Dr. Alisha  Kumar  Md image

Dr. Alisha Kumar Md

1200 Pleasant St
Des Moines IA 50309
515 415-5008
Medical School: Other - Unknown
Accepts Medicare: No
Participates In eRX: No
Participates In PQRS: No
Participates In EHR: No
License #: R-9729
NPI: 1225476310
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Preventing lower extremity distal embolization using embolic filter protection: results of the PROTECT registry. - Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists
To report the results from a single-center prospective registry (PROTECT) established to evaluate the safety and effectiveness of embolic filter protection (EFP) in reducing distal embolization during percutaneous lower extremity interventions.Patients undergoing angioplasty, stenting, or SilverHawk atherectomy and adjunctive balloon angioplasty for infrainguinal occlusive disease were eligible if the lesion(s) met one or more of these angiographic criteria: (1) moderate or severe calcification of any length, (2) total occlusions of any length, (3) a filling defect, (4) irregular (ulcerated) lesions at least 30 mm in length, and/or (5) smooth, non-ulcerated lesions at least 50 mm in length. The primary angiographic outcome was the ability of the filter to prevent angiographically visible distal embolization, slow flow, and loss of distal tibial runoff with or without capturing macrodebris.Forty patients (23 men; mean age 71.4+/-11.5 years) with 56 lesions (42 de novo and 14 restenotic) underwent treatment with angioplasty/stenting (group A, n = 29; 43 lesions) or SilverHawk atherectomy (group B, n = 11; 13 lesions). One filter was used per patient (25 SpiderFX and 15 EmboShield). Macroembolization occurred in 22 (55.0%) patients, 11 (37.9%) in group A and 11 (100%) in group B (p<0.001). Clinically significant (> or =2 mm in diameter) macrodebris was found in 18 (45.0%) patients: 8 (27.6%) in group A and 10 (90.9%) in group B (p<0.001). All filters were retrieved successfully with no complications. One side-branch embolization occurred proximal to the filter. In another case, the filter was overfilled, resulting in no distal flow; it was retrieved, with subsequent tibial embolization when the procedure was continued without protection.Macroembolization is very frequent in patients undergoing lower extremity interventions, particularly with SilverHawk atherectomy. EFP appears to be very effective in capturing macrodebris, and its use is associated with good acute angiographic outcome. The clinical significance of these findings needs to be determined in future studies.
Utilization of GP IIb/IIIa inhibitors in peripheral percutaneous interventions: current applications and in-hospital outcomes at a tertiary referral center. - The Journal of invasive cardiology
The pattern of use of glycoprotein (GP) IIb/IIIa receptor inhibitors in peripheral percutaneous interventions (PPI) remains unclear. Data on patients who received GP IIb/IIIa inhibitors during PPI were extracted from a prospective registry that tracks demographic, angiographic and in-hospital outcomes of patients at 2 medical centers. Primary success was defined as establishing thrombolysis in myocardial infarction (TIMI) 3 flow and < 30% residual in vessels treated. Primary safety endpoints included death, unplanned amputation, vascular access complications, major bleeding and thrombocytopenia. Patients were divided into planned versus bailout use of GP IIb/IIIa inhibitors. A total of 46 patients (128 vessels) were included in this study. The procedure was performed emergently, urgently and electively in 13%, 26.1% and 60.9% of patients, respectively. The mean age was 70.9 +/- 11.2 years and 52.2% of patients were males. The patients' Rutherford-Baker Classes III, IV and V-VI were observed in 32.6%, 32.6% and 34.8%, respectively. Patients had the following comorbidities: current smokers 37%, diabetics 35.8%, dyslipidemics 71.7% and hypertensives 78.3%. Angiographic thrombus was suspected in 45.7% of patients prior to and during the procedure. The primary success endpoint was met in 66.4% of vessels and 69.6% of patients. Primary safety endpoints were as follows: death 2.2%, vascular access complication 2.2%, major unplanned amputation 0%, major bleeding 0% and thrombocytopenia 2.2%. Treatment with GP IIb/IIIa inhibitors was planned in 13 (28.3%) patients and bailout in 33 patients (71.7%). Reasons for planned GP IIb/IIIa were the presence of angiographic thrombus in 7 (53.8%) patients, advanced limb ischemia (Rutherford-Baker IV-VI) with total occlusions in 5 (38.5%) patients and acute presentation with total occlusion in 1 (7.7%) patient. Reasons for bailout were slow-flow in 16 (48.5%) patients, thrombus with no slow-flow in 12 (36.4%) patients, poor runoff in 1 (3%) patient and preventative during the procedure in 4 (12%) patients. In patients who received planned GP IIb/IIIa treatment, slow-flow occurred in 1/13 (7.7%) and embolization in 0/13 (0%) patients. We conclude that GP IIb/IIIa inhibitors were used as adjunctive therapy prior to angioplasty in critical limb ischemia patients or thrombotic lesions or as bailout in patients experiencing slow-flow and thrombus during PPI. Planned GP IIb/IIIa inhibitors appear to have favorable outcomes with a low incidence of slow-flow and embolization, however, randomized data are needed before establishing the role of GP IIb/IIIa inhibitor use in high-risk PPI.

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