Search Results (87)

Background and Clinical Significance: Ruptured common iliac artery aneurysms may mimic urological disease, particularly when retroperitoneal bleeding causes ureteral compression and secondary hydronephrosis. This case is clinically relevant because the first symptom was acute stabbing testicular pain, followed by lumbar discomfort and ultrasound findings suggestive of obstructive uropathy. Case Presentation: A 73-year-old man with arterial hypertension and active smoking presented to the Emergency Department with sudden left lumbar pain that initially radiated to, or was perceived in, the left testicle. The testicular pain resolved spontaneously, but persistent poorly localized lumbar pain continued. He was afebrile and initially hemodynamically stable. Point-of-care ultrasound showed left hydronephrosis, while the abdominal aorta appeared unremarkable. Because the patient looked clinically unwell and the abrupt, stabbing onset was not fully explained by uncomplicated renal colic, contrast-enhanced abdominal and pelvic computed tomography was performed. CT revealed a fissured saccular aneurysm of the left common iliac artery with active contrast extravasation and a large retroperitoneal hematoma compressing the ipsilateral ureter, thereby causing secondary hydronephrosis. The patient underwent urgent endovascular treatment with percutaneous transluminal angioplasty and Bentley stent. Post-revascularization CT showed no further contrast extravasation, and the patient was discharged after seven days without complications. Conclusions: In older patients with cardiovascular risk factors, sudden testicular, flank, or lumbar pain may warrant consideration of retroperitoneal vascular emergencies, even when initial ultrasound suggests a urological diagnosis. In this patient, discordance between the clinical presentation and the initial ultrasound findings prompted contrast-enhanced CT, which enabled diagnosis and timely vascular management. Full article

This single-center prospective observational study evaluated peri-procedural changes in circulating markers of endothelial glycocalyx injury in patients with chronic limb-threatening ischemia undergoing lower extremity endovascular treatment. Fifty patients (mean age 72.2 years; 56% with diabetes mellitus; 42% current smokers) underwent percutaneous transluminal angioplasty, most commonly involving the femoropopliteal segment and using 4F introducer sheaths. Serum concentrations of syndecan-1, heparan sulfate, and hyaluronic acid were measured using ELISA before and one day after the procedure. No significant differences were observed between baseline and post-procedural biomarker levels, with minimal median changes, overlapping interquartile ranges, and negligible paired effect sizes. Although individual biomarker trajectories demonstrated considerable interindividual variability, no consistent directional trend was identified. Furthermore, demographic and clinical factors, including age, sex, diabetes, and smoking status, as well as procedural variables such as stent implantation, sheath size, and intervention level, were not associated with biomarker changes in univariate or multivariable analyses. These findings suggest that contemporary endovascular revascularization is biologically well tolerated and does not induce detectable systemic endothelial glycocalyx disruption. Nevertheless, the interpretation of these findings is limited by the moderate sample size and single-center design of the study. In addition, syndecan-1, heparan sulfate, and hyaluronic acid are not exclusive markers of endothelial glycocalyx injury and may also reflect extracellular matrix turnover and tissue remodeling. Full article

This study aimed to establish the first national diagnostic reference levels (DRLs) for coronary angiography (CAG) and interventional cardiology procedures in Korea, based on a nationwide patient-dose survey conducted in 2024. Radiation dose data were collected from 20 cardiovascular centers between April and December 2024 using a dedicated server system for radiation dose-structured reports, namely, Digital Imaging and Communications in Medicine. We classified 1980 procedures into the following seven procedural groups: CAG, CAG with percutaneous coronary intervention (CAG + PCI), CAG with percutaneous transluminal coronary angioplasty (CAG + PTCA), coronary spasm provocation, acute myocardial infarction (AMI), chronic total occlusion (CTO), and PCI alone. The DRLs were defined as the 75th percentile of the cumulative kerma–area product (KAP) and fluoroscopy time (FT). The established DRLs for KAP (Gy·cm²) were: CAG, 18.68; CAG + PCI, 63.40; AMI, 58.52; and CTO, 106.83. The corresponding DRLs for FT (s) were: CAG, 440.00; CAG + PCI, 1201.50; AMI, 947.64; and CTO, 2819.00. This study established the first official national DRLs for CAG and interventional cardiology procedures in Korea, using real-world clinical data. These reference levels provide a practical framework for institutions to benchmark radiation exposure, evaluate practice patterns, and optimize patient radiation safety. Full article

We describe a case of a 3-year-old girl with neurofibromatosis type 1 presenting with arterial hypertension, in whom multimodal vascular imaging identified significant right renal artery stenosis. The patient was successfully treated with percutaneous transluminal renal angioplasty; however, post-procedural Doppler ultrasound revealed a transient vascular fistula. Changes in renal arterial inflow during the procedure may have temporarily altered pressure gradients, facilitating the opening of communication involving pre-existing compensatory collateral vessels. This case illustrates the diagnostic value of multimodal vascular imaging in pediatric hypertension and highlights a rare, self-limiting post-interventional vascular phenomenon. Full article

Background/Objectives: No-reflow phenomenon (NRP) is a frequent and clinically relevant complication during percutaneous coronary intervention (PCI) of saphenous vein grafts (SVGs). The Naples Prognostic Score (NPS), a composite index reflecting systemic inflammation and nutritional status, may help identify patients at increased risk before the procedure. We investigated whether NPS predicts NRP in patients undergoing PCI/percutaneous transluminal coronary angioplasty (PTCA) for SVG stenosis. Methods: In this retrospective multicenter observational study, consecutive post-coronary artery bypass grafting patients undergoing PCI/PTCA for SVG stenosis were analyzed. NRP was defined as post-procedural thrombolysis in myocardial infarction (TIMI) flow grade <3 in the absence of dissection, residual stenosis, or vasospasm. NPS (0–4) was calculated from serum albumin, total cholesterol, neutrophil-to-lymphocyte ratio, and lymphocyte-to-monocyte ratio. Independent predictors of NRP were assessed using logistic regression, and discrimination was evaluated by receiver operating characteristic (ROC) analysis. Results: Among 252 patients, 55 (21.8%) developed NRP. NPS was significantly higher in the NRP group than in the normal-reflow group (2.61 ± 0.95 vs. 1.73 ± 0.95; p < 0.001). In multivariable analysis, NPS independently predicted NRP (per 1-point increase: odds ratio 2.577, 95% CI 1.428–5.384; p < 0.001 for univariate and 6.077, 95% CI 3.194–11.563; p < 0.001 for multivariate analysis), together with high thrombus burden (TIMI thrombus grades 4–5). NPS showed good discrimination for NRP (AUC 0.742; p < 0.001), with 75% sensitivity and 66% specificity at the optimal cut-off. Conclusions: NPS is a simple, readily available score that independently predicts angiographic no-reflow during SVG PCI and may aid preprocedural risk stratification and tailoring of preventive strategies. Full article

Background/Objectives: After the negative results of the SAMMPRIS trial, the indication for endovascular treatment of atherosclerotic intracranial artery stenosis (ICAS) was widely restricted. It was the aim of our study to report whether intracranial arterial percutaneous transluminal angioplasty and stenting (PTAS) as ultima ratio therapy is still effective and safe enough. Methods: Between February 2011 and June 2019, 63 consecutive patients with and without emergent large vessel occlusion (ELVO) who received PTAS for symptomatic ICAS in the anterior or vertebrobasilar circulation were included in our study. Results: A total of 32 patients had ELVO. In the remaining 31 patients, a known ICAS was treated with PTAS either because of recurrent stroke despite aggressive medical therapy with dual antiplatelet inhibition (n = 24) or due to progressive hemodynamic ischemia (n = 7). Stenting was successful in all 63 cases. Successful reperfusion was achieved in 94% of ELVO patients. Complications with new neurologic deficits, including dissection, subarachnoid hemorrhage, intracerebral hemorrhage (PH2), and stent thrombosis, were seen in five ELVO patients (16%). At discharge, neurological status improved in 16 patients (50%) and deteriorated in 7 patients (22%). In-hospital mortality happened in 5 of 32 ELVO cases (16%), and all of them had lesions in the vertebrobasilar circulation. Regarding non-ELVO cases, two patients (6%) developed new neurologic deficits due to perforator strokes. There was no in-hospital mortality in this group. Conclusions: Even in unfavorable situations with acute atherothrombotic occlusions or recurrent strokes under aggressive medical therapy of known ICAS, PTAS remains a treatment option with reasonable effectiveness. This should be balanced against other treatment options, taking into account the complication rate, which is not negligible. Full article

Background/Objectives: Endovascular therapy (EVT) is the treatment of choice for femoropopliteal artery (FPA) disease manifesting as critical limb-threatening ischemia (CLTI) or intermittent claudication (IC). This study aimed to compare the clinical outcomes of patients with CLTI with those of patients with IC after EVT in a real-world setting. Methods: In total, 1924 patients with FPA disease (CLTI: n = 812, IC: n = 1112) from the K-VIS ELLA (Korean Vascular Intervention Society Endovascular Therapy in Lower Limb Artery Diseases) registry who underwent EVT between 2006 and 2021 were analyzed. The primary endpoint was defined as target limb amputation or clinically driven (CD) target extremity revascularization (TER) 2 years after the procedure. Results: The incidence of the primary endpoint after inverse probability of treatment weighting (IPTW) was significantly higher in the CLTI group (hazard ratio [HR], 1.314; 95% confidence interval [CI], 1.105–1.561; p = 0.002). The incidences of loss of clinical patency, major adverse limb events (MALEs), and all-cause mortality were also higher in the CLTI group (hazard ratio [HR], 1.312; 95% confidence interval [CI], 1.157–1.488; p < 0.001). However, the risk of repeat percutaneous transluminal angioplasty (PTA) was similar between the groups (HR, 1.014; 95% CI, 0.833–1.234; p = 0.920). The use of drug-coated balloons (DCBs) was associated with favorable primary outcomes in both groups, particularly in patients with IC (HR: 0.429, 95% CI: 0.25–0.734; p = 0.002). Conclusions: Patients with CLTI undergoing EVT for FPA disease experienced worse clinical outcomes than those with IC, although the repeat PTA rates were similar. The use of DCBs showed promising results in both groups. Full article

Background/Objectives: The increasing use of endovascular procedures with common femoral artery (CFA) access has led to a rise in iatrogenic arterial injuries at this site. The most frequent injuries are pseudoaneurysms (PSA), retrograde dissections (RD), arteriovenous fistulas (AVF), and arterial perforations. Surgical repair is the standard treatment; however, the use of covered stents (CS) may represent a valid alternative, despite current instructions for use (IFU) not recommending CFA implantation. Methods: We conducted a single-center retrospective study on a prospectively maintained database. Patients undergoing transcatheter aortic valve repair (TAVR), endovascular aortic repair EVAR, diagnostic or therapeutic coronary angiography, or peripheral percutaneous transluminal angioplasty, who were subsequently treated for CFA injury with CS implantation between February 2015 and May 2024, were included. Endpoints were technical success (complete arterial repair), 30-day mortality, overall mortality, reintervention rates, and long-term stent patency. Results: A total of 41 patients were included: 10 (24.4%) PSA, 3 (7.3%) AVF, 27 (65.8%) perforations, and 2 (4.9%) RD. Of which 28 (68.3%) were treated with self-expandable CS and 13 (31.7%) with balloon-expandable CS. Additionally, 33 (80.5%) underwent urgent treatment. Technical success was achieved in 97.5%. Thirty-day mortality was 7.3%, with no procedure-related deaths. At a mean follow-up of 50.8 months (range 1–109), survival was 63.4%, with 100% stent patency and no procedure-related reinterventions. Conclusions: CS implantation for CFA iatrogenic injuries achieved high technical success and excellent long-term patency, representing a viable alternative to open repair. Further studies are needed to integrate CS use for CFA injuries into treatment algorithms and to update device IFUs accordingly. Full article

Venous stenosis or occlusion often hinders transvenous cardiac device lead implantation, especially in patients with prior devices or long-term venous access. Surgical alternatives and femoral routes carry higher risk. We retrospectively evaluated percutaneous transluminal angioplasty (PTA) in 11 patients with significant venous obstruction. Recanalization was successful in 10/11 cases (91%). Eight leads were implanted immediately, two delayed, with one re-occlusion linked to delay. No peri-procedural complications occurred. Technical success was defined as successful lead implantation through the recanalized vein; clinical success was defined as absence of subclavian venous syndrome (no arm pain or swelling) during follow-up. During follow-up, no symptomatic re-occlusion was observed. PTA appears safe and effective, with same-session lead implantation minimizing re-occlusion risk, offering a valuable alternative when conventional venous access is not feasible. Full article

Background/Objectives: The Tron FX is a stent retriever thrombectomy device that underwent a clinical trial in Japan in 2016. Its key feature is the availability of a 2/15 mm model designed for medium-vessel occlusion (MeVO). This study reports the results of postmarketing surveillance (PMS) conducted from 2019 to 2020. Methods: The PMS included data from 240 patients in whom a Tron FX was used during the first pass at 24 Japanese institutions. Occluded vessels involving the M2 and M3 segments of the middle cerebral artery, anterior cerebral artery, and posterior cerebral artery were classified as MeVO. The recanalization rate, first pass effect (FPE) rate, symptomatic intracranial hemorrhage (sICH) rate, and favorable prognosis rate at 90 days were evaluated. Treatment outcomes were also analyzed for cases in which the device was used after the second pass, excluding those with tandem occlusion, atherothrombotic brain infarction (ATBI), or percutaneous transluminal angioplasty (evaluation-appropriate cases), stratified by MeVO and large vessel occlusion (LVO) and according to Tron FX device size. Results: A total of 244 cases were enrolled, of which 218 were evaluation-appropriate. Across all cases, the recanalization rate (modified Thrombolysis in Cerebral Infarction score ≥ 2b) was 70.9%, the FPE rate was 23.4%, the sICH rate was 3.8%, and the proportion of patients with a good prognosis (modified Rankin Scale score 0–2 at 90 days) was 53.1%. Among evaluation-appropriate cases, excluding those with tandem lesions or ATBI, the corresponding rates were 72.9%, 24.8%, 6.9%, and 45.5%, respectively. When analyzed by occluded vessel type, the rates for MeVO were 71.9%, 23.7%, 6.1%, and 45.7%, respectively, while those for LVO were 74.0%, 26.0%, 7.7%, and 45.1%. According to device size, the outcomes for the 2/15 mm Tron FX were 72.9%, 23.5%, 4.7%, and 50.0%, respectively, and those for the 4/20 mm device were 72.9%, 25.6%, 8.3%, and 42.5%. Conclusions: The PMS results for the Tron FX thrombectomy device were excellent, particularly for MeVO and the 2/15 mm model. These findings suggest that the Tron FX may help improve thrombectomy outcomes in MeVO. Full article

Background/Objectives: The optimal method to facilitate femoral access in patients with aortic stenosis and severe peripheral arterial disease (PAD) undergoing transcatheter aortic valve implantation (TAVI) remains unclear. This study compared the safety and efficacy of percutaneous transluminal angioplasty (PTA) versus Shockwave^® intravascular lithotripsy (IVL) in patients with severe PAD undergoing TAVI via the trans-femoral route enrolled in the Hostile TAVI registry trial. Methods: Patients with severe PAD from 28 international centers were enrolled in the registry. This sub-study analyzed patients who underwent transfemoral TAVI facilitated by PTA (n = 352) or IVL (n = 166). Primary endpoints included rates of survival, major vascular complications, and major bleeding. Outcomes were also stratified according to the severity of PAD using the novel Hostile risk score. Results: Patients in the PTA group were older and had lower rates of prior stroke/TIA. All-cause mortality at 3 years was similar between PTA and IVL groups (34.9% vs. 38.6%; p = 0.27, respectively). However, IVL was associated with fewer major vascular complications (21.7% vs. 13.3%; p = 0.033, respectively), less major bleeding (14.0% vs. 7.0%; p = 0.024, respectively), and shorter hospital stays (7.06 ± 6.69 vs. 4.29 ± 4.78 days; p < 0.001; 95% CI: 1.63–3.91, respectively). Cox regression analysis showed that at low (≤8.5) Hostile Scores, PTA was associated with higher rates of major vascular complications and major bleeding than IVL. Conclusions: In patients with aortic stenosis and severe PAD undergoing TAVI via the transfemoral route, IVL is safer than PTA, with fewer vascular and bleeding complications but similar intermediate-term survival. Full article

Background: Intracranial atherosclerotic stenosis (ICAS) is a significant cause of ischemic stroke worldwide, with high recurrence rates despite optimal medical therapy. While endovascular stenting has been proposed as an adjunctive treatment, its clinical benefit remains controversial as a first line therapy. Objective: To evaluate the efficacy and safety of stenting plus medical therapy (STN+MT) compared to medical therapy alone (MT) in patients with symptomatic ICAS through a systematic review and meta-analysis of randomized controlled trials (RCTs). Methods: We systematically searched PubMed, Web of Science, the Cochrane Library, Embase, Scopus, and EBSCO for RCTs comparing STN+MT with MT in adult patients with symptomatic ICAS. Primary outcomes included transient ischemic attack (TIA), stroke, intracerebral hemorrhage (ICH), and death at 30 days and 1 year. Pooled risk ratios with 95% confidence intervals were calculated using random-effects or fixed-effects models as appropriate. Meta-regression was conducted to assess effect modification by study-level characteristics. Results: Four trials comprising 990 patients were included. STN+MT was associated with significantly higher 30-day risk of stroke and ICH compared to MT alone. No significant differences in TIA, stroke, ICH, or death were found at 1 year. Meta-regression revealed no significant effect modifiers, suggesting consistent findings across subgroups. Conclusions: Our meta-analysis consolidates the evidence that intracranial stenting as a first line therapy offers no significant advantage over medical therapy in preventing stroke in symptomatic ICAS, while it does pose added early risks. This holds true across different trials, patient demographics, and clinical scenarios examined. The consistency of this message across multiple RCTs provides a high level of evidence to guide practice. At present, aggressive medical therapy alone should be the default management for most patients. Endovascular intervention should be reserved for clinical trial settings or carefully selected salvage cases, until and unless new evidence emerges to change the risk–benefit calculus such as the promising use of balloon angioplasty in the BASIS trial. Full article

Background/Objectives: Noninvasive arrhythmic risk stratification in patients with ischemic heart disease is poor nowadays, and further investigations are needed. The most correct approach is based on the use of electrocardiogram (ECG) with the extraction of indices such as ECG alternans (ECGA). The aim of this study is to monitor the ECG evidence of ischemic coronary artery occlusion by the ECGA and to verify its ability to monitor the time course of balloon inflation, with the final goal of contributing to the exploration of the prognostic role of ECGA in ischemic heart disease. Methods: The ECGA amplitude and magnitude were computed by the correlation method (CM) on the STAFF III database, where ischemic coronary artery occlusion was induced in a controlled manner through coronary artery blockage by balloon inflation. ECGA computed during balloon inflation was also compared with periods before and after the inflation. Results: ECGA values became statistically higher during inflation than in the pre-inflation period and increased as inflation time increased, although not always in a statistically significant manner. ECGA went from values in the range 4–7 µV and 169–396 µV·beat before inflation to values in the range 5–9 µV and 208–573 µV·beat during 5 min of inflation (resulting statistically higher than before inflation), returning towards values in the range 4–8 µV and 182–360 µV·beat after inflation for amplitude and magnitude, respectively. Conclusions: CM-based ECGA detection was able to track the balloon inflation period. Our ECGA investigation represents a contribution in the field of research exploring its prognostic role as a noninvasive electrical risk index in ischemic heart disease. Full article

Background and Objectives: Post-transplant anastomotic pseudoaneurysms are a rare but serious complication of renal transplantation, typically requiring graft sacrifice. This case report demonstrates a novel hybrid approach for managing a mycotic pseudoaneurysm while preserving graft function. Case report: A 56-year-old male developed a pseudoaneurysm at the anastomotic site after cadaveric kidney transplantation, presenting with recurrent infections and declining renal function. Imaging confirmed the pseudoaneurysm. A hybrid strategy combining femoral–femoral bypass with a polytetrafluoroethylene graft, percutaneous transluminal angioplasty with stenting, and coil embolization was performed. Results: The intervention successfully isolated the pseudoaneurysm and preserved graft function. Post-procedure, serum creatinine levels improved, stabilizing at 2.3 mg/dL during follow-up. Imaging confirmed no residual flow in the aneurysm, and vascular complications were absent. Conclusions: This report highlights a successful combined surgical and endovascular approach for treating mycotic pseudoaneurysms, preserving graft function and restoring limb blood flow. This strategy offers a promising alternative for managing complex post-transplant complications, though long-term outcomes require further evaluation. Full article

Background: Residual stenosis and dissections occurring after femoro-popliteal percutaneous transluminal angioplasty (PTA) can compromise vessel patency and should therefore be properly dealt with at the time of the index procedure. Sometimes, the decision to optimize the PTA result may be challenging because it is based on evidence from angiography which, as a bi-dimensional imaging technique, has well-known limitations. Objectives: The objective of this study was to evaluate whether an intraoperative Doppler ultrasound (DUS) assessment of femoro-popliteal lesions that have undergone PTA allows for a more accurate definition of technical success compared to angiography. This was assessed through the identification of those lesions that, despite fulfilling angiographic criteria for technical success, have a functional relevance at DUS. Methods: In this cross-sectional study, data from 62 patients who had undergone femoro-popliteal PTA and intraoperative DUS were retrieved. The procedures were performed at two referral hospitals for peripheral interventions between 2018 and 2019. The selected patients had 48 residual stenoses in the range of 40–50% and 14 grade-C dissections. Results: The mean lesion length was 211 ± 85.2. Angiography-based and DUS-based technical success matched 41 lesions (66%). The remaining 21 lesions, which had abnormal DUS, were successfully optimized by post-dilatation or stenting in 19 cases. Finally, after PTA optimization, DUS-based and angiography-based technical success matched 95% of cases. Conclusions: An intraoperative DUS assessment of intermediate residual stenosis or grade C dissections occurring after PTA of long femoro-popliteal arteries allowed for a more accurate definition of technical success than angiography and guided a further PTA optimization in one-third of the cases. Full article