Very late stent thrombosis caused by the rupture of in-stent neoatherosclerosis 15 years after bare nitinol stent implantation in superficial femoral artery visualized with multimodality imaging.
Very late stent thrombosis caused by the rupture of in-stent neoatherosclerosis 15 years after bare nitinol stent implantation in superficial femoral artery visualized with multimodality imaging.
Project description:An 80-year-old man received the implantation of a self-expanding stent (Luminexx, Bard, Inc., Murray Hill, NJ, USA) for an in-stent restenosis (ISR) lesion in the superficial femoral artery. However, angiography 141 months after the Luminexx stent implantation showed 90% ISR and a floating fractured stent in the Luminexx site. Furthermore, the floating fractured stent strut itself was completely separated and flowed toward the posterior tibial artery. The stent strut was removed by a catheter for removing intravascular foreign substances. <Learning objective: We report a case of a floating fractured stent 141 months after stent implantation in the superficial femoral artery (SFA). Although this case is rare, in endovascular therapy with stenting for SFA, it is necessary to consider the risk of stent fracture in the very late phase.>.
Project description:A 69-year-old man developed very late stent thrombosis (VLST) 3 years after Orsiro stent implantation in the proximal left anterior descending coronary artery. Intravascular imaging evaluations before and after the onset of VLST allowed us to document neoatherosclerosis as the etiology of VLST.
Project description:The VIABAHN stent graft is often used for traumatic and iatrogenic vascular injuries. In this case, vascular injury at both edges of the VIABAHN stent graft was noted 4 months after endovascular repair for idiopathic superficial femoral artery (SFA) rupture. The longitudinal compression of the SFA with a decrease in hematoma size was assumed to exceed the flexibility of the stent graft. Thus, the use of stent grafts for vascular injuries with giant pseudoaneurysms may result in late vascular injuries at both edges of the stent graft. Therefore, cautious assessment of its indications and strict surveillance are required.
Project description:The femoropopliteal artery is one of the commonest sites of involvement in peripheral artery disease (PAD) leading to intermittent claudication and/or critical limb ischemia. Endovascular therapy for superficial femoral artery (SFA) disease has been recognized as a safe and efficient therapy and is recommended by current guidelines as the first-line approach. Although the widespread use of new-generation, self-expanding, nitinol stents in SFA stenosis has reduced the shortcomings associated with plain old balloon angioplasty (POBA), lumen renarrowing at the stented (in-stent restenosis - ISR) level still represents a relevant clinical problem, because of higher risk of recurrent ISR, occlusion and surgical revascularization compared to de-novo lesions. In this setting, different treatment options are available and drug-coated balloons (DCBs) have shown good results in terms of safety and effectiveness. In this review we examine the results of different trials exploring the outcome of using DCBs for the treatment of SFA ISR. The available data demonstrate that SFA ISR can be safely treated with percutaneous transluminal angioplasty with a DCB, with a reduction in recurrent restenosis and target lesion revascularization (TLR) at least at 1 year after POBA. The consistent and positive results of different registries and randomized trials support the use of DCB to reduce SFA ISR recurrence.
Project description:We evaluated Viabahn stent-graft (W.L. Gore & Associates, Flagstaff, AZ, USA) implanted in the superficial femoral artery at 6 months and one year after implantation because the patient felt claudication due to repeated restenosis of bare nitinol stent which was implanted just proximal to the site of Viabahn stent-graft. At 6 months, angioscopy showed severe thrombosis in the stent-graft while the stent-graft was entirely patent. However, at one year, angioscopic evaluation revealed no thrombosis in the stent-graft. She received the same dual antiplatelet therapy. <Learning objective: We report a case with Viabahn stent-graft in whom an angioscopy revealed severe thrombosis at 6 months but no thrombosis at one year during the same dual antiplatelet therapy (DAPT). It might be necessary to continue DAPT after Viabahn stent-graft implantation at least over one year to prevent thrombosis.>.
Project description:Vascular injuries after total knee arthroplasty are highly infrequent, especially in the femoral artery. These lesions can cause severe damage. Early diagnosis is important to prevent catastrophic complications (such as loss of limb) and to offer adequate treatment. This study reports a patient with femoral artery injury of unknown etiology after total knee arthroplasty. Progressive and insidious symptoms from deep vein thrombosis to compartment syndrome made management even more challenging, requiring amputation of the extremity.
Project description:PurposeContemporary diagnostic modalities, including contrast-enhanced computed tomography (CTA) and duplex ultrasound, have been insufficiently able to predict endograft thrombosis. This study introduces an implementation of image-based computational fluid dynamics (CFD), by exemplification with 4 patients treated with an endograft for occlusive disease of the superficial femoral artery (SFA). The potential of personalized CFD for predicting endograft thrombosis is investigated.Materials and methodsFour patients treated with endografts for an occluded SFA were retrospectively included. CFD simulations, based on CTA and duplex ultrasound, were compared for patients with and without endograft thrombosis to investigate potential flow-related causes of endograft thrombosis. Time-averaged wall shear stress (TAWSS) was computed, which highlights areas of prolonged residence times of coagulation factors in the graft.ResultsCFD simulations demonstrated normal TAWSS (>0.4 Pa) in the SFA for cases 1 and 2, but low levels of TAWSS (<0.4 Pa) in cases 3 and 4, respectively. Primary patency was achieved in cases 1 and 2 for over 2 year follow-up. Cases 3 and 4 were complicated by recurrent endograft thrombosis.ConclusionThe presence of a low TAWSS was associated with recurrent endograft thrombosis in subjects with otherwise normal anatomic and ultrasound assessment and a good distal run-off.
Project description:Drug-coated balloons (DCB) are effective in treating in-stent restenosis (ISR) with neointimal proliferation after bare-metal stent (BMS) implantation, but it is unclear whether DCB are effective in treating BMS-ISR accompanied by thrombosis. An 84-year-old man with previous inferior myocardial infarction and atrial fibrillation developed acute myocardial infarction (AMI) during hospitalization for intracerebral hemorrhage. Emergent coronary angiography (CAG) revealed severe stenosis of the distal left circumflex coronary artery. We implanted a BMS to avoid long-term triple antithrombotic therapy. He received aspirin, clopidogrel, and rivaroxaban for 1 month and then received clopidogrel and rivaroxaban. Seventy days after BMS implantation, he developed AMI, and emergent CAG revealed occlusion of the BMS due to late stent thrombosis. After thrombus aspiration, intravascular ultrasound showed incomplete neointimal healing in the proximal portion of the stent and excessive neointimal proliferation in the distal portion of the stent. DCB angioplasty of the entire BMS was performed after scoring balloon pre-dilation. Seven months after BMS implantation, follow-up CAG revealed binary ISR. DCB angioplasty of the entire BMS was performed again after scoring balloon pre-dilation. Thirteen months after BMS implantation, follow-up CAG did not reveal recurrence of ISR. <Learning objective: Drug-coated balloons (DCB) were ineffective when there was excessive neointimal proliferation accompanied by thrombosis, but effective in binary in-stent restenosis (ISR). DCB may be ineffective in early ISR after bare-metal stent implantations and when there is excessive neointimal proliferation accompanied by thrombosis. Since the safety and efficacy of DCB to treat excessive neointimal proliferation occurring with late stent thrombosis is unclear, further studies are needed.>.