The Experts below are selected from a list of 2079 Experts worldwide ranked by ideXlab platform

Gennaro Giustino - One of the best experts on this subject based on the ideXlab platform.

Nicolas M. Van Mieghem - One of the best experts on this subject based on the ideXlab platform.

  • TCT-754 Predictors For Tissue Embolization During Transcatheter Aortic Valve Implantation
    Journal of the American College of Cardiology, 2014
    Co-Authors: Nicolas M. Van Mieghem, Peter De Jaegere
    Abstract:

    Cerebrovascular embolization is frequent during Transcatheter Aortic Valve Implantation (TAVI). The aim of this study was to identify variables associated with tissue embolization during TAVI. A total of 82 patients underwent TAVI with a dual filter– based Embolic Protection Device (Montage Dual

  • Histopathology of Embolic Debris Captured During Transcatheter Aortic Valve Replacement
    Circulation, 2013
    Co-Authors: Nicolas M. Van Mieghem, Marguerite E.i. Schipper, Elena Ladich, Elham Faqiri, Robert M.a. Van Der Boon, Abas Randjgari, Carl Schultz, Adriaan Moelker, Robert Jan Van Geuns, Fumiyuki Otsuka
    Abstract:

    Background—Recent transcatheter aortic valve replacement studies have raised concerns about adverse cerebrovascular events. The etiopathology of the embolized material is currently unknown. Methods and Results—A total of 40 patients underwent transcatheter aortic valve replacement with the use of a dual filter–based Embolic Protection Device (Montage Dual Filter System, Claret Medical, Inc). Macroscopic material liberated during the transcatheter aortic valve replacement procedure was captured in the Device filter baskets in 30 (75%) patients and sent for histopathologic analysis. The captured material varied in size from 0.15 to 4.0 mm. Amorphous calcified material (size, 0.55–1.8 mm) was identified in 5 patients (17%). In 8 patients (27%), the captured material (size, 0.25–4.0 mm) contained valve tissue composed of loose connective tissue (collagen and elastic fibers) with focal areas of myxoid stroma, with or without coverage by endothelial cells and intermixed with fibrin. In another 13 (43%) patients...

Ju Han - One of the best experts on this subject based on the ideXlab platform.

  • endovascular recanalization of nonacute symptomatic vertebral ostial occlusion performed using a distal Embolic Protection Device
    World Neurosurgery, 2020
    Co-Authors: Meimei Zheng, Wei Wang, Jinping Zhang, Yun Song, Wei Zhao, Lili Sun, Jun Zhang, Hao Yin, Ju Han
    Abstract:

    Objective Endovascular recanalization of symptomatic vertebral ostial occlusion in the nonacute phase has not been well documented. Distal thromboEmbolic events negatively affect the success of endovascular treatment. We aimed to investigate the feasibility, safety, and outcomes of stenting performed with the use of a distal Embolic Protection Device for patients with symptomatic vertebral ostial occlusion in the nonacute phase. Methods We retrospectively reviewed the data of 7 patients with symptomatic vertebral ostial occlusion despite medical management who underwent stenting performed using a distal Embolic Protection Device between January 2015 and February 2019. The occlusive lesions were predilated with small balloons, followed by placement of distal Embolic Protection Devices and stents sequentially. At last, the Protection Devices were retrieved. The rate of successful recanalization, perioperative complications, and clinical and angiographic outcomes were analyzed. Results The rate of successful recanalization was 100% with all distal Embolic Protection Devices deployed and retrieved. Poststenting angiography showed no significant residual stenosis. There were no major acute thromboEmbolic events during and after the procedure. There were no recurrent ischemic symptoms after a mean clinical follow-up of 20.6 ± 16.3 months. At 6-month imaging follow-up, repeat vascular images from 5 patients showed asymptomatic restenosis in 1 artery. Conclusions Our single-center preliminary experience indicated that performing stent placement for vertebral ostial occlusion using a distal Protection Device may be feasible with a high rate of procedural success. However, this strategy should be confirmed in future prospective randomized studies with larger patient numbers.

  • Endovascular Recanalization of Nonacute Symptomatic Vertebral Ostial Occlusion Performed Using a Distal Embolic Protection Device.
    World neurosurgery, 2019
    Co-Authors: Meimei Zheng, Wei Wang, Jinping Zhang, Yun Song, Wei Zhao, Lili Sun, Jun Zhang, Hao Yin, Ju Han
    Abstract:

    Endovascular recanalization of symptomatic vertebral ostial occlusion in the nonacute phase has not been well documented. Distal thromboEmbolic events negatively affect the success of endovascular treatment. We aimed to investigate the feasibility, safety, and outcomes of stenting performed with the use of a distal Embolic Protection Device for patients with symptomatic vertebral ostial occlusion in the nonacute phase. We retrospectively reviewed the data of 7 patients with symptomatic vertebral ostial occlusion despite medical management who underwent stenting performed using a distal Embolic Protection Device between January 2015 and February 2019. The occlusive lesions were predilated with small balloons, followed by placement of distal Embolic Protection Devices and stents sequentially. At last, the Protection Devices were retrieved. The rate of successful recanalization, perioperative complications, and clinical and angiographic outcomes were analyzed. The rate of successful recanalization was 100% with all distal Embolic Protection Devices deployed and retrieved. Poststenting angiography showed no significant residual stenosis. There were no major acute thromboEmbolic events during and after the procedure. There were no recurrent ischemic symptoms after a mean clinical follow-up of 20.6 ± 16.3 months. At 6-month imaging follow-up, repeat vascular images from 5 patients showed asymptomatic restenosis in 1 artery. Our single-center preliminary experience indicated that performing stent placement for vertebral ostial occlusion using a distal Protection Device may be feasible with a high rate of procedural success. However, this strategy should be confirmed in future prospective randomized studies with larger patient numbers. Copyright © 2019 Elsevier Inc. All rights reserved.

Fumiyuki Otsuka - One of the best experts on this subject based on the ideXlab platform.

  • Histopathology of Embolic Debris Captured During Transcatheter Aortic Valve Replacement
    Circulation, 2013
    Co-Authors: Nicolas M. Van Mieghem, Marguerite E.i. Schipper, Elena Ladich, Elham Faqiri, Robert M.a. Van Der Boon, Abas Randjgari, Carl Schultz, Adriaan Moelker, Robert Jan Van Geuns, Fumiyuki Otsuka
    Abstract:

    Background—Recent transcatheter aortic valve replacement studies have raised concerns about adverse cerebrovascular events. The etiopathology of the embolized material is currently unknown. Methods and Results—A total of 40 patients underwent transcatheter aortic valve replacement with the use of a dual filter–based Embolic Protection Device (Montage Dual Filter System, Claret Medical, Inc). Macroscopic material liberated during the transcatheter aortic valve replacement procedure was captured in the Device filter baskets in 30 (75%) patients and sent for histopathologic analysis. The captured material varied in size from 0.15 to 4.0 mm. Amorphous calcified material (size, 0.55–1.8 mm) was identified in 5 patients (17%). In 8 patients (27%), the captured material (size, 0.25–4.0 mm) contained valve tissue composed of loose connective tissue (collagen and elastic fibers) with focal areas of myxoid stroma, with or without coverage by endothelial cells and intermixed with fibrin. In another 13 (43%) patients...

Jeffrey J Popma - One of the best experts on this subject based on the ideXlab platform.

  • a novel filter based distal Embolic Protection Device for percutaneous intervention of saphenous vein graft lesions results of the amethyst randomized controlled trial
    Jacc-cardiovascular Interventions, 2008
    Co-Authors: Dean J. Kereiakes, Jeffrey J Popma, Robert L Feldman, Jeffrey A Breall, Mark Turco, Naim Farhat, Brent T. Mclaurin, Laura Mauri, Peter Zimetbaum
    Abstract:

    Objectives We sought to evaluate the relative safety and efficacy of the novel Interceptor PLUS Coronary Filter System (Medtronic Vascular, Santa Rosa, California) compared with approved Embolic-Protection Devices (e.g., GuardWire, Medtronic Vascular/FilterWire EZ, Boston Scientific, Natick, Massachusetts) during percutaneous coronary intervention (PCI) of degenerative saphenous vein grafts (SVG). Background Percutaneous coronary intervention of degenerative SVG is associated with embolization of atherothrombotic debris and subsequent myocardial infarction in a significant portion of patients. The use of distal Embolic-Protection Devices has previously been demonstrated to reduce major adverse cardiovascular events associated with PCI in these patients. Methods In this multicenter, randomized noninferiority trial, 797 patients undergoing PCI with stenting of SVG stenoses (de novo or restenotic) with reference vessel diameter 2.5 mm to 5.25 mm were randomly assigned 2:1 to either the Interceptor PLUS (n = 533) or control distal-Protection Devices (GuardWire [n = 191], FilterWire EZ [n = 73]) at the physician9s discretion. Results The trial primary clinical end point (composite occurrence of death, myocardial infarction, or urgent repeat revascularization through 30 days) was observed in 8% and 7.3% of Interceptor and control-treated patients, respectively (p = 0.025 for noninferiority; p = 0.77 for difference). Key secondary end points for Device and procedural success were similar between randomly assigned treatment strategies. Conclusions The Interceptor PLUS Coronary Filter System is noninferior in safety and efficacy to 30 days when compared with the GuardWire and FilterWire EZ distal Embolic Protection Devices.

  • A Novel Filter-Based Distal Embolic Protection Device for Percutaneous Intervention of Saphenous Vein Graft Lesions. Results of the AMEthyst Randomized Controlled Trial
    JACC. Cardiovascular interventions, 2008
    Co-Authors: Dean J. Kereiakes, Jeffrey J Popma, Robert L Feldman, Jeffrey A Breall, Mark Turco, Naim Farhat, Brent T. Mclaurin, Laura Mauri, Peter Zimetbaum, Joseph M. Massaro
    Abstract:

    We sought to evaluate the relative safety and efficacy of the novel Interceptor PLUS Coronary Filter System (Medtronic Vascular, Santa Rosa, California) compared with approved Embolic-Protection Devices (e.g., GuardWire, Medtronic Vascular/FilterWire EZ, Boston Scientific, Natick, Massachusetts) during percutaneous coronary intervention (PCI) of degenerative saphenous vein grafts (SVG). Percutaneous coronary intervention of degenerative SVG is associated with embolization of atherothrombotic debris and subsequent myocardial infarction in a significant portion of patients. The use of distal Embolic-Protection Devices has previously been demonstrated to reduce major adverse cardiovascular events associated with PCI in these patients. In this multicenter, randomized noninferiority trial, 797 patients undergoing PCI with stenting of SVG stenoses (de novo or restenotic) with reference vessel diameter 2.5 mm to 5.25 mm were randomly assigned 2:1 to either the Interceptor PLUS (n = 533) or control distal-Protection Devices (GuardWire [n = 191], FilterWire EZ [n = 73]) at the physician's discretion. The trial primary clinical end point (composite occurrence of death, myocardial infarction, or urgent repeat revascularization through 30 days) was observed in 8% and 7.3% of Interceptor and control-treated patients, respectively (p = 0.025 for noninferiority; p = 0.77 for difference). Key secondary end points for Device and procedural success were similar between randomly assigned treatment strategies. The Interceptor PLUS Coronary Filter System is noninferior in safety and efficacy to 30 days when compared with the GuardWire and FilterWire EZ distal Embolic Protection Devices.

  • determinants of 30 day adverse events following saphenous vein graft intervention with and without a distal occlusion Embolic Protection Device
    American Journal of Cardiology, 2005
    Co-Authors: Gregory R Giugliano, Richard E Kuntz, Jeffrey J Popma, Donald E Cutlip, Donald S Baim
    Abstract:

    Distal balloon occlusion was approved as a means of Embolic Protection during saphenous vein graft intervention based on its ability to decrease major adverse clinical events (MACEs) by 42% in the 801-patient Saphenous Vein Graft Angioplasty Free of Emboli Randomized (SAFER) trial. However, the cost and technical complexity of this Device have limited its widespread use and prompted some to avoid its use in cases that appear at "low risk" for complications. If predictors of MACEs and their potential decrease by distal balloon occlusion could be identified, this would have important clinical implications in this challenging population. We therefore used standard demographic and angiographic variables and 2 new angiographic markers (extent of graft degeneration and estimated volume of plaque in the target lesion) to construct multivariable logistic regression models of 30-day of MACEs in the SAFER trial. Independent correlates of increased 30-day MACEs were more extensive vein graft degeneration (p = 0.0001) and bulkier lesions (larger estimated plaque volume, p = 0.0005). Use of a distal balloon occlusion Device was independently predictive of lower 30-day rates of MACE (p = 0.01), with uniform benefit across risk strata (no significant interaction between Device use and independent angiographic risk factors). Thus, the risk of 30-day MACEs after percutaneous intervention in aortocoronary saphenous vein grafts is increased in more diffusely diseased grafts and in bulkier lesions, but a significant benefit of the GuardWire was seen across all levels of MACE risk rather than just those perceived to be at highest risk.

  • randomized trial of a distal Embolic Protection Device during percutaneous intervention of saphenous vein aorto coronary bypass grafts
    Circulation, 2002
    Co-Authors: Donald S Baim, Dennis W Wahr, Barry S George, Joel Greenberg, Unsal Kaya, Jeffrey J Popma, Donald E Cutlip, Kalon K L Ho, Martin B Leon, Richard E Kuntz
    Abstract:

    Background— Stents provide effective treatment for stenotic saphenous venous aorto-coronary bypass grafts, but their placement carries a 20% incidence of procedure-related complications, which potentially are related to the distal embolization of atherosclerotic debris. We report the first multicenter randomized trial to evaluate use of a distal Embolic Protection Device during stenting of such lesions. Methods and Results— Of 801 eligible patients, 406 were randomly assigned to stent placement over the shaft of the distal Protection Device, and 395 were assigned to stent placement over a conventional 0.014-inch angioplasty guidewire (control group). The primary end point—a composite of death, myocardial infarction, emergency bypass, or target lesion revascularization by 30 days—was observed in 65 patients (16.5%) assigned to the control group and 39 patients (9.6%) assigned to the Embolic Protection Device (P=0.004). This 42% relative reduction in major adverse cardiac events was driven by myocardial inf...

  • Randomized trial of a distal Embolic Protection Device during percutaneous intervention of saphenous vein aorto-coronary bypass grafts
    Journal of Invasive Cardiology, 2002
    Co-Authors: Donald S Baim, Dennis W Wahr, Barry S George, Joel Greenberg, Unsal Kaya, Jeffrey J Popma, Donald E Cutlip, Martin B Leon, Richard E Kuntz
    Abstract:

    Background. Stents provide effective treatment for stenotic saphenous venous aorto-coronary bypass grafts, but their placement carries a 20% incidence of procedure-related complications, which potentially are related to the distal embolization of atherosclerotic debris. We report the first multicenter randomized trial to evaluate use of a distal Embolic Protection Device during stenting of such lesions. Methods and Results. Of 801 eligible patients, there were 406 randomly assigned to stent placement over the shaft of the distal Protection Device, and 395 were assigned to stent placement over a conventional 0.014" angioplasty guidewire (control group). The primary endpoint - a composite of death, myocardial infarction, emergency bypass, or target lesion revascularization by 30 days - was observed in 65 patients (16.5%) assigned to the control group, and 39 patients (9.6%) assigned to the Embolic Protection Device (p = 0.004). This 42% relative reduction in major adverse cardiac events was driven by myocardial infarction (8.6% versus 14.7%; p = 0.008) and "no-reflow" phenomenon (3% versus 9%; p = 0.02). Clinical benefit was seen even when platelet glycoprotein IIb/IIIa receptor blockers were administered (61% of patients), with composite endpoints occurring in 10.7% of Protection Device patients versus 19.4% of control patients (p = 0.008). Conclusions. Use of this distal Protection Device during stenting of stenotic venous grafts was associated with a highly significant reduction in major adverse events compared with stenting over a conventional angioplasty guidewire. This demonstrates the importance of distal embolization in causing major adverse cardiac events and the value of Embolic Protection Devices in preventing such complications.