Publications by authors named "Gail A Shammas"

Background: There are limited data on the mechanism of the Rotarex Rotational Excisional Atherectomy System in treating femoropopliteal arterial disease. The Rotarex iDissection study is a prospective, single center study evaluating the extent of excision and dissection in de novo and restenotic (not in-stent) lesions of the femoropopliteal arteries in symptomatic peripheral arterial disease patients.

Methods: Consecutive patients with symptomatic peripheral arterial disease were prospectively enrolled in the Rotarex iDissection study at a single US center after obtaining informed consent.

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The 355 nm Auryon laser (AngioDynamics, Inc., Latham, New York) has been shown to be effective and safe in treating various morphology lesions in the femoropopliteal arteries. There are limited data on the Auryon laser in treating below-the-knee (BTK) arteries in patients with chronic limb-threatening ischemia.

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Paclitaxel drug-coated balloons (DCB) have been shown to reduce target lesion revascularization (TLR) rate, but recently an association between paclitaxel and an increase in mortality at 5-year was reported. We reviewed the 5-year mortality and freedom from TLR rates from a single center among patients that received DCB. Consecutive patients that received DCB from July 8, 2015 to November 27, 2019 with follow-up obtained from medical records and review of official death certificates were reviewed.

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Article Synopsis
  • The study focused on comparing the Flex VP micro-incision catheter followed by angioplasty (PTA) to PTA alone in patients with femoropopliteal artery disease, assessing the occurrence of deep dissections using intravascular ultrasound (IVUS).
  • Seventeen patients (20 limbs) were included, and while baseline characteristics were largely similar, a significant difference was noted in gender distribution and treated length between the two groups.
  • Results indicated that severe dissections (assessed by IVUS) were significantly fewer in patients treated with the Flex VP catheter compared to those receiving only PTA, suggesting potential advantages of using Flex VP in preventing deeper vessel injuries.
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  • The Auryon 355-nm laser atherectomy system demonstrated low target-lesion revascularization (TLR) rates at 6 months and was further examined for its 1-year outcomes in treating infrainguinal arteries.
  • A retrospective study of 56 patients showed no TLR at 6 months, and TLR rates were evaluated at the 1-year mark alongside secondary endpoints like major amputations and mortality.
  • Results revealed that 3.1% of limbs required TLR at 1 year, with the study group predominantly consisting of older males, many exhibiting severe lesions, and a small percentage experiencing mortality within the follow-up period.
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Background: The Auryon 355-nm laser atherectomy system (AngioDynamics, Inc) showed a low rate of target-lesion revascularization (TLR) at 6-month follow-up in the investigational device exemption study. At present, real-world data are not available. In this study, we analyze major adverse events and 6-month outcomes with the Auryon laser system in treating infrainguinal arterial disease in all comers at a single center.

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Background: Femoropopliteal arterial angiographic dissections with the use of the Auryon laser atherectomy system (previously the B-laser) have been infrequent and non-flow limiting. However, the pattern of these dissections (depth and arc) using intravascular ultrasound remains unknown.

Materials And Methods: We prospectively enrolled 29 patients in the iDissection Auryon study.

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  • This study revises a scoring system for diagnosing iliac vein compression (ILVC) using minimal luminal area (MLA) and age, focusing on patients aged 65 and younger.
  • A total of 70 symptomatic patients were evaluated, and the revised scoring system showed a high sensitivity (98.1%) but low specificity (16.7%) in predicting ILVC via intravascular ultrasound (IVUS).
  • The findings suggest that the combination of MLA and age can serve as a useful diagnostic tool for detecting significant ILVC, with an overall accuracy of 77.1%.
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Background: Treatment of common femoral artery (CFA) disease has been traditionally surgical. Recent data indicate that an endovascular option is feasible in treating CFA disease but there remains significant controversy about the endovascular versus surgical approach to treatment. Newer modalities of therapy have emerged to treat the CFA including atherectomy and drug coated balloons.

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Purpose: To report the results of a study evaluating JetStream atherectomy for the treatment of in-stent restenosis (ISR).

Materials And Methods: The JetStream XC atherectomy device, a rotational cutter with aspiration capacity, was evaluated in a prospective, multicenter study (JET-ISR) of 60 patients (mean age 70.2±10.

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Background: We present the results of a patient-level meta-analysis of the two currently completed and core-lab adjudicated prospective trials of Jetstream atherectomy system (Boston Scientific) in femoropopliteal in-stent restenosis (FP-ISR) and compare the findings to a published, prespecified 6-month performance goal of target-lesion revascularization (TLR) with angioplasty alone.

Methods: The JETSTREAM-ISR (n = 29 patients; n = 32 lesions) was a two-center feasibility study that evaluated Jetstream atherectomy in FP-ISR. The JET-ISR (n = 60 patients; n = 60 lesions) was a 10-center investigational device exemption study that evaluated the same.

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Background: Calcium is a predictor of poor outcome in the treatment of infrainguinal arterial disease. Rotational atherectomy can effectively debulk atherosclerotic calcium but is less likely to significantly modify medial and adventitial calcinosis. Shockwave IVL provides circumferential sonic pressure waves capable of disrupting deeper calcium and theoretically complements the debulking process of atherectomy.

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Purpose: To investigate if imaging with intravascular ultrasound (IVUS) yields a more accurate estimate of vessel diameter and the presence of dissections than angiography after intervention in the infrapopliteal arteries.

Materials And Methods: A prospective, single-center study enrolled 20 consecutive patients (mean age 74.1±12.

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Article Synopsis
  • The study investigates the effects of the Flex Vessel Prep system on reducing dissections during balloon angioplasty in patients with femoropopliteal artery issues.
  • Patients showed improved outcomes post-intervention, with significant reductions in stenosis severity after using the Flex system followed by angioplasty.
  • The results indicate a higher number of dissections identified through intravascular ultrasound compared to angiography, suggesting that ultrasound may reveal more complications than traditional imaging post-procedure.
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Article Synopsis
  • Intravascular ultrasound (IVUS) is the gold standard for diagnosing common iliac vein (CIV) compression, with >50% surface area reduction indicating significant compression.
  • A study evaluated computed tomography angiography (CTA) and venography against IVUS in 96 patients, finding varying degrees of correlation between the different imaging techniques for measuring percent stenosis (PS) and minimal lumen area (MLA).
  • The results showed that while PS from venography correlated with IVUS, it generally underestimated PS, whereas CTA and IVUS provided similar PS readings despite CTA yielding larger MLA measurements.
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Background: The WIRION EPS filter was recently approved by the Food and Drug Administration (FDA) to be used in conjunction with all atherectomy devices when treating infrainguinal peripheral arterial disease. The safety of this filter with Jetstream atherectomy (JA) in a real world setting remains unclear.

Methods: Consecutive patients from the practice of one operator who underwent JA under WIRION EPS when treating femoropopliteal arteries were enrolled in this retrospective analysis.

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Background: The long-term outcome of Jetstream atherectomy (JA) with or without adjunctive drug coated balloons (DCB) in a real-world setting remains unknown. We report 16-month target lesion revascularization (TLR) rates on patients treated for femoropopliteal (FP) artery disease with JA in a single center by one operator.

Methods: From 1/1/12 to 8/24/16 a total of 311 procedures were performed with atherectomy by a single operator at a single center.

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  • The study evaluated the safety and effectiveness of the Atlas Gold balloon during iliofemoral vein procedures across a group of 77 patients over a 1-year period.
  • There were no major device-related adverse events reported, achieving over 95% intraprocedural safety, with significant symptom improvement noted in 89% of patients after the procedure.
  • At the one-year mark, all stents maintained patency with no instances of stent thrombosis or complications, confirming the balloon's reliability in venous interventions.
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Background: Dissections occur post atherectomy of the infrainguinal arteries. We hypothesized that angiography under-estimates their presence significantly.

Methods: In this prospective pilot study, a total of 15 patients were evaluated by intravascular ultrasound (IVUS) following treatment of femoropopliteal de novo or non-stent restenosis using atherectomy.

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Background: Hospital inpatient readmissions for patients admitted initially with the primary diagnosis of heart failure (HF) can be as high as 20-25% within 30 days of discharge. This, however, does not include admissions for observations or emergency department (ED) visits within the same time frame and does not show a time-dependent hospital encounter following discharge after an index admission. We present data on time-dependent hospital encounter of HF patients discharged after an index admission for a primary diagnosis of HF.

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Background: Intraoperative radiofrequency ablation (RFA) has been advocated to treat atrial fibrillation (AF). This report examines the long-term effects of intraoperative RFA in the prevention of recurrence of AF when used as an adjunctive treatment in patients undergoing cardiac procedures for primary indications unrelated to their arrhythmia.

Methods: The study reviewed the records of patients from a tertiary medical center which had 2 cardiac surgeons performing an intraoperative adjunctive RFA procedure.

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Background: Target-lesion revascularization (TLR) and loss of patency remain high following treatment of in-stent restenosis (ISR) of the femoropopliteal (FP) artery. Excimer laser atherectomy (ELA) is effective in reducing TLR and improves patency at 6-month and 1-year follow-up when compared with balloon angioplasty (PTA). The long-term sustainability of these early results is unknown.

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Background: It is unclear whether patients on oral anticoagulants (OAC) undergoing a procedure using common femoral artery access have higher adverse events when compared to patients who are not anticoagulated at the time of the procedure.

Methods: We retrospectively reviewed data from consecutive patients who underwent a cardiac procedure at a tertiary medical center. Patients were considered (group A) fully or partially anticoagulated if they had an international normalized ratio (INR) ≥1.

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Bailout stenting of the common femoral artery (CFA) may become necessary with failed balloon angioplasty or atherectomy or in case of bleeding requiring a covered stent over the arteriotomy site. Reaccessing the CFA through a previously placed stent may occur during angiography. The safety and effectiveness of applying a closure device, or manual compression to achieve hemostasis through an accessed stented CFA are unknown.

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Article Synopsis
  • The study compares two techniques for detecting venous reflux: standing position (SP) and reverse Trendelenburg at 60° (RT-60), focusing on patients unable to stand.
  • Of 33 symptomatic patients, the RT-60 technique showed a high correlation with the SP technique, effectively identifying reflux in the great and small saphenous veins.
  • The results suggest that RT-60 could be a reliable alternative for patients with mobility issues when assessing venous reflux.
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