Safety and efficacy of balloon angioplasty compared to stent-basedstrategies with pulmonary vein stenosis:A systematic review and meta-analysis

BACKGROUND Pulmonary vein stenosis(PVS)is an uncommon but known cause of morbidity and mortality in adults and children and can be managed with percutaneous revascularization strategies of pulmonary vein balloon angioplasty(PBA)or pulmonary vein stent implantation(PSI).AIM To study the safety and efficacy outcomes of PBA vs PSI in all patient categories with PVS.METHODS We performed a literature search of all studies comparing outcomes of patients evaluated by PBA vs PSI for PVS.We selected all published studies comparing PBA vs PSI for PVS with reported outcomes of restenosis and procedure-related complications in all patient categories.In adults,PVS following atrial fibrillation ablation and in children PVS related to congenital etiology or post-procedural PVS following total or partial anomalous pulmonary venous return repair were included.The patient-centered outcomes were risk of restenosis requiring re-intervention and procedural-related complications.The metaanalysis was performed by computing odds ratios(ORs)using the random effects model based on underlying statistical heterogeneity.RESULTS Eight observational studies treating 768 severe PVS in 487 patients met our inclusion criteria.The age range of patients was 6 months to 70 years and 67%were males.The primary outcome of the re-stenosis requiring re-intervention occurred in 196 of 325 veins in the PBA group and 111 of 443 veins in the PSI group.Compared to PSI,PBA was associated with a significantly increased risk of re-stenosis(OR 2.91,95%CI:1.15-7.37,P=0.025,I2=79.2%).Secondary outcomes of the procedurerelated complications occurred in 7 of 122 patients in the PBA group and 6 of 69 in the PSI group.There were no statistically significant differences in the safety outcomes between the two groups(OR:0.94,95%CI:0.23-3.76,P=0.929,I^(2)=0.0%).CONCLUSION Across all patient categories with PVS,PSI is associated with reduced risk of re-intervention and is as safe as PBA and should be considered first-line therapy for PVS.

Primary balloon angioplasty for chronic occlusion of intracranial internal carotid artery: A case report

Chronic occlusion of large intracranial arteries is the main cause of ischemic stroke in China.Patients with symptomatic intracranial artery occlusion and hemodynamic impairment are at high risk of recurrent stroke.Chronic occlusion of the intracranial segment of the internal carotid artery is a common type of intracranial artery occlusion.Medical management is regarded as the standard treatment for this disease.With the development of endovascular treatment,some patients with chronic cerebral artery occlusion have achieved satisfactory results with endovascular therapy.We reported a patient with symptomatic chronic occlusion of the ophthalmic segment of the internal carotid artery.Simple balloon angioplasty was performed,and the occluded ophthalmic segment of the internal carotid artery was successfully recanalized without perioperative complications.At 4 months followup,the internal carotid artery remained patent and perfusion of the right cerebral hemisphere improved dramatically.In addition,we briefly reviewed the relevant literature.

Long-Term Results of Balloon Angioplasty for Native Coarctation of the Aorta in the Surgical Specialty Teaching Hospital/Cardiac Center/Hawler

Background: Coarctation of aorta is a common congenital cardiac malformation;controversy has surrounded the use of balloon angioplasty for native coarctation of aorta as the primary treatment for patients with various ages with coarctation. Aim: This study aimed to assess the long term outcome of balloon angioplasty especially concerning aneurysm formation. Patients and Methods: A case series (case follow-up) study was carried out on a total of 50 patients (31 male and 19 female) with native coarctation of aorta aged 1 - 21 years of age who were treated with balloon angioplasty for more than 1 year at the time of follow up evaluation in surgical specialty hospital/cardiac center in Erbil Iraq. They were recalled and subjected to detail clinical examination, body weight, height, blood pressure measurements. Radiographic, Echo Doppler data, CT angiography were obtained. CT angiography was done for 34 patients. Full echocardiographic evaluation was done in follow up visits. Results: There was a significant reduction in the peak instantaneous pressure gradient across the coarctated area by Doppler echocardiogram gradient before balloon angioplasty and at the follow up visit from 56.92 ± 14.6 mmHg to 30.68 ± 16.89, P = 0.00. Six cases of total 50 patients had evidence of diastolic runoff pattern by Doppler Echcardiogram. While the only 6 of total 34 cases had the report of CT angiography that documented aneurysm formation (12%). Conclusions: Balloon angioplasty of native aortic coarctation can be performed safely and effectively with good immediate outcome. Furthermore, it offers satisfactory long-term results with low incidence of persisting restenosis, hypertension and aneurysm formation.

Balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension:State of the art

Chronic thromboembolic pulmonary hypertension(CTEPH)is a complex chronic disease in which pulmonary artery stenosis or obstruction caused by organized thrombus can lead to increased pulmonary artery pressure and pulmonary vascular resistance,ultimately triggering progressive right heart failure and death.Currently,its exact mechanism is not fully understood.Pulmonary endarterectomy(PEA)has immediate effects with low perioperative mortality and satisfactory prognosis in experienced expert centers for CTEPH patients with proximal lesions.Nevertheless,37%of patients are deemed unsuitable for PEA surgery due to comorbidities and other factors,and nearly half of the operated patients have residual or recurrent pulmonary hypertension.Riociguat is the only approved drug for CTEPH,although its effect is limited.Balloon pulmonary angioplasty(BPA)is a promising alternative treatment for patients with CTEPH.After more than 30 years of development and refinements,emerging evidence has confirmed its role in patients with inoperable CTEPH or residual/recurrent pulmonary hypertension,with acceptable complications and comparable longterm prognosis to PEA.This review summarizes the pathophysiology of CTEPH,BPA history and development,therapeutic principles,indications and contraindications,interventional procedures,imaging modalities,efficacy and prognosis,complications and management,bridging and hybrid therapies,ongoing clinical trials and future prospects.

“Guidezilla”extension catheter combined with balloon technique for treating pulmonary artery stenosis caused by Takayasu arteritis

Takayasu arteritis(TA)is a rare systemic vasculitis of the aorta and its primary branches,which usually occurs in young women.Due to its insidious onset and lack of specific symptoms,this disease can be easily misdiagnosed or missed.Approximately 50%of the patients having TA with pulmonary artery involvement develop pulmonary hypertension(PH).The 3-year survival rate among patients with TA-related PH is lower than that among patients with TA alone.Early balloon pulmonary angioplasty(BPA)can improve the clinical symptoms and survival of patients with stable TA.To the best of our knowledge,this is the first case reported in the English literature in which a“Guidezilla”catheter was used during BPA to treat stenosis and occlusion of the pulmonary artery caused by Takayasu arteritis(TA).

Management of adults with coarctation of aorta

Coarctation of the aorta(CoA)is a relatively common congenital cardiac defect often causing few symptoms and therefore can be challenging to diagnose.The hallmark finding on physical examination is upper extremity hypertension,and for this reason,CoA should be considered in any young hypertensive patient,justifying measurement of lower extremity blood pressure at least once in these individuals.The presence of a significant pressure gradient between the arms and legs is highly suggestive of the diagnosis.Early diagnosis and treatment are important as long-term data consistently demonstrate that patients with CoA have a reduced life expectancy and increased risk of cardiovascular complications.Surgical repair has traditionally been the mainstay of therapy for correction,although advances in endovascular technology with covered stents or stent grafts permit nonsurgical approaches for the management of older children and adults with native CoA and complications.Persistent hypertension and vascular dysfunction can lead to an increased risk of coronary disease,which,remains the greatest cause of long-term mortality.Thus,blood pressure control and periodic reassessment with transthoracic echocardiography and threedimensional imaging(computed tomography or cardiac magnetic resonance)for should be performed regularly as cardiovascular complications may occur decades after the intervention.

Budd-Chiari syndrome associated with liver cirrhosis: A case report

BACKGROUND Budd-Chiari syndrome(BCS)is a rare heterogeneous liver disease characterized by obstruction of the hepatic venous outflow tract.The incidence of BCS is so low that it is difficult to detect in general practice and difficult to include within the scope of routine diagnosis.The clinical manifestations of BCS are not specific;hence,BCS tends to be misdiagnosed.CASE SUMMARY We report the case of a 33-year-old Chinese woman who presented with progressive distension in the upper abdomen.She was initially misdiagnosed with liver cirrhosis(LC)due to abnormalities on an upper abdominal computed tomography scan.Although she was taking standard anti-cirrhosis therapy,her symptoms did not improve.Magnetic resonance imaging showed caudate lobe hypertrophy;and dilated lumbar and hemiazygos veins.Venography revealed membranous obstruction of the inferior vena cava owing to congenital vascular malformation.A definitive diagnosis of BCS was made.Balloon angioplasty was performed to recanalize the obstructed inferior vena cava and the patient’s symptoms were completely resolved.CONCLUSIONBCS lacks specific clinical features and can eventually lead to LC. Clinicians andradiologists must carefully differentiate BCS from LC. Correct diagnosis andtimely treatment are vital to the patient's health.

Comparison of Post-Procedural and 30-day Post-Implantation Transcatheter Aortic Valve Replacement Gradients with and without preimplantation Balloon Valvuloplasty:A Real-World Analysis of Early Results using a Novel Balloon Expandable Transcatheter Aortic Valve

Objectives:This study describes a real-world experience of implanting a novel balloon expandable transcatheter aortic valve replacement(TAVR)compared to devices commonly used in clinical practice.As a secondary objective,the effect of balloon angioplasty(BAV)before TAVR on the transvalvular gradient 1 and 30 days after implantation was evaluated.Background:For most commercial TAVR valves,the 30-day average mean aortic valve gradients have been re-ported.Our experience with the Lotus Valve System had indicated higher immediate post-implant gradients than those in the literature.We sought to evaluate both these valves,comparing them to other valves.Methods:We analyzed discharge and 30-day echocardiograms of Lotus valves from 7/5/2019 to 8/27/2020.In re-sponse to higher-than-expected post-implant gradients,patients from 11/4/19 to 8/27/20 underwent BAV before the valve implantation,whereas patients from 7/5/19 to 10/18/19 did not(no-BAV).We compared these samples to each other and to a random sampling of TAVR valves implanted by the same interventionalist.Results:At discharge,27 patients received Lotus valves.The average mean aortic valve gradient was 16.7 mmHg(SD=5.5 mmHg)for the no-BAV and 14.7 mmHg(SD=3.7 mmHg)for the BAV(P=0.177)cohorts.No-BAV Lotus valve mean gradients were significantly higher(P<0.001)than those of the Sapien valve(M=12 mmHg,SD=4.3)and CoreValve(M=9.18 mmHg,SD=3.96).At the 30-day assessment,the mean gradients in the no-BAV and BAV groups were similar to those in the literature(M=11 mmHg SD 3.5;M=12 mmHg,SD 4.1(P=0.287))and those of other valves.Conclusions:The Lotus valve demonstrated higher post-implantation gradients than other valves.This effect was not attenuated by BAV.These elevated gradients were not significant at the 30-day follow-up.

Novel economic treatment for coronary wire perforation:A case report

BACKGROUND Coronary artery perforation is a rare but potentially life-threatening complication of percutaneous coronary intervention(PCI),however if recognized and managed promptly,its adverse consequences can be minimized.Risk factors include the use of advanced PCI technique(such as atherectomy and chronic total occlusion interventions)and treatment of severely calcified lesions.Large vessel perforation is usually treated with implantation of a covered stent,whereas distal and collateral vessel perforations are usually treated with embolization of coils,fat,thrombin,or collagen.We describe a novel and cost-effective method of embolisation using a cut remnant of a used angioplasty balloon that was successful in sealing a distal wire perforation.we advocate this method as a simple method of managing distal vessel perforation.CASE SUMMARY A 73-year-old male with previous coronary Bypass graft operation and recurrent angina on minimal exertion had undergone rotablation and PCI to his dominant left circumflex.At the end of the procedure there was evidence of wire perforation at the distal branch and despite prolonged balloon tamponade there continued to be extravasation and the decision was made to seal this perforation.A cut piece of an angioplasty balloon was used and delivered on the original angioplasty wire to before the perforation area and released which resulted in sealing of the perforation with no unwanted clinical consequences.CONCLUSION The use of a balloon remnant for embolization in coronary perforation presents a simple,efficient and cost-effective method for managing coronary perforations and may be an alternative for achieving hemostasis and preventing poor outcome.Prevention remains the most important part with meticulous attention to the distal wire position,particularly with hydrophilic wires.

Treatment and Clinical Management of Chronic Thromboembolic Pulmonary Hypertension:An Update of Literature Review

Chronic thromboembolic pulmonary hypertension(CTEPH)is a chronic,progressive,debilitating,and life-threa-tening complication of pulmonary embolism(PE).Recent technological advances have permitted various treat-ment options for the treatment of CTEPH,including surgery,angioplasty,and medical treatment,depending on the location and characteristics of lesions.Pulmonary endarterectomy(PEA)is the treatment of choice for CTEPH,as it offers excellent long-term outcomes and a high probability of recovery.Moreover,various medical and interventional therapies are currently being developed for patients with inoperable CTEPH.This review mainly summarizes the current treatment approaches of CTEPH,offering more options for specialist physicians to,thus,better manage chronic thromboembolic syndromes.