The presence of long and heavily calcified lesions predisposes for fracture in patients undergoing stenting of the first part of the subclavian artery

Hüttl, András Béla; Hüttl, Artúr; Vértes, Miklós; Nguyen, Dat Tin; Bérczi, Ákos; Hüttl, Kálmán; Dósa, Edit

doi:10.1016/j.jvs.2019.01.056

Cited by 10 publications

(12 citation statements)

References 28 publications

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“…10 The incidence of fracture was found to be 35% in patients who had stenting of the prevertebral subclavian artery either with balloon-expandable or self-expandable models. 11 The 39% SF rate revealed by the current study is in keeping with these experiences. The relatively high prevalence of fractures in patients with innominate, subclavian, and CCA stents can be explained by the fact that the impact of vessel movement on metal fatigue and fracture through the transmission of mechanical forcesd such as flexion, torsion, and tension/compression during the cardiac cycledis quite pronounced in these vascular regions.…”

Section: Discussionsupporting

confidence: 87%

“…8 Except for one study including eight patients with proximal CCA stenting by Usman et al, 9 no detailed information is available about the incidence of CCA SFs. We hypothesized that CCA SFs, similar to innominate and subclavian artery SFs, 10,11 are common owing to the close proximity of the beating heart and the shear forces from the curvature of the aortic arch. 9 The primary objective of this study was to examine the prevalence of SFs after endovascular treatment of the proximal third of the CCA and to determine the correlation between SFs and ISR as well as reintervention rates.…”

mentioning

confidence: 99%

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The incidence and risk factors of stent fracture in patients treated for proximal common carotid artery stenosis

Vértes

Nguyen

Székely

et al. 2020

Journal of Vascular Surgery

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Section: Discussionsupporting

confidence: 87%

mentioning

confidence: 99%

The incidence and risk factors of stent fracture in patients treated for proximal common carotid artery stenosis

Vértes

Nguyen

Székely

et al. 2020

Journal of Vascular Surgery

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“…Regarding the type of fracture, we observed a greater number of type II and III fractures, eight cases out of 12 (66%), and a higher rate of flow impairment, that is, six out of eight stents (75%) with stenosis / occlusion. This fact contrasts with data from the literature that suggest that simpler fractures (I and II) have little clinical significance, while more complex ones (III to V) often cause more stenoses 12 .…”

Section: Endovascular Treatment Of Femoral Obstructivecontrasting

confidence: 87%

Stents in the femoropopliteal territory: prevalence of fractures and their consequences

Daher

Lopez

Duarte

2020

Rev. Col. Bras. Cir.

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Endovascular treatment for femoropopliteal arterial disease has made revascularization procedures less invasive, but the self-expanding stents used can suffer great wear in arteries with extreme mobility. Objective: to evaluate the prevalence of fractures in stents implanted in the femoropopliteal segment, to identify predisposing factors and consequences on arterial patency. Method: between March and June 2019, thirty patients previously operated for femoropopliteal obstruction underwent stent X-rays in anteroposterior and lateral views to detect fractures and Doppler to analyze arterial patency. Results: we observed 12 cases with fractures (33.3%): 1 type I (2.8%), 3 type II (8.3%), 5 type III (13.9%), 3 type IV (8.3%) and no type V. According to the TASC II we had 1 in group B (8.3%), 6 in group C (50%) and 5 in group D (41.6%) p <0.004. The number of stents per limb was 3.1 (± 1.3) in cases of fracture versus 2.3 (± 1.3) in cases without fracture (p = 0.08). The extension was 274.17mm (± 100.94) in cases of fracture and 230.83mm (± 135.44) in cases without fracture (p = 0.29). On Doppler we had: 17 patients (47.2%) without stenosis, 9 patients (25%) with stenosis> 50% and 10 patients (27.8%) with occlusion (p = 0.37). There was no correlation between fracture and arterial obstruction (p = 0.33). Conclusion: stent fractures are a frequent finding in the femoropopliteal area (33.3%), being more prevalent in cases of more advanced disease (C and D). There was no association between the finding of fracture and arterial obstruction.

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“…Percutaneous transluminal angioplasty can be used as a treatment for plaque-induced vascular stenosis (44). However, the presence of calcification changes the morphology and compliance of the vascular wall, which reduces the effectiveness of angioplasty and stent deployment and is prone to poor stent attachment or even fractures (20). There is still a lack of effective therapy for vascular calcification.…”

Section: Discussionmentioning

confidence: 99%

Macrophage galectin-3 enhances intimal translocation of vascular calcification in diabetes mellitus

Sun

Zhang

et al. 2020

American Journal of Physiology-Heart and Circulatory Physiology

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The clinical risks and prognosis of diabetic vascular intimal calcification (VIC) and medial calcification (VMC) are different. This study aims to investigate the mechanism of VIC/VMC translocation. Anterior tibial arteries were collected from patients with diabetic foot amputation. The patients were then divided into VIC and VMC groups. There were plaques in all anterior tibial arteries, while the enrichment of galectin-3 in arterial plaques in the VIC group was significantly higher than that in the VMC group. Furthermore, a macrophage/vascular smooth muscle cell (VSMC) coculture system was constructed. VSMC-derived extracellular vesicles (EVs) was labeled with fluorescent probe. After macrophages were pretreated with recombinant galectin-3 protein, the migration of VSMC-derived EVs and VSMC-derived calcification was more pronounced. And anti-galectin-3 antibody can inhibit this process of EVs and calcification translocation. Then, lentivirus (LV)-treated bone marrow cells (BMCs) were transplanted into apolipoprotein E-deficient (ApoE−/−) mice, and a diabetic atherosclerosis mouse model was constructed. After 15 wk of high-fat diet, ApoE−/− mice transplanted with LV-shgalectin-3 BMCs exhibited medial calcification and a concentrated distribution of EVs in the media. In conclusion, upregulation of galectin-3 in macrophages promotes the migration of VSMC-derived EVs to the intima and induces diabetic vascular intimal calcification. NEW & NOTEWORTHY The clinical risk and prognosis of vascular intimal and medial calcification are different. Macrophage galectin-3 regulates the migration of vascular smooth muscle cell-derived extracellular vesicles and mediates diabetic vascular intimal/medial calcification translocation. This study may provide insights into the early intervention in diabetic vascular calcification.

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The presence of long and heavily calcified lesions predisposes for fracture in patients undergoing stenting of the first part of the subclavian artery

Cited by 10 publications

References 28 publications

The incidence and risk factors of stent fracture in patients treated for proximal common carotid artery stenosis

The incidence and risk factors of stent fracture in patients treated for proximal common carotid artery stenosis

Stents in the femoropopliteal territory: prevalence of fractures and their consequences

Macrophage galectin-3 enhances intimal translocation of vascular calcification in diabetes mellitus

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