Ender Özgün Çakmak

Background: Clinically driven target lesion revascularization (CD-TLR) following endovascular recanalization of femoropopliteal chronic total occlusions (CTOs) remains a primary determinant of long-term procedural durability. This study aimed to identify clinical, anatomical, and procedural predictors associated with 12-month CD-TLR following successful femoropopliteal CTO endovascular treatment. Methods: This retrospective single-center cohort study evaluated 246 successfully recanalized patients who underwent endovascular treatment for femoropopliteal CTO between June 2020 and June 2025. The primary endpoint was 12-month CD-TLR. To overcome severe multicollinearity and prevent overfitting among correlated predictors, five survival algorithms were benchmarked across the complete 27-variable candidate set. Model discrimination was evaluated using Harrell’s concordance index (C-index) with bootstrap correction. Results: Over a 12-month time-to-event follow-up (median 365 days), CD-TLR occurred in 114 patients (46.3%). Multivariable-regularized Elastic Net Cox regression retained 22 informative predictors, achieving an apparent C-index of 0.715 (95% CI: 0.66–0.77) and an optimism-corrected C-index of 0.653. Higher occluded below-the-knee vessel count, baseline Rutherford classes 4–6, popliteal CTO extension, distal runoff impairment, active smoking, and overall concomitant interventions showed positive associations with 12-month CD-TLR risk. Conversely, shorter lesion length (<5 cm) and female sex showed inverse associations, while findings related to stent dimensions were considered exploratory. Conclusion: Twelve-month CD-TLR after endovascular treatment of femoropopliteal CTO was associated with greater distal vascular disease burden, anatomical complexity, a worse baseline Rutherford class and impaired distal runoff. The Elastic Net model provided the highest optimism-corrected discrimination among the evaluated strategies, although prospective external validation remains necessary before broad clinical application.

Introduction: Coronary collateral circulation (CCC) is a natural bypass system for restoring blood flow, and a well-developed CCC is held to protect myocardial function and improve survival after coronary obstruction in patients with coronary artery disease (CAD). Sex steroids have been suggested as potentially hampering the course of CAD progression. We explored the relationship between the serum levels of sex steroids and CCC. Patients and Methods: A total of 115 males with chronic coronary artery disease who had at least one total coronary artery occlusion were included. Patients were divided into two groups: a well CCC group (Rentrop grades 2-3, n= 64) and a poorly developed CCC group (Rentrop grades 0-1, n= 51). Serum levels of total testosterone, free testosterone, sex hormone-binding globulin (SHBG), and dehydroepiandrosterone sulfate (DHEA-S) were recorded. A p-value below 0.05 was accepted as significant in all analyses. The confidence interval was accepted as 95%. Results: Serum total testosterone (ng/dL; 274.5 ± 57.7 vs. 329 ± 64.8, p< 0.001), free testosterone (pg/mL; 8.2 ± 2.4 vs. 12 ± 3.2, p< 0.001), DHEAS [µg/dL; 111 (58) vs. 160 (85.5), p< 0.001] and SHBG concentrations (nmol/L; 29.3 ± 8.6 vs. 33.2 ± 10.2; p= 0.027) were significantly higher in the well coronary collateral group (WCG). According to the results of multiple regression analyses, diabetes [OR= 3.56, CI (1.26-3.5) p= 0.017], free testosterone level [OR= 1.57, CI (1.26-1.96), p< 0.001] and total testosterone level [OR= 1.01, CI (1.00-1.02), p= 0.009] were determined to be independent predictors. Conclusion: This study showed that a high level of sex steroids was a predictor of good collateral development in patients with chronic CAD.

The effect of malnutrition on outcomes after carotid artery stenting (CAS) is not well known. This study reports the relationship between malnutrition and post-procedure 30-day major adverse events (MAEs). A total of 978 patients hospitalized for CAS were enrolled in the study. Controlling nutritional status (CONUT) score, the nutritional risk index (NRI), and the prognostic nutritional index (PNI) were calculated. MAEs (myocardial infarction, stroke/transient ischemic attack and mortality) were compared. According to the CONUT score, NRI, and PNI, 9.4%, 41%, and 11.4% patients were moderately or severely malnourished, respectively; 74.8% were at least mildly malnourished by at least 1 score. Forty-seven patients (4.8%) had a post-procedure 30-day MAE. Continuous classifications of the indexes were independently associated with higher MAE. CONUT showed the highest predictive ability, whereas NRI had the lowest (C-index: CONUT, 0.701; NRI, 0.681; PNI, 0.688). According to categorical classification of indexes, only CONUT and PNI showed predictive ability for MAE. Malnutrition assessment could identify patients with CAS at elevated risk for MAE. CONUT, NRI, and PNI continuous scores were independent prognostic factors for the post-procedure 30-day MAE. According to our study, CONUT showed the highest predictive ability.

Aim: We sought to determine the relationship between presence of atrial fibrillation (AF) and serum biomarkers, including native thiol (antioxidant), disulphide/native thiol ratio, Hs-CRP and high-...

We report the results of endovascular treatment of Trans-Atlantic Inter-Society Consensus II (TASC) A&B, TASC C, and TASC D aortoiliac lesions in a single vascular center. In this retrospective, observational cohort study, we analyzed 395 patients (mean age 61.2 ± 9.0; 359 men) between January 2015 and December 2017. Technical success was achieved in 96.5%; in-hospital mortality was 1.2% (n = 5). Median follow-up was 36 months (range 24-49 months). After 1 and 5 years, the primary patency rates were 99% and 85% for TASC A&B, 90%, and 78% for TASC C, and 90% and 74% for TASC D. Secondary patency rates were 99% and 90% for TASC A&B, 98% and 65% for TASC C, and 97% and 65% for TASC D. Previous peripheral revascularization (hazard ratio: 1.76, 95% CI: 1.01-3.08, P = .04) was associated with decreased primary patency along with lower age, TASC C, and TASC D class. This analysis reported the acceptable effectiveness and safety of stenting for all types of aortoiliac occlusive disease in a modern setting, with few complications and excellent long-term primary and secondary patency rates.