assisted angioplasty for this condition is increasing. Given the lack of universally accepted definitions, the goal of this document is to provide consensus recommendations for reporting standards, terminology, and written definitions when reporting clinical and radiological evaluation, technique, and outcome of endovascular treatment using angioplasty or stent-assisted angioplasty for stenotic and occlusive intracranial atherosclerosis. This article was written under the auspices of Joint Writing Group of the Technology Assessment Committee, Society of Neurolnterventional Surgery, Society of Interventional Radiology; Joint Section on Cerebro-vascular Neurosurgery of the American Association of Neurological Surgeons and Congress of Neurological Surgeons; and the Section of Stroke and Interventional Neurology of the American Academy of Neurology. A computerized search of the National Library of Medicine database of literature (PubMed) from January 1997 to December 2007 was conducted with the goal to identify published endovascular cerebrovascular interventional data in stenotic intracranial atherosclerosis that could be used as benchmarks for quality assessment. We sought to identify those risk adjustment variables that affect the likelihood of success and complications. This document offers the rationale for different clinical and technical considerations that may be important during the design of clinical trials for endovascular treatment of intracranial stenotic and occlusive atherosclerosis. Included in this guidance document are suggestions for uniform reporting standards for such trials. These definitions and standards are primarily intended for research purposes; however, they should

Aspirin inhibition of platelet deposition at angioplasty sites: demonstration by platelet scintigraphy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Cuningham, D.A.; Kumar, B.; Siegel, B.A.

In-111 platelet scintigraphy was used to evaluate the effects of prior aspirin administration on the accumulation of In-111-labeled autologous platelets at sites of arterial injury resulting from iliac, femoral, or popliteal transluminal angioplasty in a nonrandomized study of 17 men. The degree of platelet localization at angioplasty sites was significantly less in nine men who had received aspirin in varying doses within the 4 days before angioplasty than in eight men who had not received aspirin for at least two weeks. The results suggest that aspirin treatment before angioplasty limits the early platelet deposition at the angioplasty site in men.

Acute and mid-term outcomes after treatment of multiple, recurrent restenoses of the lower limb arteries.

PubMed

Meyborg, M; Engelbertz, C; Lüders, F; Gebauer, K; Malyar, N M; Reinecke, H

2015-06-01

Recanalization of long segmental occlusions of femoropopliteal arteries can be achieved by angioplasty and implantation of nitinol stents with high procedural success rates. However, due to recurrent in-stent restenoses (ISR) some patients need repeated interventions and their intermediate success rates are uncertain. Patients who were treated in our center from March 2008 through February 2011 due to symptomatic ISR (as determined by Duplex sonography) were retrospectively included in the study. After endovascular treatment of their ISR, they were prospectively evaluated with regard to recurrent ISR of the target lesions. A total of 36 limbs (=lesions) in 32 patients (69% male, mean age 69±9 years) were successfully treated by balloon-angioplasty. Adjunctive cutting balloons and drug eluting balloons were used in 78% and 8%, respectively. Mean follow-up was 326 days. Recurrent ISR occurred in 10 (28%) lesions, while 26 (78%) lesions showed no recurrence of ISR. In a multivariate logistic regression analysis, age, gender, cardiovascular risk factors, renal failure and medication with cilostazol were not significantly associated with recurrent ISR. Moreover, the number of previous interventions of the target lesions was not an independent predictor of recurrent ISR. Patients with multiple recurrences of ISR seem to have the same prospects of acute and mid-term success for endovascular treatment as those with first presentation of ISR. However, this observation has to be confirmed by prospective, large scale studies with a longer follow-up period to determine the significance of endovascular intervention within the scope of different revascularization approaches for treatment of recurrent ISR.

Use of a balloon-expandable metallic stent for treatment of nasopharyngeal stenosis in dogs and cats: six cases (2005-2007).

PubMed

Berent, Allyson C; Weisse, Chick; Todd, Kimberly; Rondeau, Mark P; Reiter, Alexander M

2008-11-01

To determine outcome associated with use of a balloon-expandable metallic stent for treatment of nasopharyngeal stenosis in dogs and cats. Retrospective case series. 3 dogs and 3 cats. All 6 animals had severe inspiratory stertor at initial examination. Two animals had no orifice present at the stenosis. Nasopharyngeal stenosis was diagnosed and stent size determined by use of computed tomography. A percutaneous transluminal angioplasty balloon premounted with a balloon-expandable metallic stent was placed over a guidewire, advanced through the stenotic lesion under fluoroscopic and rhinoscopic guidance, and dilated to restore patency. All animals had immediate resolution of clinical signs after stent placement. The procedure took a median of 38 minutes (range, 22 to 70 minutes). One animal with a stenosis located far caudally needed the tip of the stent resected because of hairball entrapment and exaggerated swallowing. Both animals without an orifice in the stenosis had tissue in-growth requiring a covered stent. All animals were reexamined 6 to 12 weeks after treatment via rhinoscopy, radiography, computed tomography, or a combination of techniques. All animals lacked signs of discomfort; 5 of 6 were breathing normally 12 to 28 months after the procedure. Transnasal balloon-expandable metallic stent placement may represent a rapid, safe, noninvasive, and effective treatment in animals with nasopharyngeal stenosis. If the stenosis is extremely caudal in the nasopharynx, serial balloon dilatation might be considered prior to stent placement. A covered stent should be considered initially if the stenosis is completely closed.

Evaluation of the Distribution of Paclitaxel After Application of a Paclitaxel-Coated Balloon in the Rabbit Urethra.

PubMed

Barbalias, Dimitrios; Lappas, Georgios; Ravazoula, Panagiotia; Liourdi, Despoina; Kyriazis, Iason; Liatsikos, Evangelos; Kallidonis, Panagiotis

2018-05-01

Urethral strictures are a common urologic problem that could require complex reconstructive procedures. Urethral dilatation represents a frequent practiced intervention associated with high recurrence rates. Drug-coated percutaneous angioplasty balloons (DCBs) with cytostatic drugs have been effectively used for the prevention of vascular restenosis after balloon dilatation. To reduce restenosis rates of urethral dilatation, these balloons could be used in the urethra. Nevertheless, the urothelium is different than the endothelium and these drugs may not be distributed to the outer layers of the urethra. Thus, an experiment was performed to evaluate the distribution of paclitaxel (PTX) in the rabbit urethra after the inflation of a PTX-coated balloon (PCB). Eleven rabbits underwent dilatation of the posterior urethra with common endoscopic balloons after urethrography. Nine of these rabbits were additionally treated with PCB. The urethras of the two control animals were removed along with three more dilated with PCB urethras immediately after the dilatation. The remaining of the urethras were removed after 24 (n = 3) and 48 hours (n = 3). The posterior segments of the urethras were evaluated with hematoxylin and eosin staining as well as with immunohistochemistry with polyclonal anti-PTX antibody. The two control specimens showed denudation of the urothelium after balloon dilatations and no PTX was observed. All specimens from dilated PCB urethras showed distribution of PTX to all layers of the urethra. The specimens that were immediately removed exhibited denudation of the urothelium without any inflammation. The specimens removed at 24 and 48 hours showed mild acute inflammation. PTX was distributed to the urothelial, submucosal, and smooth muscle layers of the normal rabbit urethra immediately after dilatation with a DCB. PTX and mild inflammation were present at the site 24 and 48 hours after the dilatation.

Pre-hospital electrocardiogram triage with tele-cardiology support is associated with shorter time-to-balloon and higher rates of timely reperfusion even in rural areas: data from the Bari- Barletta/Andria/Trani public emergency medical service 118 registry on primary angioplasty in ST-elevation myocardial infarction.

PubMed

Brunetti, Natale Daniele; Di Pietro, Gaetano; Aquilino, Ambrogio; Bruno, Angela I; Dellegrottaglie, Giulia; Di Giuseppe, Giuseppe; Lopriore, Claudio; De Gennaro, Luisa; Lanzone, Saverio; Caldarola, Pasquale; Antonelli, Gianfranco; Di Biase, Matteo

2014-09-01

We report the preliminary data from a regional registry on ST-elevation myocardial infarction (STEMI) patients treated with primary angioplasty in Apulia, Italy; the region is covered by a single public health-care service, a single public emergency medical service (EMS), and a single tele-medicine service provider. Two hundred and ninety-seven consecutive patients with STEMI transferred by regional free public EMS 1-1-8 for primary-PCI were enrolled in the study; 123 underwent pre-hospital electrocardiograms (ECGs) triage by tele-cardiology support and directly referred for primary-PCI, those remaining were just transferred by 1-1-8 ambulances for primary percutaneous coronary intervention (PCI) (diagnosis not based on tele-medicine ECG; already hospitalised patients, emergency-room without tele-medicine support). Time from first ECG diagnostic for STEMI to balloon was recorded; a time-to-balloon <1 h was considered as optimal and patients as timely treated. Mean time-to-balloon with pre-hospital triage and tele-cardiology ECG was significantly shorter (0:41 ± 0:17 vs 1:34 ± 1:11 h, p<0.001, -0:53 h, -56%) and rates of patients timely treated higher (85% vs 35%, p<0.001, +141%), both in patients from the 'inner' zone closer to PCI catheterisation laboratories (0:34 ± 0:13 vs 0:54 ± 0:30 h, p<0.001; 96% vs 77%, p<0.01, +30%) and in the 'outer' zone (0:52 ± 0:17 vs 1:41 ± 1:14 h, p<0.001; 69% vs 29%, p<0.001, +138%). Results remained significant even after multivariable analysis (odds ratio for time-to-balloon 0.71, 95% confidence interval (CI) 0.63-0.80, p<0.001; 1.39, 95% CI 1.25-1.55, p<0.001, for timely primary-PCI). Pre-hospital triage with tele-cardiology ECG in an EMS registry from an area with more than one and a half million inhabitants was associated with shorter time-to-balloon and higher rates of timely treated patients, even in 'rural' areas. © The European Society of Cardiology 2014.

A randomized trial comparing primary angioplasty versus stent placement for symptomatic intracranial stenosis

PubMed Central

Qureshi, Adnan I; Chaudhry, Saqib A; Siddiq, Farhan; Majidi, Shahram; Rodriguez, Gustavo J; Suri, M Fareed K

2013-01-01

Background: Both primary angioplasty alone and angioplasty with a self-expanding stent have been compared in non-randomized concurrent clinical studies that suggest equivalent results. However, there is no randomized trial that has compared the two procedures in patients with symptomatic high grade intracranial stenosis. Objective: The primary aim of the randomized trial was to compare the clinical and angiographic efficacy of primary angioplasty and angioplasty followed by stent placement in preventing restenosis, stroke, requirement for second treatment, and death in patients with symptomatic intracranial stenosis. Methods: The study prospectively evaluated efficacy and safety of the two existing neurointerventional techniques for treatment of moderate intracranial stenosis (stenosis ≥ 50%) with documented failure of medical treatment or severe stenosis (≥70%) with or without failure of medical treatment. Results: A total of 18 patients were recruited in the study (mean age [±SD] was 64.7 ± 15.1 years); out of these, 12 were men. Of these 18, 10 were treated with primary angioplasty and 8 were treated with angioplasty followed by self-expanding stent. The technical success rates of intracranial angioplasty and stent placements defined as ability to achieve <30% residual stenosis when assessed by immediate post-procedure angiography was 5 of 10 and 5 of 8 patients, respectively. The total fluoroscopic time (mean [±SD]) was lower in patients undergoing primary angioplasty 37 [±11] min versus those undergoing angioplasty followed by self-expanding stent 42 [±15] min, P = 0.4321. The stroke and death rate within 1 month was very low in both patient groups (1 of 10 versus 0 of 8 patients). One patient randomized to stent placement continued to have recurrent ischemic symptoms requiring another angioplasty in the vertebral artery on post-procedure Day 2. Conclusions: The trial suggests that a randomized trial comparing primary angioplasty to angioplasty

Paclitaxel-Coated Balloon in Infrapopliteal Arteries: 12-Month Results From the BIOLUX P-II Randomized Trial (BIOTRONIK'S-First in Man study of the Passeo-18 LUX drug releasing PTA Balloon Catheter vs. the uncoated Passeo-18 PTA balloon catheter in subjects requiring revascularization of infrapopliteal arteries).

PubMed

Zeller, Thomas; Beschorner, Ulrich; Pilger, Ernst; Bosiers, Marc; Deloose, Koen; Peeters, Patrick; Scheinert, Dierk; Schulte, Karl-Ludwig; Rastan, Aljoscha; Brodmann, Marianne

2015-10-01

The aim of BIOLUX P-II (BIOTRONIK'S-First in Man study of the Passeo-18 LUX drug releasing PTA Balloon Catheter vs. the uncoated Passeo-18 PTA balloon catheter in subjects requiring revascularization of infrapopliteal arteries) trial was to compare the safety and efficacy of a novel paclitaxel-coated drug-eluting balloon (DEB) versus an uncoated balloon (percutaneous transluminal angioplasty [PTA]) in de novo or native restenotic lesions of the infrapopliteal arteries in patients with claudication and critical limb ischemia. DEB have shown promising results in femoropopliteal lesions, but data for infrapopliteal lesions are scarce. In this prospective, multicenter, randomized first-in-man study, 72 patients were randomized 1:1 to either a Passeo-18 Lux DEB (Biotronik AG, Buelach, Switzerland) (n = 36) or Passeo-18 PTA (n = 36). Follow-up assessments were scheduled at 1, 6, and 12 months, with angiographic assessment at 6 months. Adverse events were adjudicated by an independent clinical events committee, and angiographic parameters were assessed by an independent core laboratory. The primary safety endpoint (a composite of all-cause mortality, target extremity major amputation, target lesion thrombosis, and target vessel revascularization at 30 days) was 0% in the DEB group versus 8.3% in the PTA group (p = 0.239). The primary performance endpoint (patency loss at 6 months) was 17.1% in the DEB group versus 26.1% in the PTA group (p = 0.298), and major amputations of the target extremity occurred in 3.3% versus 5.6% of the patients at 12 months, respectively. The Passeo-18 Lux DEB has been proven to be safe and effective in infrapopliteal lesions with comparable outcomes to PTA. Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Ballooning Then...and Ballooning Now.

ERIC Educational Resources Information Center

Journal of Aerospace Education, 1978

1978-01-01

Describes the history of hot-air balloon travel, starting with its French origins and continuing through to the 1978 national championship. An address for Balloon Federation of America membership is included. (MA)

Evaluation of a New Balloon Catheter for Difficult Calcified Lesions in Infrainguinal Arterial Disease: Outcome of a Multicenter Registry

DOE Office of Scientific and Technical Information (OSTI.GOV)

Spaargaren, G. J.; Lee, M. J.; Reekers, J. A.

2009-01-15

The purpose of this study was to assess the technical performance and immediate procedure outcome of a new balloon catheter in the treatment of calcified lesions in infrainguinal arterial disease. Seventy-five patients with infrainguinal arterial disease were prospectively entered into the registry. The catheter (ReeKross Clearstream, Ireland) is a 5- to 6-Fr balloon catheter with a rigid shaft intended for enhanced pushability. Only technical procedural outcome was recorded. Treated calcified lesions (range: 5-30 cm), assessed angiographically, were located in the superficial femoral, popliteal, and crural arteries. In 67 patients the lesion was an occlusion. Guidewire passage occurred subintimally in 68more » patients. In 24 patients a standard balloon catheter was chosen as first treatment catheter: 5 failed to cross the lesion, 8 balloons ruptured, and in 11 patients there was an inadequate dilatation result. In only one of the five patients did subsequent use of the ReeKross catheter also fail in lesion crossing. The ReeKross was successful as secondary catheter in the other 23 cases. In 50 patients the ReeKross was used as primary catheter. In total the ReeKross crossed the lesions in 74 patients. After passage and dilatation with this catheter in 73 patients (1 failed true-lumen reentry), 19 had >30% residual lesions, of which 11 were not treated and 8 were successfully stented. No ReeKross balloons ruptured. We conclude that in the treatment of difficult calcified lesions in arterial stenotic or occlusive disease, the choice of a high-pushability angioplasty catheter, with more calcification-resistant balloon characteristics, like the ReeKross, warrants consideration.« less

Quantification of lung perfusion blood volume (lung PBV) by dual-energy CT in patients with chronic thromboembolic pulmonary hypertension (CTEPH) before and after balloon pulmonary angioplasty (BPA): Preliminary results.

PubMed

Koike, Hirofumi; Sueyoshi, Eijun; Sakamoto, Ichiro; Uetani, Masataka; Nakata, Tomoo; Maemura, Kouji

2016-09-01

Balloon pulmonary angioplasty (BPA) is a treatment option for patients with chronic thromboembolic pulmonary hypertension (CTEPH). Its effect on pulmonary perfusion has not been quantified; we examined the clinical significance of pulmonary blood volume (PBV) using dual-energy computed tomography (DECT) in patients with CTEPH undergoing BPA. In this retrospective study of 16 BPAs in eight female patients with CTEPH, we evaluated both-lung (n=16), right- or left-lung (n=32), and three right- or left-segment (upper, middle, and lower) (n=96) PBVs before and after BPA, using DECT. We evaluated the relationships between improvement in lung PBV and pulmonary artery (PA) pressure (PAP), cardiac index (CI), pulmonary vascular resistance (PVR), and 6-min walking distance. We measured PA enhancement (PAenh) on DECT images and calculated lung PBV/PAenh to adjust timing. Pre- and post-BPA 6-segment lung PBV/PAenh were 0.067±0.021 and 0.077±0.019, respectively, in the treated segment (p<0.0001). There were significant positive correlations between pre- to post-BPA improvements in both-lung PBV/PAenh and PAP (R=0.69, p=0.005), PVR (R=0.56, p=0.03), and 6-min walking distance (R=0.67, p=0.01). Improved PBV after BPA, reflecting increased lung perfusion, was positively correlated with PAP, PVR, and 6-min walking distance. Lung PBV may be an indicator of BPA treatment effect. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Delayed reendothelialization with rapamycin is rescued by the addition of nicorandil in balloon-injured rat carotid arteries.

PubMed

Zhang, Ying Qian; Tian, Feng; Chen, Jin Song; Chen, Yun Dai; Zhou, Ying; Li, Bo; Ma, Qiang; Zhang, Ying

2016-11-15

Rapamycin is an immunosuppressive agent that is added to drug eluting stents. It prevents restenosis, but it also impairs reendothelialization. Nicorandil is a hybrid agent with adenosine triphosphated (ATP)-sensitive K+ (KATP) channel opener and nitrate properties. It prevents oxidative stress and cell apoptosis induced by rapamycin in endothelial cells in vitro. However, whether nicorandil promotes reendothelialization after angioplasty delayed by rapamycin remains to be determined. Balloon injury model was established in SD rats. Nicorandil increased reendothelialization impaired by rapamycin, and it decreased xanthine oxidase (XO)-generated reactive oxygen species (ROS) induced by rapamycin. In addition, eNOS expression inhibited by rapamycin was increased by nicorandil in vivo. In vitro, rapamycin-impeded cardiac microvascular endothelial cells (CMECs) migration, proliferation and rapamycin-induced ROS production were reversed by nicorandil. Knockdown of XO partially inhibited rapamycin-induced ROS production and cell apoptosis in CMECs, and it promoted CMECs migration and proliferation suppressed by rapamycin. Knockdown of Akt partially prevents eNOS upregulation promoted by nicorandil. The beneficial effect of nicorandil is exhibited by inhibiting XO and up-regulating Akt pathway. Nicorandil combined with rapamycin in effect rescue the deficiencies of rapamycin alone in arterial healing after angioplasty.

Delayed reendothelialization with rapamycin is rescued by the addition of nicorandil in balloon-injured rat carotid arteries

PubMed Central

Zhang, Ying Qian; Tian, Feng; Chen, Jin Song; Chen, Yun Dai; Zhou, Ying; Li, Bo; Ma, Qiang; Zhang, Ying

2016-01-01

Rapamycin is an immunosuppressive agent that is added to drug eluting stents. It prevents restenosis, but it also impairs reendothelialization. Nicorandil is a hybrid agent with adenosine triphosphated (ATP)-sensitive K+ (KATP) channel opener and nitrate properties. It prevents oxidative stress and cell apoptosis induced by rapamycin in endothelial cells in vitro. However, whether nicorandil promotes reendothelialization after angioplasty delayed by rapamycin remains to be determined. Balloon injury model was established in SD rats. Nicorandil increased reendothelialization impaired by rapamycin, and it decreased xanthine oxidase (XO)-generated reactive oxygen species (ROS) induced by rapamycin. In addition, eNOS expression inhibited by rapamycin was increased by nicorandil in vivo. In vitro, rapamycin-impeded cardiac microvascular endothelial cells (CMECs) migration, proliferation and rapamycin-induced ROS production were reversed by nicorandil. Knockdown of XO partially inhibited rapamycin-induced ROS production and cell apoptosis in CMECs, and it promoted CMECs migration and proliferation suppressed by rapamycin. Knockdown of Akt partially prevents eNOS upregulation promoted by nicorandil. The beneficial effect of nicorandil is exhibited by inhibiting XO and up-regulating Akt pathway. Nicorandil combined with rapamycin in effect rescue the deficiencies of rapamycin alone in arterial healing after angioplasty. PMID:27713157

Primary angioplasty: the past, the present and the future.

PubMed

Oomman, A; Ramachandran, P

2001-09-01

Primary angioplasty (PTCA) in acute myocardial infarction has many theoretical advantages including better antegrade flow and reduced intracranial haemorrhage. However the improvement in the mortality and morbidity of primary angioplasty in the randomized trials from sophisticated centres has not been translated to the community setting. Primary PTCA is a suitable alternative to thrombolytic therapy if performed in a timely fashion by persons skilled in the procedure in a suitable laboratory. It is also recommended in patients with cardiogenic shock and in those with contraindications to thrombolytic therapy. Combination of thrombolytics and glycoprotein IIb/IIIa inhibitors with primary angioplasty may form the reperfusion strategy of the future.

Paclitaxel-Coated Balloons for the Treatment of Dysfunctional Dialysis Access. Results from a Single-Center, Retrospective Analysis

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kitrou, Panagiotis M., E-mail: panoskitrou@gmail.com; Spiliopoulos, Stavros; Papadimatos, Panagiotis

PurposeTo investigate the safety and effectiveness of lutonix paclitaxel-coated balloon (PCB) for the treatment of dysfunctional dialysis access.Materials and MethodsThis was a single-center, single-arm, retrospective analysis of 39 patients (23 male, 59 %) undergoing 61 interventions using 69 PCBs in a 20-month period. There was a balance between arteriovenous fistulae (AVF) and grafts (AVG) (20 AVFs, 19AVGs), and the majority of lesions were restenotic (25/39, 64.1 %). Mean balloon diameter used was 6.6 mm and length 73.4 mm. Primary outcome measure was target lesion primary patency (TLPP) at 6 months, while secondary outcome measures included factors affecting TLPP and major complications. As there were lesionsmore » treated more than once with PCB, authors also compared patency results after first and second PCB angioplasty.ResultsTLPP was 72.2 % at 6 months with a median patency of 260 days according to the Kaplan–Meier survival analysis. No major complications occurred. TLPP between AVFs and AVGs (311 vs. 237 days, respectively; p = 0.29) and de novo and restenotic lesions was similar (270.5 vs. 267.5 days, respectively; p = 0.50). In 14 cases, in which lesions were treated with two PCB angioplasties, a statistically significant difference in TLPP after the second treatment was noted (first intervention 179.5 days vs. second intervention 273.5 days; p = 0.032).ConclusionIn this retrospective analysis, Lutonix PCB proved to be safe and effective in treating restenosis in dysfunctional dialysis access with results comparable to the literature available. Larger studies are needed to prove abovementioned results.« less

Percutaneous transluminal coronary angioplasty (PTCA)

MedlinePlus Videos and Cool Tools

... angioplasty (PTCA) is a minimally invasive procedure to open up blocked coronary arteries, allowing blood to circulate ... within the coronary artery to keep the vessel open. Once the compression has been performed, contrast media ...

Guide Catheter Extension Device Is Effective in Renal Angioplasty for Severely Calcified Lesions.

PubMed

Sugimoto, Takeshi; Nomura, Tetsuya; Hori, Yusuke; Yoshioka, Kenichi; Kubota, Hiroshi; Miyawaki, Daisuke; Urata, Ryota; Kikai, Masakazu; Keira, Natsuya; Tatsumi, Tetsuya

2017-05-23

BACKGROUND The GuideLiner catheter extension device is a monorail-type "Child" support catheter that facilitates coaxial alignment with the guide catheter and provides an appropriate back-up force. This device has been developed in the field of coronary intervention, and now is becoming widely applied in the field of endovascular treatment. However, there has been no report on the effectiveness of the guide catheter extension device in percutaneous transluminal renal angioplasty (PTRA). CASE REPORT We encountered a case of atherosclerotic subtotal occlusion at the ostium of the left renal artery. Due to the severely calcified orifice and weaker back-up force provided by a JR4 guide catheter, we could not pass any guidewires through the target lesion. Therefore, we introduced a guide catheter extension device, the GuideLiner catheter, through the guide catheter and achieved good guidewire maneuverability. We finally deployed 2 balloon-expandable stents and successfully performed all PTRA procedures. CONCLUSIONS The guide catheter extension device can be effective in PTRA for severely calcified subtotal occlusion.

Serial assessment of the index of microcirculatory resistance during primary percutaneous coronary intervention comparing manual aspiration catheter thrombectomy with balloon angioplasty (IMPACT study): a randomised controlled pilot study.

PubMed

Hoole, Stephen P; Jaworski, Catherine; Brown, Adam J; McCormick, Liam M; Agrawal, Bobby; Clarke, Sarah C; West, Nick E J

2015-01-01

Utilising a novel study design, we evaluated serial measurements of the index of microcirculatory resistance (IMR) in patients undergoing primary percutaneous coronary intervention (PPCI) for ST-segment elevation myocardial infarction (STEMI) to assess the impact of device therapy on microvascular function, and determine what proportion of microvascular injury is related to the PPCI procedure, and what is an inevitable consequence of STEMI. 41 patients undergoing PPCI for STEMI were randomised to balloon angioplasty (BA, n=20) or manual thrombectomy (MT, n=21) prior to stenting. Serial IMR measurements, corrected for collaterals, were recorded at baseline and at each stage of the procedure. Microvascular obstruction (MVO) and infarct size at 24 h and 3 months were measured by troponin and cardiac MRI (CMR). IMR did not change significantly following PPCI, but patients with lower IMR values (<32, n=30) at baseline had a significant increase in IMR following PPCI (baseline: 21.2±7.9 vs post-stent: 33.0±23.7, p=0.01) attributable to prestent IRA instrumentation (baseline: 21.7±8.0 vs post-BA or MT: 36.9±25.9, p=0.006). Post-stent IMR correlated with early MVO on CMR (p=0.01). There was no significant difference in post-stent IMR, presence of early MVO or final infarct size between patients with BA and patients treated with MT. Patients with STEMI and less microcirculatory dysfunction may be susceptible to acute iatrogenic microcirculatory injury from prestent coronary devices. MT did not appear to be superior to BA in maintaining microcirculatory integrity when the guide wire partially restores IRA flow during PPCI. ISRCTN31767278.

Orbital Atherectomy Plaque Modification Assessment of the Femoropopliteal Artery Via Intravascular Ultrasound (TRUTH Study)

PubMed Central

Zavlunova, Susanna; Attubato, Michael J.; Martinsen, Brad J.; Mintz, Gary S.; Maehara, Akiko

2015-01-01

Objective: The Tissue Removal Assessment with Ultrasound of the SFA and Popliteal (TRUTH) study assessed the performance of the orbital atherectomy system (OAS) to treat femoropopliteal arteries, including determining its effect on plaque removal. Methods: Patients with symptomatic femoropopliteal peripheral arterial disease were treated with the OAS followed by adjunctive balloon angioplasty (BA). Intravascular ultrasound (IVUS) images were collected pre- and post-OAS and post-OAS BA. Patients were followed through 12 months post-procedure. Results: Twenty-nine lesions were treated with OAS-BA in 25 patients. The mean maximum balloon inflation pressure was 5.2 ± 1.2 atm. Virtual histology IVUS (VH-IVUS) analysis revealed at the maximum calcium ablation site that calcium reduction was responsible for 86% of the lumen area increase. The minimum lumen area increased from 4.0 mm2 to 9.1 mm2 (<.0001), and the percentage of area stenosis decreased from 76.9% to 43.0% (<.0001) after OAS-BA. At 12 months, the target lesion revascularization rate was 8.2%, and ankle–brachial index and Rutherford classification improved significantly from baseline through follow-up. Conclusion: The VH-IVUS analysis reveals that OAS modifies the calcified component of the plaque burden. It is hypothesized that calcium modification by OAS changes the lesion compliance, allowing for low pressure adjunctive BA. The clinical outcomes were favorable through 12-month follow-up. PMID:26490645

Orbital Atherectomy Plaque Modification Assessment of the Femoropopliteal Artery Via Intravascular Ultrasound (TRUTH Study).

PubMed

Babaev, Anvar; Zavlunova, Susanna; Attubato, Michael J; Martinsen, Brad J; Mintz, Gary S; Maehara, Akiko

2015-10-01

The Tissue Removal Assessment with Ultrasound of the SFA and Popliteal (TRUTH) study assessed the performance of the orbital atherectomy system (OAS) to treat femoropopliteal arteries, including determining its effect on plaque removal. Patients with symptomatic femoropopliteal peripheral arterial disease were treated with the OAS followed by adjunctive balloon angioplasty (BA). Intravascular ultrasound (IVUS) images were collected pre- and post-OAS and post-OAS BA. Patients were followed through 12 months post-procedure. Twenty-nine lesions were treated with OAS-BA in 25 patients. The mean maximum balloon inflation pressure was 5.2 ± 1.2 atm. Virtual histology IVUS (VH-IVUS) analysis revealed at the maximum calcium ablation site that calcium reduction was responsible for 86% of the lumen area increase. The minimum lumen area increased from 4.0 mm(2) to 9.1 mm(2) (<.0001), and the percentage of area stenosis decreased from 76.9% to 43.0% (<.0001) after OAS-BA. At 12 months, the target lesion revascularization rate was 8.2%, and ankle-brachial index and Rutherford classification improved significantly from baseline through follow-up. The VH-IVUS analysis reveals that OAS modifies the calcified component of the plaque burden. It is hypothesized that calcium modification by OAS changes the lesion compliance, allowing for low pressure adjunctive BA. The clinical outcomes were favorable through 12-month follow-up. © The Author(s) 2015.

Adjuncts Matter: A Qualitative Study of Adjuncts' Job Satisfaction

ERIC Educational Resources Information Center

Rich, Telvis M.

2016-01-01

The extrinsic factors that influence the workplace experiences of 27 adjuncts teaching online were explored. In this qualitative research study, the adjuncts' lived experiences were examined through in-depth interviews. The results indicated three emergent factors which influenced the participants' workplace experiences, and the alternative…

Japanese Balloon Program

NASA Astrophysics Data System (ADS)

Yoshida, Tetsuya; Fuke, Hideyuki; Shoji, Yasuhiro; Iijima, Issei; Izutsu, Naoki; Kato, Yoichi; Matsuzaka, Yukihiko; Mizuta, Eiichi; Sato, Takatoshi; Tamura, Keisuke; Saito, Yoshitaka; Kakehashi, Yuya

2012-07-01

Institute of Space and Astronautical Science, Japan Aerospace Exploration Agency conducts domestic balloon campaigns at Taiki Aerospace Research Field (TARF) in Hokkaido since 2008. The ballooning at TARF becomes stable after four year operation. Because the field faces to the Pacific Ocean, heavy balloons and payloads can be launched safely using a very unique sliding launcher. Recoveries at the inshore along the Tokachi coast can be done very quickly and smoothly. Unfortunately, flight opportunities are recently limited due to unfriendly weather condition. Unstable Jet stream also prevents us to have so-called `boomerang flight' to achieve long flight duration more than several hours. Six balloon-borne experiments were carried out in 2010 and 2011. Three of them were demonstrations of challenges of space engineering, two were in-situ atmospheric observation, and one was the technical flight of new high-resolution γ-ray telescope. In addition to these flights, we carried out two launches for next generation balloons: one for Tawara-shaped superpressure balloon and the other for ultra-thin high-altitude balloon. In this paper, recent activities of the Japanese scientific balloon program will be introduced. On-going development of the balloon system will also be presented.

Treatment Effect of Drug-Coated Balloons Is Durable to 3 Years in the Femoropopliteal Arteries

PubMed Central

Laird, John R.; Tepe, Gunnar; Brodmann, Marianne; Zeller, Thomas; Scheinert, Dierk; Metzger, Christopher; Micari, Antonio; Sachar, Ravish; Jaff, Michael R.; Wang, Hong; Hasenbank, Melissa S.; Krishnan, Prakash

2018-01-01

Background— Randomized controlled trials have reported favorable 1-year outcomes with drug-coated balloons (DCBs) for the treatment of symptomatic peripheral arterial disease when compared with standard percutaneous transluminal angioplasty (PTA). Evidence remains limited on the durability of the treatment effect with DCBs in the longer term. Methods and Results— IN.PACT SFA is a single-blind, randomized trial (Randomized Trial of IN.PACT Admiral Paclitaxel-Coated Percutaneous Transluminal Angioplasty [PTA] Balloon Catheter vs Standard PTA for the Treatment of Atherosclerotic Lesions in the Superficial Femoral Artery [SFA] and/or Proximal Popliteal Artery [PPA]) that enrolled 331 patients with symptomatic (Rutherford 2–4) femoropopliteal lesions up to 18 cm in length. Patients were randomized 2:1 to receive treatment with DCB or PTA. The 36-month assessments included primary patency, freedom from clinically driven target lesion revascularization, major adverse events, and functional outcomes. At 36 months, primary patency remained significantly higher among patients treated with DCB compared with PTA (69.5% versus 45.1%; log rank P<0.001). The rates of clinically driven target lesion revascularization were 15.2% and 31.1% (P=0.002) for the DCB and PTA groups, respectively. Functional outcomes were similarly improved between treatment groups even though subjects in the DCB group required significantly fewer reinterventions versus those in the PTA group (P<0.001 for target lesion revascularization, P=0.001 for target vessel revascularization). There were no device- or procedure-related deaths as adjudicated by an independent Clinical Events Committee. Conclusions— Three-year results demonstrate a durable and superior treatment effect among patients treated with DCB versus standard PTA, with significantly higher primary patency and lower clinically driven target lesion revascularization, resulting in similar functional improvements with reduced need for repeat

State of the art of CO laser angioplasty system

NASA Astrophysics Data System (ADS)

Arai, Tsunenori; Mizuno, Kyoichi; Miyamoto, Akira; Sakurada, Masami; Kikuchi, Makoto; Kurita, Akira; Nakamura, Haruo; Takaoka, Hidetsugu; Utsumi, Atsushi; Takeuchi, Kiyoshi

1994-07-01

A unique percutaneous transluminal coronary angioplasty system new IR therapy laser with IR glass fiber delivery under novel angioscope guidance was described. Carbon monoxide (CO) laser emission of 5 mm in wavelength was employed as therapy laser to achieve precise ablation of atheromatous plaque with a flexible As-S IR glass fiber for laser delivery. We developed the first medical CO laser as well as As-S IR glass fiber cable. We also developed 5.5 Fr. thin angioscope catheter with complete directional manipulatability at its tip. The system control unit could manage to prevent failure irradiations and fiber damages. This novel angioplasty system was evaluated by a stenosis model of mongrel dogs. We demonstrated the usefulness of our system to overcome current issues on laser angioplasty using multifiber catheter with over-the-guidewire system.

The Role of Coagulation and Inflammation After Angioplasty in Patients with Peripheral Arterial Disease

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wahlgren, C.M.; Sten-Linder, M.; Egberg, N.

2006-08-15

Purpose. Restenosis remains a frequent complication after angioplasty in peripheral arterial disease. Inflammation plays a critical role in the vascular response to injury. Effective medical treatment to improve patency after angioplasty is still elusive. The aims of this prospective clinical study were to investigate changes in blood coagulation and inflammatory markers after angioplasty and their significance for restenosis. Methods. Thirty-four patients with peripheral arterial disease underwent angioplasty of the iliac and superficial femoral arteries. Ten patients undergoing diagnostic angiography were included in the study as controls. Plasma levels of tissue factor, prothrombin fragment 1 + 2, D-dimer, P-selectin, C-reactive proteinmore » (CRP), and fibrinogen were analyzed before and after angioplasty. Patients were followed up with angiography after 6 months to assess restenosis. Results. CRP was elevated the day after angioplasty (6.6 mg/l, p = 0.0001) and tended to peak after 1 week (11 mg/l, p = 0.09). There was a significant increase of D-dimer and P-selectin 1-4 hr after angioplasty (0.4 mg/l, p = 0.001 and 68 ng/ml, p = 0.05, respectively). None of the biochemical markers was a statistically significant predictor of restenosis. Conclusion. We have observed a much more prolonged inflammatory response than previously noted, but only minor changes in coagulation activity after angioplasty. The biochemical markers, before and after angioplasty, were not related to restenosis. Further studies are needed to delineate the molecular mechanisms behind these observations and their involvement in thrombosis and restenosis. If these pathways are further defined, improved treatment strategies, including antithrombotic treatments and statins, could be tailored to modulate postprocedural inflammation.« less

Adjunct Accounting

ERIC Educational Resources Information Center

Lesesne, Cherise

2012-01-01

With colleges and universities recruiting more adjunct professors, schools have been able to reduce the costly expenses of large salary and benefit packages that are typically associated with full-time employees. Yet, schools have started to re-evaluate their use of adjunct professors in order to comply with the Affordable Care Act (ACA), dubbed…

Design of a cost-effective, hemodynamically adjustable model for resuscitative endovascular balloon occlusion of the aorta (REBOA) simulation.

PubMed

Keller, Benjamin A; Salcedo, Edgardo S; Williams, Timothy K; Neff, Lucas P; Carden, Anthony J; Li, Yiran; Gotlib, Oren; Tran, Nam K; Galante, Joseph M

2016-09-01

Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an adjunct technique for salvaging patients with noncompressible torso hemorrhage. Current REBOA training paradigms require large animals, virtual reality simulators, or human cadavers for acquisition of skills. These training strategies are expensive and resource intensive, which may prevent widespread dissemination of REBOA. We have developed a low-cost, near-physiologic, pulsatile REBOA simulator by connecting an anatomic vascular circuit constructed out of latex and polyvinyl chloride tubing to a commercially available pump. This pulsatile simulator is capable of generating cardiac outputs ranging from 1.7 to 6.8 L/min with corresponding arterial blood pressures of 54 to 226/14 to 121 mmHg. The simulator accommodates a 12 French introducer sheath and a CODA balloon catheter. Upon balloon inflation, the arterial waveform distal to the occlusion flattens, distal pulsation within the simulator is lost, and systolic blood pressures proximal to the balloon catheter increase by up to 62 mmHg. Further development and validation of this simulator will allow for refinement, reduction, and replacement of large animal models, costly virtual reality simulators, and perfused cadavers for training purposes. This will ultimately facilitate the low-cost, high-fidelity REBOA simulation needed for the widespread dissemination of this life-saving technique.

Evaluation of workforce and organizational issues in establishing primary angioplasty in England.

PubMed

Carter, Angela; Wood, Stephen; Goodacre, Steve; Sampson, Fiona; Stables, Rod

2010-01-01

To assess workforce and organizational issues in establishing a primary angioplasty service in England. Staff associated with the heart attack pathway at seven acute hospitals participating in the National Infarct Angioplasty Project (NIAP) completed a questionnaire, participated in focus groups and interviews, and observations were undertaken in catheter laboratories. All seven hospitals implemented primary angioplasty though not all provided a 24-hour service. Hospitals varied in size, number of staff involved in the delivery of angioplasty and the volume of cases. Hospitals that developed the service by incremental expansion encountered more problems than hospitals that planned for a full service at the outset. Simple, direct access to a catheter laboratory reduced delays and could be facilitated by an angioplasty gatekeeper. Little attention was paid to later cardiac rehabilitation. Multiskilling and the ability to work across traditional professional boundaries appeared to provide substantial advantages. Building relationships with key staff and auditing the heart attack pathway were critical to successful service development. Differences in remuneration and rest for staff undertaking out-of-hours working threatened sustainability. Primary angioplasty was feasible in varied settings and generally supported by staff. However, the participating hospitals were selected enthusiasts, only some implemented a 24-hour service and activity levels were relatively low. Organizational and workforce issues need to be addressed to achieve an efficient and sustainable service.

Coronary Angioplasty Induces Rise in Chlamydia pneumoniae-Specific Antibodies

PubMed Central

Tiran, Andreas; Tio, Rene A.; Ossewaarde, Jacobus M.; Tiran, Beate; den Heijer, Peter; The, T. Hauw; Wilders-Truschnig, Martie M.

1999-01-01

Chlamydia pneumoniae is frequently found in atherosclerotic lesions, and high titers of specific antibodies are associated with increased risk for acute myocardial infarction. However, a causative relation has not been established yet. We performed a prospective study of 93 patients undergoing percutaneous transluminal coronary angioplasty (PTCA) to investigate whether angioplasty influences Chlamydia-specific antibody titers and whether there is an association with restenosis. Blood samples were obtained before and 1 and 6 months after angioplasty. Antibodies against chlamydial lipopolysaccharide and against purified C. pneumoniae elementary bodies were measured by enzyme-linked immunosorbent assay (ELISA). After angioplasty, the prevalence of antibodies to lipopolysaccharide rose from 20 to 26% for immunoglobulin A (IgA), from 53 to 64% for IgG, and from 2 to 7% for IgM (P = 0.021, 0.004, and 0.046, respectively). There was a rapid increase of mean antibody titers of all antibody classes within 1 month of PTCA. During the following 5 months, antibody titers decreased slightly but were still higher than baseline values. Results of the C. pneumoniae-specific ELISA were essentially the same. The rise of anti-Chlamydia antibodies was not caused by unspecific reactivation of the immune system, as levels of antibodies against cytomegalovirus did not change. Neither seropositivity nor antibody titers were related to restenosis. However, increases in mean IgA and IgM titers were restricted to patients who had suffered from myocardial infarction earlier in their lives. In conclusion, we show that PTCA induces a stimulation of the humoral immune response against C. pneumoniae. These data support the idea that plaque disruption during angioplasty might make hidden chlamydial antigens accessible to the immune system. PMID:10074519

Novel paclitaxel-coated angioplasty balloon catheter based on cetylpyridinium salicylate: preparation, characterization and simulated use in an in vitro vessel model.

PubMed

Petersen, Svea; Kaule, Sebastian; Stein, Florian; Minrath, Ingo; Schmitz, Klaus-Peter; Kragl, Udo; Sternberg, Katrin

2013-10-01

Drug-coated balloons (DCB), which have emerged as therapeutic alternative to drug-eluting stents in percutaneous cardiovascular intervention, are well described with regard to clinical efficiency and safety within a number of clinical studies. In vitro studies elucidating the correlation of coating method and composition with DCB performance are however rare but considered important for the understanding of DCB requirements and the improvement of established DCB. In this context, we evaluated the applicability of a pipetting, dip-coating, and spray-coating process for the establishment of DCB based on paclitaxel (PTX) and the ionic liquid cetylpyridinium salicylate (Cetpyrsal) as novel innovative additive in three different compositions. Among tested methods and compositions, the pipetting process with 50 wt.% PTX resulted in most promising coatings as drug load was less controllable by the other processes and higher PTX contents led to considerable drug crystallization, as visualized by electron microscopy, accelerating PTX loss during short-term elution. Applying these conditions, homogeneous coatings could be applied on balloon catheter, whose simulated use in an in vitro vessel model revealed percental drug losses of 36 and 28% during transit and percental drug transfers of 12 and 40% under expansion for coatings applied in expanded and folded balloon condition, respectively. In comparison to literature values, these results support the high potential of Cetpyrsal as novel DCB matrix regarding low drug loss and efficient drug transfer. © 2013.

Balloons and Science Kit.

ERIC Educational Resources Information Center

Balloon Council, Washington, DC.

This document provides background information on balloons including: (1) the history of balloons; (2) balloon manufacturing; (3) biodegradability; (4) the fate of latex balloons; and (5) the effect of balloons on the rainforest and sea mammals. Also included as part of this instructional kit are four fun experiments that allow students to…

Recent Developments in Balloon Support Instrumentation at TIFR Balloon Facility, Hyderabad.

NASA Astrophysics Data System (ADS)

Vasudevan, Rajagopalan

2012-07-01

The Balloon Facility of Tata Institute of Fundamental Research has been conducting stratospheric balloon flights regularly for various experiments in Space Astronomy and Atmospheric Sciences. A continuous improvement in Balloon flight Support instrumentation by the Control Instrumentation Group to keep in space with the growing complexities of the scientific payloads have contributed to the total success of balloon flights conducted recently. Recent improvements in display of Balloon position during balloon flight by showing on real time the balloon GPS position against Google TM maps is of immense help in selecting the right spot for payload landing and safe recovery . For further speeding up the payload recovery process, a new GPS-GSM payload system has been developed which gives SMS of the payload position information to the recovery team on their cell phones. On parallel footing, a new GPS- VHF system has been developed using GPS and Radio Modems for Balloon Tracking and also for obtaining the payload impact point. On the Telecommand side, a single board Telecommand/ Timer weighing less than 2 Kg has been specially developed for use in the mesosphere balloon test flight. The interference on the existing Short Range Telemetry System has been eliminated by introducing a Band Pass Filter and LNA in the Receiving system of the modules, thereby enhancing its reliability. In this paper , we present the details of the above mentioned developments.

GHOST balloons around Antarctica

NASA Technical Reports Server (NTRS)

Stearns, Charles R.

1988-01-01

The GHOST balloon position as a function of time data shows that the atmospheric circulation around the Antarctic Continent at the 100 mb and 200 mb levels is complex. The GHOST balloons supposedly follow the horizontal trajectory of the air at the balloon level. The position of GHOST balloon 98Q for a three month period in 1968 is shown. The balloon moved to within 2 deg of the South Pole on 1 October 1968 and then by 9 December 1968 was 35 deg from the South Pole and close to its position on 1 September 1968. The balloon generally moved from west to east but on two occasions moved in the opposite direction for a few days. The latitude of GHOST balloons 98Q and 149Z which was at 200 mb is given. Both balloons tended to get closer to the South Pole in September and October. Other GHOST balloons at the same pressure and time period may not indicate similar behavior.

Angioplasty and stent placement - peripheral arteries

MedlinePlus

... medlineplus.gov/ency/article/007393.htm Angioplasty and stent placement - peripheral arteries To use the sharing features ... inside the arteries and block blood flow. A stent is a small, metal mesh tube that keeps ...

The influence of depression and anxiety in the development of heart failure after coronary angioplasty.

PubMed

Gegenava, T; Gegenava, M; Kavtaradze, G

2009-03-01

The aim of our study was to investigate the association between history of depressive episode and anxiety and complications in patients after 6 months of coronary artery angioplasty. The research was conducted on 70 patients, the grade of coronary occlusion that would not respond to therapeutic treatment and need coronary angioplasty had been established. Complications were estimated in 60 patients after 6 months of coronary angioplasty. To evaluate depression we used Beck depression scale Anxiety was assessed by Spilberger State-trait anxiety scale. Statistic analysis of the data was made by means of the methods of variation statistics using Students' criterion and program of STATISTICA w 5.0. Complications were discovered in 36 (60%) patients; 24 (40%) patients had not complications. There was not revealed significant statistical differences in depression and anxiety degree in coronary angioplasty period and after 6 months of coronary angioplasty. There was not revealed significant statistical differences in depression and anxiety degree in coronary angioplasty period and after 6 months of coronary angioplasty. Our study demonstrated that complications were revealed in patients who had high degree of depression and anxiety.

Changing profile of excimer laser coronary angioplasty: refinements in catheters

NASA Astrophysics Data System (ADS)

Bittl, John A.

1994-07-01

During more than five years of investigation with excimer laser angioplasty, several changes have been made in patient selection and laser catheters. It is unclear, however, whether these changes have improved the outcome of excimer laser angioplasty. A total of 2041 patients underwent treatment with excimer laser coronary angioplasty for 2324 lesions with clinical success in 89%, ischemic complications in 7.5%, and vessel perforation in 2.1%. When the entire 5-year period of investigation was divided into four discrete phases, as defined by the successive release of improved laser catheters (prototype, flexible, extremely flexible, and eccentric), clinical success was seen to improve from 86% to 95% (p<0.001) despite the increased incidence of advanced age (pequals0.01) and unstable angina (p<0.001). Multivariable analysis identified improved laser catheters, saphenous vein graft lesions, and unclarified stenoses as predictors of favorable outcome. Operator experience was associated with decreased complications. Reduced catheter size relative to vessel size was associated with decreased risk of vessel perforation. Thus, refinements in patient selection and in laser technique have been associated with enhanced safety and efficacy of excimer laser angioplasty.

Safety of low dose heparin in elective coronary angioplasty.

PubMed Central

Koch, K. T.; Piek, J. J.; de Winter, R. J.; David, G. K.; Mulder, K.; Tijssen, J. G.; Lie, K. I.

1997-01-01

OBJECTIVES: To evaluate the safety of a low dose of heparin in consecutive stable patients undergoing elective percutaneous transluminal coronary angioplasty (PTCA). DESIGN: Open prospective study in a single centre. PATIENTS: 1375 consecutive patients had elective PTCA (1952 lesions: type A 11%, B1 34%, B2 36%, and C 19%). There were no angiographic exclusion criteria. INTERVENTIONS: A bolus of 5000 IU heparin was used as the standard anticoagulation regimen during PTCA. The sheaths were removed immediately after successful completion of the procedure. Prolongation of heparin treatment was left to the operator's discretion. MAIN OUTCOME MEASURES: Procedural success was defined as < 50% residual stenosis without death from any cause, acute myocardial infarction, urgent coronary bypass surgery, or repeat angioplasty within 48 hours for acute recurrent ischaemia; the need for prolonged heparinisation; and the occurrence of puncture site complications. RESULTS: Procedural success without clinical events was achieved in 90% of patients. Mortality was 0.3%; coronary bypass surgery was performed in 1.7% of the procedures. The rate of myocardial infarction was 3.3%; repeat angioplasty within 48 hours was carried out in 0.7% of patients. A total of 89.1% of the patients were treated according to the protocol. Prolonged treatment with heparin was considered necessary in 123 patients (8.9%). Repeat angioplasty for abrupt closure was performed in two patients shortly after sheath removal and in two during prolonged heparinisation. Puncture site complications occurred in 2.1% of patients (low dose heparin 1.9% and prolonged heparinisation 4.9%). CONCLUSION: Elective PTCA can be safely performed using a low dose of heparin, with a negligible risk for subacute closure. Low dose heparin may reduce the incidence of puncture site complications, shorten hospitalisation, and enable out-patient angioplasty. PMID:9227294

A prospective, multi-center study of the chocolate balloon in femoropopliteal peripheral artery disease: The Chocolate BAR registry.

PubMed

Mustapha, Jihad A; Lansky, Alexandra; Shishehbor, Mehdi; Miles McClure, John; Johnson, Sarah; Davis, Thomas; Makam, Prakash; Crowder, William; Konstantino, Eitan; Attaran, Robert R

2018-05-01

The Chocolate BAR study is a prospective multicenter post-market registry designed to evaluate the safety and performance of the Chocolate percutaneous transluminal angioplasty balloon catheter in a broad population with symptomatic peripheral arterial disease. The primary endpoint is acute procedural success (defined as ≤30% residual stenosis without flow-limiting dissection); secondary long-term outcomes include freedom from target lesion revascularization (TLR), major unplanned amputation, survival, and patency. A total of 262 patients (290 femoropopliteal lesions) were enrolled at 30 US centers between 2012 and 2014. The primary endpoint of procedure success was achieved in 85.1% of cases, and freedom from stenting occurred in 93.1%. Bail out stenting by independent adjudication occurred in 1.6% of cases and there were no flow limiting dissections. There was mean improvement of 2.1 Rutherford classes (±1.5) at 12-months, with 78.5% freedom from TLR, 97.2% freedom from major amputation, and 93.3% freedom from all-cause mortality. Core Lab adjudicated patency was 64.1% at 12 months. Use of the Chocolate balloon in an "all-comers" population achieved excellent procedural outcomes with low dissection rates and bailout stent use. © 2018 Wiley Periodicals, Inc.

Alterations of Blood Flow Through Arteries Following Atherectomy and the Impact on Pressure Variation and Velocity.

PubMed

Plourde, Brian D; Vallez, Lauren J; Sun, Biyuan; Nelson-Cheeseman, Brittany B; Abraham, John P; Staniloae, Cezar S

2016-09-01

Simulations were made of the pressure and velocity fields throughout an artery before and after removal of plaque using orbital atherectomy plus adjunctive balloon angioplasty or stenting. The calculations were carried out with an unsteady computational fluid dynamic solver that allows the fluid to naturally transition to turbulence. The results of the atherectomy procedure leads to an increased flow through the stenotic zone with a coincident decrease in pressure drop across the stenosis. The measured effect of atherectomy and adjunctive treatment showed decrease the systolic pressure drop by a factor of 2.3. Waveforms obtained from a measurements were input into a numerical simulation of blood flow through geometry obtained from medical imaging. From the numerical simulations, a detailed investigation of the sources of pressure loss was obtained. It is found that the major sources of pressure drop are related to the acceleration of blood through heavily occluded cross sections and the imperfect flow recovery downstream. This finding suggests that targeting only the most occluded parts of a stenosis would benefit the hemodynamics. The calculated change in systolic pressure drop through the lesion was a factor of 2.4, in excellent agreement with the measured improvement. The systolic and cardiac-cycle-average pressure results were compared with measurements made in a multi-patient study treated with orbital atherectomy and adjunctive treatment. The agreements between the measured and calculated systolic pressure drop before and after the treatment were within 3%. This excellent agreement adds further confidence to the results. This research demonstrates the use of orbital atherectomy to facilitate balloon expansion to restore blood flow and how pressure measurements can be utilized to optimize revascularization of occluded peripheral vessels.

Endothelium dependent and independent responses in coronary artery disease measured at angioplasty.

PubMed Central

Holdright, D R; Clarke, D; Poole-Wilson, P A; Fox, K; Collins, P

1993-01-01

OBJECTIVE--To investigate the effects of substance P and papaverine, two drugs that increase coronary blood flow by different mechanisms, on vasomotion in stenotic coronary arteries at percutaneous transluminal coronary angioplasty (PTCA). DESIGN--Coronary blood flow responses to substance P and papaverine were measured in stenotic coronary arteries at the time of PTCA with quantitative angiography and a Doppler flow probe. SETTING--A cardiothoracic referral centre. PATIENTS--15 patients undergoing elective PTCA of a discrete epicardial coronary artery stenosis. INTERVENTIONS--Pharmacological coronary flow reserve was determined with papaverine 5-10 minutes before and after successful PTCA. Endothelium dependent responses to 2 minute infusions of substance P (10-15 pmol.min-1) were assessed immediately before PTCA. MAIN OUTCOME MEASURES--Coronary blood flow responses and changes in epicardial coronary artery area at stenotic, proximal, and distal sites with papaverine and substance P. RESULTS--Stenotic sites dilated with papaverine before PTCA (17.7%(6.9%) (mean (SEM)) area increase, p < 0.05 v baseline). Substance P dilated stenotic sites (16.8%(5.7%) area increase, p < 0.05) and proximal (14.3%(5.4%), p < 0.05) and distal sites (41.7%(9.3%), p < 0.005). Coronary flow reserve increased but did not reach normal values after PTCA (2.3(0.4) before PTCA v 3.0(0.4) after PTCA, p < 0.05) and was associated with an increase in peak flow with papaverine. Angioplasty did not alter baseline flow. After PTCA papaverine caused significant vasoconstriction at the stenotic site (-13.6%(4.3%) area decrease, p < 0.05). There was a negative correlation (r = -0.68, p < 0.05) between the dilator response with papaverine before PTCA and the constrictor response after PTCA. CONCLUSIONS--Substance P causes endothelium dependent dilatation in atheromatous coronary arteries, even at sites of overt atheroma. The cause of the paradoxical constrictor response to papaverine after PTCA is

Guide Catheter Extension Device Is Effective in Renal Angioplasty for Severely Calcified Lesions

PubMed Central

Sugimoto, Takeshi; Nomura, Tetsuya; Hori, Yusuke; Yoshioka, Kenichi; Kubota, Hiroshi; Miyawaki, Daisuke; Urata, Ryota; Kikai, Masakazu; Keira, Natsuya; Tatsumi, Tetsuya

2017-01-01

Patient: Male, 69 Final Diagnosis: Atherosclerotic renal artery stenosis Symptoms: None Medication: — Clinical Procedure: — Specialty: Radiology Objective: Unusual setting of medical care Background: The GuideLiner catheter extension device is a monorail-type “Child” support catheter that facilitates coaxial alignment with the guide catheter and provides an appropriate back-up force. This device has been developed in the field of coronary intervention, and now is becoming widely applied in the field of endovascular treatment. However, there has been no report on the effectiveness of the guide catheter extension device in percutaneous transluminal renal angioplasty (PTRA). Case Report: We encountered a case of atherosclerotic subtotal occlusion at the ostium of the left renal artery. Due to the severely calcified orifice and weaker back-up force provided by a JR4 guide catheter, we could not pass any guide-wires through the target lesion. Therefore, we introduced a guide catheter extension device, the GuideLiner catheter, through the guide catheter and achieved good guidewire maneuverability. We finally deployed 2 balloon-expandable stents and successfully performed all PTRA procedures. Conclusions: The guide catheter extension device can be effective in PTRA for severely calcified subtotal occlusion. PMID:28533503

Ballooning Comes of Age: Make Your Own Balloon.

ERIC Educational Resources Information Center

Eckford, Jim

1983-01-01

Provides instructions for building a working model of a hot-air balloon, offering suggestions for a successful flight. Indicates that children can be involved in the projects, for example, by filling in colors in the panels of a balloon drawing. (JN)

Atherectomy of the femoropopliteal artery: a systematic review and meta-analysis of randomized controlled trials.

PubMed

Diamantopoulos, A; Katsanos, K

2014-10-01

A systematic review was performed to provide a qualitative analysis and quantitative data synthesis of randomized controlled trials (RCTs) assessing debulking atherectomy versus balloon angioplasty for treatment of femoropopliteal artery occlusive disease. PubMed (MEDLINE), EMBASE, AMED, Scopus, online content and meeting abstracts were searched in May 2014 for eligible RCTs following the PRISMA selection process. Risk of bias was assessed using the Cochrane Collaboration's tool. Pooled risks were calculated with a random effects model to account for clinical and conceptual heterogeneity. Sensitivity analysis was employed to test the robustness of the results. Six RCTs comprising 287 patients (328 lesions) treated with either debulking atherectomy or balloon angioplasty for femoropopliteal artery disease were analyzed and synthesized. Technical success was similar between the atherectomy and the angioplasty group (93.6% vs. 96.2%, RR: 0.99. 95%CI: 0.95-1.03, P=0.57, I(2)=0%). Need for bail-out stenting and distal arterial embolization were largely similar between atherectomy and balloon angioplasty alone. After a median follow-up of 9 months the 2 groups showed similar primary patency (RR: 0.90, 95%CI: 0.56-1.46, P=0.68, I(2)=69%). Only 2 low-quality studies reported amputation and mortality rates, both of which were found significantly less in the atherectomy arms. Analysis of a limited body of low quality evidence with high risk of bias showed that debulking atherectomy of the femoropopliteal artery does not seem to confer any procedural advantage or improvement of clinical outcomes over balloon angioplasty alone.

Coronary surgery and coronary angioplasty in patients with two-vessel coronary artery disease.

PubMed

Weintraub, W S; King, S B; Jones, E L; Douglas, J S; Craver, J M; Liberman, H A; Morris, D C; Guyton, R A

1993-03-01

There is uncertainty regarding the selection between coronary artery surgery and angioplasty in many patients with coronary artery disease, especially in those with 2-vessel disease. Whereas randomized trials will provide the best possible and most detailed data comparing therapy in these patients, clinical data bases may be used to provide a current perspective. The purpose of this study was to compare the long-term outcome of patients with 2-vessel coronary artery disease undergoing coronary surgery or angioplasty at Emory University hospitals in the years 1984 and 1985. Data on all patients with 2-vessel disease diagnosed at Emory University who underwent elective angioplasty or coronary surgery in the years 1984 and 1985 were compared. Categoric variables were analyzed by chi-square and continuous variables by unpaired t test. Survival was determined by the Kaplan-Meier method and differences in survival by the Mantel-Cox method. Determinants of survival were determined by Cox model analysis. There were 415 angioplasty patients and 454 surgical patients. Surgical patients were older and had more frequent systemic hypertension, diabetes mellitus, prior myocardial infarction, severe angina and congestive failure, and more significant narrowing in the left anterior descending coronary artery, totally occluded vessels and left ventricular dysfunction than did angioplasty patients. Complete revascularization was achieved more often in surgical patients. There was no difference in Q-wave myocardial infarction in the hospital. No angioplasty patient died compared with 1.1% of surgical patients (p = 0.03). Whereas 5-year survival was 93% in angioplasty patients and 89% in surgical patients (p = 0.11), there was no difference in risk-adjusted survival.(ABSTRACT TRUNCATED AT 250 WORDS)

Carotid angioplasty and stenting under protection. Techniques, results and limitations.

PubMed

Henry, M; Polydorou, A; Henry, I; Anagnostopoulou, I S; Polydorou, I A; Hugel, M

2006-10-01

A carotid stenosis is responsible for about 30% of strokes occurring. Carotid endarterectomy (CEA) is considered to be the gold standard treatment of a carotid stenosis. Carotid angioplasty and stenting (CAS) is emerging as a new alternative treatment for a carotid artery stenosis, but the risk of neurological complications and brain embolism remains the major drawback to this procedure. Therefore, in order to reduce the risks, we need: 1) good indications, good patient and lesion selection; 2) correct techniques; 3) brain protection devices (cerebral protection devices should be routinely used and are mandatory for any procedure); 4) 3 types of protection devices are available, but filters are the most commonly used (all protection devices have limitations and cannot prevent from all embolic events; however, neurological complications can be reduced by 60%); 5) a good choice of the stent and correct implantation (all stents are not equivalent and have different geometrical effects); 6) pharmacological adjuncts; 7) a good team. Recent studies have shown that CAS has superior short-term outcomes than CEA in high surgical risk patients, but there are enough reported data to conclude that CAS is also not inferior to CEA in low-risk patients. CAS under protection is the standard of care and is maybe becoming the gold standard treatment of a carotid stenosis at least in some subgroups of patients.

Energy from solar balloons

DOE Office of Scientific and Technical Information (OSTI.GOV)

Grena, Roberto

2010-04-15

Solar balloons are hot air balloons in which the air is heated directly by the sun, by means of a black absorber. The lift force of a tethered solar balloon can be used to produce energy by activating a generator during the ascending motion of the balloon. The hot air is then discharged when the balloon reaches a predefined maximum height. A preliminary study is presented, along with an efficiency estimation and some considerations on possible realistic configurations. (author)

Endovascular treatment of atherosclerotic popliteal artery disease based on dynamic angiography findings.

PubMed

Cui, Chaoyi; Huang, Xintian; Liu, Xiaobing; Li, Weimin; Lu, Xinwu; Lu, Min; Jiang, Mier; Yin, Minyi

2017-01-01

To evaluate efficacy, safety, and midterm patency of endovascular treatment of obstructive popliteal artery (PA) disease. A retrospective evaluation of patients with atherosclerotic PA disease who underwent percutaneous transluminal balloon angioplasty and provisional stent, based on both conventional and dynamic angiographies, was conducted from June 2011 to June 2014. Forty-three patients were included in the study, and most patients had limited surgical revascularization options. Demographic characteristics, angiographic findings, interventional data, complications, vessel patency, limb salvage rates, and survival rates were analyzed. The median lesion length was 5 cm with 72.1% having total occlusions. The second popliteal segment (P2) was involved most frequently (60.5%, n = 26). Critical limb ischemia was present in 69.8%. The technical success rate was 92.9% (42/43 limbs), with 29 cases requiring adjunctive nitinol stents after balloon angioplasty (47.6% based on conventional angiography, 21.4% based on dynamic angiography, and 4.8% additional stents based on dynamic angiography). Complications included thromboembolism (2.3%), perforation (2.3%), pseudoaneurysm (2.3%), and myocardial infarction (2.3%). Stent fracture was present in three cases (7.1%) during the mean follow-up period of 18.3 months. The baseline ankle-brachial index significantly improved after the intervention, from 0.49 ± 0.11 to 0.92 ± 0.14 (P < .01). The Rutherford-Becker class decreased from 3.95 ± 0.76 to 1.76 ± 0.95 (P < .01) at 12 months. The 1-year primary, primary-assisted, and secondary patency rates were 75.2% ± 6.8%, 82.4% ± 6.0%, and 89.9% ± 4.8%, respectively. The limb salvage and amputation-free survival rates at 12 months were 91.6% and 87.0%, respectively. Balloon angioplasty with a provisional stent based on dynamic angiography is a feasible, safe, and effective therapy for patients with obstructive PA disease. Although the occurrence of stent fracture

Cerebrospinal fluid enhancement on fluid attenuated inversion recovery images after carotid artery stenting with neuroprotective balloon occlusions: hemodynamic instability and blood-brain barrier disruption.

PubMed

Ogami, Ryo; Nakahara, Toshinori; Hamasaki, Osamu; Araki, Hayato; Kurisu, Kaoru

2011-10-01

A rare complication of carotid artery stenting (CAS), prolonged reversible neurological symptoms with delayed cerebrospinal fluid (CSF) space enhancement on fluid attenuated inversion recovery (FLAIR) images, is associated with blood-brain barrier (BBB) disruption. We prospectively identified patients who showed CSF space enhancement on FLAIR images. Nineteen patients-5 acute-phase and 14 scheduled-underwent 21 CAS procedures. Balloon catheters were navigated across stenoses, angioplasty was performed using a neuroprotective balloon, and stents were placed with after dilation under distal balloon protection. CSF space hyperintensity or obscuration on FLAIR after versus before CAS indicated CSF space enhancement. Correlations with clinical factors were examined. CSF space was enhanced on FLAIR in 12 (57.1%) cases. Postprocedural CSF space enhancement was significantly related to age, stenosis rate, acute-stage procedure, and total occlusion time. All acute-stage CAS patients showed delayed enhancement. Only age was associated with delayed CSF space enhancement in scheduled CAS patients. Ischemic intolerance for severe carotid artery stenosis and temporary neuroprotective balloon occlusion, causing reperfusion injury, seem to be the main factors that underlie BBB disruption with delayed CSF space enhancement shortly after CAS, rather than sudden poststenting hemodynamic change. Our results suggest that factors related to hemodynamic instability or ischemic intolerance seem to be associated with post-CAS BBB vulnerability. Patients at risk for hemodynamic instability or with ischemic intolerance, which decrease BBB integrity, require careful management to prevent intracranial hemorrhagic and other post-CAS complications.

Percutaneous Transluminal Angioplasty for Complete Membranous Obstruction of Suprahepatic Inferior Vena Cava: Long-Term Results

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kucukay, Fahrettin, E-mail: fkucukay@hotmail.com; Akdogan, Meral, E-mail: akdmeral@yahoo.com; Bostanci, Erdal Birol, E-mail: ebbostanci@yahoo.com

PurposeTo determine the long-term results of percutaneous transluminal angioplasty (PTA) for a complete membranous obstruction of the suprahepatic inferior vena cava.MethodsPatients (n = 65) who were referred to the interventional unit for PTA for a complete membranous obstruction of the suprahepatic inferior vena cava between January 2006 and October 2014 were included in the study. Thirty-two patients (18 males, 14 females, mean age 35 ± 10.7, range 20–42 years) were treated. The patients presented with symptoms of ascites (88 %), pleural effusion (53 %), varicose veins (94 %), hepatomegaly (97 %), abdominal pain (84 %), and splenomegaly (40 %). Transjugular liver access set and re-entry catheter were used to puncture andmore » traverse the obstruction from the jugular side. PTA balloon dilations were performed. The mean follow-up period was 65.6 ± 24.5 months. The objective was to evaluate technical success, complications, primary patency, and clinical improvement in the symptoms of the patients.ResultsThe technical success rate was 94 %. In two patients, obstruction could not be traversed. These patients underwent cavoatrial graft bypass surgery. There were no procedure-related complications. Clinical improvements were achieved in all patients within 3 months. The primary patency rate at 4 years was 90 %. There was no primary assisted patency. There was no need for metallic stent deployment in the cohort. The secondary patency rate at 4 years was 100 %.ConclusionsPercutaneous transluminal angioplasty for a complete membranous obstruction of the suprahepatic inferior vena cava is safe and effective, and the long-term results are excellent.« less

Three-dimensional fractal analysis of 99mTc-MAA SPECT images in chronic thromboembolic pulmonary hypertension for evaluation of response to balloon pulmonary angioplasty: association with pulmonary arterial pressure.

PubMed

Maruoka, Yasuhiro; Nagao, Michinobu; Baba, Shingo; Isoda, Takuro; Kitamura, Yoshiyuki; Yamazaki, Yuzo; Abe, Koichiro; Sasaki, Masayuki; Abe, Kohtaro; Honda, Hiroshi

2017-06-01

Balloon pulmonary angioplasty (BPA) is used for inoperable chronic thromboembolic pulmonary hypertension (CTEPH), but its effect cannot be evaluated noninvasively. We devised a noninvasive quantitative index of response to BPA using three-dimensional fractal analysis (3D-FA) of technetium-99m-macroaggregated albumin (Tc-MAA) single-photon emission computed tomography (SPECT). Forty CTEPH patients who underwent pulmonary perfusion scintigraphy and mean pulmonary arterial pressure (mPAP) measurement by right heart catheterization before and after BPA were studied. The total uptake volume (TUV) in bilateral lungs was determined from maximum intensity projection Tc-MAA SPECT images. Fractal dimension was assessed by 3D-FA. Parameters were compared before and after BPA, and between patients with post-BPA mPAP more than 30 mmHg and less than or equal to 30 mmHg. Receiver operating characteristic analysis was carried out. BPA significantly improved TUV (595±204-885±214 ml, P<0.001) and reduced the laterality of uptake (238±147-135±131 ml, P<0.001). Patients with poor therapeutic response (post-BPA mPAP≥30 mmHg, n=16) showed a significantly smaller TUV increase (P=0.044) and a significantly greater post-BPA fractal dimension (P<0.001) than the low-mPAP group. Fractal dimension correlated with mPAP values before and after BPA (P=0.013 and 0.001, respectively). A post-BPA fractal dimension threshold of 2.4 distinguished between BPA success and failure with 75% sensitivity, 79% specificity, 78% accuracy, and area under the curve of 0.85. 3D-FA using Tc-MAA SPECT pulmonary perfusion scintigraphy enables a noninvasive evaluation of the response of CTEPH patients to BPA.

Adjunct Faculty Handbook.

ERIC Educational Resources Information Center

Thompson, Merle O'Rourke

This handbook for Northern Virginia Community College (NVCC) adjunct faculty presents a variety of information designed for adjunct lecturers in English. Three short introductory sections focus on general information, helpful hints, and the use of office machines. The body of the handbook contains the following sections: (1) Services, including…

Single balloon versus double balloon bipedicular kyphoplasty: a systematic review and meta-analysis.

PubMed

Jing, Zehao; Dong, Jianli; Li, Zhengwei; Nan, Feng

2018-06-19

Kyphoplasty has been widely used to treat vertebral compression fractures (VCFs). In standard procedure of kyphoplasty, two balloons were inserted into the vertebral body through bipedicular and inflated simultaneously, while using a single balloon two times is also a common method in clinic to lessen the financial burden of patients. However, the effect and safety of single balloon versus double balloon bipedicular kyphoplasty are still controversy. In this systematic review and meta-analysis, eligible studies were identified through a comprehensive literature search of PubMed, Cochrane library EMBASE, Web of Science, Wanfang, CNKI, VIP and CBM until January 1, 2018. Results from individual studies were pooled using a random or fixed effects model. Seven articles were included in the systematic review and five studies were consisted in meta-analysis. We observed no significant difference between single balloon and double balloon bipedicular kyphoplasty in visual analog scale (VAS), angle (kyphotic angle and Cobb angle), consumption (operation time, cement volume and volume of bleeding), vertebral height (anterior height, medium height and posterior height) and complications (cement leakage and new VCFs), while the cost of single balloon bipedicular kyphoplasty is lower than that of double balloon bipedicular kyphoplasty. The results of our meta-analysis also demonstrated that single balloon can significantly improve the VAS, angle and vertebral height of patients suffering from VCFs. This systematic review and meta-analysis collectively concludes that single balloon bipedicular kyphoplasty is as effective as double balloon bipedicular kyphoplasty in improving clinical symptoms, deformity and complications of VCFs but not so expensive. These slides can be retrieved under Electronic Supplementary Material.

Balloon Design Software

NASA Technical Reports Server (NTRS)

Farley, Rodger

2007-01-01

PlanetaryBalloon Version 5.0 is a software package for the design of meridionally lobed planetary balloons. It operates in a Windows environment, and programming was done in Visual Basic 6. By including the effects of circular lobes with load tapes, skin mass, hoop and meridional stress, and elasticity in the structural elements, a more accurate balloon shape of practical construction can be determined as well as the room-temperature cut pattern for the gore shapes. The computer algorithm is formulated for sizing meridionally lobed balloons for any generalized atmosphere or planet. This also covers zero-pressure, over-pressure, and super-pressure balloons. Low circumferential loads with meridionally reinforced load tapes will produce shapes close to what are known as the "natural shape." The software allows for the design of constant angle, constant radius, or constant hoop stress balloons. It uses the desired payload capacity for given atmospheric conditions and determines the required volume, allowing users to design exactly to their requirements. The formulations are generalized to use any lift gas (or mixture of gases), any atmosphere, or any planet as described by the local acceleration of gravity. PlanetaryBalloon software has a comprehensive user manual that covers features ranging from, but not limited to, buoyancy and super-pressure, convenient design equations, shape formulation, and orthotropic stress/strain.

Angioplasty and stent placement - peripheral arteries - discharge

MedlinePlus

... medlineplus.gov/ency/patientinstructions/000234.htm Angioplasty and stent placement - peripheral arteries - discharge To use the sharing ... peripheral artery). You may have also had a stent placed. To perform the procedure: Your doctor inserted ...

Angioplasty and stent placement - carotid artery - discharge

MedlinePlus

... medlineplus.gov/ency/patientinstructions/000235.htm Angioplasty and stent placement - carotid artery - discharge To use the sharing ... the hospital. You may have also had a stent (a tiny wire mesh tube) placed in the ...

Endovascular Revascularization of Symptomatic Infrapopliteal Arteriosclerotic Occlusive Disease: Comparison of Atherectomy and Angioplasty

PubMed Central

Tan, Tze-Woei; Semaan, Elie; Nasr, Wael; Eberhardt, Robert T.; Hamburg, Naomi; Doros, Gheorghe; Rybin, Denis; Shaw, Palma M.; Farber, Alik

2011-01-01

The preferred method for revascularization of symptomatic infrapopliteal arterial occlusive disease (IPAD) has traditionally been open vascular bypass. Endovascular techniques have been increasingly applied to treat tibial disease with mixed results. We evaluated the short-term outcome of percutaneous infrapopliteal intervention and compared the different techniques used. A retrospective analysis of consecutive patients undergoing endovascular treatment for infrapopliteal arterial occlusive lesions between 2003 and 2007 in a tertiary teaching hospital was performed. Patient demographic data, indication for intervention, and periprocedural complications were recorded. Periprocedural and short-term outcomes were measured and compared. Forty-nine infrapopliteal arteries in 35 patients were treated. Twenty vessels (15 patients) underwent angioplasty and 29 vessels (20 patients) were treated with atherectomy. Demographic and angiographic characteristics were similar between the groups. Twenty-six patients had concurrent femoral and/or popliteal artery interventions. Overall, technical success was 90% and similar between angioplasty and atherectomy groups (85% versus 93%, p = NS). The vessel-specific complication rate was 10% and was similar between both groups (angioplasty 5% versus atherectomy 14%, p = NS). One dissection occurred in the angioplasty group; one perforation and three thromboembolic events occurred in the atherectomy group. Limb salvage and freedom from reintervention at 6 months were 81% and 68%, respectively, and were not significantly different between the angioplasty and atherectomy groups. Endovascular intervention for IPAD had acceptable periprocedural and short-term success rates in our high-risk patient population. Both atherectomy and angioplasty can be used successfully to treat symptomatic IPAD. PMID:22532766

Door-to-balloon delays before primary angioplasty in the Regional Acute Myocardial Infarction Registry of Brittany. An analysis of the Observatoire Régional Breton sur l'Infarctus du myocarde (ORBI).

PubMed

Leurent, Guillaume; Fougerou, Claire; Pennec, Pierre-Yves; Filippi, Emmanuelle; Moquet, Benoît; Druelles, Philippe; Hacot, Jean-Philippe; Rialan, Antoine; Rouault, Gilles; Gervais, Renaud; Bedossa, Marc; Boulmier, Dominique; Boulanger, Bertrand; Hamon, Christian; Treuil, Josiane; Coudert, Isabelle; Courcoux, Hubert; Le Breton, Hervé

2009-11-01

Minimizing delays to coronary reperfusion is critical in the management of acute myocardial infarction (AMI). To determine delays in in-hospital management and factors associated with delays of over 45min. We analysed data from the Observatoire Régional Breton sur l'Infarctus, a registry of AMI patients admitted within 24h of symptom onset (July 2007 to December 2008) to an interventional cardiology centre in Brittany. Prehospital delay was defined as time between first responder arrival at the patient and patient arrival at an interventional cardiovascular centre. In-hospital delay was defined as time between admission to the interventional cardiovascular centre and first balloon inflation. Patients were grouped according to duration of in-hospital delay (>45 vs angioplasty was over 45min in 50% of patients. Overall, delays were longer than recommended, due to excessively long prehospital delays. Patient admission during working hours and direct admission to a catheterization laboratory were associated with short in-hospital delay.

Managing Budd-Chiari syndrome: a retrospective review of percutaneous hepatic vein angioplasty and surgical shunting

PubMed Central

Fisher, N; McCafferty, I; Dolapci, M; Wali, M; Buckels, J; Olliff, S; Elias, E

1999-01-01

BACKGROUND—The role of percutaneous hepatic vein angioplasty in the management of Budd-Chiari syndrome has not been well defined. Over a 10 year period at our unit, we have often used this technique in cases of short length hepatic vein stenosis or occlusion, reserving surgical mesocaval shunting for cases of diffuse hepatic vein occlusion or failed angioplasty. 
AIMS—To review the outcome of angioplasty and surgical shunting to define their respective roles. 
PATIENTS—All patients treated by angioplasty or surgical shunting for non-malignant hepatic vein obstruction over a ten year period from 1987 to 1996. 
METHODS—A case note review of pretreatment features and clinical outcome. 
RESULTS—Angioplasty was attempted in 21 patients with patent hepatic vein branches and was succesful in 18; in three patients treatment was unsuccessful and these patients had surgical shunts. Fifteen patients were treated by surgical shunting only. Mortality according to definitive treatment was 3/18 following angioplasty and 8/18 following surgery; in most cases this reflected high risk status prior to treatment. Venous or shunt reocclusion rates were similar for both groups and were associated with subtherapeutic warfarin in half of these cases. Most surviving patients in both groups are asymptomatic although one surgical patient has chronic hepatic encephalopathy. 
CONCLUSION—With appropriate case selection, many patients with Budd-Chiari syndrome caused by short length hepatic vein stenosis or occlusion may be managed successfully by angioplasty alone. Medium term outcome is good following this procedure provided that anticoagulation is maintained. Further follow up is required to assess for definitive benefits but we suggest that this should be included as a valid initial approach in the algorithm for management of Budd-Chiari syndrome. 

 Keywords: Budd-Chiari syndrome; short length hepatic vein stenosis; hepatic vein occlusion; percutaneous hepatic vein

Balloon dilatation of benign and malignant esophageal strictures. Blind retrograde balloon dilatation.

PubMed

Graham, D Y; Smith, J L

1985-06-01

Balloon esophageal dilatation offers many theoretical advantages (safety, speed, and patient comfort) over dilatation with mercury-filled bougies or with the Eder-Puestow system. The authors used balloon dilators in 22 patients with dysphagia secondary to benign or malignant strictures. Dilatation was performed with fluoroscopic guidance, blindly, or by a combination of these techniques. For "blind" stricture dilatation, an Eder-Puestow spring-tipped guide wire is placed into the stomach using a fiberoptic endoscope. The distance from the incisor teeth to the stricture is measured, and the balloon shaft is marked to indicate when the middle of the balloon is within the stricture. Dilatation is then performed using the antegrade or, the preferred, retrograde technique. Finally, the dilated stricture is calibrated by pulling an inflated balloon through the previously strictured area without difficulty. An attempt was made to achieve an esophageal diameter of 15 mm at the initial dilatation episode, and patient discomfort was used as a guide as to the final diameter. The balloon dilatation technique was highly successful, and a stricture diameter of 15 mm (45-47 French) was achieved at the initial dilatation in most instances. Malignant strictures were easily dilated. Balloon dilatation is convenient, effective, quick, and potentially safer than the previous Eder-Puestow or mercury-filled bougie techniques.

Cerebrospinal Fluid Enhancement on Fluid Attenuated Inversion Recovery Images After Carotid Artery Stenting with Neuroprotective Balloon Occlusions: Hemodynamic Instability and Blood-Brain Barrier Disruption

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ogami, Ryo, E-mail: ogami.r@mazda.co.jp; Nakahara, Toshinori; Hamasaki, Osamu

2011-10-15

Purpose: A rare complication of carotid artery stenting (CAS), prolonged reversible neurological symptoms with delayed cerebrospinal fluid (CSF) space enhancement on fluid attenuated inversion recovery (FLAIR) images, is associated with blood-brain barrier (BBB) disruption. We prospectively identified patients who showed CSF space enhancement on FLAIR images. Methods: Nineteen patients-5 acute-phase and 14 scheduled-underwent 21 CAS procedures. Balloon catheters were navigated across stenoses, angioplasty was performed using a neuroprotective balloon, and stents were placed with after dilation under distal balloon protection. CSF space hyperintensity or obscuration on FLAIR after versus before CAS indicated CSF space enhancement. Correlations with clinical factors weremore » examined. Results: CSF space was enhanced on FLAIR in 12 (57.1%) cases. Postprocedural CSF space enhancement was significantly related to age, stenosis rate, acute-stage procedure, and total occlusion time. All acute-stage CAS patients showed delayed enhancement. Only age was associated with delayed CSF space enhancement in scheduled CAS patients. Conclusions: Ischemic intolerance for severe carotid artery stenosis and temporary neuroprotective balloon occlusion, causing reperfusion injury, seem to be the main factors that underlie BBB disruption with delayed CSF space enhancement shortly after CAS, rather than sudden poststenting hemodynamic change. Our results suggest that factors related to hemodynamic instability or ischemic intolerance seem to be associated with post-CAS BBB vulnerability. Patients at risk for hemodynamic instability or with ischemic intolerance, which decrease BBB integrity, require careful management to prevent intracranial hemorrhagic and other post-CAS complications.« less

Scientific Balloons for Venus Exploration

NASA Astrophysics Data System (ADS)

Cutts, James; Yavrouian, Andre; Nott, Julian; Baines, Kevin; Limaye, Sanjay; Wilson, Colin; Kerzhanovich, Viktor; Voss, Paul; Hall, Jeffery

Almost 30 years ago, two balloons were successfully deployed into the atmosphere of Venus as an element of the VeGa - Venus Halley mission conducted by the Soviet Union. As interest in further Venus exploration grows among the established planetary exploration agencies - in Europe, Japan, Russia and the United States, use of balloons is emerging as an essential part of that investigative program. Venus balloons have been proposed in NASA’s Discovery program and ESA’s cosmic vision program and are a key element in NASA’s strategic plan for Venus exploration. At JPL, the focus for the last decade has been on the development of a 7m diameter superpressure pressure(twice that of VeGa) capable of carrying a 100 kg payload (14 times that of VeGA balloons), operating for more than 30 days (15 times the 2 day flight duration of the VeGa balloons) and transmitting up to 20 Mbit of data (300 times that of VeGa balloons). This new generation of balloons must tolerate day night transitions on Venus as well as extended exposure to the sulfuric acid environment. These constant altitude balloons operating at an altitude of about 55 km on Venus where temperatures are benign can also deploy sondes to sound the atmosphere beneath the probe and deliver deep sondes equipped to survive and operate down to the surface. The technology for these balloons is now maturing rapidly and we are now looking forward to the prospects for altitude control balloons that can cycle repeatedly through the Venus cloud region. One concept, which has been used for tropospheric profiling in Antarctica, is the pumped-helium balloon, with heritage to the anchor balloon, and would be best adapted for flight above the 55 km level. Phase change balloons, which use the atmosphere as a heat engine, can be used to investigate the lower cloud region down to 30 km. Progress in components for high temperature operation may also enable investigation of the deep atmosphere of Venus with metal-based balloons.

Scientific Ballooning Activities and Recent Developments in Technology and Instrumentation of the TIFR Balloon Facility, Hyderabad

NASA Astrophysics Data System (ADS)

Buduru, Suneel Kumar

2016-07-01

The Balloon Facility of Tata Institute of Fundamental Research (TIFR-BF) is a unique center of expertise working throughout the year to design, fabricate and launch scientific balloons mainly for space astronomy, atmospheric science and engineering experiments. Recently TIFR-BF extended its support to new user scientists for conducting balloon launches for biological and middle atmospheric sciences. For the first time two balloon launches conducted for sending live lab rats to upper stratosphere and provided launch support for different balloon campaigns such as Tropical Tropopause Dynamics (TTD) to study water vapour content in upper tropospheric and lower stratospheric regions over Hyderabad and the other balloon campaign to study the Asian Tropopause Aerosol Layer (BATAL) during the Indian summer monsoon season. BATAL is the first campaign to conduct balloon launches during active (South-West) monsoon season using zero pressure balloons of different volumes. TIFR-BF also provided zero pressure and sounding balloon support to various research institutes and organizations in India and for several international space projects. In this paper, we present details on our increased capability of balloon fabrication for carrying heavier payloads, development of high strength balloon load tapes and recent developments of flight control and safety systems. A summary of the various flights conducted in two years will be presented along with the future ballooning plans.

Telescope Systems for Balloon-Borne Research

NASA Technical Reports Server (NTRS)

Swift, C. (Editor); Witteborn, F. C. (Editor); Shipley, A. (Editor)

1974-01-01

The proceedings of a conference on the use of balloons for scientific research are presented. The subjects discussed include the following: (1) astronomical observations with balloon-borne telescopes, (2) orientable, stabilized balloon-borne gondola for around-the-world flights, (3) ultraviolet stellar spectrophotometry from a balloon platform, (4) infrared telescope for balloon-borne infrared astronomy, and (5) stabilization, pointing, and command control of balloon-borne telescopes.

Status of the NASA Balloon Program

NASA Astrophysics Data System (ADS)

Needleman, H. C.; Nock, R. S.; Bawcom, D. W.

1993-02-01

In the early 1980's the U.S. National Aeronautics and Space Administration (NASA) Balloon Program was faced with a problem of catastrophic balloon failures. In 1986 a balloon recovery program was initiated. This program included qualification of new balloon films, and investigations into materials, processing, structures and performance of balloons. This recovery program has been very successful. To date, more than 100 balloons manufactured of newly developed films have been flown with unprecedented success. There has been much progress made across the spectrum of balloon related disciplines. A new design philosophy has been developed and is being used for all NASA balloons. An updated balloon reliability and quality assurance program is in effect. The long duration balloon development project has been initiated with the first flight test having been conducted in December 1989 from Antarctica. A comprehensive research and development (R&D) effort has been initiated and is progressing well. The progress, status and future plans for these and other aspects of the NASA program, along with a description of the comprehensive balloon R&D activity, will be presented.

The National Scientific Balloon Facility. [balloon launching capabilities of ground facility

NASA Technical Reports Server (NTRS)

Kubara, R. S.

1974-01-01

The establishment and operation of the National Scientific Balloon Facility are discussed. The balloon launching capabilities are described. The ground support systems, communication facilities, and meteorological services are analyzed.

Investigation of hot air balloon fatalities.

PubMed

McConnell, T S; Smialek, J E; Capron, R G

1985-04-01

The rising popularity of the sport of hot air ballooning has been accompanied by several recent incidents, both in this country and other parts of the world, where mechanical defects and the improper operation of balloons have resulted in several fatalities. A study was conducted to identify the location and frequency of hot air ballooning accidents. Furthermore, the study attempted to identify those accidents that were the result of improper handling on the part of the balloon operators and those that were related to specific defects in the construction of the balloon. This paper presents a background of the sport of hot air ballooning, together with an analysis of the construction of a typical hot air balloon, pointing out the specific areas where defects may occur that could result in a potential fatal balloon crash. Specific attention is given to the two recent balloon crashes that occurred in Albuquerque, N.M., hot air balloon capital of the world, and that resulted in multiple fatalities.

A comparative study of internally and externally capped balloons using small scale test balloons

NASA Technical Reports Server (NTRS)

Bell, Douglas P.

1994-01-01

Caps have been used to structurally reinforce scientific research balloons since the late 1950's. The scientific research balloons used by the National Aeronautics and Space Administration (NASA) use internal caps. A NASA cap placement specification does not exist since no empirical information exisits concerning cap placement. To develop a cap placement specification, NASA has completed two in-hangar inflation tests comparing the structural contributions of internal caps and external caps. The tests used small scale test balloons designed to develop the highest possible stresses within the constraints of the hangar and balloon materials. An externally capped test balloon and an internally capped test balloon were designed, built, inflated and simulated to determine the structural contributions and benefits of each. The results of the tests and simulations are presented.

Balloons Revisited

ERIC Educational Resources Information Center

Jeskova, Z.; Featonby, D.; Fekova, V.

2012-01-01

Whilst everyone is familiar with the process of blowing up a balloon, few of us have gone further to quantify the actual pressures involved at different stages in the inflation process. This paper seeks to describe experiments to fill some of those gaps and examine some of the apparently anomalous behaviour of connected balloons. (Contains 12…

Unmanned powered balloons

NASA Technical Reports Server (NTRS)

Korn, A. O.

1975-01-01

In the late 1960's several governmental agencies sponsored efforts to develop unmanned, powered balloon systems for scientific experimentation and military operations. Some of the programs resulted in hardware and limited flight tests; others, to date, have not progressed beyond the paper study stage. Balloon system designs, materials, propulsion units and capabilities are briefly described, and critical problem areas are pointed out which require further study in order to achieve operational powered balloon systems capable of long duration flight at high altitudes.

Coronary artery balloon angioplasty - slideshow

MedlinePlus

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Cryoplasty for Canine Iliac Artery Stenosis and its Impact on Expression of TIMP-2 and MMP-2.

PubMed

Wu, Zhengzhong; Zang, Shengbing; Liu, Wenwen; Jiang, Na; Yang, Weizhu

2015-01-01

This study was performed to observe the effects of cryoplasty on canine iliac artery stenosis and the expression of tissue inhibition of matrix metalloproteinase 2 (TIMP-2) and matrix metalloproteinase 2 (MMP-2). We produced a reliable canine model to mimic the atherosclerotic stenosis in the iliac artery by suturing the artery followed by vessel ligation to create an injury to intimal and medial walls. Sixteen mongrel dogs with iliac artery stenosis were randomized to conventional balloon angioplasty (n = 8) or cryoplasty (n = 8). Four weeks posttreatment, the cryoplasty group with less collagen fibers and smooth muscle demonstrated significantly larger luminal diameter of iliac artery compared to the balloon angioplasty group (P < .001). Expression of TIMP-2 significantly increased and expression of MMP-2 significantly reduced in iliac artery of the cryoplasty group compared to conventional balloon angioplasty. Our study suggests cryoplasty might increase the expression of TIMP-2 and decrease the expression of MMP-2, thereby inhibiting vascular hyperplasia and collagen fibers synthesis of the stenotic vessels. © The Author(s) 2015.

In vivo Molecular Imaging of Glutamate Carboxypeptidase II Expression in Re-endothelialisation after Percutaneous Balloon Denudation in a Rat Model.

PubMed

Endepols, Heike; Mottaghy, Felix M; Simsekyilmaz, Sakine; Bucerius, Jan; Vogt, Felix; Winz, Oliver; Richarz, Raphael; Krapf, Philipp; Neumaier, Bernd; Zlatopolskiy, Boris D; Morgenroth, Agnieszka

2018-05-09

The short- and long-term success of intravascular stents depends on a proper re-endothelialisation after the intervention-induced endothelial denudation. The aim of this study was to evaluate the potential of in vivo molecular imaging of glutamate carboxypeptidase II (GCPII; identical with prostate-specific membrane antigen PSMA) expression as a marker of re-endothelialisation. Fifteen Sprague Dawley rats underwent unilateral balloon angioplasty of the common carotid artery (CCA). Positron emission tomography (PET) using the GCPII-targeting tracer [ 18 F]DCFPyL was performed after 5-21 days (scan 60-120 min post injection). In two animals, the GCPII inhibitor PMPA (23 mg/kg BW) was added to the tracer solution. After PET, both CCAs were removed, dissected, and immunostained with the GCPII specific antibody YPSMA-1. Difference of GCPII expression between both CCAs was established by PCR analysis. [ 18 F]DCFPyL uptake was significantly higher in the ipsilateral compared to the contralateral CCA with an ipsi-/contralateral ratio of 1.67 ± 0.39. PMPA blocked tracer binding. The selective expression of GCPII in endothelial cells of the treated CCA was confirmed by immunohistological staining. PCR analysis verified the site-specific GCPII expression. By using a molecular imaging marker of GCPII expression, we provide the first non-invasive in vivo delineation of re-endothelialisation after angioplasty.

Is Angiosome-Targeted Angioplasty Effective for Limb Salvage and Wound Healing in Diabetic Foot? : A Meta-Analysis.

PubMed

Chae, Kum Ju; Shin, Jin Yong

2016-01-01

Given that the efficacy of employing angiosome-targeted angioplasty in the treatment of diabetic foot remains controversial, this study was conducted to examine its efficacy. We performed a systematic literature review and meta-analysis using core databases, extracting the treatment modality of angiosome-targeted angioplasty as the predictor variable, and limb salvage, wound healing, and revision rate as the outcome variables. We used the Newcastle-Ottawa Scale to assess the study quality, along with the Cochrane Risk of Bias Tool. We evaluated publication bias using a funnel plot. The search strategy identified 518 publications. After screening these, we selected four articles for review. The meta-analysis revealed that overall limb salvage and wound healing rates were significantly higher (Odds ratio = 2.209, 3.290, p = 0.001, p<0.001) in patients who received angiosome-targeted angioplasty than in those who received nonangiosome-targeted angioplasty. The revision rate between the angiosome and nonangiosome groups was not significantly different (Odds ratio = 0.747, p = 0.314). Although a further randomized controlled trial is required for confirmation, angiosome-targeted angioplasty in diabetic foot was more effective than nonangiosome-targeted angioplasty with respect to wound healing and limb salvage.

Adjunct Control in Telugu and Assamese

ERIC Educational Resources Information Center

Haddad, Youssef A.

2007-01-01

My study explores Adjunct Control in two South Asian languages, Telugu (Dravidian) and Assamese (Indo-Aryan), within the Minimalist Program of syntactic theory. Adjunct Control is a relation of obligatory co-referentiality between two subjects, one in the matrix clause and one in an adjunct/subordinate clause of the same structure. Telugu and…

Scientific Ballooning in India - Recent Developments

NASA Astrophysics Data System (ADS)

Manchanda, R. K.; Srinivasan, S.; Subbarao, J. V.

Established in 1972, the National Balloon Facility operated by TIFR in Hyderabad, India is is a unique facility in the country, which provides a complete solution in scientific ballooning. It is also one of its kind in the world since it combines both, the in-house balloon production and a complete flight support for scientific ballooning. With a large team working through out the year to design, fabricate and launch scientific balloons, the Hyderabad Facility is a unique centre of expertise where the balloon design, Research and Development, the production and launch facilities are located under one roof. Our balloons are manufactured from 100% indigenous components. The mission specific balloon design, high reliability control and support instrumentation, in-house competence in tracking, telemetry, telecommand, data processing, system design and mechanics is a hallmark of the Hyderabad balloon facility. In the past few years we have executed a major programme of upgradation of different components of balloon production, telemetry and telecommand hardware and various support facilities. This paper focuses on our increased capability of balloon production of large sizes up to size of 780,000 M^3 using Antrix film, development of high strength balloon load tapes with the breaking strength of 182 kg, and the recent introduction of S-band telemetry and a commandable timer cut-off unit in the flight hardware. A summary of the various flights conducted in recent years will be presented along with the plans for new facilities.

Percutaneous balloon pulmonary valvuloplasty (PBPV) of extreme pulmonary valve stenosis by the use of Accura balloon.

PubMed

Sinha, Santosh Kumar; Mishra, Vikas; Razi, Mahmadula; Jha, Mukesh Jitendra

2017-10-04

Transcatheter therapy of valvular pulmonary stenosis is one of first catheter interventions facilitating its application in field of structural heart disease and now treatment of choice for significant pulmonary stenosis. Myriads of balloon catheter have been used for this purpose starting from Diamond (Boston Scientific,Natick, MA USA), Marshal (Medi-Tech,Watertown MAUSA), Innoue balloon, Tyshak I and currently Tyshak II. Diameter and length of balloon depend on size of annulus and age group, respectively. Problem with shorter balloon is difficulty in keeping it across the annulus while inflation as it tends to slip distally whereas with longer balloon, potential of tricuspid leak or conduction block as it may impinge on adjacent structures. Potential advantage of Accura balloon over Tyshak balloon lies in its peculiar shape while inflation and variable diameter, making stepwise dilatation possible. Here, we report a case of successful balloon pulmonary valvuloplasty using Accura balloon (Vascular Concept, UK) with little modification of conventional technique. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Paclitaxel-Coated Balloons: Review of a Promising Interventional Approach to Preventing Restenosis in Femoropopliteal Arteries

PubMed Central

Teleb, Mohamed; Wardi, Miraie; Gosavi, Sucheta; Said, Sarmad; Mukherjee, Debabrata

2015-01-01

Peripheral arterial disease (PAD), a major cause of morbidity and mortality worldwide, is characterized by intermittent claudication and is associated with chronic diseases such as diabetes and hypertension. The goal of treatment is to address the underlying cause and to modify risk factors. Although medical management is the first-line treatment of PAD, some individuals may have severe symptoms and require revascularization with percutaneous transluminal angioplasty with or without stent placement or surgery. Interventional approaches may, however, be associated with high prevalence of restenosis and subsequent complications such as critical limb ischemia and amputation. Drug-eluting balloons (DEBs) are a new interventional technology with the primary goal of preventing restenosis. We review the clinical trials and studies that assessed the efficacy and safety profile of DEB and will focus on the restenosis rate in femoropopliteal arteries including target lesion revascularization (TLR) and late lumen lesion (LLL) using different modalities of intervention such as stents and DEB. Average data collected from the trials reported included restenosis rate of 25%, 0.3 mm LLL, and 14% reduction in TLR with DEB versus uncoated balloons. Below the knee (BTK) only intervention studies were excluded from this review as endovascular approach is usually reserved for critical limb ischemia for BTK disease. Interventional approach to treat PAD with DEB appears to be a promising technology. Additional larger studies are needed to further define safety, efficacy, and longer term outcome with this novel technology. PMID:27231422

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ni, Nina, E-mail: nina.ni@yale.edu; Mojibian, Hamid; Pollak, Jeffrey

To compare the rates of central venous stenosis in patients undergoing hemodialysis who underwent disruption of fibrin sheath with percutaneous transluminal angioplasty balloons and those who underwent over-the-wire catheter exchange. This study is a retrospective review of 209 percutaneous transluminal angioplasty balloon disruption and 1304 over-the-wire catheter exchange procedures performed in 753 patients. Approval from the Human Investigations Committee was obtained for this study. Up to 10-year follow-up was performed. A {chi}{sup 2} test was used to compare the rates of central venous stenosis after balloon disruption versus catheter exchange. A t-test was used to compare time to central venousmore » stenosis development. Of the 753 patients in the study, 127 patients underwent balloon disruption of fibrin sheath and 626 had catheter exchange. Within the balloon disruption group, 18 (14.2%) of 127 patients subsequently developed central venous stenosis, compared with 44 (7.0%) of 626 in the catheter exchange group (P < 0.01, {chi}{sup 2} test). Time to central venous stenosis development was approximately 3 years in both groups and not significantly different (1371 and 1010 days, P = 0.20). A total of 25.2% of patients in the balloon disruption group had four or more subsequent catheter exchanges, versus 12.6% in the catheter exchange group (P < 0.01, {chi}{sup 2} test). In conclusions, there is a possible association between percutaneous transluminal angioplasty balloon disruption of fibrin sheath and late-onset central venous stenosis. Because venography was not routinely performed in catheter exchange patients, future randomized studies are necessary to confirm these findings.« less

Hot-Air Ballooning in Physics Teaching.

ERIC Educational Resources Information Center

Haugland, Ole Anton

1991-01-01

Describes the modern hot-air balloon and the physics of ballooning. Proposes that students construct their own hot-air balloon and presents an experiment calculating the time needed for a balloon to rise to the ceiling of a gymnasium. (MDH)

A New Approach: Regional Nerve Blockade for Angioplasty of the Lower Limb

DOE Office of Scientific and Technical Information (OSTI.GOV)

Marcus, A.J., E-mail: Adrian.Marcus@bcf.nhs.uk; Lotzof, K.; Kamath, B.S.K.

2006-04-15

Purpose. An audit study investigated the pilot use of regional nerve block analgesia (as an alternative to sedative/opiate, general or central neuraxial anesthesia) performed by radiologists with the assistance of imaging techniques during complex prolonged angiography. Methods. Radiologists were trained by anesthetic consultants to administer and use lower limb peripheral nerve block for difficult prolonged angioplasty procedures for patients with severe lower limb rest pain who were unable to lie in the supine position. In a pilot study 25 patients with limb-threatening ischemia received sciatic and femoral nerve blockade for angioplasty. The technique was developed and perfected in 12 patientsmore » and in a subsequent 13 patients the details of the angiography procedures, peripheral anesthesia, supplementary analgesia, complications, and pain assessment scores were recorded. Pain scores were also recorded in 11 patients prior to epidural/spinal anesthesia for critical ischemic leg angioplasty. Results. All patients with peripheral nerve blockade experienced a reduction in their ischemic rest pain to a level that permitted angioplasty techniques to be performed without spinal, epidural or general analgesia. In patients undergoing complex angioplasty intervention, the mean pain score by visual analogue scale was 3.7, out of a maximum score of 10. Conclusions. The successful use of peripheral nerve blocks was safe and effective as an alternative to sedative/opiate, epidural or general anesthesia in patients undergoing complex angiography and has optimized the use of radiological and anesthetic department resources. This has permitted the frequent radiological treatment of patients with limb-threatening ischemia and reduced delays caused by the difficulty in enlisting the help of anesthetists, often at short notice, from the busy operating lists.« less

Optimum designs for superpressure balloons

NASA Astrophysics Data System (ADS)

Smith, M. S.; Rainwater, E. L.

2004-01-01

The elastica shape is now well known to be the best basic shape for superpressure balloon design. This shape, also known as the pumpkin, or natural shape for balloons, has been well understood since the early 1900s when it was applied to the determination of the shape of descending parachutes. The elastica shape was also investigated in the 1950s when high strength films were used to produce superpressure cylinder balloons. The need for uniform stress distribution in shells of early superpressure balloons led to a long period of the development of spherical superpressure balloons. Not until the late 1970s was the elastica shape revisited for the purpose of the producing superpressure balloons. This paper will review various development efforts in the field of superpressure design and will elaborate on the current state-of-the-art with suggestions for future developments.

Flow Past a Descending Balloon

NASA Technical Reports Server (NTRS)

Baginski, Frank

2001-01-01

In this report, we present our findings related to aerodynamic loading of partially inflated balloon shapes. This report will consider aerodynamic loading of partially inflated inextensible natural shape balloons and some relevant problems in potential flow. For the axisymmetric modeling, we modified our Balloon Design Shape Program (BDSP) to handle axisymmetric inextensible ascent shapes with aerodynamic loading. For a few simple examples of two dimensional potential flows, we used the Matlab PDE Toolbox. In addition, we propose a model for aerodynamic loading of strained energy minimizing balloon shapes with lobes. Numerical solutions are presented for partially inflated strained balloon shapes with lobes and no aerodynamic loading.

Status of the NASA Balloon Program

NASA Technical Reports Server (NTRS)

Needleman, H. C.; Nock, R. S.; Bawcom, D. W.

1993-01-01

The NASA Balloon Program (BP) is examined in an overview of design philosophy, R&D activities, flight testing, and the development of a long-duration balloon for Antarctic use. The Balloon Recovery Program was developed to qualify the use of existing films and to design improved materials and seals. Balloon flights are described for studying the supernova SN1987a, and systems were developed to enhance balloon campaigns including mobile launch vehicles and tracking/data-acquisition systems. The technical approach to long-duration ballooning is reviewed which allows the use of payloads of up to 1350 kg for two to three weeks. The BP is responsible for the development of several candidate polyethylene balloon films as well as design/performance standards for candidate balloons. Specific progress is noted in reliability and in R&D with respect to optimization of structural design, resin blending, and extrusion.

Deep intubation of 8 Fr guiding catheter to deliver coronary stent graft to seal coronary perforation: a case report.

PubMed

Salwan, R; Mathur, A; Jhamb, D K; Seth, A

2001-09-01

Coronary perforation is an uncommon complication of angioplasty and is a challenging situation to manage. We describe a case of complex multivessel coronary angioplasty complicated by coronary perforation following balloon rupture that was successfully managed with a coronary stent graft. Delivery of the stent graft to the site of vessel rupture required deep intubation of an 8 Fr guiding catheter over the shaft of an inflated balloon. In addition to the availability of covered stents, it is essential to be familiar with various skills necessary to deploy these stents. Cathet Cardiovasc Intervent 2001;54:59-62. Copyright 2001 Wiley-Liss, Inc.

Scientific ballooning in India Recent developments

NASA Astrophysics Data System (ADS)

Manchanda, R. K.

Established in 1971, the National Balloon Facility operated by TIFR in Hyderabad, India, is a unique facility in the country, which provides a complete solution in scientific ballooning. It is also one of its kind in the world since it combines both, the in-house balloon production and a complete flight support for scientific ballooning. With a large team working through out the year to design, fabricate and launch scientific balloons, the Hyderabad Facility is a unique centre of expertise where the balloon design, research and development, the production and launch facilities are located under one roof. Our balloons are manufactured from 100% indigenous components. The mission specific balloon design, high reliability control and support instrumentation, in-house competence in tracking, telemetry, telecommand, data processing, system design and mechanics is its hallmark. In the past few years, we have executed a major programme of upgradation of different components of balloon production, telemetry and telecommand hardware and various support facilities. This paper focuses on our increased capability of balloon production of large sizes up to 780,000 m 3 using Antrix film, development of high strength balloon load tapes with the breaking strength of 182 kg, and the recent introduction of S-band telemetry and a commandable timer cut-off unit in the flight hardware. A summary of the various flights conducted in recent years will be presented along with the plans for new facilities.

Renal angioplasty and stenting under protection: the way for the future?

PubMed

Henry, Michel; Henry, Isabelle; Klonaris, Christos; Polydorou, Antonio; Rath, Pathrap; Lakshmi, Gopalakrishnan; Rajacopal, Sriram; Hugel, Michèle

2003-11-01

The purpose of this study was to evaluate the feasibility and safety of renal artery angioplasty and stenting utilizing a distal protection device to reduce the risk of intraprocedural artery embolism and avoid deterioration of the renal function. Fifty-six hypertensive patients (32 men; mean age, 66 +/- 11.8 years; range, 22-87) with atherosclerotic renal artery stenosis (8 bilateral) underwent angioplasty and stenting with distal protection in 65 renal arteries (58 ostial lesions). Five patients had a solitary kidney, 18 a renal insufficiency. The lesion was crossed either with a GuardWire temporary occlusion balloon (n = 38), which was inflated to provide parenchyma protection or with a filter (EPI Filter; n = 26), or with Angioguard (n = 1), which allows a continuous flow. Generated debris was aspirated and analyzed. Blood pressure and serum creatinine levels were followed. Immediate technical success was 100%. All lesions except one were stented, either directly (43 ostial lesions) or after predilatation (22 ostial lesions). Visible debris were aspirated with the PercuSurge in all patients or removed with filters in 80% of the patients. Mean particle number and diameter were 98.1 +/- 60.0 per procedure (range, 13-208) and 201.0 +/- 76.0 microm (range, 38-6,206), respectively. Mean renal artery occlusion time was 6.55 +/- 2.46 min (range, 2.29-13.21) with the PercuSurge device. Mean time in situ (filters) was 4.25 +/- 1.12 min. Mean follow-up was 22.6 +/- 17.6 months (range, 1-47). Systolic and diastolic blood pressure declined from 169.0 +/- 15.2 and 104.0 +/- 13.0 mm Hg, respectively, to 149.7 +/- 12.4 and 92.7 +/- 6.7 mm Hg after the procedure. The mean creatinine level remains constant during the follow-up. At 6-month follow-up (45 patients), renal function did not deteriorate in any patient, whereas 8 patients with baseline renal insufficiency improved after the procedure. At 3 years (19 patients), renal function deteriorated only in 1 patient with renal

Ballooning for Biologists: Mission Essentials for Flying Experiments on Large NASA Balloons

NASA Technical Reports Server (NTRS)

Smith, David J.; Sowa, Marianne

2017-01-01

Despite centuries of scientific balloon flights, only a handful of experiments have produced biologically-relevant results. Yet unlike orbital spaceflight, it is much faster and cheaper to conduct biology research with balloons, sending specimens to the near space environment of Earths stratosphere. Samples can be loaded the morning of a launch and sometimes returned to the laboratory within one day after flying. The National Aeronautics and Space Administration (NASA) flies large, unmanned scientific balloons from all over the globe, with missions ranging from hours to weeks in duration. A payload in the middle portion of the stratosphere (approx. 35 km above sea level) will be exposed to an environment similar to the surface of Mars: temperatures generally around -36 C, atmospheric pressure at a thin 1 kPa, relative humidity levels <1%, and a harsh illumination of ultraviolet (UV) and cosmic radiation levels (about 100 W/sq m and 0.1 mGy/d, respectively) that can be obtained nowhere else on the surface of the Earth, including environmental chambers and particle accelerator facilities attempting to simulate space radiation effects. Considering the operational advantages of ballooning and the fidelity of space-like stressors in the stratosphere, researchers in aerobiology, astrobiology, and space biology can benefit from balloon flight experiments as an intermediary step on the extraterrestrial continuum (ground, low Earth orbit, and deep space studies). Our presentation targets biologists with no background or experience in scientific ballooning. We will provide an overview of large balloon operations, biology topics that can be uniquely addressed in the stratosphere, and a roadmap for developing payloads to fly with NASA.

Histological Analysis of a New Route after Subintimal Crural Angioplasty.

PubMed

Akamatsu, Daijirou; Fujishima, Fumiyoshi; Goto, Hitoshi; Hashimoto, Munetaka; Tsuchida, Ken; Kawamura, Keiichirou; Tajima, Yuta; Umetsu, Michihisa; Suzuki, Syunya; Kamei, Takashi

2017-11-01

Subintimal angioplasty is an alternative approach in treating critical limb ischemia with crural artery disease. However, route or location of the newly created channel is not understood. A 68-year-old man was referred to our hospital with ischemic gangrene of the right big toe. We performed endovascular treatment because he was a poor candidate for bypass surgery. The posterior tibial artery was treated using subintimal angioplasty, although it resulted in early occlusion. We decided that he was not able to receive any further limb salvage treatment and performed amputation below the knee 7 days after treatment. The specimen from the origin of posterior tibial artery to plantar artery bifurcation was resected and the formalin-fixed vessel was cut into 39 segments. Histological analysis showed that the newly formed lumen was comparatively well dilated and created in the media by tearing internal elastic lamina in almost the whole of its length. The severely poor runoff vessels below the ankle were thought to be a main cause of early occlusion. The newly formed lumen by subintimal crural angioplasty could be well dilated and created in the media. Copyright © 2017 Elsevier Inc. All rights reserved.

Endogenous testosterone attenuates neointima formation after moderate coronary balloon injury in male swine

PubMed Central

Tharp, Darla L.; Masseau, Isabelle; Ivey, Jan; Ganjam, Venkataseshu K.; Bowles, Douglas K.

2009-01-01

Aims Previous studies from our laboratory have demonstrated that testosterone increases coronary smooth muscle protein kinase C delta (PKCδ) both in vivo and in vitro and inhibits coronary smooth muscle proliferation by inducing G0/G1 cell cycle arrest in a PKCδ-dependent manner. The purpose of the present study was to determine whether endogenous testosterone limits coronary neointima (NI) formation in a porcine model of post-angioplasty restenosis. Methods and results Sexually mature, male Yucatan miniature swine were either left intact (IM), castrated (CM), or castrated with testosterone replacement (CMT; Androgel, 10 mg/day). Angioplasty was performed in both the left anterior descending and left circumflex coronary arteries with balloon catheter overinflation to induce either moderate (1.25–1.3x diameter; 3 × 30 s) or severe (1.4x diameter; 3 × 30 s) injury, and animals were allowed to recover for either 10 or 28 days. Injured coronary sections were dissected, fixed, stained (Verheoff-Van Gieson, Ki67, PKCδ, p27), and analysed. Vessels without internal elastic laminal rupture were excluded. Following moderate injury, intimal area, intima-to-media ratio (I/M), and I/M normalized to rupture index (RI) were increased in CM compared with IM and CMT. RI, medial area, and intimal/medial thickness (IMT) were not different between groups. NI formation was inversely related to serum testosterone concentration. Conversely, following severe injury, there were no significant differences between the groups. Testosterone inhibited proliferation and stimulated PKCδ and p27kip1 expression during NI formation (10 days post-injury). Conclusion These findings demonstrate that endogenous testosterone limits coronary NI formation in male swine and provides support for a protective role for testosterone in coronary vasculoproliferative diseases, such as restenosis and atherosclerosis. PMID:19181935

Endogenous testosterone attenuates neointima formation after moderate coronary balloon injury in male swine.

PubMed

Tharp, Darla L; Masseau, Isabelle; Ivey, Jan; Ganjam, Venkataseshu K; Bowles, Douglas K

2009-04-01

Previous studies from our laboratory have demonstrated that testosterone increases coronary smooth muscle protein kinase C delta (PKC delta) both in vivo and in vitro and inhibits coronary smooth muscle proliferation by inducing G(0)/G(1) cell cycle arrest in a PKC delta-dependent manner. The purpose of the present study was to determine whether endogenous testosterone limits coronary neointima (NI) formation in a porcine model of post-angioplasty restenosis. Sexually mature, male Yucatan miniature swine were either left intact (IM), castrated (CM), or castrated with testosterone replacement (CMT; Androgel, 10 mg/day). Angioplasty was performed in both the left anterior descending and left circumflex coronary arteries with balloon catheter overinflation to induce either moderate (1.25-1.3 x diameter; 3 x 30 s) or severe (1.4x diameter; 3 x 30 s) injury, and animals were allowed to recover for either 10 or 28 days. Injured coronary sections were dissected, fixed, stained (Verheoff-Van Gieson, Ki67, PKC delta, p27), and analysed. Vessels without internal elastic laminal rupture were excluded. Following moderate injury, intimal area, intima-to-media ratio (I/M), and I/M normalized to rupture index (RI) were increased in CM compared with IM and CMT. RI, medial area, and intimal/medial thickness (IMT) were not different between groups. NI formation was inversely related to serum testosterone concentration. Conversely, following severe injury, there were no significant differences between the groups. Testosterone inhibited proliferation and stimulated PKC delta and p27(kip1) expression during NI formation (10 days post-injury). These findings demonstrate that endogenous testosterone limits coronary NI formation in male swine and provides support for a protective role for testosterone in coronary vasculoproliferative diseases, such as restenosis and atherosclerosis.

A stress index model for ascending balloons

NASA Technical Reports Server (NTRS)

Smith, I. S.

1986-01-01

Attention is given to the development on the part of NASA of a simplified stress 'index' model to establish the relative stress magnitudes along a balloon's gore position as a function of altitude. Application of this model to several hundred balloon flights showed a good correlation between balloon failure rate and stress 'index' level. This model can be used during the balloon design process to lower the levels of stress in the balloon. By increasing the wall thickness of the balloon, adding caps, lengthening caps, or using external caps, lower stress can be accomplished. As a result, in January 1985, the NASA Balloon Program established a stress index specification to limit the design and flight stresses for NASA balloons.

Launching Garbage-Bag Balloons.

ERIC Educational Resources Information Center

Kim, Hy

1997-01-01

Presents a modification of a procedure for making and launching hot air balloons made out of garbage bags. Student instructions for balloon construction, launching instructions, and scale diagrams are included. (DDR)

Factors associated with quality of life in patients undergoing coronary angioplasty

PubMed Central

Darvishpour, Azar; Javadi-Pashaki, Nazila; Salari, Arsalan; Sadeghi, Tahere; Taleshan-Nejad, Marayam

2017-01-01

Objective: Percutaneous coronary intervention has been effective in increasing longevity of patients with cardiovascular disease. However, the evidence shows that the quality of life after the intervention is still lower than optimal level. The quality of life can be affected by various factors. The aim of this study is to determine the quality of life and its related factors in patients undergoing coronary angioplasty. Methods: This cross-sectional study was performed on 106 patients undergoing coronary angioplasty during 2015-2016. This study population included all patients who referred to a cardiac clinic in Rasht, Iran, were passed 3 months after their angioplasty. Research samples met the inclusion criteria and were willing to participate to the study, were selected gradually (continually). Research tools were a self-structured questionnaire regarding factors associated with the quality of life and the MacNew quality of life questionnaire. Data were collected through asking patients questions and using patient’s medical records. Data analysis was conducted using descriptive and inferential statistics. Results: The results of multivariate linear regression analysis showed that independent variables of age (P = 0.0001), the number of diseased vessels (P = 0.0001), and the number of comorbidities (P < 0.05) were the most important factors associated with the quality of life. Conclusion: Health-care professionals can play an effective role in promoting the quality of life of patients undergoing coronary angioplasty by modifying lifestyle based on the related factors and to provide comprehensive care programs, especially for elderly. PMID:29085266

Variation in hospital rates of intraaortic balloon pump use in coronary artery bypass operations.

PubMed

Ghali, W A; Ash, A S; Hall, R E; Moskowitz, M A

1999-02-01

Little is known about regional patterns of intraaortic balloon pump (IABP) use in coronary artery bypass graft (CABG) operations. Our objectives were (1) to identify clinical variables associated with IABP use, and (2) to examine risk-adjusted rates of IABP use for 12 Massachusetts hospitals performing CABG operations. We used hospital discharge data to identify 6944 CABG surgical cases. Logistic regression was used to identify clinical variables associated with IABP use, and the resulting multivariate model was then used to risk adjust hospital rates of IABP use. The IABP was used in 13.4% of the CABG surgical cases. The clinical variables independently associated with IABP use were cardiogenic shock, same admission angioplasty, prior CABG operation, cardiac arrest, congestive heart failure, recent myocardial infarction, and urgent admission status. Risk-adjusted rates of IABP use varied widely across hospitals from 7.8% to 20.8% (p < 0.0001). Hospital rates of IABP use vary considerably in Massachusetts. This practice variation may be related to the persistent uncertainty regarding the precise clinical indications for the IABP in this patient population.

Atherectomy for peripheral arterial disease.

PubMed

Ambler, Graeme K; Radwan, Rami; Hayes, Paul D; Twine, Christopher P

2014-03-17

Symptomatic peripheral arterial disease may be treated by a number of options including exercise therapy, angioplasty, stenting and bypass surgery. Atherectomy is an alternative technique where atheroma is excised by a rotating cutting blade. The objective of this review was to analyse randomised controlled trials comparing atherectomy against any established treatment for peripheral arterial disease in order to evaluate the effectiveness of atherectomy. The Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator searched the Specialised Register (last searched November 2013) and CENTRAL (2013, Issue 10). Trials databases were searched for details of ongoing or unpublished studies. Randomised controlled trials (RCTs) comparing atherectomy and other established treatments were selected for inclusion. All participants had symptomatic peripheral arterial disease with either claudication or critical limb ischaemia and evidence of lower limb arterial disease. Two review authors (GA and CT) screened studies for inclusion, extracted data and assessed the quality of the trials. Any disagreements were resolved through discussion. Four trials were included with a total of 220 participants (118 treated with atherectomy, 102 treated with balloon angioplasty) and 259 treated vessels (129 treated with atherectomy, 130 treated with balloon angioplasty). All studies compared atherectomy with angioplasty. No study was properly powered or assessors blinded to the procedures and there was a high risk of selection, attrition, detection and reporting biases.The estimated risk of success was similar between the treatment modalities although the confidence interval (CI) was compatible with small benefits of either treatment for the initial procedural success rate (Mantel-Haenszel risk ratio (RR) 0.92, 95% CI 0.44 to 1.91, P = 0.82), patency at six months (Mantel-Haenszel RR 0.92, 95% CI 0.51 to 1.66, P = 0.79) and patency at 12 months (Mantel-Haenszel RR 1.17, 95% CI 0

Perioperative Internal Iliac Artery Balloon Occlusion, In the Setting of Placenta Accreta and Its Variants: The Role of the Interventional Radiologist.

PubMed

Petrov, David A; Karlberg, Benjamin; Singh, Kamalpreet; Hartman, Matthew; Mittal, Pardeep K

2017-11-10

Placenta accreta and its variants (increta and percreta) are conditions of abnormal placentation that are encountered with increasing frequency. The spectrum of placenta accreta (including placenta increta and percreta) involves an abnormal attachment of the placental chorionic villi to the uterine myometrium. This abnormal attachment leads to increased adherence of the placenta to the uterus and abnormal placental-uterine separation at the time of delivery. Placental invasion into, or through the myometrium is associated with increased postpartum morbidity and mortality as a result of uterine hemorrhage during and following cesarean section. A multidisciplinary clinical approach to the treatment of patients with placenta accreta is recommended by the American College of Obstetricians and Gynecologists. As potential members of an interdisciplinary team, interventional radiologists can perform prophylactic internal iliac arterial balloon occlusion as an adjunctive therapy for reducing potentially life-threatening postpartum hemorrhage. The procedure involves placement of a balloon catheter into the internal iliac or common iliac arteries bilaterally prior to cesarean section. Following delivery, and prior to placental separation, the catheter balloons are inflated with a pre-determined volume of saline leading to transient occlusion of the internal iliac arteries and reduced uterine blood flow. Copyright © 2017 Elsevier Inc. All rights reserved.

Mechanical properties of ANTRIX balloon film and fabrication of single cap large volume balloons

NASA Astrophysics Data System (ADS)

Suneel Kumar, B.; Sreenivasan, S.; Subba Rao, J. V.; Manchanda, R. K.

2008-11-01

The zero pressure plastic balloons used for high altitude studies are generally made from polyethylene material. Tensile properties of the thin film polymer are the key parameters for material selection due to extremely low temperature of -90 °C encountered by the balloons in the tropopause region during the ascent at equatorial latitudes. The physical and structural properties of the material determine the uniformity of the stress distribution over the entire shell. Load stresses from the suspended load propagate via load tapes heat sealed along with the gore seals as per the balloon design. A balance between this heat seal strength and the film strength is a desirable property of the basic resin in terms of the bubble strength, gauge uniformity, and long-term storage properties. In addition, the design of the top shell of the balloon and its stress distribution play an important role since only a fraction of the balloon is deployed during the filling operation and the ascent. In this paper we describe the mechanical properties of the 'ANTRIX' film developed by us and the optimized design of single cap balloons, which have been successfully used in our experiments over the past 5 years.

[Rotation angioplasty of chronic coronary artery stenosis].

PubMed

Kaltenbach, M; Vallbracht, C

1990-10-01

Coronary artery occlusion of more than six months duration can only rarely be recanalized with conventional techniques. For this reason, rotational angioplasty, which has been successfully applied for occlusion of peripheral arteries, has been employed in modified form for recanalization of chronic coronary artery occlusion. Rotational angioplasty is based on the concept that the slowly revolving, dull and relatively thick head of the flexible rotation catheter will seek the path of least resistance which, even in the case of relatively old arterial occlusions, mostly represents thrombotic material. The elastic, high-torque rotational catheter constructed of several V2A spiral steel wires has an interior lumen for insertion of exchange guidewires up to 0.014" and injection of contrast medium and an olive-shaped head of V2A steel with a diameter of 1.3 to 1.6 mm. A protection catheter made of polyethylene with metal markers and conically-tapered tip provides variable stiffness of the rotating catheter and protection of the endothelium in the proximal vascular segment. The slow rotation of 200 r.p.m. is performed with a small electric motor. Between April 1987 and February 1988, rotation angioplasty was performed in 20 patients, 17 with occlusion of the right coronary artery, two with occlusion of the left anterior descending artery and one with bypass graft occlusion to the left anterior descending artery in whom a conventional guidewire through the chronic occlusion could not be advanced. The duration of occlusion, based on previous angiograms anginal complaints or myocardial infarction, ranged from one month to twelve years, in twelve patients more than six months. In all patients, the indication for revascularization was clearly established.(ABSTRACT TRUNCATED AT 250 WORDS)

[Surgical angioplasty of the left main coronary artery].

PubMed

Vranes, Mile; Velinović, Milos; Kocica, Mladen; Mikić, Aleksandar; Velimirović, Dusan; Djukić, Petar

2010-01-01

The conventional treatment for isolated stenosis of the left main coronary artery is bypass surgery (myocardial revascularization). However, the process of atherosclerosis is not arrested by myocardial revascularization and it will lead to the occlusion of the left main coronary artery. Revascularization will establish retrograde perfusion for 50-70% of the myocardium of the left ventricle. Direct surgical angioplasty of the left main coronary artery enables normal physiological perfusion of the whole myocardium and better myocardial function. The aim of our study is to point out a new surgical approach of treating left main coronary artery stenosis. Between October 2002 and October 2003, direct surgical angioplasty of the main left coronary artery was performed on three patients with isolated stenosis of the left main coronary artery using the anterior approach and the pericardium as a patch. The procedure was performed under total endotracheal anaesthesia and standard cardiopulmonary circulation, moderate hypothermia, anterograde St. Tomas cardioplegia and local cooling. Patients were followed clinically, echocardiographically and by load-tests. All three patients were without complications. In postoperative follow-up (54-68 months) neither angina pectoris nor electrocardiographically registered ischaemic changes were found. Load-tests performed every six months on all three patients were negative. Surgical angioplasty of isolated stenosis of the left main coronary artery is a preferred method for treating this type of coronary disease. Contraindications for this type of treatment are stenosis of the left main coronary artery with bifurcation and advanced calcification of the left main coronary artery.

Caught in the Adjunct Trap

ERIC Educational Resources Information Center

Hose, Linda; Ford, E. J.

2014-01-01

Based on personal experiences garnered through years of adjunct instruction, the authors explore the challenges associated with working in academia without the guarantees of a long-term contract or tenure. Further, adjuncts are desperate to accept any position that is remunerative and this willingness undermines contract negotiation leverage of…

Percutaneous Mitral Valve Dilatation: Single Balloon versus Double Balloon - A Finite Element Study

DOE Office of Scientific and Technical Information (OSTI.GOV)

Schievano, Silvia; Kunzelman, Karyn; Nicosia, Mark

2009-01-01

Background: Percutaneous mitral valve (MV) dilatation is performed with either a single balloon (SB) or double balloon (DB) technique. The aim of this study was to compare the two balloon system results using the finite element (FE) method. Methods and Results: An established FE model of the MV was modified by fusing the MV leaflet edges at commissure level to simulate a stenotic valve (orifice area=180mm2). A FE model of a 30mm SB (low-pressure, elastomeric balloon) and an 18mm DB system (high-pressure, non-elastic balloon) was created. Both SB and DB simulations resulted in splitting of the commissures and subsequent stenosismore » dilatation (final MV area=610mm2 and 560mm2 respectively). Stresses induced by the two balloon systems varied across the valve. At the end of inflation, SB showed higher stresses in the central part of the leaflets and at the commissures compared to DB simulation, which demonstrated a more uniform stress distribution. The higher stresses in the SB analysis were due to the mismatch of the round balloon shape with the oval mitral orifice. The commissural split was not easily accomplished with the SB due to its high compliance. The high pressure applied to the DB guaranteed the commissural split even when high forces were required to break the commissure welds. Conclusions: The FE model demonstrated that MV dilatation can be accomplished by both SB and DB techniques. However, the DB method resulted in higher probability of splitting of the fused commissures and less damage caused to the MV leaflets by overstretching.« less

Technologies developed by CNES balloon team

NASA Astrophysics Data System (ADS)

Sosa-Sesma, Sergio; Charbonnier, Jean-Marc; Deramecourt, Arnaud

CNES balloon team develops and operates all the components of this kind of vehicle: it means envelope and gondola. This abstract will point out only developments done for envelope. Nowadays CNES offers to scientists four types of envelops that cover a large range of mission demands. These envelops are: 1. Zero pressure balloons: Size going from 3,000m3 to 600,000m3, this kind of envelop is ideal for short duration flights (a few hours) but if we use an intelligent management of ballast consumption and if we chose the best launch site, it is possible to perform medium duration flights (10/20 days depending on the ballast on board). Flight train mass starts at 50kg for small balloons and reach 1000kg for larger ones. Zero pressure balloons are inflated with helium gas. 2. Super pressure balloons: Diameter going from 2.5m to 12m, this kind of envelop is ideal for long duration flights (1 to 6 months). Flight train is inside the envelop for small balloons, it means 2.5 diameter meters which is usually called BPCL (Super pressure balloon for Earth boundary layer) and it is about 3kg of mass. Larger ones could lift external flight trains about 50kg of mass. Super pressure balloons are inflated with helium gas. 3. MIR balloons: Size going from 36,000m3 to 46,000m3. Ceiling is reach with helium gas but after three days helium is no longer present inside and lift force is produced by difference of temperature between air inside and air of atmosphere. Flight trains must not be over 50kg. 4. Aero Clipper balloons: A concept to correlate measurements done in oceans and in nearest layers of atmosphere simultaneously. Flight train is made by a "fish" that drags inside water and an atmospheric gondola few meters above "fish", both pushed by a balloon which profits of the wind force. Materials used for construction and assembling depend on balloon type; they are usually made of polyester or polyethylene. Thickness varies from 12 micrometers to 120 micrometers. Balloon assembling

Air Force Cambridge Research Laboratories balloon operations

NASA Technical Reports Server (NTRS)

Danaher, T. J.

1974-01-01

The establishment and functions of the AFCRL balloon operations facility are discussed. The types of research work conducted by the facility are defined. The facilities which support the balloon programs are described. The free balloon and tethered balloon capabilities are analyzed.

Morphological characterization of selected balloon films and its effects on balloon performances

NASA Technical Reports Server (NTRS)

Said, Magdi A.

1994-01-01

Morphological characterization of several polyethylene balloon films have been studied using various techniques. The objective is to determine, if any, differentiating structural or morphological features that can be related to the performance of these balloon film materials. The results of the study indicate that the films are composed of either linear low denstiy polyethylene (LLDPE) or low density polyethylene (LDPE). A selective examination of these data imply that films limited degree of branching and larger crystallites size (same % crystallinity) showed good mechanical properties that appear to correlate with their high level of success in balloon flights.

CO laser angioplasty system: efficacy of manipulatable laser angioscope catheter

NASA Astrophysics Data System (ADS)

Arai, Tsunenori; Kikuchi, Makoto; Mizuno, Kyoichi; Sakurada, Masami; Miyamoto, Akira; Arakawa, Koh; Kurita, Akira; Nakamura, Haruo; Takeuchi, Kiyoshi; Utsumi, Atsushi; Akai, Yoshiro

1992-08-01

A percutaneous transluminal coronary angioplasty system using a unique combination of CO laser (5 micrometers ) and As-S infrared glass fiber under the guidance of a manipulatable laser angioscope catheter is described. The ablation and guidance functions of this system are evaluated. The angioplasty treatment procedure under angioscope guidance was studied by in vitro model experiment and in vivo animal experiment. The whole angioplasty system is newly developed. That is, a transportable compact medical CO laser device which can emit up to 10 W, a 5 F manipulatable laser angioscope catheter, a thin CO laser cable of which the diameter is 0.6 mm, an angioscope imaging system for laser ablation guidance, and a system controller were developed. Anesthetized adult mongrel dogs (n equals 5) with an artificial complete occlusion in the femoral artery and an artificial human vessel model including occluded or stenotic coronary artery were used. The manipulatability of the catheter was drastically improved (both rotation and bending), therefore, precise control of ablation to expand stenosis was obtained. A 90% artificial stenosis made of human yellow plaque in 4.0 mm diameter in the vessel was expanded to 70% stenosis by repetitive CO laser ablations of which total energy was 220 J. All procedures were performed and controlled under angioscope visualization.

The EUSO-Balloon pathfinder

NASA Astrophysics Data System (ADS)

Adams, J. H.; Ahmad, S.; Albert, J.-N.; Allard, D.; Anchordoqui, L.; Andreev, V.; Anzalone, A.; Arai, Y.; Asano, K.; Ave Pernas, M.; Baragatti, P.; Barrillon, P.; Batsch, T.; Bayer, J.; Bechini, R.; Belenguer, T.; Bellotti, R.; Belov, K.; Berlind, A. A.; Bertaina, M.; Biermann, P. L.; Biktemerova, S.; Blaksley, C.; Blanc, N.; Błȩcki, J.; Blin-Bondil, S.; Blümer, J.; Bobik, P.; Bogomilov, M.; Bonamente, M.; Briggs, M. S.; Briz, S.; Bruno, A.; Cafagna, F.; Campana, D.; Capdevielle, J.-N.; Caruso, R.; Casolino, M.; Cassardo, C.; Castellinic, G.; Catalano, C.; Catalano, G.; Cellino, A.; Chikawa, M.; Christl, M. J.; Cline, D.; Connaughton, V.; Conti, L.; Cordero, G.; Crawford, H. J.; Cremonini, R.; Csorna, S.; Dagoret-Campagne, S.; de Castro, A. J.; De Donato, C.; de la Taille, C.; De Santis, C.; del Peral, L.; Dell'Oro, A.; De Simone, N.; Di Martino, M.; Distratis, G.; Dulucq, F.; Dupieux, M.; Ebersoldt, A.; Ebisuzaki, T.; Engel, R.; Falk, S.; Fang, K.; Fenu, F.; Fernández-Gómez, I.; Ferrarese, S.; Finco, D.; Flamini, M.; Fornaro, C.; Franceschi, A.; Fujimoto, J.; Fukushima, M.; Galeotti, P.; Garipov, G.; Geary, J.; Gelmini, G.; Giraudo, G.; Gonchar, M.; González Alvarado, C.; Gorodetzky, P.; Guarino, F.; Guzmán, A.; Hachisu, Y.; Harlov, B.; Haungs, A.; Hernández Carretero, J.; Higashide, K.; Ikeda, D.; Ikeda, H.; Inoue, N.; Inoue, S.; Insolia, A.; Isgrò, F.; Itow, Y.; Joven, E.; Judd, E. G.; Jung, A.; Kajino, F.; Kajino, T.; Kaneko, I.; Karadzhov, Y.; Karczmarczyk, J.; Karus, M.; Katahira, K.; Kawai, K.; Kawasaki, Y.; Keilhauer, B.; Khrenov, B. A.; Kim, J.-S.; Kim, S.-W.; Kim, S.-W.; Kleifges, M.; Klimov, P. A.; Kolev, D.; Kreykenbohm, I.; Kudela, K.; Kurihara, Y.; Kusenko, A.; Kuznetsov, E.; Lacombe, M.; Lachaud, C.; Lee, J.; Licandro, J.; Lim, H.; López, F.; Maccarone, M. C.; Mannheim, K.; Maravilla, D.; Marcelli, L.; Marini, A.; Martinez, O.; Masciantonio, G.; Mase, K.; Matev, R.; Medina-Tanco, G.; Mernik, T.; Miyamoto, H.; Miyazaki, Y.; Mizumoto, Y.; Modestino, G.; Monaco, A.; Monnier-Ragaigne, D.; Morales de los Ríos, J. A.; Moretto, C.; Morozenko, V. S.; Mot, B.; Murakami, T.; Murakami, M. Nagano; Nagata, M.; Nagataki, S.; Nakamura, T.; Napolitano, T.; Naumov, D.; Nava, R.; Neronov, A.; Nomoto, K.; Nonaka, T.; Ogawa, T.; Ogio, S.; Ohmori, H.; Olinto, A. V.; Orleański, P.; Osteria, G.; Panasyuk, M. I.; Parizot, E.; Park, I. H.; Park, H. W.; Pastircak, B.; Patzak, T.; Paul, T.; Pennypacker, C.; Perez Cano, S.; Peter, T.; Picozza, P.; Pierog, T.; Piotrowski, L. W.; Piraino, S.; Plebaniak, Z.; Pollini, A.; Prat, P.; Prévôt, G.; Prieto, H.; Putis, M.; Reardon, P.; Reyes, M.; Ricci, M.; Rodríguez, I.; Rodríguez Frías, M. D.; Ronga, F.; Roth, M.; Rothkaehl, H.; Roudil, G.; Rusinov, I.; Rybczyński, M.; Sabau, M. D.; Sáez-Cano, G.; Sagawa, H.; Saito, A.; Sakaki, N.; Sakata, M.; Salazar, H.; Sánchez, S.; Santangelo, A.; Santiago Crúz, L.; Sanz Palomino, M.; Saprykin, O.; Sarazin, F.; Sato, H.; Sato, M.; Schanz, T.; Schieler, H.; Scotti, V.; Segreto, A.; Selmane, S.; Semikoz, D.; Serra, M.; Sharakin, S.; Shibata, T.; Shimizu, H. M.; Shinozaki, K.; Shirahama, T.; Siemieniec-Oziȩbło, G.; Silva López, H. H.; Sledd, J.; Słomińska, K.; Sobey, A.; Sugiyama, T.; Supanitsky, D.; Suzuki, M.; Szabelska, B.; Szabelski, J.; Tajima, F.; Tajima, N.; Tajima, T.; Takahashi, Y.; Takami, H.; Takeda, M.; Takizawa, Y.; Tenzer, C.; Tibolla, O.; Tkachev, L.; Tokuno, H.; Tomida, T.; Tone, N.; Toscano, S.; Trillaud, F.; Tsenov, R.; Tsunesada, Y.; Tsuno, K.; Tymieniecka, T.; Uchihori, Y.; Unger, M.; Vaduvescu, O.; Valdés-Galicia, J. F.; Vallania, P.; Valore, L.; Vankova, G.; Vigorito, C.; Villaseñor, L.; von Ballmoos, P.; Wada, S.; Watanabe, J.; Watanabe, S.; Watts, J.; Weber, M.; Weiler, T. J.; Wibig, T.; Wiencke, L.; Wille, M.; Wilms, J.; Włodarczyk, Z.; Yamamoto, T.; Yamamoto, Y.; Yang, J.; Yano, H.; Yashin, I. V.; Yonetoku, D.; Yoshida, K.; Yoshida, S.; Young, R.; Zotov, M. Yu.; Zuccaro Marchi, A.

2015-11-01

EUSO-Balloon is a pathfinder for JEM-EUSO, the Extreme Universe Space Observatory which is to be hosted on-board the International Space Station. As JEM-EUSO is designed to observe Ultra-High Energy Cosmic Rays (UHECR)-induced Extensive Air Showers (EAS) by detecting their ultraviolet light tracks "from above", EUSO-Balloon is a nadir-pointing UV telescope too. With its Fresnel Optics and Photo-Detector Module, the instrument monitors a 50 km2 ground surface area in a wavelength band of 290-430 nm, collecting series of images at a rate of 400,000 frames/sec. The objectives of the balloon demonstrator are threefold: a) perform a full end-to-end test of a JEM-EUSO prototype consisting of all the main subsystems of the space experiment, b) measure the effective terrestrial UV background, with a spatial and temporal resolution relevant for JEM-EUSO. c) detect tracks of ultraviolet light from near space for the first time. The latter is a milestone in the development of UHECR science, paving the way for any future space-based UHECR observatory. On August 25, 2014, EUSO-Balloon was launched from Timmins Stratospheric Balloon Base (Ontario, Canada) by the balloon division of the French Space Agency CNES. From a float altitude of 38 km, the instrument operated during the entire astronomical night, observing UV-light from a variety of ground-covers and from hundreds of simulated EASs, produced by flashers and a laser during a two-hour helicopter under-flight.

Predictors for adverse outcome after iliac angioplasty and stenting for limb-threatening ischemia.

PubMed

Timaran, Carlos H; Stevens, Scott L; Freeman, Michael B; Goldman, Mitchell H

2002-09-01

The role of iliac artery angioplasty and stenting (IAS) for the treatment of limb-threatening ischemia is not defined. IAS has been used primarily for patients with disabling claudication. Because poorer results have been shown in patients with critical ischemia after iliac artery angioplasty, the purpose of this study was to estimate the influence of risk factors on the outcome of iliac angioplasty and stent placement in patients with limb-threatening ischemia. During a 5-year period (from 1996 to 2001), 85 iliac angioplasty and stent placement procedures (107 stents) were performed in 31 women and 43 men with limb-threatening ischemia. Patients with claudication were specifically excluded. The criteria prepared by the Ad Hoc Committee on Reporting Standards (Society for Vascular Surgery/International Society for Cardiovascular Surgery) were followed to define the variables. The TransAtlantic InterSociety Consensus classification was used to characterize the type of iliac lesions. Both univariate (Kaplan-Meier [KM]) and multivariate analyses (Cox proportional hazards model) were used to determine the association between variables, cumulative patency, limb salvage, and survival. Indications for iliac angioplasty with stenting were ischemic rest pain (56%) and tissue loss (44%). Primary stenting was performed in 36 patients (42%). Stents were placed selectively after iliac angioplasty mainly for residual stenosis or pressure gradient (43%). Overall, primary stent patency rate was 90% at 1 year, 74% at 3 years, and 69% at 5 years. Primary stent patency rate was significantly reduced in women compared with men (KM, log-rank test, P <.001). Primary patency rates at 1, 3, and 5 years were 79%, 57%, and 38% for women and 92%, 88%, and 88% for men. Primary stent patency rate also was significantly reduced in patients with renal insufficiency (creatinine level, >1.6 mg/dL; KM, log-rank test, P <.001). Cox regression analysis identified female gender (relative risk, 5.1; 95

Two Tethered Balloon Systems

NASA Technical Reports Server (NTRS)

Youngbluth, Otto; Owens, Thomas L.; Storey, Richard W.

1990-01-01

Systems take meteorological measurements for variety of research projects. Report describes work done by NASA Langley Research Center in atmospheric research using tethered balloon systems composed of commercially available equipment. Two separate tethered balloon systems described in report have payloads and configurations tailored to requirements of specific projects. Each system capable of measuring atmospheric parameter or species in situ and then telemetering this data in real time to ground station. Meteorological data and concentration of ozone typically measured. Indicates instrumented tethered balloon systems have distinct advantages over other systems for gathering data on troposphere.

Mobile, high-wind, balloon-launching apparatus

NASA Technical Reports Server (NTRS)

Rust, W. David; Marshall, Thomas C.

1989-01-01

In order to place instruments for measuring meteorological and electrical parameters into thunderstorms, an inexpensive apparatus has been developed which makes it possible to inflate, transport, and launch balloons in high winds. The launching apparatus is a cylinder of bubble plastic that is made by joining the sides of the cylinder together with a velcro rip strip. A balloon is launched by pulling the rip strip rapidly. This allows the balloon to pop upward into the ambient low-level wind and carry its instrumentation aloft. Different-sized launch tubes are constructed to accommodate particular sizes of balloons. Balloons have been launched in winds of about 20 m/s.

Successful angioplasty of tripolar renal arteries in a single setting: a case report.

PubMed

Sharma, Gyarsi Lal; Morice, Marie-Claude; Catineau, Patrick

2002-08-01

Renal artery stenosis (RAS) is one of the important causes of correctable hypertension. There are various modes of therapy for RAS, including percutaneous transluminal renal angioplasty (PTRA) and surgery. PTRA has emerged as the treatment of choice in cases of renal artery stenosis. PTRA combined with stenting is associated with good immediate and long-term results. This case report describes successful angioplasty of bilateral multiple renal arteries in a single setting with good immediate and follow-up results.

Online Adjuncts.

ERIC Educational Resources Information Center

Reeves, Kimberly

2002-01-01

Describes how some universities are hiring adjuncts to teach Web-based educational administration courses. Includes descriptions of administrators' experiences with Web-based teaching and four major universities that offer Web-based graduate and undergraduate education courses. (PKP)

Universal stratospheric balloon gradiometer

NASA Astrophysics Data System (ADS)

Tsvetkov, Yury; Filippov, Sergey; Brekhov, Oleg; Nikolaev, Nikolay

The study of the interior structure of the Earth and laws of its evolution is one of the most difficult problems of natural science. Among the geophysical fields the anomaly magnetic field is one of the most informational in questions of the Earth’s crust structure. Many important parameters of an environment are expedient for measuring at lower altitudes, than satellite ones. So, one of the alternatives is stratospheric balloon survey. The balloon flight altitudes cover the range from 20 to 50 km. At such altitudes there are steady zone air flows due to which the balloon flight trajectories can be of any direction, including round-the-world (round-the-pole). For investigation of Earth's magnetic field one of the examples of such sounding system have been designed, developed and maintained at IZMIRAN and MAI during already about 25 years. This system consists of three instrumental containers uniformly placed along a vertical 6 km line. Up today this set has been used only for geomagnetic purposes. So we describe this system on example of the measuring of the geomagnetic field gradient. System allows measuring a module and vertical gradient of the geomagnetic field along the whole flight trajectory and so one’s name is - stratospheric balloon magnetic gradiometer (SMBG). The GPS-receivers, located in each instrumental container, fix the flight coordinates to within several tens meters. Process of SBMG deployment, feature of the exit of rope from the magazine at the moment of balloon launching has been studied. Used magazine is cellular type. The hodograph of the measuring base of SBMG and the technique of correction of the deviations of the measuring base from the vertical line (introduction of the amendments for the deviation) during the flight have been investigated. It is shown that estimation of the normal level of values of the vertical gradient of the geomagnetic field is determined by the accuracy of determining the length of the measuring base SBMG

DOE Office of Scientific and Technical Information (OSTI.GOV)

Vajda, Zsolt, E-mail: Z.Vajda@klinikum-stuttgart.de; Guethe, Thomas, E-mail: T.Guethe@klinikum-stuttgart.de; Perez, Marta Aguilar, E-mail: M.Aguilar@klinikum-stuttgart.de

Stenting in intracranial atherosclerotic disease (ICAD) is increasingly debated, due to issues of procedural safety, technical efficacy, and in-stent recurrent stenoses (ISR). In the present study, feasibility, safety, and efficacy of angioplasty using a drug-eluting balloon (DEB) followed by the implantation of a self-expanding stent (Enterprise) were evaluated for the treatment of ICAD lesions. Fifty-two patients (median age: 71 years; range: 54-86 years; male/female ratio 37:15) underwent stenting of high-grade ICAD lesions between February 2010 and November 2011 in a single center. Angioplasty using a paclitaxel coated SeQuent Please (B. Braun, Germany) or DIOR (Eurocor, Germany) coronary PTCA balloon, followedmore » by the implantation of a self-expanding stent (Enterprise, Codman, USA) was performed in 54 lesions. Angiographic and clinical follow-up was performed at 6 and 12 weeks, 6 and 12 months, and yearly thereafter. Technical success rate, periprocedural complications, occurrence of recurrent ischemic symptoms, and the development of an ISR were analyzed. Angioplasty using a DEB followed by stent implantation was successfully performed in 44 (81 %) cases. DEB insertion failed in 19 % of the cases and angioplasty was finally performed using a conventional PTCA balloon. The combined procedure related permanent neurologic morbidity and mortality rate (stroke, ICH, and subarachnoid hemorrhage) at 30 days and beyond was 5 %. Angiographic and clinical follow-up were obtained in 33 (61 %) lesions in 32 patients. Recurrent stenosis was seen in one (3 %) lesion. Angioplasty and stenting using a DEB is safe and yields encouragingly low ISR rates. Further technical developments to improve lesion accessibility are, nevertheless, mandatory.« less

The Great Balloon Controversy.

ERIC Educational Resources Information Center

Chase, Valerie

1989-01-01

Discusses the harmful effects of balloon launches and the dumping of plastic debris into oceans. Cites several examples of plastic materials being discovered inside the bodies of sick and/or dead marine animals. Offers alternative activities to releasing balloons into the atmosphere. (RT)

Current trends of balloon laryngoplasty in Thailand.

PubMed

Moungthong, Greetha; Bunbanjerdsuk, Sacarin; Wright, Nida; Sathavornmanee, Thanakrit; Setabutr, Dhave

2017-06-01

To describe the current trend in balloon laryngoplasty usage and experience by practicing otolaryngologists in Thailand. Anonymous 11 question online and paper survey of otolaryngologists on their current balloon laryngoplasty practices. Current practices and experience in balloon laryngoplasty were queried with multiple choice and open-ended questions. Laser use is the most commonly utilized instrument to treat airway stenosis in Thailand. 86% of respondents do not have experience with balloon dilatation; yet, almost half (47.6%) report they perform a minimum of five airway surgeries per year. Most respondents had been in practice for less than 6 years (41%) and reported that they did not have exposure to balloon use during residency training. The largest barrier reported for the use of balloon instrumentation in the airway is inexperience (44.4%) followed by cost (38.3%), yet most feel that treatment in airway stenosis could benefit by usage of balloons (95.5%). Most otolaryngologists in Thailand do not have experience with the use of balloon dilatation and lack of exposure remains the largest barrier to its use. Otolaryngologists in Thailand feel that increased usage of balloons in the airway could improve airway stenosis treatment in the country.

Reference level winds from balloon platforms

NASA Technical Reports Server (NTRS)

Lally, Vincent E.

1985-01-01

The superpressure balloon was developed to provide a method of obtaining global winds at all altitudes from 5 to 30 km. If a balloon could be made to fly for several weeks at a constant altitude, and if it could be tracked accurately on its global circuits, the balloon would provide a tag for the air parcel in which it was embedded. The Lagrangian data on the atmospheric circulation would provide a superior data input to the numerical model. The Global Atmospheric Research Program (GARP) was initiated in large part based on the promise of this technique coupled with free-floating ocean buoys and satellite radiometers. The initial name proposed by Charney for GARP was SABABURA 'SAtellite BAlloon BUoy RAdiometric system' (Charney, 1966). However, although the superpressure balloon exceeded its designers' expectations for flight duration in the stratosphere (longest flight duration of 744 days), flight duration below 10 km was limited by icing in super-cooled clouds to a few days. The balloon was relegated to a secondary role during the GARP Special Observing Periods. The several major superpressure balloon programs for global wind measurement are described as well as those new developments which make the balloon once again an attractive vehicle for measurement of global winds as a reference and bench-mark system for future satellite systems.

Modelling Hot Air Balloons.

ERIC Educational Resources Information Center

Brimicombe, M. W.

1991-01-01

A macroscopic way of modeling hot air balloons using a Newtonian approach is presented. Misleading examples using a car tire and the concept of hot air rising are discussed. Pressure gradient changes in the atmosphere are used to explain how hot air balloons work. (KR)

Balloon-augmented Onyx embolization of cerebral arteriovenous malformations using a dual-lumen balloon: a multicenter experience.

PubMed

Spiotta, Alejandro M; James, Robert F; Lowe, Stephen R; Vargas, Jan; Turk, Aquilla S; Chaudry, M Imran; Bhalla, Tarun; Janjua, Rashid M; Delaney, John J; Quintero-Wolfe, Stacey; Turner, Raymond D

2015-10-01

Conventional Onyx embolization of cerebral arteriovenous malformations (AVMs) requires lengthy procedure and fluoroscopy times to form an adequate 'proximal plug' which allows forward nidal penetration while preventing reflux and non-targeted embolization. We review our experience with balloon-augmented Onyx embolization of cerebral AVMs using a dual-lumen balloon catheter technique designed to minimize these challenges. Retrospectively acquired data for all balloon-augmented cerebral AVM embolizations performed between 2011 and 2014 were obtained from four tertiary care centers. For each procedure, at least one Scepter C balloon catheter was advanced into the AVM arterial pedicle of interest and Onyx embolization was performed through the inner lumen after balloon inflation via the outer lumen. Twenty patients underwent embolization with the balloon-augmented technique over 24 discreet treatment episodes. There were 37 total arterial pedicles embolized with the balloon-augmented technique, a mean of 1.9 per patient (range 1-5). The treated AVMs were heterogeneous in their location and size (mean 3.3±1.6 cm). Mean fluoroscopy time for each procedure was 48±26 min (28 min per embolized pedicle). Two Scepter C balloon catheter-related complications (8.3% of embolization sessions, 5.4% of pedicles embolized) were observed: an intraprocedural rupture of a feeding pedicle and fracture and retention of a catheter fragment. This multicenter experience represents the largest reported series of balloon-augmented Onyx embolization of cerebral AVMs. The technique appears safe and effective in the treatment of AVMs, allowing more efficient and controlled injection of Onyx with a decreased risk of reflux and decreased fluoroscopy times. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Solar research with stratospheric balloons

NASA Astrophysics Data System (ADS)

Vázquez, Manuel; Wittmann, Axel D.

Balloons, driven by hot air or some gas lighter than air, were the first artificial machines able to lift payloads (including humans) from the ground. After some pioneering flights the study of the physical properties of the terrestrial atmosphere constituted the first scientific target. A bit later astronomers realized that the turbulence of the atmospheric layers above their ground-based telescopes deteriorated the image quality, and that balloons were an appropriate means to overcome, total or partially, this problem. Some of the most highly-resolved photographs and spectrograms of the sun during the 20th century were actually obtained by balloon-borne telescopes from the stratosphere. Some more recent projects of solar balloon astronomy will also be described.

Successful technical and clinical outcome using a second generation balloon expandable coronary stent for transplant renal artery stenosis: Our experience.

PubMed

Salsamendi, Jason; Pereira, Keith; Baker, Reginald; Bhatia, Shivank S; Narayanan, Govindarajan

2015-10-01

Transplant renal artery stenosis (TRAS) is a vascular complication frequently seen because of increase in the number of renal transplantations. Early diagnosis and management is essential to optimize a proper graft function. Currently, the endovascular treatment of TRAS using angioplasty and/or stenting is considered the treatment of choice with the advantage that it does not preclude subsequent surgical correction. Treatment of TRAS with the use of stents, particularly in tortuous transplant renal anatomy presents a unique challenge to an interventional radiologist. In this study, we present three cases from our practice highlighting the use of a balloon-expandable Multi-Link RX Ultra coronary stent system (Abbott Laboratories, Abbott Park, Illinois, USA) for treating high grade focal stenosis along very tortuous renal arterial segments. Cobalt-Chromium alloy stent scaffold provides excellent radial force, whereas the flexible stent design conforms to the vessel course allowing for optimal stent alignment.

21 CFR 870.1350 - Catheter balloon repair kit.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Catheter balloon repair kit. 870.1350 Section 870... repair kit. (a) Identification. A catheter balloon repair kit is a device used to repair or replace the balloon of a balloon catheter. The kit contains the materials, such as glue and balloons, necessary to...

21 CFR 870.1350 - Catheter balloon repair kit.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Catheter balloon repair kit. 870.1350 Section 870... repair kit. (a) Identification. A catheter balloon repair kit is a device used to repair or replace the balloon of a balloon catheter. The kit contains the materials, such as glue and balloons, necessary to...

21 CFR 870.1350 - Catheter balloon repair kit.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Catheter balloon repair kit. 870.1350 Section 870... repair kit. (a) Identification. A catheter balloon repair kit is a device used to repair or replace the balloon of a balloon catheter. The kit contains the materials, such as glue and balloons, necessary to...

Calculating Payload for a Tethered Balloon System

Treesearch

Charles D. Tangren

1980-01-01

A graph method to calculate payload for a tethered balloon system, with the supporting helium lift and payload equations. is described. The balloon system is designed to collect emissions data during the convective-lift and no-convective-lift phases of a forest fire. A description of the balloon system and a list of factors affecting balloon selection are included....

Biological effect of orbital atherectomy and adjunctive paclitaxel-coated balloon therapy on vascular healing and drug retention: early experimental insights into the familial hypercholesterolaemic swine model of femoral artery stenosis.

PubMed

Tellez, Armando; Dattilo, Raymond; Mustapha, Jihad A; Gongora, Carlos A; Hyon, Chelsea M; Palmieri, Taylor; Rousselle, Serge; Kaluza, Greg L; Granada, Juan F

2014-12-01

The efficacy of paclitaxel-coated balloons (PCB) for the treatment of superficial femoral artery (SFA) disease has been demonstrated in the clinical setting. Due to the high frequency of arterial calcification found in this vascular territory, the adjunctive use of atherectomy plus PCB has been proposed. In this study, we aimed to evaluate the biological effect on vascular healing and drug retention of this combination approach in the familial hypercholesterolaemic swine (FHS) model of femoral artery stenosis. Eleven femoral arteries (six superficial and five profunda arteries) were included. Vessels were injured (x2) over a 28-day period and all animals were maintained on a high cholesterol diet for 60 days following initial injury. Vessels were randomised to PCB (n=5) or orbital atherectomy system (OAS) plus PCB (n=6). At 28 days following therapy, vessels were followed with angiography, intravascular ultrasound (IVUS) and optical coherence tomography (OCT). Vessels were harvested for histological and pharmacokinetic analysis. Angiographic findings were comparable at termination between both groups. The OCT findings were comparable at termination. There were no differences in the vascular healing profile between both groups. The paclitaxel levels at termination were comparable between both groups (PCB=5.16 vs. OAS+PCB=3.03 ng/mg). In the experimental setting, the combination of OAS+PCB appears to be safe by demonstrating a vascular healing profile and drug tissue levels comparable to PCB only. The vascular effect of PCB may be enhanced by the use of OAS by decreasing plaque burden and cholesterol crystals.

Flight Qualification of the NASA's Super Pressure Balloon

NASA Astrophysics Data System (ADS)

Cathey, Henry; Said, Magdi; Fairbrother, Debora

Designs of new balloons to support space science require a number of actual flights under various flight conditions to qualify them to as standard balloon flight offerings to the science community. Development of the new Super Pressure Balloon for the National Aeronautics and Space Administration’s Balloon Program Office has entailed employing new design, analysis, and production techniques to advance the state of the art. Some of these advances have been evolutionary steps and some have been revolutionary steps requiring a maturing understanding of the materials, designs, and manufacturing approaches. The NASA Super Pressure Balloon development end goal is to produce a flight vehicle that is qualified to carry a ton of science instrumentation, at an altitude greater than 33 km while maintaining a near constant pressure altitude for extended periods of up to 100 days, and at any latitude on the globe. The NASA’s Balloon Program Office has pursued this development in a carefully executed incremental approach by gradually increasing payload carrying capability and increasing balloon volume to reach these end goal. A very successful test flight of a ~200,700 m3 balloon was launch in late 2008 from Antarctica. This balloon flew for over 54 days at a constant altitude and circled the Antarctic continent almost three times. A larger balloon was flown from Antarctica in early 2011. This ~422,400 m3 flew at a constant altitude for 22 days making one circuit around Antarctica. Although the performance was nominal, the flight was terminated via command to recover high valued assets from the payload. The balloon designed to reach the program goals is a ~532,200 m3 pumpkin shaped Super Pressure Balloon. A test flight of this balloon was launched from the Swedish Space Corporation’s Esrange Balloon Launch Facilities near Kiruna, Sweden on 14 August, 2012. This flight was another success for this development program. Valuable information was gained from this short test

The Effects of Adjunct Questions on Prose Learning.

ERIC Educational Resources Information Center

Hamaker, Christiaan

1986-01-01

The research literature on the effects of factual and higher order adjunct questions is reviewed. The influence of 13 design variables on the direction and size of adjunct-questions effects is investigated. It is indicated that higher order adjunct questions may have a more general facilitative effect. (Author/JAZ)

Clopidogrel Responsiveness in Patients Undergoing Peripheral Angioplasty

DOE Office of Scientific and Technical Information (OSTI.GOV)

Pastromas, Georgios, E-mail: geopastromas@gmail.com; Spiliopoulos, Stavros, E-mail: stavspiliop@upatras.gr; Katsanos, Konstantinos, E-mail: katsanos@med.upatras.gr

2013-12-15

Purpose: To investigate the incidence and clinical significance of platelet responsiveness in patients receiving clopidogrel after peripheral angioplasty procedures. Materials and Methods: This prospective study included patients receiving antiplatelet therapy with clopidogrel 75 mg after infrainguinal angioplasty or stenting and who presented to our department during routine follow-up. Clopidogrel responsiveness was tested using the VerifyNow P2Y12 Assay. Patients with residual platelet reactivity units (PRU) {>=} 235 were considered as nonresponders (NR group NR), whereas patients with PRU < 235 were considered as normal (responders [group R]). Primary end points were incidence of resistance to clopidogrel and target limb reintervention (TLR)-freemore » survival, whereas secondary end points included limb salvage rates and the identification of any independent predictors influencing clinical outcomes. Results: In total, 113 consecutive patients (mean age 69 {+-} 8 years) with 139 limbs were enrolled. After clopidogrel responsiveness analysis, 61 patients (53.9 %) with 73 limbs (52.5 %) were assigned to group R and 52 patients (46.1 %) with 66 limbs (47.5 %) to group NR. Mean follow-up interval was 27.7 {+-} 22.9 months (range 3-95). Diabetes mellitus, critical limb ischemia, and renal disease were associated with clopidogrel resistance (Fisher's exact test; p < 0.05). According to Kaplan-Meier analysis, TLR-free survival was significantly superior in group R compared with group NR (20.7 vs. 1.9 %, respectively, at 7-year follow-up; p = 0.001), whereas resistance to clopidogrel was identified as the only independent predictor of decreased TLR-free survival (hazard rate 0.536, 95 % confidence interval 0.31-0.90; p = 0.01). Cumulative TLR rate was significantly increased in group NR compared with group R (71.2 % [52 of 73] vs. 31.8 % [21 of 66], respectively; p < 0.001). Limb salvage was similar in both groups. Conclusion: Clopidogrel resistance was related with

Early Cosmic Ray Research with Balloons

NASA Astrophysics Data System (ADS)

Walter, Michael

2013-06-01

The discovery of cosmic rays by Victor Hess during a balloon flight in 1912 at an altitude of 5350 m would not have been possible without the more than one hundred years development of scientific ballooning. The discovery of hot air and hydrogen balloons and their first flights in Europe is shortly described. Scientific ballooning was mainly connected with activities of meteorologists. It was also the geologist and meteorologist Franz Linke, who probably observed first indications of a penetrating radiation whose intensity seemed to increase with the altitude. Karl Bergwitz and Albert Gockel were the first physicists studying the penetrating radiation during balloon flights. The main part of the article deals with the discovery of the extraterrestrial radiation by V. Hess and the confirmation by Werner Kolhörster.

Biological effect on drug distribution and vascular healing via paclitaxel-coated balloon technology in drug eluting stent restenosis swine model.

PubMed

Li, Yan; Tellez, Armando; Rousselle, Serge D; Dillon, Krista N; Garza, Javier A; Barry, Chris; Granada, Juan F

2016-07-01

To evaluate the biological effect of a paclitaxel-coated balloon (PCB) technology on vascular drug distribution and healing in drug eluting stent restenosis (DES-ISR) swine model. The mechanism of action and healing response via PCB technology in DES-ISR is not completely understood. A total of 27 bare metal stents were implanted in coronary arteries and 30 days later the in-stent restenosis was treated with PCB. Treated segments were harvested at 1 hr, 14 days and 30 days post treatment for the pharmacokinetic analysis. In addition, 24 DES were implanted in coronary arteries for 30 days, then all DES-ISRs were treated with either PCB (n = 12) or uncoated balloon (n = 12). At day 60, vessels were harvested for histology following angiography and optical coherence tomography (OCT). The paclitaxel level in neointimal tissue was about 18 times higher (P = 0.0004) at 1 hr Cmax , and retained about five times higher (P = 0.008) at day 60 than that in vessel wall. A homogenous distribution of paclitaxel in ISR was demonstrated by using fluorescently labeled paclitaxel. Notably, in DES-ISR, both termination OCT and quantitative coronary angioplasty showed a significant neointimal reduction and less late lumen loss (P = 0.05 and P = 0.03, respectively) post PCB versus post uncoated balloon. The PES-ISR + PCB group displayed higher levels of peri-strut inflammation and fibrin scores compared to the -limus DES-ISR + PCB group. In ISR, paclitaxel is primarily deposited in neointimal tissue and effectively retained over time following PCB use. Despite the presence of metallic struts, a uniform distribution was characterized. PCB demonstrated an equivalent biological effect in DES-ISR without significantly increasing inflammation. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.

Biological effect on drug distribution and vascular healing via paclitaxel‐coated balloon technology in drug eluting stent restenosis swine model

PubMed Central

Li, Yan; Tellez, Armando; Rousselle, Serge D.; Dillon, Krista N.; Garza, Javier A.; Barry, Chris

2015-01-01

Objectives To evaluate the biological effect of a paclitaxel‐coated balloon (PCB) technology on vascular drug distribution and healing in drug eluting stent restenosis (DES‐ISR) swine model. Background The mechanism of action and healing response via PCB technology in DES‐ISR is not completely understood. Methods A total of 27 bare metal stents were implanted in coronary arteries and 30 days later the in‐stent restenosis was treated with PCB. Treated segments were harvested at 1 hr, 14 days and 30 days post treatment for the pharmacokinetic analysis. In addition, 24 DES were implanted in coronary arteries for 30 days, then all DES‐ISRs were treated with either PCB (n = 12) or uncoated balloon (n = 12). At day 60, vessels were harvested for histology following angiography and optical coherence tomography (OCT). Results The paclitaxel level in neointimal tissue was about 18 times higher (P = 0.0004) at 1 hr C max, and retained about five times higher (P = 0.008) at day 60 than that in vessel wall. A homogenous distribution of paclitaxel in ISR was demonstrated by using fluorescently labeled paclitaxel. Notably, in DES‐ISR, both termination OCT and quantitative coronary angioplasty showed a significant neointimal reduction and less late lumen loss (P = 0.05 and P = 0.03, respectively) post PCB versus post uncoated balloon. The PES‐ISR + PCB group displayed higher levels of peri‐strut inflammation and fibrin scores compared to the ‐limus DES‐ISR + PCB group. Conclusions In ISR, paclitaxel is primarily deposited in neointimal tissue and effectively retained over time following PCB use. Despite the presence of metallic struts, a uniform distribution was characterized. PCB demonstrated an equivalent biological effect in DES‐ISR without significantly increasing inflammation. © 2015 Wiley Periodicals, Inc. PMID:26613810

Alloplastic adjuncts in breast reconstruction

PubMed Central

Cabalag, Miguel S.; Rostek, Marie; Miller, George S.; Chae, Michael P.; Quinn, Tam; Rozen, Warren M.

2016-01-01

Background There has been an increasing role of acellular dermal matrices (ADMs) and synthetic meshes in both single- and two-stage implant/expander breast reconstruction. Numerous alloplastic adjuncts exist, and these vary in material type, processing, storage, surgical preparation, level of sterility, available sizes and cost. However, there is little published data on most, posing a significant challenge to the reconstructive surgeon trying to compare and select the most suitable product. The aims of this systematic review were to identify, summarize and evaluate the outcomes of studies describing the use of alloplastic adjuncts for post-mastectomy breast reconstruction. The secondary aims were to determine their cost-effectiveness and analyze outcomes in patients who also underwent radiotherapy. Methods Using the PRSIMA 2009 statement, a systematic review was conducted to find articles reporting on the outcomes on the use of alloplastic adjuncts in post-mastectomy breast reconstruction. Multiple databases were searched independently by three authors (Cabalag MS, Miller GS and Chae MP), including: Ovid MEDLINE (1950 to present), Embase (1980 to 2015), PubMed and Cochrane Database of Systematic Reviews. Results Current published literature on available alloplastic adjuncts are predominantly centered on ADMs, both allogeneic and xenogeneic, with few outcome studies available for synthetic meshes. Outcomes on the 89 articles, which met the inclusion criteria, were summarized and analyzed. The reported outcomes on alloplastic adjunct-assisted breast reconstruction were varied, with most data available on the use of ADMs, particularly AlloDerm® (LifeCell, Branchburg, New Jersey, USA). The use of ADMs in single-stage direct-to-implant breast reconstruction resulted in lower complication rates (infection, seroma, implant loss and late revision), and was more cost effective when compared to non-ADM, two-stage reconstruction. The majority of studies demonstrated

Krüppel-like factor 4 is induced by rapamycin and mediates the anti-proliferative effect of rapamycin in rat carotid arteries after balloon injury.

PubMed

Wang, Ying; Zhao, Beilei; Zhang, Yi; Tang, Zhihui; Shen, Qiang; Zhang, Youyi; Zhang, Weizhen; Du, Jie; Chien, Shu; Wang, Nanping

2012-04-01

The transcription factor, Krüppel-like factor 4 (KLF4), plays an important role in regulating the proliferation of vascular smooth muscle cells. This study aimed to examine the effect of rapamycin on the expression of KLF4 and the role of KLF4 in arterial neointimal formation. Expression of KLF4 was monitored using real-time PCR and immunoblotting in cultured vascular smooth muscle cells. and in rat carotid arteries in vivo after balloon injury. Adenovirus-mediated overexpression and siRNA-mediated knockdown of KLF4 were used to examine the role of KLF4 in mediating the anti-proliferative role of rapamycin . KLF4-regulated genes were identified using cDNA microarray. Rapamycin induced the expression of KLF4 in vitro and in vivo. Overexpression of KLF4 inhibited cell proliferation and the activity of mammalian target of rapamycin (mTOR) and its downstream pathways, including 4EBP-1 and p70S6K in vascular smooth muscle cells and prevented the neointimal formation in the balloon-injured arteries. KLF4 up-regulated the expression of GADD45β, p57(kip2) and p27(kip1) . Furthermore, knockdown of KLF4 attenuated the anti-proliferative effect of rapamycin both in vitro and in vivo. KLF4 plays an important role in mediating the anti-proliferative effect of rapamycin in VSMCs and balloon-injured arteries. Thus, it is a potential target for the treatment of proliferative vascular disorders such as restenosis after angioplasty. © 2011 The Authors. British Journal of Pharmacology © 2011 The British Pharmacological Society.

History and perspectives of scientific ballooning

NASA Astrophysics Data System (ADS)

Lefevre, Frank

2001-08-01

Prehistory: Robertson, Biot and Gay-Lussac; Glaisher and the first studies of the atmosphere; Flammarion. The rebirth of scientific ballooning: polyethylene and mylar vehicles at Minneapolis. Super-pressurized balloons. The CNES and the Nasa programs; meteorology, aeronomy and astronomy, The Eole program. The Venus and Mars balloons in the French-Soviet space program. The future.

Intravascular ultrasound for intracranial angioplasty and stent placement: technical case report.

PubMed

Wehman, J Christopher; Holmes, David R; Hanel, Ricardo A; Levy, Elad I; Hopkins, L Nelson

2006-10-01

Intravascular ultrasound (IVUS) imaging has been used extensively in coronary artery interventions and has provided invaluable information for the understanding and treatment of coronary arterial disease. We present here the first description, to our knowledge, of IVUS-guided intracranial arterial interventions in the clinical setting. Two patients underwent intracranial angioplasty and stent placement with the assistance of IVUS for the evaluation of their lesions. One patient underwent stenting to treat an occlusive dissection of the left internal carotid artery that occurred during arteriovenous malformation embolization. Another patient underwent angioplasty and stenting for high-grade restenosis of a basilar artery atherosclerotic lesion. Both patients underwent successful revascularization procedures. The patient with the dissection had a small intraventricular and parenchymal hemorrhage documented by computed tomography 4 hours after treatment, but did not develop hydrocephalus or further hemorrhage. Both patients did well clinically and had no permanent neurological deficits. IVUS provided important information in terms of lesion evaluation, stent selection, and stent placement in each case. IVUS of the intracranial circulation may assist the performance of intracranial angioplasty and stenting. It provides useful information that can affect clinical decisions. It may prove to be a valuable tool in clinical use and enhance our understanding of vascular disease of the intracranial circulation, as it has in the coronary circulation.

[Angioplasty in native coronary circulation in patients treated with myocardial revascularization].

PubMed

Pimentel Filho, W A; Ascer, E; Büchler, J R; Assis, S F; Hirschfeld, R; Neves, M; Araújo, E C; Pinheiro, L F; Souza, J A; De Carvalho, V B

1992-05-01

To evaluate the clinical results after angioplasty in the native coronary vessels in patients who had undergone previous coronary artery surgery. From June 1987 to July 1990, 69 patients with previous coronary artery surgery underwent coronary angioplasty in the native arteries. Age ranged from 31 to 82 (mean = 57.5) years, fifty eight were males. Angina was present in all patients. The patients were classified in three groups according to the following criteria: group I--incomplete revascularization following bypass surgery (28 patients); group II--progression of the disease in ungrafted vessels (24 patients) and group III--progression of the disease in grafted vessels (17 patients). Primary success was achieved in 94% (65/69). Ninety-five percent in group I, 92% in group II and 94% in group III. Complications occurred in 4%; emergency surgery or deaths were not observed in this study. Forty patients (61%) repeated coronary arteriography an average follow-up of 4 months and restenosis was detected in 10 (25%); 8 of them were redilated. Survival rates was 95% and 75% of them were free of coronary events after an average follow-up of 13 months. Coronary angioplasty in these patients is a safe and effective interventional procedure in the treatment of coronary artery disease in native coronary vessels.

+Ophitoxaemia and myocardial infarction—the issues during primary angioplasty: a review

PubMed Central

Gupta, Prabha Nini; Thomas, Jinesh; Francis, Preetham Kumar; Shylaja, Sajith Vamadevan

2014-01-01

‘The Big four’ are the most poisonous snakes in India, and especially in Kerala. These include the cobra, the viper, the krait and the sea snake. Most of the poisonous snakebites in India occur in Kerala. We believe there are only a few reports of myocardial infarction after snakebites and most of these are viper bites. We believe this is the second case of primary angioplasty for a snakebite. There are at least a few potential issues in performing a primary angioplasty in a snakebite case, namely (1) Is it a thrombus or a spasm? (2) Are the bleeding parameters deranged? Will the patient tolerate tirofiban and other glycoprotein (GB) 2b3a inhibitors? Will he develop dangerous bleeding due to the high dose of heparin needed? Further, would we save the patient from myocardial infarction only to lose him to renal failure, both due to the nephrotoxicity of the venom, the kidney being further damaged by the contrast media used for the angioplasty? We discuss all these issues as they crossed our mind, and hope it will help further treatment in others. We would like to review the available literature on these points and describe a recent case of ours. PMID:25342187

Athletic Trainers' Knowledge Regarding Airway Adjuncts

ERIC Educational Resources Information Center

Edler, Jessica R.; Eberman, Lindsey E.; Kahanov, Leamor; Roman, Christopher; Mata, Heather Lynne

2015-01-01

Context: Research suggests that knowledge gaps regarding the appropriate use of airway adjuncts exist among various health care practitioners, and that knowledge is especially limited within athletic training. Objective: To determine the relationship between perceived knowledge (PK) and actual knowledge (AK) of airway adjunct use and the…

Retrospective study of rapid-exchange monorail versus over-the-wire technique for femoropopliteal angioplasty.

PubMed

Jahnke, Thomas; Schäfer, Jost Philipp; Bolte, Hendrik; Schäfer, Fritz; Michalek, Jens; Charalambous, Nicholas; Sapoval, Marc; Müller-Hülsbeck, Stefan

2008-01-01

The purpose of this study was to compare procedural outcome of rapid-exchange (RX) monorail versus conventional over-the-wire (OTW) technique for femoropopliteal angioplasty. Demographic data, procedure details, angioplasty success, and complications of 328 consecutive percutaneous transluminal angioplasties (PTAs) were collected from a prospective database and retrospectively analyzed. Procedure details included duration of fluoroscopy, area-dose product, amount of contrast agent, sheath sizes, access route, length of stenosis, presence of total occlusion, technical and anatomical success (residual stenosis < 30% in the absence of complications), need for bail-out stenting, and periprocedural complications. The RX technique alone was used in 102 of 328 cases (31%); the OTW technique, in 226 of 328 of cases (68%). Technical success was 98% for the RX versus 95.4% for the OTW technique (p = 0.2). A significantly greater number of stents had to be implanted due to angioplasty failure when the OTW technique was used (RX, 5.9%; OTW, 13.7%; p = 0.04). There were no significant differences in fluoroscopy time, dose-area product, or amount of contrast medium used. The RX system facilitated the use of smaller sheath sizes (5 Fr = 38% and 6 Fr = 59% for RX versus 5 Fr = 16.8% and > or = 6 Fr = 82.5% for OTW) but showed only a tendency toward lower overall complication rates (16.6% [17/102] in the RX group versus 19.9% [45/226] in the OTW group; p = 0.09). There was no effect on length of hospitalization. RX monorail systems were not associated with higher procedural costs when compared to conventional OTW technique. We conclude that RX monorail systems seem to enhance the technical success of femoropopliteal angioplasty. Although smaller sheath sizes can be used due to the lower profile of the RX systems, there is only a tendency toward lower complication rates.

Charles Theodore Dotter: The Father of Intervention

PubMed Central

Payne, Misty M.

2001-01-01

The 1st percutaneous transluminal angioplasty marked a new era in the treatment of peripheral atherosclerotic lesions. The early techniques used in peripheral percutaneous transluminal angioplasty form the basis for subsequent percutaneous intervention both in the peripheral and coronary arteries and are largely the contribution of Charles Dotter. Dotter was the 1st to describe flow-directed balloon catheterization, the double-lumen balloon catheter, the safety guidewire, percutaneous arterial stenting, and more. This practical genius dedicated his considerable energy to the belief that there is always a better way to treat disease. His personal contributions to clinical medicine, research, and teaching have saved millions of limbs and lives all over the world. PMID:11330737

Histopathology of balloon-dilation Eustachian tuboplasty.

PubMed

Kivekäs, Ilkka; Chao, Wei-Chieh; Faquin, William; Hollowell, Monica; Silvola, Juha; Rasooly, Tali; Poe, Dennis

2015-02-01

Surgical intervention of the Eustachian tube (ET) has become increasingly common in the past decade, and balloon dilation has shown promising results in recent studies. It is unclear how balloon dilation enhances ET function. Our aim was to evaluate histological changes in the ET's mucosal lumen comparing before balloon dilation, immediately after, and postoperatively. Case series. Thirteen patients with bilateral ET dysfunction were enrolled. Biopsies of the ET mucosa were obtained just before balloon dilation; immediately after; and in three cases, 5 to 12 weeks postoperatively. Specimens were retrospectively examined under light microscopy by two pathologists blinded to the clinical information and whether specimens were pre- or postballoon dilation. Preoperative biopsies were characterized by inflammatory changes within the epithelium and submucosal layer. Immediate response to balloon dilation was thinning of the mucosa, shearing of epithelium and crush injury to the submucosa, especially to lymphocytic infiltrates. Postoperative biopsies demonstrated healthy pseudocolumnar epithelium and replacement of lymphocytic infiltrate with a thinner layer of fibrous tissue. Reduction of inflammatory epithelial changes and submucosal inflammatory infiltrate appeared to be the principal result of balloon dilation. The balloon may shear or crush portions of inflamed epithelium but usually spared the basal layer, allowing for rapid healing. Additionally, it appeared to effectively crush lymphocytes and lymphocytic follicles that may become replaced with thinner fibrous scar. Histopathology of the ET undergoing balloon dilation demonstrated effects that could reduce the overall inflammatory burden and may contribute to clinical improvement in ET function. 4. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.

Effect of intra-aortic balloon pump on coronary blood flow during different balloon cycles support: A computer study.

PubMed

Aye, Thin Pa Pa; Htet, Zwe Lin; Singhavilai, Thamvarit; Naiyanetr, Phornphop

2015-01-01

Intra-aortic balloon pump (IABP) has been used in clinical treatment as a mechanical circulatory support device for patients with heart failure. A computer model is used to study the effect on coronary blood flow (CBF) with different balloon cycles under both normal and pathological conditions. The model of cardiovascular and IABP is developed by using MATLAB SIMULINK. The effect on coronary blood flow has been studied under both normal and pathological conditions using different balloon cycles (balloon off; 1:4; 1:2; 1:1). A pathological heart is implemented by reducing the left ventricular contractility. The result of this study shows that the rate of balloon cycles is related to the level of coronary blood flow.

NASA balloon design and flight - Philosophy and criteria

NASA Technical Reports Server (NTRS)

Smith, I. S., Jr.

1993-01-01

The NASA philosophy and criteria for the design and flight of scientific balloons are set forth and discussed. The thickness of balloon films is standardized at 20.3 microns to isolate potential film problems, and design equations are given for specific balloon parameters. Expressions are given for: flight-stress index, total required thickness, cap length, load-tape rating, and venting-duct area. The balloon design criteria were used in the design of scientific balloons under NASA auspices since 1986, and the resulting designs are shown to be 95 percent effective. These results represent a significant increase in the effectiveness of the balloons and therefore indicate that the design criteria are valuable. The criteria are applicable to four balloon volume classes in combination with seven payload ranges.

Adjuncts to colonic cleansing before colonoscopy.

PubMed

Park, Sanghoon; Lim, Yun Jeong

2014-03-21

Pre-procedural cleansing of the bowel can maximize the effectiveness and efficiency of colonoscopy. Yet, efficacy of the current gold standard colonic preparation method - high-volume oral administration of purgative agents 12-24 h prior to the procedure - is limited by several factors, such as patient compliance (due to poor palatability and inconvenience of the dosing regimen) and risks of complications (due to drug interactions or intolerance). Attempts to resolve these limitations have included providing adjunctive agents and methods to promote the colonic cleansing ability of the principal purgative agent, with the aim of lessening unpleasant side effects (such as bloating) and reducing the large ingested volume requirement. Several promising adjunctive agents are bisacodyl, magnesium citrate, senna, simethicone, metoclopramide, and prokinetics, and each are being investigated for their potential. This review provides an up to date summary of the reported investigations into the potencies and weaknesses of the key adjuncts currently being applied in clinic as supplements to the traditional bowel preparation agents. While the comparative analysis of these adjuncts showed that no single agent or method has yet achieved the goal of completely overcoming the limitations of the current gold standard preparation method, they at least provide endoscopists with an array of alternatives to help improve the suboptimal efficacy of the main cleansing solutions when used alone. To aid in this clinical endeavor, a subjective grade was assigned to each adjunct to indicate its practical value. In addition, the systematic review of the currently available agents and methods provides insight into the features of each that may be overcome or exploited to create novel drugs and strategies that may become adopted as effective bowel cleansing adjuncts or alternatives.

Long-Duration Altitude-Controlled Balloons for Venus: A Feasibility Study Informed by Balloon Flights in Remote Environments on Earth

NASA Astrophysics Data System (ADS)

Voss, P. B.; Nott, J.; Cutts, J. A.; Hall, J. L.; Beauchamp, P. M.; Limaye, S. S.; Baines, K. H.; Hole, L. R.

2013-12-01

In situ exploration of the upper atmosphere of Venus, approximately 65-77 km altitude, could answer many important questions (Limaye 2013, Crisp 2013). This region contains a time-variable UV absorber of unknown composition that controls many aspects of the heat balance on Venus. Understanding the composition and dynamics of this unknown absorber is an important science goal; in situ optical and chemical measurements are needed. However, conventional approaches do not provide access to this altitude range, repeated traverses, and a mission lifetime of several months needed to effectively carry out the science. This paper examines concepts for altitude-controlled balloons not previously flown on planetary missions that could potentially provide the desired measurements. The concepts take advantage of the fact that at 60 km altitude, for example, the atmospheric density on Venus is about 40% of the sea-level density on earth and the temperature is a moderate 230 K. The solar flux is approximately double that on earth, creating some thermal challenges, but making photovoltaic power highly effective. Using a steady-state thermodynamic model and flight data from Earth, we evaluate the suitability of two types of altitude-controlled balloons for a potential mission on Venus. Such balloons could repeatedly measure profiles, avoid diurnal temperature extremes, and navigate using wind shear. The first balloon design uses air ballast (AB) whereby ambient air can be compressed into or released from a constant-volume balloon, causing it to descend or ascend accordingly. The second design uses lift-gas compression (LGC) to change the volume of a zero-pressure balloon, thereby changing its effective density and altitude. For an altitude range of 60-75 km on Venus, we find that the superpressure volume for a LGC balloon is about 5% of that needed for an AB balloon while the maximum pressurization is the same for both systems. The compressor work per km descent of the LGC balloon

Adjunct Professorships

ERIC Educational Resources Information Center

Goldman, Jay P.

2011-01-01

Colleges of education have come to rely heavily on superintendents to teach graduate-level classes in educational administration. While no national organization tracks this phenomenon, anecdotal evidence points to widespread and perhaps growing involvement in the adjunct ranks. While the majority reported being assigned to teach semester-long…

Power supplies for long duration balloon flights

NASA Astrophysics Data System (ADS)

Lichfield, Ernest W.

Long duration balloon flights require more electrical power than can be carried in primary batteries. This paper provides design information for selecting rechargeable batteries and charging systems. Solar panels for recharging batteries are discussed, with particular emphasis on cells mounting suitable for balloon flights and panel orientation for maximum power collection. Since efficient utilization of power is so important, modern DC to DC power conversion techniques are presented. On short flights of 1 day or less, system designers have not been greatly concerned with battery weight. But, with the advent of long duration balloon flights using superpressure balloons, anchor balloon systems, and RACOON balloon techniques, power supplies and their weight become of prime importance. The criteria for evaluating power systems for long duration balloon flights is performance per unit weight. Instrumented balloon systems have flown 44 days. For these very long duration flights, batteries recharged from solar cells are the only solution. For intermediate flight duration, say less than 10 days, the system designer should seriously consider using primary cells. The National Center for Atmospheric Research is sponsored by the National Science Foundation. Any opinions, findings and conclusions or recommendations expressed in this publication are those of the authors and do not necessarily reflect the views of the National Science Foundation.

Gondola development for CNES stratospheric balloons

NASA Astrophysics Data System (ADS)

Vargas, A.; Audoubert, J.; Cau, M.; Evrard, J.; Verdier, N.

The CNES has been supporting scientific ballooning since its establishment in 1962. The two main parts of the balloon system or aerostat are the balloon itself and the flight train, comprising the house-keeping gondola, for the control of balloon flight (localization and operational telemetry & telecommand - TM/TC), and the scientific gondola with its dedicated telecommunication system. For zero pressure balloon, the development of new TM/TC system for the housekeeping and science data transmission are going on from 1999. The main concepts are : - for balloon house-keeping and low rate scientific telemetry, the ELITE system, which is based on single I2C bus standardizing communication between the different components of the system : trajectography, balloon control, power supply, scientific TM/TC, .... In this concept, Radio Frequency links are developed between the house keeping gondola and the components of the aerostat (balloon valve, ballast machine, balloon gas temperature measurements, ...). The main objectives are to simplify the flight train preparation in term of gondola testing before flight, and also by reducing the number of long electrical cables integrated in the balloon and the flight train; - for high rate scientific telemetry, the use of functional interconnection Internet Protocol (IP) in interface with the Radio Frequency link. The main idea is to use off-the-shelf IP hardware products (routers, industrial PC, ...) and IP software (Telnet, FTP, Web-HTTP, ...) to reduce the development costs; - for safety increase, the adding, in the flight train, of a totally independent house keeping gondola based on the satellite Inmarsat M and Iridium telecommunication systems, which permits to get real time communications between the on-board data mobile and the ground station, reduced to a PC computer with modem connected to the phone network. These GEO and LEO telecommunication systems give also the capability to operate balloon flights over longer distance

Desire for Professional Development among Adjunct Business Faculty

ERIC Educational Resources Information Center

Backhaus, Kristin

2009-01-01

This study provides a foundation for further work about motivation for training and the world of contingent employment in higher education and beyond for adjunct faculty. This sample of adjunct business faculty shows there is much to be learned about why adjunct faculty choose to work in higher education and how they view their own professional…

The uncertain role of thrombolytic angioplasty within the treatment strategy for myocardial infarction.

PubMed

Ross, A M

1988-12-06

The logical hypothesis that early angioplasty after lytic therapy would be of considerable clinical value flows from the recognized shortcomings of pharmacologic reperfusion efforts. These shortcomings are: (1) failure to lyse some thrombotic occlusions; (2) limited quantifiable salvage relative to risk area, possibly related to low magnitude or reperfusion coronary flow through a tight residual stenosis; (3) frequent early postlytic reocclusion and reinfarction; and (4) common postinfarction angina after lysis and some degree of salvage. Recently however, important controlled clinical trials of percutaneous transluminal coronary angioplasty (PTCA) after lytic therapy (most notably Thrombolysis and Angioplasty in Myocardial Infarction study group, Thrombolysis in Myocardial Infarction trial and the European Cooperative trial) have not confirmed this hypothesis. Very early PTCA after intravenous lytic therapy has not produced a favorable short-term outcome compared with delayed PTCA or a more conservative approach. Where is the flaw? Is it the hypothesis, the patient selection criteria or the specifics of therapeutic algorithms? While these issues are further investigated, current prudent clinical recommendations are best modified downward from enthusiastic rapid postlytic dilatation.

Endovascular balloon-assisted embolization of intracranial and cervical arteriovenous malformations using dual-lumen coaxial balloon microcatheters and Onyx: initial experience.

PubMed

Jagadeesan, Bharathi D; Grigoryan, Mikayel; Hassan, Ameer E; Grande, Andrew W; Tummala, Ramachandra P

2013-12-01

Ethylene vinyl alcohol copolymer (Onyx) is widely used for the embolization of arteriovenous malformations (AVMs) of the brain, head, and neck. Balloon-assisted Onyx embolization may provide additional unique advantages in the treatment of AVMs in comparison with traditional catheter-based techniques. To report our initial experience in performing balloon-assisted AVM embolization for brain and neck AVMs with the use of the new Scepter-C and Scepter-XC coaxial dual-lumen balloon microcatheters. Balloon-assisted transarterial embolization was performed in a series of 7 patients with AVMs (4 with brain AVMs, 1 with a dural arteriovenous fistula, and 2 with neck AVMs) by using Onyx delivered through the lumen of Scepter-C or Scepter XC coaxial balloon microcatheters. Following the initial balloon-catheter navigation into a feeding artery and the subsequent inflation of the balloon, the embolization was performed by using Onyx 18, Onyx 34, or both. A total of 12 embolization sessions were performed via 17 arterial feeders in these 7 patients. In 1 patient, there was an arterial perforation from the inflation of the balloon; in all others, the embolization goals were successfully achieved with no adverse events. The balloon microcatheters showed excellent navigability, and there were no problems with retrieval or with the repeated inflation and deflation of the balloons. A proximal Onyx plug, which is crucial in many AVM embolizations, was not necessary with this technique. Additionally, fluoroscopy and procedural times seemed lower with this technique compared with conventional embolization methods.

Are drug-coated balloons cost effective for femoropopliteal occlusive disease? A comparison of bare metal stents and uncoated balloons.

PubMed

Poder, Thomas G; Fisette, Jean-François

2016-07-01

To perform a cost-effectiveness analysis to help hospital decision-makers with regard to the use of drug-coated balloons compared with bare metal stents and uncoated balloons for femoropopliteal occlusive disease. Clinical outcomes were extracted from the results of meta-analyses already published, and cost units are those used in the Quebec healthcare network. The literature review was limited to the last four years to obtain the most recent data. The cost-effectiveness analysis was based on a 2-year perspective, and risk factors of reintervention were considered. The cost-effectiveness analysis indicated that drug-coated balloons were generally more efficient than bare metal stents, particularly for patients with higher risk of reintervention (up to CAD$1686 per patient TASC II C or D). Compared with uncoated balloons, results indicated that drug-coated balloons were more efficient if the reintervention rate associated with uncoated balloons is very high and for patients with higher risk of reintervention (up to CAD$3301 per patient). The higher a patient's risk of reintervention, the higher the savings associated with the use of a drug-coated balloon will be. For patients at lower risk, the uncoated balloon strategy is still recommended as a first choice for endovascular intervention.

Management of obstructed balloon catheters.

PubMed Central

Browning, G G; Barr, L; Horsburgh, A G

1984-01-01

Failure of a balloon catheter to deflate is not uncommon and prevents its removal. Methods of overcoming the problem include traction, bursting the balloon by overinflation, dissolving it with solvents, puncturing it percutaneously with a needle, or puncturing it with a wire stylet passed through the catheter. All except the last technique have major disadvantages and are of questionable safety. Transcatheter puncture of the balloon was used in 16 patients to remove obstructed balloon catheters without any technical difficulty, distress to the patient, or complication. The procedure is safe, simple, and does not require an anaesthetic. If necessary it could be performed safely by nursing or paramedical staff without the patient having to be admitted to hospital. It is the method of choice for the management of this problem. Images FIG 1 FIG 2 FIG 3 FIG 4 PMID:6428691

Adjuncts to colonic cleansing before colonoscopy

PubMed Central

Park, Sanghoon; Lim, Yun Jeong

2014-01-01

Pre-procedural cleansing of the bowel can maximize the effectiveness and efficiency of colonoscopy. Yet, efficacy of the current gold standard colonic preparation method - high-volume oral administration of purgative agents 12-24 h prior to the procedure - is limited by several factors, such as patient compliance (due to poor palatability and inconvenience of the dosing regimen) and risks of complications (due to drug interactions or intolerance). Attempts to resolve these limitations have included providing adjunctive agents and methods to promote the colonic cleansing ability of the principal purgative agent, with the aim of lessening unpleasant side effects (such as bloating) and reducing the large ingested volume requirement. Several promising adjunctive agents are bisacodyl, magnesium citrate, senna, simethicone, metoclopramide, and prokinetics, and each are being investigated for their potential. This review provides an up to date summary of the reported investigations into the potencies and weaknesses of the key adjuncts currently being applied in clinic as supplements to the traditional bowel preparation agents. While the comparative analysis of these adjuncts showed that no single agent or method has yet achieved the goal of completely overcoming the limitations of the current gold standard preparation method, they at least provide endoscopists with an array of alternatives to help improve the suboptimal efficacy of the main cleansing solutions when used alone. To aid in this clinical endeavor, a subjective grade was assigned to each adjunct to indicate its practical value. In addition, the systematic review of the currently available agents and methods provides insight into the features of each that may be overcome or exploited to create novel drugs and strategies that may become adopted as effective bowel cleansing adjuncts or alternatives. PMID:24659864

Balloon Ascent: 3-D Simulation Tool for the Ascent and Float of High-Altitude Balloons

NASA Technical Reports Server (NTRS)

Farley, Rodger E.

2005-01-01

The BalloonAscent balloon flight simulation code represents a from-scratch development using Visual Basic 5 as the software platform. The simulation code is a transient analysis of balloon flight, predicting the skin and gas temperatures along with the 3-D position and velocity in a time and spatially varying environment. There are manual and automated controls for gas valving and the dropping of ballast. Also, there are many handy calculators, such as appropriate free lift, and steady-state thermal solutions with temperature gradients. The strength of this simulation model over others in the past is that the infrared environment is deterministic rather than guessed at. The ground temperature is specified along with the emissivity, which creates a ground level IR environment that is then partially absorbed as it travels upward through the atmosphere to the altitude of the balloon.

Meeting the Challenge to Balloon Science

NASA Astrophysics Data System (ADS)

Jones, W. Vernon

The promise of superpressure ballooning is helping the balloon program evolve toward a cost-effective means for frequent access to near-space. Superpressure balloons fabricated from strong, light-weight composite materials have the potential for increasing flight times of ton-class payloads to 100 days or more at altitudes above 5 mbars at essentially any geographic latitude. Although this new capability is still in an embryonic stage, its potential has already had an impact. Specifically, a new NASA Office of Space Science policy for University-class Explorer missions allows balloon investigations to compete on an equal basis with other low-cost missions requiring expendable launch vehicles. The new challenge for the science community is to design winning payloads that can be built within the cost cap of $13 M, including launch costs, and be developed within two to three years from selection to launch. Defining the international trajectories and getting the overflight agreements for balloon flights that make several circumnavigations of Earth will also be a challenge

The French balloon and sounding rocket space program

NASA Astrophysics Data System (ADS)

Coutin/Faye, S.; Sadourny, I.

1987-08-01

Stratospheric and long duration flight balloon programs are outlined. Open stratospheric balloons up to 1 million cu m volume are used to carry astronomy, solar system, aeronomy, stratosphere, biology, space physics, and geophysics experiments. The long duration balloons can carry 50 kg payloads at 20 to 30 km altitude for 10 days to several weeks. Pressurized stratospheric balloons, and infrared hot air balloons are used. They are used to study the dynamics of stratospheric waves and atmospheric water vapor. Laboratories participating in sounding rocket programs are listed.

TMBM: Tethered Micro-Balloons on Mars

NASA Technical Reports Server (NTRS)

Sims, M. H.; Greeley, R.; Cutts, J. A.; Yavrouian, A. H.; Murbach, M.

2000-01-01

The use of balloons/aerobots on Mars has been under consideration for many years. Concepts include deployment during entry into the atmosphere from a carrier spacecraft, deployment from a lander, use of super-pressurized systems for long duration flights, 'hot-air' systems, etc. Principal advantages include the ability to obtain high-resolution data of the surface because balloons provide a low-altitude platform which moves relatively slowly. Work conducted within the last few years has removed many of the technical difficulties encountered in deployment and operation of balloons/aerobots on Mars. The concept proposed here (a tethered balloon released from a lander) uses a relatively simple approach which would enable aspects of Martian balloons to be tested while providing useful and potentially unique science results. Tethered Micro-Balloons on Mars (TMBM) would be carried to Mars on board a future lander as a stand-alone experiment having a total mass of one to two kilograms. It would consist of a helium balloon of up to 50 cubic meters that is inflated after landing and initially tethered to the lander. Its primary instrumentation would be a camera that would be carried to an altitude of up to tens of meters above the surface. Imaging data would be transmitted to the lander for inclusion in the mission data stream. The tether would be released in stages allowing different resolutions and coverage. In addition during this staged release a lander camera system may observe the motion of the balloon at various heights above he lander. Under some scenarios upon completion of the primary phase of TMBM operations, the tether would be cut, allowing TMBM to drift away from the landing site, during which images would be taken along the ground.

Advances in Scientific Balloon Thermal Modeling

NASA Technical Reports Server (NTRS)

Bohaboj, T.; Cathey, H. M., Jr.

2004-01-01

The National Aeronautics and Space Administration's Balloon Program office has long acknowledged that the accurate modeling of balloon performance and flight prediction is dependant on how well the balloon is thermally modeled. This ongoing effort is focused on developing accurate balloon thermal models that can be used to quickly predict balloon temperatures and balloon performance. The ability to model parametric changes is also a driver for this effort. This paper will present the most recent advances made in this area. This research effort continues to utilize the "Thrmal Desktop" addition to AUTO CAD for the modeling. Recent advances have been made by using this analytical tool. A number of analyses have been completed to test the applicability of this tool to the problem with very positive results. Progressively detailed models have been developed to explore the capabilities of the tool as well as to provide guidance in model formulation. A number of parametric studies have been completed. These studies have varied the shape of the structure, material properties, environmental inputs, and model geometry. These studies have concentrated on spherical "proxy models" for the initial development stages and then to transition to the natural shaped zero pressure and super pressure balloons. An assessment of required model resolution has also been determined. Model solutions have been cross checked with known solutions via hand calculations. The comparison of these cases will also be presented. One goal is to develop analysis guidelines and an approach for modeling balloons for both simple first order estimates and detailed full models. This papa presents the step by step advances made as part of this effort, capabilities, limitations, and the lessons learned. Also presented are the plans for further thermal modeling work.

Thermal performance modeling of NASA s scientific balloons

NASA Astrophysics Data System (ADS)

Franco, H.; Cathey, H.

The flight performance of a scientific balloon is highly dependant on the interaction between the balloon and its environment. The balloon is a thermal vehicle. Modeling a scientific balloon's thermal performance has proven to be a difficult analytical task. Most previous thermal models have attempted these analyses by using either a bulk thermal model approach, or by simplified representations of the balloon. These approaches to date have provided reasonable, but not very accurate results. Improvements have been made in recent years using thermal analysis tools developed for the thermal modeling of spacecraft and other sophisticated heat transfer problems. These tools, which now allow for accurate modeling of highly transmissive materials, have been applied to the thermal analysis of NASA's scientific balloons. A research effort has been started that utilizes the "Thermal Desktop" addition to AUTO CAD. This paper will discuss the development of thermal models for both conventional and Ultra Long Duration super-pressure balloons. This research effort has focused on incremental analysis stages of development to assess the accuracy of the tool and the required model resolution to produce usable data. The first stage balloon thermal analyses started with simple spherical balloon models with a limited number of nodes, and expanded the number of nodes to determine required model resolution. These models were then modified to include additional details such as load tapes. The second stage analyses looked at natural shaped Zero Pressure balloons. Load tapes were then added to these shapes, again with the goal of determining the required modeling accuracy by varying the number of gores. The third stage, following the same steps as the Zero Pressure balloon efforts, was directed at modeling super-pressure pumpkin shaped balloons. The results were then used to develop analysis guidelines and an approach for modeling balloons for both simple first order estimates and detailed

Development of a super-pressure balloon with a diamond-shaped net --- result of a ground inflation test of a 2,000 cubic-meter balloon ---

NASA Astrophysics Data System (ADS)

Saito, Yoshitaka; Nakashino, Kyoichi; Akita, Daisuke; Matsushima, Kiyoho; Shimadu, Shigeyuki; Goto, Ken; Hashimoto, Hiroyuki; Matsuo, Takuma

2016-07-01

A light super-pressure balloon has been developed using a method to cover a balloon with a diamond-shaped net of high-tensile fibers. The goal is to fly a payload of 900 kg to the altitude of 37 km with a 300,000 m^{3} balloon. Beginning from a demonstration test of the net-balloon with a 10 m^{3} balloon in 2010, we have been polished the net-balloon through ground inflation tests and flight tests, including a flight test of a 3,000 m ^{3} balloon in the tandem balloon configuration with a 15,000 m^{3} zero-pressure balloon in 2012, and a flight test of a 10 m^{3} balloon in the tandem balloon configuration with a 2 kg rubber balloon in 2013, as reported in the last COSPAR. In 2014, we developed a 5,000 m^{3} balloon and performed a ground inflation test to find that the balloon burst from a lip panel for termination with a differential pressure of 425 Pa. It was due to a stress concentration at the edge of a thick tape attached along the termination mechanism. In 2015, we modified the balloon by adding tapes on the lip panel to avoid the stress concentration, and also shorten the net length to leave some margin of the film and performed a ground inflation test again to find the balloon showed asymmetrical deployment and burst from the edge of the net with a differential pressure of 348 Pa. We consider it is due to the margin of the film along the circumferential direction, and proposed a gore shape which circumference length is kept as determined by the pumpkin shape of the balloon but setting meridian length longer than that. We developed a 10 m^{3} balloon with the gore design to find that the balloon deployed symmetrically and showed the burst pressure of 10,000 Pa. In 2016, we are going to develop a 2,000 m^{3} balloon with the gore design and perform its ground inflation test. In this paper, we are going to report its result with the sequence of the development.

Immediate Outcome of Balloon Mitral Valvuloplasty with JOMIVA Balloon during Pregnancy

PubMed Central

Ramasamy, Ramona; Kaliappan, Tamilarasu; Gopalan, Rajendiran; Palanimuthu, Ramasmy; Anandhan, Premkrishna

2017-01-01

Introduction Rheumatic mitral stenosis is the most common Valvular Heart Disease encountered during pregnancy. Balloon Mitral Valvuloplasty (BMV) is one of the treatment option available if the symptoms are refractory to the medical management and the valve anatomy is suitable for balloon dilatation. BMV with Inoue balloon is the most common technique being followed worldwide. Over the wire BMV is a modified technique using Joseph Mitral Valvuloplasty (JOMIVA) balloon catheter which is being followed in certain centres. Aim To assess the immediate post procedure outcome of over the wire BMV with JOMIVA balloon. Materials and Methods Clinical and echocardiographic parameters of pregnant women with significant mitral stenosis who underwent elective BMV with JOMIVA balloon in our institute from 2005 to 2015 were analysed retrospectively. Severity of breathlessness (New York Heart Association Functional Class), and duration of pregnancy was included in the analysis. Pre procedural echocardiographic parameters which included severity of mitral stenosis and Wilkin’s scoring were analysed. Clinical, haemodynamic and echocardiographic outcomes immediately after the procedure were analysed. Results Among the patients who underwent BMV in our Institute 38 were pregnant women. Twenty four patients (63%) were in New York Heart Association (NYHA) Class III. All of them were in sinus rhythm except two (5%) who had atrial fibrillation. Thirty four patients (89.5%) were in second trimester of pregnancy at the time of presentation and four (10.5%) were in third trimester. Echocardiographic analysis of the mitral valve showed that the mean Wilkin’s score was 7.3. Mean mitral valve area pre procedure was 0.8 cm2. Mean gradient across the valve was 18 mmHg. Ten patients (26.5%) had mild mitral regurgitation and none had more than mild mitral regurgitation. Thirty six patients had pulmonary hypertension as assessed by tricuspid regurgitation jet velocity. All of them underwent BMV

A Methane Balloon Inflation Chamber

ERIC Educational Resources Information Center

Czerwinski, Curtis J.; Cordes, Tanya J.; Franek, Joe

2005-01-01

The various equipments, procedure and hazards in constructing the device for inflating a methane balloon using a standard methane outlet in a laboratory are described. This device is fast, safe, inexpensive, and easy to use as compared to a hydrogen gas cylinder for inflating balloons.

Endovascular Therapy of the Superficial Femoral Artery Via a Stand-Alone Transradial Access: A Single-Center Experience.

PubMed

Hanna, Elias B; Ababneh, Bashar A; Amin, Amit N

2018-02-01

We describe our experience in transradial recanalization of the superficial femoral artery (SFA), and we provide a stepwise approach accounting for the patient's height and optimizing the yield of currently available devices. Fifteen patients with simple SFA disease, including 4 patients with total SFA occlusions <15 cm, were selected for stand-alone transradial recanalization. A 6F, 125-cm multipurpose guiding catheter was used to cannulate the limb of interest and support device delivery. The procedure was successful in all patients and consisted of balloon angioplasty (using 0.014″, 200-cm shaft monorail balloons) in all patients, and orbital atherectomy in 6 patients. We illustrate the steps and challenges of the transradial approach, namely the limited support in complex disease and the limited reach of current equipment. In patients with simple SFA disease, transradial recanalization appears feasible and safe but currently limited to balloon angioplasty ± orbital atherectomy. Proximal SFA stenting may be feasible in patients <160 cm in height.

Study design and rationale of the 'Balloon-Expandable Cobalt Chromium SCUBA Stent versus Self-Expandable COMPLETE-SE Nitinol Stent for the Atherosclerotic ILIAC Arterial Disease (SENS-ILIAC Trial) Trial': study protocol for a randomized controlled trial.

PubMed

Choi, Woong Gil; Rha, Seung Woon; Choi, Cheol Ung; Kim, Eung Ju; Oh, Dong Joo; Cho, Yoon Hyung; Park, Sang Ho; Lee, Seung Jin; Hur, Ae Yong; Ko, Young Guk; Park, Sang Min; Kim, Ki Chang; Kim, Joo Han; Kim, Min Woong; Kim, Sang Min; Bae, Jang Ho; Bong, Jung Min; Kang, Won Yu; Seo, Jae Bin; Jung, Woo Yong; Cho, Jang Hyun; Kim, Do Hoi; Ahn, Ji Hoon; Kim, Soo Hyun; Jang, Ji Yong

2016-06-25

The self-expandable COMPLETE™ stent (Medtronic) has greater elasticity, allowing it to regain its shape after the compression force reduces, and has higher trackability, thus is easier to maneuver through tortuous vessels, whereas the balloon-expandable SCUBA™ stent (Medtronic) has higher radial stiffness and can afford more accurate placement without geographic miss, which is important in aortoiliac bifurcation lesions. To date, there have been no randomized control trials comparing efficacy and safety between the self-expanding stent and balloon-expandable stent in advanced atherosclerotic iliac artery disease. The purpose of our study is to examine primary patency (efficacy) and incidence of stent fracture and geographic miss (safety) between two different major representative stents, the self-expanding nitinol stent (COMPLETE-SE™) and the balloon-expanding cobalt-chromium stent (SCUBA™), in stenotic or occlusive iliac arterial lesions. This trial is designed as a prospective, randomized, multicenter trial to demonstrate a noninferiority of SCUBA™ stent to COMPLETE-SE™ stent following balloon angioplasty in iliac arterial lesions, and a total of 280 patients will be enrolled. The primary end point of this study is the rate of primary patency in the treated segment at 12 months after intervention as determined by catheter angiography, computed tomography angiography, or duplex ultrasound. The SENS-ILIAC trial will give powerful insight into whether the stent choice according to deployment mechanics would impact stent patency, geographic miss, or stent fracture in patients undergoing stent implantation in iliac artery lesions. National Institutes of Health Clinical Trials Registry (ClinicalTrials.gov identifier: NCT01834495 ), registration date: May 8, 2012.

All Adjuncts Are Not Created Equal: An Exploratory Study of Teaching and Professional Needs of Online Adjuncts

ERIC Educational Resources Information Center

Bedford, Laurie; Miller, Heather

2013-01-01

Online education programs continue to rely on a significant contingent of adjunct faculty to meet the instructional needs of the students. Discourse relating to this situation primarily focuses on the extent to which adjuncts are able to ensure the rigor and quality of instruction as well as the ability of the organization to attract, retain, and…

Balloon pulmonary valvotomy--not just a simple balloon dilatation.

PubMed

Mohanty, Subhendu; Pandit, Bhagya Narayan; Tyagi, Sanjay

2014-01-01

Balloon pulmonary valvotomy is the preferred mode of treatment in patients with isolated pulmonary valvar stenosis and has shown good long term results. It is generally considered a safe procedure with few complications. There have been however, case reports of potentially fatal acute severe pulmonary edema occurring after the procedure in some patients. The cause of this complication and its pathophysiology is still not clear. Its occurrence is also infrequent with less than 5 cases reported till now. We report a case of pulmonary valvar stenosis which developed acute severe refractory pulmonary edema immediately after balloon pulmonary valvotomy. Copyright © 2014 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.

14 CFR 61.115 - Balloon rating: Limitations.

Code of Federal Regulations, 2010 CFR

2010-01-01

... takes a practical test in a balloon with an airborne heater: (1) The pilot certificate will contain a limitation restricting the exercise of the privileges of that certificate to a balloon with an airborne... removed when the person obtains the required aeronautical experience in a balloon with an airborne heater...

Gradient magnetometer system balloons

NASA Astrophysics Data System (ADS)

Korepanov, Valery; Tsvetkov, Yury

2005-08-01

Earth's magnetic field study still remains one of the leading edges of experimental geophysics. Thus study is executed on the Earth surface, including ocean bottom, and on satellite heights using component, mostly flux-gate magnetometers. But balloon experiments with component magnetometers are very seldom, first of all because of great complexity of data interpretation. This niche still waits for new experimental ideology, which will allow to get the measurements results with high accuracy, especially in gradient mode. The great importance of precise balloon-borne component magnetic field gradient study is obvious. Its technical realization is based both on the available at the marked high-precision non-magnetic tiltmeters and on recent achievements of flux-gate magnetometry. The scientific goals of balloon-borne magnetic gradiometric experiment are discussed and its practical realization is proposed.

NASA Langley Research Center tethered balloon systems

NASA Technical Reports Server (NTRS)

Owens, Thomas L.; Storey, Richard W.; Youngbluth, Otto

1987-01-01

The NASA Langley Research Center tethered balloon system operations are covered in this report for the period of 1979 through 1983. Meteorological data, ozone concentrations, and other data were obtained from in situ measurements. The large tethered balloon had a lifting capability of 30 kilograms to 2500 meters. The report includes descriptions of the various components of the balloon systems such as the balloons, the sensors, the electronics, and the hardware. Several photographs of the system are included as well as a list of projects including the types of data gathered.

Heat Transfer Model for Hot Air Balloons

NASA Astrophysics Data System (ADS)

Llado-Gambin, Adriana

A heat transfer model and analysis for hot air balloons is presented in this work, backed with a flow simulation using SolidWorks. The objective is to understand the major heat losses in the balloon and to identify the parameters that affect most its flight performance. Results show that more than 70% of the heat losses are due to the emitted radiation from the balloon envelope and that convection losses represent around 20% of the total. A simulated heating source is also included in the modeling based on typical thermal input from a balloon propane burner. The burner duty cycle to keep a constant altitude can vary from 10% to 28% depending on the atmospheric conditions, and the ambient temperature is the parameter that most affects the total thermal input needed. The simulation and analysis also predict that the gas temperature inside the balloon decreases at a rate of -0.25 K/s when there is no burner activity, and it increases at a rate of +1 K/s when the balloon pilot operates the burner. The results were compared to actual flight data and they show very good agreement indicating that the major physical processes responsible for balloon performance aloft are accurately captured in the simulation.

Balloon Borne Ultraviolet Spectrometer.

DTIC Science & Technology

1978-12-28

n.c.aaary ond lden lfy by block numb.r) ultraviolet ground support equipment (GSE) spectrometers flight electronics instrumentation balloons \\ solar ...Assembly 4 Fig. 3 Solar Balloon Experiment Ass ’y 7 Fig. 4 Mechanical Interface , UV Spectrometer 8 Fig . 5 Spectrometer Body Assemb ly 10 Fig. 6...Diagram, GSE )bnitor 48 Selector and Battery Charger Fig. 25 Schematic Diagram, GSE Serial to 49 Parallel Data Converter Fig. 26 Schematic Diagram

Determination of balloon drag

NASA Technical Reports Server (NTRS)

Conrad, George R.; Robbins, Edward J.

1991-01-01

The evolution of an empirical drag relationship that has stimulated rethinking regarding the physics of balloon drag phenomena is discussed. Combined parasitic drag from all sources in the balloon system are estimated to constitute less than 10 percent of the total system drag. It is shown that the difference between flight-determined drag coefficients and those based on the spherical assumption should be related to the square of the Froude number.

Yellow Balloon in a Briar Patch.

ERIC Educational Resources Information Center

Cooper, Frank; Fitzmaurice, Robert W.

1978-01-01

As part of a meteorology unit, sixth grade science students launched helium balloons with attached return postcards. This article describes Weather Service monitoring of the balloons and postcard return results. (MA)

21 CFR 874.4100 - Epistaxis balloon.

Code of Federal Regulations, 2010 CFR

2010-04-01

.... An epistaxis balloon is a device consisting of an inflatable balloon intended to control internal... (general controls). The device is exempt from the premarket notification procedures in subpart E of part...

Auditory Risk of Exploding Hydrogen-Oxygen Balloons

ERIC Educational Resources Information Center

Gee, Kent L.; Vernon, Julia A.; Macedone, Jeffrey H.

2010-01-01

Although hydrogen-oxygen balloon explosions are popular demonstrations, the acoustic impulse created poses a hearing damage risk if the peak level exceeds 140 dB at the listener's ear. The results of acoustical measurements of hydrogen-oxygen balloons of varying volume and oxygen content are described. It is shown that hydrogen balloons may be…

Balloon cell nevus of the iris.

PubMed

Morcos, Mohib W; Odashiro, Alexandre; Bazin, Richard; Pereira, Patricia Rusa; O'Meara, Aisling; Burnier, Miguel N

2014-12-01

Balloon cell nevus is a rare histopathological lesion characterized by a predominance of large, vesicular and clear cells, called balloon cells. There is only 1 case of balloon cell nevus of the iris reported in the literature. A 55 year-old man presented a pigmented elevated lesion in the right iris since the age of 12 years old. The lesion had been growing for the past 2 years and excision was performed. Histopathological examination showed a balloon cell nevus composed of clear and vacuolated cells without atypia. A typical spindle cell nevus of the iris was also observed. The differential diagnosis included xanthomatous lesions, brown adipocyte or other adipocytic lesions, clear cell hidradenoma, metastatic clear cell carcinoma of the kidney and clear cell sarcoma. The tumor was positive for Melan A, S100 protein and HMB45. Balloon cell nevus of the iris is rare but should be considered in the differential diagnosis of melanocytic lesions of the iris. Copyright © 2014 Elsevier GmbH. All rights reserved.

Transport for abciximab facilitated primary angioplasty versus on-site thrombolysis with a liberal rescue policy: the randomised Holland Infarction Study (HIS).

PubMed

Dieker, Hendrik-Jan; van Horssen, Elvira V; Hersbach, Ferry M R J; Brouwer, Marc A; van Boven, Ad J; van 't Hof, Arnoud W J; Aengevaeren, Wim R M; Verheugt, Freek W A; Bär, Frits W H M

2006-08-01

As of to date, the only large transportation trial comparing on-site fibrin-specific thrombolysis with transfer for primary angioplasty in patients presenting in a referral centre is the DANAMI-2 trial, with only 3% rescue angioplasty. The Holland Infarction Study (HIS) compared abciximab facilitated primary angioplasty (FP) with on-site fibrin-specific thrombolytic therapy (TT) with a liberal protocol-driven rescue angioplasty (transport to intervention centre in case < 50% ST resolution at 60 min). Patients in a referral centre without shock and < 4.5 h of chest pain presenting with ST-elevation having > or = 12 mm ST-segment shift were randomised to either strategy. Of the originally planned 900 patients only 48 were included due to suspension of financial funding. Death, recurrent MI and stroke at one year was 8% for the FP-group and 22% for the TT-group (p = 0.2). Two hours after randomisation the rates of complete ST-segment resolution (> or =70%) were 52% and 35%, respectively (p = 0.2). This prematurely discontinued randomised transportation trial shows favorable trends with respect to long-term clinical outcome and early ST-resolution for abciximab facilitated primary angioplasty. In view of the real world delays associated with interhospital transport for primary angioplasty, treatment strategies focusing on early fibrin-specific lysis with a liberal selective rescue policy are warranted.

Debulking Atherectomy in the Peripheral Arteries: Is There a Role and What is the Evidence?

PubMed

Katsanos, Konstantinos; Spiliopoulos, Stavros; Reppas, Lazaros; Karnabatidis, Dimitris

2017-07-01

Traditional percutaneous balloon angioplasty and stent placement is based on mechanical plaque disruption and displacement within the arterial wall. On the contrary, transcatheter atherectomy achieves atherosclerotic plaque clearance by means of directional plaque excision or rotational plaque removal or laser plaque ablation. Debulking atherectomy may allow for a more uniform angioplasty result at lower pressures with consequently less vessel barotrauma and improved luminal gain, thereby decreasing the risk of plaque recoil and dissection that may require permanent metal stenting. It has been also argued that atherectomy may disrupt the calcium barrier and optimize drug transfer and delivery in case of drug-coated balloon applications. The authors discuss the various types of atherectomy devices available in clinical practice to date and critically appraise their mode of action as well as relevant published data in each case. Overall, amassed randomized and observational evidence indicates that percutaneous atherectomy of the femoropopliteal and infrapopliteal arteries may achieve high technical success rates and seems to lessen the frequency of bailout stenting, however, at the expense of increased risk of peri-procedural distal embolization. Long-term clinical outcomes reported to date do not support the superiority of percutaneous atherectomy over traditional balloon angioplasty and stent placement in terms of vessel patency or limb salvage. The combination of debulking atherectomy and drug-coated balloons has shown promise in early studies, especially in the treatment of more complex lesions. Unanswered questions and future perspectives of this continuously evolving endovascular technology as part of a broader treatment algorithm are discussed.

A critical view of the peripheral atherectomy data in the treatment of infrainguinal arterial disease.

PubMed

Quevedo, Henry C; Arain, Salman A; Ali, Gholam; Abi Rafeh, Nidal

2014-01-01

Revascularization of the peripheral arteries remains technically challenging. By decreasing the volume of the atherosclerotic plaque, debulking procedures may confer superior primary patency after revascularization. To assess the impact of atherectomy on primary patency rates at 12 months compared to balloon angioplasty and/or stent placement alone in patients with infrainguinal arterial disease. A database search for "directional," "orbital," "rotational," and "laser atherectomy" in peripheral arterial disease (PAD) was performed. Studies were screened according to the STROBE (Strengthening the Reporting of Observational studies in Epidemiology) critical appraisal tool and summarized by population, methodology, and outcomes (primary patency and major adverse events). Only two randomized studies were found. Most of the data were obtained from single-arm studies and registries. The primary patency with directional atherectomy approaches 60% at 12 months as a stand-alone technique, whereas orbital atherectomy in conjunction with balloon angioplasty and stenting achieved primary patency rates of 90%. Laser atherectomy is universally employed with balloon angioplasty and stenting for in-stent restenosis lesions with a primary patency rate of 64%. Although there are data for the safe use of rotational atherectomy, robust data to support its effectiveness are lacking. The combination of drug-coated balloons and atherectomy for the treatment of heavily calcified lesions in patients with critical limb ischemia is under evaluation. Despite the successful procedural outcomes reported in clinical registries, the available data do not support the use of atherectomy alone in PAD. Larger randomized controlled studies are warranted to define its role in contemporary endovascular practice.

Percutaneous endovascular therapy for symptomatic chronic total occlusion of the left subclavian artery.

PubMed

Akif Cakar, Mehmet; Tatli, Ersun; Tokatli, Alptug; Kilic, Harun; Gunduz, Huseyin; Akdemir, Ramazan

2018-03-16

Percutaneous endovascular therapy is an accepted and preferred procedure for symptomatic subclavian artery disease. However, the technical feasibility and effectiveness of treating chronic total occlusion of the subclavian artery with this approach is uncertain. We aimed to evaluate the initial and mid-term results of endovascular therapy for patients with symptomatic chronic total occlusion of the left subclavian artery. Consecutive patients who underwent balloon angioplasty and stenting for chronic total occlusion of the left subclavian artery between January 2010 and February 2014 were included. Overall, 16 patients (10 male, 6 female; mean age 56 ± 13 years) underwent balloon angioplasty and stenting for chronic total occlusion of the left subclavian artery - 6 (37.5%) had arm claudication, 8 (50.0%) had vertebrobasilar insufficiency and 2 (12.5%) had coronary steal. 18 balloon-expandable stents were implanted to 15 patients. The central luminal passage was not achieved in one patient because of the subintimal position of guidewire (procedural success rate 93.8%). There were no procedure-related complications. Mean preprocedural and postprocedural systolic blood pressure differences between the upper extremities were 37 ± 13 (range 25-60) mmHg and 11 ± 9 (range 5-38) mmHg, respectively; the improvement was statistically significant. Outpatient follow-up revealed one asymptomatic restenosis at two years. Patency rate at two years was 93.3%. Balloon angioplasty and stenting for chronic total occlusion of the left subclavian artery is safe and effective, with good acute success rate and mid-term patency. Prospective randomised studies on larger patient populations would provide more precise results.

Use of the radial approach in primary angioplasty: results in 1029 consecutive patients and analyses in unfavorable subgroups.

PubMed

Hernández-Pérez, Francisco J; Blasco-Lobo, Ana; Goicolea, Leire; Muñiz-Lozano, Ana; Fernandez-Díaz, José A; Domínguez, José R; Goicolea-Ruigómez, Javier

2014-01-01

The transradial approach is associated with a reduction in vascular access-related complications after primary percutaneous coronary interventions. The purpose of this study was to examine the feasibility of the routine use of transradial access in primary angioplasty and to evaluate how it affects subgroups with less favorable characteristics. We analyzed 1029 consecutive patients with an ST-segment elevation acute coronary syndrome treated with primary angioplasty. Transradial access was the primary approach in 93.1% of the patients. The success rate of primary angioplasty was 95.9%, and 87.6% of the patients were event-free 30 days after the procedure. Crossover was required in 3.0% of the patients with primary transradial access, and this rate remained stable over the years. Predictors of the need for crossover were age older than 75 years (odds ratio=2.50, 95% confidence interval, 1.09-5.71; P=.03) and a history of ischemic heart disease (odds ratio=2.65; 95% confidence interval, 1.12-6.24; P=.02). Primary transfemoral access use was higher in women older than 75 years. Use of the transradial approach in this subgroup did not affect reperfusion time or the success of angioplasty, although there was a greater need for crossover (10.9% vs 2.6%; P=.006). Among patients in cardiogenic shock, the transradial approach was used in 51.5%; reperfusion times and angioplasty success rates were similar to those obtained with transfemoral access, but there was a greater need for crossover. Transradial access can be used safely and effectively in most primary angioplasty procedures. In older women and in patients in cardiogenic shock, there is a higher crossover requirement, with no detriment to reperfusion time. Copyright © 2013 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.

When is carotid angioplasty and stenting the cost-effective alternative for revascularization of symptomatic carotid stenosis? A Canadian health system perspective.

PubMed

Almekhlafi, M A; Hill, M D; Wiebe, S; Goyal, M; Yavin, D; Wong, J H; Clement, F M

2014-02-01

Carotid revascularization procedures can be complicated by stroke. Additional disability adds to the already high costs of the procedure. To weigh the cost and benefit, we estimated the cost-utility of carotid angioplasty and stenting compared with carotid endarterectomy among patients with symptomatic carotid stenosis, with special emphasis on scenario analyses that would yield carotid angioplasty and stenting as the cost-effective alternative relative to carotid endarterectomy. A cost-utility analysis from the perspective of the health system payer was performed by using a Markov analytic model. Clinical estimates were based on a meta-analysis. The procedural costs were derived from a microcosting data base. The costs for hospitalization and rehabilitation of patients with stroke were based on a Canadian multicenter study. Utilities were based on a randomized controlled trial. In the base case analysis, carotid angioplasty and stenting were more expensive (incremental cost of $6107) and had a lower utility (-0.12 quality-adjusted life years) than carotid endarterectomy. The results are sensitive to changes in the risk of clinical events and the relative risk of death and stroke. Carotid angioplasty and stenting were more economically attractive among high-risk surgical patients. For carotid angioplasty and stenting to become the preferred option, their costs would need to fall from more than $7300 to $4350 or less and the risks of the periprocedural and annual minor strokes would have to be equivalent to that of carotid endarterectomy. In the base case analysis, carotid angioplasty and stenting were associated with higher costs and lower utility compared with carotid endarterectomy for patients with symptomatic carotid stenosis. Carotid angioplasty and stenting were cost-effective for patients with high surgical risk.

32 CFR 728.93 - Chart of adjuncts.

Code of Federal Regulations, 2010 CFR

2010-07-01

... National Defense Department of Defense (Continued) DEPARTMENT OF THE NAVY PERSONNEL MEDICAL AND DENTAL CARE FOR ELIGIBLE PERSONS AT NAVY MEDICAL DEPARTMENT FACILITIES Adjuncts to Medical Care § 728.93 Chart of... the several categories of beneficiaries eligible for medical care at naval MTFs. Adjuncts Active duty...

32 CFR 728.93 - Chart of adjuncts.

Code of Federal Regulations, 2011 CFR

2011-07-01

... National Defense Department of Defense (Continued) DEPARTMENT OF THE NAVY PERSONNEL MEDICAL AND DENTAL CARE FOR ELIGIBLE PERSONS AT NAVY MEDICAL DEPARTMENT FACILITIES Adjuncts to Medical Care § 728.93 Chart of... the several categories of beneficiaries eligible for medical care at naval MTFs. Adjuncts Active duty...

Adjuncts in Social Work Programs: Good Practice or Unethical?

ERIC Educational Resources Information Center

Pearlman, Catherine A.

2013-01-01

Social work education programs rely heavily on adjunct instructors, as do most academic institutions. This article adds to existing literature on adjuncts by focusing on the unique issues in social work education, using social work values and ethics as a focus. The benefits and detriments for adjuncts, programs, and students in schools of social…

The French Balloon Program 2013 - 2017

NASA Astrophysics Data System (ADS)

Dubourg, Vincent; Vargas, André; Raizonville, Philippe

2016-07-01

With over 50 years' experience in the field, the French Centre National d'Etudes Spatiales (CNES) goes on supporting - as designer and operator - a significant scientific ballooning program. In particular so because balloons still give a unique and valuable access to near space science. From 2008 to 2013, an important renovation effort was achieved, beginning by Zero Pressure Balloons (ZPB) systems, to comply with more stringent Safety constraints and to the growing reliability and performance requirements from scientific missions. The paper will give an overview of the CNES new capabilities and services for operational balloon activities, and their availability status. The scientific launch campaigns of the past two years will be presented. A focus will be made on the results of the Stratoscience 2015 flight campaign from Timmins, Ontario, using the NOSYCA command and control system for ZPB, qualified in flight in 2013. In particular, the PILOT telescope successfully flew during the 2015 campaign, key figures about the flight and mission will be given. An outlook of the new stratospheric long duration flight systems currently in process of developement at CNES will be given, as well as the presentation of the Stratéole 2 project, dedicated to the survey of the low stratosphere and upper troposphere in equatorial regions, with a fleet of small suprer pressure balloons (SPB). As far as tropospheric balloons are concerned, the Aeroclipper initiative will be presented, aiming at qualifying a quasi-tethered balloon, pushed by the winds close to the sea surface, for the study of cyclones. The scientific launch campaigns and the main payloads in the study for the near future will also be presented.

Vertical sounding balloons for stratospheric photochemistry

NASA Astrophysics Data System (ADS)

Pommereau, J. P.

The use of vertical sounding balloons for stratospheric photochemistry studies is illustrated by the use of a vertical piloted gas balloon for the search of NO2 diurnal variations. It is shown that the use of montgolfieres (hot air balloons) can enhance the vertical sounding technique. Particular attention is given to a sun-heated montgolfiere and to the more sophisticated infrared montgolfiere that is able to perform three to four vertical excursions per day and to remain aloft for weeks or months.

Balloon mania: news in the air.

PubMed

Kim, Mi Gyung

2004-12-01

The hot-air balloon, invented by the Montgolfier brothers in 1783, enabled the French King to project his glory, the nobility to exhibit their valor, the literary public to transmit the ideal of the Enlightenment and the plebian public to rejoice in a scientific spectacle. The ensuing balloon mania helped create an integrated public that, because of its size and composition, can only be described as 'democratic' just a few years before the French Revolution. The monumental impact of the balloon was well represented in a flood of poetry, pamphlets, books, journal reports, academic papers and consumer items. Sifting through these artifacts and considering the crowd that witnessed the ascent of the balloon will bring us to the historical moment when things, spectacles, and events (rather than words) shaped public and popular opinion.

Large eccentric laser angioplasty catheter

NASA Astrophysics Data System (ADS)

Taylor, Kevin D.; Reiser, Christopher

1997-05-01

In response to recent demand for increased debulking of large diameter coronary vascular segments, a large eccentric catheter for excimer laser coronary angioplasty has been developed. The outer tip diameter is 2.0 mm and incorporates approximately 300 fibers of 50 micron diameter in a monorail- type percutaneous catheter. The basic function of the device is to ablate a coronary atherosclerotic lesion with 308 nm excimer laser pulses, while passing the tip of the catheter through the lesion. By employing multiple passes through the lesion, rotating the catheter 90 degrees after each pass, we expect to create luminal diameters close to 3 mm with this device. Design characteristics, in-vitro testing, and initial clinical experience is presented.

Adjunct Faculty Job Satisfaction in California Community Colleges: A Narrative Inquiry

ERIC Educational Resources Information Center

Nagle, Tonya

2016-01-01

The problem addressed in the qualitative narrative inquiry is the perceived level of adjunct faculty job satisfaction. The general problem is the inconclusive and contradictory information on job satisfaction for adjuncts nationwide. The specific problem is poor job satisfaction for adjunct faculty in California where adjuncts are 48% of the…

Application of Electrocautery Needle Knife Combined with Balloon Dilatation versus Balloon Dilatation in the Treatment of Tracheal Fibrotic Scar Stenosis.

PubMed

Bo, Liyan; Li, Congcong; Chen, Min; Mu, Deguang; Jin, Faguang

Electrocautery needle knives can largely reduce scar and granulation tissue hyperplasia and play an important role in treating patients with benign stricture. The aim of this retrospective study was to evaluate the efficacy and safety of electrocautery needle knife combined with balloon dilatation versus balloon dilatation alone in the treatment of tracheal stenosis caused by tracheal intubation or tracheotomy. We retrospectively analysed the clinical data of 43 patients with tracheal stenosis caused by tracheotomy or tracheal intubation in our department from January 2013 to January 2016. Among these 43 patients, 23 had simple web-like stenosis and 20 had complex steno sis. All patients were treated under general anaesthesia, and the treatment methods were (1) balloon dilatation alone, (2) needle knife excision of fibrotic tissue combined with balloon dilatation, and (3) needle knife radial incision of fibrotic tissue combined with balloon dilatation. After treatment the symptoms, such as shortness of breath, were markedly improved immediately in all cases. The stenosis degree of patients who were treated with the elec-trocautery needle knife combined with balloon dilatation had better improvement compared with that of those treated with balloon dilatation treatment alone after 3 months (0.45 ± 0.04 vs. 0.67 ± 0.05, p < 0.01), and the proportion of restenosis occurrence that required further treatment was decreased at 6 months (46.9 vs. 81.8%), especially for the web-like stenosis patients, as most of their stenoses dilated with no obvious restenosis and achieved clinical cure. Electrocautery needle knife combined with balloon dilatation is an effective and safe treatment for tracheal fibrotic stenosis compared with balloon dilatation alone. © 2017 S. Karger AG, Basel.

Global electrodynamics from superpressure balloons

NASA Technical Reports Server (NTRS)

Holzworth, R. H.; Hu, H.

1995-01-01

Electric field and conductivity measurements in the stratosphere between November 1992 and March 1993 have been made using superpressure balloons in the southern hemisphere. Over 400 payload-days of data have been made during a record setting experiment called ELBBO (Extended Life Balloon Borne Observatories). This experiment resulted in 4 flights aloft simultaneously for over 2 months including one flight which lasted over 4 months. Electrodynamical coupling between the atmosphere and ionosphere is studied using the measured electric fields, and a simple empirical model of the stratospheric conductivity. Altitude profiles of conductivity have been obtained from several superpressure balloon flights using the large end-of-flight altitude swings on the last few days of each flight (as the balloon begins to loose superpressure). Coupling between the fields and atmospheric inertial waves has been observed. Effects and dynamics of the global circuit suggest that standard models are missing significant phenomena. Large scale ionospheric convection activity has been studied from the polar cap to the middle latitudes. Cusp latitude fields have been continuously measured for many days in a row.

NASA Scientific Balloon in Antarctica

NASA Image and Video Library

2017-12-08

NASA image captured December 25, 2011 A NASA scientific balloon awaits launch in McMurdo, Antarctica. The balloon, carrying Indiana University's Cosmic Ray Electron Synchrotron Telescope (CREST), was launched on December 25. After a circum-navigational flight around the South Pole, the payload landed on January 5. The CREST payload is one of two scheduled as part of this seasons' annual NASA Antarctic balloon Campaign which is conducted in cooperation with the National Science Foundation's Office of Polar Programs. The campaign's second payload is the University of Arizona's Stratospheric Terahertz Observatory (STO). You can follow the flights at the Columbia Scientific Balloon Facility's web site at www.csbf.nasa.gov/antarctica/ice.htm Credit: NASA NASA image use policy. NASA Goddard Space Flight Center enables NASA’s mission through four scientific endeavors: Earth Science, Heliophysics, Solar System Exploration, and Astrophysics. Goddard plays a leading role in NASA’s accomplishments by contributing compelling scientific knowledge to advance the Agency’s mission. Follow us on Twitter Like us on Facebook Find us on Instagram

Correlating Coating Characteristics with the Performance of Drug-Coated Balloons – A Comparative In Vitro Investigation of Own Established Hydrogel- and Ionic Liquid-Based Coating Matrices

PubMed Central

Kaule, Sebastian; Minrath, Ingo; Stein, Florian; Kragl, Udo; Schmidt, Wolfram; Schmitz, Klaus-Peter; Sternberg, Katrin; Petersen, Svea

2015-01-01

Drug-coated balloons (DCB), which have emerged as a therapeutic alternative to drug-eluting stents in percutaneous cardiovascular intervention, are well described with regard to clinical efficacy and safety within a number of clinical studies. In vitro studies elucidating the correlation between coating additive and DCB performance are however rare but considered important for the understanding of DCB requirements and the improvement of established DCB. In this regard, we examined three different DCB-systems, which were developed in former studies based on the ionic liquid cetylpyridinium salicylate, the body-own hydrogel hyaluronic acid and the pharmaceutically well-established hydrogel polyvinylpyrrolidone, considering coating morphology, coating thickness, drug-loss, drug-transfer to the vessel wall, residual drug-concentration on the balloon surface and entire drug-load during simulated use in an in vitro vessel model. Moreover, we investigated particle release of the different DCB during simulated use and determined the influence of the three coatings on the mechanical behavior of the balloon catheter. We could show that coating characteristics can be indeed correlated with the performance of DCB. For instance, paclitaxel incorporation in the matrix can reduce the drug wash-off and benefit a high drug transfer. Additionally, a thin coating with a smooth surface and high but delayed solubility can reduce drug wash-off and decrease particle burden. As a result, we suggest that it is very important to characterize DCB in terms of mentioned properties in vitro in addition to their clinical efficacy in order to better understand their function and provide more data for the clinicians to improve the tool of DCB in coronary angioplasty. PMID:25734818

Development of a Super-Pressure Balloon with an Improved Design

NASA Astrophysics Data System (ADS)

Izutsu, Naoki; Akita, Daisuke; Fuke, Hideyuki; Iijima, Issei; Kato, Yoichi; Kawada, Jiro; Matsushima, Kiyoho; Matsuzaka, Yukihiko; Mizuta, Eiichi; Nakada, Takashi; Nonaka, Naoki; Saito, Yoshitaka; Takada, Atsushi; Tamura, Keisuke; Yamada, Kazuhiko; Yoshida, Tetsuya

A zero-pressure balloon used for scientific observation in the stratosphere has an unmanageable limitation that its floating altitude decreases during a nighttime because of temperature drop of the lifting gas. Since a super-pressure balloon may not change its volume, the lifetime can extend very long. We had introduced so called the ‘lobed-pumpkin’ type of super-pressure balloon that can realize a full-scale long-duration balloon and it will be in practical use in the very near future. As for larger super-pressure balloons, however, we still have some potential difficulties to be resolved. We here propose a new design suitable for a larger super-pressure balloon, which is roughly ‘lobed pumpkin with lobed cylinder’ and can adapt a single design for balloons of a wide range of volumes. Indoor inflation tests were successfully carried out with balloons designed and made by the method. It has been shown that the limit of the resisting pressure differential for a new designed balloon is same as that of a normal lobed-pumpkin balloon.

Evolution of scientific ballooning and its impact on astrophysics research

NASA Astrophysics Data System (ADS)

Jones, William Vernon

2014-05-01

As we celebrate the centennial year of the discovery of cosmic rays on a manned balloon, it seems appropriate to reflect on the evolution of ballooning and its scientific impact. Balloons have been used for scientific research since they were invented in France more than 200 years ago. Ballooning was revolutionized in 1950 with the introduction of the so-called natural shape balloon with integral load tapes. This basic design has been used with more or less continuously improved materials for scientific balloon flights for more than a half century, including long-duration balloon (LDB) flights around Antarctica for the past two decades. The U.S. National Aeronautics and Space Administration (NASA) is currently developing the next generation super-pressure balloon that would enable extended duration missions above 99.5% of the Earth's atmosphere at any latitude. The Astro2010 Decadal Survey report supports super-pressure balloon development and the giant step forward it offers with ultra-long-duration balloon (ULDB) flights at constant altitudes for about 100 days.

Combined Endovascular Treatment with Distal Radial Artery Coil Embolization and Angioplasty in Steal Syndrome Associated with Forearm Dialysis Fistula.

PubMed

Tercan, Fahri; Koçyiğit, Ali; Güney, Bünyamin

2016-09-01

The present study was performed to define the results of the endovascular treatment with angioplasty and distal radial artery embolization in ischemic steal syndrome associated with forearm arteriovenous accesses. The cases referred to our interventional radiology unit with symptoms and physical examination findings suggestive of ischemic steal syndrome were retrospectively evaluated first by Doppler ultrasonography, and then by angiography. Cases with proximal artery stenosis were applied angioplasty, and those with steal syndrome underwent coil embolization to distal radial artery. Of 589 patients who underwent endovascular intervention for dialysis arteriovenous fistulae (AVF)-associated problems, 6 (1.01 %) (5 female, 1 males; mean age 62 (range 41-78) with forearm fistula underwent combined endovascular treatment for steal syndrome. In addition to steal phenomenon, there were stenosis and/or occlusion in proximal radial and/or ulnar artery in 6 patients concurrently. Embolization of distal radial artery and angioplasty to proximal arterial stenoses were performed in all patients. Ischemic symptoms were eliminated in all patients and the AVF were in use at the time of study. In one patient, ischemic symptoms recurring 6 months later were alleviated by repeat angioplasty of ulnar artery. In palmar arch steal syndrome affecting forearm fistulae, combined distal radial embolization and angioplasty is also an effective treatment method in the presence of proximal radial and ulnar arterial stenoses and occlusions.

Absorption spectrometer balloon flight and iodine investigations

NASA Technical Reports Server (NTRS)

1970-01-01

A high altitude balloon flight experiment to determine the technical feasibility of employing absorption spectroscopy to measure SO2 and NO2 gases in the earth's atmosphere from above the atmospheric ozone layer is discussed. In addition to the balloon experiment the contract includes a ground-based survey of natural I emissions from geological sources and studies of the feasibility of mapping I2 from spacecraft. This report is divided into three major sections as follows: (1) the planning engineering and execution of the balloon experiment, (2) data reduction and analysis of the balloon data, and (3) the results of the I2 phase of the contract.

Preoperative optimization of multi-organ failure following acute myocardial infarction and ischemic mitral regurgitation by placement of a transthoracic intra-aortic balloon pump.

PubMed

Umakanthan, Ramanan; Dubose, Robert; Byrne, John G; Ahmad, Rashid M

2010-10-01

The management of acute myocardial infarction with resultant acute ischemic mitral regurgitation and acute multi-organ failure can prove to be a very challenging scenario. The presence of concomitant vascular disease can only serve to further compromise the complexity of the situation. We demonstrate a new indication for the transthoracic intra-aortic balloon pump as a preoperative means of unloading the heart and improving clinical outcome in such high-risk patients with severe vascular disease. We present the case of a 75-year-old man with a history of severe vascular disease who was transferred emergently to Vanderbilt University Medical Center with an acute inferolateral wall myocardial infarction resulting in severe acute ischemic mitral regurgitation and acute multi-organ failure. He presented with shock liver (serum glutamic-oxaloacetic transaminase [SGOT] of 958), renal failure (creatinine of 3.0), and respiratory failure with a pH of 7.18. Emergent cardiac catheterization revealed 100% occlusion of the left circumflex artery as well as severe ileofemoral disease. The advanced nature of his ileofemoral disease was such that the arterial access catheter occluded the right femoral artery. The duration of time that the catheter was in the artery led to transient limb ischemia with an elevation of his creatine phosphokinase (CPK) to 10,809. Balloon angioplasty followed by stent placement was successfully performed, which restored flow to the coronary vessel. Given the grave nature of the patient's condition, we were very concerned that immediate operative intervention for his condition would entail prohibitively high risk. In fact, the Society of Thoracic Surgeons predicted risk adjusted mortality was calculated to be 56%. In order to minimize patient mortality and morbidity, it was critical to help restore perfusion and organ recovery. Therefore, we decided that the chances for this patient's survival would improve if his condition could be optimized by

Aerodynamics of a Party Balloon

ERIC Educational Resources Information Center

Cross, Rod

2007-01-01

It is well-known that a party balloon can be made to fly erratically across a room, but it can also be used for quantitative measurements of other aspects of aerodynamics. Since a balloon is light and has a large surface area, even relatively weak aerodynamic forces can be readily demonstrated or measured in the classroom. Accurate measurements…

Five-year clinical and angiographic follow-up after intracoronary iridium-192 radiation therapy.

PubMed

Condado, Jose A; Waksman, Ron; Saucedo, Jorge F; Bhargava, Balram; Lansky, Alexandra J; Calderas, Carlos; Gurdiel, Orlando; Gonzalez, Juan; Fadoul, Merche; Parra, Bogart; Iturria, Isabel; Amezaga, Bingen

2002-01-01

Ionizing gamma radiation has been shown to reduce neointimal formation and the incidence of restenosis after balloon angioplasty and stenting in clinical trials. However, the long-term effects of this therapy are unknown. The first cohort of patients to receive intracoronary gamma radiation after balloon angioplasty for the prevention of restenosis have completed a 5-year angiographic and clinical follow-up. The outcome of these patients is presented and discussed. Twenty-one patients with unstable angina (22 arteries) underwent standard balloon angioplasty. Intracoronary radiation therapy was performed immediately after the intervention using an Iridium-192 source wire hand-delivered to the angioplasty site. All patients were followed clinically and Quantitative Coronary Analysis (QCA) was performed at 6, 24, 36 and 60 months. Target lesion revascularization occurred in six lesions, three of which were total occlusions (two early within 30 days and one occurred at 2 years), and one patient had a myocardial infarction attributable to a nontarget vessel. Serial QCA detected a binary restenosis rate of 28.6% (n=6) at 6 months. The late loss (0.29 mm) and loss index (0.25) remained low at 2, 3 and 5 years. Angiographic complications included four aneurysms (two procedure related and two occurring within 3 months). At 2 years, only one aneurysm increased in size (46 vs. 27 mm(2)); and at 3 and 5 years, all aneurysms remained unchanged. No other angiographic complications were observed. The early clinical and angiographic effects of intracoronary gamma radiation were maintained at 5 years without further increase in the aneurysm formation or apparent new adverse effects related to the radiation therapy between 2 and 5 years.

Optimizing logistics for balloon-occluded retrograde transvenous obliteration (BRTO) of gastric varices by doing away with the indwelling balloon: concept and techniques.

PubMed

Saad, Wael E; Nicholson, David B

2013-06-01

Since the conception of balloon-occluded retrograde transvenous obliteration (BRTO) of gastric varices 25 years ago, the placement of an indwelling balloon for hours has been central to the BRTO procedure. Numerous variables and variations of the BRTO procedure have been described, including methods to reduce sclerosant, combining percutaneous transhepatic obliteration, varying sclerosant, and using multiple sclerosants within the same procedure. However, the consistent feature of BRTO has always remained the indwelling balloon. Placing an indwelling balloon over hours for the BRTO procedure is a logistical burden that taxes the interventional radiology team and hospital resources. Substituting the balloon with hardware (coils or Amplatzer vascular plugs [AVPs] or both) is technically feasible and its risks most likely correlate with gastrorenal shunt (GRS) size. The current authors use packed 0.018- or 0.035-in coils or both for small gastric variceal systems (GRS size A and B) and AVPs for GRS sizes up to size E (from size A-E). The current authors recommend an indwelling balloon (no hardware substitute) for very large gastric variceal system (GRS size F). Substituting the indwelling balloon for hardware in size F and potentially size E GRS can also be risky. The current article describes the techniques of placing up to 16-mm AVPs through balloon occlusion guide catheters and then deflating the balloon once it has been substituted with the AVPs. In addition, 22-mm AVPs can be placed through sheaths once the balloon occlusion catheters are removed to further augment the 16-mm Amplatzer occlusion. To date, there are no studies describing, let alone evaluating, the clinical feasibility of performing BRTO without indwelling balloons. The described techniques have been successfully performed by the current authors. However, the long-term safety and effectiveness of these techniques is yet to be determined. Copyright © 2013 Elsevier Inc. All rights reserved.

Concepts for autonomous flight control for a balloon on Mars

NASA Technical Reports Server (NTRS)

Heinsheimer, Thomas F.; Friend, Robyn C.; Siegel, Neil G.

1988-01-01

Balloons operating as airborne rovers have been suggested as ideal candidates for early exploration of the Martian surface. An international study team composed of scientists from the U.S.S.R., France, and the U.S.A. is planning the launching in 1994 of a balloon system to fly on Mars. The current likely design is a dual thermal/gas balloon that consists of a gas balloon suspended above a solar-heated thermal balloon. At night, the thermal balloon provides no lift, and the balloon system drifts just above the Martian surface; the lift of the gas balloon is just sufficient to prevent the science payload from hitting the ground. During the day, the balloon system flies at an altitude of 4 to 5 kilometers, rising due to the added lift provided by the thermal balloon. Over the course of a single Martian day, there may be winds in several directions, and in fact it can be expected that there will be winds simultaneously in different directions at different altitudes. Therefore, a balloon system capable of controlling its own altitude, via an autonomous flight control system, can take advantage of these different winds to control its direction, thereby greatly increasing both its mission utility and its longevity.

Stratospheric Balloons for Planetary Science and the Balloon Observation Platform for Planetary Science (BOPPS) Mission Summary

NASA Technical Reports Server (NTRS)

Kremic, Tibor; Cheng, Andrew F.; Hibbitts, Karl; Young, Eliot F.; Ansari, Rafat R.; Dolloff, Matthew D.; Landis, Rob R.

2015-01-01

NASA and the planetary science community have been exploring the potential contributions approximately 200 questions raised in the Decadal Survey have identified about 45 topics that are potentially suitable for addressing by stratospheric balloon platforms. A stratospheric balloon mission was flown in the fall of 2014 called BOPPS, Balloon Observation Platform for Planetary Science. This mission observed a number of planetary targets including two Oort cloud comets. The optical system and instrumentation payload was able to provide unique measurements of the intended targets and increase our understanding of these primitive bodies and their implications for us here on Earth. This paper will discuss the mission, instrumentation and initial results and how these may contribute to the broader planetary science objectives of NASA and the scientific community. This paper will also identify how the instrument platform on BOPPS may be able to contribute to future balloon-based science. Finally the paper will address potential future enhancements and the expected science impacts should those enhancements be implemented.

How to perform combined cutting balloon and high pressure balloon valvuloplasty for dogs with subaortic stenosis.

PubMed

Kleman, Mandi E; Estrada, Amara H; Maisenbacher, Herbert W; Prošek, Robert; Pogue, Brandon; Shih, Andre; Paolillo, Joseph A

2012-01-01

Subvalvular aortic stenosis (SAS) is one of the most common congenital cardiac malformations in dogs. Unfortunately, the long term success rate and survival data following either open heart surgery or catheter based intervention has been disappointing in dogs with severe subaortic stenosis. Medical therapy is currently the only standard recommended treatment option. A cutting balloon dilation catheter has been used successfully for resistant coronary artery and peripheral pulmonary arterial stenoses in humans. This catheter is unique in that it has the ability to cut, or score, the stenotic region prior to balloon dilatation of the stenosis. The use of cutting balloon valvuloplasty combined with high pressure valvuloplasty for dogs with severe subaortic stenosis has recently been reported to be a safe and feasible alternative therapeutic option. The following report describes this technique, outlines the materials required, and provides some 'tips' for successful percutaneous subaortic balloon valvuloplasty. Copyright © 2012 Elsevier B.V. All rights reserved.

[Brief history of interventional radiology].

PubMed

Tang, Zhenliang; Jia, Aiqin; Li, Luoyun; Li, Chunyu

2014-05-01

In 1923, angiography was first successively used for the human body. In 1953, a Swedish doctor Sven-Ivar Seldinger pioneered the Seldinger technique, which laid down the foundation of interventional radiology. In 1963, Charles Dotter first proposed the idea of interventional radiology. In 1964, Charles Dotter opened a new era of percutaneous angioplasty through accidental operation, marking the formation of interventional radiology. On this basis, the techniques of balloon catheter dilation and metal stent implantation was developed. Endovascular stent was proposed in 1969. In 1973, the percutaneous angioplasty has been a breakthrough with the emergence of soft double-lumen balloon catheter. Percutaneous coronary angioplasty is applied in 1977. Since the 1990s, balloon angioplasty relegated to secondary status with the emergence of metal stent. Currently, endovascular stent have entered a new stage with the emergence of temporary stent and stent grafts and biological stent. Transcatheter arterial embolization had been one of the most important basic techniques for interventional radiology since 1965, it had also been a corresponding development with the improvement of embolic agents and catheter technology for the treatment of diseases now. Transjugular intrahepatic portosystemic stent-shunt is a comprehensive interventional radiology technology since 1967, in which the biliary system can be reached through a jugular vein, and the improvement appeared with balloon expandable stent in 1986.Since 1972, non-vascular interventional techniques was another important branch of interventional radiology. Currently, it is applied in the diagnosis and treatment of many diseases of the internal organs like the pancreas, liver, kidney, spinal cord, Fallopian tubes, esophagus and other organs. In 1973, Chinese radiologist first conducted the angiography test. Interventional radiology was introduced into China in the 1980s, it was readily developed through the sponsoring of

Comparison of costs of percutaneous transluminal coronary angioplasty and coronary bypass surgery for patients with angina pectoris.

PubMed

van den Brand, M; van Halem, C; van den Brink, F; de Feyter, P; Serruys, P; Suryapranata, H; Meeter, K; Bos, E; van Dalen, F J

1990-08-01

To determine the costs of a procedure, the total costs of the department that provides the service must be considered and, in addition, the direct cost of the specific procedure. Applying this principle to the cost accounting of angioplasty and bypass surgery results in a direct, i.e. procedural, cost, including the initial hospital stay, of respectively 8694 Dfl and 20,987 Dfl. A review of the follow-up data for the first year after the original intervention revealed a 2% reintervention rate for bypass surgery, while this percentage was 29% for angioplasty. Adding the first year costs involved with reinterventions to the procedural costs results in a 1-year cost of angioplasty and bypass operation of 13,625 Dfl and 21,363 Dfl, respectively. It is concluded that because of reinterventions in the first year, a mark up of 57% on the procedural cost of angioplasty must be added to cover 1-year costs, while for bypass surgery this is only 1%. Nevertheless, the 1-year cost for angioplasty is still 36% less than for bypass surgery. As reinterventions after PTCA may stay considerably higher than for CABG for several years, the mark-up percentages will be substantially higher for longer time spans. This may tend to equalize the total costs of PTCA and CABG over time spans of perhaps 5-8 years. Sufficient data are not available to verify this statement. Clinicians must realize that choosing the most appropriate procedure is not only a matter of medical assessment but also a matter of cost effectiveness. CABG can be seen as an 'investment decision' while PTCA tends to become a decision with characteristics of 'maintenance planning'!

NASA’s BARREL Mission Launches 20 Balloons

NASA Image and Video Library

2017-12-08

A BARREL balloon floats into the sky as it is partially filled. When fully inflated, each balloon is 90 feet in diameter and carries an instrument suite that weighs 50 pounds. This is small for an Antarctica balloon launch, which can have balloons Typical balloons l the size of a football field with payloads of some 3,000 pounds. Credit: NASA --- In Antarctica in January, 2013 – the summer at the South Pole – scientists launched 20 balloons up into the air to study an enduring mystery of space weather: when the giant radiation belts surrounding Earth lose material, where do the extra particles actually go? The mission is called BARREL (Balloon Array for Radiation belt Relativistic Electron Losses) and it is led by physicist Robyn Millan of Dartmouth College in Hanover, NH. Millan provided photographs from the team’s time in Antarctica. The team launched a balloon every day or two into the circumpolar winds that circulate around the pole. Each balloon floated for anywhere from 3 to 40 days, measuring X-rays produced by fast-moving electrons high up in the atmosphere. BARREL works hand in hand with another NASA mission called the Van Allen Probes, which travels through the Van Allen radiation belts surrounding Earth. The belts wax and wane over time in response to incoming energy and material from the sun, sometimes intensifying the radiation through which satellites must travel. Scientists wish to understand this process better, and even provide forecasts of this space weather, in order to protect our spacecraft. As the Van Allen Probes were observing what was happening in the belts, BARREL tracked electrons that precipitated out of the belts and hurtled down Earth’s magnetic field lines toward the poles. By comparing data, scientists will be able to track how what’s happening in the belts correlates to the loss of particles – information that can help us understand this mysterious, dynamic region that can impact spacecraft. Having launched balloons in

Optical Coherence Tomography

MedlinePlus

... patients who undergo balloon angioplasty also receive a stent—a small mesh-like device placed inside the ... OCT images can help cardiologists see if a stent is holding an artery open and whether the ...

21 CFR 884.5050 - Metreurynter-balloon abortion system.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Metreurynter-balloon abortion system. 884.5050... Devices § 884.5050 Metreurynter-balloon abortion system. (a) Identification. A metreurynter-balloon abortion system is a device used to induce abortion. The device is inserted into the uterine cavity...

21 CFR 884.5050 - Metreurynter-balloon abortion system.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Metreurynter-balloon abortion system. 884.5050... Devices § 884.5050 Metreurynter-balloon abortion system. (a) Identification. A metreurynter-balloon abortion system is a device used to induce abortion. The device is inserted into the uterine cavity...

21 CFR 884.5050 - Metreurynter-balloon abortion system.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Metreurynter-balloon abortion system. 884.5050... Devices § 884.5050 Metreurynter-balloon abortion system. (a) Identification. A metreurynter-balloon abortion system is a device used to induce abortion. The device is inserted into the uterine cavity...

21 CFR 884.5050 - Metreurynter-balloon abortion system.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Metreurynter-balloon abortion system. 884.5050... Devices § 884.5050 Metreurynter-balloon abortion system. (a) Identification. A metreurynter-balloon abortion system is a device used to induce abortion. The device is inserted into the uterine cavity...

21 CFR 884.5050 - Metreurynter-balloon abortion system.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Metreurynter-balloon abortion system. 884.5050... Devices § 884.5050 Metreurynter-balloon abortion system. (a) Identification. A metreurynter-balloon abortion system is a device used to induce abortion. The device is inserted into the uterine cavity...

Investigating Diffusion and Entropy with Carbon Dioxide-Filled Balloons

ERIC Educational Resources Information Center

Jadrich, James; Bruxvoort, Crystal

2010-01-01

Fill an ordinary latex balloon with helium gas and you know what to expect. Over the next day or two the volume will decrease noticeably as helium escapes from the balloon. So what happens when a latex balloon is filled with carbon dioxide gas? Surprisingly, carbon dioxide balloons deflate at rates as much as an order of magnitude faster than…

Dose Reduction Study in Vaginal Balloon Packing Filled With Contrast for HDR Brachytherapy Treatment;HDR; Uterine cervix cancer; Vaginal balloon packing; Contrast; Monte Carlo

DOE Office of Scientific and Technical Information (OSTI.GOV)

Saini, Amarjit S.; Zhang, Geoffrey G., E-mail: geoffrey.zhang@moffitt.org; Finkelstein, Steven E.

2011-07-15

Purpose: Vaginal balloon packing is a means to displace organs at risk during high dose rate brachytherapy of the uterine cervix. We tested the hypothesis that contrast-filled vaginal balloon packing reduces radiation dose to organs at risk, such as the bladder and rectum, in comparison to water- or air-filled balloons. Methods and Materials: In a phantom study, semispherical vaginal packing balloons were filled with air, saline solution, and contrast agents. A high dose rate iridium-192 source was placed on the anterior surface of the balloon, and the diode detector was placed on the posterior surface. Dose ratios were taken withmore » each material in the balloon. Monte Carlo (MC) simulations, by use of the MC computer program DOSXYZnrc, were performed to study dose reduction vs. balloon size and contrast material, including commercially available iodine- and gadolinium-based contrast agents. Results: Measured dose ratios on the phantom with the balloon radius of 3.4 cm were 0.922 {+-} 0.002 for contrast/saline solution and 0.808 {+-} 0.001 for contrast/air. The corresponding ratios by MC simulations were 0.895 {+-} 0.010 and 0.781 {+-} 0.010. The iodine concentration in the contrast was 23.3% by weight. The dose reduction of contrast-filled balloon ranges from 6% to 15% compared with water-filled balloon and 11% to 26% compared with air-filled balloon, with a balloon size range between 1.4 and 3.8 cm, and iodine concentration in contrast of 24.9%. The dose reduction was proportional to the contrast agent concentration. The gadolinium-based contrast agents showed less dose reduction because of much lower concentrations in their solutions. Conclusions: The dose to the posterior wall of the bladder and the anterior wall of the rectum can be reduced if the vaginal balloon is filled with contrast agent in comparison to vaginal balloons filled with saline solution or air.« less

Precursors and adjuncts of a lunar base

NASA Technical Reports Server (NTRS)

Burke, J. D.

1988-01-01

The automated, teleoperated, robotic and human-tended subsystems which will precede and accompany a lunar base program are discussed. The information about lunar conditions that can be provided by such precursors and adjuncts is addressed. The use of precursors and adjuncts for communications and navigation, for safety and survival, for lunar archives, and for entertainment and leisure is examined.

Under Pressure: Intraluminal Filling Pressures of Postpartum Hemorrhage Tamponade Balloons

PubMed Central

Antony, Kathleen M.; Racusin, Diana A.; Belfort, Michael A.; Dildy, Gary A.

2017-01-01

Objective Uterine tamponade by fluid-filled balloons is now an accepted method of controlling postpartum hemorrhage. Available tamponade balloons vary in design and material, which affects the filling attributes and volume at which they rupture. We aimed to characterize the filling capacity and pressure-volume relationship of various tamponade balloons. Study Design Balloons were filled with water ex vivo. Intraluminal pressure was measured incrementally (every 10 mL for the Foley balloons and every 50 mL for all other balloons). Balloons were filled until they ruptured or until 5,000 mL was reached. Results The Foley balloons had higher intraluminal pressures than the larger-volume balloons. The intraluminal pressure of the Sengstaken-Blakemore tube (gastric balloon) was initially high, but it decreased until shortly before rupture occurred. The Bakri intraluminal pressure steadily increased until rupture occurred at 2,850 mL. The condom catheter, BT-Cath, and ebb all had low intraluminal pressures. Both the BT-Cath and the ebb remained unruptured at 5,000 mL. Conclusion In the setting of acute hemorrhage, expeditious management is critical. Balloons that have a low intraluminal pressure-volume ratio may fill more rapidly, more easily, and to greater volumes. We found that the BT-Cath, the ebb, and the condom catheter all had low intraluminal pressures throughout filling. PMID:28497006

Eating behavior and nutritional status in patients who underwent coronary angioplasty.

PubMed

Proença Vieira, L; Nobre, M Roberto; Gonçalves de Queiroz, G

2012-01-01

The identification of stages of dietary change and the factors affecting food choices can direct more effective nutritional intervention against coronary heart disease progression. Identify the stages of change of eating behavior and its relation with nutritional status, food consumption and previous cardiovascular events in patients who underwent coronary angioplasty. A cross-sectional study with 200 hospitalized patients from a specialized cardiology hospital, after elective coronary angioplasty. They were applied an algorithm that identifies the provision of change of eating habits for a healthier pattern. Variables measured were stages of change of eating behavior, nutritional status, food consumption and cardiovascular events (previous myocardial infarction or angioplasty). It was realized comparison of averages by analysis of variance or Student's test and Chi-square test for qualitative variables. Value of significance was taken at 5%. The patients were classified in the following stages: 36% maintenance, 26% preparation, 17% precontemplation, 12% action and 9% contemplation. It was observed higher cardiovascular events in maintenance/action group (p = 0.04), higher consumption of calories (p = 0.04), meat/eggs (p = 0.01) and sweets (p = 0.03) in preparation stage, comparing to maintenance group, and no association between nutritional status and stages of change (p = 0.13), although 62% of the individuals in maintenance stage were overweight. This work contributed to identifying the stages of change and conditions that favor changes in eating pattern. Even patients that classified themselves into the maintenance stage need to adjust their eating habits in order to reach a healthy weight.

Preclinical Feasibility of a Technology Framework for MRI-guided Iliac Angioplasty

PubMed Central

Rube, Martin A.; Fernandez-Gutierrez, Fabiola; Cox, Benjamin F.; Holbrook, Andrew B.; Houston, J. Graeme; White, Richard D.; McLeod, Helen; Fatahi, Mahsa; Melzer, Andreas

2015-01-01

Purpose Interventional MRI has significant potential for image guidance of iliac angioplasty and related vascular procedures. A technology framework with in-room image display, control, communication and MRI-guided intervention techniques was designed and tested for its potential to provide safe, fast and efficient MRI-guided angioplasty of the iliac arteries. Methods A 1.5T MRI scanner was adapted for interactive imaging during endovascular procedures using new or modified interventional devices such as guidewires and catheters. A perfused vascular phantom was used for testing. Pre-, intra- and post-procedural visualization and measurement of vascular morphology and flow was implemented. A detailed analysis of X-Ray fluoroscopic angiography workflow was conducted and applied. Two interventional radiologists and one physician in training performed 39 procedures. All procedures were timed and analyzed. Results MRI-guided iliac angioplasty procedures were successfully performed with progressive adaptation of techniques and workflow. The workflow, setup and protocol enabled a reduction in table time for a dedicated MRI-guided procedure to 6 min 33 s with a mean procedure time of 9 min 2 s, comparable to the mean procedure time of 8 min 42 s for the standard X-Ray guided procedure. Conclusions MRI-guided iliac vascular interventions were found to be feasible and practical using this framework and optimized workflow. In particular the real-time flow analysis was found to be helpful for pre- and post-interventional assessments. Design optimization of the catheters and in vivo experiments are required before clinical evaluation. PMID:25102933

Overview of the Scientific Balloon Activity in Sweden

NASA Astrophysics Data System (ADS)

Abrahamsson, Mattias; Kemi, Stig; Lockowandt, Christian; Andersson, Kent

SSC, formerly known as Swedish Space Corporation, is a Swedish state-owned company working in several different space related fields, including scientific stratospheric balloon launches. Esrange Space Centre (Esrange in short) located in the north of Sweden is the launch facility of SSC, where both sounding rocket launches and stratospheric balloon launches are conducted. At Esrange there are also facilities for satellite communication, including one of the largest civilian satellite data reception stations in the world. Stratospheric balloons have been launched from Esrange since 1974, when the first flights were performed together with the French space agency CNES. These balloon flights have normally flown eastward either only over Sweden or into Finland. Some flights have also had permission to fly into Russia, as far as the Ural Mountains. Normal flight times are from 4 to 12 hours. These eastward flights are conducted during the winter months (September to May). Long duration flights have been flown from ESC since 2005, when NASA flew the BLAST payload from Sweden to north Canada. The prevailing westerly wind pattern is very advantageous for trans-Atlantic flights during summer (late May to late July). The long flight times are very beneficial for astronomical payloads, such as telescopes that need long observation times. In 2013 two such payloads were flown, the first called SUNRISE was a German/US solar telescope, and the other called PoGOLite with a Swedish gamma-ray telescope. In 14 days PoGOLite, which had permission to fly over Russia, made an almost complete circumpolar flight. Typical scientific balloon payload fields include atmospheric research, including research on ozone depletion, astronomical and cosmological research, and research in technical fields such as aerodynamics. University students from all over Europe are involved in flights from Esrange under a Swedish/German programme called BEXUS. Two stratospheric balloons are flown with student

The Case for Adjunctive Monoclonal Antibody Immunotherapy in Schizophrenia.

PubMed

Miller, Brian J; Buckley, Peter F

2016-06-01

This article presents the case in favor of clinical trials of adjunctive monoclonal antibody immunotherapy in schizophrenia. Evidence for prenatal and premorbid immune risk factors for the development of schizophrenia in the offspring is highlighted. Then key evidence for immune dysfunction in patients with schizophrenia is considered. Next, previous trials of adjunctive anti-inflammatory or other immunotherapy in schizophrenia are discussed. Then evidence for psychosis as a side effect of immunotherapy for other disorders is discussed. Also presented is preliminary evidence for adjunctive monoclonal antibody immunotherapy in psychiatric disorders. Finally, important considerations in the design and implementation of clinical trials of adjunctive monoclonal antibody immunotherapy in schizophrenia are discussed. Copyright © 2016 Elsevier Inc. All rights reserved.

Simulating clefts in pumpkin balloons

NASA Astrophysics Data System (ADS)

Baginski, Frank; Brakke, Kenneth

2010-02-01

The geometry of a large axisymmetric balloon with positive differential pressure, such as a sphere, leads to very high film stresses. These stresses can be significantly reduced by using a tendon re-enforced lobed pumpkin-like shape. A number of schemes have been proposed to achieve a cyclically symmetric pumpkin shape, including the constant bulge angle (CBA) design, the constant bulge radius (CBR) design, CBA/CBR hybrids, and NASA’s recent constant stress (CS) design. Utilizing a hybrid CBA/CBR pumpkin design, Flight 555-NT in June 2006 formed an S-cleft and was unable to fully deploy. In order to better understand the S-cleft phenomenon, a series of inflation tests involving four 27-m diameter 200-gore pumpkin balloons were conducted in 2007. One of the test vehicles was a 1/3-scale mockup of the Flight 555-NT balloon. Using an inflation procedure intended to mimic ascent, the 1/3-scale mockup developed an S-cleft feature strikingly similar to the one observed in Flight 555-NT. Our analysis of the 1/3-scale mockup found it to be unstable. We compute asymmetric equilibrium configurations of this balloon, including shapes with an S-cleft feature.

Heart and vascular services

MedlinePlus

... using x-rays and injected contrast dye to evaluate blood vessels) Angioplasty (using a small balloon to ... ADAM Health Solutions. About MedlinePlus Site Map FAQs Customer Support Get email updates Subscribe to RSS Follow ...

Combined Endovascular Treatment with Distal Radial Artery Coil Embolization and Angioplasty in Steal Syndrome Associated with Forearm Dialysis Fistula

DOE Office of Scientific and Technical Information (OSTI.GOV)

Tercan, Fahri, E-mail: ftercan@yahoo.com; Koçyiğit, Ali, E-mail: alkoc@yahoo.com; Güney, Bünyamin

PurposeThe present study was performed to define the results of the endovascular treatment with angioplasty and distal radial artery embolization in ischemic steal syndrome associated with forearm arteriovenous accesses.MethodThe cases referred to our interventional radiology unit with symptoms and physical examination findings suggestive of ischemic steal syndrome were retrospectively evaluated first by Doppler ultrasonography, and then by angiography. Cases with proximal artery stenosis were applied angioplasty, and those with steal syndrome underwent coil embolization to distal radial artery.ResultsOf 589 patients who underwent endovascular intervention for dialysis arteriovenous fistulae (AVF)-associated problems, 6 (1.01 %) (5 female, 1 males; mean age 62 (rangemore » 41–78) with forearm fistula underwent combined endovascular treatment for steal syndrome. In addition to steal phenomenon, there were stenosis and/or occlusion in proximal radial and/or ulnar artery in 6 patients concurrently. Embolization of distal radial artery and angioplasty to proximal arterial stenoses were performed in all patients. Ischemic symptoms were eliminated in all patients and the AVF were in use at the time of study. In one patient, ischemic symptoms recurring 6 months later were alleviated by repeat angioplasty of ulnar artery.ConclusionIn palmar arch steal syndrome affecting forearm fistulae, combined distal radial embolization and angioplasty is also an effective treatment method in the presence of proximal radial and ulnar arterial stenoses and occlusions.« less

The Entrepreneurial Adjunct

ERIC Educational Resources Information Center

Hess, John

2004-01-01

Increasingly, the higher education community is witnessing what the author calls the "entrepreneurial adjunct phenomenon": a kind of merchandising of the needs, concerns, and activities of faculty with short-term, often part-time, appointments that depend on factors like enrollment, budget, and program changes. These faculty members are called any…

Adjunct Faculty Organizational Sense of Belonging and Affective Organizational Commitment

ERIC Educational Resources Information Center

Merriman, Constance L.

2010-01-01

In recent years all public higher education institutions have increased their reliance on adjunct faculty. Adjuncts provide expertise in key areas, are available at times that meet the needs of the changing student demographic, and cover an increasing number of introductory courses. It has been suggested that adjunct faculty may be more weakly…

Retained intraaortic balloon. Case report and review of the literature.

PubMed

Grande, A M; Martinelli, L; Graffigna, A; Viganò, M

1995-01-01

We report a case of intraaortic balloon entrapment in a 70-year-old man who underwent emergency triple coronary bypass. Intraaortic balloon rupture caused the formation of a clot inside the balloon that eventually was responsible for the balloon's entrapment at the aortic bifurcation. The patient had severe atherosclerosis of the aorta and iliac arteries. Balloon removal required aorto-iliac exposure and aorto-bifemoral bypass. After 16 months, he is symptom free and at home.

Incorporation of Scientific Ballooning into Science Education

NASA Astrophysics Data System (ADS)

Chanover, N.; Stochaj, S.; Petty, C.

1999-12-01

We are augmenting the science curriculum of the Roswell Independent School District in Roswell, NM, to take advantage of the proximity of a NASA scientific balloon base. The basic science related to balloon experimentation is being incorporated into the K-12 science curriculum via the discussion of topics such as atmospheric properties, weather, phases of matter, plotting skills, and communications in the context of a high-altitude balloon flight. These efforts will culminate in the construction of balloon-borne instruments by high school students, which will be launched during the spring of 2000. A demonstration flight, launched in the spring of 1999, was used to build student enthusiasm and community support for this program, which is funded by the NASA/IDEAS program.

Nimbus 4/IRLS Balloon Interrogation Package (BIP)

NASA Technical Reports Server (NTRS)

1971-01-01

The balloon interrogation package (BIP), an integral part of the overall interrogation, recording, and location subsystems (IRLS) for the Nimbus 4 program, is described. The BIP is a self-contained, integrated transponder designed to be carried aloft by a constant altitude, superpressure balloon to an altitude of 67,000 or 78,000 feet. After launch the BIP senses high-altitude balloon overpressure and temperature, and upon receipt of an interrogated command from the IRLS aboard the Nimbus 4 satellite, the BIP enodes the data on a real-time basis into a pulse-code modulation (PCM) format and transmits this data to the satellite. A summary of the program activity to produce 30 BIP systems and to support balloon launches from Ascension Island is presented.

Scientific balloons: historical remarks.

NASA Astrophysics Data System (ADS)

Ubertini, P.

The paper is an overview of the Human attempt to fly, from the myth of Daedalus and his son Icarus to the first "aerostatic" experiment by Joseph-Michel and Jaques-Etienne Montgolfier. Then, via a jump of about 200 years, we arrive to the era of the modern stratospheric ballooning that, from the beginning of the last century, have provided a unique flight opportunity for aerospace experiments. In particular, the Italian scientific community has employed stratospheric balloons since the '50s for cosmic rays and high energy astrophysical experiments with initial launches performed from Cagliari Helmas Airport (Sardinia). More recently an almost ideal location was found in the area of Trapani-Milo (Sicily, Italy), were an old abandoned airport was refurbished to be used as a new launch site that became operative at the beginning of the '70s. Finally, we suggest a short reminiscence of the first transatlantic experiment carried out on August 1975 in collaboration between SAS-CNR (Italy) and NSBF-NASA (USA). The reason why the Long Duration Balloon has been recently re-oriented in a different direction is analysed and future perspectives discussed. Finally, the spirit of the balloon launch performed by the Groups lead by Edoardo Amaldi, Livio Scarsi and other Italian pioneers, with payloads looking like "refrigerators" weighting a few tens of kg is intact and the wide participation to the present Workshop is the clear demonstration.

Primary Self-EXPANDing Nitinol Stenting vs Balloon Angioplasty With Optional Bailout Stenting for the Treatment of Infrapopliteal Artery Disease in Patients With Severe Intermittent Claudication or Critical Limb Ischemia (EXPAND Study).

PubMed

Schulte, Karl-Ludwig; Pilger, Ernst; Schellong, Sebastian; Tan, Kong Ten; Baumann, Frederic; Langhoff, Ralf; Torsello, Giovanni; Zeller, Thomas; Amendt, Klaus; Brodmann, Marianne

2015-10-01

To compare primary placement of a self-expanding nitinol stent to percutaneous transluminal angioplasty (PTA) with bailout stenting in infrapopliteal arteries of patients with severe intermittent claudication or critical limb ischemia (CLI). In the EXPAND trial (ClinicalTrials.gov; identifier NCT00906022), 92 patients (mean age 72.9±9.5 years; 62 men) undergoing treatment for infrapopliteal stenosis in 11 European centers were randomized 1:1 to either self-expanding nitinol stenting with the Astron Pulsar/Pulsar-18 nitinol stent or PTA with bailout stenting. The primary endpoint was sustainable clinical improvement after 12 months, defined as a ≥1-category increase for Rutherford category 3 patients or a ≥2-category increase for CLI patients (Rutherford categories 4/5) compared with baseline. Furthermore, target lesion revascularization (TLR), mortality, and amputation were assessed after 12 months. Sustained clinical improvement at 1 year was observed in 74.3% of the patients treated with primary stenting and in 68.6% of the patients treated with PTA and bailout stenting (p>0.05). Kaplan-Meier estimates of freedom from TLR (76.6% and 77.6%), mortality (7.4% vs 2.1%), and amputation [8.9% (major 6.7%) vs 13.2% (major 8.7%)] at 1 year were not significantly different. Primary self-expanding nitinol stenting did not show statistically different clinical outcomes compared to angioplasty with bailout stenting for infrapopliteal lesions. © The Author(s) 2015.

Balloon Exoplanet Nulling Interferometer (BENI)

NASA Technical Reports Server (NTRS)

Lyon, Richard G.; Clampin, Mark; Woodruff, Robert A.; Vasudevan, Gopal; Ford, Holland; Petro, Larry; Herman, Jay; Rinehart, Stephen; Carpenter, Kenneth; Marzouk, Joe

2009-01-01

We evaluate the feasibility of using a balloon-borne nulling interferometer to detect and characterize exosolar planets and debris disks. The existing instrument consists of a 3-telescope Fizeau imaging interferometer with 3 fast steering mirrors and 3 delay lines operating at 800 Hz for closed-loop control of wavefront errors and fine pointing. A compact visible nulling interferometer is under development which when coupled to the imaging interferometer would in-principle allow deep suppression of starlight. We have conducted atmospheric simulations of the environment above 100,000 feet and believe balloons are a feasible path forward towards detection and characterization of a limited set of exoplanets and their debris disks. Herein we will discuss the BENI instrument, the balloon environment and the feasibility of such as mission.

Retained intraaortic balloon. Case report and review of the literature.

PubMed Central

Grande, A M; Martinelli, L; Graffigna, A; Viganò, M

1995-01-01

We report a case of intraaortic balloon entrapment in a 70-year-old man who underwent emergency triple coronary bypass. Intraaortic balloon rupture caused the formation of a clot inside the balloon that eventually was responsible for the balloon's entrapment at the aortic bifurcation. The patient had severe atherosclerosis of the aorta and iliac arteries. Balloon removal required aorto-iliac exposure and aorto-bifemoral bypass. After 16 months, he is symptom free and at home. Images PMID:8605436

Low-Altitude Exploration of the Venus Atmosphere by Balloon

NASA Technical Reports Server (NTRS)

Landis, Geoffrey A.

2010-01-01

The planet Venus represents an exciting target for future exploration by spacecraft. One target of scientific interest is the lower atmosphere, which represents an environment of high temperature and moderate to high atmospheric pressure. This represents a considerable challenge to the technical art of ballooning, but one which may be amenable to solution. Several possible designs for low-altitude balloons are discussed. Conceptual design for three mission examples are analyzed: a conventional balloon operating below the cloud level at an altitude of 25 kilometers, a large rigid-envelope balloon operating near the surface at an altitude of 5 kilometers, and a small, technology demonstrator rigid-envelope balloon operating at 5 kilometers.

29 CFR 780.617 - Adjunct livestock auction operations.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 29 Labor 3 2010-07-01 2010-07-01 false Adjunct livestock auction operations. 780.617 Section 780... Employment in Agriculture and Livestock Auction Operations Under the Section 13(b)(13) Exemption Requirements for Exemption § 780.617 Adjunct livestock auction operations. The livestock auction operations...

The radiation controlled balloon (RACOON)

NASA Astrophysics Data System (ADS)

Lally, Vincent E.

The RACOON concept permits the flight of large, low-cost polyethylene balloons for several weeks at stratospheric altitudes without ballast. The theory of operations is described. The RACOON balloon ascends each morning and descends at night. This movement of 15 to 20 km in altitude provides an ideal platform for vertical soundings and sampling measurements in the stratosphere. Results of a number of globe-circling flights are presented.

[Incidence, associated factors, and follow-up of hospital heart failure complicating acute anterior myocardial infarction successfully treated by primary angioplasty].

PubMed

Meimoun, P; M'barek, D; Dragomir, C; Luycx-Bore, A; Elmkies, F; Boulanger, J; Zemir, H; Martis, S; Neykova, A; Tzvetkov, B; Clerc, J

2013-11-01

Heart failure (HF) complicating acute myocardial infarction (AMI) is of poor prognosis and is often associated with patient's characteristics and success of reperfusion strategies. However, few data is available regarding the high-risk subgroup of patients with anterior AMI treated successfully by primary angioplasty. The aim of the study was to assess the incidence, associated factors, and the future of HF occurring during hospitalisation, in the setting of anterior AMI treated successfully by primary angioplasty. Eighty-five consecutive patients with anterior AMI treated successfully by primary angioplasty (final angiographic TIMI flow grade=3, without residual stenosis) were included. Clinical, biochemical, angiographic, and echocardiographic data were prospectively collected and compared between patients with (Killip 2 and 3) and without HF during hospitalisation. Fifteen patients had HF (18%) during hospitalisation and 70 did not. By comparison to patients without HF, patients with HF were more frequently diabetics, had troponin peak and CPK, leucocytes count, and fasting glucose higher, LVEF and wall motion score index in the left anterior descending territory (WMSi-lad) poorer, and a lower non-invasive coronary flow reserve (CFR) in the LAD 24hours after angioplasty (all, P<0.05). In multivariate analysis, fasting glucose, leucocytes count after angioplasty, CFR and WMSi-lad were independently associated with HF, even after adjusting with angiographic variables (all, P<0.05). At 6months, patients with HF had less recovery of LV function and higher frequency of adverse LV remodelling (58% versus 20%, P<0.01) by comparison to patients without HF. In conclusion, HF is not uncommon even after successful primary angioplasty for anterior AMI (nearly one patient out of 5), is associated with hyperglycaemia and inflammation, a poor microvascular reperfusion, and left ventricular systolic function, and is more frequently complicated by adverse LV remodelling and lack

The NASA super pressure balloon - A path to flight

NASA Astrophysics Data System (ADS)

Cathey, H. M.

2009-07-01

The National Aeronautics and Space Administration's Balloon Program Office has invested significant time and effort in extensive ground testing of model super pressure balloons. The testing path has been developed as an outgrowth of the results of the super pressure balloon test flight in 2006. Summary results of the June 2006 super pressure test flight from Kiruna, Sweden are presented including the balloon performance and "lessons learned". This balloons flight performance exceeded expectations, but did not fully deploy. The flight was safely terminated by command. The results of this test flight refocused the project's efforts toward additional ground testing and analysis; a path to flight. A series of small 4 m diameter models were made and tested to further explore the deployment and structural capabilities of the balloons and materials. A series of ˜27 m model balloons were successfully tested indoors. These balloons successfully replicated the cleft seen in the Sweden flight, explored the deployment trade space to help characterize better design approaches, and demonstrated an acceptable fix to the deployment issue. Photogrammetry was employed during these ˜27 m model tests to help characterize both the balloon and gore shape evolution under pressurization. A ˜8.5 m ground model was used to explore the design and materials performance. Results of these tests will be presented. A general overview of some of the other project advancements made related to demonstrating the strain arresting nature of the proposed design, materials and analysis work will also be presented. All of this work has prepared a clear path toward a renewed round of test flights. This paper will give an overview of the development approach pursued for this super pressure balloon development. A description of the balloon design, including the modifications made as a result of the lessons learned, is presented. A short deployment test flight of the National Aeronautics and Space

Experiments with Helium-Filled Balloons