Balloons are valuable tools in the armamentarium of a neurointerventionist. In this report, we describe 2 cases in which a balloon aided in the navigation of a second remodeling balloon through difficult vascular anatomy. The first case was a patient with a ruptured proximal posterior inferior cerebellar artery aneurysm and the second case was a patient with a ruptured anterior communicating artery aneurysm. In both cases, the coiling microcatheter and the remodeling balloon catheters were advanced through different vessels. The remodeling balloon reached the target location using a transcirculation approach, and the navigation of the remodeling balloon was aided by utilizing a second balloon. Challenging vascular anatomy is often encountered when performing neuroendovascular procedures. The strategy of using balloon assistance for the transcirculation access of a remodeling balloon can be used successfully in difficult situations to manage complex aneurysms.
Importance: Drug-coated balloon (DCB) angioplasty has emerged as an alternative to drug-eluting stent (DES) implantation for percutaneous coronary intervention (PCI) in patients with coronary in-stent restenosis (ISR) as well as de novo coronary artery disease.
Observations: DCBs are balloons coated with antiproliferative agents and excipients, whose aim is to foster favorable vessel healing after appropriate lesion preparation. By providing homogeneous antiproliferative drug delivery in the absence of permanent foreign body implantation, DCBs offer multiple advantages over DES, including preservation of vessel anatomy and function and positive vessel remodeling.
DCB Academy, Milano, Italy; Fondazione Ricerca e Innovazione Cardiovascolare, Milano, Italy; University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA. Electronic address:
Percutaneous coronary intervention (PCI) with drug-coated balloon (DCB) has been expanding progressively in recent years. Convincing evidence demonstrated the ability of some DCB to promote positive vessel remodeling with potential clinical benefits at follow-up. When PCI with DCB results in suboptimal angiographic results (residual stenosis >30% or type C-F dissection), bailout stenting (BS) implantation is recommended to mitigate the risk of abrupt vessel occlusion or restenosis.
We describe a case of retrograde acute type A aortic dissection approached by a hybrid, staged approach consisting of a zone 2 arch replacement and completion thoracic endovascular aortic repair procedure combined with distal balloon-assisted stent graft dilatation to prevent retrograde false lumen flow. This technique may be an alternative and more complete when compared with a frozen elephant trunk procedure at onset. Additionally, favorable remodeling of the entire thoracic aorta is observed.
Introduction: The phenotypic transition of vascular smooth muscle cells (VSMCs) from a quiescent, contractile type to a secretory phenotype with high proliferation and mobility is a key event in vascular remodeling. PF-477736 is an ATP-competitive inhibitor of Chk1 which induces the accumulation of DNA damage by increasing the level of replicative stress, and ultimately inhibiting cell proliferation or causing cell death. Although this compound has been utilized as an anti-tumor drug, its role in vascular remodeling remains unclear.
Purpose: We compared adults with mitral stenosis (MS) to 8 controls (CONT) to see how pulmonary impedance and wave reflections differ at baseline and after balloon valvuloplasty.
Methods: We separated the MS patients into groups according to mean pulmonary artery pressure: moderate (MOD; ≤ 26 mmHg, n = 21) and high (HIGH; > 26 mmHg, n = 33). We made baseline high-fidelity measurements in all patients, in the MS groups after vasodilation with nitroprusside, immediately and 4 months after balloon valvuloplasty.
