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TCT-578: Durable Results Found in Patients Followed More Than Two Years Post Orbital Atherectomy Treatment
http://www.aievolution.com/tct0901/
TUESDAY, SEPTEMBER 22, 2009, 8:00AM - 10:00AM
TCT-576 Primary Angioplasty Guided By An Angiosome Model Of Reperfusion In The Treatment Of Ischemic Inferior Limb Diabetic Wounds: Preliminary Results Vlad-Adrian Alexandrescu, Christian Ngongang, Gaetane Vincent, Gerard Hubermont Princess Paola Hospital, Marche-en-Famenne, Belgium Introduction /Aim of the study: To assess the preliminary clinical outcome of primary angioplasty (subintimal (SA) and/or endoluminal (EA), targeted by an angiosome-model of revascularization, in diabetic neuro-ischemic limbs with distal wounds. Materials & method: 6LQFH -DQXDU\ XQWLO 6HSWHPEHU D VHULHV of 134 ischemic limbs in 122 diabetic patients having various calf and foot tissue lesions were treated by primary angioplasty following an angiosome perfusion model and were retrospectively reviewed. There were 84/134 associated SA and EA procedures, 25/134 multi-level EAs and 25/134 single SA interventions, following an angiosome model of reperfusion. Results: Initial technical success was achieved in 107 (79%) interventions (86/109 SAs and 21/25of the EAs). The cumulative patency, clinical success and limb salvage were: 48%, 70% and 80% at 36 also 40 months, respectively. Complete healing of ulcers with or without minor amputation was observed LQ OLPEV GXULQJ WKH ¿UVW PRQWKV 7KH OLPE VDOYDJH UDWHV appeared to be negatively affected at one and three years by extended Wagner JUDGHOHVLRQVWKHODFNRIDPEXODWLRQWKH(65'DQGWKHOHIWYHQWULFXODU decline (p<0.0001).
during the initial acute event. All patients showed heavy residuals in computer tomographic scan (CT), signs of right heart failure and high pulmonary pressure by transthoracic echocardiography and doppler (TTE). Method: Pulmonary angiography was done and a heparin bolus of 10.000 IE were given. Balloon size was selected by measurements of the vessel size by intravascular ultrasound (IVUS). Multiple dilatation of the pulmonary arteries (PA) were done. After dilatation a 4 french pigtail catheter was placed in the target PA. In three patients it was necessary to place two pigtail catheters, one in the right and one in the left PA. A selective 250.000 IE urocinase bolus was given. The combined intravenous therapy started 30 minutes later. Control RIWKHSDUWLDOWKURPERSODVWLQWLPHDQG¿EULQRJHQZHUHGRQHDOOKRXUV7KH therapy was stopped after 3 ± 2 days. All patients were controlled invasivly and bei CT scan. Oraly warfarin therapy began. In three patients it was necessary to give erythrocyte concentrates because of a bleeding in the groin. The following hospital stay was without complications. Results: 7KH LQLWLDO SXOPRQDU\ SUHVVXUH 3$PHDQ GHFUHDVHG VLJQL¿FDQWO\ from 47 ± 17 mmHg to 17 ± 9 mmHg (p < 0.001). CT- scan and TTE showed widely normal parameters after therapy during hospitalisation. Conclusion: Percuntaneous IVUS guided dilatation of the PA and selective urocinase and heparin therapy seems to be a new effective and save treatment option for young chronic embolic lung embolism. This option seems to reduce WKH GHYHORSPHQW RI SXOPRQDU\ K\SHUWHQVLRQ E\ D PDQDJHDEOH ULVN ,Q WKH future more patients and long term follow ups are necessary for evaluation of these method. TCT-578 Durable Results Found in Patients Followed More Than Two Years Post Orbital Atherectomy Treatment Barry Weinstock1, Daniel Dulas2, John Paul Runyon3, Michael Hagley4, Khusrow Niazi5, Puneet Khanna6, Falahat Ali Farooqui5 1 Florida Hospital, Orlando, FL;2Mercy Medical Center, Minneapolis, MN;3Christ Hospital, Cincinnati, OH;4Hutchinson Clinic, Hutchinson, KS;5Emory University, Atlanta, GA;6Eisenhower Medical Center, Rancho Mirage, CA
P O S T E R A B S T R AC T S
Conclusion: The angiosomes-oriented primary angioplasty may represent a useful method of revascularization to improve the clinical success in critical ischemic ulcers. However, synchronous multidisciplinary control of the DVVRFLDWHGGLDEHWLFULVNIDFWRUVSOD\VDQLQÀXHQWLDOUROHLQZRXQGKHDOLQJDQG longer term limb salvage rates, as well. TCT-577 Percutaneous Dilatation Of Pulmonary Arteries And Combined Selective Lysis With Urocinase And Heparin As A New Treatment Option In Patients With Chronic Embolic Lung Embolism Thomas F M Konorza, Hagen Kaelsch, Sylvia Hartenstein, Bjoern Plicht, Konstantinos Iliodromitis, Gorgeous Aidonides, Raimund Erbel University of Essen, Essen, Germany Background: Chronic embolic lung embolism is a rare und misconceive cause of the development of pulmonary hypertension. The main treatment option is a longlife warfarin therapy. In rare cases surgical thrombendarterectomy is possible DQGHIIHFWLYH2QHWUHDWPHQWRSWLRQRIIUHVKOXQJHPEROLVPLVWREUHDNGRZQ the thrombus by percutaneous intervention. The principle seems to be a new approach to treat chronic embolic lung embolism (> 3 months) in combination of a long term selective lysis with urocinase and heparin. The enlargement of the surface allows the improvement of the potency of the lysis agents. Patient population: Between 10/2007 and 4/2009 fourteen patients (6 men, 8 women) with chronic embolic lung embolism were treated by percuntaneous intervention and selective urocinase und heparin lysis. The age of lung embolism was 7 ± 4 months. In 5 patients systemic lysis was performed
214D
Background:7KHVDIHW\DQGHI¿FDF\RIRUELWDODWKHUHFWRP\LQWKHWUHDWPHQW of peripheral arterial disease was demonstrated in a prospective, nonrandomized, IDE study called OASIS. In this study, the target lesion and vessel revascularization rates (TLR/TVR) were 2.4% and 5.6% at 180 days. To determine whether these encouraging early results were durable after the sixmonth endpoint, additional followup was conducted after the close of OASIS. Methods:$OOVLWHVWKDWHQUROOHGSDWLHQWVLQ2$6,6ZHUHDVNHGWRSDUWLFLSDWH in a followup evaluation of patients treated more than two years ago with the 'LDPRQGEDFN 2UELWDO $WKHUHFWRP\ 6\VWHP &DUGLRYDVFXODU 6\VWHPV Inc., St. Paul, MN). Twelve sites provided late TLR/TVR, amputation and ABI scores for available patients. This longer-term data was compared to baseline patient history, angiographic lesion characteristics and treatment variables. Results: Sixty-four subjects (mean age 73.2; 71.9% male) were followed 24 or more months (median 29 months) post index procedure. Baseline demographics were: 51.6% diabetes, 81.3% HTN, 71.4% hyperlipidemia, FXUUHQWRUIRUPHUVPRNHUVPHGLDQ5XWKHUIRUG&ODVVDQGPHDQ$%, 0.67. Lesions were located in the peroneal, posterior tibial and anterior tibials (80%) and SFA/popliteal (20%). Lesions averaged 26.6 mm in length, and ZHUHFDOFL¿HG0HDQGLDPHWHUVWHQRVLVLPSURYHGIURPWR post procedure (p<0.001). The longer-term follow-up showed durable rates of TLR (13.6%; median = 7.21 months) and TVR (15.5%; median = 12 months). TLR rates were 4.9% at 6 months, 8.7% at 12 months, 10.7% at 18 months and 13.6% at 24 months. Since the close of the OASIS study, no planned minor or major amputations occurred, and ABI scores increased by an average of 0.29 (p<0.001; 36 pairs). Conclusion: Two-year followup of patients treated with orbital atherectomy demonstrates durable TLR/TVR rates, no additional occurrence of amputation DQG VLJQL¿FDQWO\ LPSURYHG $%, VFRUHV $GGLWLRQDO SRVWPDUNHW VWXGLHV DUH XQGHUZD\WRIXUWKHUGH¿QHWKHEHQH¿WVRIWKLVQRYHOWUHDWPHQWRSWLRQ
The American Journal of Cardiology® |
September 21-25, 2009
|
TCT Abstracts/POSTER
TUESDAY, SEPTEMBER 22, 2009, 8:00AM - 10:00AM
TCT-576 Primary Angioplasty Guided By An Angiosome Model Of Reperfusion In The Treatment Of Ischemic Inferior Limb Diabetic Wounds: Preliminary Results Vlad-Adrian Alexandrescu, Christian Ngongang, Gaetane Vincent, Gerard Hubermont Princess Paola Hospital, Marche-en-Famenne, Belgium Introduction /Aim of the study: To assess the preliminary clinical outcome of primary angioplasty (subintimal (SA) and/or endoluminal (EA), targeted by an angiosome-model of revascularization, in diabetic neuro-ischemic limbs with distal wounds. Materials & method: 6LQFH -DQXDU\ XQWLO 6HSWHPEHU D VHULHV of 134 ischemic limbs in 122 diabetic patients having various calf and foot tissue lesions were treated by primary angioplasty following an angiosome perfusion model and were retrospectively reviewed. There were 84/134 associated SA and EA procedures, 25/134 multi-level EAs and 25/134 single SA interventions, following an angiosome model of reperfusion. Results: Initial technical success was achieved in 107 (79%) interventions (86/109 SAs and 21/25of the EAs). The cumulative patency, clinical success and limb salvage were: 48%, 70% and 80% at 36 also 40 months, respectively. Complete healing of ulcers with or without minor amputation was observed LQ OLPEV GXULQJ WKH ¿UVW PRQWKV 7KH OLPE VDOYDJH UDWHV appeared to be negatively affected at one and three years by extended Wagner JUDGHOHVLRQVWKHODFNRIDPEXODWLRQWKH(65'DQGWKHOHIWYHQWULFXODU decline (p<0.0001).
during the initial acute event. All patients showed heavy residuals in computer tomographic scan (CT), signs of right heart failure and high pulmonary pressure by transthoracic echocardiography and doppler (TTE). Method: Pulmonary angiography was done and a heparin bolus of 10.000 IE were given. Balloon size was selected by measurements of the vessel size by intravascular ultrasound (IVUS). Multiple dilatation of the pulmonary arteries (PA) were done. After dilatation a 4 french pigtail catheter was placed in the target PA. In three patients it was necessary to place two pigtail catheters, one in the right and one in the left PA. A selective 250.000 IE urocinase bolus was given. The combined intravenous therapy started 30 minutes later. Control RIWKHSDUWLDOWKURPERSODVWLQWLPHDQG¿EULQRJHQZHUHGRQHDOOKRXUV7KH therapy was stopped after 3 ± 2 days. All patients were controlled invasivly and bei CT scan. Oraly warfarin therapy began. In three patients it was necessary to give erythrocyte concentrates because of a bleeding in the groin. The following hospital stay was without complications. Results: 7KH LQLWLDO SXOPRQDU\ SUHVVXUH 3$PHDQ GHFUHDVHG VLJQL¿FDQWO\ from 47 ± 17 mmHg to 17 ± 9 mmHg (p < 0.001). CT- scan and TTE showed widely normal parameters after therapy during hospitalisation. Conclusion: Percuntaneous IVUS guided dilatation of the PA and selective urocinase and heparin therapy seems to be a new effective and save treatment option for young chronic embolic lung embolism. This option seems to reduce WKH GHYHORSPHQW RI SXOPRQDU\ K\SHUWHQVLRQ E\ D PDQDJHDEOH ULVN ,Q WKH future more patients and long term follow ups are necessary for evaluation of these method. TCT-578 Durable Results Found in Patients Followed More Than Two Years Post Orbital Atherectomy Treatment Barry Weinstock1, Daniel Dulas2, John Paul Runyon3, Michael Hagley4, Khusrow Niazi5, Puneet Khanna6, Falahat Ali Farooqui5 1 Florida Hospital, Orlando, FL;2Mercy Medical Center, Minneapolis, MN;3Christ Hospital, Cincinnati, OH;4Hutchinson Clinic, Hutchinson, KS;5Emory University, Atlanta, GA;6Eisenhower Medical Center, Rancho Mirage, CA
P O S T E R A B S T R AC T S
Conclusion: The angiosomes-oriented primary angioplasty may represent a useful method of revascularization to improve the clinical success in critical ischemic ulcers. However, synchronous multidisciplinary control of the DVVRFLDWHGGLDEHWLFULVNIDFWRUVSOD\VDQLQÀXHQWLDOUROHLQZRXQGKHDOLQJDQG longer term limb salvage rates, as well. TCT-577 Percutaneous Dilatation Of Pulmonary Arteries And Combined Selective Lysis With Urocinase And Heparin As A New Treatment Option In Patients With Chronic Embolic Lung Embolism Thomas F M Konorza, Hagen Kaelsch, Sylvia Hartenstein, Bjoern Plicht, Konstantinos Iliodromitis, Gorgeous Aidonides, Raimund Erbel University of Essen, Essen, Germany Background: Chronic embolic lung embolism is a rare und misconceive cause of the development of pulmonary hypertension. The main treatment option is a longlife warfarin therapy. In rare cases surgical thrombendarterectomy is possible DQGHIIHFWLYH2QHWUHDWPHQWRSWLRQRIIUHVKOXQJHPEROLVPLVWREUHDNGRZQ the thrombus by percutaneous intervention. The principle seems to be a new approach to treat chronic embolic lung embolism (> 3 months) in combination of a long term selective lysis with urocinase and heparin. The enlargement of the surface allows the improvement of the potency of the lysis agents. Patient population: Between 10/2007 and 4/2009 fourteen patients (6 men, 8 women) with chronic embolic lung embolism were treated by percuntaneous intervention and selective urocinase und heparin lysis. The age of lung embolism was 7 ± 4 months. In 5 patients systemic lysis was performed
214D
Background:7KHVDIHW\DQGHI¿FDF\RIRUELWDODWKHUHFWRP\LQWKHWUHDWPHQW of peripheral arterial disease was demonstrated in a prospective, nonrandomized, IDE study called OASIS. In this study, the target lesion and vessel revascularization rates (TLR/TVR) were 2.4% and 5.6% at 180 days. To determine whether these encouraging early results were durable after the sixmonth endpoint, additional followup was conducted after the close of OASIS. Methods:$OOVLWHVWKDWHQUROOHGSDWLHQWVLQ2$6,6ZHUHDVNHGWRSDUWLFLSDWH in a followup evaluation of patients treated more than two years ago with the 'LDPRQGEDFN 2UELWDO $WKHUHFWRP\ 6\VWHP &DUGLRYDVFXODU 6\VWHPV Inc., St. Paul, MN). Twelve sites provided late TLR/TVR, amputation and ABI scores for available patients. This longer-term data was compared to baseline patient history, angiographic lesion characteristics and treatment variables. Results: Sixty-four subjects (mean age 73.2; 71.9% male) were followed 24 or more months (median 29 months) post index procedure. Baseline demographics were: 51.6% diabetes, 81.3% HTN, 71.4% hyperlipidemia, FXUUHQWRUIRUPHUVPRNHUVPHGLDQ5XWKHUIRUG&ODVVDQGPHDQ$%, 0.67. Lesions were located in the peroneal, posterior tibial and anterior tibials (80%) and SFA/popliteal (20%). Lesions averaged 26.6 mm in length, and ZHUHFDOFL¿HG0HDQGLDPHWHUVWHQRVLVLPSURYHGIURPWR post procedure (p<0.001). The longer-term follow-up showed durable rates of TLR (13.6%; median = 7.21 months) and TVR (15.5%; median = 12 months). TLR rates were 4.9% at 6 months, 8.7% at 12 months, 10.7% at 18 months and 13.6% at 24 months. Since the close of the OASIS study, no planned minor or major amputations occurred, and ABI scores increased by an average of 0.29 (p<0.001; 36 pairs). Conclusion: Two-year followup of patients treated with orbital atherectomy demonstrates durable TLR/TVR rates, no additional occurrence of amputation DQG VLJQL¿FDQWO\ LPSURYHG $%, VFRUHV $GGLWLRQDO SRVWPDUNHW VWXGLHV DUH XQGHUZD\WRIXUWKHUGH¿QHWKHEHQH¿WVRIWKLVQRYHOWUHDWPHQWRSWLRQ
The American Journal of Cardiology® |
September 21-25, 2009
|
TCT Abstracts/POSTER