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Artery Revascularization (artery + revascularization)

Distribution by Scientific Domains
Medical Sciences100%

Kinds of Artery Revascularization

  • coronary artery revascularization
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    Selected Abstracts

    Coronary Artery Bypass Grafting in a Patient with Glanzmann's Thrombasthenia

    JOURNAL OF CARDIAC SURGERY, Issue 6 2005
    Jon G. Ryckman M.D.
    First described by Dr. Glanzmann in 1918, the disorder is characterized clinically by mucocutaneous bleeding and physiologically by absent platelet aggregation to collagen, epinephrine, and adenosine diphosphate stimulation. While there are multiple reports of patients with Glanzmann's thrombasthenia undergoing surgery, to our knowledge there has been no report of a patient with Glanzmann's undergoing coronary artery bypass grafting. We present the first such report of a patient who successfully underwent operative coronary artery revascularization, and offer suggestions for future management of these patients. [source]

    How to Avoid Problems in Redo Coronary Artery Bypass Surgery

    JOURNAL OF CARDIAC SURGERY, Issue 4 2004
    V. R. Machiraju M.D.
    When a patient accepts redo cardiac surgery in spite of known higher morbidity and mortality, the patient strongly believes that he will come out of this operation successfully and enjoy several more years of life. Weintraub1 reported that redo cardiac surgery has higher mortality and morbidity; 5% in elective cases, 11% in urgent cases, and 16.4% in emergency cases. He and associates2 described that the female gender, a low ejection fraction (EF), and preoperative arrhythmias are significant risk factors. Lemmer and associates3 described poor postoperative functional results with the majority of patients having emergency repeat coronary artery revascularization developing recurrent ischemic syndrome within a short period of time. I am outlining the problems from our experience of 543 patients in the last five years. [source]

    Dor Operation for a Young Male with Left Ventricular Aneurysm due to Spontaneous Left Anterior Descending Coronary Artery Dissection

    JOURNAL OF CARDIAC SURGERY, Issue 1 2004
    Masato Nakajima M.D.
    We describe a young male who had a myocardial infarction with left ventricular aneurysm due to spontaneous left anterior descending coronary artery dissection. He was successfully treated with Dor's left ventriculoplasty without coronary artery revascularization. The Dor procedure was a simple and effective treatment. To our knowledge, this is the first report in which the Dor procedure was used to treat spontaneous coronary artery dissection with left ventricular aneurysm. (J Card Surg 2004;19:54-56) [source]

    Diagnostic Coronary Angiography in Patients with Peripheral Arterial Disease: A Sub-study of the Coronary Artery Revascularization Prophylaxis Trial

    JOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 5 2008
    SANTIAGO GARCIA M.D.
    Background: Although patients in need of elective vascular surgery are often considered candidates for diagnostic coronary angiography, the safety of this invasive study has not been systematically studied in a large cohort of patients scheduled for an elective vascular operation. The goal of this sub-study of the Coronary Artery Revascularization Prophylaxis (CARP) trial was to assess the safety of coronary angiography in patients with peripheral vascular disease. Methods: The CARP trial tested the long-term benefit of coronary artery revascularization prior to elective vascular operations. Among those patients who underwent diagnostic coronary angiography during screening for the trial, the associated complications were determined at 24 hours following the diagnostic procedure. Results: Over 5,000 patients were screened during a 4-year recruitment period at 18 major VA medical centers and the present cohort consists of 1,298 patients who underwent preoperative coronary angiography. Surgical indications for vascular surgery included an expanding aortic aneurysm (AAA) (n = 446; 34.4%) or arterial occlusive disease with either claudication (n = 457; 35.2%) or rest pain (n = 395; 30.4%). A total of 39 patients had a confirmed complication with a major complication identified in 17 patients (1.3%). Complication rates were higher in patients with arterial occlusive symptoms compared with expanding aneurysms (1.8% vs. 0.5%; P = 0.07) and were not dissimilar with femoral (2.8%) versus nonfemoral (4.7%) access sites (P = 0.42). Conclusions: Coronary angiography is safe in patients with peripheral arterial disease undergoing preoperative coronary angiography. The complication rate is higher in patients with symptoms of arterial occlusive disease. [source]

    Utilization of excimer laser debulking for critical lesions unsuitable for standard renal angioplasty,

    LASERS IN SURGERY AND MEDICINE, Issue 9 2009
    On Topaz MD
    Abstract Background The energy emitted by ultraviolet laser is avidly absorbed in atherosclerotic plaques. Conceptually, it could be applied for debulking of selected atherosclerotic renal artery stenoses. We describe early experience with revascularization of critical renal artery lesions deemed unsuitable for standard renal angioplasty. Institutional Review Board permission to conduct the data analysis was obtained. Methods Among 130 percutaneous renal artery interventions with balloon angioplasty and adjunct stenting, there were 12 (9%) patients who underwent laser debulking prior to stenting. These patients presented with critical (95±3.5% stenoses) lesions (11 de novo, 1 stent restenosis) deemed unsuitable for standard renal angioplasty because of marked eccentricity and presence of thrombus. Indications for intervention included preservation of kidney function, treatment of uncontrolled hypertension, management of congestive heart failure, and treatment of unstable angina. Blood pressure and estimated glomerular filtration rate (eGFR) were measured pre- and 3 weeks post-intervention. Results A baseline angiographic stenosis of 95±3.5% was reduced to 50±13% with laser debulking. There were no laser-induced complications. Post-stenting the angiographic residual stenosis was 0%. The mean gradient across the lesions was reduced from baseline 85±40 to 0,mmHg. A normal post-intervention antegrade renal flow was observed in all patients. Baseline mean systolic BP of 178±20,mmHg decreased to 132±12,mmHg (P<0.0001) and mean diastolic pressure of 85±16,mmHg reduced to 71±9,mmHg (P,=,0.01). A pre-intervention mean eGFR of 47.7±19,ml/min/1.73,m2 increased to 56±20.4,ml/min/1.73,m2 (P,=,0.05) post-procedure. The interventions were not associated with major renal or cardiac adverse events. During follow-up one patient developed transient contrast-induced nephropathy. Conclusions Debulking of select renal artery stenoses with laser angioplasty followed by adjunct stenting is feasible. Further prospective, randomized studies will be required to explore the role of debulking and laser angioplasty in renal artery revascularization. Lasers Surg. Med. 41:622,627, 2009. © 2009 Wiley-Liss, Inc. [source]

    Embolization of Polycystic Kidneys as an Alternative to Nephrectomy Before Renal Transplantation: A Pilot Study

    AMERICAN JOURNAL OF TRANSPLANTATION, Issue 10 2010
    F. Cornelis
    In autosomal polycystic kidney disease, nephrectomy is required before transplantation if kidney volume is excessive. We evaluated the effectiveness of transcatheter arterial embolization (TAE) to obtain sufficient volume reduction for graft implantation. From March 2007 to December 2009, 25 patients with kidneys descending below the iliac crest had unilateral renal TAE associated with a postembolization syndrome protocol. Volume reduction was evaluated by CT before, 3, and 6 months after embolization. The strategy was considered a success if the temporary contraindication for renal transplantation could be withdrawn within 6 months after TAE. TAE was well tolerated and the objective was reached in 21 patients. The temporary contraindication for transplantation was withdrawn within 3 months after TAE in 9 patients and within 6 months in 12 additional patients. The mean reduction in volume was 42% at 3 months (p = 0.01) and 54% at 6 months (p = 0.001). One patient required a cyst sclerosis to reach the objective. The absence of sufficient volume reduction was due to an excessive basal renal volume, a missed accessory artery and/or renal artery revascularization. Embolization of enlarged polycystic kidneys appears to be an advantageous alternative to nephrectomy before renal transplantation. [source]

    Predicting Coronary Heart Disease after Kidney Transplantation: Patient Outcomes in Renal Transplantation (PORT) Study

    AMERICAN JOURNAL OF TRANSPLANTATION, Issue 2 2010
    A. K. Israni
    Traditional risk factors do not adequately explain coronary heart disease (CHD) risk after kidney transplantation. We used a large, multicenter database to compare traditional and nontraditional CHD risk factors, and to develop risk-prediction equations for kidney transplant patients in standard clinical practice. We retrospectively assessed risk factors for CHD (acute myocardial infarction, coronary artery revascularization or sudden death) in 23 575 adult kidney transplant patients from 14 transplant centers worldwide. The CHD cumulative incidence was 3.1%, 5.2% and 7.6%, at 1, 3 and 5 years posttransplant, respectively. In separate Cox proportional hazards analyses of CHD in the first posttransplant year (predicted at time of transplant), and predicted within 3 years after a clinic visit occurring in posttransplant years 1,5, important risk factors included pretransplant diabetes, new onset posttransplant diabetes, prior pre- and posttransplant cardiovascular disease events, estimated glomerular filtration rate, delayed graft function, acute rejection, age, sex, race and duration of pretransplant end-stage kidney disease. The risk-prediction equations performed well, with the time-dependent c-statistic greater than 0.75. Traditional risk factors (e.g. hypertension, dyslipidemia and cigarette smoking) added little additional predictive value. Thus, transplant-related risk factors, particularly those linked to graft function, explain much of the variation in CHD after kidney transplantation. [source]

    Critical review of indications for renal artery stenting: Do randomized trials give the answer?,

    CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 2 2009
    Uwe Schwarzwälder MD
    Abstract Significant renal artery stenosis (RAS) is a well accepted cause of deterioration of arterial hypertension and of renal insufficiency. Just recently, more interest has been focused on the impact of RAS on structural heart disease and patient survival. Technical improvements of diagnostic and interventional endovascular tools have lead to a more widespread use of endoluminal renal artery revascularization and extension of the indications for this type of therapy during the past 2 decades. Since the first renal artery angioplasties performed by Felix Mahler and Andreas Grüntzig, numerous single centre studies have reported the beneficial effect of percutaneous transluminal renal angioplasty, and since the early 1990's stenting of renal artery stenosis caused either by atherosclerosis or fibromuscular dysplasia. However, none of the so far published or presented randomized controlled trials (RCT) could prove a beneficial outcome of RAS revascularization compared with medical management. As a result of these negative trials including the recently presented ASTRAL trial, referrals to endovascular renal artery revascularization went down and moreover, reimbursement of these procedures became a matter of debate. This article summarizes the background and the limitations of the so far published and still ongoing controlled trials. Moreover, we discuss why well-designed registries might give important insight on the impact of endovascular revascularization of hemodynamically relevant atherosclerotic RAS. © 2009 Wiley-Liss, Inc. [source]

    Carotid artery revascularization in high surgical risk patients with the NexStent and the Filterwire EX/EZ

    CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 7 2008
    1-Year results in the CABERNET trial
    Abstract Objective: The multicenter, single-arm CABERNET trial evaluated outcomes in high-surgical-risk patients with carotid artery stenosis treated with the NexStent® plus FilterWire EX®/EZÔ Emboli Protection System. Background: For patients at high surgical risk, carotid artery stenting (CAS) offers a less invasive alternative to carotid endarterectomy (CEA). Methods: The trial enrolled 454 high-surgical-risk patients with carotid stenosis by angiography ,50% for symptomatic patients and ,60% for asymptomatic patients. The comparator primary endpoint was the 1-year major adverse event (MAE, defined as any death, stroke, or myocardial infarction [MI]) rate. It was compared with a proportionally weighted objective performance criterion (OPC) of 12.1% representative of published CEA results in similar patients plus a prespecified noninferiority margin (delta) of 4%. A second primary endpoint was the composite rate of 30-day MAE plus late (31,365 days) ipsilateral stroke. Results: Symptoms of carotid stenosis were present in 24.2% of patients; 36.6% of patients were considered high-surgical-risk due to comorbid risk factors and 63.4% due to anatomic risk factors. The rate of 30-day MAE plus late ipsilateral stroke was 4.7% (20/438). The comparator primary endpoint of 1-year MAE was 11.6% (51/438) and was noninferior to the OPC of 12.1% (95% upper confidence interval of 14.5% versus OPC plus delta of 16.1%, P = 0.005). Late ipsilateral stroke was 0.7% and target vessel revascularization at 1 year was 2.4%. Conclusions: The CABERNET trial demonstrates that CAS with NexStent and FilterWire is noninferior to (equivalent or better than) traditional CEA at 1 year in high-surgical-risk patients based on historical controls. © 2008 Wiley-Liss, Inc. [source]

    Carotid stenting with a new system for distal embolic protection and stenting in high-risk patients: The carotid revascularization with ev3 arterial technology evolution (CREATE) feasibility trial

    CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 1 2004
    Robert D. Safian MD
    Abstract The purpose of this study was to evaluate the feasibility of carotid artery revascularization using a new system for carotid stenting and distal embolic protection in 30 patients with severe carotid stenosis and high risk for carotid endarterectomy (Carotid Revascularization With ev3 Arterial Technology Evolution, or CREATE). Previous studies suggest that patients with carotid stenosis and serious comorbid cardiopulmonary and anatomic conditions are at high risk for carotid endarterectomy. All patients underwent percutaneous revascularization using the Protégé GPS self-expanding nitinol stent (ev3, Plymouth, MN) and the Spider distal embolic protection system (ev3). In-hospital and 30-day outcomes were analyzed. High-risk features included age > 75 years (63%), left ventricular ejection fraction < 35% (20%), and restenosis after prior carotid endarterectomy (53%). Procedural success was 100%. In-hospital complications included severe vasovagal reactions in six patients (20%) and a popliteal embolus in one patient (3.3%), treated by successful embolectomy. During 30 days of follow-up, two patients (6.6%) experienced minor neurological deficits, including transient expressive aphasia that resolved without therapy in one patient and homonymous hemianopsia due to contralateral posterior circulation stroke in one patient. This study supports the feasibility of percutaneous carotid artery revascularization with the Protégé GPS self-expanding stent and Spider distal embolic protection system, which will be evaluated in a large multicenter pivotal trial (CREATE Pivotal Trial). Catheter Cardiovasc Interv 2004;63:1,6. © 2004 Wiley-Liss, Inc. [source]

    Gender-Related Differences in Coronary Artery Dimensions: A Volumetric Analysis

    CLINICAL CARDIOLOGY, Issue 2 2010
    Jennifer A. Dickerson MD
    Abstract Background Women consistently have poorer revascularization outcomes and more coronary vascular complications compared to men. This has been attributed to smaller coronary arteries, though limited data exist to support this assumption. Hypothesis By using volumetric data obtained from multidetector cardiovascular computed tomography (CCT), we sought to determine to what extent gender influences coronary artery dimensions and test the hypothesis that women would have smaller coronary dimensions even after normalizing for body surface area and cardiac mass. Methods CCT examinations completed on a 64-slice scanner were identified from a university cardiovascular database. Data sets from 50 women and 44 men without coronary artery disease were selected for analysis. Cross-sectional areas of proximal and distal segments of the left anterior descending (LAD), circumflex (LCx), and right coronary artery (RCA) were measured, blinded to patient gender. Measurements were compared using 2-sample t tests and linear regression analysis techniques accounting for body surface area (BSA) and left ventricular (LV) mass. Results Analysis of cross-sectional coronary artery areas, unadjusted for BSA and LV mass showed smaller coronary artery size in women compared to men in the proximal portion of both the LAD (P = .01) and RCA (P = .002), but no significant difference in the remaining coronary segments. Conclusion Gender significantly impacts proximal LAD and RCA size. Differences in coronary artery dimensions may explain some, but not all excess gender-related risk with coronary artery revascularization, underscoring the importance of considering multiple contributing factors. Copyright © 2010 Wiley Periodicals, Inc. [source]