Successful modeling of long term outcomes in end-stage renal disease patients undergoing percutaneous coronary intervention with drug-eluting stents.

Objectives: The objective of this study is to identify and model risk factors for major adverse cardiac events (MACE) and all-cause mortality among patients with ESRD treated with PCI using DES.

Background: Patients with end-stage renal disease (ESRD) have poor long-term outcomes after percutaneous coronary intervention (PCI) compared with non-ESRD patients. However, there is a paucity of literature regarding risk factors associated with outcomes of ESRD patients after PCI with drug-eluding stents (DES).

Prediabetic Patient Outcomes 8 to 15 Years After Drug-Eluting Coronary Stenting.

Guidelines suggest differential management of diabetics and nondiabetics with coronary artery disease (CAD) referred for revascularization, but pre-diabetics, who now comprise up to 20% to 30% of CAD patients, have been excluded from the diabetic group. To address this, we studied long-term cardiac outcomes in 1,323 consecutively drug-eluting stent (DES)-stented patients from prespecified local zip codes, dividing patients into normal-glycemic patients, prediabetics and diabetics, based upon conventional definitions. Patient age was 63±11 years, 65.

Comparison of Long-Term Clinical Outcomes After Drug-Eluting Stenting in Blacks-vs-Whites.

Patients of different racial backgrounds may have socioeconomic, cultural, or genetic differences that impact outcomes after percutaneous coronary intervention (PCI). There are limited data beyond 2 to 3 years for Blacks to inform discussions and perhaps improve outcomes. We studied consecutive limus-stent treated patients, having their first PCI at our institution January 2003 to March 2010 in 2 cohorts; Cohort 1: standard 3-year follow-up (n = 3,782, 12.

Clinical Outcomes and Cost Comparisons of Stent and Non-Stent Interventions in Infrainguinal Peripheral Artery Disease: Insights From the Excellence in Peripheral Artery Disease (XLPAD) Registry.

Background: The contemporary limb outcomes and costs of stent-based vs non-stent based strategies in endovascular revascularization of femoropopliteal (FP) peripheral artery disease (PAD) are not well understood.

Methods And Results: We present data from the ongoing United States multicenter Excellence in Peripheral Artery Disease Registry between 2006-2016 to compare stent vs non-stent treatment outcomes and associated costs in FP interventions. A total of 2910 FP interventions were performed in 2162 patients (mean age, 66 years), comprising 1339 stent based (superficial femoral artery, 93%) in 1007 patients and 1571 non-stent interventions (superficial femoral artery, 85%) in 1155 patients.

Clinical utility of cerebral angiography in the preoperative assessment of endocarditis.

Cerebral angiography is an invasive procedure utilized without supporting guidelines in preoperative evaluations of infective endocarditis (IE). It is used to identify mycotic intracranial aneurysm, which is suspected to increase the risk of intracranial bleeding during cardiac surgery. Our objectives were to: (1) assess the utility of cerebral angiography by determining which subset of IE patients benefit from its performance; and (2) identify clinical and noninvasive screening tests that can preclude the need for invasive cerebral angiography.

A direct comparison of early and late outcomes with three approaches to carotid revascularization and open heart surgery.

Objectives: The aim of this study was a comparison of risk-adjusted outcomes of 3 approaches to carotid revascularization in the open heart surgery (OHS) population.

Background: Without randomized clinical trials, the best approach to managing coexisting severe carotid and coronary disease remains uncertain. Staged carotid endarterectomy (CEA) followed by OHS or combined CEA and OHS are commonly used.

Cause of death within 30 days of percutaneous coronary intervention in an era of mandatory outcome reporting.

Objectives: This study sought to ascertain causes of death and the incidence of percutaneous coronary intervention (PCI)-related mortality within 30 days.

Background: Public reporting of 30-day mortality after PCI without clearly identifying the cause may result in operator risk avoidance and affect hospital reputation and reimbursements. Death certificates, utilized by previous reports, have poor correlation with actual cause of death and may be inadequate for public reporting.

Predictive value of renal resistive index in percutaneous renal interventions for atherosclerotic renal artery stenosis.

Background: The clinical benefit of percutaneous interventional therapies for atherosclerotic renal artery stenosis (ARAS) is still obscure. Randomized trials conducted on general patient populations provided unsatisfactory results in justifying the interventional treatment. In this study, the predictive value of renal resistive index (RRI) was retrospectively analyzed in identifying the patients who may benefit from renal angioplasty and stenting.

Outcomes of carotid stenting in patients with previous neck radiation.

Objectives: Our aim was to report outcomes of percutaneous stenting of carotid stenosis in patients with previous neck radiation.

Background: Post-irradiation carotid disease is often extensive and involves atypical areas. Data regarding outcomes of stenting of these lesions are scarce.

Characteristics of duplex sonographic parameters over time after successful carotid artery stenting.

Objectives: Carotid duplex sonography is the primary tool for surveillance after carotid artery stenting, but the course of sonographic velocities over time after successful stenting is unclear. The purpose of this study was to describe carotid duplex sonographic velocity parameters after successful carotid artery stenting and to determine the predictors of poststent sonographic velocities.

Methods: We queried institutional carotid stent and noninvasive vascular laboratory databases for internal carotid artery stents placed between January 2004 and June 2007.

Percutaneous coronary revascularization in coronary artery disease: lessons from a single center experience.

Objectives: To determine the role of percutaneous coronary intervention (PCI) and its impact on mortality in coronary artery disease (CAD).

Background: It's unclear whether PCI provides benefit in patients with CAD outside of acute settings. We sought to determine the role of PCI and its effect on mortality in patients with similar entry criteria to prior RCTs and compare outcomes with medical treatment.

Technique and outcome of ostial common carotid artery stenting: a single centre experience.

Aims: Our aim was to report techniques and outcomes of our experience in percutaneous stenting of ostial common carotid artery lesions.

Methods And Results: We retrospectively reviewed patient medical records at our institution from January 2005 until April 2011 to determine baseline characteristics, procedural details and follow-up data of patients who underwent percutaneous stenting of ostial lesions of the common carotid artery. Our study included 17 patients of whom eight (47%) were male.

Comparison of outcomes of unprotected left main versus multivessel coronary artery interventions.

Left main coronary artery (LMCA) percutaneous coronary intervention (PCI) has emerged as an appealing alternative to bypass surgery for significant LMCA disease, especially in high-risk candidates. PCI for unprotected LMCA stenosis is currently designated a class IIb indication. Direct comparisons between unprotected LMCA PCI and multivessel PCI are lacking.

Enhanced prediction of mortality after percutaneous coronary intervention by consideration of general and neurological indicators.

Objectives: This study sought to improve methodology for predicting post-percutaneous coronary intervention (PCI) mortality.

Background: Recently, an increased proportion of post-PCI deaths caused by noncardiac causes has been suggested, often in rapidly triaged patients resuscitated from sudden cardiac death or presenting with cardiogenic shock. Older risk adjustment algorithms may not adequately reflect these issues.

Carotid stenting vs surgery: parsing the risk of stroke and MI.

The Carotid Revascularization Endarterectomy Versus Stenting Trial (CREST) is the largest randomized prospective study to date to compare carotid artery stenting and carotid endarterectomy in a patient population similar to that seen in everyday practice. CREST showed stenting and surgery to be equivalent in terms of the composite end point of stroke, myocardial infarction (MI), or death within 30 days, as well as for the rate of stroke at up to 4 years (N Engl J Med 2010; 363:11-23). Importantly, the risk of major stroke was low with either intervention.

Safety and efficacy of carotid stenting in individuals with concomitant severe carotid and aortic stenosis.

Aims: Carotid artery stenting (CAS) prior to open-heart surgery may be a useful approach to minimise the risk of neurologic events in patients undergoing aortic valve replacement (AVR).

Methods And Results: All patients referred for carotid intervention at our institution between 1998 and 2005 with concomitant severe aortic stenosis (AS) (aortic valve area <1.0 cm2) were included.

Predictors of difficult carotid stenting as determined by aortic arch angiography.

Objective: Although different aortic arch classifications exist to help determine carotid artery stenting (CAS) difficulty, they are not validated. We compared quantitative angiographic characteristics of aortic arch between easy and difficult CAS.

Methods: We defined difficult procedures as requiring the longest fluoroscopy time (FT) (90th percentile) and easy procedures as the shortest FT (10th percentile) from our CAS database.

Intracranial angioplasty and stenting in the awake patient.

Background And Purpose: Endovascular treatment for intracranial atherosclerosis is evolving, but complications remain an issue. Most interventions are performed under general anesthesia, preventing intraprocedural clinical evaluations. We describe our approach to intracranial angioplasty and stenting, using local rather than general anesthesia, and intraprocedural neurological assessment.

Evaluating the optimal activated clotting time during carotid artery stenting.

Carotid artery stenting is an alternative to carotid endarterectomy for patients at high risk for surgery for carotid artery stenosis. Although unfractionated heparin is routinely used, there are no published data evaluating the optimal activated clotting time during carotid stenting. In a retrospective analysis of 605 patients who underwent carotid stenting using unfractionated heparin at the Cleveland Clinic Foundation, the optimal peak procedural activated clotting time associated with the lowest combined incidence of death, stroke, or myocardial infarction was 250 to 299 seconds.

Rate, predictors, and consequences of hemodynamic depression after carotid artery stenting.

Objectives: We sought to determine the frequency, predictors, and consequences of hemodynamic depression (HD) after carotid artery stenting (CAS).

Background: Hemodynamic depression has been reported after carotid artery stenting CAS and carotid endarterectomy (CEA).

Methods: We retrospectively analyzed data on 500 consecutive CAS procedures performed over a 5-year period.