Search Results (21)

Two geriatric (>9 years old) dogs presented with vomiting, depression, and anorexia and were diagnosed with extrahepatic biliary obstruction (EHBO) secondary to ruptured gallbladder mucoceles. Diagnosis was based on serum biochemical analysis, abdominal radiography, and ultrasonography, which revealed gallbladder rupture, peritonitis, and common bile duct dilation. Both dogs underwent emergency surgical intervention involving cholecystectomy and choledochal stent placement in the common bile duct without cholecystojejunostomy or cholecystoduodenostomy. Postoperatively, the clinical symptoms and serum chemistry values improved, and both dogs survived without recurrence for over one year. These cases demonstrate that choledochal stenting can be an effective adjunct to cholecystectomy for managing EHBO in dogs with ruptured gallbladder mucoceles, potentially preventing reocclusion and promoting recovery, especially when histopathological evaluation is not feasible in clinical settings. However, persistent elevation of liver enzymes may occur postoperatively, necessitating prolonged monitoring and medical management in some cases. Full article

Objectives: Differentiation of hyperdense areas on non-contrast computed tomography (NCCT) images as hemorrhagic transformation (HT) and contrast accumulation (CA) after endovascular thrombectomy (EVT) in acute ischemic stroke (AIS) patients are critical for early antiplatelet and anticoagulant therapy. This study aimed to predict HT and CA on initial NCCT using deep learning. Material and Methods: This study was conducted between January and December 2024. The study included 556 images of 52 patients (21 female and 31 male) who underwent EVT due to AIS, with hyperdense areas observed in the NCCT examination within the first 24 h post-EVT. The evaluated images were labeled as ‘contrast accumulation’ and ‘hemorrhagic transformation’. These labeled images were trained with nine different models under a convolutional neural network (CNN) architecture using a large dataset, such as ImageNet. These models are DenseNet201, InceptionResNet, InceptionV3, NASNetLarge, ResNet50, ResNet101, VGG16, VGG19 and Xception. After training the CNN models, their performance was evaluated using accuracy, loss, validation accuracy, validation loss, F1 score, Receiver Operating Characteristic (ROC) Curve, confusion matrix, confidence interval, and p-value analysis. Results: The models trained in the study were derived from 556 images in data sets obtained from 52 patients; 186 images in training data for CA and 186 images training data for HT (with an increase to 558 images), 115 images used for validation data, and 69 images were compared using test data. In the test set, the Area Under the Curve (AUC) metrics showing sensitivity and specificity values under different cutoff points for the models were as follows: DenseNet201 model AUC = 0.95, InceptionV3 model AUC = 0.93, NasNetLarge model AUC = 0.89, Xception model AUC = 0.91, Inception_ResNet model AUC = 0.84, Resnet50 and Resnet101 models AUC = 0.74. The InceptionV3 model demonstrates the best performance with an F1 score of 0.85. Recall scores generally ranged between 0.62 and 0.85. Conclusions: In our study, hyperdensity areas in initial NCCT images obtained after EVT in AIS patients were successfully differentiated from HT and CA with high accuracy using CNN architectures. Our findings may enable the early identification of patients who would benefit from anticoagulation or antiplatelet therapy to prevent re-occlusion or progression after EVT. Full article

Objective: The objective of this study is to compare the long-term outcomes of femorofemoral crossover bypass (FCOB) and endovascular treatment (ET) in managing iliac artery occlusions. Methods: The data of 200 patients with iliac artery lesions who were treated at a single center within 7 years were evaluated retrospectively. Of these, 82 (41%) underwent FCOB, and 118 (59%) received ET. Primary outcomes included patency, limb salvage, and survival rates, while secondary outcomes assessed complications, including wound infections and restenosis. Follow-up was conducted over a median of 4.98 years. Results: Primary patency (PP) rates after 3 years were 80% for FCOB and 88% for ET. Primary assisted patency (PAP) was 95% for FCOB and 93% for ET. Secondary patency (SP) was 97% for FCOB and 98% for ET. Both FCOB and ET achieved comparable long-term outcomes in limb salvage, 94% in both groups at 8 years. ET demonstrated advantages in shorter hospital stays (1.49 ± 2.51 vs. 8.21 ± 9.82 days, p < 0.0001) and lower perioperative complications, including transfusion rates (3.4% vs. 13.4%, p = 0.01226). However, FCOB exhibited lower restenosis rates (6.1% vs. 20.39%, p = 0.00441), despite a higher rate of reocclusion (19.5% vs. 6.8%, p = 0.00800). Survival rates at 8 years were 54% for FCOB and 67% for ET. Conclusions: ET is the preferred first-line approach due to its minimally invasive technique, shorter recovery time, and fewer complications. FCOB remains essential for patients with complex lesions or when ET is not feasible, offering durable long-term outcomes. Appropriate treatment selection should consider both the patient’s condition and clinical and anatomical factors to optimize the best possible patient outcomes. Full article

Diabetic foot syndrome is often associated with inflammation. The aim of this study was to evaluate the impact of improved blood supply on the change in the clinical status and culturable bacteriota of chronic wounds. Patients with diabetic foot and peripheral arterial disease with a Rutherford score of 5 or 6 were included (n = 23). The blood supply to the limb was assessed with laboratory tests and two time-point qualitative cultures using a wound biopsy. The baseline parameters of the blood supply to the limb were Transcutaneous Oxygen Perfusion (TCPO2) of 15.0 mmHg, an Ankle Brachial Index (ABI) of 0.7, and a Toe Brachial Index (TBI) of 0.1, with an average Wound, Infection, Inflammation (WIfI) score of 5.7 (high). The most frequently isolated pathogens were Staphylococcus aureus (26.1%), followed by the Enterobacteriaceae family and Pseudomonas spp. (13.0%, each). Negative cultures were present in 47.8% (n = 11). The control parameters of blood supply improved; TCPO2 was 38.5 mmHg, the ABI was 0.9, and the TBI was 0.3, with a reduction in the average WIfI score to 3.7 (mild), while total colony-forming units (CFUs) increased by 13.5%. No cases of reocclusion or restenosis were observed during the study; however, small amputations were performed in two patients (8.7%). Five (21.7%) ulcers were significantly reduced and two (8.7%) progressed, while a negative culture at follow-up was obtained in five fewer patients than at baseline and nine patients presented growth despite having an initial negative result. Quantitative reduction was obtained in four (17.4%) cases. Pathogen distribution at follow-up resembled baseline findings. Optimizing clinical environments (enhancing blood flow and controlling inflammation) in general over focusing singularly on microbiota composition or revascularization seems to be crucial and arguably outweighed the impact of microbial change alone; in particular, reperfusion may increase the conditions to bacterial growth at the first stage. Full article

Background: Re-occlusion of initially recanalized arteries after thrombectomy is a significant concern that may lead to poor outcomes. This study aimed to identify the risk factors and evaluate the prognosis of arterial re-occlusion following successful thrombectomy in patients diagnosed with emergent large-vessel occlusion (ELVO). Methods: We retrospectively analyzed data from 155 consecutive patients with ELVO who underwent mechanical thrombectomy (MT). Patients were classified into two groups according to whether the initial recanalized artery was re-occluded within 7 days after successful thrombectomy: re-occlusion and non-occlusion groups. Multivariate analysis was performed for potentially associated variables with p < 0.20 in the univariate analysis to identify the independent risk factors of re-occlusion. Differences in clinical outcomes were also assessed in these two groups. Results: Re-occlusion occurred in 10.3% of patients (16/155). Multivariate analysis demonstrated that large artery atherosclerosis (odds ratio [OR]: 3.942, 95% confidence interval [CI]: 1.247–12.464; p = 0.020), the number of device passes (OR: 2.509, 95% CI: 1.352–4.654; p = 0.004), and residual thrombus/stenosis (OR: 4.123, 95% CI: 1.267–13.415; p = 0.019) were independently associated with re-occlusion. Patients with re-occlusion had significantly worse NIHSS scores at discharge and lower opportunities for achieving functional independence at 3 months after MT than patients without re-occlusion. Conclusions: Large artery atherosclerosis, a high number of thrombectomy device passes, and residual thrombus/stenosis seemed to promote re-occlusion after successful recanalization. Timely identification and proper treatment strategies to prevent re-occlusion are warranted to improve clinical outcomes, especially among high-risk patients. Full article

Background and Objectives: Percutaneous coronary intervention (PCI) of chronic total occlusion (CTO) is often associated with longer total stent length. Our aim was to evaluate the long-term safety and effectiveness of bioresorbable scaffold (BRS) implantation in CTO to avoid using a full metal jacket. Materials and Methods: We conducted a single-center prospective longitudinal case study including 34 patients who underwent PCI of CTO with at least one BRS and drug-eluting stent (DES) implantation (n = 27) or BRS-only at the Latvian Centre of Cardiology between 2016 and 2018. Quantitative coronary angiography (QCA) and intravascular ultrasound were performed during the index procedure and long-term follow-up. Results: Of 34 patients with a mean age of 60.6 ± 9.5 years, 76.5% were male. The most common CTO artery was the right coronary artery (73.5%, n = 25). The median length of occlusion was 23.0 mm (interquartile range (IQR) = 13.9–32.7), with a total mean BRS/DES length of 49.6 ± 20.4 mm. During the median follow-up of 5.6 years (IQR = 5.0–5.9), the primary endpoint of target vessel re-occlusion occurred in 5.9% (n = 2) of patients. Target lesion revascularization (TLR) was performed in 35.3% (n = 12) of patients, with a mean time to TLR of 62.5 (95% confidence interval (CI), 53.9–71.2) months. Through QCA, there was a statistically significant increase in median residual diameter stenosis (20.1–31.4%, p < 0.01) and residual length of stenosis (5.2–7.1%, p = 0.04) compared with the index procedure. Conclusions: Our study demonstrates that BRS is a safe and feasible option for PCI of CTO, allowing for the avoidance of long segment stenting and ensuring long-term patency of the coronary artery. Full article

Factor XIII is a transglutaminase enzyme that plays a crucial role in hemostasis and wound healing. It crosslinks fibrin strands, stabilizing clots and promoting clot resistance to fibrinolysis. Additionally, Factor XIII has been found to have multiple other functions that extend beyond coagulation, including the regulation of inflammation and tissue repair processes. Emerging evidence suggests that Factor XIII may also have differential roles in acute myocardial infarction and ischemic stroke, two common cardiovascular events with significant morbidity and mortality. In acute myocardial infarction, Factor XIII has been implicated in promoting clot stability and reducing the risk of re-occlusion. In ischemic stroke, Factor XIII may also contribute to the pathogenesis of cerebral ischemia by promoting clot formation and exacerbating neuronal damage. Several studies have investigated the association between Factor XIII and these cardiovascular events, using various approaches such as genetic polymorphism analysis, animal models, and clinical data analysis. These studies have provided important insights into the role of Factor XIII in acute myocardial infarction and ischemic stroke, highlighting its potential as a therapeutic target for interventions aimed at improving outcomes in these conditions. In this review, we will summarize the current understanding of Factor XIII’s role in acute myocardial infarction and ischemic stroke. Full article

The injury-triggered reocclusion (restenosis) of arteries treated with angioplasty to relieve atherosclerotic obstruction remains a challenge due to limitations of existing therapies. A combination of magnetic guidance and affinity-mediated arterial binding can pave the way to a new approach for treating restenosis by enabling efficient site-specific localization of therapeutic agents formulated in magnetizable nanoparticles (MNPs) and by maintaining their presence at the site of arterial injury throughout the vulnerability period of the disease. In these studies, we investigated a dual-targeted antirestenotic strategy using drug-loaded biodegradable MNPs, surface-modified with a fibrin-avid peptide to provide affinity for the injured arterial wall. The MNPs were characterized with regard to their magnetic properties, efficiency of surface functionalization, disassembly kinetics, and interaction with fibrin-coated substrates. The antiproliferative effects of MNPs formulated with paclitaxel were studied in vitro using a fetal cell line (A10) exhibiting the defining characteristics of neointimal smooth muscle cells. Animal studies examined the efficiency of combined (physical/affinity) MNP targeting to stented arteries in Sprague Dawley rats using fluorimetric analysis and fluorescent in vivo imaging. The antirestenotic effect of the dual-targeted therapy was determined in a rat model of in-stent restenosis 28 days post-treatment. The results showed that MNPs can be efficiently functionalized to exhibit a strong binding affinity using a simple two-step chemical process, without adversely affecting their size distribution, magnetic properties, or antiproliferative potency. Dual-targeted delivery strongly enhanced the localization and retention of MNPs in stented carotid arteries up to 7 days post-treatment, while minimizing redistribution of the carrier particles to peripheral tissues. Of the two targeting elements, the effect of magnetic guidance was shown to dominate arterial localization (p = 0.004 vs. 0.084 for magnetic targeting and peptide modification, respectively), consistent with the magnetically driven MNP accumulation step defining the extent of the ultimate affinity-mediated arterial binding and subsequent retention of the carrier particles. The enhanced arterial uptake and sustained presence of paclitaxel-loaded MNPs at the site of stent deployment were associated with a strong inhibition of restenosis in the rat carotid stenting model, with both the neointima-to-media ratio (N/M) and % stenosis markedly reduced in the dual-targeted treatment group (1.62 ± 0.2 and 21 ± 3 vs. 2.17 ± 0.40 and 29 ± 6 in the control animals; p < 0.05). We conclude that the dual-targeted delivery of antirestenotic agents formulated in fibrin-avid MNPs can provide a new platform for the safe and effective treatment of in-stent restenosis. Full article

Purpose: To evaluate the potential differences in characteristics of femoropopliteal in-stent restenosis (ISR) stratified by stent design with a focus on the swirling flow-inducing BioMimics 3D helical centerline stent. Methods: Patients with ISR of the superficial femoral and popliteal arteries undergoing reintervention were included in this study. The primary endpoint was the angiographic localization and extent of restenosis or reocclusion with the following five different stent systems: SMART Control stent, Supera peripheral stent, GORE^® VIABAHN^® endoprosthesis, BioMimics 3D stent, and Zilver^® PTX^® stent. Results: 414 ISR lesions were analyzed, affecting 236 Supera stents, 67 BioMimics 3D stents, 48 Zilver^® PTX^® stents, 38 SMART Control stents, and 25 VIABAHN^® endoprostheses. The mean stent diameter and length were 5.7 ± 0.77 mm and 121.4 ± 94.8 mm, respectively. ISR included 310 (74.9%) lesions with 1 stent, 89 (21.5%) lesions with 2 stents, 14 (3.4%) lesions with 3 stents, and 1 lesion (0.2%) with 4 stents. Most lesions presented as reocclusions (67.4%) rather than focal (13.3%) or diffuse restenoses (19.3%). No significant differences in ISR lesion morphology were found. By trend, BioMimics 3D stent lesion extension was more focal (16.4% versus 12.7%, p = 0.258), with the highest proportion of lesions in which only the proximal stent third was affected (9.0% versus 5.8%, p = 0.230), as compared to the average of the other four devices. The occlusion rate was the second lowest for the BioMimics 3D stent (64.2 vs. 68.0%, p = 0.316). Risk factors for restenosis or occlusion were active smoking, pre-interventional occlusion, and popliteal intervention. Conclusion: Our results suggest that the helical centerline stent design of the BioMimics 3D stent, which results in a swirling flow with increased wall shear stress, may offer protective properties over straight stent designs, including DES and endoprosthesis, regarding localization and extension of restenosis. Prospective, randomized studies are warranted. Full article

Peripheral arterial disease (PAD)-induced ischemia is an important component of diabetic foot syndrome (DFS). The results of revascularization of the lower extremity arteries (including percutaneous transluminal angioplasty [PTA]) do not always give satisfactory long-term results, which is due to many factors. The aim of the study was to investigate the alterations in selected circulating angiogenic factors and microcirculation parameters in 41 patients with DFS following PTA and analyze their relationships with clinical outcomes during 1-year follow-up. Our study revealed a general decrease in pro-angiogenic factor levels after PTA and their subsequent stabilization during subsequent observation. The results indicated a significant association between plasma circulating FGF-2 level and poor outcomes (including the incidence of restenosis/reocclusion of treated arteries) during 12 months of observation. The perioperative changes in FGF-2 showed a significant association with LDF alterations after PTA. Follow-up 1–3 months post-intervention showed a tendency towards elevated TcpO2, VEGF-A, and VEGF-R2 levels in patients free from adverse events. These results may provide a basis for further research on the potential use of selected circulating angiogenic factors for monitoring the treatment of patients with DFS following PTA. Full article

Acute lower limb ischemia (ALI) is a common vascular emergency, requiring urgent revascularization by open or endovascular means. The aim of this retrospective study was to evaluate patient demographics, treatment and periprocedural variables affecting the outcome in ALI patients in a consecutive cohort in a tertiary referral center. Primary outcome events (POE) were 30-day (safety) and 180-day (efficacy) combined mortality and major amputation rates, respectively. Secondary outcomes were perioperative medical and surgical leg-related complications and the 5-year combined mortality and major amputation rate. Statistical analysis used descriptive and uni- and multivariable Cox regression analysis. In 985 patients (71 ± 9 years, 56% men) from 2004 to 2020, the 30-day and 180-day combined mortality and major amputation rates were 15% and 27%. Upon multivariable analysis, older age (30 d: aHR 1.17; 180 d: 1.27) and advanced Rutherford ischemia stage significantly worsened the safety and efficacy POE (30 d: TASC IIa aHR 3.29, TASC IIb aHR 3.93, TASC III aHR 7.79; 180 d: TASC IIa aHR 1.97, TASC IIb aHR 2.43, TASC III aHR 4.2), while endovascular treatment was associated with significant improved POE after 30 days (aHR 0.35) and 180 days (aHR 0.39), respectively. Looking at five consecutive patient quintiles, a significant increase in endovascular procedures especially in the last quintile could be observed (17.5% to 39.5%, p < 0.001). Simultaneously, the re-occlusion rate as well as the number of patients with any previous revascularization increased. In conclusion, despite a slightly increasing early re-occlusion rate, endovascular treatment might, if possible, be favorable in ALI treatment. Full article

Percutaneous transluminal angioplasty (PTA) is widely performed for arteriovenous fistula (AVF) that fails to mature after initial formation. We observed that some immature AVFs re-occlude earlier than others. We sought to investigate the predictors for early post-intervention failure of immature fistulas after primary PTA. We retrospectively reviewed the records and angiographic images of patients who had immature fistulas and thereby received PTA between 2013 and 2019 at our center. We investigated the short-term post-intervention outcomes of the patients within 90 days post-PTA. Patients who had re-occlusion within the period were defined as the early failure group and the rest as the patent group. We investigated factors associated with early failure. There were 80 eligible patients with 22 brachio-cephalic (BC) and 58 radio-cephalic (RC) AVFs. The median age of the patients was 64 years [range, 38–87]. There were 51 (63%) males and 29 (36%) females. Among the 58 RC AVFs, 10 (17%) patients had early failure. Logistic regression analysis showed that a larger artery to fistula (A/F) diameter ratio was the sole independent predictor of early failure after primary PTA (odd ratio 2.29 [1.023–5.147], p value = 0.044). Although further studies on a larger scale are required to confirm the clinical significance, a larger A/F diameter ratio was a potential predictor of early re-occlusion in immature fistulas after primary PTA. Full article

Local tirofiban infusion has been reported as a rescue strategy for intracranial atherosclerotic stenosis (ICAS)-related stroke. However, the long-term outcomes of local tirofiban infusion during endovascular reperfusion therapy (ERT) for ICAS-related stroke are still uncertain. This study aimed to investigate the long-term outcomes of local tirofiban infusion during ERT. We retrospectively analyzed acute patients with ICAS-related stroke who were treated with local tirofiban as a rescue strategy during ERT. The primary outcomes were ischemic stroke, transient ischemic stroke (TIA), and stroke-related death within 30 days. Secondary outcomes included ischemic stroke and TIA beyond 30 days and up to 2 years after ERT in the corresponding treated vessel, symptomatic brain hemorrhage, any stroke, and non-stroke-related death. During a median follow-up of 24.0 months, 12 patients developed an ischemic stroke and TIA (4 within 30 days and 8 afterward). The 1-year risk of stroke and TIA was 9.2% (95% confidence interval, 8.0–18.6%). This study demonstrates that 1-year outcomes of local tirofiban infusion were comparable to the results of intracranial stenting in patients with symptomatic ICAS. Local tirofiban infusion for ICAS-related stroke may be a feasible rescue strategy that can have a bridging role until the maximum effect of antiplatelet agents is achieved. Full article

Background and Purpose: Previous studies showed that acute reocclusion after endovascular therapy is related to residual stenosis. However, we observed that reperfusion status but not residual stenosis severity is related to acute reocclusion. This study aimed to assess which factor mention above is more likely to be associated with artery reocclusion after endovascular treatment. Methods: This study included 86 acute ischemic stroke patients who had middle cerebral artery (MCA) atherosclerotic occlusions and received endovascular treatment within 24 h of a stroke. The primary outcomes included intraprocedural reocclusion assessed during endovascular treatment and delayed reocclusion assessed through follow-up angiography. Results: Of the 86 patients, the intraprocedural reocclusion rate was 7.0% (6/86) and the delayed reocclusion rate was 2.3% (2/86). Regarding intraprocedural occlusion, for patients with severe residual stenosis, patients with successful thrombectomy reperfusion showed a significantly lower rate than unsuccessful thrombectomy reperfusion (0/30 vs. 6/31, p = 0.003); on the other hand, for patients with successful thrombectomy reperfusion, patients with severe residual stenosis showed no difference from those with mild to moderate residual stenosis in terms of intraprocedural occlusion (0/30 vs. 0/25, p = 1.00). In addition, after endovascular treatment, all patients achieved successful reperfusion. There was no significant difference in the delayed reocclusion rate between patients with severe residual stenosis and those with mild to moderate residual stenosis (2/25 vs. 0/61, p = 0.085). Conclusion: Reperfusion status rather than residual stenosis severity is associated with artery reocclusion after endovascular treatment. Once successful reperfusion was achieved, the reocclusion occurrence was fairly low in MCA atherosclerosis stroke patients, even with severe residual stenosis. Full article

Balloon angioplasty and stent implantation are standard techniques to reopen stenotic vessels. Often, balloons or stents coated with cytostatic drugs are used to prevent re-occlusion of the arteries. Resveratrol, which is known for its numerous beneficial effects on cardiovascular health, is used as an antioxidant additive on paclitaxel-coated balloon catheters. What is still unclear is whether resveratrol-only balloon coating in combination with a bare metal stent (BMS) also has positive effects on vascular healing. Here, we analyzed neointimal thickening, fibrin deposition, inflammation, vasa vasorum density, and reendothelialization after implantation of BMS via a resveratrol coated balloon approach in a porcine model. In general, resveratrol treatment did not result in significantly altered responses compared to the control group in peripheral arteries. In coronary arteries, an increase in vasa vasorum density became evident three days after resveratrol treatment compared to the control group and abolished up to day 7. Significant effects of the resveratrol treatment on the fibrin score or intima-media area were transient and restricted to either peripheral or coronary arteries. In conclusion, local single-dose resveratrol treatment via a resveratrol-only coated balloon and BMS approach did not lead to adverse systemic or local effects, but also no significant beneficial effects on vascular healing were detected in the current study. Full article