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Endovascular intervention devices for femoral-popliteal arterial disease have evolved in the last decade to more effectively treat patients with symptoms of claudication, improve tissue healing, and prevent amputation in patients with critical limb ischemia. Drug-eluting stents and drug-coated balloon therapies have demonstrated significant improvements in short- and mid-term patency and decreases in future target vessel interventions over uncoated balloon angioplasty. Adjunctive lesion preparation options including atherectomy devices are available to treat more complex and calcified lesions, but comparative data are still required. Endovascular revascularization for aortoiliac occlusive disease (AIOD) is now considered first-line therapy for patients with claudication and critical limb ischemia and in asymptomatic patients in whom large-bore access is required (eg, mechanical circulatory support or transcatheter aortic valve replacement). The authors review the data supporting endovascular therapy for AIOD, indications and contraindications for AIOD revascularization, as well as the procedural techniques required to safely perform endovascular therapy in this vascular bed. They review prevention and management of the major complications that can occur during these procedures. Finally, they discuss postprocedural management to maintain patency and optimize patient outcomes. Atherosclerotic renal artery stenosis is the most common cause of secondary hypertension and may cause progressive renal disease and cardiac destabilization syndromes. Guideline-directed medical therapy is advised in all patients. MSC-4381 datasheet Patients with refractory symptoms and hemodynamically significant stenoses are more likely to benefit from renal artery stent placement. Chronic mesenteric ischemia (CMI) is an infrequent and difficult to diagnose illness. Due to robust collateralization, clinical symptoms from mesenteric artery stenosis or occlusion is uncommon. Atherosclerosis is the most common etiology of CMI. Current evidence suggests that, compared with open surgical repair, endovascular therapy is the most cost-effective choice for CMI. Most abdominal aortic aneurysms are treated with endovascular repair (EVAR) in current practice. EVAR has lower periprocedural mortality and morbidity than open surgical repair. Aneurysm neck morphology, iliac anatomy, and access vessel anatomy need careful assessment for the successful performance of EVAR. Regular and long-term follow-up with imaging is mandatory after EVAR, and patients who are less likely to comply are less favorable EVAR candidates. Endoleaks are the most frequent complication of EVAR. Most can be managed with transcatheter or endovascular means. Evolving technology and techniques are allowing more patients to be treated with EVAR with better long-term outcomes. Carotid atherosclerosis most frequently manifests in the proximal internal carotid artery and the common carotid artery bifurcations. Subclavian artery atherosclerosis affects the proximal segments with a relatively higher incidence on the left and becomes clinically important in the presence of vertebrobasilar insufficiency or coronary steal. Atherosclerosis of the vertebral artery can lead to posterior circulation stroke. The authors review the major trials on carotid carotid, brachiocephalic and vertebral artery stenosis along with the various available diagnostic and interventional techniques. Plaque modification (PM) for atherosclerotic peripheral vascular lesions includes a variety of device types to alter the vessel structure with the aim of enhancing procedural success. PM device utilization has expanded significantly in the United States in recent years despite limited high-quality clinical trials. This article reviews societal guidelines for PM, evaluates currently available trial evidence, examines various pathologic subsets in which PM may be used, and discusses future areas for research. Peripheral arterial interventions require safe and effective vascular access and closure. The sites, techniques, and equipment used may vary depending on patient and procedural factors. To minimize the risk of procedural complications, arterial access should use micropuncture technique, ultrasound and fluoroscopic guidance, a compressible arterial access site, and the smallest diameter sheath necessary. Hemostasis at an arteriotomy site may be achieved by manual compression, device-mediated compression, an intravascular closure device, or an extravascular closure device. Although closure devices improve patient comfort and expedite hemostasis, they have not been shown to reduce complications in comparison with compression. In recent years, the inter-relationship between the innate immune system and the central nervous system (CNS) has moved to the forefront of biomedical research, with the discovery that these two physiological systems modulate each other by a steady mutual interaction. During normal brain aging, but also under certain pathological conditions, this crosstalk can go beyond physiological control, resulting in an unresolved inflammatory response of the CNS-resident immune cells that might initiate and propagate the progression of severe tissue damage and neurodegeneration. In this review, we focus on the impact of CNS-resident cells of the innate immune system for the development of neurodegenerative diseases, review immune pathway genes that have been identified, and discuss the vicious cycle between inflammation and neurodegeneration. Understanding neuroimmunological disorders is essential for developing new diagnostic and therapeutic strategies. Rodent models have provided valuable insights, but are sometimes equated with their human counterparts. Here, we summarize how novel technologies may enable an improved human-focused view of immune mechanisms. Recent studies have applied these new technologies to the brain parenchyma, its surrounding cerebrospinal fluid, and peripheral immune compartments. Therapeutic interventions have also facilitated translational understanding in a reverse way. However, with improved technology, access to patient samples remains a rate-limiting step in translational research. We anticipate that next-generation neuroimmunology is likely to integrate, in the immediate future, diverse technical tools for optimal diagnosis, prognosis, and treatment of neuroimmunological disorders.
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