scholarly journals Combination of Carbon Dioxide Angiography and Outback® Elite for Revascularization of a Patient with Renal Insufficiency with Bilateral Femoropopliteal Chronic Total Occlusions

2017 ◽  
Vol 2017 ◽  
pp. 1-5
Author(s):  
Yuhei Nojima ◽  
Shinsuke Nanto ◽  
Hidenori Adachi ◽  
Madoka Ihara ◽  
Tetsuya Kurimoto
Keyword(s):  
Carbon Dioxide ◽  
Contrast Medium ◽  
Surgical Revascularization ◽  
Total Occlusion ◽  
Chronic Total Occlusions ◽  
Iodine Contrast Medium ◽  
New Device ◽  
Severe Chronic Kidney Disease ◽  
History Of ◽  
Carbon Dioxide Angiography

A new reentry device (Outback Elite) system has been available in Japan since June 2016. This new device enables easier treatment of chronic total occlusion (CTO) in the lower extremities. We report a case of a woman in her 70s who underwent revascularization using this new device twice to treat both of her femoropopliteal CTO lesions. She was referred to our hospital complaining of intermittent claudication in both legs. She had a long history of diabetes mellitus complicated with severe chronic kidney disease. Her estimated glomerular filtration rate was <20. She refused surgical revascularization; therefore, we performed our treatment without iodine contrast medium. First, magnetic resonance imaging was performed to confirm that the CTO lesions had caused severe claudication before intervention. Subsequently, the Outback Elite device and carbon dioxide (CO2) angiography made it possible to revascularize both of her legs without iodine contrast medium. At 6 months after the procedures, we did not observe exacerbation of claudication in her legs.

Safety and outcomes of combined carbon dioxide angiography and OCT-guided femoro-popliteal chronic total occlusion crossing and directional atherectomy in patients with chronic kidney disease

Vascular ◽  
2021 ◽  
pp. 170853812199437
Author(s):  
Sehrish Memon ◽  
Sean Janzer ◽  
Jon C George
Keyword(s):  
Carbon Dioxide ◽  
Chronic Kidney Disease ◽  
Optical Coherence Tomography ◽  
Kidney Disease ◽  
Chronic Total Occlusion ◽  
Optical Coherence ◽  
Total Occlusion ◽  
Directional Atherectomy ◽  
Optical Coherence Tomography Imaging ◽  
Carbon Dioxide Angiography

Background Carbon dioxide angiography with addition of optical coherence tomography imaging may improve procedural success and clinical outcomes in patients with peripheral artery disease and chronic kidney disease. Methods Single-center, retrospective analysis of patients with chronic kidney disease who underwent carbon dioxide angiography and optical coherence tomography-guided chronic total occlusion crossing and/or optical coherence tomography-guided directional atherectomy was performed. Patient and procedure-related characteristics, along with peri- and one-year post-procedural major adverse events, were analyzed. Results A total of 18 vessels in 11 patients, with mean age 70 years were treated. All had co-morbidities such as hypertension, hyperlipidemia, had history or were current smokers with baseline peripheral artery disease. Majority were diabetic with coronary disease (82%); 55% baseline chronic kidney disease IV, 55% Rutherford class III and 45% class IV. Contrast was used in only two patients. Mean total fluoroscopy time and radiation dose was 24.1 min and 249.2 mGY, respectively. Half of the lesions were femoro-popliteal chronic total occlusions, and Ocelot catheter was used to cross seven of nine chronic total occlusions and was successful in six. Adjunctive optical coherence tomography-guided directional atherectomy was performed in 8 of 11 patients. Only two adverse events occurred: one clinically significant event of slow-flow intra-procedurally and one target limb revascularization within one year of index procedure in a vessel different than prior treated. Optical coherence tomography imaging in both chronic total occlusion-crossing and atherectomy resulted in 10-min mean fluoroscopy reduction time and 32 mGY reduction in radiation dose. Conclusion Carbon dioxide angiography with the addition of optical coherence tomography imaging for chronic total occlusion crossing and/or optical coherence tomography-guided directional atherectomy reduced the need for contrast agents, total fluoroscopy time, and radiation exposure in patients with peripheral artery disease and baseline chronic kidney disease.

scholarly journals Biologically sensitive field-effect transistors: from ISFETs to NanoFETs

2016 ◽  
Vol 60 (1) ◽  
pp. 81-90 ◽  
Author(s):  
Vivek Pachauri ◽  
Sven Ingebrandt
Keyword(s):  
Field Effect ◽  
Gate Dielectric ◽  
Gate Dielectrics ◽  
Field Effect Transistors ◽  
Silicon Nanowire ◽  
Label Free ◽  
Biomolecular Detection ◽  
New Device ◽  
Label Free Detection ◽  
History Of

Biologically sensitive field-effect transistors (BioFETs) are one of the most abundant classes of electronic sensors for biomolecular detection. Most of the time these sensors are realized as classical ion-sensitive field-effect transistors (ISFETs) having non-metallized gate dielectrics facing an electrolyte solution. In ISFETs, a semiconductor material is used as the active transducer element covered by a gate dielectric layer which is electronically sensitive to the (bio-)chemical changes that occur on its surface. This review will provide a brief overview of the history of ISFET biosensors with general operation concepts and sensing mechanisms. We also discuss silicon nanowire-based ISFETs (SiNW FETs) as the modern nanoscale version of classical ISFETs, as well as strategies to functionalize them with biologically sensitive layers. We include in our discussion other ISFET types based on nanomaterials such as carbon nanotubes, metal oxides and so on. The latest examples of highly sensitive label-free detection of deoxyribonucleic acid (DNA) molecules using SiNW FETs and single-cell recordings for drug screening and other applications of ISFETs will be highlighted. Finally, we suggest new device platforms and newly developed, miniaturized read-out tools with multichannel potentiometric and impedimetric measurement capabilities for future biomedical applications.

Reflections on the HIFI Trial

PEDIATRICS ◽  
1991 ◽  
Vol 87 (4) ◽  
pp. 565-567
Author(s):  
A. CHARLES BRYAN ◽  
ALISON B. FROESE
Keyword(s):  
Carbon Dioxide ◽  
Mechanical Ventilation ◽  
Lung Disease ◽  
Prolonged Mechanical Ventilation ◽  
Mechanical Ventilators ◽  
History Of ◽  
Closing Pressure

Mechanical ventilators have only two functions: to provide a flux to eliminate carbon dioxide from those who will not or cannot breathe and to establish an adequate gas-exchanging volume to reduce shunting. The concept of volume recruitment to reduce shunting goes back at least to Mead and Collier in 1959,1 who showed that without periodic inflations there was a progressive fall in compliance during prolonged mechanical ventilation. Much of the subsequent history of mechanical ventilation in acute lung disease has really been the search for better methods of volume recruitment. The lung has to be inflated past the pressure at which atelectatic lung begins to open and be maintained above its closing pressure (that pressure below which alveoli and airways start to close again).

scholarly journals A New Algorithm for Crossing Chronic Total Occlusions From the Asia Pacific Chronic Total Occlusion Club

2017 ◽  
Vol 10 (21) ◽  
pp. 2135-2143 ◽  
Author(s):  
Scott A. Harding ◽  
Eugene B. Wu ◽  
Sidney Lo ◽  
Soo Teik Lim ◽  
Lei Ge ◽  
...  
Keyword(s):  
Chronic Total Occlusion ◽  
Asia Pacific ◽  
Total Occlusion ◽  
Chronic Total Occlusions

scholarly journals Antegrade Chronic Total Occlusion Strategies: A Technical Focus for 2020

2020 ◽  
Vol 15 ◽  
Author(s):  
Calum Creaney ◽  
Simon J Walsh
Keyword(s):  
Chronic Total Occlusion ◽  
Coronary Intervention ◽  
Total Occlusion ◽  
Chronic Total Occlusions ◽  
Initial Strategy ◽  
Percutaneous Coronary ◽  
Probability Of Success ◽  
Procedural Strategy ◽  
Low Probability ◽  
Procedural Success

Chronic total occlusions (CTOs) are common in patients with ischaemic heart disease. In many countries, patients with CTOs are underserved by percutaneous coronary intervention (PCI). One of the barriers to CTO PCI is the technical challenges of these procedures. Improvements in technique and dedicated devices for CTO PCI, combined with advances in procedural strategy, have resulted in a dramatic increase in procedural success and outcomes. Antegrade wiring (AW) is the preferred initial strategy in short CTOs, where the proximal cap and course of the vessel is understood. For many longer, more complex occlusions, AW has a low probability of success. Dissection and re-entry techniques allow longer CTOs and those with ambiguous anatomy to be crossed safely and efficiently, and CTO operators must also be familiar with these strategies. The CrossBoss and Stingray system is currently the primary targeted re-entry device used during antegrade dissection and re-entry (ADR), and there continues to be an evolution in its use to increase procedural efficiency. In contrast to older ADR techniques, targeted re-entry allows preservation of important side-branches, and there is no difference in outcomes compared to intraplaque stenting.

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