Randomized Comparison of Distal and Proximal Cerebral Protection During Carotid Artery Stenting

December 17, 2013 · No Comments

The two major approaches to embolic protection (a distal filter device to “catch” emboli during the CAS, or, 2) a proximal occlusion device whereby antegrade flow in the vessel is stopped by occluding the CCA, and the potential emboli are aspirated prior to restoring antegrade flow in the carotid) are evaluated in a randomized, open-label trial of 60 adults at a single center with severe asymptomatic (>80%) or severe symptomatic (>50%) carotid stenosis who underwent CAS between July 2008-July 2011. Only one stent type was used.

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No CommentsTags: Author: Phillip Erwin · Carotid Artery Stenting

Comparison of ultrasound guidance with the traditional palpation and fluoroscopy method for the common femoral artery puncture.

June 06, 2013 · No Comments

Ultrasound guidance for vascular access has become to standard of care for placement of central venous catheters, but femoral arteriotomies continue to be performed using only palpation and fluoroscopically-guided identification of the femoral head. Presumably, by precisely defining common femoral artery anatomy and thereby avoiding punctures above the inguinal ligament or punctures of the superficial femoral artery, ultrasound guided arteriotomy might decrease access site complications.

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No CommentsTags: Author: Phillip Erwin · Peripheral Arterial Disease · Peripheral vascular ultrasound · vascular complications

Mechanical Recanalization With Flow Restoration in Acute Ischemic Stroke

May 28, 2013 · No Comments

New endovascular technologies, such as the use of retrievable stents for thrombectomy and mechanical restoration of vessel patency (i.e., “stentrievers”) may have significant impact on clinical outcomes of patients with acute ischemic stroke, especially for strokes caused by occlusion of large intracranial vessels (2,3).  The Mechanical Recanalization With Flow Restoration in Acute Ischemic Stroke (ReFlow) Study used a new stentriever revascularization device, the Solitaire FR (ev3, Irvine, California), to determine its safety and feasibility.

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No CommentsTags: Acute Ischemic Stroke · Author: Phillip Erwin · Stroke

Strategies of Clopidogrel Load and Atorvastatin Reload to Prevent Ischemic Cerebral Events

May 20, 2013 · No Comments

G Patti, F Tomai, R Melfi, et al.  J Amer Coll Cardiol 2013;61(13):1379-87

This study by Patti et al. provides yet another new strategy by which ischemic events following CAS may be reduced.

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No CommentsTags: Author Beau Hawkins

Interdisciplinary Expert Consensus Document on Management of Type B Aortic Dissection

May 19, 2013 · No Comments

R Fattori, P Cao, P De Rango, et al. J Am Coll Cardiol 2013;61(16):1661-78.

Management strategies for type B aortic dissection have evolved with the greater availability of newer technologies such as thoracic endovascular repair (TEVAR). This document offers recommendations based on review of current literature on the prognoses and management of acute, subacute, and chronic type B aortic dissection. 

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No CommentsTags: Author: Joe Lau · TEVAR · Type B Aortic Dissection

Closure of Patent Foramen Ovale versus Medical Therapy after Cryptogenic Stroke

April 10, 2013 · No Comments

JD Carroll, JL Saver, DE Thaler, et al. N Engl J Med 2013; 368:1092-1100.

The optimal management of patients with cryptogenic stroke and a patent foramen ovale (PFO) is not known.  While the association between presumptive paradoxical embolism across a PFO and cryptogenic stroke dates to the 19th century, there has not been any definitive trial evidence that mechanical closure of PFOs prevents recurrent events in patients with cryptogenic stroke.

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No CommentsTags: Acute Ischemic Stroke · Anticoagulation · Author: Phillip Erwin · Patent foramen ovale · PFO · PFO Closure · Thrombotic Stroke

Treatment of Femoropopliteal In-Stent Restenosis With Paclitaxel-Eluting Stents

April 08, 2013 · No Comments

T Zeller, M Dake, G Tepe et al. JACC Cardiovasc Interv. 2013; 6(3):274-281

This study demonstrates that patients who have undergone revascularization of femoropopliteal ISR are likely to benefit from a paclitaxel-eluting nitinol stent.

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No CommentsTags: Author: Kevin Cohoon · In-Stent Restenosis · Peripheral Arterial Disease

Endovascular treatment for infrainguinal vessels in patients with critical limb ischemia: OLIVE Registry, a prospective, multicenter study in Japan with 12-month follow-up

March 12, 2013 · No Comments

O Iida, M Nakamura, Y Yamauchi, et al. Circ Cardiovasc Interv 2013;6:68-76 (Link).

Critical limb ischemia (CLI) is an increasingly prevalent condition associated with substantial morbidity and mortality. Though endovascular therapy (EVT) is often used as a first-line revascularization therapy for CLI patients, prospective data reporting outcomes in contemporary practice are needed.

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No CommentsTags: Author Beau Hawkins · Critical Limb Ischemia · Peripheral Arterial Disease

Endovascular Treatment for Acute Ischemic Stroke

March 11, 2013 · No Comments

A Ciccone, L Valvassori, M Nichelatti, et al. N Engl J Med 2013; 368:904-913 (Link).

Given the superior outcomes of primary PCI over thrombolysis in ST-elevation myocardial infarction, it is conceptually attractive to assume that in acute ischemic stroke, endovascular therapy, with recanalization rates superior to systemic thrombolyisis, would be superior to IV TPA . Ciccone, et al. challenge this premise with their provocative study that shows no difference in disability-free survival at 90 days. 

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No CommentsTags: Acute Ischemic Stroke · Author: Phillip Erwin · Stroke

Effect of Ramipril on Walking Times and Quality of Life Among Patients With Peripheral Artery Disease and Intermittent Claudication: A Randomized Control Trial

February 25, 2013 · No Comments

AA Ahimastos, PJ Walker, C Askew, et al. JAMA 2013;309;453-460 (Link).

Current drug treatments only provide modest improvement in the walk distance for patients with peripheral artery disease (PAD) and intermittent claudication. Results from previous trials investigating ramipril therapy in improving walk distance in claudicants have been mixed.  This randomized trial conducted by Ahimastos and colleagues demonstrate that ramipril therapy may lead to notable improvements in walking ability in patients with PAD.

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No CommentsTags: Author: Joe Lau · Claudication · Exercise · Peripheral Artery Disease