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Angioplasty
Kinds of Angioplasty Selected AbstractsKISSING BALLOON TECHNIQUE IS A USEFUL METHOD FOR ANGIOPLASTY OF THE RADIOCEPHALIC FISTULA BIFURCATION THROUGH A PERCUTANEOUS TRANS-RADIAL ARTERIAL APPROACHNEPHROLOGY, Issue 3 2010JIUNG-HSIUN LIU No abstract is available for this article. [source] COMMON FACIAL VEIN: AN ALTERNATIVE PATCH MATERIAL IN CAROTID ANGIOPLASTYANZ JOURNAL OF SURGERY, Issue 3 2008Abeywardana M. S. Abeysekara Patch angioplasty is a popular adjunct to carotid endarterectomy to facilitate arteriotomy closure. The long saphenous vein is the common autogenous patch in use. We tested the feasibility of using the ipsilateral common facial vein (CFV), which is usually sacrificed during exposure of the carotid bifurcation. A consecutive series of 17 patients undergoing carotid endarterectomy was examined to show the use of CFV patch in arteriotomy closure in 18 procedures. During exposure of the carotid bifurcation, the facial vein was harvested and distended with heparinized saline to assess the size of the vein. If the vein had an adequate diameter, it was everted and used as a double-layered patch. Patients were followed up postoperatively with serial duplex scanning at 3, 6 and 12 months, and yearly thereafter. The median (range) age of the patients in the series was 66 years (52,72 years). Of the 18 CFV harvested, 2 were rejected because of small calibre. The median (range) length of the vein harvested was 5 cm (4,6 cm). The average diameter of harvested vein was 5 mm. The median (range) time taken for harvesting, distending and everting the vein was 10 min (8,12 min). There were no perioperative deaths or strokes. There was no significant re-stenosis during the follow up of 24 months (18,36 months), with a mean peak velocity of 0.86 m/s (0.58,1.29 ). The use of everted CFV patch in carotid angioplasty is safe, quick, convenient and durable, whereas saphenous veins are spared and lower limb incisions avoided. [source] Angioplasty and stenting of symptomatic and asymptomatic vertebral artery stenosis: to treat or not to treatEUROPEAN JOURNAL OF NEUROLOGY, Issue 2 2010V. Parkhutik Background and purpose:, Comprehensive indications for treatment of symptomatic vertebral stenosis remain unavailable. Even less is known about endovascular treatment of asymptomatic cases. We treated symptomatic and asymptomatic vertebral ostium stenosis with angioplasty and stenting and investigated the long term outcome. Methods:, Consecutive patients with two different indications were included. Group 1 (G1) had symptomatic >50% stenosis. Group 2 (G2) had asymptomatic >50% stenosis and severe lesions of anterior circulation and were expected to benefit from additional cerebral blood supply. Results:, Twenty nine vertebral origin stenoses in 28 patients (75% men, mean age 64 ± 9 years) were treated. There were 16 G1 and 13 G2 cases. Technical success rate was 100%. Immediate neurological complications rate was 3.4% (one G1 patient with vertebral TIA due to release of emboli). Two further strokes were seen during follow up (32 ± 24 months): vertebrobasilar stroke in a G2 patient with permeable stent in V1 segment, new ipsilateral V3 occlusion and high-risk cardioembolic source, and carotid stroke in a G1 patient who had had ipsilateral carotid stenting. There were no deaths of any cause. Asymptomatic restenosis was observed in one out of 19 patients from both groups who underwent a follow up angiography. Conclusions:, Angioplasty and stenting appears to be technically feasible and safe in asymptomatic and symptomatic vertebral stenosis. More studies are needed in order to clarify its role in primary and secondary prevention of vertebrobasilar stroke. High risk anterior circulation lesions should be taken into account as a possible indication in patients with asymptomatic vertebral stenosis. [source] The ARMYDA trials (Atorvastatin for Reduction of MYocardial Damage during Angioplasty) at Campus Bio-Medico University: rationale, results and future horizonsFUNDAMENTAL & CLINICAL PHARMACOLOGY, Issue 2007Germano Di Sciascio Abstract Myocardial protection by atorvastation pretreatment was found in several trials applied to percutaneous coronary intervention by the ARMYDA study group. This article reviews those studies and explores future avenues. [source] Old Age and Outcome After Primary Angioplasty for Acute Myocardial InfarctionJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 5 2010Menko-Jan De Boer MD OBJECTIVES: To assess the influence of age as an independent factor determining the prognosis and outcome of patients with acute myocardial infarction (AMI) treated using primary percutaneous coronary intervention (PCI). DESIGN: A retrospective analysis from a dedicated database. SETTING: A high-volume interventional cardiology center in the Netherlands. PARTICIPANTS: Four thousand nine hundred thirty-three consecutive patients with AMI. MEASUREMENTS: Baseline characteristics and clinical outcomes after 30 days and 1 year were compared according to age categorized in three groups: younger than 65, 65 to 74, and 75 and older. A more-detailed analysis was performed with six age groups, from younger than 40 to 80 and older. RESULTS: Of the 4,933 consecutive patients with AMI treated with PCI between 1992 and 2004, 643 were aged 75 and older. Multivariate analysis revealed that patients aged 65 to 75 had a greater risk of 1-year mortality than those younger than 65 (adjusted odds ratio (AOR)=1.57, 95% confidence interval (CI)=1.15,2.16) and that those aged 75 and older had a greater risk of 1-year mortality than those younger than 65 (AOR=3.03, 95% CI=2.14,4.29). CONCLUSION: In this retrospective analysis, older age was independently associated with greater mortality after PCI for AMI. Patients aged 65 and older had a higher risk of mortality than younger patients, and those aged 75 and older had the highest risk of mortality. [source] Surgical Intervention to Remove an Entrapped Fractured Guidewire during AngioplastyJOURNAL OF CARDIAC SURGERY, Issue 6 2007Ahmad K. Darwazah Ph.D., F.R.C.S. Such complication is potentially dangerous. We present two cases of an entrapped fractured guidewire during angioplasty. They were managed by urgent coronary bypass. [source] Intracranial Angioplasty and StentingJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 1 2009F.A.C.C., JAY S. YADAV M.D. First page of article [source] Direct Stenting after Thrombus Removal before Primary Angioplasty in Acute Myocardial InfarctionJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 4 2008PEDRO SILVA-ORREGO M.D. Objectives:To verify whether direct stenting (DS) after thrombus removal during primary angioplasty (PPCI) in patients with ST-elevation acute myocardial infarction (STEMI) can improve myocardial reperfusion and prevent distal embolization compared to conventional stent implantation. Background:Both mechanical removal and DS reduce thrombus dislodgment and improve microcirculatory reperfusion during PPCI. However, the additional effect of DS after thrombus removal has not been definitely assessed. Methods:The DEAR-MI study included 148 consecutive STEMI patients who were randomly assigned to undergo or not thrombus aspiration before PPCI. For the purpose of the present study, we interrogated the DEAR-MI data bank to compare the occurrence of complete (>70%) ST-segment resolution (STR), myocardial blush grade (MBG)-3, no-reflow, and angiographic embolization in patients treated and untreated with DS. Results:Clinical and angiographic characteristics were similar in the two groups. Comparing DS and no-DS groups, complete STR was found in 67% versus 51% (P = 0.08), MBG-3 in 86% versus 49% (P < 0.001), no-reflow in 1% versus14% (P < 0.01), angiographic embolization in 3% versus 19% (P < 0.01), TIMI flow-3 in 89% versus 70% (P < 0.01), and the corrected TIMI frame count was 16.2 versus 18.8 (P < 0.05). Among patients undergoing thrombus aspiration, the odds ratio of DS for MBG-3 and distal embolization was 4 (95% CI 1,16.6) and 0.10 (95% CI 0.01,0.93), respectively. At multivariable analysis, thrombus aspiration (P < 0.001) and DS (P < 0.05) independently predicted MBG-3, while thrombus aspiration was the only independent predictor of DS. Conclusions:DS during PPCI reduces distal embolization and improves myocardial reperfusion. This effect is significantly more relevant after thrombus aspiration. [source] Management of Multivessel Coronary Disease after ST Elevation Myocardial Infarction Treated by Primary AngioplastyJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 1 2008Ph.D., STEFANO RIGATTIERI M.D. Background: Optimal treatment strategy of patients with ST elevation myocardial infarction (STEMI) and multivessel coronary artery disease (CAD) undergoing primary angioplasty is still unclear. Percutaneous coronary intervention (PCI) of non-culprit vessels simultaneously or soon after primary angioplasty is feasible and safe, but available data failed to consistently show a benefit in long-term clinical outcomes. Methods: We retrospectively compared in-hospital and long-term outcomes for patients with STEMI and multivessel CAD treated by primary angioplasty with (Group 1, n=64) or without (Group 2, n=46) early, staged PCI of other angiographically significant coronary lesions. In-hospital major adverse cardiovascular events (MACE) were defined as a composite of death, periprocedural myocardial infarction after staged, elective PCI, stroke, stent thrombosis, major bleeding, and vascular complications. MACE at follow-up were defined as a composite of death, stroke, stent thrombosis, any coronary revascularization, and re-hospitalization for acute coronary syndrome. Results: Group 1 patients underwent staged PCI 5.9 ± 3.5 days after primary angioplasty. The mean length of follow-up was 13 months (392 ± 236 days). The incidence of in-hospital MACE was 20.3% in Group 1 and 10.8% in Group 2 (P=0.186); the incidence of out of hospital MACE was 9.3% in Group 1 and 23.9% in Group 2 (P=0.037). In Group 1 in-hospital MACE were driven by periprocedural myocardial infarction after the elective procedure, which occurred in 15.6% of patients. Conclusions: Our data show that multivessel, staged PCI in STEMI patients is associated with a low incidence of adverse events at follow-up but with a higher incidence of in-hospital MACE, mainly driven by periprocedural myocardial infarction during the elective procedure. [source] Inflammatory Cytokine Imbalance after Coronary Angioplasty: Links with Coronary AtherosclerosisJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 4 2007NATALE DANIELE BRUNETTI M.D., Ph.D. Aim:To investigate release of some inflammatory cytokines (Cys) after coronary angioplasty and its links with coronary atherosclerosis. Methods:Twenty-seven consecutive subjects with acute coronary syndrome (ACS) who underwent percutaneous coronary intervention (PCI) were enrolled in the study: serial blood samples were taken in order to evaluate plasma concentrations of Interleukin (IL)-2, IL-10, IL-18, TNF,, and IFN, just before PCI at 12 and 24 hours. Patients were then divided, considering balance between each inflammatory Cy and IL-10, an antiinflammatory Cy, into four groups, ranging from a prevalent antiinflammatory response (stable inflammatory Cy,increasing IL-10 values) to a marked inflammatory imbalance (increasing inflammatory Cy,stable IL-10 values). Results:All Cys showed significant increases in plasma concentrations if compared with baseline values. Release curves were not significantly different when comparing subjects with ST-elevation myocardial infarction (STEMI) versus unstable angina,non-STEMI (UA-NSTEMI), diabetics versus controls. Subjects with marked inflammatory response showed a higher incidence of stenosis on left anterior descending (LAD) coronary artery (IL-2 ,2 and IFN, P < 0.05); Cy release was higher in patients with multivessel coronary disease (IL-2 and IFN,, ANOVA P < 0.01). Correlations were also referable between Cys and myocardial enzyme release. Subjects treated with sirolimus-eluting stents (SES) showed significantly lower Cy periprocedure ratio if compared with those treated with bare metal stents. Conclusions:A significant Cy release is detectable after PCI: inflammatory response seems to correlate with both PCI due to plaque instabilization and coronary atherosclerosis. A blunted inflammatory response is detectable in subjects treated with SES. [source] Effectiveness of a Multidisciplinary Quality Improvement Initiative in Reducing Door-to-Balloon Times in Primary AngioplastyJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 4 2004F.A.C.C., STUART W. ZARICH M.D. Primary angioplasty (PA) for acute myocardial infarction (AMI) has emerged as the standard of care in hospitals with cardiac interventional facilities. The benefits from the PA are time dependent, but recent data raise concerns regarding the timeliness of delivery of care in AMI and the level of benefit achieved by current standards. We assessed the effectiveness of an extensive multidisciplinary quality improvement initiative in reducing door-to-balloon (DTB) times in PA. The PA process was divided into six separate time periods, which were assessed individually. Subsequent quality initiatives resulted in a dramatic reduction in the mean DTB time (141.3 minutes preintervention compared to 95.1 minutes postintervention; P < 0.001). [source] Immediate and 3-Month Follow-Up Outcome After Cutting Balloon Angioplasty for Bifurcation LesionsJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 1 2004HIDEO TAKEBAYASHI M.D. Balloon angioplasty of a bifurcation lesion is associated with lower rates of success and higher rates of complications than such treatment of lesions of most other morphologies. To date, the best device or procedure for bifurcation lesions has not been determined. The aim of this study was to compare the immediate and 3-month follow-up outcome of cutting balloon angioplasty (CBA) versus conventional balloon angioplasty (PTCA) for the treatment of bifurcation lesions. We treated 87 consecutive bifurcation lesions with CBA (n = 50) or PTCA (n = 37). Paired angiograms were analyzed by quantitative angiography, and angiographic follow-up was achieved for 93% of the lesions. The procedural success was 92% in the CBA group and 76% in the PTCA group (P < 0.05). Major in-hospital complications occurred in two lesions in the CBA group and six in the PTCA group (P = 0.05). The incidence of bail-out stenting in the CBA group was lower than in the conventional PTCA (8% vs 24%, P < 0.05). At the 3-month follow-up, the restenosis rate was 40% in the CBA group versus 67% in the PTCA group (P < 0.05). Clinical events during follow-up did not differ between the two groups. In conclusion, in comparison with PTCA, procedural success was greater and the restenosis rate lower with CBA. The results of this study support the use of the cutting balloon as optimal treatment for bifurcation lesions. (J Interven Cardiol 2004;17:1,7) [source] Safety, Efficacy, and Cost Advantages of Combined Coronary Angiography and AngioplastyJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 3 2003CLAUDE LE FEUVRE M.D., F.E.S.C. Aim: The safety and efficacy of ad hoc PTCA has been previously reported and this approach is performed in many angioplasty centers as a routine procedure. The aim of this study is to examine whether this approach reduces the length, and cost of hospital stay. Methods and results: To determine the hospital costs we studied 2,440 PTCAs over 11 years in our institution (1990,2000). Urgent PTCA for acute coronary syndromes refractory to medical treatment were excluded. In 1809 patients (74%) angioplasty was performed immediately after coronary angiography, while separate procedures were performed in 631 patients. Indication for PTCA was unstable angina in 1342 patients (55%). In the ad hoc PTCA group, 92% of the culprit lesions were successfully treated; complications included myocardial infarction (2%), urgent bypass surgery (0.6%) and death (0.9%). The rate of combined procedure progressively increased from 54% in 1990 to 88% in 2000, with a significant decrease in the rate of complications. After adjusting for clinical and angiographic differences between combined and separate procedures, angiographic success and complication rates were not statistically different in the two groups. Mean length of hospital stay decreased all along the years, and was 45% less in the ad hoc PTCA group (11.4 ± 6.9vs18.2 ± 7.7in 1990,5.4 ± 4.3vs10.8 ± 5.7in 2000,P < 0.0001). The cost was 40% lower in the ad hoc PTCA group. For patients with stable angina, the savings were 49%, and for those with unstable angina, they were 29%. Conclusion: In the era of coronary stenting, ad hoc PTCA can be performed in most of the patients as safely and successfully as a separate procedure. It reduces the length, and the cost of hospital stay in patients with stable or unstable angina. (J Interven Cardiol 2003;16:195,199) [source] Clinical and Angiographic Outcome after Cutting Balloon AngioplastyJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 1 2003JOHANN AUER M.D. The cutting balloon is a new device for coronary angioplasty, that, by the combination of incision and dilatation of the plaque, is believed to be promising for treatment of in-stent restenosis. The purpose of the study was to evaluate the safety and efficacy of CBA. We reviewed the immediate and 6-month follow-up angiographic and clinical outcome of 147 patients (109 men and 38 women) with a mean age of67.3 ± 10undergoing this procedure at eight interventional centers in Austria. The target lesions treated with CBA were in-stent restenosis in 61% of patients, stenosis after balloon angioplasty in 8% of patients, and native lesions in 33% of patients. Sixty-five percent of the patients included had multivessel disease. Lesion type was A in 18% of patients, B1 in 31% of patients, B2 in 39% of patients, and C in 12% of patients. The degree of stenosis was87%± 9%,the length of the target lesion treated with CBA was8.8 ± 5.1 mm. Target vessel was left circumflex artery in 22 cases, right coronary artery in 36 cases, and left anterior descending artery in 89 cases. The overall procedural success rate was 90.5%. "Stand-alone" CBA was performed in 63% of patients, the procedure was combined with coronary stenting in 16% of patients, and with balloon angioplasty in 21% of patients. Coronary complications occurred in eight cases (5.4%) with coronary dissection in seven (total dissection rate of 4.7%) and urgent bypass surgery in one case (0.7%). No further complications such as death, occlusion, or perforation of coronary arteries, embolization, or thrombosis were observed. Six-month clinical follow-up revealed q-wave myocardial infarction in 2.7% of patients, aortocoronary bypass surgery in 8.5% of patients, and repeated percutaneous coronary intervention in 17% of patients (11.5% with stenting). Six-month angiographic follow-up of patients with recurrent angina showed target lesion restenosis (>50% diameter stenosis) in 14% of patients, late lumen loss with ,50% diameter stenosis in 6% of patients and progression of "other than target" lesions with >50% diameter stenosis in 14% of patients. This series demonstrates the safety and feasibility of cutting balloon angioplasty in patients with complex coronary artery disease and in-stent restenosis. (J Interven Cardiol 2003;16:15,21) [source] Resource Utilization, Cost, and Health Status Impacts of Coronary Stent Versus "Optimal" Percutaneous Coronary Angioplasty: Results from the OPUS-I TrialJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 4 2002NANCY NEIL Ph.D. In the OPUS-I trial, primary coronary stent implantation reduced 6-month composite incidence of death, myocardial infarction, cardiac surgery, or target vessel revascularization relative to a strategy of initial PTCA with provisional s tenting inpatients undergoing single vessel coronary angioplasty. The purpose of this research was to compare the economic and health status impacts of each treatment strategy. Resource utilization data were collected for the 479 patients randomized in OPUS-I. Itemized cost estimates were derived from primary hospital charge data gathered in previous multicenter trials evaluating coronary stents, and adjusted to approximate 1997 Medicare-based costs for a cardiac population. Health status at 6 months was assessed using the Seattle Angina Questionnaire (SAQ). Initial procedure related costs for patients treated with a primary stent strategy were higher than those treated with optimal PTCA/provisional stent ($5,389 vs $4,339, P<0.001). Costs of initial hospitalization were also higher for patients in the primary stent group ($9,234 vs $8,434, P<0.01) chiefly because of the cost differences in the index revascularization. Mean 6-month costs were similar in the two groups; however, there was a slight cost advantage associated with primary stenting. Bootstrap replication of 6-month cost data sustained the economic attractiveness of the primary stent strategy. There were no differences in SAQ scores between treatment groups. In patients undergoing single vessel coronary angioplasty, routine stent implantation improves important clinical outcomes at comparable, or even reduced cost, compared to a strategy of initial balloon angioplasty with provisional stenting. [source] Identification of Hemodynamically Significant Restenosis after Percutaneous Transluminal Coronary Angioplasty in Acute Myocardial Infarction by Transesophageal Dobutamine Stress Echocardiography and Comparison with Myocardial Single Photon Emission Computed TomographyJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 3 2001STEPHAN ROSENKRANZ M.D. Background: Beside thrombolysis, percutaneous transluminal coronary angioplasty (PTCA) has become a well-established treatment for acute myocardial infarction. However, restenosis occurs in approximately 15%-40 % of patients. Despite a frequently occurring infarct-related regional systolic dysfunction at rest, the identification of hemodynamically relevant restenosis seems important in terms of risk stratification, adequate treatment, and possible improvement of prognosis in these patients. This study was designed to assess the role of transesophageal dobutamine stress echocardiography and myocardial scintigraphy for identification of hemodynamically significant restenosis after PTCA for acute myocardial infarction. Methods: Multiplane transesophageal stress echocardiography (dobutamine 5, 10, 20, 30, and 40 ,g/kg per min) studies and myocardial single photon emission computed tomography (SPECT) studies were performed in 40 patients, all of whom underwent PTCA in the setting of acute myocardial infarction , 4 months prior to the test. Repeated coronary angiography was performed in all study patients who showed stress-induced perfusion defects or wall-motion abnormalities, or both. Results: Significant restenosis (, 50%) was angiographically found in 15 (37.5%) of 40 patients. Of these 15 patients, transesophageal dobutamine stress echocardiography identified restenosis in 12 (80%) and myocardial SPECT in 14 (93%), yielding diagnostic agreement in 70% of patients. Echocardiographic detection of restenosis was based mainly on a biphasic response to increasing doses of dobutamine. Sensitivity and specificity for identification of hemodynamically relevant restenosis in individual patients was 80% and 92%, respectively for dobutamine stress echocardiography versus 93% and 68% for myocardial SPECT. Conclusions: Both transesophageal dobutamine stress echocardiography and myocardial SPECT were highly sensitive in identifying significant restenosis after PTCA for acute myocardial infarction. Therefore, either test, as a single diagnostic tool or especially if performed together, are clinically valuable alternatives to coronary angiography for the detection of restenosis after PTCA for acute myocardial infarction. [source] Percutaneous Transluminal Angioplasty of the Anomalous Circumflex ArteryJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 1 2001DIDIER BLANCHARD M.D. The technical experience reported in the literature concerning angioplasty in patients with anomalous origin of the left circumflex artery is limited. Balloon angioplasty seems to be a favorable approach for revascularization in these vessels, and major determinants of successful angioplasty are angiographic knowledge of their course and structure, appropriate selection of guiding catheter, and the possibility of advancing the balloon into the anomalous vessel. Five consecutive patients with severe atherosclerotic lesions on the anomalous left circumflex artery who underwent coronary angioplasty of the anomalous vessel are reported. Angiographic and clinical success were achieved in three patients with balloon alone and in one with stent implantation. (J Interven Cardiol 2001;14:11,16) [source] Primary Angioplasty Should Become the Standard-of-Care at Qualified Hospitals Without On-Site Cardiac SurgeryJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 3 2000F.A.C.C., THOMAS P. WHARTON JR. [source] Cutting Balloon Angioplasty for Ostial Lesions of the Left Anterior Descending ArteryJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 1 2000TERUO INOUE M.D. We evaluated the effectiveness of Cutting Balloon angioplasty for ostial lesions of the left anterior descending artery compared with conventional balloon angioplasty. Cutting Balloon angioplasty (n = 7) produced larger acute gain (1.70 ± 0.37 vs 0.48 ± 0.25 mm, P < 0.001) and smaller late loss index (0.54 ± 0.55 vs 1.32 ± 0.81, P < 0.05) than conventional balloon angioplasty (n = 7). As a result, late restenosis was seen in only two patients undergoing Cutting Balloon angioplasty, but in all seven patients undergoing conventional balloon angioplasty. Ostial lesions of the left anterior descending artery may be one of the suitable targets of Cutting Balloon angioplasty. (J Interven Cardiol 2000;13:7,14) [source] Decision Memo for Percutaneous Transluminal Angioplasty of the Carotid Artery Concurrent with Stenting (CAG-00085R3)JOURNAL OF NEUROIMAGING, Issue 3 2008Osama O. Zaidat MD No abstract is available for this article. [source] Coronary Vein Angioplasty with Noncompliant Balloon for Resistant Coronary Vein Stenosis During Left Ventricular Lead ImplantationPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 2 2008KETUL CHAUHAN M.D. This report describes a patient who underwent cardiac resynchronization therapy (CRT) in the setting of a severe stenosis in the lateral coronary vein that prevented passage of a left ventricular lead. The stenosis was unresponsive to standard compliant balloon dilatation but was successfully treated with a noncompliant balloon. Venoplasty with noncompliant balloon should be considered for resistant coronary vein stenosis encountered during CRT device implantation. [source] Risk Factors and Long-Term Outcome of Transplant Renal Artery Stenosis in Adult Recipients After Treatment by Percutaneous Transluminal AngioplastyAMERICAN JOURNAL OF TRANSPLANTATION, Issue 1 2006V. Audard Transplant renal artery stenosis (TRAS) is a common complication of kidney transplantation but attempts to identify predisposing risk factors for TRAS have yielded conflicting results. In order to determine the predisposing factors for transplant (TRAS), we retrospectively reviewed the records of 29 renal allograft recipients with TRAS treated with percutaneous transluminal angioplasty (PTA). The TRAS group was compared with a case-control group of 58 patients. Predisposing factors for TRAS included CMV infection (41.4% vs. 12.1% p = 0.0018) and initial delayed graft function (DGF) (48.3% vs. 15.5% p = 0.0018), respectively in the TRAS and the control group. Acute rejection occurred more frequently in patients from the TRAS group (48.3%) compared with the control group (27.6%), although the difference was not significant (p = 0.06). In a multivariate analysis, only CMV infection (p = 0.005) and DGF (p = 0.009) appear to be significantly and independently associated with TRAS. The long-term graft survival was significantly higher in the control group, compared with the TRAS group (p = 0.03). Our study suggests that CMV infection and DGF are two reliable risk factors for TRAS. Despite treatment by PTA with primary successful results, TRAS significantly affects long-term graft outcome. [source] Comparison of Different Methods of ST Segment Resolution Analysis for Prediction of 1-Year Mortality after Primary Angioplasty for Acute Myocardial InfarctionANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 1 2007Jakub Przyluski M.D. Background: Resolution of ST segment elevation corresponds with myocardial tissue reperfusion and correlates with clinical outcome after ST elevation myocardial infarction. Simpler method evaluating the extent of maximal deviation persisting in a single ECG lead was an even stronger mortality predictor. Our aim was to evaluate and compare prognostic accuracy of different methods of ST segment elevation resolution analysis after primary percutaneous coronary intervention (PCI) in a real-life setting. Methods: Paired 12-lead ECGs were analyzed in 324 consecutive and unselected patients treated routinely with primary PCI in a single high-volume center. ST segment resolution was quantified and categorized into complete, partial, or none, upon the (1) sum of multilead ST elevations (sumSTE) and (2) sum of ST elevations plus reciprocal depressions (sumSTE+D); or into the low-, medium-, and high-risk groups by (3) the single-lead extent of maximal postprocedural ST deviation (maxSTE). Results: Complete, partial, and nonresolution groups by sumSTE constituted 39%, 40%, and 21% of patients, respective groups by sumSTE+D comprised 40%, 39%, and 21%. The low-, medium-, and high-risk groups constituted 43%, 32%, and 25%. One-year mortality rates for rising risk groups by sumSTE were 4.7%, 10.2%, and 14.5% (P = 0.049), for sumSTE+D 3.8%, 9.6%, and 17.6% (P = 0.004) and for maxSTE 5.1%, 6.7%, and 18.5% (P = 0.001), respectively. After adjustment for multiple covariates only maxSTE (high vs low-risk, odds ratio [OR] 3.10; 95% confidence interval [CI] 1.11,8.63; P = 0.030) and age (OR 1.07; 95% CI 1.02,1.11; P = 0.002) remained independent predictors of mortality. Conclusions: In unselected population risk stratifications based on the postprocedural ST resolution analysis correlate with 1-year mortality after primary PCI. However, only the single-lead ST deviation analysis allows an independent mortality prediction. [source] Comparison of extra-anatomic bypass grafting with angioplasty for atherosclerotic disease of the supra-aortic trunksBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 11 2004B. Modarai Background: Symptomatic stenosis of the supra-aortic trunks (subclavian, innominate and common carotid arteries) can be treated by angioplasty/stenting or surgical bypass. The aim of this study was to compare the initial success and outcome of these two types of treatment. Methods: A prospective database was used to collect information on the presentation, initial success, complications and outcome in 76 patients treated in a single centre between 1983 and 2003. Results: Thirty-five surgical extra-anatomic bypasses were performed, 13 carotid to carotid, 14 carotid to subclavian, two carotid to axillary, three axillary to axillary, one subclavian to axillary and two subclavian to subclavian. One graft occluded after 19 years. No limbs were amputated and no patient had a stroke. The secondary patency rate was 97 per cent at a mean follow-up of 5 years. Forty-one angioplasties were attempted, 34 of the left subclavian, six of the right subclavian and one of the innominate artery. Angioplasty for six subclavian occlusions was unsuccessful. Twenty-seven of 33 arteries remained patent at a mean follow-up of 4 years after a successful endovascular procedure. Conclusion: Extra-anatomic bypass for supra-aortic trunk disease has a better patency than angioplasty, with a comparable complication rate. Copyright © 2004 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] Impact of angioplasty on infrainguinal bypass for critical ischaemia of the legBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 4 2001D. Evoy Background: Both angioplasty and infrainguinal bypass procedures may be used to achieve limb salvage in patients with critical ischaemia. The authors investigated the effect of the introduction of angioplasty on the frequency with which infrainguinal bypass was performed and, second, the changes in outcome of infrainguinal bypass following the introduction of angioplasty. Methods: All patients had critical ischaemia of the leg. Three patient groups were studied: 215 patients undergoing infrainguinal bypass before the introduction of angioplasty (1986,1991), 216 patients who had infrainguinal bypass after the introduction of angioplasty (1993,1998) and 193 patients undergoing angioplasty in the same 5-year interval (1993,1998). Results: The age and risk profile of the three groups was identical. The overall caseload increased by 19 per cent following the introduction of angioplasty. Primary and secondary patency rates were superior for bypass compared with angioplasty, but were similar for the two bypass groups (5-year primary patency rate 60 per cent versus 18-month primary patency rate 45 per cent; 5-year secondary patency rate 80 per cent versus 18-month secondary patency rate 60 per cent). By 18 months 26 per cent of patients having angioplasty had gone on to have bypass. The limb salvage rate of 90 per cent at 1 year was similar for all groups. Survival was significantly higher in the group of patients undergoing bypass from 1993 to 1998 compared with the other two groups (80 versus 60 per cent; P < 0·0002). Conclusion: The introduction of angioplasty has increased overall workload. Angioplasty has a lower patency rate than bypass but a comparable limb salvage rate, making it a suitable alternative to bypass in the management of patients with critical ischaemia. © 2001 British Journal of Surgery Society Ltd [source] New distal embolic protection device the FiberNet® 3 dimensional filter: First carotid human studyCATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 7 2007Michel Henry Abstract Objective: Evaluate the performance and safety of the FiberNet® Embolic Protection System during carotid artery intervention. Background: Carotid Angioplasty and Stenting (CAS) can be proposed to treat the majority of carotid stenoses. Brain embolization takes place and routine use of Embolic Protection Devices (EPD) is warranted. Many EPDs have significant limitations, which may be addressed by a new EPD, the FiberNet® (Lumen Biomedical, Plymouth, MN). Methods: The system consists of a 3-dimensional expandable filter made of fibers, which expand radially, mounted onto a 0.014, wire and retrieval catheter. FiberNet can capture particles as small as 40 ,m without compromising flow. Results: 35 lesions treated in 34 patients. Male 67.6%. Age: 71.4 ± 8.8 (50,85). Average stenosis 84.5% ± 7.9 (70,99). 29.4% were symptomatic. Technical success: 34/35 (97%). No stroke or death within 30 days. Neurological events: two permanent amaurosis, one amaurosis fugax. All samples visually contained significant amounts of emboli. The mean surface area of debris caught was 63.8 mm2 (37.7,107.5). Comparisons were made with other EPDs. The mean surface area of debris caught was 12.2 mm2 (2.7,34.3). No changes were noted in CT/MRI at 30-day post procedure. Conclusion: The first human use of this new novel EPD in carotid artery stenting is encouraging. The FiberNet was easy to use and confirmed the ability to capture particles less than 100 ,m. The feasibility of the FiberNet has been demonstrated. Additional patients will demonstrate the overall safety and efficacy of this new EPD device. © 2007 Wiley-Liss, Inc. [source] Staged revascularization in critically ill patients with coronary artery diseaseCLINICAL CARDIOLOGY, Issue 5 2001Nasser Jowhar Hayat M.D., Ph.D. Abstract Background: Critically ill patients undergoing bypass surgery experience a higher mortality and morbidity. Hypothesis: The study was undertaken to evaluate the efficacy and value of percutaneous transluminal coronary angioplasty (PTCA) as a bridge to coronary artery bypass graft surgery (CABG) in high-risk patients with refractory unstable angina or cardiogenic shock. Methods: We present 11 seriously unstable patients with severe multivessel coronary artery disease undergoing culprit vessel PTCA. Angioplasty was performed not as a definitive procedure but rather as a bridge to surgical revascularization. All the patients had sustained at least one myocardial infarction prior to catheterization, all had refractory unstable angina, eight patients had only a single patent coronary artery, and five patients were in cardiogenic shock. Results: Following PTCA, all patients enjoyed a stable in-hospital period. One patient died 12 weeks after successful PTCA while awaiting second CABG. Seven patients subsequently underwent CABG and are doing well. The remaining three patients were also advised to undergo CABG, but elected to continue medical management. Conclusions: Coronary angioplasty of the culprit vessel may play a role as a bridge to surgery in critically ill patients. [source] Restenosis and Progression of Coronary Disease after Balloon Angioplasty in Patients with Diabetes MellitusCLINICAL CARDIOLOGY, Issue 12 2000Yoseph Rozenman M.D. Abstract Background: Patients with diabetes mellitus (D) (both insulin-requiring D [IRD] and non-IRD) who undergo angioplasty have worse long-term outcome than do non-D patients. Few data are available in the literature that explain these findings. Hypothesis: The study was undertaken to compare restenosis and progression of coronary disease after angioplasty in IRD patients, in non-IRD patients, and in non-D patients. Methods: Diabetic patients who underwent coronary angioplasty were separated into two subgroups: IRD and non-IRD patients. Their angiographic outcome was compared with non-D patients. We examined retrospectively 353 coronary angiograms of patients who were referred for diagnostic angiography > 1 month after successful angioplasty. Quantitative angiography was used to determine the outcome in dilated narrowings (restenosis) and in nondilated narrowings (disease progression). Results: Baseline clinical and angiographic characteristics were similar in all groups. Restenosis rate was higher in IRD (61 %) than in non-IRD (36%) and non-D (35%) patients (p = 0.04). Late luminal loss after angioplasty was two times greater in IRD patients than in the other two groups (p=0.01). Disease progression of nondilated narrowings was significantly more prominent in non-IRD than in non-D patients: Diameter stenoses were similar in the initial angiogram, but narrowings were significantly more severe (p=0.02) in the final angiogram (70 ± 27% and 60 ± 33%, respectively). New narrowings were more common in non-IRD than in non-D patients: there was a 23% increase in the number of narrowings in the follow-up angiogram in non-IRD patients compared with only 12% in non-D patients (p < 0.003). These new narrowings were more common (p=0.01) in angioplasty arteries (57 narrowings on 420 arteries,13.6%) than in nonangioplasty arteries (54 narrowings on 639 arteries,8.5%). Conclusion: Restenosis is more common in IRD patients and explains the high rate of adverse cardiac events within the first year after coronary intervention in these patients (mainly target lesion revascularization). Disease progression (including new narrowings) is the main determinant of patient outcome > 1 year after coronary intervention and is accelerated in non-IRD compared with non-D patients. [source] Universal Health Insurance and the Effect of Cost Containment on Mortality Rates: Strokes and Heart Attacks in JapanJOURNAL OF EMPIRICAL LEGAL STUDIES, Issue 2 2009J. Mark Ramseyer For more than four decades, Japan has offered universal health insurance. Despite the demand subsidy entailed, it has kept costs low by regulatorily capping the amounts it pays doctors, particularly for the most modern and sophisticated procedures. Facing subsidized demand but stringently capped prices on complex procedures, Japanese physicians have had little incentive to invest in specialized expertise. Instead, they have invested in small private clinics and hospitals. The resulting proliferation of primitive clinics and hospitals has cut both the number of complex modern medical procedures performed, and the number of hospitals with any substantial experience in those procedures. With a quarter of the heart disease in the United States, Japan performs less than 3 percent as many coronary bypass operations and less than 6 percent as many angioplasties. Of the 855 cities and regions in Japan, 77 percent lack any hospital with substantial experience in the sophisticated modern treatment (defined below) of cerebrovascular disease, and 89 percent lack much experience in angioplasties. In this article, I estimate one of the costs of this regulatorily-driven lack of expertise. Toward that end, I combine mortality data from 855 cities with information on local hospital expertise and local demographic composition. In the typical city, I find that the addition of one hospital with substantial experience in modern stroke treatment would cut annual stroke mortality by 7 to 16 deaths. The addition of one hospital with substantial experience in angioplasties would cut the annual deaths from heart attacks in the city by over 19. [source] Ulnar Artery as Access Site for Cardiac Catheterization: Anatomical ConsiderationsJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 1 2008DOBRIN VASSILEV M.D. Transradial approach to coronary angiography and angioplasty has been widely accepted in the last few years. As an alternative approach from the forearm, with some potential advantages, we decided to test the transulnar approach as a first-choice strategy. Methods and Results: Transulnar approach was tried in 131 patients. In 29 patients there was no palpable ulnar artery or Allen test was negative. From the remaining 92 patients we performed successful coronary angiography and angioplasties in 59 patients (64% success rate in those who had palpable artery). The most frequent reason for access site failure (54.5% of all failed procedures) was inability to introduce wire despite good arterial flow. We found that the ulnar artery was not the largest artery of the forearm (mean diameter 2.76 ± 0.08 mm compared with radial artery 3.11 ± 0.12 mm) and had relatively frequent anatomical anomalies,11.9%. There were no major local complications, with very few minor complications. Spasm frequency was 13.6%, which is higher than that reported for transradial studies. Conclusions: Transulnar artery approach is feasible for cardiac catheterization: however, it has higher access site failure rates in an unselected patient population. It could be used as an alternative option in selected patients, but operators must be prepared to overcome frequent anatomical anomalies and spasm. [source] | |||||||||||||||||||||||||||||||||||||