Browsing by Subject "endovascular"

Sort by: Order: Results:

Now showing items 1-5 of 5
  • Herajärvi, Johanna; Jormalainen, Mikko; Mustonen, Caius; Kesävuori, Risto; Raivio, Peter; Biancari, Fausto; Juvonen, Tatu (2022)
    Background. Acute type B aortic dissection (TBAD) is catastrophic event associated with significant mortality and lifelong morbidity. The optimal treatment strategy of TBAD is still controversial. Methods. This analysis includes patients treated for TBAD at the Helsinki University Hospital, Finland in 2007-2019. The endpoints were early and late mortality, and intervention of the aorta. Results. There were 205 consecutive TBAD patients, 59 complicated and 146 uncomplicated patients (mean age of 66 +/- 14, females 27.8%). In-hospital and 30-day mortality rates were higher in complicated patients compared with uncomplicated patients with a statistically significant difference (p = 0.035 and p = 0.015, respectively). After a mean follow-up of 4.9 +/- 3.8 years, 36 (25.0%) and 22 (37.9%) TBAD -related adverse events occurred in the uncomplicated and complicated groups, respectively (p = 0.066). Freedom from composite outcome was 83 +/- 3% and 69 +/- 6% at 1 year, 75 +/- 4% and 63 +/- 7% at 5 years, 70 +/- 5% and 59 +/- 7% at 10 years in the uncomplicated group and in the complicated group, respectively (p = 0.052). There were 25 (39.1%) TBAD-related deaths in the overall series and prior aortic aneurysm was the only risk factor for adverse aortic-related events in multivariate analysis (HR 3.46, 95% CI 1.72-6.96, p < 0.001). Conclusion. TBAD is associated with a significant risk of early and late adverse events. Such a risk tends to be lower among patients with uncomplicated dissection, still one fourth of them experience TBAD-related event. Recognition of risk factors in the uncomplicated group who may benefit from early aortic repair would be beneficial.
  • CLOTBUST-ER Trial Investigators; Alexandrov, Andrei V.; Tsivgoulis, Georgios; Köhrmann, Martin; Soinne, Lauri; Schellinger, Peter D. (2019)
    Background: Results of our recently published phase III randomized clinical trial of ultrasound-enhanced thrombolysis (sonothrombolysis) using an operator-independent, high frequency ultrasound device revealed heterogeneity of patient recruitment among centers. Methods: We performed a post hoc analysis after excluding subjects that were recruited at centers reporting a decline in the balance of randomization between sonothrombolysis and concurrent endovascular trials. Results: From a total of 676 participants randomized in the CLOTBUST-ER trial we identified 52 patients from 7 centers with perceived equipoise shift in favor of endovascular treatment. Post hoc sensitivity analysis in the intention-to-treat population adjusted for age, National Institutes of Health Scale score at baseline, time from stroke onset to tPA bolus and baseline serum glucose showed a significant (p <0.01) interaction of perceived endovascular equipoise shift on the association between sonothrombolysis and 3 month functional outcome [adjusted common odds ratio (cOR) in centers with perceived endovascular equipoise shift: 0.22, 95% CI 0.06-0.75; p = 0.02; adjusted cOR for centers without endovascular equipoise shift: 1.20, 95% CI 0.89-1.62; p = 0.24)]. After excluding centers with perceived endovascular equipoise shift, patients randomized to sonothrombolysis had higher odds of 3 month functional independence (mRS scores 0-2) compared with patients treated with tPA only (adjusted OR: 1.53; 95% CI 1.01-2.31; p = 0.04). Conclusion: Our experience in CLOTBUST-ER indicates that increasing implementation of endovascular therapies across major academic stroke centers raises significant challenges for clinical trials aiming to test noninterventional or adjuvant reperfusion strategies.
  • Wahlgren, Nils; Moreira, Tiago; Michel, Patrik; Steiner, Thorsten; Jansen, Olav; Cognard, Christophe; Mattle, Heinrich P.; van Zwam, Wim; Holmin, Staffan; Tatlisumak, Turgut; Petersson, Jesper; Caso, Valeria; Hacke, Werner; Mazighi, Mikael; Arnold, Marcel; Fischer, Urs; Szikora, Istvan; Pierot, Laurent; Fiehler, Jens; Gralla, Jan; Fazekas, Franz; Lees, Kennedy R.; ESO-KSU; ESO; ESMINT; ESNR; EAN (2016)
    The original version of this consensus statement on mechanical thrombectomy was approved at the European Stroke Organisation (ESO)-Karolinska Stroke Update conference in Stockholm, 16-18 November 2014. The statement has later, during 2015, been updated with new clinical trials data in accordance with a decision made at the conference. Revisions have been made at a face-to-face meeting during the ESO Winter School in Berne in February, through email exchanges and the final version has then been approved by each society. The recommendations are identical to the original version with evidence level upgraded by 20 February 2015 and confirmed by 15 May 2015. The purpose of the ESO-Karolinska Stroke Update meetings is to provide updates on recent stroke therapy research and to discuss how the results may be implemented into clinical routine. Selected topics are discussed at consensus sessions, for which a consensus statement is prepared and discussed by the participants at the meeting. The statements are advisory to the ESO guidelines committee. This consensus statement includes recommendations on mechanical thrombectomy after acute stroke. The statement is supported by ESO, European Society of Minimally Invasive Neurological Therapy (ESMINT), European Society of Neuroradiology (ESNR), and European Academy of Neurology (EAN).
  • Tolonen, Matti; Lemma, Aurora; Vikatmaa, Pirkka; Peltola, Erno; Mentula, Panu; Björkman, Patrick; Leppäniemi, Ari; Sallinen, Ville (2021)
    BACKGROUND Acute mesenteric ischemia (AMI) is a disease with high mortality and requires a multidisciplinary approach for effective management. A pathway and care bundle were developed and implemented with the objective to reduce mortality. The aim of this retrospective comparative study was to analyze the effects of the pathway on patient management and outcome. METHODS All consecutive patients operated in a secondary and tertiary referral center because of occlusive arterial AMI were identified between 2014 and April 2020. The pathway aimed to increase overall awareness, and hasten and improve diagnostics and management. Patients treated before implementation of the pathway (pregroup, years 2014-2017) were compared with patients treated using the pathway (postgroup, May 2018 to April 2020). Univariate and multivariate analyses were used to compare the groups. RESULTS There were 78 patients in the pregroup and 67 patients in the postgroup with comparable baseline characteristics and disease acuity. The postgroup was more often diagnosed with contrast-enhanced computed tomography (58 [74%] vs. 63 [94%], p = 0.001) and had shorter mean in-hospital delay to operating room (7 hours [interquartile range, 3.5-12.5] vs. 3 hours [interquartile range, 2-11], p = 0.023). Revascularization was done more often in the postgroup (53 [68%] vs. 56 [84%], p = 0.030) especially using endovascular treatment (26 [33%] vs. 43 [64%], p < 0.001). Thirty-day mortality was lower in the postgroup (23 [51%] vs. 17 [25%], p = 0.001). Being managed in the postgroup remained as a protective factor (odds ratio, 0.32; 95% confidence interval, 0.14-0.75; p = 0.008) for 30-day mortality in the multivariate analysis. CONCLUSION Implementing a pathway and care bundle resulted in enhanced regional and in-hospital awareness of AMI, more appropriate computed tomography imaging, shorter in-hospital delays, increased number of revascularizations, and, hence, lower mortality.
  • Björkman, Patrick; Toiviainen, Simo; Laukontaus, Sani; Venermo, Maarit; Aho, Pekka (Helsingin yliopisto, 2022)
    Vatsa-aortan aneurysma korjataan nykyään yleensä suonensisäisellä tekniikalla. Jos potilaan aneurysman ja aortan anatomia eivät sovi suonensisäiselle toimenpiteelle, harkitaan avoleikkausta. Suonensisäisessä korjauksessa aneurysma eristetään verenkierron ulkopuolelle stenttiproteesin avulla, joka viedään aorttaan perkutaanisesti nivusvaltimoiden kautta. Endovaskulaarinen hoito edellyttää myös sitä, että valtimoissa ei ole merkittävää kalkkista ahtaumaa tai mutkaisuutta, joka estäisi stentin kulun aorttaan. Femoraalisuonten sulkulaitteiden käyttö suonensisäisten aneurysman korjausleikkauksissa vähentää komplikaatioiden ilmenemistä, vähentää aikaa hemostaasiin, sekä mahdollistaa aikaisemman potilaan mobilisaation toimenpiteen jälkeen. Sulkulaitteiden asennukseen liittyy kuitenkin komplikaatioriskejä. Tavallisimmat komplikaatiot ovat vuoto, verenpurkauman kehittyminen, pseudoaneurysma ja suonen tukkiutuminen. Aikaisemmissa tutkimuksissa on todettu MANTA-sulkulaitteella olevan pienempi komplikaatioriski verrattuna ProGlide-sulkulaitteeseen. Tämä tutkimus tehtiin kuitenkin aikana jolloin sulkulaitteita ei asennettu ultraääniohjatusti. Tämän retrospektiivisen tutkimuksen tarkoituksena oli selvittää, vaikuttaako ultraäänilaitteen käyttö ProGlide-sulkulaitteen komplikaatioriskiin. Tutkimuksen aineisto koostui 2.1.2017-9.2.2022 välisenä aikana kerättyyn aineistoon HUSpotilastietojärjestelmästä. Potilaiden tapahtumia seurattiin toimenpiteestä kotiutumiseen koko sairaalaolon ajan. Kaikissa toimenpiteissä oli käytössä ultraäänilaite sulkulaitteen asennusvaiheessa. Lopullinen potilasaineisto koostui 637 potilaasta, joista 12 peruuntui sairastumisen vuoksi. Hoidettuja nivusia oli kokonaisuudessaan 1235, joista 1046 elektiivisiä, 129 stabiileja aneurysman ruptuuroita ja 60 epästabiileja aneurysman ruptuuroita. ProGlide-sulkulaitetta käytettiin elektiivisissä toimenpiteissä 973 kertaa, stabiileissa ruptuuroissa 119 kertaa ja epästabiileissa 32 kertaa. MANTA-sulkulaitetta käytettiin yhteensä 37 kertaa, Angioseal-sulkulaitetta 37 kertaa, suoraan avotoimenpiteeseen ilman sulkulaitteita päädyttiin 33 kertaa. ProGlide vaihdettiin toiseen sulkulaitteeseen 19 kertaa sekä konvertoitiin avoleikkaukseen 30 kertaa. Primaari päätetapahtuma on onnistunut sulkulaitteen käyttö ilman vaihtoa toiseen sulkulaitteeseen tai avoleikkaukseen. Sekundaari päätetapahtuma on femoraalisuonten jälkikorjausten määrä ja akuutin raajaiskemian tai infektion insidenssi toimenpiteen jälkeen. ProGlide-sulkulaittetta käytettiin ilman komplikaatioita elektiivisesti 936 kertaa (96,20%), stabiileissa RAAA-potilaissa 111 kertaa (93,28%), epästabiileissa RAAA-potilaissa 28 kertaa (87,50%). Tutkimuksen päätelmänä on, että ProGlide sulkulaite on turvallinen ja tehokas väline nivuspunktioiden sulkemiseen aortan aneurysmien hoidossa silloin, kun punktion yhteydessä käytetään ultraääniohjausta. Lisäksi todettiin että instabiileilla aneurysmaruptuuroilla sukulaitetta ei aina voida asentaa ennen aortan sulkupallon asennusta.