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  • 1
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    Online Resource
    Sustained Effectiveness of Cilostazol After Endovascular Treatment of Femoropopliteal Lesions: Midterm Follow-up From the Sufficient Treatment of Peripheral Intervention by Cilostazol (STOP-IC) Study
    SAGE Publications ; 2018
    In:  Journal of Endovascular Therapy Vol. 25, No. 3 ( 2018-06), p. 306-312
    Details
    In: Journal of Endovascular Therapy, SAGE Publications, Vol. 25, No. 3 ( 2018-06), p. 306-312
    Abstract: Purpose: To investigate the midterm safety and effectiveness of cilostazol treatment in claudicant patients undergoing endovascular therapy. Methods: The Sufficient Treatment of Peripheral Intervention by Cilostazol (STOP-IC) study ( ClinicalTrials.gov identifier NCT00912756; University Hospital Medical Information Network identifier UMIN000002091) enrolled 200 patients (mean age 73 years; 131 men) treated for femoropopliteal disease from March 2009 to April 2011 at 13 cardiovascular centers in Japan. The participants were randomized 1:1 to receive oral aspirin with or without cilostazol. Of the 100 patients assigned to the 2 treatment groups, 7 patients in the cilostazol group and 2 patients in the no-cilostazol group were withdrawn from the study without undergoing endovascular treatment, leaving 93 patients in the cilostazol group and 98 patients in the no-cilostazol group for follow-up analysis. The primary outcome measure was primary patency; secondary outcome measures were freedom from clinically-driven target lesion revascularization (CD-TLR) and overall survival. Outcomes were analyzed on an intention-to-treat basis using the Kaplan-Meier method; estimates were compared with the log-rank test. Results: The median follow-up was 38.1 months (interquartile range 25.1, 47.7). Among the 93 subjects in the cilostazol group, 7 died and 26 withdrew from administration 1 year after the endovascular procedure. Discontinuation of cilostazol was not a significant factor for restenosis. Primary patency was significantly higher in the cilostazol group than in the no-cilostazol group (69% vs 54%, p=0.026) at 3 years. The cilostazol group also had better 3-year freedom from CD-TLR (78% vs 63%, p=0.014), although overall survival estimates did not differ significantly (p=0.95). Conclusion: These results suggest that the safety and effectiveness of cilostazol treatment were sustained in patients with femoropopliteal disease undergoing endovascular treatment.
    Type of Medium: Online Resource
    ISSN: 1526-6028 , 1545-1550
    URL: Article
    DOI: 10.1177/1526602818771358
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2018
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  • 2
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    Relationship Between Primary Patency and Lesion Length Following Bare Nitinol Stent Placement for Femoropopliteal Disease
    SAGE Publications ; 2015
    In:  Journal of Endovascular Therapy Vol. 22, No. 6 ( 2015-12), p. 862-867
    Details
    In: Journal of Endovascular Therapy, SAGE Publications, Vol. 22, No. 6 ( 2015-12), p. 862-867
    Abstract: Purpose: To evaluate the relationship between 1-year primary patency and lesion length in patients with femoropopliteal disease treated with bare nitinol stents. Methods: The study was a retrospective analysis of a prospectively maintained multicenter database. Between January 2004 and December 2011, 1047 consecutive patients (mean age 72 years; 765 men) underwent femoropopliteal stenting with nitinol stents in 1373 limbs. The mean vessel diameter was 5.3±0.7 mm and the mean lesion length was 142±75 mm. One-year follow-up data were collected and analyzed to ascertain which lesion length would be expected to demonstrate a 1-year primary patency above the established 66% objective performance goal (OPG). Results: The lower limit of the 95% confidence interval (CI) for the unadjusted 1-year primary patency was 〉 66% when the lesion length was ≤243 mm. After adjustment of the covariates to match those of the OPG-derived population, the 1-year primary patency decreased linearly with longer lesion length. The 1-year primary patency was 83.2% (95% CI 79.8% to 86.1%) for a 100-mm lesion length, 76.4% (95% CI 71.7% to 80.5%) for a 200-mm lesion length, and 70.7% (95% CI 62.4% to 77.7%) for a 300-mm lesion length. The maximum lesion length providing a 1-year primary patency significantly greater than 66% was calculated to be 263 mm. Conclusion: The 1-year primary patency of femoropopliteal lesions treated with bare nitinol stents decreased linearly with longer lesion length. The maximum lesion length providing a higher patency rate than the OPG of 66% was ~25 cm.
    Type of Medium: Online Resource
    ISSN: 1526-6028 , 1545-1550
    URL: Article
    DOI: 10.1177/1526602815610118
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2015
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  • 3
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    Clinical characteristics of patients with Rutherford category IV, compared with V and VI
    SAGE Publications ; 2015
    In:  SAGE Open Medicine Vol. 3 ( 2015-10-27), p. 205031211559708-
    Details
    In: SAGE Open Medicine, SAGE Publications, Vol. 3 ( 2015-10-27), p. 205031211559708-
    Type of Medium: Online Resource
    ISSN: 2050-3121 , 2050-3121
    URL: Article
    DOI: 10.1177/2050312115597087
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2015
    detail.hit.zdb_id: 2735399-0
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  • 4
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    The Role of the Acromioclavicular Ligament in Acromioclavicular Joint Stability: A Cadaveric Biomechanical Study
    SAGE Publications ; 2021
    In:  Orthopaedic Journal of Sports Medicine Vol. 9, No. 2 ( 2021-02-01), p. 232596712098294-
    Details
    In: Orthopaedic Journal of Sports Medicine, SAGE Publications, Vol. 9, No. 2 ( 2021-02-01), p. 232596712098294-
    Abstract: Acromioclavicular (AC) joint dislocation is evaluated using the radiologically based Rockwood classification. The relationship between ligamentous injury and radiological assessment is still controversial. Purpose/Hypothesis: To investigate how the AC ligament and trapezoid ligament biomechanically contribute to the stability of the AC joint using cadaveric specimens. The hypothesis was that isolated sectioning of the AC ligament would result in increased instability in the superior direction and that displacement 〉 50% of the AC joint would occur. Study Design: Controlled laboratory study. Methods: Six shoulders from 6 fresh-frozen cadavers were used in this study. Both the scapula and sternum were solidly fixed on a customized wooden jig with an external fixator. We simulated distal clavicular dislocation with sequential sectioning of the AC and coracoclavicular (CC) ligaments. Sectioning stages were defined as follows: stage 0, the AC ligament, CC ligament, and AC joint capsule were left intact; stage 1, the anteroinferior bundle of the AC ligament, joint capsule, and disk were sectioned; stage 2, the superoposterior bundle of the AC ligament was sectioned; and stage 3, the trapezoid ligament was sectioned. The distal clavicle was loaded with 70 N in the superior and posterior directions, and the magnitudes of displacement were measured. Results: The amounts of superior displacement averaged 3.7 mm (stage 0), 3.8 mm (stage 1), 8.3 mm (stage 2), and 9.5 mm (stage 3). Superior displacement 〉 50% of the AC joint was observed in stage 2 (4/6; 67%) and stage 3 (6/6; 100%). The magnitudes of posterior displacement were 3.7 mm (stage 0), 3.7 mm (stage 1), 5.6 mm (stage 2), and 9.8 mm (stage 3). Posterior displacement 〉 50% of the AC joint was observed in stage 3 (1/6; 17%). Conclusion: We found that the AC ligaments contribute significantly to AC joint stability, and superior displacement 〉 50% of the AC joint can occur with AC ligament tears alone. Clinical Relevance: The AC ligament plays an important role not only in horizontal stability but also in vertical stability of the AC joint.
    Type of Medium: Online Resource
    ISSN: 2325-9671 , 2325-9671
    URL: Article
    DOI: 10.1177/2325967120982947
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2021
    detail.hit.zdb_id: 2706251-X
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  • 5
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    Mortality Risk Following Application of a Paclitaxel-Coated Stent in Femoropopliteal Lesions
    SAGE Publications ; 2019
    In:  Journal of Endovascular Therapy Vol. 26, No. 5 ( 2019-10), p. 593-599
    Details
    In: Journal of Endovascular Therapy, SAGE Publications, Vol. 26, No. 5 ( 2019-10), p. 593-599
    Abstract: To examine if endovascular therapy (EVT) with paclitaxel-coated stents increases the mortality risk in patients with symptomatic lower limb peripheral artery disease (PAD). Materials and Methods: A retrospective analysis was conducted of paclitaxel-coated stent use in the femoropopliteal segment of 1535 symptomatic (Rutherford category 2 to 4) patients treated between January 2010 and December 2016 at 4 hospitals in Japan. The risk of all-cause mortality was examined between the 285 patients (mean age 73±8 years; 213 men) treated with a paclitaxel-coated stent (PTX-coated group) and 1250 patients (mean age 73±9 years; 872 men) not exposed to a paclitaxel-coated device (PTX-free group) during EVT. Propensity score matching was employed to balance baseline characteristics. Cox proportional hazards models stratified on the quintiles of the propensity score were used to investigate paclitaxel-coated stent use and mortality risk as well as interactions among baseline variables and the main outcome. Interactions between a PXT-coated stent and subgroups of the PTX-free group (bare stent and angioplasty) were also investigated, as was the impact of paclitaxel dose on mortality risk. The results of regression analysis are reported as the hazard ratio (HR) and 95% confidence interval (CI). Results: The 3-year overall survival estimates were 86.4% in the PTX-coated group vs 87.7% in the PTX-free group; the corresponding 5-year estimates were 77.5% vs 73.7%, respectively. There was no significant difference in all-cause mortality between the 2 groups (HR 0.89, 95% CI 0.66 to 1.19, p=0.41). The cause of death also showed no remarkable difference between the groups. Chronic renal failure (p=0.044) and arterial calcification (p=0.022) demonstrated a significant interaction effect on the association of the use of a PTX-coated stent with all-cause mortality. No subgroup demonstrated that the use of a paclitaxel-coated stent was associated with an increased risk of all-cause mortality. A dose dependency was not evident. Conclusion: Mortality risk following application of a PTX-coated stent did not increase over 5 years, irrespective of the dose. A PTX-coated stent for femoropopliteal lesions in PAD patients is a safe treatment option.
    Type of Medium: Online Resource
    ISSN: 1526-6028 , 1545-1550
    URL: Article
    DOI: 10.1177/1526602819870309
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2019
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  • 6
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    Cerebral Blood Flow and Metabolism of Hyperperfusion after Cerebral Revascularization in Patients with Moyamoya Disease
    SAGE Publications ; 2012
    In:  Journal of Cerebral Blood Flow & Metabolism Vol. 32, No. 11 ( 2012-11), p. 2066-2075
    Details
    In: Journal of Cerebral Blood Flow & Metabolism, SAGE Publications, Vol. 32, No. 11 ( 2012-11), p. 2066-2075
    Abstract: In moyamoya disease (MMD), surgical revascularization may be complicated with postoperative hyperperfusion. We analyzed cerebral perfusion and metabolism using positron emission tomography (PET) or single-photon emission computed tomography (SPECT) before and after bypass surgery on 42 sides of 34 adult patients with MMD. In seven cases (16.7%) with symptomatic hyperperfusion, diagnosed by qualitative 123 I-iodoamphetamine (IMP) SPECT, a subsequent PET study during postoperative subacute stages revealed significantly increased cerebral blood flow (CBF) from 34.1 ± 8.2 to 74.3 ± 12.8 mL/100 g per minute ( P 〈 0.01), a persistent increase in cerebral blood volume (CBV)from 5.77 ± 1.67 to 7.01 ± 1.44 mL/100 g and a significant decrease in oxygen extraction fraction (OEF) from 0.61 ± 0.09 to 0.40 ± 0.08 ( P 〈 0.01). Mean absolute CBF values during symptomatic hyperperfusion were more than the normal control +2 standard deviations, the predefined criteria of PET. Interestingly, two patients with markedly increased cerebral metabolic rate of oxygen (CMRO 2 ) at hyperperfusion were complicated with postoperative seizure. Among preoperative PET parameters, increased OEF was the only significant risk factor for symptomatic hyperperfusion ( P 〈 0.05). This study revealed that symptomatic hyperperfusion in MMD is characterized by temporary increases in CBF 〉 100% over preoperative values caused by prolonged recovery of increased CBV.
    Type of Medium: Online Resource
    ISSN: 0271-678X , 1559-7016
    URL: Article
    DOI: 10.1038/jcbfm.2012.110
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2012
    detail.hit.zdb_id: 2039456-1
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  • 7
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    Impaired neuronal integrity in traumatic brain injury detected by 123 I-iomazenil single photon emission computed tomography and MRI
    SAGE Publications ; 2022
    In:  Journal of Cerebral Blood Flow & Metabolism Vol. 42, No. 12 ( 2022-12), p. 2245-2254
    Details
    In: Journal of Cerebral Blood Flow & Metabolism, SAGE Publications, Vol. 42, No. 12 ( 2022-12), p. 2245-2254
    Abstract: This study was aiming at investigating the extent of neuronal damage in cases of traumatic brain injury (TBI) with diffuse axonal injury (DAI) using 123 I-iomazenil(IMZ) SPECT and MRI. We compared the findings in 31 patients with TBI without any major focal brain lesions and 25 age-matched normal controls. Subjects underwent 123 I-IMZ SPECT and MRI, and also assessment by cognitive function tests. The partial volume effect of 123 I-IMZ SPECT was corrected using MRI. In the patients with TBI, decreased spatial concentration of 123 I-IMZ binding was detected in the medial frontal/orbitofrontal cortex, posterior cingulate gyrus, cuneus, precuneus, and superior region of the cerebellum. ROC analysis of 123 I-IMZ SPECT for the detection of neuronal injury showed a high diagnostic ability of 123 I-IMZ binding density for TBI in these areas. The decreased 123 I-IMZ uptake density in the cuneus and precuneus was associated with cognitive decline after the injury. In the patients with TBI, brain atrophy was detected in the frontal lobe, anterior temporal and parietal cortex, corpus callosum, and posterior part of the cerebellum. Evaluation of the neuronal integrity by 123 I-IMZ SPECT and MRI provides important information for the diagnosis and pathological interpretation in cases of TBI with DAI.
    Type of Medium: Online Resource
    ISSN: 0271-678X , 1559-7016
    URL: Article
    DOI: 10.1177/0271678X221113001
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2022
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  • 8
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    Propensity Score Analysis Comparing Clinical Outcomes of Drug-Eluting vs Bare Nitinol Stents in Femoropopliteal Lesions
    SAGE Publications ; 2016
    In:  Journal of Endovascular Therapy Vol. 23, No. 1 ( 2016-02), p. 33-39
    Details
    In: Journal of Endovascular Therapy, SAGE Publications, Vol. 23, No. 1 ( 2016-02), p. 33-39
    Abstract: Purpose: To present a propensity score matching analysis comparing the 1-year outcomes of de novo femoropopliteal lesions treated with drug-eluting stents (DES) or bare nitinol stents (BNS). Methods: A retrospective review was conducted of 452 limbs in 389 patients (mean age 74±8 years; 284 men) treated with DES implantation and 1808 limbs in 1441 patients (mean age 72±9 years; 1023 men) implanted with BNS for de novo femoropopliteal lesions. One-year follow-up data were available on all patients. The primary endpoint was 12-month restenosis assessed by duplex ultrasonography or follow-up angiography within ±2 months. Secondary endpoint was major adverse limb events (MALE) including major amputation, any reintervention, and restenosis. Results: The BNS group was more likely to have current smoking, chronic total occlusion, and poor below-the-knee runoff. The stratification analysis demonstrated that diabetes mellitus (DM) and reference vessel diameter (RVD) had a significant interaction on the association of DES vs BNS implantation with restenosis (interaction p 〈 0.05). Thus, the population was stratified into 4 subgroups (1: –DM, RVD ≥5 mm, 2: +DM, RVD ≥5 mm, 3: –DM, RVD 〈 5 mm, and 4: +DM, RVD 〈 5 mm); the RVD threshold was empirically determined. There were no significant intergroup differences in baseline variables after matching. There was no significant difference in restenosis risk between DES and BNS in the RVD ≥5 mm subgroup regardless of the presence of DM. The DES group had a significantly higher restenosis risk in the RVD 〈 5 mm subgroup regardless of the presence of DM. No significant difference was observed in the risk of major amputation, reintervention, or MALE in any subgroup. Conclusion: These results suggest that a first-generation DES was not superior to a conventional BNS for femoropopliteal lesions.
    Type of Medium: Online Resource
    ISSN: 1526-6028 , 1545-1550
    URL: Article
    DOI: 10.1177/1526602815622953
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2016
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  • 9
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    Outcomes of Endovascular Therapy for Upper Extremity Peripheral Artery Disease With Critical Hand Ischemia
    SAGE Publications ; 2016
    In:  Journal of Endovascular Therapy Vol. 23, No. 5 ( 2016-10), p. 717-722
    Details
    In: Journal of Endovascular Therapy, SAGE Publications, Vol. 23, No. 5 ( 2016-10), p. 717-722
    Abstract: Purpose: To investigate the clinical outcomes of endovascular therapy (EVT) for upper extremity peripheral artery disease (PAD) with critical hand ischemia (CHI). Methods: A subanalysis was performed of multicenter registry data on 36 consecutive patients (mean age 65.7±10.3 years; 19 men) who underwent EVT from January 2003 to December 2013 for angiographically diagnosed de novo upper limb PAD with CHI in 40 limbs. Fifty percent of patients had diabetes, and two-thirds were on hemodialysis. Technical success of EVT was straight-line flow to the hand and final residual diameter stenosis ≤50% for balloon angioplasty alone and ≤30% without flow-limiting dissection for subclavian artery stenting. The primary outcome was 12-month amputation-free survival [AFS; freedom from a composite of major (above-the-wrist) amputation and death]. The 12-month secondary outcomes were overall survival, limb salvage, freedom from major adverse limb events (MALE; major amputation or any repeat revascularization of the limb), and wound healing (complete epithelialization without death or major amputation). Results: Initial success was achieved in 87% (35 of 40 limbs); 1 patient experienced puncture site problems, and 3 (8%) of 36 patients (4 treated limbs) died within 30 days. Hand symptoms were alleviated in 37 (92%) limbs. The mean follow-up was 26.8±27.8 months. Seven fingers (5 limbs) underwent phalanx amputations and 2 limbs had an amputation above the wrist. Complete wound healing was achieved in only 5 (19%) of 26 surviving patients at 12 months. At 1 year, the Kaplan-Meier estimates for AFS, overall survival, limb salvage, and freedom from MALE were 56.4%, 59.4%, 93.1%, and 78.5%, respectively. Univariate analysis revealed that the predictors of AFS at 1 year were diabetes (p=0.03), hemodialysis (p 〈 0.001), PAD (p=0.003), and the presence of a wound (p 〈 0.001). During follow-up, 20 (56%) patients died; a cardiovascular cause accounted for 40% of deaths. Conclusion: Endovascular therapy for upper limb PAD with CHI was technically successful and alleviated symptoms in the majority of cases, but the prognosis of patients with CHI was extremely poor in real-world clinical practice.
    Type of Medium: Online Resource
    ISSN: 1526-6028 , 1545-1550
    URL: Article
    DOI: 10.1177/1526602816659279
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2016
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  • 10
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    Clinical Outcomes of SMART Versus Luminexx Nitinol Stent Implantation for Aortoiliac Artery Disease : A Propensity Score-Matched Multicenter Study
    SAGE Publications ; 2015
    In:  Angiology Vol. 66, No. 9 ( 2015-10), p. 875-881
    Details
    In: Angiology, SAGE Publications, Vol. 66, No. 9 ( 2015-10), p. 875-881
    Abstract: Endovascular therapy for aortoiliac (AI) lesions using stents is widely accepted. However, the long-term outcome of 2 different types of nitinol stents for AI lesions is unknown. The aim of this study was to examine the long-term outcome of the SMART and Luminexx nitinol stents for the treatment of de novo AI lesions. Methods: This study was a multicenter retrospective analysis of a prospectively maintained database. The study enrolled consecutive patients undergoing primary stenting for de novo AI artery stenosis between January 2005 and December 2009. A total of 1503 lesions in 1229 patients treated with SMART or Luminexx primary stenting were enrolled. The primary end point was primary patency, secondary end points were the primary assisted patency, secondary patency, and major adverse limb events (MALEs), which included major amputation and major reintervention. To minimize the differences between the groups, a propensity score matching analysis was performed, and 284 lesions per group were analyzed to identify outcomes. Results: After the propensity score matching analysis, the lesion length was 60 ± 37 and 57 ± 31 mm ( P = .275), and the reference vessel diameter was 8.2 ± 1.5 and 8.3 ± 1.5 mm ( P = .482) in the SMART and Luminexx groups, respectively. The primary patency at 3 years was not significantly different between the groups (83.5% vs 82.2%, P = .842, respectively). The assisted primary patency and secondary patency rates were also not significantly different (91.7% vs 93.2%, P = .340, 99.2% vs 98.8%, P = .922). In addition, the MALE rate was not significantly different between the groups (98.3% vs 97.3%, P = .821). Conclusion: The current data suggest that the use of nitinol stents for the AI artery provided good long-term patency and freedom from MALE for 3 years of follow-up, regardless of whether SMART or Luminexx stents were used.
    Type of Medium: Online Resource
    ISSN: 0003-3197 , 1940-1574
    URL: Article
    DOI: 10.1177/0003319714564207
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2015
    detail.hit.zdb_id: 2065911-8
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