Although the carotid endarterectomy presently represents the standard therapeutic approach for most patients with significant carotid artery stenosis, a percutaneous transluminal angioplasty (PTA) with stenting has become an alternative method for treating patients with co-mobid conditions, particulary coronary artery disease. A PTA with stenting has the potential for being safer, less traumatic, more cost-effective, and useful in patients at high surgical risk. As well, they are not limited to the cervical carotid artery. But it is reported that carotid angioplasty by femoral approach is difficult to do in 1 - 2% of patients with carotid stenosis due to abnormal origin of carotid artery or occlusion of femoral arteries. We succeeded in PTA with stenting of tight stenosis of right internal carotid artery through the transseptal approach in case of a sharply angled right brachiocephalic artery take-off from the aorta. The transseptal approach can be used for PTA with stenting in case of problems with femoral approach.
Angioplasty ; Aorta ; Arteries ; Carotid Arteries* ; Carotid Artery, Internal ; Carotid Stenosis* ; Constriction, Pathologic ; Coronary Artery Disease ; Endarterectomy, Carotid ; Femoral Artery ; Humans ; Stents*

No abstract available.
Coronary Artery Disease* ; Coronary Vessels* ; Drug-Eluting Stents*

Critical limb ischemia (CLI) is the most severe peripheral artery disease and caused by thrombus formation in blood vessel. The current strategies for treating CLI does not protect limb amputation and reduction in the risk of mortality. Recently, human bone marrow derived mesenchymal stem cells (BD-MSC) were reported to have a paracrine effects on angiogenesis in several ischemic diseases. So, we validate to determine whether BD-MSC protect against ferric chloride treated CLI and induce angiogenesis. To characterized human bone marrow derived stem cell, BD-MSC differentiated to osteocytes and adipocytes and validated stemness using flow cytometry. Endothelial cell induced angiogenesis followed by mesenchymal stem cell cultured medium treatment in HUVEC in vitro. We also mimicked CLI patients condition using FeCl₃ treated CLI mouse and injected one hundred thousand of BD-MSC along the femoral artery to leg muscle. We validated stem cell survival, blood vessel formation, leg muscle condition and fibrosis compared by saline injected mice 28 days later. In this study, BD-MSC cultured medium treatment increased migration and tube formation of HUVEC and BD-MSC injection had an effective blood vessel formation in FeCl₃ treated CLI. As well as blood vessel formation, limb salvage rate also improved and fibrosis area statistically decreased in BD-MSC injected mice. In conclusion, bone marrow derived mesenchymal stem cell improved not only blood vessel formation but also reduction of fibrosis in FeCl₃ treated CLI mice and finally protected limb amputation.
Adipocytes ; Amputation ; Animals ; Blood Vessels ; Bone Marrow ; Endothelial Cells ; Extremities* ; Femoral Artery ; Fibrosis ; Flow Cytometry ; Humans ; In Vitro Techniques ; Ischemia* ; Leg ; Limb Salvage ; Mesenchymal Stromal Cells ; Mice ; Mortality ; Osteocytes ; Peripheral Arterial Disease ; Stem Cells ; Thrombosis

Endovascular therapy, proposed as an alternative to surgery, is considered a therapeutic innovation because of its low degree of invasiveness, allowing for the treatment of high-risk surgical patients and outcomes of limited complications and mortality. The combination of endovascular exclusion with cerebral branch revascularization for the treatment of thoracic aortic aneurysms involving arch has also been attempted. With improved capability to recognize proper anatomy and select clinical candidates, endovascular therapy may offer a strategy to optimize management and improve prognosis for thoracic aortic aneurysm patients.
Aortic Aneurysm, Thoracic* ; Humans ; Mortality ; Prognosis

No abstract available.
Carcinoma, Hepatocellular* ; Heart Atria*

Renal artery aneurysm (RAA) is a rare disease, and the precise incidence has not been very well known. It appears that with the increasing use of diagnostic ultrasound, computed tomography and arteriography, RAA are being identified more frequently than in the past. Rupture of RAA is associated with 10% mortality and the chance of nephrectomy is very high. Although, most of renal artery aneurysms are treated by endovascular technique, surgery is often necessary for aneurysms associated with bifurcation area or large braches. Here, we report a case of saccular renal artery aneurysm which was managed by open surgery.
Aneurysm ; Angiography ; Endovascular Procedures ; Incidence ; Nephrectomy ; Rare Diseases ; Renal Artery ; Rupture

BACKGROUND AND OBJECTIVES: To evaluate the feasibility and the short- and mid-term follow-up outcomes of endovascular stent-graft implantation in patients with Stanford type B aortic dissection. SUBJECTS AND METHODS: Twenty-eight patients with Stanford type B aortic dissection were evaluated. An aortogram was performed immediately after the procedure and a follow-up computed tomography (CT) scan was performed within one week, between 3 and 6 months, and annually thereafter. Clinical status was also evaluated at the same time. RESULTS: Endovascular stent-graft implantation at the target site was successful in 27 patients (96.4%). There were primary endoleaks in 6 patients and one case of procedure failure owing to migration of the stent-graft; and no procedure-related mortality. The number of patients with early complications requiring treatment was 2 (2/27, 4%). Fourteen patients experienced postimplantation syndrome (14/27, 52%). The average follow-up period was 22.1+/-17.5 months. Complete resolution or thrombosis of the false lumen was achieved in 14 patients and partial thrombosis was achieved in 10 patients. Operative treatments were required in three patients due to a progressing dissection or new dissection. There were no deaths and no instances of aneurysm or aortic rupture during the follow-up period. CONCLUSION: Endovascular stent-graft implantation for Stanford type B aortic dissection is a feasible, safe, and effective treatment modality. All patients who underwent surgery had a persisting leak. Therefore, regular evaluation of the aortic dissection and management of endoleaks were crucial for a favorable outcome in endovascular stent-graft implantation for a Stanford type B aortic dissection.
Aneurysm ; Aortic Rupture ; Endoleak ; Follow-Up Studies ; Humans ; Mortality ; Thrombosis

No abstract available.
Coronary Vessels ; Multidetector Computed Tomography ; Sinus of Valsalva

BACKGROUND AND OBJECTIVES: Primary percutaneous coronary intervention (PCI) has been reported to be effective reperfusion therapy for acute myocardial infarction (AMI). In the very thrombotic environment of AMI, primary PCI, with heparin-coated stents, has been known to reduce the early reocclusion of the stented vessel by preventing thrombosis. However, little data exist regarding the long-term clinical outcomes. The aim of our study was to evaluate the safety, feasibility and long-term efficacy of heparin-coated stents in AMI. SUBJECTS AND METHODS: Between January 1998 and July 2002, primary PCI with heparin-coated stents was performed in 132 consecutive patients (98 males, with a mean age of 56.3+/-0.7 years) admitted with the diagnosis of AMI within 12 hours from the onset of the chest pain. Major adverse cardiac events (MACE), including death, MI, TLR (target lesion revascularization) and CABG, were recorded during hospitalization and the follow-up period. Angiograms were obtained at the baseline, after stent implantation and at 6 months following implantation. RESULTS: The angiographic and procedure success rate was 96.2%. During hospitalization, there was no evidence of reocclusion of stented vessel, but 1 patient underwent a repeat PCI due to dissection. There were no bleeding complications. A six-month angiographic follow-up was completed in 47.2% of eligible patients and binary restenosis was present in 20.1%. During the long-term clinical follow-up (mean follow-up period 37.2+/-7.2 months), there were 12 deaths, 1 myocardial infarction and 18 TLR. The MACE free survival rate was 76.5%. CONCLUSION: Primary PCI, with heparin-coated stents, shows favorable long-term clinical outcomes.
Chest Pain ; Diagnosis ; Follow-Up Studies ; Hemorrhage ; Hospitalization ; Humans ; Male ; Myocardial Infarction* ; Percutaneous Coronary Intervention ; Reperfusion ; Stents* ; Survival Rate ; Thrombosis