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Abstract No. 45: Severity of renal artery lesions in patients enrolled into the CORAL trial
5:03 PM
Abstract No. 44
Single center experience with a cobalt chromium balloon expandable stents for treatment of atherosclerotic renal artery stenosis S. Honig, A. Stangl, F. Nowakowski, E. Kim, J.L. Weintraub, R. Lookstein; Mount Sinai Hospital, New York, NY. Purpose: To report a single center experience in the use of cobalt chromium balloon expandable stents in the treatment of de novo atherosclerotic renal artery stenosis. Materials and Methods: Over a 28 month period at a single clinical site, 61 consecutive patients (22 Male, 39 Female) (mean age 73 years; 53-92) underwent placement of 82 cobalt chromium balloon expandable stents to treat de novo atherosclerotic renal artery stenosis. Procedural data for all cases were recorded in an endovascular database. All cases were scheduled for clinical and imaging follow up using duplex or MDCT angiography at one month, six months, twelve months, and annually thereafter. All case were reviewed for clinical and technical details of the procedure, including incidence of complications. All cases were reviewed for primary patency assessed by duplex or MDCT angiography. The effect of stent placement on renal function was assessed by estimated creatinine clearance (CrCl) at follow up. Results: Technical Success for delivery and deployment of the stents was 100%. All procedures were performed using intraprocedrual unfractionated heparin and peri-procedural dual anti-platelet therapy. 5 patients had bleeding complications at the access site requiring transfusion (8%). 43 patients (70%) underwent surveillance with duplex ultrasonography and the remaining 18 patients underwent surveillance with MDCT angiography. Mean follow up for this cohort was 9.1 months (1-24 months). In-stent restenosis was observed in 6/78 stents (8%) at 6 month follow up and 7/55 stents (13%)at 12 month follow up. No stent occlusions were observed at follow up. Mean CrCl at baseline was 54ml/min (17-128). At follow up mean CrCl was 60ml/min (17-154). Conclusion: Cobalt chromium balloon expandable stents have an excellent technical success rate and primary patency for treatment of de novo atherosclerotic renal atery stenosis. Renal function was preserved in this cohort at follow up. Further studies are warranted to compare the results of this novel stent design with existing balloon expandable stents for this application. 5:15 PM
Abstract No. 45
Severity of renal artery lesions in patients enrolled into the CORAL trial A.H. Matsumoto1, C. Cooper2, T. Murphy3, D. Cutlip4, M. Conaway5, L. Dworkin6; 1Radiology, University of
Purpose: To determine the severity of renal artery stenosis (RAS) in patients enrolled in the randomized phase of the CORAL Trial in comparison to lesion severity in the patients enrolled in the GREAT, ASPIRE-II, and STAR Trials. Materials and Methods: The database from the angiographic Corelab for the CORAL Trial was assessed for the percent diameter stenosis distribution. The presence of global renal ischemia (bilateral RAS, RAS in a solitary kidney, or unilateral RAS with a total renal artery occlusion in the contralateral kidney), and the translesion pressure gradients (when obtained) were also determined from the Corelab database. Results: To date, 611 randomized subjects had a mean percent diameter RAS by QVA of 67.9%, and a median stenosis of 68.1%, with a standard deviation of 13.2%. The distribution of percent stenoses reveals that 74% of patients had a ⱖ 60% stenosis, 45% had a ⬎ 70% stenosis, and 21% had a stenosis ⬎ 80%. About 7% of patients had a diameter stenosis ⬍ 50%. 19.4% of the patients had global ischemia. Although translesion pressure gradients were not required per study protocol, 176 patients underwent pressure measurements. The mean and median peak systolic pressure gradients were 46 mmHg and 37 mmHg, respectively, with a standard deviation of 27.6 mmHg. The peak systolic pressure gradients had a direct correlation with the percent diameter (P⬍0.0001). In the GREAT Trial (JVIR 2005; 16:1195-1202), the mean percent diameter stenosis by Corelab QVA was 68.2% ⫾ 12% with a median of 65.9%. For the ASPIRE II (JACC 2005; 46:776-783), the mean percent stenosis by Corelab QVA was 61.5%. In the STAR Trial (Ann Int Med 2009; 150: 840-48.), a Corelab was not employed and 12 of 64 (18.75%) patients enrolled in the stent arm had ⬍ 50% diameter stenosis. Conclusion: CORAL investigators are enrolling patients with renal artery stenosis at least as severe as other published Trials. When compared to the most recent randomized renal stent Trial, fewer patients in CORAL have ⬍50% diameter lesions. 5:27 PM
Abstract No. 46
Computed tomography perfusion imaging in an endovascular model of rabbit hindlimb ischemia: A functional quantification of arteriogenesis A. Karatzas, K. Katsanos, A. Diamantopoulos, D. Karnabatidis, D. Siablis; University Hospital of Patras, Patras, Greece. Purpose: Therapeutic stimulation of arteriogenesis is an attractive research field of leg ischemia treatment. We applied Computed Tomography Perfusion (CTP) imaging of the process of arteriogenesis in an endovascular model of rabbit hindlimb ischemia. Materials and Methods: Unilateral femoral artery coil embolization was performed in 10 New Zealand White rabbits using a novel approach through the auricular artery.CTP was carried out at 3,10,20 and 40-day intervals with contrast S19
SUNDAY
Conclusion: Prevalence of abnormal ABI is high among those otherwise not considered at high risk using conventional Framingham-based risk assessment.
Virginia Health System, Charlottesville, VA; 2University of Toledo Medical Center, Toledo, OH; 3Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Providence, RI; 4Harvard Clinical Research Institution, Boston, MA; 5Public Health Sciences, University of Virginia Health System, Charlottesville, VA; 6Medicine, The Warren Alpert Medical School of Brown University, Providence, RI.
Scientific Sessions
14.2% (Exact 95% CI 11.9%-16.8%). A low FRS was observed in 256 participants (31.1%), intermediate in 414 participants (50.4%), and 152 participants (18.5%) had high FRS. Among participants with low FRS, 11.3% had abnormal ABI; and among participants with intermediate FRS, 12.8% had abnormal ABI. Overall, 10.0% of the 822 PEDAL participants had abnormal ABI but were otherwise at low-intermediate FRS and would not be considered for aggressive risk factor management.
Abstract No. 44
Single center experience with a cobalt chromium balloon expandable stents for treatment of atherosclerotic renal artery stenosis S. Honig, A. Stangl, F. Nowakowski, E. Kim, J.L. Weintraub, R. Lookstein; Mount Sinai Hospital, New York, NY. Purpose: To report a single center experience in the use of cobalt chromium balloon expandable stents in the treatment of de novo atherosclerotic renal artery stenosis. Materials and Methods: Over a 28 month period at a single clinical site, 61 consecutive patients (22 Male, 39 Female) (mean age 73 years; 53-92) underwent placement of 82 cobalt chromium balloon expandable stents to treat de novo atherosclerotic renal artery stenosis. Procedural data for all cases were recorded in an endovascular database. All cases were scheduled for clinical and imaging follow up using duplex or MDCT angiography at one month, six months, twelve months, and annually thereafter. All case were reviewed for clinical and technical details of the procedure, including incidence of complications. All cases were reviewed for primary patency assessed by duplex or MDCT angiography. The effect of stent placement on renal function was assessed by estimated creatinine clearance (CrCl) at follow up. Results: Technical Success for delivery and deployment of the stents was 100%. All procedures were performed using intraprocedrual unfractionated heparin and peri-procedural dual anti-platelet therapy. 5 patients had bleeding complications at the access site requiring transfusion (8%). 43 patients (70%) underwent surveillance with duplex ultrasonography and the remaining 18 patients underwent surveillance with MDCT angiography. Mean follow up for this cohort was 9.1 months (1-24 months). In-stent restenosis was observed in 6/78 stents (8%) at 6 month follow up and 7/55 stents (13%)at 12 month follow up. No stent occlusions were observed at follow up. Mean CrCl at baseline was 54ml/min (17-128). At follow up mean CrCl was 60ml/min (17-154). Conclusion: Cobalt chromium balloon expandable stents have an excellent technical success rate and primary patency for treatment of de novo atherosclerotic renal atery stenosis. Renal function was preserved in this cohort at follow up. Further studies are warranted to compare the results of this novel stent design with existing balloon expandable stents for this application. 5:15 PM
Abstract No. 45
Severity of renal artery lesions in patients enrolled into the CORAL trial A.H. Matsumoto1, C. Cooper2, T. Murphy3, D. Cutlip4, M. Conaway5, L. Dworkin6; 1Radiology, University of
Purpose: To determine the severity of renal artery stenosis (RAS) in patients enrolled in the randomized phase of the CORAL Trial in comparison to lesion severity in the patients enrolled in the GREAT, ASPIRE-II, and STAR Trials. Materials and Methods: The database from the angiographic Corelab for the CORAL Trial was assessed for the percent diameter stenosis distribution. The presence of global renal ischemia (bilateral RAS, RAS in a solitary kidney, or unilateral RAS with a total renal artery occlusion in the contralateral kidney), and the translesion pressure gradients (when obtained) were also determined from the Corelab database. Results: To date, 611 randomized subjects had a mean percent diameter RAS by QVA of 67.9%, and a median stenosis of 68.1%, with a standard deviation of 13.2%. The distribution of percent stenoses reveals that 74% of patients had a ⱖ 60% stenosis, 45% had a ⬎ 70% stenosis, and 21% had a stenosis ⬎ 80%. About 7% of patients had a diameter stenosis ⬍ 50%. 19.4% of the patients had global ischemia. Although translesion pressure gradients were not required per study protocol, 176 patients underwent pressure measurements. The mean and median peak systolic pressure gradients were 46 mmHg and 37 mmHg, respectively, with a standard deviation of 27.6 mmHg. The peak systolic pressure gradients had a direct correlation with the percent diameter (P⬍0.0001). In the GREAT Trial (JVIR 2005; 16:1195-1202), the mean percent diameter stenosis by Corelab QVA was 68.2% ⫾ 12% with a median of 65.9%. For the ASPIRE II (JACC 2005; 46:776-783), the mean percent stenosis by Corelab QVA was 61.5%. In the STAR Trial (Ann Int Med 2009; 150: 840-48.), a Corelab was not employed and 12 of 64 (18.75%) patients enrolled in the stent arm had ⬍ 50% diameter stenosis. Conclusion: CORAL investigators are enrolling patients with renal artery stenosis at least as severe as other published Trials. When compared to the most recent randomized renal stent Trial, fewer patients in CORAL have ⬍50% diameter lesions. 5:27 PM
Abstract No. 46
Computed tomography perfusion imaging in an endovascular model of rabbit hindlimb ischemia: A functional quantification of arteriogenesis A. Karatzas, K. Katsanos, A. Diamantopoulos, D. Karnabatidis, D. Siablis; University Hospital of Patras, Patras, Greece. Purpose: Therapeutic stimulation of arteriogenesis is an attractive research field of leg ischemia treatment. We applied Computed Tomography Perfusion (CTP) imaging of the process of arteriogenesis in an endovascular model of rabbit hindlimb ischemia. Materials and Methods: Unilateral femoral artery coil embolization was performed in 10 New Zealand White rabbits using a novel approach through the auricular artery.CTP was carried out at 3,10,20 and 40-day intervals with contrast S19
SUNDAY
Conclusion: Prevalence of abnormal ABI is high among those otherwise not considered at high risk using conventional Framingham-based risk assessment.
Virginia Health System, Charlottesville, VA; 2University of Toledo Medical Center, Toledo, OH; 3Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Providence, RI; 4Harvard Clinical Research Institution, Boston, MA; 5Public Health Sciences, University of Virginia Health System, Charlottesville, VA; 6Medicine, The Warren Alpert Medical School of Brown University, Providence, RI.
Scientific Sessions
14.2% (Exact 95% CI 11.9%-16.8%). A low FRS was observed in 256 participants (31.1%), intermediate in 414 participants (50.4%), and 152 participants (18.5%) had high FRS. Among participants with low FRS, 11.3% had abnormal ABI; and among participants with intermediate FRS, 12.8% had abnormal ABI. Overall, 10.0% of the 822 PEDAL participants had abnormal ABI but were otherwise at low-intermediate FRS and would not be considered for aggressive risk factor management.