Antonios Polydorou

Treatment of Renal Artery Aneurysm With the Multilayer Stent

Purpose: To describe a new type of stent consisting of a 3-dimensional (3D) braided tube made of 2 interconnected layers without any covering to treat a renal artery aneurysm. Case Report: A 78-year-old hypertensive man with multiple comorbidities was incidentally found to have a large (28-×30 mm) saccular aneurysm in the main right renal artery involving the inferior renal artery. Via a percutaneous femoral approach, a 6–3×0-mm Multilayer stent was deployed easily in front of the aneurysm neck covering the inferior renal artery. Blood flow inside the sac was immediately and significantly reduced. All the renal artery branches remained patent. Blood pressure returned to normal after the procedure. At 6 months, angiography showed complete shrinkage of the aneurysm wall; all the inferior renal artery branches remained patent. Conclusion: The 3D multilayer fluid modulating stent concept appears to be a viable alternative for renal aneurysm exclusion. A larger study is underway to evaluate this new stent in other peripheral aneurysms.

Carotid angioplasty under cerebral protection with the percusurge guardwire system

The purpose of this study was to examine the possible beneficial effect of the PercuSurge GuardWire cerebral protection device based on balloon occlusion of the distal internal carotid artery and debris aspiration for patients undergoing carotid artery stenting (CAS). A total of 268 CAS procedures were attempted under cerebral protection using the PercuSurge GuardWire system in 242 patients (194 men; mean age, 71.2 ± 9.4 years; range, 40–91). The lesions were mainly atherosclerotic; 64% were symptomatic. Technical success was 99.3%. All lesions were stented except three postangioplasty restenoses. Prophylactic occlusion during balloon dilatation and stenting was well tolerated in 255 patients (95.9%). Microscopic analysis of the aspirated blood showed different types of particles numbering between 7 and 145 per procedure, with a mean diameter of 250 μm (mean, 56–2,652 μm). The 30‐day stroke and death rate was 2.3%, with four periprocedural complications at < 48 hr (one retinal embolism and three transient ischemic attacks), one intracerebral hemorrhage at 3 days, and one death of cardiac failure at 3 weeks. This technique appears safe and efficient with a low rate of periprocedural embolic events. Protection devices seem indispensable to perform CAS and expand the applicability of the procedure. Randomized studies (surgery vs. CAS with and without cerebral protection) are awaited. Catheter Cardiovasc Interv 2004;61:293–305.

New distal embolic protection device the FiberNet® 3 dimensional filter: First carotid human study

Objective: Evaluate the performance and safety of the FiberNet® Embolic Protection System during carotid artery intervention. Background: Carotid Angioplasty and Stenting (CAS) can be proposed to treat the majority of carotid stenoses. Brain embolization takes place and routine use of Embolic Protection Devices (EPD) is warranted. Many EPDs have significant limitations, which may be addressed by a new EPD, the FiberNet® (Lumen Biomedical, Plymouth, MN). Methods: The system consists of a 3‐dimensional expandable filter made of fibers, which expand radially, mounted onto a 0.014″ wire and retrieval catheter. FiberNet can capture particles as small as 40 μm without compromising flow. Results: 35 lesions treated in 34 patients. Male 67.6%. Age: 71.4 ± 8.8 (50–85). Average stenosis 84.5% ± 7.9 (70–99). 29.4% were symptomatic. Technical success: 34/35 (97%). No stroke or death within 30 days. Neurological events: two permanent amaurosis, one amaurosis fugax. All samples visually contained significant amounts of emboli. The mean surface area of debris caught was 63.8 mm2 (37.7–107.5). Comparisons were made with other EPDs. The mean surface area of debris caught was 12.2 mm2 (2.7–34.3). No changes were noted in CT/MRI at 30‐day post procedure. Conclusion: The first human use of this new novel EPD in carotid artery stenting is encouraging. The FiberNet was easy to use and confirmed the ability to capture particles less than 100 μm. The feasibility of the FiberNet has been demonstrated. Additional patients will demonstrate the overall safety and efficacy of this new EPD device.

Carotid angioplasty and stenting in octogenarians: Is it safe?

Purpose: Elderly patients have a higher risk of complications in carotid endarterectomy. The aim of the study was to evaluate whether carotid artery stenting (CAS) performed in octogenarians also increases the procedure related risk. Methods: 870 patients (male 626) mean age 70.9 ± 9.3 years underwent 930 CAS for de novo lesions (n = 851) restenoses (n = 54) post radiation (n = 14) inflammatory arteritis (n = 9) post trauma aneurysms (n = 2). Indications for treatment: symptomatic carotid stenosis ≥ 70% (n = 577) or asymptomatic stenosis ≥ 80%. Patients were separated into two age groups: <80 years (749 patients, 806 CAS) and >80 years (121 patients, 124 CAS). 187 CAS performed without protection (N.P−) 6 patients >80 years, 743 with protection (NP+) (occlusion balloon: 334, filters: 404, reversal flow: 6) 118 patients >80 years. Data analysis included neurological complications, death and myocardial infarction (MI) rate at 30 days, anatomical particularities. Technical points will be described depending on the age of the patient. Results: Technical success 804/806 in patients <80 years, 123/124 in patients >80 years (NS). 30 days outcomes: in the patient group <80 years we observed 9 TIA (1.1%) 3 without NP (1.7%) 6 with NP (0.9%), 5 minor strokes (0.6%) 2 without NP (1.1%) 3 with NP (0.5%), 3 major strokes: 2 without NP (1.1%) 1 with NP (0.2%), 5 deaths (0.6%) 2 without NP (1.1%) 3 with NP (0.5%). Death/stroke/MI: 14 (1.8%) 6 without NP (3.3%), 8 with NP (1.3%). In the group >80 years, we observed 2 TIA (1.7%) 1 without NP 1 with NP (0.92%) 1 minor stroke without NP (17%) no major stroke, no death. Death/stroke/MI 1 without NP (17%). Conclusion: CAS can be performed in elderly patients without higher risk than in younger patients. But good indications, a meticulous technique, protection devices are mandatory and some technical points must be pointed out to avoid neurological complications and failures.

The Carotid and Supra-Aortic Trunks: Diagnosis, Angioplasty and Stenting

The carotid and supra-aortic trunks :diagnosis, angioplasty, and stenting / , The carotid and supra-aortic trunks :diagnosis, angioplasty, and stenting / , کتابخانه مرکزی دانشگاه علوم پزشکی تهران

Impact on myocardial reperfusion using the M-Guard stent in primary percutaneous coronary intervention for ST-elevation myocardial infarction

reperfusion injury in a realistic rodent model of acute limb ischemia. Circulation 2008;118(19):1920–8. [8] Eikelboom JW, Hirsh J. Monitoring unfractionated heparin with the aPTT: time for a fresh look. Thromb Haemost 2006;96(5):547–52. [9] Liu A, Dirsch O, Fang H, et al. HMGB1 in ischemic and non-ischemic liver after selective warm ischemia/reperfusion in rat. Histochem Cell Biol 2011;135(5):443–52. [10] Ling Y, Yang ZY, Yin T, et al. Heparin changes the conformation of high-mobility group protein 1 and decreases its affinity toward receptor for advanced glycation endproducts in vitro. Int Immunopharmacol 2011;11(2):187–93.

Endovascular Treatment of Aortic Aneurysms: the Role of the Multilayer Stent

The Takotsubo syndrome or apical ballooning, also known as “broken heart syndrome” (BHS) among a variety of suggested names, was first described by Sato et al in the Japanese population approximately 20 years ago. Since then, it has been increasingly recognized in other countries and in 2006 it was classified as a type of stress cardiomyopathy among acquired cardiomyopathies. The prevalence of the BHS is estimated to be 1-2% of patients presenting with an acute coronary syndrome but higher rates have been reported lately, due to a wider recognition of the syndrome. One of the hallmarks of the BHS is a strict predilection for postmenopausal women (over 90% in most series), whereas men account for less than 10% of cases. It has also been reported that among BHS patients, 43% had a preceding acute medical condition and 27% had a severe emotional or physical stressor associated with a “fight or flight” hypersympathetic response... (excerpt)Patients with diabetes mellitus have more advanced coronary artery disease (CAD) eith greater plaque burden, longer lesions, smaller, more diffusely diseased vessels. On the other hand, approximately 25% undergoing percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) have diabetes. Regardless of the type of revascularization, diabetic patients have worse prognosis compared to patients without diabetes. With regards to PCI, diabetic patients have a higher restenosis rate and are at greater risk for myocardial infarction and stent thrombosis than patients without diabetes... (excerpt)

Carotid Plaque Texture Analysis Using 3-Dimensional Volume Ultrasonic Imaging

The principles of 3-dimensional (3D) image reconstruction from a series of consecutive two-dimensional (2D) ultrasound images and the measurement of plaque volume and plaque surface irregularity have been described in Chaps. 16 and 17.