The everolimus-eluting self-expanding nitinol stent can be successfully implanted in patients with severe peripheral arterial disease with favorable outcomes and clinical improvements observed in the majority of patients.
Outcomes from the largest prospectively gathered, independently adjudicated, multicenter CAS study indicate that CAS can be safely performed in a variety of hospital settings by physicians with various specialties. The most important determinant of perioperative CAS outcomes was both site and operator CAS volume. A threshold of 72 cases was found to be necessary for consistently achieving a DS rate below 3% in this later-phase single arm study; background era and non-study operator experience will affect this determination. (Second Phase of "Carotid RX ACCULINK/RX ACCUNET Post-Approval Trial to Uncover Unanticipated or Rare Events"; NCT00302237).
CAS outcomes in patients at high risk for CEA have improved from earlier carotid stent trials. With periprocedural rates of DSMI of 2.3%, death or stroke at 1.8%, and death or major stroke rate of 0.5%, PROTECT has the lowest rate of periprocedural complications among other comparable single-arm CAS trials in patients at high risk for CEA.
Objective To compare the clinical and radiographic outcomes between the Tri‐Lock Bone Preservation Stem (BPS) and the conventional standard Corail stem in primary total hip arthroplasty (THA). Methods From March 2012 to May 2014, we retrospectively reviewed 84 patients (104 hips) who received Tri‐Lock (BPS) and 84 patients (115 hips) who received conventional standard Corail stem in THA. Their mean ages were 53.12 ± 2.32 years and 52.00 ± 2.11 years, respectively. The clinical outcomes were assessed by Western Ontario and McMaster University Osteoarthritis Index (WOMAC), Pain Visual Analogue Scale (VAS) and Harris Hip Score (HHS). The radiological outcomes were evaluated by the radiological examination. Accordingly, Intraoperative and postoperative complications were observed as well. Results The mean follow‐up time was 48.23 ± 2.91 months in the Tri‐Lock (BPS) group and 49.11 ± 2.11 months in the Corail group, respectively. The bleeding volumes in two groups were comparable (169.22 ± 58.11 mL vs 179.30 ± 59.14 mL, P = 0.003), with more bleeding volume in Corail group patients, while no statistically significance with respect to operation time was observed (65.41 ± 6.24 min vs 63.99 ± 6.33 min, P = 0.567). The rates of intraoperative fracture was 8% for the Corail group while 1% for the Tri‐Lock (BPS) group (8% vs 1%, P = 0.030). At final follow‐up, no statistical differences in regard to HHS, WOMAC, and Pain VAS were revealed between the two groups (P > 0.05). The rate of thigh pain was higher in Corail group than in Tri‐lock (BPS) group (5% vs 0%, P = 0.043). However, incidence of stress shielding in grade 1 was higher in Tri‐Lock (BPS) than in the Corail group (76% vs 23%, P < 0.01), while those in grade 2 and 3 were lower compared to the Corail stem (15% vs 28%, P < 0.01; 9% vs 16%, P = 0.008, respectively). Intriguingly, other assessments in relation to radiographic outcomes and postoperative complications were not comparable between the two groups. The Kaplan–Meier survival rate (revision surgery performed for any reason was defined as the end point) was similar between the two groups (P = 0.57), with 98.8% (95% confidence interval, 92.3%–100%) in Tri‐lock (BPS) group and 97.6% (95% confidence interval, 94.6%–100%) in Corail group. Conclusions The Tri‐Lock (BPS) has similar clinic performances compared to the Corail stem. Furthermore, the Tri‐lock (BPS) stem has some advantages in achieving lower incidence of thigh pain, stress shielding and intra‐operative fracture. Therefore, we recommend the Tri‐lock (BPS) stem as a good alternative in primary total hip arthroplasty, especially taking into account patient factors, including bone deficiency and convenience of extraction of the stem in hip revision.
Objective To investigate risk factors of cage retropulsion after posterior lumbar interbody fusion (PLIF) in China and to establish a scoring system of cage retropulsion. Methods The retrospective analysis was based on two hospital databases. The medical data records of posterior lumbar interbody fusion with cage retropulsion were selected from August 2009 to August 2019. Inclusion and exclusion criteria were set in advance. Risk factors including patients' baseline demographics (age, gender, operation diagnosis time difference), preoperative neurological symptoms, whether the fusion involves single or double segments, screw type, intraoperative compression, preoperative bone mineral density, whether there are neurological symptoms before surgery, whether there is urine dysfunction before surgery, disease type, complete removal of the endplate, and patient's education level. The research endpoint was the retropulsion of fusion cages. The Kaplan–Meier (K‐M) method was used to analyze potential risk factors, and multivariate Cox regression was used to identify independent risk factors (P < 0.05). The Statistical Package for the Social Sciences (version 22.0; SPSS, IBM, Chicago, IL, USA) software was used for statistical analysis, and univariate analysis was used to screen out the factors related to cage retropulsion. All independent risk factors were included to predict the survival time of the retropulsion of cage. Results This study included a total of 32 patients with PLIF between 2009 to 2019. All patients were residents of China. Univariate analysis showed that there were 13 patients over 60 years old and 19 patients under 60 years old. There were 20 male patients and 12 female patients. The surgical diagnosis time was seven patients within 1 month, 17 patients within 1 to 3 months, and eight patients over 3 months. The disease type was 18 cases of lumbar disc herniation, 10 cases of lumbar spinal stenosis, four cases of lumbar spondylolisthesis. The fusion segment was 18 cases of single segment, 14 cases of double segment. The intraoperative compression was seven cases of compression, 25 cases of no compression. The preoperative bone mineral density was 10 cases of low density, 18 cases of normal, four cases of osteoporosis. The screw type was 27 cases of universal screw, five cases of one‐way screw. Preoperative neurological symptoms were found in 25 cases and not in seven cases. Preoperative urination dysfunction occurred in 8 cases, whereas 24 cases did not have this dysfunction. The endplate was completely removed in 10 cases and not in 22 cases. Education level was nine cases of primary school education, 10 cases of secondary school, 13 cases of university level. Cox regression analysis showed that intraoperative pressure (hazard ratio [HR] = 4.604, P = 0.015) and complete removal of the endplate (HR = 0.205, P = 0.027) are associated with the time of cage retropulsion. According to the HR of each factor, the scoring rules were formulated, and the patients were divided into the low‐risk group, moderate‐r...
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