High-risk carotid plaque features may be more accurate predictors of ipsilateral ischemic stroke risk than the degree of carotid artery stenosis.

Introduction: The optimal management of patients with asymptomatic carotid stenosis (AsxCS) is enduringly controversial. The current stratification of AsxCS patients based on the degree of stenosis alone does not always reflect ipsilateral ischemic stroke risk. We hypothesized that the presence of ≥1 "high-risk" carotid plaque feature may more accurately identify AsxCS patients at high risk for a future ipsilateral ischemic cerebrovascular event.

Geographic variation in endovascular revascularization for chronic limb-threatening ischemia care among Medicare beneficiaries (2016-2023).

Objective: Chronic limb-threatening ischemia (CLTI), the most severe manifestation of peripheral artery disease, is associated with high risk of major amputation and mortality. Although timely revascularization is a cornerstone of CLTI management, disparities in access to care and outcomes persist across U.S.

Validation of Pedal Acceleration Time for the Assessment of Perfusion in Patients with Chronic Limb-Threatening Ischemia.

Background: Accurate hemodynamic assessment of perfusion is critical in managing patients with chronic limb-threatening ischemia (CLTI). Traditional methods such as ankle-brachial index (ABI) and toe pressures (TPs) may be inadequate due to arterial calcification and toe amputations. Pedal acceleration time (PAT), a novel technique, aims to address these limitations.

Contemporary outcomes in no-option chronic limb-threatening ischemia.

The incidence of chronic limb-threatening ischemia, the most severe form of peripheral artery disease, is increasing. A considerable portion are deemed "no-option" patients and have high rates of limb loss and death, with even worse outcomes in underrepresented populations. This study aimed to delineate real-world, contemporary outcomes in an observational study of no-option chronic limb-threatening ischemia patients.

The future in the management of patients with asymptomatic carotid artery stenosis.

Introduction: The optimal management of patients with asymptomatic (AsxCS) and symptomatic carotid stenosis (SxCS) is still debatable. The present article will discuss emerging technological advances for the diagnosis and management of patients with AsxCS.

Evidence Acquisition: PubMed/MedLine was searched until December 31, 2024 for studies in English discussing emerging technological advances in the diagnosis and management of patients with AsxCS.

The Incidence and Consequences of Endovascular Technical Failure in Patients with Chronic Limb-Threatening Ischemia: Results from the Best Endovascular versus Best Surgical Therapy in Patients with Critical Limb-Threatening Ischemia (BEST-CLI) Trial.

Purpose: To analyze the causes and clinical impacts of endovascular technical failure (ETF) in the Best Endovascular versus Best Surgical Therapy in Patients with Critical Limb-Threatening Ischemia (BEST-CLI) trial, which compared endovascular therapy with bypass surgery in patients with chronic limb-threatening ischemia (CLTI).

Materials And Methods: Patients with CLTI were randomized to infrainguinal bypass or endovascular therapy. ETF was defined as the inability to complete the endovascular procedure.

Large language models can accurately populate Vascular Quality Initiative procedural databases using narrative operative reports.

Objective: Participation in the Vascular Quality Initiative (VQI) provides important resources to surgeons, but the ability to do so is often limited by time and data entry personnel. Large language models (LLMs) such as ChatGPT (OpenAI) are examples of generative artificial intelligence products that may help bridge this gap. Trained on large volumes of data, the models are used for natural language processing and text generation.

An International, Expert-Based Delphi Consensus Document on Controversial Issues about TransCarotid Artery Revascularization (TCAR).

Background: Transcarotid artery revascularization (TCAR) has emerged as an alternative therapeutic modality to carotid endarterectomy (CEA) and transfemoral carotid artery stenting (TFCAS) for the management of patients with carotid artery stenosis. However, certain issues regarding the indications and contraindications of TCAR remain unanswered or unresolved. The aim of this international, expert-based Delphi consensus document was to attempt to provide some guidance on these topics.

The impact of revascularization strategy on clinical failure, hemodynamic failure, and chronic limb-threatening ischemia symptoms in the BEST-CLI Trial.

Objective: Sustained clinical and hemodynamic benefit after revascularization for chronic limb-threatening ischemia (CLTI) is needed to resolve symptoms and prevent limb loss. We sought to compare rates of clinical and hemodynamic failure as well as resolution of initial and prevention of recurrent CLTI after endovascular (ENDO) vs bypass (OPEN) revascularization in the Best-Endovascular-versus-best-Surgical-Therapy-in-patients-with-CLTI (BEST-CLI) trial.

Methods: As planned secondary analyses of the BEST-CLI trial, we examined the rates of (1) clinical failure (a composite of all-cause death, above-ankle amputation, major reintervention, and degradation of WIfI stage); (2) hemodynamic failure (a composite of above-ankle amputation, major and minor reintervention to maintain index limb patency, failure to an initial increase or a subsequent decrease in ankle brachial index of 0.

Why selective screening for asymptomatic carotid stenosis is currently appropriate: a special report.

Introduction: Two of the main reasons recent guidelines do not recommend routine population-wide screening programs for asymptomatic carotid artery stenosis (AsxCS) is that screening could lead to an increase of carotid revascularization procedures and that such mass screening programs may not be cost-effective. Nevertheless, selective screening for AsxCS could have several benefits. This article presents the rationale for such a program.

Relevance of BEST-CLI trial endpoints in a tertiary care limb preservation program.

Objective: Major adverse limb event-free survival (MALE-FS) differed significantly by initial revascularization approach in the BEST-CLI randomized trial. The BEST-CLI trial represented a highly selected subgroup of patients seen in clinical practice; thus, we examined the endpoint of MALE-FS in an all-comers tertiary care practice setting.

Methods: This is a single-center retrospective study of consecutive, unique patients who underwent technically successful infrainguinal revascularization for chronic limb-threatening ischemia (2011-2021).

Outcomes following carotid revascularization for stroke stratified by Modified Rankin Scale and time of intervention.

Objectives: The relationship between baseline Modified Rankin Scale (mRS) in patients with prior stroke and optimal timing of carotid revascularization is unclear. Therefore, we evaluated the timing of transfemoral carotid artery stenting (tfCAS), transcarotid artery revascularization (TCAR), and carotid endarterectomy (CEA) after prior stroke, stratified by preoperative mRS.

Methods: We identified patients with recent stroke who underwent tfCAS, TCAR, or CEA between 2012 and 2021.

Serration Angioplasty Is Associated With Less Recoil in Infrapopliteal Arteries Compared With Plain Balloon Angioplasty.

Purpose: Recoil following balloon angioplasty of tibial arteries is a known mechanism of lumen loss and widely considered to be a contributing factor in early failure or later restenosis. The Serranator balloon has been designed to provide a controlled lumen gain while minimizing vessel injury. The objective of this study was to assess the ability to define and measure postangioplasty recoil in infrapopliteal arteries and to compare recoil after serration angioplasty and plain balloon angioplasty (POBA).

Mortality in randomised controlled trials using paclitaxel-coated devices for femoropopliteal interventional procedures: an updated patient-level meta-analysis.

Background: Numerous randomised clinical trials and real-world studies have supported the safety of paclitaxel-coated devices for the treatment of femoropopliteal occlusive disease. However, a 2018 summary-level meta-analysis suggested an increased mortality risk for paclitaxel-coated devices compared with uncoated control devices. This study presents an updated analysis of deaths using the most complete and current data available from pivotal trials of paclitaxel-coated versus control devices.

How I do it: optimizing angioplasty using the Tack endovascular system in the management of chronic limb threatening ischemia.

Dissection occurring after percutaneous transluminal angioplasty (PTA) is associated with decreased vessel patency and an increased incidence of target lesion revascularization. Management of post-PTA dissection with the Tack Endovascular System (Philips, N.V.