Lianrui Guo

A phase I clinical study of naked DNA expressing two isoforms of hepatocyte growth factor to treat patients with critical limb ischemia.

The purpose of the present phase I clinical trial was to evaluate the safety, tolerability, and preliminary efficacy of naked DNA therapy expressing two isoforms of hepatocyte growth factor (pCK‐HGF‐X7) in critical limb ischemia (CLI) patients.

Endovascular Stenting vs. Extrathoracic Surgical Bypass for Symptomatic Subclavian Steal Syndrome

Purpose To analyze the immediate and long-term outcomes of endovascular stenting vs. extrathoracic surgical bypass for subclavian steal syndrome. Methods From 1989 to 2010, 252 consecutive patients (173 men; mean age 62 years) with vertebrobasilar and upper extremity symptoms of subclavian steal were treated with balloon-expandable stents (n = 148) or extrathoracic surgical bypasses (n = 104: 71 axilloaxillary and 33 carotid-subclavian) using polytetrafluoroethylene grafts. Results The technical success rate was 97.3% in the stent group vs. 99.0% for the bypass group (p=0.605). There was no perioperative mortality or any permanent neurological deficit in either group. The overall perioperative complication rate was 6.1% in the stent group vs. 9.6% in the bypass group (p=0.295). The 10-year target vessel revascularization rate was 46.6% for stenting vs. 5.8% for bypass (p<0.001). The cumulative primary patency rates at 1, 3, 5, and 10 years were 91%, 78%, 67%, and 49% for the stent group vs. 99%, 97%, 95%, and 89% for the bypass group (p<0.001). The cumulative secondary patency rates were 95%, 91%, 86%, and 64%, respectively, for the stent group vs. 99%, 99%, 98%, and 94% for the bypass group (p=0.001). No difference was detected in overall survival curves between the groups (p=0.527). Conclusion Both endovascular stenting and extrathoracic surgical bypass are safe and effective treatments for subclavian steal syndrome in the short and medium term; however, extrathoracic surgical bypasses are more durable in the long term.

Drug-eluting vs. bare metal stents for symptomatic vertebral artery stenosis.

Purpose To evaluate the immediate and long-term outcomes of drug-eluting stent (DES) vs. bare metal stent (BMS) for symptomatic vertebral artery stenosis (VAS). Methods From 2003 to 2010, 206 consecutive patients (158 men; mean age 66.8 years) underwent DES (sirolimus-eluting or paclitaxel-eluting) or BMS placement for symptomatic extracranial and intracranial stenoses in 219 vertebral arteries. The technical success, clinical success, periprocedural complications, target vessel revascularization (TVR), and overall survival were compared between the DES and BMS groups. Results The technical success rate was 98.3% (119/121) for the DES group vs. 100% for the BMS group (p=0.503). The clinical success rate was 95.5% (107/112) for the DES group vs. 97.9% (92/94) for the BMS group (p=0.592). No periprocedural death or stroke occurred. The overall periprocedural complication rate was 2.7% (3/112) in the DES group vs. 4.3% (4/94) in BMS group (p=0.813). The median follow-up was 43 months (range 3–95) for the DES group and 46 months (range 6–89) for BMS. At last follow-up, the TVR rate was 6.3% (7/112) for the DES group vs. 20.2% (19/94) for the BMS group (p=0.003); 4 (3.6%) patients in the DES group and 8 (8.5%) patients in the BMS group experienced a VBS stroke (p=0.132). By life-table analysis, the 5-year TVR rate was 4.5% (5/112) for the DES group vs. 19.1% (18/94) for the BMS group (p=0.001). No difference was detected in the overall survival curves between the groups (p=0.500). Conclusion Both DES and BMS are feasible, safe, and effective for symptomatic VAS. However, DES can significantly decrease the TVR rate in the long term compared with BMS.

Endovascular repair of subclavian artery aneurysms: results from a single-center experience:

Objective: To present our experience of the endovascular treatment of subclavian artery aneurysms (SAAs) and analyze the clinical manifestations, imaging findings and treatment outcomes. Methods: In this retrospective study, nine patients with SAAs underwent endovascular stent placement in our center between July 2011 and June 2016. Clinical features, imaging findings, treatment outcomes and follow-up results of these SAA patients were retrospectively analyzed. Results: Nine patients were diagnosed with SAAs by computer tomography angiography (CTA). Five patients underwent percutaneous endovascular stent placement in the subclavian artery. Three patients underwent endovascular repair of the SAAs with coil embolization and stent graft. One patient underwent stent graft implantation by the simultaneous kissing stent technique. Five patients had their symptoms relieved and thrombosis occurred in one case. The mean follow-up period was 17 months, ranging from 8 to 40 months. Conclusion: For patients with SAAs, endovascular treatment is a feasible choice, with a high success rate, few complications and good clinical outcomes.

Three-Year Clinical Results of Carotid Artery Stenting in Treating Patients with Contralateral Carotid Artery Occlusion

BACKGROUND Patients presenting a carotid stenosis and contralateral carotid occlusion (CCO) have been historically considered at high risk of carotid surgical treatment, and there are few data regarding short-term recovery after stenting therapy in patients with CCO. The aim of this study is to evaluate the short-term recovery and safety of stenting for patients with CCO and different subgroup population. METHODS We retrospectively reviewed the records of consecutive patients with CCO who were treated with stenting endovascular methods between 2008 and 2014. The postoperative outcomes were analyzed according to age, ischemic symptom, cerebral infarction history, and collateral situation subgroups, respectively. RESULTS Fifty-eight consecutive patients with CCO were treated and 49 (84.5%) completed a 3-year follow-up. There were significant higher stroke, myocardial infarction, or death events in the aged (≥75 years old) group and poor collateral group (P = .007 and .0024, respectively). There was no difference in the 3-year primary endpoint incidence between the cerebral ischemia symptom subgroups and cerebral infarction history subgroups. Event-free survival, aged group, and poor collateral group were lower (P = .007 and P = .0024, respectively). CONCLUSIONS Carotid artery stenting (CAS) for patients with common carotid artery is a safe and effective therapy. Factors such as age 75 years or older and poor collateral are associated with a higher 3-year rate of postprocedural stroke, myocardial infarction and death, and lower event-free survival in patients with CCO treated by CAS. Meanwhile, our data do not show a significant impact of cerebral ischemic symptom and cerebral infarction history on clinical outcome of patients with CCO undergoing CAS.

Angiojet rheolytic thrombectomy combined with catheter fragmentation in a patient presenting with massive pulmonary embolism and cardiogenic shock

Massive pulmonary embolism (MPE) is associated with a high rate of mortality, and chronic thromboembolic pulmonary hypertension leads to ongoing morbidity among many survivors. Here we report a case of a MPE successfully treated by Angiojet rheolytic thrombectomy combined with catheter fragmentation. This is the first report of the use of these two methods together for MPE treatment.

A comparative study of percutaneous atherectomy for femoropopliteal arterial occlusive disease

BACKGROUND SilverHawk™ directional atherectomy has been used to treat more than 300 thousand cases of lower extremity atherosclerotic occlusive disease in the world since it was approved by FDA in 2003. This study aimed to analyze the safety and effectiveness of symptomatic femoral popliteal atherosclerotic disease treated by directional atherectomy (DA). METHODS Clinical data of all consecutive patients treated with percutaneous atherectomy utilizing the SilverHawk™ plaque excision was retrospectively analyzed. The anatomic criteria of the atherosclerotic lesions were divided into four types: type I stenosis; type II occlusion; type III in-stent restenosis; type IV stent occlusion. RESULTS There were 160 patients treated during the study period. Intermittent claudication in 75 patients (47%), rest pain in 55 patients (34.5%) and tissue loss in 30 patients (18.5%). The number of patients was 72, 15, 49 and 24 in type I, II, III and IV lesions, respectively. Technical success rate was 98.6%, 93.3%, 97.9% and 91.7% in type I, II, III and IV lesions, respectively. Debris of intimal plaque was captured by protection device in 92 patients (71.3%). The mean follow-up period was 23.5±10.4 months. Restenosis rate of type I to IV lesions was 21%, 36%, 36% and 40% respectively. Restenosis rate in type I lesion was significantly lower than that in type III and IV lesions (P<0.05). Patients with tissue loss responded to revascularization as follow: type I, 11/13 healed or reduced (84.6%), type II, 3/3 patients improved (100%), type III, 5/6 patients improved (83.3%) and type IV 4/4 healed (100%). In type IV group, four patients had in-stent thrombosis found by postoperative Duplex ultrasonography. They all underwent DA after catheter-directed thrombolysis with good angiographic results. CONCLUSIONS Percutaneous DA is safe and effective for both de-novo atherosclerotic and in-stent stenotic or occlusive lesions. Thrombolysis before plaque excision is recommended in case of in-stenting thrombosis.