Home About us Contact
|
Home About us Contact | ||
|
|
||
Recurrent Angina (recurrent + angina)
Selected AbstractsResults of Treatment Methods in Cardiac Arrest Following Coronary Artery Bypass GraftingJOURNAL OF CARDIAC SURGERY, Issue 3 2009Mehmet R. Guney M.D. We evaluated the short- and long-term consequences of these two methods and discussed the indications for re-revascularization. Methods: Between 1998 and 2004, a total of 148 CABG patients, who were complicated with cardiac arrest, were treated with emergency re-revascularization (n = 36, group R) and ICU procedures (n = 112, group ICU). Re-revascularizations are mostly blind operations depending on clinical/hemodynamic criteria. These are: no response to resuscitation, recurrent tachycardia/fibrillation, and severe hemodynamic instability after resuscitation. Re-angiography could only be performed in 3.3% of the patients. Event-free survival of the groups was calculated by the Kaplan-Meier method. Events are: death, recurrent angina, myocardial infarction, functional capacity, and reintervention. Results: Seventy percent of patients, who were complicated with cardiac arrest, had perioperative myocardial infarction (PMI). This rate was significantly higher in group R (p = 0.013). The major finding in group R was graft occlusion (91.6%). During in-hospital period, no difference was observed in mortality rates between the two groups. However, hemodynamic stabilization time (p = 0.012), duration of hospitalization (p = 0.00006), and mechanical support use (p = 0.003) significantly decreased by re-revascularization. During the mean 37.1 ± 25.1 months of follow-up period, long-term mortality (p = 0.03) and event-free survival (p = 0.029) rates were significantly in favor of group R. Conclusion: Better short- and long-term results were observed in the re-revascularization group. [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] Coronary Artery Stenting in Vessels with Reference Diameter < 3 MMJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 5 2000ALFRIED GERMING M.D. The study included 220 consecutive patients with coronary artery stenting. In 128 patients (60.8 ± 10.2 years, 68% men), a total of 184 stents were placed in coronary vessels with a reference diameter < 3 mm (group S). One hundred thirty-four stents were implanted in 92 patients (62.9 ± 9.8 years, 82.6% men) in vessels > 3 mm (group L). There was no significant difference according to clinical baseline characteristics. The primary end point of this retrospective study was the rate of periinterventional complications (death, stent thrombosis, myocardial infarction, urgent angioplasty, or surgical revascularization). The, secondary end point was the clinical and angiographic follow-ups (restenosis, recurrent angina, further revascularization) after 3 months. Cardiac complications occurred in group S in two (1.6%) patients, two stent thromboses with urgent angioplasty, one Q-wave and one non-Q-wave infarction. There was one (1.1%) event in group L, a stent thrombosis with Q-wave infarction and urgent angioplasty. Angiography at 3-month follow-up was performed in 148 patients. Restenosis occurred in group S in 31.8% and in group L in 21.7% (NS). Data according recurrent angina and recommended surgical revascularization did not differ between both groups. In group S, significantly more angioplasties of the stented lesion were performed (23/60 patients) compared to group L (6/88) (P = 0,015). Coronary artery stenting in vessels with a reference diameter < 3 mm can be performed without a high rate of periinterventional complications. Restenosis tends to be more frequent in the small vessel group, a higher rate of reangioplasties have to be expected. The clinical follow-up is comparable to a control group. [source] Treatment of Palmaz-Schatz In-stent Restenosis: 6,Month Clinical Follow-upJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 5 2000HUAY-CHEEM TAN M.D. To identify predictors of Palmaz-Schatz in-stent restenosis and determine outcomes of treatment, we assessed 6,month outcomes in 402 patients who had coronary intervention with stent placement; 60 (15%) developed angiographic and clinical evidence of restenosis. Predictors of restenosis included family history of cardiovascular disease, prior bypass surgery, nonelective stenting, stenting of a vein graft, and multiple stents. Of 60 patients with stent restenosis, 47 had repeat percutaneous intervention and 10 had bypass surgery; only 1 of these 10 patients developed symptoms requiring repeat revascularization. Of the 47 with repeat percutaneous intervention, 32 (68%) had conventional balloon angioplasty; the others had perfusion balloon catheters, laser ablation, and repeat coronary stenting. During follow-up, 22 (47%) of these 47 patients suffered recurrent angina, myocardial infarction, or death. A third revascularization procedure was performed in 14 (30%), including 5 referred for bypass. This study shows the limitations of percutaneous modalities for patients with Palmaz-Schatz in-stem restenosis. Such patients are likely to have recurrent symptoms and to undergo repeat target-vessel revascularization. [source] | ||||||||||