Percutaneous renal artery angioplasty and stenting for pulmonary edema caused by Takayasu's arteritis:A case report

Takayasu arteritis （TA） commonly occurs in woman younger than 50 years old and can manifest as isolated, atypical and/or catas- trophic disease. The disease can implicate in any or all of the major organs I As a chronic relapsing and remitting disorder, the overall 10-year survival rate is approximately 90%; however, this rate is reduced in the presence of major complications. The overall mortality rate of TA depends on the severity of the le- sions and involved organs.

Long Term Clinical and Angiographic Outcome Following Percutaneous Transluminal Angioplasty and Stent Placement for Iliac and Femoral Artery Stenosis

Objective This study reportsthe initial and late results of percutaneous transluminal angioplasty (PTA) and intravascular stenting for atherosclerotic stenosis of the iliac and femoral arteries. Methods and Results From December 1994 to March 1997, we performed iliac and femoral artery angioplasty and primary intravascular stent placement in 37 vessel of 33 patients (19 men and 14 women; mean age, 70. 5 years). A total of 43 self - expanding Wallstents (Boston, Inc. ) were deployed. All patients underwent angioplasty and stent placement successfully. Clinical follow - up was available for all patients at a mean of 26±14months. All patient clinical is-chemic category (claudication or rest pain) was improved. Angiographic follow - up was completed for 17 of 23 patients at a mean follow-up of 10±5 months, The iliac artery restenosis rate was 0(0/8). The femoral artery restenosis rate was 33 % (3/9), All 3 patients underwent repeat balloon angioplasty successfully. Conclusion The iliac and femoral arteries can be performed and reasonable early and late patency rates.

Ultrasound-guided carotid angioplasty and stenting in a patient with iodinated contrast allergy:A case report

BACKGROUND Ischemic stroke is an entity with high incidence,morbidity,and mortality rates.Carotid artery stenosis is an important and independent risk factor for ischemic stroke.The three current approaches for treating carotid artery stenosis are drug treatment,carotid endarterectomy(CEA),carotid angioplasty and stenting(CAS).The approach is chosen based on the degree of stenosis.CEA or CAS could have been chosen for the current patient,who had severe carotid stenosis and an iodinated contrast allergy.After thoroughly communicating with the patient,the patient chose CAS for treatment.Therefore,we performed ultrasound-guided CAS to avoid the use of iodinated contrast.CASE SUMMARY The main symptoms of the patient were numbness and weakness of the left limb.Computed tomography angiography of the head and neck at another hospital indicated multiple sites of stenosis in the arteries of the head and neck.The patient requested CAS for treatment but was allergic to iodinated contrast media.Thus,routine digital subtraction angiography(DSA)with iodinated contrast could not be used for the procedure.The diagnosis of this patient was as follows:(1)Right parietal lobe cerebral infarction;(2)multiple sites of stenosis in the arteries of the head and neck(severe stenosis of the right internal carotid artery,severe stenosis of the right subclavian artery);(3)right subclavian steal syndrome;and(4)hypertension(stage 3,high risk).The interventions included routine treatment for cerebral infarction,oral administration of clopidogrel(75 mg qd)and aspirin(100 mg qd),ultrasound-guided CAS,and postoperative follow-up.Postoperative color Doppler ultrasound and cerebrovascular magnetic resonance angiography of the carotid artery showed good vascular recovery,and the postoperative follow-up indicated a good prognosis.CONCLUSION This case study suggests that ultrasound-guided endovascular treatment is a potential option for patients with contraindications to the iodinated contrast agents used in DSA-guided surgery,although excellent surgical operating skills are needed.

Prognostic indicator by urinary microglobulin after renal stenting

Objective To evaluate the effect of revascularization of the renal artery on urinary microglobulin in patients with coronaryartery disease and significant renal artery stenosis(RAS).Methods Forty-four patients with coronary artery disease and severe RAS(luminal narrowing>70%)underwent percutaneous transluminal renal artery angioplasty(PTRA)and stenting,as well as percutaneous coronary intervention.The urine-microglobulin(α_(1)-MG)andβ_(2)-Cmicroglobulin(β_(2)-MG)at baseline and at 3 months after the procedures were measured.Procedural success rate,procedural complications,serum creatinine concentration at baseline and at 3-months were also recorded.Results At 3-months after the renal revascularization therapy,there was no significant change of urineα_(1)-MG ompared with that of the baseline,however,the urineβ_(2)-MG decreased significantly 3-months after the treatment(237±187μg/L vs 377±173μg/L,P<0.01).Multivariate analysis revealed that persistent elevation of urine was an independent predictor of severe events(including re-admission and renal failure)after renal revascularization therapy in patients with severe RAS(OR=3.01,95%CI 1.01-8.95,P=0.036).Conclusions In patients with coronary artery disease and severe RAS,revascularization with PTRA and stenting may improve renal tubular function,but a continuous high level of urinary microglobulins after intervention is associated with more frequent re-hospitalization and renal failure.

Multivariate Analysis of Clinical Factors in Restenosis after Coronary Stenting

Ojbective To find the independent predictors for restenosis after coronary stenting. Methods Quantitative angiography was performed on 60 cases (67 successfully dilated lesions) after angio-plasty over 6-months follow-up, and both univariate and multivariate logistic regression analysis were done to i-dentify the correlations of restenosis with clinical factors. Results The total restenosis rate was 31. 3% (21 of 67 lesions), and according to univariate analysis the patients who underwent coronary stenting≥ 3. 5mm had a lower rate of restenosis ( P < 0. 01). Collateral circulation to the obstruction site, high maximal inflation pressure, smoking and the less minimal lumen diameter after PTCA made the rate of restenosis higherower ( P < 0. 05) . Multivariate logistic regression analysis showed that coronary stenting ≥3. 5mm had a low rate of restenosis, but high maximal inflation pressure and smoking made the restenosis rate higher. Conclusion Coronary stent size, maximal inflation pressure and. smoking were independent predictors for restenosis.

EXPERIMENTAL RENAL ARTERY STENOSIS AND ANGIOPLASTY THE MECHANISM OF THE ANGIOPLASTY

The mechanism of percutaneous transluminal renal angioplasty (PTRA) was studied in 18 dogs. The dogs were divided into two groups. Seven dogs were in the early group and eleven were within 1-3 weeks after PTRA. A 4 / 0 resorbable chronic catgut was used to Hgate subtotally the renal artery to create fibromuscular dysplasia. PTRA was performed after renal artery stenosis for 6-8 weeks. The changes of ultrastructure of renal artery were studied. A countrary orientation balance hypothesis was proposed to explain the mechanism of PTRA.