Stroke, PAD, and CLI: The February Issue of VDM

The February issue of VDM is now live online and on the tablet (in the iTunes store and the Android market). This issue takes a look at the prevalence of stroke following open vs endovascular repair of descending aortic pathology, incidence of critical limb ischemia in the Medicare population, and medication therapy for peripheral artery disease. Also featured is an interview with Christopher Kwolek, MD, about a suction-based catheter used to remove massive thrombus in large pieces. The table of contents below will direct you to each of the articles from this issue.

Volume 10 – Issue 2 – February 2013

Editor’s Corner » Stroke

Renewed Focus on Stroke as a Complication of Thoracic Aortic Procedures

By Frank J. Criado, MD, FACS, FSVM, Editor-in-Chief, Endovascular Specialist, MedStar Union Memorial Hospital, Baltimore, Maryland

Stroke is still a challenging complication of TEVAR that requires further study, as in the review article by Lyons et al in this issue.

Case Files by Dr. George » Subclavian stent recoil

Subclavian Stent Recoil: Endovascular Management Using a Manually Crimped High Radial Strength Bare Metal Stent

By Harit Desai, DO, Luke Groben, DO, Nemalan Selvaraj, DO, and Jon C. George, MD, from the Division of Interventional Cardiology & Endovascular Medicine Deborah Heart and Lung Center, Browns Mills, New Jersey.

The authors present a unique case of right subclavian artery stenosis resulting in a subclavian steal syndrome, managed with percutaneous stenting but complicated by stent recoil requiring the use of a manually crimped stent with increased radial strength to support the patency of the vessel.

Original Research » Critical Limb Ischemia

Prevalence, Incidence, and Outcomes of Critical Limb Ischemia in the US Medicare Population

By Onur Baser, MS, PhD,1 Patrice Verpillat,2 Sylvie Gabriel,2 Li Wang3, from 1STATinMED Research/The University of Michigan, Ann Arbor, Michigan, USA, 2Market Access and Pricing Strategy Department, Sanofi Groupe, Paris, France, and 3STATinMED Research, Dallas, Texas, USA.

This study aimed to assess annual prevalence and incidence of critical limb ischemia and associated outcomes in elderly persons in the United States.

Clinical Review » Peripheral artery disease

Antiplatelets, Statins, and Cilostazol in Peripheral Artery Disease: Medical Therapy Is the Responsibility of the Interventionalist

By Vishesh Kumar, MD, David P. Slovut, MD, PhD, from Massachusetts General Hospital, Boston, Massachusetts, and Montefiore Medical Center, New York, New York.

The authors review guidelines for prescribing antiplatelet agents, statins, and cilostazol in patients with peripheral artery disease and present a “report card” of healthcare provider compliance with these guidelines.

Clinical Review » Stroke

Stroke Following Open and Endovascular Thoracic Aortic Repair

By Oliver T. A. Lyons, MBBS, BSc, MRCS,1 Ashish S. Patel, MRCS, MBBS, PhD,1 Rizwan Q. Attia, MBBS, BSc, MRCS,2 Peter R. Taylor, MA, Mchir, FRCS1, from the 1Vascular Unit and 2Cardiothoracic Surgery, Kings Health Partners, St Thomas’ Hospital, London, United Kingdom.

The cause of stroke following endovascular aortic interventions has been inadequately studied. The authors discuss indications for left subclavian revascularization prior to deliberate coverage in endovascular repair.

Interview » Pulmonary embolus

Large-Diameter Catheter for Pulmonary Embolism: An Interview with Christopher Kwolek, MD

At the 2012 VEITHsymposium, Christopher Kwolek, MD, gave a presentation describing the use of the Vortex AngioVac Suction Cannula (AngioDynamics) for pulmonary emboli. Vascular Disease Management spoke with Dr. Kwolek about new developments for the system.

Increased Focus on Stroke After TEVAR

Although thoracic endovascular aortic procedures for aneurysm and other thoracic pathology are seen now as a viable alternative treatment to open repair, there are still related challenges. Stroke is one potential complication that needs further study, said Vascular Disease Management editor in chief Frank Criado, MD, FACS, FSVM, in the editorial for the February issue of VDM, “Renewed Focus on Stroke as a Complication of Thoracic Aortic Procedures.”

“For some reason, TEVAR-induced stroke remained almost totally off the radar for several years, perhaps overshadowed by the ‘fear of paraplegia’ that has always ranked atop all things related to the thoracic aorta,” said Criado. “But this has changed now with the realization that stroke risk is as high as that of paraplegia, and frequently higher.”

Read the article by Lyons et al in this month’s issue, “Stroke Following Open and Endovascular Thoracic Aortic Repair,” for an in-depth study of the prevalence of stroke in both open and endovascular repair of aneurysms.