bluuebunny/crossref_metadata_2025 huggingface dataset:
Success Rate and Incidence of Restenosis Following Coronary Excimer Laser Angioplasty: Results of a Single Center Experience
Authors: HAASE K.K. , BAUMBACH A. , HANKE H. , VOELKER W. , MAUSER M. , KARSCH K.R.
Published: June 2007

The initial single center experience of percutaneous coronary excimer laser angioplasty is described for the first three series of 147 patients. Sixty patients were treated with a prototype 1.4‐mm laser catheter, 40 patients with improved transmission devices, and the third series of 47 patients with an increased pulse width of the laser system allowing improved energy transmission. In 17 patients (12%) laser angioplasty could not be initiated due to inability to cross the lesion with the guidewire or to place the catheter coaxially within the vessel. In 32 patients (58%) of series I, II patients (31%) of series 2, and 17 patients (43%) of series 3, additional balloon dilatation following laser treatment was necessary due to vessel closure (24%) or due to an insufficient angiographic result (35%). There was one death in series 1(2%) and 2 (3%) each, one perforation in series 2 (3%), two transmural myocardial infarctions in series 1 (4%), and one myocardial infarction in series 2 (3%). During the 6‐month follow‐up period one patient in series 2 (2%), and one patient in series 3 (3%) died. Angiographic restenosis was found in 22, 12, and 11 patients of series 1 (40%), 2 (34%), and 3 (27%), respectively. No patient developed a transmural myocardial infarction. Thus, percutaneous coronary excimer laser angioplasty can be performed as a safe and feasible procedure in patients with coronary artery disease. However, the need for additional balloon angioplasty due to vessel closure or due to an insufficient angiographic result demands further improvement in laser and catheter technology. The overall incidence of restenosis following excimer laser angioplasty was comparable to balloon dilatation in this limited series of patients. (J Interven Cardiol 1992; 5:15–23)
Percutaneous Balloon Coarctation Angioplasty: Long‐Term Results
Authors: LABABIDI ZUHDI
Published: June 2007

One hundred and ten patients, age 2 days to 35 years (mean 7.0 ± 7.0 years), have undergone 118 percutaneous balloon angioplasty procedures for discrete coarctation of the aorta since April 1982. The mean systolic gradient was significantly decreased from 48 ± 22 to 8 ± 7 mmHg after angioplasty (P < 0.0001). Long‐term results were evaluated in 95 patients, by follow‐up catheterization in 30 and Doppler echocardiography in 65 patients. The follow‐up period was 1–9 years (4.2 ± 2.1). At follow‐up the mean residual gradient was 9 ± 8 mmHg. On the basis of follow‐up data, four groups of patients were identified:group I consisted of 53 patients over 3 months of age with native coarctation of the aorta; group II consisted of 13 patients with postoperative coarctation restenosis; group III consisted of 21 infants 3 months of age or younger with native coarctation of the aorta; and group IV consisted of eight infants who developed postdilatation restenosis. Patients in groups I and II had good results and required no redilatation or surgical repair. In group III successful redilatation in eight and surgical repair in seven infants were performed 1 month to 5 years after the initial dilatation. There were no mortalities related to the 118 dilatation procedures. Of the seven patients who had surgical repair of the coarctation and the associated cardiac anomalies, four expired in the immediate postoperative period. Percutaneous balloon coarctation angioplasty is an effective definitive treatment for native as well as postoperative aortic coarctation in patients over the age of 3 months. Infants with coarctation of the aorta associated with other cardiac anomalies may require repeat dilatation or surgical repair.
Mechanical Dilatation Rather Than Plaque Removal as Major Mechanism of Transluminal Coronary Extraction Atherectomy
Authors: PIZZULLI LUCIANO , KÖHLER ULRICH , MANZ MATTHIAS , LÜDERITZ BERNDT
Published: June 2007

Atherectomy with the transluminal extraction endarterectomy catheter (TEC) is a new approach for treatment of coronary artery disease, which continues to undergo FDA investigational studies, The major mechanism of the TEC device should be excision of plaque and its removal due to suction applied through an attached vacuum. We report about the acute results in 24 patients treated with TEC atherectomy in native vessels and the outcome of 18 patients who, until recently, underwent follow‐up catheterization after 6 months. The procedure was successful (residual stenosis < 50%) in 7 of 24 patients with TEC atherectomy alone (29%); 15 of 24 patients (65%)required additional PTCA in order to achieve angiographic success (10 of 24) or to treat total occlusion (2 of 24) or distal embolization (3 of 24) following atherectomy. One TEC attempt failed due to guiding catheter problems, another major complication was a vessel perforation leading to a non‐Q wave infarction. The minimal residual diameter after passage of the stenosis (prior to additional PTCA) with the 5.5Fr catheter (n = 14) nsas 1.5 ± 0.2 mm, with the 6Fr catheter (n = 9) 1.8 ± 0.4 mm, and 2.2 ± 0.2 mm using the 7Fr catheter (n = 10). The histologic findings revealed intimal cells, fibrous tissue, and homogenate with no identifiable tissue in five cases (21%), whereas in 17 patients (72%) light microscopy could only assess blood cells. Restenosis was present in 9 of 18 patients (50%), occurred in 3 of 7 patients treated with TEC alone, and in 6 of 11 patients treated with TEC + PTCA. The primary underlying mechanism of TEC atherectomy seems to be mechanical dilatation while tissue excision proved to be inadequate to explain the angiographic result. Further studies should be designed to directly compare TEC atherectomy to PTCA in specific patient subgroups (e.g., bypass grafts, intraluminal thrombus, diffuse disease), in order to define the role of this device.
Reduction of Vasoreactivity and Thrombogenicity with Laser‐Thermal Angioplasty: Comparison with Balloon Angioplasty
Authors: TOMARU TAKANOBU , UCHIDA YASUMI , NAKAMURA FUMITAKA , YANAGISAWA‐MIWA ATSUKO , KAMIJO TAKESHI , SUGIMOTO TSUNEAKI
Published: June 2007

The vasoreactivity and thrombogenicity of laser‐thermal angioplasty were examined and compared with those of balloon angioplasty in an atherosclerotic rabbit iliac artery. Eight rabbits underwent laser‐thermal angioplasty with a 1.7‐mm hot‐tip probe activated at 7 W with a probe temperature of 126 ± 19°C in one iliac artery. The other iliac artery was treated with balloon angioplasty irsing a 2.0mm balloon. Angiographic luminal diameter increased from 0.19 ± 0.15 to 1.54 ± 0.35 mm by laser and from 0.29 ± 0.22 to 1.84 ± 0.20 mm by balloon (P < 0.0001. respectively). However, it decreased to 1.34 ± 0.42 for laser and 0.45 ± 0.39 for balloon 60 minutes later (P < 0.0001 vs immediately post). Both iliac arteries were visualized using angioscopy, which revealed thrombotic obstruction of 91% stenosis in the ballooned artery and 8% stenosis in the lased artery. Vasoreactivity of treated vessels was also investigated. Segments 3‐mm long were obtained from either treated artery or control artery and examined for noradrenaline (10−7 M) contraction. The segments were then mounted isotnetrically with 1 g tension in Krebs‐bicarbonate buffer. Developed tension was 0.13 ± 0.21 g for laser thermal and 2.33 ± 0.4 g for its control (P < 0.0001), and 0.15 ± 0.16 g for balloon dilatation and 2.12 ± 0.43 g for its control (P < 0.0001). Neither acetylcholine at 10−6 M or papaverine at 10−4 M induced relaxation of treated segments. Histology showed slight thermal injury at thermally‐treated sites without thrombus, and intimal and medial dissection with thrombus formation at balloon dilated site. In conclusion: (1) neither a laser‐thermal recanalized or a balloon dilated obstructed artery is vasoreactive to constrictive or relaxant agents; and (2) laser‐thermal angioplase results in less thrombogenicity than balloon angioplasty under moderate probe temperature.
Percutaneous Coronary Angioscopy: Applications in Interventional Cardiology
Authors: WHITE CHRISTOPHER J. , RAMEE STEPHEN R. , COLLINS TYRONE J. , MESA JUAN E. , JAIN ASHIT , VENTURA HECTOR O.
Published: June 2007

We performed percutaneous coronary angioscopy in 35 patients to study the surface morphology of coronary artery lesions. Twenty‐five patients had angioscopy performed in conjunction with PTCA, including 20 patients with de novo lesions (16 patients with unstable angina, four patients with stable angina), and five patients with restenosis lesions. Ten cardiac transplant patients had angioscopy performed in conjunction with annual follow‐up angiography in an attempt to identify accelerated atherosclerotic lesions. There were no complications of angioscopy in any patient. There were no intracoronary thrombi seen either by angiography or angioscopy in the stable angina patients. In the unstable angina group, angiography identified thrombus in 2 out of 16 (12.5%) versus 15 out of 16 (94%) (P < 0.001) with angioscopy. Following angioplasty, dissections were seen angiographically in 7 out of 16 (44%) of patients versus 16 of 16 (100%) of the patients by angioscopy (P < 0.01). Restenosis lesions were characterized by a white, fibrous appearance instead of the usual yellow color of primary atherosclerotic lesions. In the ten cardiac transplant patients, angioscopy appeared to be more sensitive than angiography for the detection of atherosclerosis. Yellow (atherosclerotic) and white (fibrotic) plaques were seen in the transplant patients, which often were not detected by angiography. In summary, angioscopy is an excellent tool for visualizing the surface morphology of coronary artery lesions. The clinical indications for angioscopy remain undefined at present. Possible applications for angioscopy include intracoronary thrombolytic therapy, stratification of high risk angiographic results after angioplasty (“hazy” artery), and, finally, as an adjunct to interventional procedures such as stem implantation.
Coronary Artery Spasm Induced by Stent Implantation: Studies in a Swine Model
Authors: RODGERS GEORGE P. , MINOR STEVEN T. , HESS KENNETH , RAIZNER ALBERT E.
Published: June 2007

Mechanical stimulation is a known cause of arterial spasm. Since stent implantation in the coronary arteries imparts mechanical trauma, we investigated, in an animal model that simulates human coronary anatomy and physiology, the frequency of occurrence and factors that influence the development of spasm. In 28 Hanford miniature swine, 9 of which were atherosclerotic and 19 of which were nonatherosclerotic, spasm occurred in 15 (54%). Stent‐induced spasm directly caused the death of one animal and was implicated in the death of two others. Factors that significantly contributed to coronary spasm were the stent: artery ratio (more spasm with oversized stents) and the size of the artery (more spasm with smaller arteries). There was a trend toward more spasm in atherosclerotic arteries. Spasm occurred despite the use of antispasmodic agents before, during, and after the scenting procedure. Our data suggest that coronary artery spasm may be an important clinical accompaniment to stent implantation in man and may be minimized by the judicious selection of stent size to avoid overdistention of the artery and the avoidance of stent placement in smaller arteries. (J Interven Cardiol 1993; 6:149–155)
Results of Balloon Aortic Valvuloplasty in Patients with Aortic Stenosis Associated with Significant Aortic Regurgitation
Authors: KONING RENÉ , ASSELIN CLAUDINE , SAOUDI NADIR , CHAN CHARLES , DERUMEAUX GENEVIÈVE , CRIBIER ALAIN , LETAC BRICE
Published: June 2007

The influence of balloon aortic valvuloplasty (BAV) on aortic regurgitation (AR) in patients with severe aortic stenosis associated with grade II AR was studied by supraaortic angiogram before and after BAV. The results of 50 patients aged 72 ± 12 years with significant AR before BAV (group A) were compared to 297 patients (mean age 76 ± 10 years) with no or mild AR (group B). In group A, the patients had a higher left ventricular end diastolic volume (96 ± 19 mL/m2 vs 81 ± 32 mL/m2, P < 0.01) and left ventricular end diastolic pressure (23 ± 9 mmHg vs 19 ± 9 mmHg, P < 0.01). The aortic valve area was similar in both groups. Following BAV, the improvement in aortic valve area and hernodynamics were similar in both groups. In group A, AR remained unchanged in 31 patients (62%), increased by 1 grade in 13 patients (26%), and decreased by 1 grade in 6 patients (12%). In group B, AR increased by > 1 grade in 34 patients (11%) and > 2 grades in 4 patients (1.3%) post‐BAV. Two patients in group B underwent emergency aortic valve replacement following BAV because of severe acute AR. In conclusion, when it is indicated, BAV can be performed with similar risk in patients with significant AR. (J Interven Cardiol 1993; 6:207–211)
A Prospective Randomized Trial of Novoste Right Versus Judkins Catheters for Engagement of the Right Coronary Artery During Diagnostic Catheterization
Authors: ABRAHAMJOSEPH S. , DAVIDTALLEY J. , AMMASH NASER , GOAD JOHN , MALDONADO CLAUDIO , VOGEL ROBERT , SHIH ANDREW , YUSSMAN ZOEANN
Published: June 2007

There has been little technical advancement in catheter shape for diagnostic cardiac catheterization since the early reports of Sones and colleagues during the development of the procedure. In order to determine the utility of a new catheter that directly, without torque or rotation, engages the right coronary artery (RCA), one hundred patients were randomized between 6Fr standard RCA Judkins (6Fr R4) (Cordis Corporation, Miami, FL, USA) or 6Fr Novoste RCA catheters (Novoste Corporation, Aguadilla, Puerto Rico). Endpoints included the duration of the various aspects of the procedure and a qualitative and quantitative assessment of angiographic quality. The Novoste RCA catheters were associated with statistically decreased times of catheter insertion (42 ± 37 vs 90 ± 119 secs), and engagement (31 ± 35 vs 77 ± 117 secs), of the right coronary artery as compared to Judkins catheters. Judkins RCA catheters had a significantly higher primary success rate (96%) than the Novoste group (84%, P = 0.045). There was no difference in angiographic quality in either group and no complications occurred during the study. While taller patients (mean 68 in) had increased success with the Novoste catheter, no other clinical, demographic, or anatomical characteristics of the RCA orifice predicted successful engagement and angiography. The direct engagement Novoste RCA catheter is associated with a more expeditious procedure than Judkins catheters when they can engage the RCA orifice. However, Novoste catheters were less successful and required more frequent exchanges to complete the procedure. (J Interven Cardiol 1993; 6:213–218)
Double Balloon Mitral Valvuloplasty Through Dual Femoral Vein Punctures and a Single Atrial Septal Puncture
Authors: D.V. BOURDILLON PATRICK , DILLON JAMES C.
Published: June 2007

A modification of a previously described double balloon mitral valvuloplasty procedure is described. This involves dual femoral vein punctures with a single atrial septal puncture. After initial transseptal catheterization and predilatation of the interatrial septum with an 8‐mm balloon, a second catheter is advanced through the resulting atrial septal defect allowing access to the left atrium and left ventricle through the mitral valve via two separate femoral vein puncture sites. In comparison with the previously described technique using two balloon catheters inserted through a single femoral vein puncture site, this modification has reduced the amount of bleeding from the femoral vein and the need for transfusion. Furthermore, the potential for subsequent interatrial shunting is less than with the alternative previously described technique utilizing two femoral vein punctures with two separate punctures in the interatrial septum. In utilizing two separate femoral vein punctures with only one atrial septal puncture this technique combines advantages of the two previously described techniques. (J Interven Cardiol 1993; 6:219–222)
ST Segment Alternans During Balloon Occlusion in Elective Percutaneous Transluminal Coronary Angioplasty: Case Report and Review of the Literature
Authors: ABRAHAMJOSEPH S. , DAVIDTALLEY J.
Published: June 2007

ST segment alternans has been described in experimental coronary artery occlusion and in patients with variant angina. It is also seen during coronary angioplasty and may represent a continuum of the ST segment changes secondary to transmural myocardial ischemia. Its presence has been associated with ventricular arrhythmias and its relative infrequency attributed to the coexistent use of calcium channel blockers in patients undergoing elective angioplasty. We describe a patient with this phenomenon during balloon angioplasty of the left anterior descending coronary artery with a review of the literature. (J Interven Cardiol 1993; 6:231–234)
NASPE POLICY STATEMENT The NASPE* BPEG** Defibrillator Code
Authors: BERNSTEIN ALAN D. , CAMM A. JOHN , FISHER JOHN D. , FLETCHER ROSS D. , MEAD R. HARDWIN , NATHAN ANTHONY W. , PARSONNET VICTOR , RICKARDS ANTHONY F. , SMYTH NICHOLAS P.D. , SUTTON RICHARD , TARJAN PETER P.
Published: June 2007

BERNSTEIN, A.D., et al.: The NASPE/BPEG Defibrillator Code. A new generic code, patterned after and compatible with the NASPE/BPEG Generic Pacemaker Code (NBG Code) was adopted by the NASPE Board of Trustees on January 23, 1993. It was developed by the NASPE Mode Code Committee, including members of the North American Society of Pacing and Electrophysiology (NASPE) and the British Pacing and Electrophysiology Group (BPEG). It is abbreviated as the NBD (for NASPE/BPEG Defibrillator) Code. It is intended for describing the capabilities and operation of implanted cardioverter defibrillators (ICDs) in conversation, record keeping, and device labeling, and incorporates four positions designating: (1) shock location; (2) antitachycardia pacing location; (3) means of tachycardia detection; and (4) antibradycardia pacing location. An additional Short Form, intended only for use in conversation, was defined as a concise means of distinguishing devices capable of shock alone, shock plus antibradycardia pacing, and shock plus antitachycardia and antibradycardia pacing. (PACE, Vol. 16, September 1993)
Percutaneous Transluminal Coronary Angioplasty in Patients Undergoing Chronic Dialysis
Authors: VAITKUS PAUL T. , GUIDERA STEVEN A.
Published: June 2007

Very limited data on percutaneous transluminal coronary angioplasty in patients with chronic renal failure is available. We describe the short‐ and long‐term results of percutaneous transluminal coronary angioplasty (PTCA) in a group of seven patients undergoing chronic dialysis. Percutaneous transluminal coronary angioplasty was undertaken because of poorly controlled symptoms in five patients and reversible defects on thallium scintigraphy prior to major surgery in two patients. There were five men and two women, the mean age was 51 years (range 36–75). Six patients were on hemodialysis and one was receiving peritoneal dialysis. All seven patients had complicated baseline coronary stenosis morphology (AHA/ACC Class B‐1). Percutaneous transluminal coronary angioplasty was successful in four patients (57%) and associated with complications in two patients (29%) including one death. Surviving patients were followed for a mean of 6 months (range 3–23 months). Of three surviving patients with initially successful PTCA, two developed restenosis. All three patients with unsuccessful PTCA underwent bypass surgery with one late death. Patients with chronic renal failure compose a high risk population for PTCA with a reduced success rate, an increased complication rate, and a high restenosis rate. (J Interven Cardiol 1993; 6:293–296)
Treatment of Acute Myocardial Infarction with Prolonged Intracoronary Urokinase Delivery through Intracoronary Infusion Catheter
Authors: BARBIERI ENRICO , ANSELMI MAURIZIO , ZARDINI PIERO
Published: June 2007

Severe acute myocardial infarction in young patients is plagued by high mortality. We report the case of a 25‐year‐old man, with a family history of ischemic heart disease, who was treated with acute and prolonged intracoronary urokinase infused through a miniaturized catheter engaged in a large thrombus occluding the left anterior descending artery. Rapid and stable recanalization was achieved with complete lysis of thrombotic material. (J Interven Cardiol 1993; 6:307–314)
The Role of Noninvasive Cardiac Imaging in the Evaluation of the Postcoronary Intervention Patient
Authors: STEWART RICHARD E.
Published: June 2007

Noninvasive diagnostic techniques are playing an increasingly prominent role in the evaluation of the postcoronary interventional patient. Radionuclide myocardial perfusion imaging has proved to be of value in assessing procedural success in patients with suboptimal angiographic results and/or multivessel coronary artery disease. However, in asymptomatic patients with single vessel disease, the use of myocardial perfusion imaging may not be cost‐effective for follow‐up after successful coronary intervention. The timing of these studies is important when used to predict coronary restenosis. Radio‐nuclide ventriculography and echocardiography are two imaging modalities that, in conjunction with exercise stress, can be used to predict patient outcome and clinical events postcoronary intervention. A high degree of operator expertise is required for the optimal interpretation of the echocardiographic studies. (J Interven Cardiol 1994; 7:213–219)
Comparison of Early Recoil after Coronary Excimer Laser Angioplasty with and without Adjunctive Balloon Dilatation
Authors: NAKAMURA FUMITAKA , KVASNICKA JAN , GESCHWIND HERBERT J.
Published: June 2007

The immediate and early angiographic results in lesions treated solely with percutaneous coronary excimer laser angioplasty were compared with those obtained after combined laser and balloon angioplasty to determine whether early recoil may occur after coronary excimer laser angioplasty. The excimer laser was operated at 308 nm, 25 Hz, 40–60 mJ/mm2/pulse and 135 nsec/pulse and coupled onto multifiber wire‐guided catheters of 1.4‐ to 2.0‐mm diameter. Thirty‐five consecutive patients (32 men and 3 women; mean age 56 ± 8 years) were studied. Ten patients were treated with laser angioplasty alone (group I), and 25 patients were treated using laser angioplasty followed by balloon dilatation (group II). In group I, the minimal luminal diameter increased from 1.89 ± 0.50 mm immediately after the procedure to 2.17 ± 0.51 mm at the early follow‐up (P < 0.01), whereas in group II, the minimal luminal diameter decreased from 1.89 ± 0.45 mm to 1.50 ± 0.60 mm (P < 0.005). At the early follow‐up, the minimal luminal diameter of group II was significantly smaller than that of group I (1.50 ± 0.60 vs 2.17 ± 0.51 mm; P < 0.05). These data demonstrate that coronary excimer laser angioplasty alone results in less severe early recoil than adjunctive balloon angioplasty. (J Interven Cardiol 1994; 7:221–228)
Coronary Angioplasty in Octogenarians: Immediate and Long‐Term Results and Comparison with a Younger Population
Authors: EECKHOUT ERIC , STAUFFER JEAN‐CHRISTOPHE , JEANRENAUD XAVIER , VOGT PIERRE , BEURET PHILIPPE , GOY JEAN‐JACQUES , KAPPENBERGER LUKAS
Published: June 2007

The safety and efficacy of percutaneous transluminal coronary angioplasty (PTCA) was examined in a group of 91 octogenarians during 133 consecutive procedures and compared to the younger part of our PTCA population (3,443 procedures) during an 8‐year study period. Most octogenarians presented with refractory or unstable angina pectoris and multivessel involvement, but had normal left ventricular function. The angiographic success rate was 84%. Technical failure was observed in 12% of cases and complications in 14%. Two early procedure related deaths were observed. Restenosis was estimated at 24%. The proportion surviving and the proportion without cardiac event estimated by the Kaplan‐Meier method at 2 years were 0.89 and 0.60, respectively. In comparison to the younger population, the immediate angiographic success was lower as a result of a higher incidence of technical failure (P < 0.05). Otherwise, no difference in terms of restenosis or overall related complication rate was noted (P > 0.1). It is concluded that PTCA is an efficient and safe therapeutic option for octogenarians with severe or refractory angina pectoris. Technical failure is more frequently observed than in younger patients and explains a lower immediate angiographic success. Nevertheless, at 2‐years follow‐up, a large majority of patients are alive and asymptomatic.
Neurocardiac Responses to Acute Coronary Balloon Occlusion in Humans
Authors: FALLEN ERNEST L. , KAMATH MARKAD V. , MISHKEL GREGORY , MASSEL DAVID
Published: June 2007

Both cardioinhibitory and sympathoexcitutory responses to transient coronary artery occlusion have been ascribed to activation of cardiac sensory receptors. Using autoregressive modeling, the power spectrum of heart rate variability was determined from continuous ECG records before, during (120 sec) and following coronary balloon occlusion in 17 patients with isolated single vessel coronary artery stenosis; 11 with left anterior descending (LAD) stenoses and 6 with either right coronary artery (RCA; n = 3) or circumflex (Cfx; n = 3) stenoses. There were no significant changes in heart rate or its variance either during balloon occlusion or following releuse for both the LAD and RCA/Cfx groups. However, during LAD occlusion there was a significant 27% increase in the low frequency (LF) power (60.5 ± 15.1 to 82.3 ± 25.4 b/min2/Hz; P < 0.05) and a 37% decrease in the high frequency (HF) power (28.9 ± 13.2 to 18.3 ± 9.7 b/min2/Hz;P < 0.05). An insignificant, but directionally opposite, trend was seen for the LF power during RCA/Cfx occlusions. Neither the presence nor absence of intracoronary collaterds, beta blockade, inflation induced ischemia, or history of previous myocardial infarction appeared to influence the effect of balloon inflation on either LF or HF values. The autospectral changes seen during transient LAD occlusion had not returned to control values within 30 minutes of balloon release. Thus, transient occlusion of an LAD artery stenosis elicits a shift in cardio‐sympathovagal balance towards heightened sympathetic modulation of sinus node activity.
Temporary Stenting as a Bridge to Surgery
Authors: CHRONOS NICOLAS , STABLES RODNEY , GIBBS SIMON , NORDREHAUG JAN ERIK , SIGWART ULRICH , BULLER NIGEL
Published: June 2007

Abrupt occlusion of the coronary artery during PTCA is a relatively common complication. The majority of the acute occlusions occur when there is a significant dissection at the site of the balloon expansion. The use of a temporary stent, which can be expanded and collapsed intraluminally, allowing repositioning and finally removal of the device, is reported in this article.
Sudden Death in Recipients of First‐Generation Implantable Cardioverter Defibrillators: Analysis of Terminal Events
Authors: LEHMANN MICHAEL H. , THOMAS ANDRA , NABIH MERVAT , STEINMAN RUSSELL T. , FROMM BARBARA S. , SHAH MEENA , NORSTED STEPHAN W. , INVESTIGATORS PARTICIPATING
Published: June 2007

Clinical factors and terminal events associated with sudden death in 51 patients were analyzed from among a multicenter experience of 864 recipients of first generation automatic implantable cardioverter defibrillator (AICD™) devices (single zone, committed, monophasic pulse with ≥1 epicardial patch electrode) during the period May 1982—February 1988. For these 51 patients, mean age was 58 years and atherosclerotic heart disease was present in 84%, with a history of ventricular fibrillation (VF) in 61%, and inducible sustained ventricular tachycardia (VT) in 84%; mean left ventricular ejection fraction was 0.26. Nearly 80% experienced one or more appropriate AICDT shocks during the median 9 month (range 0‐46 months) period prior to death. Of 30 monitored deaths, the first documented terminal rhythm was VF in 12 (40%), VT in 8 (27%), and asystole or electromechanical dissociation in the remaining 10 (33%). Shocks were documented during terminal events in 21 (66%) of 32 witnessed cases of sudden death with activated devices. The proportion of monitored or witnessed sudden deaths that were known or presumed to be tachyarrhythmic (based on terminal VT, VF, or shocks) ranged from 69% (11/16 cases with activated/nondepleted devices and a defibrillation threshold [DFT] ≤ 20 J) to 81% (29/36 cases on intention‐to‐treat basis). Of 27 patients with known or presumed sudden tachyarrhythmic death, the AICD™ had been deactivated prior to death in 4 (15%); activated, but depleted in 4 (15%); activated/nondepleted, but with DFT of 25 J in 4 (15%); and activated/nondepleted, but without DFT testing in 4 (15%). The remaining 11 (41%) known or presumed sudden tachyarrhythmic deaths occurred in patients with activated/nondepleted devices and DFT ≤20 J; however, definite or suspected contributory factors (e.g., hematoma under epicardial patch, generator component failure, or drug‐induced DFT rise) could be identified in 6 (55%) of 11 cases. Thus, in this first‐generation AICD™ experience: 1) most sudden deaths occurred on the basis of a known or presumed tachyarrhythmia; and 2) an understanding of apparent “failure” of ICD therapy could often be gained through an integrated analysis of associated clinical factors and management practices, as well as device “hardware” function. These observations are likely to remain relevant, even with respect to newer generation ICDs.
Mitral Valve Prosthesis Disk Embolization During Transeptal Atrioventricular Junction Ablation
Authors: BRIDGEWATER BENJAMIN J.M. , LEVY RICHARD D. , HOOPER TIMOTHY L.
Published: June 2007

We report a case of disk embolization from a Bjork‐Shiley mitral valve prosthesis (Shiley Inc., Irvine, CA, USA) which occurred during transeptal atrioventricular (RV) junction ablation. The disk lodged in the lower thoracic aorta. The patient was treated successfully by emergency valve replacement, and the escaped disk has been left in situ with no complications. (J Interven Cardiol 1994:7:535–537)
Designing of Trials: Power Calculations Based on Matching as a Surrogate for Randomization
Authors: De JAEGERE P.P.T. , RUYGROK P.N. , De FEYTER P.J. , SERRUYS P.W.
Published: June 2007

In the design of clinical trials we strive to extract the maximum amount of information from a minimum number of patients and vet retain statistical validity. Matching has become acknowledged as a useful and valid surrogate for the randomized trial. By using data from matched trials along with power calculations we can accurately predict the number of patients required to achieve statistical significance in a related randomized trial. (J Interven Cardiol 1994; 7:581–585)
Complete Heart Block Following Removal of an Amplatz Guiding Catheter
Authors: MEHTA SAMEER , TRAUTWEIN ROBERT , MARGOLIS JAMES , KRAMER BARRY , TRAKTMAN MICHAEL
Published: June 2007

Amplatz guiding catheters are particularly suited for performing PICA of lesions involving the left circumflex coronary artery. Caution should be exercised during their removal: Complete heart block may result by an inadvertent withdrawal of these guiding catheters in presence of preexisting bundle branch blocks. (J Interven Cardin] 1994; 7:39–40)
The Clinical Utility of Angioscopy During Intracoronary Stent Implantation
Authors: SENNEFF MARTHA J. , SCHATZ RICHARD A. , TEIRSTEIN PAUL S.
Published: June 2007

Angiographic evidence of thrombiis may have important implications during coronary stent deployment procedures. The periprocedural presence of thrombus has been shown to increase the risk of subsequent stent thrombosis. Coronary angioscopy is a new technology that may prove more accurate for the detection of coronary thrombus. Angiographic filling defects suspicious for thrombus were observed in 15 (22%) of 64 patients undergoing coronary arigioscopy during stent implantation procedures. Angioscopy confirmed the presence of thrombis in 9 (60%) of these 15 patients. Protruding thrombus was found in four cases and only mural thrombus in five. In six cases (40%) thrombus was not visualized and angioscopy provided an alternative explanation for the angiogruphic filling defect. Bukly atherosclerotic plaque was seen protruding into the lumen in two cases, disection with protruding fronds of tissue was found in three cases and a ruptured venus valve was found in one final case. Thrornbolytic therapy was administered in all four cases containing protruding thrombus, in only two of the five cases containing mural thrombus, and in none of the cases where thrombus was not visualized. Angioscopy was more accurate than angiography for the diagnosis of thrombus and allowed more precise tailoring of the intervention to the underlying anatomical substraight. This resulted in an excellent clinical outcome, with no episodes of stent thrombosis and limitation of the risks associated with thrombolytic therapv to only those patients at increased risk of a thrombotic complication.
Interventional Cardiology in Chile
Authors: ALCAINO MILTON E. , ESCOBAR EDGARDO
Published: June 2007

In Chile the first experiences with cardiac catheterization began very shortly after Forssmann's first studies. Percutaneous coronary balloon angioplasty (PTCA) was first performed in 1982. Despite a progressively great interest and training of physicians in invasive cardiology there are still restrictions in its development. Most private institutions have modern facilities but their caseloads, ever increasing, are still limited because they take care of only 35% of the population. Public institutions are limited because of funding, and some are just developing PTCA. The situation has improved recently because of deals between the private and public systems. Experience with newer devices is even more limited.
Implantation and Follow‐Up of a Third‐Generation Cardioverter Defibrillator: Comparison of Epicardial and Nonthoracotomy Defibrillation Lead System
Authors: TRAPPE HANS‐JOACHIM , FIEGUTH HANS‐GERD , PFITZNER PETRA , HEINTZE JOHANNES , WENZLAFF PAUL , KIELBLOCK BIRGIT , LICHTLEN PAUL R.
Published: June 2007

Objective: The intraoperative and follow‐up results were compared in 67 patients with ventricular tachyarrhythmias who underwent implantation of the Ventritex Cadence defibrillator with either epicardial patch (EPI, 25 patients) or nonthoracotomy CPI Endotak (ENDO, 42 patients) defibrillation lead systems. Results: There was no significant difference between groups in age, sex, structural heart disease, ejection fraction, arrhythmia history, or drug therapy. Successful implantation was accomplished in all patients using either lead system in the ENDO group, 35 patients (83%) had a defibrillation threshold ≤ 550 V and did not require a subcutaneous patch. Intraoperatively, the defibrillation threshold was 453 ± 139 V (13 ± 9 J) for EPI and 490 ± 113 V (15 ± 8 J) for ENDO (P = NS). There were no periperative deaths in either group. At predischarge testing, the defibrillation threshold was 445 ± 183 V (14 ± 12 J) for EPI and 439 ± 133 V (13 ± 7 J) for ENDO (P = NS). During a mean follow‐up of 16 ± 8 months, there were no sudden deaths, and four patients died from congestive heart failure (3 EPI, 1 ENDO). During follow‐up, 916 spontaneous arrhythmia episodes occurred in 16 of 25 EPI patients (64%) and 967 episodes occurred in 31 of 42 ENDO patients (74%) (P = NS). The number of episodes detected as ventricular fibrillation were 192 for EPI (21%) and 232 for ENDO (24%), with first shock success in 76% and 75%, respectively; all episodes were successfully terminated by the device. In the remaining episodes detected as ventricular tachycardia, antitachycardia pacing was attempted and was successful in 672 of 724 episodes (93%) with EPI and 666 of 735 episodes (91%) with ENDO lead systems (P = NS). Acceleration of ventricular tachycardia with antitachycardia pacing occurred in 21 episodes (3%) with EPI and in 37 episodes (5%) with ENDO leads (P = NS). Conclusions: A nonthoracotomy approach using the third generation cardioverter defibrillator Cadence V‐100 is safe and effective and has clinical results that are not significantly different from epicardial defibrillation lead systems. (J Interven Cardiol 1995;8:219–228)
Percutanous Transluminal Coronary Angioplasty as Alternative Treatment to Coronary Artery Bypass Surgery in Iatrogenic Stenosis of the Left Main Coronary Artery
Authors: MARTÍ VICENS , M AUGÉ JOSEP , PICART JUAN GARCÍA , GUITERAS PERE , BALLESTER MANEL , OBRADOR DAMIÁ
Published: June 2007

The present report describes three patients with iatrogenic left main coronary artery after aortic valve replacement. All three patients were succesfully treated by percutaneous transluminal coronary angioplasty. No clinical or angiographic signs of restenosis were seen during the long‐term follow‐up (4, 6, and 11 years). These patients show the feasibility of percutaneous transluminal coronary angioplasty in iatrogenic left main coronary artery stenosis as alternative of coronary artery bypass surgery. However, it should be only considered in patients who would otherwise be deemed inoperable, refused reoperation, and are willing to take the risk involved. (J Interven Cardiol 1995; 8:229–231)
Initial Experience with the “Big‐Skinny” Angioplasty Catheter
Authors: EECKHOUT ERIC , STAUFFER JEAN‐CHRISTOPHE , VOGT PIERRE , KAPPENBERGER LUKAS , GOY JEAN‐JACQUES
Published: June 2007

We describe our initial experience with the “Big Skinny” angioplasty catheter, currently only available as an investigational device and in sizes of 4.5, 5, and 6 mm. Six patients with severe angina pectoris were successfully dilated with this angioplasty catheter and have remained asymptomatic up until a mean follow‐up period of 6 months. However, because of the large profile of the catheter, sufficient back‐up with an adequate guiding catheter should be obtained and predilation with a smaller angioplasty catheter should be performed. The use of this catheter may be a more simple alternative for the treatment of oversized vessel stenosis than the “hugging balloon” technique or directional atherectomy. Otherwise, it may be considered as an adjunct technique in order to optimize the angiographic result after stenting or directional atherectomy in this particular indication. (J Interven Cardiol 1995; 8:233–237)
Diagnosis and Treatment of Complications in Patients Implanted with a TCI Left Ventricular Assist Device
Authors: JASKI BRIAN E. , BRANCH KELLEY R. , DASSE KURT A. , DEMBITSKY WALTER P.
Published: June 2007

Currently used left ventricular assist devices allow chronic mechanical cardiac support in the patient with end‐stage heart failure. Recognition and treatment of problems uniquely associated with this device may be increasingly important for the invasive cardiologist as application of this technology becomes more prevalent. (J Interven Cardiol 1995;8:275‐282)
Strategies for Myocardial Repair
Authors: KOH GOU YOUNG , SOONPAA MARK H. , KLUG MICHAEL G. , FIELD LOREN J.
Published: June 2007

The therapeutic recourse for end‐stage heart disease is currently limited to cardiac transplantation. The ability to augment cardiomyocyte number in an end‐stage heart might facilitate myocardial function. Augmentation of cardiomyocyte number may be achievable by the targeted expression of cell cycle regulatory genes to the myocardium. Alternatively, intracardiac grafting of exogenous cardiomyocytes might also provide a viable approach to augment cardiomyocyte number. Potential strategies for heart muscle regeneration via gene therapy and cellular transplantation are discussed.(J Interven Cardiol 1995;8:387–393)
Rotablation and Stent Placement in an Unprotected Left Main Coronary Ostial Stenosis
Authors: KOLLER PATRICK T. , MOONEY MICHAEL R.
Published: June 2007

We report the case of a patient with postinfarction rest angina, high grade ostial left main (LM) stenosis, and right and circumflex coronary occlusion. Coronary artery bypass was performed, yet all grafts failed within 2 months of surgery. We elected to proceed with coronary intervention on the ostial LM lesion with intracoronary ultrasound lesion characterization and percutaneous cardiopulmonary bypass support. Rotablation followed by stent deployment achieved a successful angiographic outcome with no associated clinical complications. At 1‐year follow‐up, the patient remains stable with evidence of mild restenosis. Interventional approaches in unprotected LM coronary stenoses are associated with high procedural risk. Combined atherectomylablation with stent placement, guided by intracoronary ultrasound may enhance procedural and long‐term outcome.
Left Cardiac Sympathetic Denervation in Long QT Syndrome Patients
Authors: DE FERRARI GAETANO M. , LOCATT EMANUELA H. , PRIORI SILVIA G. , SCHWARTZ PETER J.
Published: June 2007

The idiopathic long QT syndrome (LQTS) is an unusual clinical disorder characterized by a prolongation of the QT interval and by syncopal episodes occurring among young subjects, most often during exercise, stress, or other conditions of increased sympathetic activity. Both an imbalance in sympathetic innervation and an intracar‐diac defect in membrane currents have been proposed as pathogenetic. mechanisms. The latter appears substantiated by recent advances in molecular genetics showing a linkage on chromosomes 11,3,7, and 4, with identification of the genes for chromosomes 3 and 7. For symptomatic patients with the long QT syndrome, β‐adrenergic blockade, with efficacy in approximately 80% of patients, currently remains the therapy of first choice. For the patients who continue to suffer syncope or cardiac arrest despite β blockade, evidence has been provided that left cardiac sympathetic denervation represents a very effective treatment. The improvement in the understanding of the molecular mechanisms involved may soon lead to gene specific therapy in most long QT patients.
Interventions on the Coronaries: PTCA Versus CABG
Authors: UNGER FELIX
Published: June 2007

The approach toward treatment of stenotic lesions in the coronary arteries is standardized. There are two principle approaches: as closed techniques, by means of percutaneous transluminal coronary angioplasty (PTCA); and open techniques, by means of direct revascularization in extracorporeal circulation. The Institute of Cardiac Survey of the European Academy of Sciences and Arts has monitored the different approaches since 1990. In Europe, an average of 343 PTCA procedures per million population were performed in 1993, compared to 300 coronary artery bypass graft procedures per million population. Great differences in cardiac care can be observed within Europe. Despite revascularization, closed techniques (PTCA) are increasing by 12% and open techniques by 14%. (J Interven Cardiol 1996;9:3–7)
Rescue and Adjunctive Directional Coronary Atherectomy
Authors: BELL MALCOLM R. , GARRATT KIRK N.
Published: June 2007

Conventional coronary balloon angioplasty is complicated by abrupt arterial occlusion in 4%‐8% of cases and remains the most important and feared acute problem with this procedure. This review discusses the significance and various treatment options for abrupt occlusion, focusing particularly on the potential use of directional coronary atherectomy to treat significant coronary arterial dissections complicating conventional angioplasty. The use of adjunctive atherectomy for the treatment of suboptimal coronary angioplasty results without dissection is also discussed. (J Interven Cardiol 1996;9:129–134)
Assessing Coronary Flow Physiology with Intracoronary Doppler Following Coronary Interventions
Authors: HIGANO STUART T. , LERMAN AMIR , GARRATT KIRK N. , NISHIMURA RICK A. , HOLMES DAVID R.
Published: June 2007

Although coronary angiography has been the gold standard for assessing coronary artery stenoses, it yields information primarily about the anatomical severity of coronary artery disease, which frequently does not correlate with its physiological severity. Coronary interventions (PTCA, atherectomy, laser, etc.) are performed primarily to improve coronary flow physiology. Coronary flow physiology may be a more important end point than angiography following coronary interventions that were performed to normalize coronary flow physiology. In addition, the physiological significance of angiographically intermediate stenoses should he assessed before proceeding with catheter‐based revascularization. Currently, the Doppler guidewire is available for routine clinical assessment of coronary flow physiology in the Cardiac Catheterization Lab. Several Doppler measurements have been used to assess the physiological effect of a stenosis, including the diastolic‐systolic velocity ratio, proximal‐distal velocity ratio, coronary flow reserve, continuity equation, and the hyperemic diastolic pressure‐flow relationship. The Doppler derived coronary flow reserve correlates highly with stress nuclear perfusion images. These Doppler measurements have been made following PTCA, directional atherectomy, rotational atherectomy, and excimer laser. Following coronary interventions, adverse clinical events may be predicted if there is impaired flow physiology or cyclic flow variations. Many of the Doppler measurements used for assessing the lesion severity remain abnormal following successful coronary interventions for reasons unrelated to the lesion. Conversely, normalization of coronary physiology does not guarantee an adequate anatomical result. Further clinical trials will provide a more complete definition of the exact role for coronary flow velocity assessment following coronary interventions. (J Interven Cardiol 1996;9:163–173)
Stent‐Assisted Carotid Percutaneous Transluminal Angioplasty: An Interventional Neuroradiologist's Perspective
Authors: FERGUSON ROBERT D.G.
Published: June 2007

There is currently no proof of the long‐term clinical effectiveness of either carotid percutaneous transluminal angioplasty (CPTA) or stent‐assisted carotid percutaneous transluminal angioplasty (SACPTA). Nevertheless, these types of endovascular therapies for carotid revascularization offer several apparent advantages over surgery. Until level I evidence of clinical safety and efficacy is available, however, the application of CPTA or SACPTA should be. restricted to patients considered poor candidates for endarterectomy, or those participating in approved multidisciplinary research initiatives.
Diltiazem Reduces Restenosis After Percutaneous Transluminal Coronary Angioplasty
Authors: UNVERDORBEN MARTIN , LEUCHT MARKUS , KUNKEL BERNHARD , GANSSER ROLF , BACHMANN KURT , VALLBRACHT CHRISTIAN
Published: June 2007

In a prospective, randomized, and double‐blinded protocol, the effect of oral diltiazem (180 mg) over placebo on the restenosis rate was assessed in 189 consecutive patients (150 males. 39 females, 57.6 ± 8.4 years) eligible for follow‐up angiography after 3.6 ± 0.6 months (diltiazem 90.4%, placebo 89.6%). Pre‐PTCA stenoses were similar in both groups (diltiazem 83.9%; placebo 84.4%). Immediately after PTCA, the remaining stenoses were identical in both groups (22.6% vs 22.8%). At follow‐up angiography there was a highly significant difference (P < 0.01) in favor of diltiazem (minimal lumen diameter 38.6% vs 50.3%). Restenosis rate (> 50% stenosis or loss of > 50% of the initial gain) was significantly (P < 0.03) reduced by diltiazem (18 [21.4%] of 84 patients) compared to placebo (33 [38.4%] of 86 patients). Diltiazem was superior to placebo in all vessels: (1) left anterior descending coronary artery: 21.6% vs. 32.7%, (2) right coronary artery: 25% vs 46.7%; and (3) left circumflex. 16.7% vs 36%. The benefit of diltiazem was most pronounced in calcified plaques (33.3% vs 47.1%), in diabetics (15% vs 46.2%), in hypercholesterolemia (20.4% vs 44.2%, P < 0.05), in the age range of 41–50 years (21.4% vs 44.4%), and in patients with CCS Class 2 (11.1% vs 64%, P < 0.01). In stratified analysis, the effect was apparent in both sexes, independent from concomitant therapy, regardless of whether or not coronary artery disease had progressed in segments other than the dilated ones. Thus, in this limited series of patients, diltiazem significantly reduced the number and extent of restenosis. Confirmation in a larger cohort is necessary.