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CRT-300.04 Comparison of Devices in Carotid Artery Stenting: A Vascular Quality Initiative Analysis of Commonly Used Carotid Stents and Embolic Protection Devices
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JACC: CARDIOVASCULAR INTERVENTIONS, VOL. 10, NO. 3, SUPPL S, 2017
CRT-300.03 Role of Transthoracic Echocardiography in the Preoperative Evaluation of Patients with Critical Limb Ischemia Undergoing Surgical Bypass
CONCLUSION Current stent-EPD combinations used in CAS are equally efficacious in preventing inpatient stroke/TIA and have similarly low rates of inpatient neurologic events.
Noor A. Al-Asady, Ashwat S. Dhillon, Sarah Elsayed, David M. Shavelle, Vincent L. Rowe, Leonardo C. Clavijo USC, Keck School of Medicine, Los Angeles, CA BACKGROUND Peripheral surgical bypass for treatment of critical limb ischemia (CLI) is associated with an increased 30-day cardiovascular event rate (8.8% MACE, 1.5% cardiac arrest, 4.7% myocardial infarction, 1.4% stroke and 2.7% death). The purpose of this study is to evaluate 30-day cardiac outcomes in CLI patients after open surgical bypass. We hypothesize that routine transthoracic echo (TTE) screening is an effective initial imaging strategy to risk stratify patients with CLI prior to surgery.
RESULTS Mean age was 62.511 years and 60.5% of patients were male. TTE identified 46 patients (60.5%) with regional wall motion abnormality and 21 patients (27.6%) with left ventricular systolic dysfunction. Fifty-two patients (68.4%) underwent pharmacologic nuclear stress testing based on TTE result and 15 patients had demonstrable myocardial ischemia (19.73%). Fourteen patients (19.3%) had coronary angiography, 11 patients (85%) had significant CAD (defined as lesion 50%). Coronary revascularization was performed in 8 patients. Overall 30 day MACE was 3.96% and death occurred in one patient, 50% lower than historical controls. CONCLUSION Routine TTE screening is an effective initial imaging strategy to risk stratify patients with CLI before peripheral surgical bypass; its use may decrease post-operatory cardiovascular complications. CRT-300.04 Comparison of Devices in Carotid Artery Stenting: A Vascular Quality Initiative Analysis of Commonly Used Carotid Stents and Embolic Protection Devices Ashwat S. Dhillon, Sisi Li, Juan Pablo Lewinger, Leonardo C. Clavijo, David M. Shavelle, Ray V. Matthews, Fred A. Weaver, Parveen Garg University of Southern California, Los Angeles, CA BACKGROUND Data regarding the efficacy of the various stent and embolic protection device (EPD) combinations to prevent stroke during carotid artery stenting (CAS) is limited. We compared postprocedure inpatient neurologic outcomes across the carotid stent-EPD combination platforms recorded in the Vascular Quality Initiative (VQI) registry. METHODS We analyzed 9428 consecutive CAS procedures in the VQI registry performed between January 1, 2005 and December 31, 2015. The most commonly used stent-EPD combinations (Table) were included in the analysis. Post-procedure inpatient neurologic outcomes included (1) any stroke or transient ischemic attack (TIA) and (2) ipsilateral stroke/TIA. Multivariate analysis was done, adjusting for age, gender, smoking history, CHF, prior stroke/TIA, hypertension, prior carotid endarterectomy or CAS, coronary artery disease and presence of a second ipsilateral stenosis >70%. RESULTS Of the 9428 CAS procedures, Xact-Emboshield (n¼1647, 17.4%), Precise-Angioguard (n¼1439, 15.2%), Acculink-Accunet (n¼815, 8.6%) and Acculink-Emboshield (n¼516, 5.5%) were the most commonly used combinations, accounting for a total of 4417 procedures. Baseline characteristics were similar across the device combinations (64% male, mean age 70 10 years). Event rate of inpatient ipsilateral stroke/TIA ranged from 2.2-3.2% and the rate of any inpatient stroke/TIA across the device combinations was similarly low (2.9-4.2%) without any statistically significant differences. Multivariate analysis demonstrated no difference in inpatient risk of ipsilateral stroke/TIA or any stroke/TIA across the device combinations (Table).
CRT-300.06 ABSTRACT WITHDRAWN CRT-300.07 Total Endovascular Caval Reconstruction for the Treatment of Inferior Vena Cava Agenesis Jeffrey Forris Beecham Chick,1 Matthew L. Osher,1 Steven David Abramowitz,2 David M. Williams,1 Mohammed Forris Beecham Noor3 1 University of Michigan Health System, Ann Arbor, MI; 2MedStar Washington Hospital Center, Washington, DC; 3FIU, Ann Arbor, MI PURPOSE To report the technical success, complications, and longterm patency of iliocaval reconstruction for the treatment of inferior vena cava (IVC) agenesis. MATERIALS AND METHODS 30 (3%) patients with suspected IVC agenesis were identified from a venous registry of 994 patients from 2000 until 2016. Patients included 23 males and 7 females with mean age of 32 years (range: 13-63 years). Computed tomography (CT), magnetic resonance imaging (MRI), both CT and MRI, or prior venography was available in 20, 5, 4, and 1 patient, respectively. Review of imaging demonstrated true IVC agenesis in 27 (90%) patients and IVC atresia/chronic thrombosis in 3 (10%). In those with true IVC agenesis, imaging demonstrated complete absence of the entire IVC (n¼6), infrarenal IVC (n¼6), hepatic IVC (n¼5), infrahepatic IVC (n¼4), segmental absence of the IVC between the liver and kidney (n¼3), suprahepatic IVC (n¼2), and suprarenal IVC (n¼1). Patients presented with lower extremity deep venous thrombosis (n¼10), iliocaval thrombosis (n¼9), lower extremity swelling (n¼6), and lower extremity varicosities (n¼5). Treatment type, technical success, stent type, number, and diameter, anticoagulation, and complications were recorded. 6, 12, and 24-month primary and secondary patencies were calculated. RESULTS 3 patients failed to present for treatment. 25 (93%) patients underwent iliocaval reconstruction. Technical success was 92%. 2 patients underwent thrombolysis only. Stents and endografts included Wallstents, Gianturco-Rösch Z-stents, AneuRx, Medtronic Endurant, and Epic in 21, 4, 2, 1, and 1 patient, respectively. Mean number of stents placed was 6 (range: 2-10). Mean stent diameter was 16 mm (range 8-22 mm). 23 patients were maintained on enoxaparin, clopidogrel, and aspirin. 1 minor complication, IVC and femoral vein perforation, and 1 major complication, right and left femoral arteriovenous fistulas, were reported. 6, 12, and 24-month primary patencies were 83%, 82%, and 72%. 6, 12, and 24-month secondary patencies 100%, 100%, and 100%, respectively. CONCLUSION Iliocaval reconstruction is a successful treatment for IVC agenesis and is associated with good long-term patency and few complications.
ENDOVASCULAR
METHODS This is a prospective study of 300 patients with CLI. Seventy-six patients underwent below the knee surgical bypass from 2011 to 2016 at LACþUSC Hospital. Baseline demographic, clinical, procedural characteristics, and cardiovascular testing results were recorded. All patients received guideline directed medical therapy. Endpoint was 30-day MACE (death, non-fatal myocardial infarction and non-fatal stroke).
JACC: CARDIOVASCULAR INTERVENTIONS, VOL. 10, NO. 3, SUPPL S, 2017
CRT-300.03 Role of Transthoracic Echocardiography in the Preoperative Evaluation of Patients with Critical Limb Ischemia Undergoing Surgical Bypass
CONCLUSION Current stent-EPD combinations used in CAS are equally efficacious in preventing inpatient stroke/TIA and have similarly low rates of inpatient neurologic events.
Noor A. Al-Asady, Ashwat S. Dhillon, Sarah Elsayed, David M. Shavelle, Vincent L. Rowe, Leonardo C. Clavijo USC, Keck School of Medicine, Los Angeles, CA BACKGROUND Peripheral surgical bypass for treatment of critical limb ischemia (CLI) is associated with an increased 30-day cardiovascular event rate (8.8% MACE, 1.5% cardiac arrest, 4.7% myocardial infarction, 1.4% stroke and 2.7% death). The purpose of this study is to evaluate 30-day cardiac outcomes in CLI patients after open surgical bypass. We hypothesize that routine transthoracic echo (TTE) screening is an effective initial imaging strategy to risk stratify patients with CLI prior to surgery.
RESULTS Mean age was 62.511 years and 60.5% of patients were male. TTE identified 46 patients (60.5%) with regional wall motion abnormality and 21 patients (27.6%) with left ventricular systolic dysfunction. Fifty-two patients (68.4%) underwent pharmacologic nuclear stress testing based on TTE result and 15 patients had demonstrable myocardial ischemia (19.73%). Fourteen patients (19.3%) had coronary angiography, 11 patients (85%) had significant CAD (defined as lesion 50%). Coronary revascularization was performed in 8 patients. Overall 30 day MACE was 3.96% and death occurred in one patient, 50% lower than historical controls. CONCLUSION Routine TTE screening is an effective initial imaging strategy to risk stratify patients with CLI before peripheral surgical bypass; its use may decrease post-operatory cardiovascular complications. CRT-300.04 Comparison of Devices in Carotid Artery Stenting: A Vascular Quality Initiative Analysis of Commonly Used Carotid Stents and Embolic Protection Devices Ashwat S. Dhillon, Sisi Li, Juan Pablo Lewinger, Leonardo C. Clavijo, David M. Shavelle, Ray V. Matthews, Fred A. Weaver, Parveen Garg University of Southern California, Los Angeles, CA BACKGROUND Data regarding the efficacy of the various stent and embolic protection device (EPD) combinations to prevent stroke during carotid artery stenting (CAS) is limited. We compared postprocedure inpatient neurologic outcomes across the carotid stent-EPD combination platforms recorded in the Vascular Quality Initiative (VQI) registry. METHODS We analyzed 9428 consecutive CAS procedures in the VQI registry performed between January 1, 2005 and December 31, 2015. The most commonly used stent-EPD combinations (Table) were included in the analysis. Post-procedure inpatient neurologic outcomes included (1) any stroke or transient ischemic attack (TIA) and (2) ipsilateral stroke/TIA. Multivariate analysis was done, adjusting for age, gender, smoking history, CHF, prior stroke/TIA, hypertension, prior carotid endarterectomy or CAS, coronary artery disease and presence of a second ipsilateral stenosis >70%. RESULTS Of the 9428 CAS procedures, Xact-Emboshield (n¼1647, 17.4%), Precise-Angioguard (n¼1439, 15.2%), Acculink-Accunet (n¼815, 8.6%) and Acculink-Emboshield (n¼516, 5.5%) were the most commonly used combinations, accounting for a total of 4417 procedures. Baseline characteristics were similar across the device combinations (64% male, mean age 70 10 years). Event rate of inpatient ipsilateral stroke/TIA ranged from 2.2-3.2% and the rate of any inpatient stroke/TIA across the device combinations was similarly low (2.9-4.2%) without any statistically significant differences. Multivariate analysis demonstrated no difference in inpatient risk of ipsilateral stroke/TIA or any stroke/TIA across the device combinations (Table).
CRT-300.06 ABSTRACT WITHDRAWN CRT-300.07 Total Endovascular Caval Reconstruction for the Treatment of Inferior Vena Cava Agenesis Jeffrey Forris Beecham Chick,1 Matthew L. Osher,1 Steven David Abramowitz,2 David M. Williams,1 Mohammed Forris Beecham Noor3 1 University of Michigan Health System, Ann Arbor, MI; 2MedStar Washington Hospital Center, Washington, DC; 3FIU, Ann Arbor, MI PURPOSE To report the technical success, complications, and longterm patency of iliocaval reconstruction for the treatment of inferior vena cava (IVC) agenesis. MATERIALS AND METHODS 30 (3%) patients with suspected IVC agenesis were identified from a venous registry of 994 patients from 2000 until 2016. Patients included 23 males and 7 females with mean age of 32 years (range: 13-63 years). Computed tomography (CT), magnetic resonance imaging (MRI), both CT and MRI, or prior venography was available in 20, 5, 4, and 1 patient, respectively. Review of imaging demonstrated true IVC agenesis in 27 (90%) patients and IVC atresia/chronic thrombosis in 3 (10%). In those with true IVC agenesis, imaging demonstrated complete absence of the entire IVC (n¼6), infrarenal IVC (n¼6), hepatic IVC (n¼5), infrahepatic IVC (n¼4), segmental absence of the IVC between the liver and kidney (n¼3), suprahepatic IVC (n¼2), and suprarenal IVC (n¼1). Patients presented with lower extremity deep venous thrombosis (n¼10), iliocaval thrombosis (n¼9), lower extremity swelling (n¼6), and lower extremity varicosities (n¼5). Treatment type, technical success, stent type, number, and diameter, anticoagulation, and complications were recorded. 6, 12, and 24-month primary and secondary patencies were calculated. RESULTS 3 patients failed to present for treatment. 25 (93%) patients underwent iliocaval reconstruction. Technical success was 92%. 2 patients underwent thrombolysis only. Stents and endografts included Wallstents, Gianturco-Rösch Z-stents, AneuRx, Medtronic Endurant, and Epic in 21, 4, 2, 1, and 1 patient, respectively. Mean number of stents placed was 6 (range: 2-10). Mean stent diameter was 16 mm (range 8-22 mm). 23 patients were maintained on enoxaparin, clopidogrel, and aspirin. 1 minor complication, IVC and femoral vein perforation, and 1 major complication, right and left femoral arteriovenous fistulas, were reported. 6, 12, and 24-month primary patencies were 83%, 82%, and 72%. 6, 12, and 24-month secondary patencies 100%, 100%, and 100%, respectively. CONCLUSION Iliocaval reconstruction is a successful treatment for IVC agenesis and is associated with good long-term patency and few complications.
ENDOVASCULAR
METHODS This is a prospective study of 300 patients with CLI. Seventy-six patients underwent below the knee surgical bypass from 2011 to 2016 at LACþUSC Hospital. Baseline demographic, clinical, procedural characteristics, and cardiovascular testing results were recorded. All patients received guideline directed medical therapy. Endpoint was 30-day MACE (death, non-fatal myocardial infarction and non-fatal stroke).