In our experience, the use of this device is very useful for the revascularization of chronic femoral occlusions, even calcific, in which an accurate re-entry cannot be achieved with the conventional subintimal technique. In these cases, the Outback device grants high technical success rates and a significant reduction of procedural and fluoroscopy times.
3D time-resolved contrast-enhanced MRI allows quantitative evaluation of pulmonary regional perfusion in patients affected by COPD, identifying patients in which perfusion defects are resolved in the clinical-stabilization phase. This technique might allow the identification of patients in whom vasospasm may be the main responsible of pulmonary hypoperfusion during acute COPD exacerbation, with potential advantages on the clinical management of these patients.
When a heel lesion is present and the transcutaneous oximetry recorded on the dorsum of the foot does not confirm the presence of critical limb ischemia (not ≤30 mmHg), a second oximetry recorded on the rearfoot is useful to point out ischemia of the peroneal artery and/or of the posterior tibial artery.
“Carotid blowout syndrome” is defined as a hemorrhage caused by rupture of the carotid artery and its branches, and may be a severe complication of rhinopharyngeal carcinoma. This study aimed to highlight the usefulness and versatility of endovascular stent-graft placement as a rescue treatment in life-threatening carotid blowout syndrome. We describe the unconventional use of a 6×5 mm balloon-expandable coronaric covered stent in a patient with a diagnosis of spinocellular rhinopharyngeal carcinoma, followed by carotid blowout syndrome. Although long-term follow-up is needed to assess the eventuality of bleeding recurrence, the immediate clinical results were satisfactory.
AIMS: The primary aim is the evaluation of the usefulness of intravascular ultrasound (IVUS) in the identification of otherwise unnoticed complications during carotid stenting. The secondary aim is the evaluation of the impact of IVUS assistance in the procedural outcomes and long-term patency rates of carotid artery stenting. MATERIALS AND METHODS: Sixty patients who underwent carotid artery stenting (CAS) during a 14-month period were evaluated prospectively. Thirty patients (50%) underwent IVUS assisted CAS, 30 patients (50%) underwent CAS using angiography as the unique diagnostic tool. All patients were enrolled through a primary duplex ultrasound evaluation; as a secondary evaluation, 54 patients (90%) underwent a preprocedural magnetic resonance angiography, whereas six patients (10%) underwent computed tomography-angiography. Patients with preocclusive stenoses (≥85%) were excluded. Mean follow-up was 23 ± 5.3 months. RESULTS: No periprocedural or late complications were observed. No statistical significance was observed in long-term stent patency between the two groups. Mean procedural time length of IVUS-assisted procedures was 10.3 ± 5 min longer than non-IVUS-assisted procedures. Virtual histology (VH) IVUS evaluation of plaque morphology led to a different stent choice in three patients. In two cases, the IVUS assessment revealed a suboptimal stent deployment, solved by angioplasty; in one patient VH-IVUS detected plaque protrusion through stent cells, immediately treated by manual aspiration. CONCLUSIONS: Though not recommended as a routine intraprocedural evaluation, IVUS may be useful for a real-time CAS control when treating challenging plaques, such as 'soft' or lipidic ones or those prone to rupture, or whenever an intraprocedural morphologic evaluation is required for the appropriate stent choice, or when higher embolic risk is evaluated.
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