bluuebunny/crossref_metadata_2025 huggingface dataset:
Acute and Mid‐Term Experiences with the Wiktor Stent in Acute Complications and Restenosis After Coronary Angioplasty
Authors: BURGER WOLFRAM , SIEVERT HORST , STEINMANN JÜRGEN , SCHRÅDER RAINER , BAUER UTE , VALLBRACHT CHRISTIAN , HARTMANN ANDREAS , KNEISSL GEORG DIETER , UTECH ANDREAS , KOBER GISBERT
Published: June 2007

We report about the 6‐month follow‐up of 28 consecutive patients treated with a new tantalum stent (Wiktor™ stent, Medtronic, Inc.). Indication for stenting was the prevention of restenosis in eight patients (restenosis group), and threatening or acute closure after PTCA in 20 patients (acute closure group). Twenty‐eight of 30 stents were successfully positioned in 27 of 28 patients (96%), whereas implantation failed twice in one patient. Immediate stent occlusion developed in two patients in the acute closure group (7.4%). Subacute stent occlusion was observed in three patients (11%), one in the restenosis group, two in the acute closure group, between 3 and 5 days after implantation. Coronary bypass surgery had to be performed in four patients (15%): one patient after failed stent placement, two after acute, and one after subacute stent thrombosis. Major bleeding complications related to the anticoagulative drug regimen occurred in nine patients (33%). Three patients (11%) died for reasons most probably not related to stent implantation. A 6‐month angiographic follow‐up revealed restenosis in two of 19 patients (11%), one patient in each group. Sixteen of the 27 stented patients (59%) reached 6‐month follow‐up without death, acute or subacute stent thrombosis, or restenosis. It is concluded that the Wiktor stent can be placed with a high rate of success. It may also reduce the risk of restenosis. The stent also offers the possibility to circumvent emergency bypass surgery in case of PTCA related vessel occlusion. Acute and subacute stent occlusion still remains an unsolved topic.
Wire‐Guided Excimer Laser Coronary Angioplasty: Instrument Selection, Lesion Characterization, and Operator Technique
Authors: BITTL JOHN A. , SANBORN TIMOTHY A. , ABELA GEORGE S. , ISNER JEFFREY M.
Published: June 2007

Laser angioplasty has now been successfully performed on over 2,000 patients worldwide. Two systems (Advanced Interventional Systems, and Spectranetics, Corp.) have now received initial approval from the Food and Drug Administration. As with all new interventional techniques designed as an alternative to balloon angioplasty, there are a variety of instrument related issues that merit consideration in terms of patient selection as well as operator technique. While the ultimate role of laser angioplasty in the percutaneous revascularization of coronary artery disease remains to be established with certainty, laser angioplasty is, in fact, being currently used on a widespread basis as an alternative or an adjunct to balloon angioplasty in a large number of centers worldwide.1–5 Industry projections suggest that the use of this technique will increase further over the next decade. Accordingly, the purpose of this article is to discuss specific issues regarding instrumentation, native anatomical considerations, operator technique, and complications that relate specifically to the applied use of this technology as it is currently being used. (J Interven Cardiol 1992; 5:275–291)
An Overview of the Patency and Stroke Rates Following Thrombolysis with Streptokinase, Alteplase, and Anistreplase Used to Treat an Acute Myocardial Infarction
Authors: BAXTER‐JONES CHRISTOPHER S. , WHITE HARVEY D. , ANDERSON JEFFREY L.
Published: June 2007

The results of an overview of early (90–240 min) and late (24 hours or more) patency and of stroke rates for each of the three commercially available thrombolytic agents, streptokinase, alteplase, and anistreplase are presented. Studies included in this analysis are all those published between 1985 and March 1992 and focus on the licensed dosage regimens of each agent. The rates of early and late patency for streptokinase were 64.7% and 80.8%; for alteplase, 66.6% and 73.7%; and for anistreplase, 72.1% and 84.5%. The rates of total and hemorrhagic stroke for streptokinase were 0.69% and 0.17%; for alteplase, 1.27% and 0.50%; and for anistreplase, 0.91% and 0.38%. These results provided evidence that the rates of early and late patency appeared to be greatest for anistreplase and that the rates of stroke are within “acceptable” ranges for all three thrombolytic agents with streptokinase affording the lowest rate.
Selective Coronary Angiography in Intracardiac Tumors
Authors: SHARMA SATYAVAN , SUNDARAM USHA , LOYA YUNUS
Published: June 2007

Cardiac catheterization and selective coronary angiography were performed in ten patients with intracardiac tumors [left atrial myxoma (7), right atrial myxoma (1), angiosarcoma of right heart (1), and right ventricular tumor (1)]. The patient with angiosarcoma had characteristic hemodynamics suggesting cardiac compression. The coronary arteriographic finding included: neovascularization (8); filling defect due to emboli (1); and displacement of coronary artery (1). Tumor neovascularization from branches of the left circumflex or right coronary artery was invariably observed in patients with myxoma. We conclude that invasive studies are safe, provide additional information of academic interest, and occasionally aid in the diagnosis. (J Interven Cardiol 1993; 6:125–129)
Effects of Ultrasound Energy on Total Peripheral Artery Occlusions: Initial Angiographic and Angioscopic Results
Authors: DROBINSKI G. , BRISSET D. , PHILIPPE F. , KREMER D. , LAURIAN C. , MONTALESCOT G. , THOMAS D.
Published: June 2007

Ultrasonic energy has been shown to ablate atherosclerotic plaques and arterial and venous thrombi. We used an ultrasonic angioplasty device developed by our group in ten patients with totally occluded femoral artery during surgical bypass. Ultrasonic angioplasty was performed with a 130‐cm long and 0.8‐cm diameter titanium probe with a 2‐ or 2.5‐mm titanium ball‐tip. In one patient, angioplasty could not be performed. Angiographic and angioscopic examination were performed before and after angioplasty in nine patients. Before ultrasound recanalization, angioscopic examination showed that the proximal end of the occlusion was formed by atheromatous material in 3 cases, red thrombus in 3 cases, and white thrombus in 3 cases. After ultrasound recanalization, angioscopy showed residual stenosis at the site of entry in only one case. In three other cases, the artery was free of residual stenosis without persistent clot. In the five other patients, a residual stenosis was present beyond the proximal occlusion point with some fibrin mesh and small clots. At angiography, flow was restored in 4 cases; in 4 patients flow rate of entry was slow in the distal segment; and in 1 patient, the distal arterial bed could not be opacified. Altogether, ultrasonic angioplasty was able to recanalize a complete occlusion in nine out of ten patients, with partial or complete dissolution of clots and with no complication. At its present stage of development, adjunctive balloon angioplasty would be needed in most cases to obtain unrestricted flow and unsignificant residual stenosis. The limited maneuverability of the probe and the relatively small size of the ball‐tip may explain that all clots could not be treated. When those limitations are overcome, ultrasonic angioplasty could become very useful because of the combination of its mechanical effects and thrombus dissolution capabilities. (J Interven Cardiol 1993; 6:157–163)
Simultaneous Implantation of Two Palmaz‐Schatz Stents Mounted on a Long Angioplasty Balloon
Authors: ERIK JAN , PRIESTLEY KIM , RICKARDS ANTHONY F. , BULLER NIGEL , SIGWART ULRICH
Published: June 2007

Three cases are presented in which two Palmaz‐Schatz stents were implanted simultaneously in a native coronary artery or saphenous vein graft. The two stents were mounted in tandem on a long angioplasty balloon. This technique has advantages in ease of delivery and positioning, with prevention of stent overlap, and when deployment of multiple stents is clinically appropriate. (J Interven Cardiol 1993; 6:223–225)
Correction of Symptomatic Coronary Arteriovenous Fistula by Coil Embolization
Authors: DORROS GERALD , KUMAR KRISHNA , LOUKINEN KARIN , BATES MARK C.
Published: June 2007

The successful percutaneous closure by coil embolization, of a right coronary artery to superior vena cava fistula in an elderly adult, abolished the symptoms caused by the significant left to right shunt. (J Interven Cardiol 1993; 6:315–318)
In‐Hospital Monitoring After Coronary Angioplasty
Authors: LI JIAN‐MEI , CAMENZIND EDOARDO , MEIER BERNHARD , URBAN PHILIP , GIROUD DIDIER , RUTISHAUSER WILHELM
Published: June 2007

At the University Hospital of Geneva there are three postcoronary angioplasty monitoring levels: (A) intensive care unit; (B) optional ECG monitoring (cardiology unit); and (C) no monitoring (other unit). To assess the adequacy of patient monitoring after coronary angioplasty, we studied the clinical out‐come of 200 consecutive patients undergoing coronary angioplasty at different monitoring levels. Thirty‐nine patients (20%) were in level A. Their outcome was 1 death, 1 emergency bypass operation, and 7 acute myocardial infarcts. Ninety‐six patients (48%) were in level B: no major complication, no transfer of monitoring level, and mean hospital stay 2.7 ± 1.3 days. Sixty‐five patients (32%) were in level C: 1 death, 2 elective bypass operations, 6 transfers to level A, and mean hospital stay 5.9 ± 4.6 days. Electrocardiogram monitoring of 135 patients yielded 23 significant findings (17%), 22 of which occurred in patients with complicated or failed procedure. In the 122 patients with successful coronary angioplasty without angiographic visible local complications and without clinical symptoms at the end of the procedure, no significant arrhythmia or acute myocardial infarction was documented. For this type of patient, ECG monitoring is not a prerequisite after coronary angioplasty. Surveying all patients after coronary angioplasty in the coronary care unit would not significantly reduce complications. Aftercare in a cardiology unit results in a shorter hospital stay.
Angioplasty of Large Diameter Coronary Arteries and Saphenous Vein Grafts Utilizing Modified Appropriately Large Diameter Balloon Dilatation Catheters
Authors: WEBB JOHN , CARERE RONALD , DODEK ARTHUR
Published: June 2007

Standard coronary angioplasty balloons have generally not been available in diameters exceding 4 mm. Consequently angioplasty of larger arteries and grafts is commonly performed with undersized balloons. “Hugging balloon” techniques and the use of peripheral angioplasty balloons introduced without a guiding catheter have been advocated. We utilized oversized (4.5–6.0‐mm diameter) modified angioplasty balloons to perform angioplasty in 20 patients with large coronary arteries and saphenous vein grafts. Oversize balloons were used in conjunction with otherwise standard coronary angioplasty, equipment and intracoronary stents.
Antithrombin and Thrombolytic Effects of a New Antithrombin Agent: Angioscopic and Angiographic Comparison with Heparin or Batroxobin
Authors: TOMARU TAKANOBU , NAKAMURA FUMITAKA , MIWA ATSUKO‐YANAGISAWA , FUJIMORI YOSHIHARU , OMATA MASAO , OKADA RYOZO , UCHIDA YASUMI
Published: June 2007

The antithrombotic effect of three different types of antithrombotic agents (antithrombin:argatroban, heparin, defibrinogenating agent: batroxobin) were evaluated in canine coronary and iliac arteries. An occlusive thrombus was produced by balloon injury. One of the three agents was infused intravenously at 1 hour after thrombus formation (heparin 250 U/kg, argatroban 0.5 mg/kg, batroxobin 0.5 U/kg) and the effect of thrombus size reduction was evaluated. On the contralateral side of the iliac artery, the preventive effect of these agents on thrombus formation was evaluated after balloon injury. In the iliac artery, angioscopic percent area obstruction by the thrombus before and 60 minutes after treatment reduced from 69% to 32% in the argatroban group, and from 64% to 51% in the batroxobin group (P < 0.0001 and P < 0.05, respectively). No significant change was observed in the heparin group. Angiography demonstrated the same trend. The percent area stenosis with thrombus at 60 minutes following balloon injury was 0.75% in the argatroban group, 18.9% in the heparin group (P < 0.05 vs argatroban), and 12.9% in the batroxobin group. Thrombus size at the treated site was smaller than that at the control site in all three groups (P < 0.05 vs control). In the coronary artery, angioscopic percent area obstruction by the thrombus before and 60 minutes after treatment reduced from 84% to 53% in the argatroban group, and from 86% to 68% in the batroxobin group (P < 0.0001 and P < 0.05, respectively). No significant change was observed in the heparin group. Angiography also demonstrated the same trend. The activated partial thromboplastin time (APTT) was prolonged to 189% of the control value with argatroban and to 1253% of the value with heparin (P < 0.0001). Fibrinogen was markedly reduced with batroxobin. These results showed that both the antithrombin agent and the defibrinogenating agent have a preventive effect on thrombus formation and the effect on thrombus size reduction, without marked prolongation of the APTT.
Current Status and Potential Applications of the Harts Removable Stent
Authors: LITVACK FRANK , MAHRER KEN , DEV VISHVA , KHORSANDI MEHRAN , KUPFER JOEL , FORRESTER JAMES , EIGLER NEAL
Published: June 2007

Permanent intracoronary scents have demonstrated considerable efficacy in the treatment of PTCA‐induced abrupt arterial occlusion, suboptimal dilatation, and restenosis. Despite their benefit, permanent stents have significant limitations including subacute thrombosis, need for anticoagulation with resultant vascular complications, prolonged hospitalization, and high costs. Temporary stem's have the potential for achieving many of the beneficial effects of permanent stenting without some of the iatrogenic complications. The HARTS (Heat Activated Removable Temporary Stent) removable stent employs the shape memory alloy Nitinol, and has the properties of being balloon deployable, but recoverable to a preset “memory” shape by heating it with warmed crystalloid solution. Preclinical experience first with a wire stent design and more recently with a slotted tubular design, has demonstrated the feasibility of implanting and recovering the HARTS device. Speculative applications of this technology include: treatment of acute postangioplasty occlusion and suboptimal angioplasty results; “stentoplasty”—the application of a temporary stent for several hours at the time of a primary angioplasty; and reduction of restenosis rate by inhibition of elastic recoil following short‐term (hours) stenting. Further, the HARTS device may be an important vehicle for local delivery of drugs or other biologically active agents to the arterial wall. All research to date has been preclinical and controlled clinical trials will be necessary to define the safety, efficacy, and potential applications of the HARTS removable stent.
Management of the Arterial Puncture Site
Authors: SPOKOJNY ARTUR M. , SANBORN TIMOTHY A.
Published: June 2007

With more complex interventional procedures, such as intracoronary stent placement, there is a higher incidence of procedural related peripheral vascular complications including pseudoaneurysm and hemorrhage. In these procedures, the amount of anticoagulation as well as the use of thrombolytic agents intraprocedurally increases the risk of complication. Meticulous care during vascular access, careful use and monitoring of anticoagulation, and patient selection are helpful in reducing the risk. Newer vascular hemostatic devices utilizing biodegradable collagen plugs might be of advantage since they allow early sheath removal without interrupting anticoagulation and, therefore, early ambulation. However, it remains to be determined, whether these devices are effective in reducing complications, duration of bed rest and hospitalization, or improvement of stent patency. Newer designs, e.g., coated or biodegradable stents, or different deployment strategies might reduce the need of anticoagulation and lower the risk of peripheral vascular complications.
BOOK REVIEWS
Authors: Rottman Jeffey , Kleiger Robert E.
Published: June 2007

Cardiac Mapping. M. Shanasa, M. Borggrefe, and G. Breithardt (eds).

Cardiac Arrhythmias: A Practical Guide for the Clinician. Second Edition. Robert A. Waugh, Barry W. Ramo, Galen S. Wagner, and Marcel Gilbert (eds).
Cardiopulmonary Support for Complex Angioplasty
Authors: HARRINGTON JOHN C. , TEIRSTEIN PAUL S.
Published: June 2007

The role of cardiopulmonary support (CPS) in interventional procedures is currently in evolution. The authors review the clinical applications and technical considerations involved in CPS including discussion of indications, hemodynamic effects, complications, and prophylactic versus stand‐by techniques. Use of the technique in high risk percutaneous transluminal coronary angioplasty patients is discussed. (J Interven Cardiol 1995;8:249–255)
BOOK REVIEWS
Authors: Lindsay Bruce D.
Published: June 2007

Radiofrequency Catheter Ablation of Cardiac Arrhythmias. Basic Concepts and Clinical Applications. Shoei K. Stephen Huang, M.D. (ed).
Balloon Valvuloplasty for Pulmonary Valve Stenosis
Authors: FEDDERLY RAYMOND T. , BEEKMAN ROBERT H.
Published: June 2007

Balloon valvuloplasty for pulmonary valve stenosis by static dilation is the treatment of choice for the treatment of isolated valvular pulmonary stenosis in the infant, child, and adolescent. The procedure is also effective in neonates; however, the complications of the procedure are significantly higher and the efficacy is less. This article reviews the background, indications, technique, acute and long‐term results, and complications of balloon valvuloplasty for pulmonary valve stenosis in the infant, child, and adolescent with pulmonary valve stenosis. The application of this technique in neonates with critical pulmonary stenosis or membranous pulmonary atresia with intact ventricular septum is also discussed. The determinants of a successful outcome in each group are addressed. (J Interven Cardiol 1995;8:451–461)
Embolization Therapy in Pediatric Cardiology
Authors: BEEKMAN ROBERT H. , SHIM DAVID , LLOYD THOMAS R.
Published: June 2007

Transcntheter embolization therapy has assumed an important role in the management of patients with congenital heart disease. A variety of embolization materials, most commonly steel coils, is available to treat or palliate patients with aortopulnwnary collateral vessels or surgical shunts, arteriovenous malformations, and anomalous venovenous connections (common after surgical intervention for the univentricular heart). At many centers, coil occlusion has recently become the treatment of choice for patients with a restrictive patent ductus arteriosus (PDA). This article describes the materials and techniques of embolization therapy, as well as the common indications encountered in the practice of pediatric interventional cardiology. (J Interven Cardiol 1995:8: 543–556)
The Use of Radiofrequency Energy in Pediatric Cardiology
Authors: DOROSTKAR PARVIN C. , DICK MACDONALD
Published: June 2007

The use of radiofrequency energy for the treatment of supraventricular tachycardia in pediatric patients has gained widespread acceptance, especially for tachyarrhythmias associated with palpitations, dizziness, presyncope or syncope, cardiomyopathy, and cardiac arrest. Ablation of the substrate supporting atrioventricular reentry, atrioventricular node reentry, and automatic atrial tachycardia yields a 90%–98% success rate with low incidence (< 1%) of complications and adverse side‐effects. Ablation of intra‐atrial reentry, including atrial flutter and fibrillation, appears to be promising and would be a significant advance in the management of patients following extensive atrial surgery for congenital heart disease. Radiofrequency energy is also used to treat various forms of idiopathic ventricular tachycardia. Finally, radiofrequency energy has been extended to control the ventricular rate associated with malignant atrial tachycardia by either modification or ablation of the atrioventricular node, and subsequent pacemaker implant. Long‐term outcome of radiofrequency ablation is unknown, but the short‐to‐intermediate (1–5 yrs) outcome is excellent, with low recurrence rate of the tachycardia, no proarrhythmic effect, and excellent clinical state. (J Interven Cardiol 1995;8:557–568)
A Prospective Randomized Trial of 0.010″ Versus 0.014″ Balloon PTCA Systems and Interventional Fellow Versus Attending Physician as Primary Operator in Elective PTCA: Economic, Technical, and Clinical End Points
Authors: TALLEY J. DAVID , MAULDIN PATRICK D. , LEESAR MASSOUD‐A. , BECKER EDMUND R.
Published: June 2007

Background: The cost of performing percutaneous transluminal coronary angioplasly (PTCA) is accelerating. The angiographic, clinical, technical, and procedural variables associated with PTCA cost are largely unknown. Methods: To determine an interrelationship between equipment size, operator experience, and PTCA cost, 50 patients were randomized to have PTCA performed with large (0.014″) or small (0.010″) balloon systems. A secondary randomization determined the primary operator of the procedure: either experienced attending physician or inexperienced fellow in interventional cardiology. End Points: Primary: PTCA cost (equipment, supplies, support personal, post‐PTCA room, and physician (utilizing resource‐based relative value scale); Secondary: measures of technical procedural and clinical outcome. Results: The total cost of the PTCA was $4,047 ±$2,133 for 0.010″ systems versus $3,451 ±$1,004 for the 0.014″ systems, P = NS. Independent variables associated with increased cost included: age, diabetes, and duration of procedure in the cardiac catheterization laboratory. There was no significant difference in procedural duration, complications, or outcome between the smaller or larger PTCA catheter systems, and, the less experienced PTCA operator required additional fluoroscopic time to cross the lesion, as well as procedure time compared with the attending physician. Conclusions: Neither miniaturization of equipment size nor primary operator experience led to PTCA cost savings. Clinical and procedural characteristics are independently correlated with increased PTCA cost. Additional study is needed to determine the exact determinants of PTCA cost, in order to stabilize the cost of this procedure. (J Interven Cardiol 1995;8:623–632)
Percutaneous Transluminal Coronary Angioplasty of the Left Main Coronary Artery with a 5Fr Catheter System
Authors: WASER MARCO , MEIER BERNHARD
Published: June 2007

The protected left main coronary artery (LM) is accessible to percutaneous transluminal coronary angioplasty (PTCA), and the procedure is usually performed with large size catheter systems. This report describes a successful PTCA of a partially protected LM through a 5Fr diagnostic catheter system in a patient with previous coronary artery bypass grafting. Such an approach is time‐ and cost‐efficient when combined with the diagnostic study.
The Role of Catheter Ablation in Atrial Tachycardia, Flutter, and Fibrillation
Authors: SALERNO‐URIARTE JORGE A. , DE PONTI ROBERTO , STORTI CESARE , FERRARI ANTONIO A. , STANKE ANDRZEJ , MAID GUSTAVO , FALCONE COLOMBA , MASSACCI M. ELISABETTA
Published: June 2007

The first experiences of nonpharmacological treatment of ectopic atrial tachycardia (EAT), common atrial flutter (AFI), and atrial fibrillation (AF) were performed by surgical techniques. Many studies reported a very high success rate on the use of catheter ablation with radiofrequency current for the treatment of supraventricular arrhythmias; and recently, various preliminary reports are dedicated to the treatment of EAT, AFI, and AF with that source of energy. To our knowledge 108 cases of EAT treated by catheter ablation of the ectopic focus are reported in the literature with a success rate superior to 90%. On the basis of our personal experience regarding 11 cases (4 of right atrium EAT and 7 of left) we discuss here the essential role of unipolar leads derived from the mapping catheter to select the target for radiofrequency applications. Two hundred and one cases of AFI tested by catheter ablation were previously reported. The majority of them (> 80%) were successfully treated with radiofrequency. Some working groups performed the procedure as the basis of electrophysiological findings, while others preferred an anatomical approach applying radiofrequency energy at the isthmus lying between the coronary sinus ostium and the tricuspid ring, near the vena cava orifice. On the basis of these assumptions, we obtained 83% of final success in 12 cases of AFI treated by radiofrequency. Finally, we discuss the problem related to the modulation of atrioventricular (AV) nodal conduction during AF. In our laboratory, five cases with chronic AF and very fast ventricular response were treated with radiofrequency with a posterior septal approach. In all patients, we obtained very encouraging results with a constant decrease of ventricular rate (from 137 ± 33 to 69 ± 14 beats per minute). All cases treated by modulation of AV nodal conduction demonstrated an appropriate chronotropic response to the variations of the functional state that persists during the follow‐up. More experience with longer follow‐up and accurate pre‐ and postprocedure evaluations are needed to finalize the most appropriate technique of radiofrequency applications in these cases.
Balloon Pulmonary Valvuloplasty as a Palliation for Tetralogy of Fallot: Our Experience and Literature Review
Authors: INO TOSHIHIRO , NISHIMOTO KEI , OHKUBO MATAICHI , AKIMOTO KATSUMI , YABUTA KEUIRO , KAWASAKI SHIORI , HOSODA YASUYUKI
Published: June 2007

Background: There was a controversy regarding the effectiveness of balloon pulmonary valvuloplasty as palliation in tetralogy of Fallot. Objective: To report our experience of the procedure, review literature, and discuss feasibility of the procedure. Patients: Seven consecutive patients were examined. Their ages ranged from 1—26 months (mean 12.3 months) and the male to female ratio was 5:2. One of the seven patients had. Down syndrome with tricuspid valve straddling. Hypoxic spells had been observed and β blackers had been given in three of the seven patients before dilation. Methods: A standard technique of balloon pulmonary valvuloplasty was used as previously described. The size of balloon diameter was selected as I20%‐140% larger than the diameter of pulmonary valve annulus. The changes in oxygen saturation level, clinical symptoms, and sizes of pulmonary artery and annulus were examined before and after the dilation and follow‐up. Results: One patient who had had a severe pulmonary stenosis associated with tetralogy of Fallot died of ductal shock during the catheter manipulation. The angioplasty catheter could not be crossed in this patient. Cyanosis was improved in all remaining six patients after the procedure. Hypoxic spells ceased in three patients and withdrawal of propranolol was possible in two patients. The oxygen saturation increased significantly from 74%± 10% to 79%± 8% (P < 0.005) immediately after the procedure. In follow‐up angiographies, the values of pulmonary artery index and valve annulus were not significantly increased compared with those, before, dilation. Only two patients had significant increase of pulmonary artery and annulus sizes during follow‐up periods, and consequently, successfully underwent total correction without systemic to pulmonary shunt operation. Conclusion: Balloon pulmonary valvuloplasty is an effective alternative for relief of deep cyanosis and hypoxic spells during short‐term periods, but is not always effective in terms of long‐term growth of the pulmonary artery and annulus. (J Interven Cardiol 1996;9:19–23)
Coronary Splinting in Cardiogenic Shock
Authors: MYERS LESLEY , LITTLE THOMAS
Published: June 2007

An 84‐year‐old woman experienced an acute anterior wall myocardial infarction complicated by cardiogenic shock. Coronary angiography demonstrated a subtotal occlusion of the proximal left anterior descending artery. Conventional percutaneous transluminal coronary angioplasty, including a 15‐minute perfusion balloon dilatation resulted in a persistent intraluminal filling defect with high grade stenosis and ongoing ischemia and hypotension. Coronary splinting was performed, using an autoperfusion balloon to achieve a 6‐hour dilatation of the vessel in conjunction with balloon aortic counterpulsation. The patient remained hemodynamically stable during this lengthy dilatation without ECG evidence of ischemia. Angiography postdilatation demonstrated a minor residual stenosis with no evidence of intraluminal thrombus. The patient was discharged 8 days later without congestive heart failure. Follow‐up at 3 months demonstrated normal left ventricular function with no evidence of anterior wall infarction or ischemia by thallium imaging. (J Interven Cardiol 1996;9:65–67)
The Cook Inc. Gianturco‐Roubin Flex‐Stent
Authors: BERGER PETER B.
Published: June 2007

The Cook Inc. Gianturco‐Roubin Flex‐Stcnt was approved by the Food and Drug Administration in May 1993 for the treatment of acute and threatened closure following balloon angioplasty or treatment with another percutaneous device. However, the stent is frequently used for additional, nonapproved indications, including the treatment of restenosis lesions, lesions that demonstrate early recoil, high risk lesions, and the treatment of primary (de novo) lesions in an attempt to improve the clinical outcome in these different settings. The aim of this article is to review the available data regarding the use of the Flex‐Stent for these approved and nonapproved indications. (J Interven Cardiol 1996;9:145–152)
Beyond the Coronary Angiogram: Further Evaluation of the Coronary Vasculature and Endothelial Function
Authors: CANNAN CHARLES R. , HIGANO STUART T. , HOLMES DAVID R. , GARRATT KIRK N. , LERMAN AMIR
Published: June 2007

Coronary artery disease is a progressive and diffuse process. The focus in the past decade was on the late stage of coronary atherosclerosis, with efforts being devoted to the development of thrombolytic drugs and sophisticated interventional devices. However, in spite of the success in decreasing morbidity and mortality from coronary atherosclerosis, the disease process continues. Early diagnosis and treatment of patients with nonobstructive coronary artery disease, may prevent the development of unstable angina and myocardial infarction. It has become apparent that the endothelium is the primary target and/or participant in the early stages of coronary atherosclerosis. The endothelium is as an active paracrine organ capable of regulating coronary vascular tone as well as the atherosclerotic and restenosis process by releasing vasorelaxing factors with antiproliferative activity and vasoconstricting and growth factors. During the evolution of coronary atherosclerosis endothelial dysfunction occurs, which is characterized by attenuated release and activity of endothelium derived vasorelaxing factors and enhanced release of vasoconstricting factors. The goal of cardiology is to develop diagnostic methods and treatment for these patients who present to us with cardiac symptoms and nonobstructive coronary artery disease. This article will review the current knowledge of endothelial function as it applies to coronary circulation and describe a clinical approach to the patient with suspected coronary disease and a normal coronary angiogram. (J Interven Cardiol 1996;9:153–161)
Coronary Intervention with the Excimer Laser: A Current Perspective
Authors: REEDER GUY S.
Published: June 2007

One variety of the excimer coronary laser system (Advanced Interventional Systems) has been available for use in selected clinical centers from 1989 through 1995. This over‐the‐wire catheter‐laser system uses a 308‐nm laser and requires prepositioning of a 0.014′’to 0.018′’guidewire across the target stenosis. Development of the coronary laser system was stimulated by the limitations of conventional angioplasty, which have included abrupt reclosure, coronary dissection, restenosis, and chronic total occlusion. The excimer coronary laser angioplasty (ELCA) registry includes nearly 4,000 patients who have undergone attempted laser angioplasty. A success rate comparable to standard balloon angioplasty and an acceptably low complication rate were achieved in this registry database. While laser angioplasty has been promoted for long, diffuse lesions, total occlusions, lesions with substantial side branch involvement, and a possible therapy to reduce the incidence of restenosis, the highly selected nature of patients enrolled in the registry prevents any definite conclusions regarding the utility of intracoronary laser in these potential indications. Additionally, the advent of newer technologies, including rotablator and stenting, may further erode any potential advantages of coronary laser angioplasty. Randomized trials of newer interventional devices will be required to determine their true value and clinical utility. (J Interven Cardiol 1996;9:175–178)
New Devices in a New Era: Reimbursement and Legality
Authors: WOOD DOUGLAS L.
Published: June 2007

The development of new technology is often anticipated with great enthusiasm by physicians involved in the evaluation of new therapies. There is a countervailing view that rapid diffusion of new technology into practice is a significant contributing factor to the rapid rate of rise of health care spending in the United States. The central argument is not that technology should not be developed; rather, that technology should be developed and evaluated according to carefully derived scientific criteria and that payment policy should not create an unintended discrimination in access to new therapies. It is essential that physicians who are involved in the development of new technologies understand the reasons for concern about technology, the requirements for evaluation of new devices, and the payment policies related to the use of new technology. (J Interven Cardiol 1996;9:179–183)
BOOK REVIEW
Authors: Aguirre Frank V.
Published: June 2007

Book review in this Article

Invasive Cardiology: Current Diagnostic and Therapeutic Issues. American Heart Association Monograph Series. George W. Vetrovec and Blase A. Carabello (eds).
Percutaneous Transluminal Angioplasty and Stents in the Treatment of Extracranial Circulation
Authors: WHOLEY MARK H. , ELES GUSTAV , JARMOLOWSKI CHESTER R. , LIM MICHAEL C.L. , VOZZT CARLOS , LONDERO HUGO , GADDA CARLOS
Published: June 2007

A feasibility study of stent supported angioplasty for the extracranial occlusive disease was conducted to include the carotid bifurcation and the internal carotid artery. One hundred seventy‐four patients have undergone extra‐cranial PTA and/or Meriting for occlusive disease involving the great vessels off the aortic arch, including the internal carotid. Sixty‐one of the patients represented carotid occlusive disease, of which 15 were managed by PTA and 46 by intravascular Johnson & Johnson Interventional Systems stents. There were 13 vertebrals in the group, 7 innominate, 81 subclavian, 10 axillary lesions, and 2 grafts, I of which was an internal carotid interposi‐tioned vein graft. The 61 patients that had carotid angioplasty and/or stents had a complication rate of 8%. However, 46 patients had a primary stenting procedure. From this group, 2 patients had minor strokes involving the upper extremities. One patient recovered fully within 24 hours, and the other had an 85% recovery at the end of a 1‐week interval. Two patients encountered transient ischemic attacks. There were no deaths, and no major disabling strokes in the carotid series. The follow‐up for the carotid stem group had a mean duration of only 2.5 months. Twenty‐nine of the patients have been reevaluated with no new onset of neurological sequelae. There were no stent deformations noted as evaluated by three‐dimensional computed tomographic angiography and color flow Doppler in addition to magnificant radiography. All patients have had 24‐hour postoperative and 1‐month color flow Doppler. All patients are required by protocol to undergo angiographic evaluation. If we include all extracranial interventions (174), a technical success of 93% was achieved in those patients undergoing PTA and 94% of those patients undergoing stenting procedures. Suboptitnal results were obtained in 6% of the PTA procedures, and 0% for stents. There is now sufficient data to document the efficacy of managing extracranial occlusive disease by percutaneous endovascutar stents. The exception, however, is the carotid bifurcation and the internal carotid artery, where a well‐controlled feasibility study with careful analysis of the data will be necessary prior to randomizing the study against the gold standard of carotid endarterectomy.
Percutaneous Transluminal Coronary Angioplasty of Single Coronary Artery
Authors: OLYMPIOS CHRISTOPHER D. , FAKIOLAS CONSTANTINE N. , SIFAKI MARIA D. , FOUSSAS STEPHANOS G.
Published: June 2007

The presence of single coronary artery is a very rare finding on coronary arteriography. This type of coronary artery anomaly was revealed in a 54‐year‐old patient with exertional angina refractory to full medical treatment and positive exercise test. The unique coronary vessel presented significant stenosis in the distal segment of circumflex artery—which continued as right coronary artery—and was successfully dilated with conventional balloon angioplasty.
Local Functional and Structural Changes in the Myocardium During Ventricular Pacing
Authors: PRINZEN FRITS W. , van MATTHIJS F.M.  , OOSTERHOUT  , ARTS THEO , RENEMAN ROBERT S.
Published: June 2007

In patients with hypertrophic obstructive cardiomyopathy (HOCM), ventricular pacing improves the hemodynamic situation from the first paced beat, while a further improvement is obtained at continuation of pacing over months and years. The mechanisms responsible for the acute and chronic improvement are not yet completely understood. This article summarizes a number of experimental studies, the results of which may improve our insight into myocardial adaptations during ventricular pacing. Experiments in anesthetized dogs showed that abnormal, asynchronous electrical activation due to epicardial ventricular pacing results in specific and even more asynchronous sequences of onset of fiber shortening. Compared to sinus rhythm, fiber shortening during ejection (by ∼ 100%), mechanical load (by – 50%), and blood flow and oxygen consumption (by – 30%) were reduced in early activated regions of the ventricular wall. These variables were increased to a similar extent in late activated regions. Subsequent studies in dogs paced for 3 months at the epicardium of the left ventricular (LV) free wall showed a ∼ 20% decrease in free‐wall thickness. In patients with left bundle branch block, the early activated septum was up to 10% thinner than the late activated free wall. These findings support the hypothesis that abnormal electrical activation causes regional differences in mechanical load, which, in the long run, may result in different local growth responses. These functional and structural adaptations may explain the progressive improvements observed during ventricular pacing in hypertrophic obstructive cardiomyopathy (HOCM) patients.
Atrioventricular Node Ablation for Optimization of Pacemaker Treatment in Hypertrophic Obstructive Cardiomyopathy
Authors: SADOUL NICOLAS , DODINOT BERNARD , BEURRIER DANIEL , CHILLOU CHRISTIAN DE. , ALIOT ETIENNE
Published: June 2007

Dual chamber pacing is a new indication for the treatment of drug resistant hypertrophic obstructive cardiontyopathy (HOCM) in patients with normal atrioventricular (AV) conduction. In sinus rhythm, the efficacy of the treatment is mainly related to the ability to bypass the normal AV conduction system in order to obtain a complete and permanent right ventricular (RV) capture. This is achieved by programming short AV delays. On the other hand, patients with HOCM frequently have co‐existing left ventricular diastolic dysfunction, and the atrial contribution to left ventricular filling is critical. The lack of improvement, rarely encountered, is probably due to incomplete RV capture andlor to the deleterious effect of short AV delay. Instrumental AV node prolongation may he indicated in this situation. This procedure should be undertaken when previous drug‐induced AV prolongation has failed. In theory, AV node modulation (i.e., creating a I ± AV block) seems ideal. However, this technique remains difficult, with disappointing chronic results. Most authors hence perform “conventional” AV node ablation. Particular attention is taken in order to perform a proximal node ablation, resulting in a complete AV block with narrow QRS escape rhythm. The reported incidence of AV node prolongation ranges from 7.5%‐37.5%. The efficacy of the procedure on symptoms is explained by improved left ventricular filling and/or a further reduction in the systolic gradient evoked by complete RV capture. Another indication for AV node ablation in HOCM is the occurrence of atrial fibrillation, in order to restore adequate and permanent RV capture.
Randomized Evaluation of an Inflatable Femoral Artery Compression Device After Cardiac Catheterization
Authors: NORDREHAUG JAN ERIK. , CHRONOS NICOLAS A. F. , PRIESTLEY KIM A. , BULLER NIGEL P. , FORAN JOHN , WAINWRIGHT RAY , VOLLSET STEIN EMIL. , SIGWART ULRICH
Published: June 2007

Mechanical femoral artery compression devices have several limitations. We compared a novel disposable beltheld pneumatic compression device to manual compression alone in 213 patients randomized into two equal groups. Both were comparable for age, gender, current therapy with aspirin (ASA) and warfarin, diameter of the arterial sheath, previous procedures via the same artery, procedure duration, and blood pressure. Manual compression time was 12 ± 3 minutes. Pneumatic compression was reduced during 60 minutes. Patient discomfort was assessed as none (82% vs 88%), mild (13% vs 8%), moderate (3% vs 4%), or severe (2% vs 0%) for the manual versus pneumatic group, respectively. Bleeding and hematoma occurred in 7.5% of patients with no difference between the treatment groups. However, manual compression was significantly more effective in the higher range of systolic blood pressure, and pneumatic in the lower range, with a cut point of approximately 170 mmHg. Predictors for bleeding were systolic blood pressure and dose of ASA. Among 113 patients with systolic blood pressure < 160 mmHg and low dose (75 mg) or no ASA, only / patient (0.9%) experienced bleeding while 31% of 16 patients with both elevated systolic blood pressure and high dose ASA (150–330 mg) bled. We conclude that pneumatic femoral artery compression does not reduce bleeding and hematoma compared with manual compression. The use of low dose (75 mg) or no ASA, as well as giving special attention to patients with elevated systolic blood pressure, may reduce the risk of bleeding after cardiac catheterization.
The Treatment of Hypertrophic Obstructive Cardiomyopathy by Nonsurgical Myocardial Reduction
Authors: KNIGHT CHARLES , GUNNING MARK , HENEIN MICHAEL , KILNER PHILIP , GIBSON DEREK , SIGWART ULRICH
Published: June 2007

We describe a novel treatment for hypertrophic obstructive cardiomyoparhy, in which septal reduction is achived via transluminal induction of focal septal infarction. The results of the first three patients treated in this fashion have been recently reported; in this preliminary series, intraventricular pressure gradients could be dramatically reduced by the creation of a localized infarction of the ventricular septum. The procedure is well tolerated and effective in reducing the obstruction to left ventricular ourflow. Further studies are underway to fully evaluate the usefulness of the technique. (J Interven Cardiol 1996;9:393–397)
Emergency Stenting for Severe Dissection During Percutaneous Transluminal Coronary Angioplasty in Dextrocardia
Authors: VOUDRIS VASILIS , MANGINAS ATHANASIOS , VASSILIKOS VASILIS , KOLOVOU GENOVEFA , COKKINOS DENNIS V.
Published: June 2007

We describe a patient with dextrocardia and angina pectoris in whom balloon angioplasty in the right coronary artery resulted in an obstructive dissection. Emergency bypass surgery was avoided by the successful placement of a stent (Palmaz‐Schatz).
Early and Late Results of the Self‐Expanding Nitinol Stents: Interim Report from a Multicenter European Study
Authors: BEYAR RAFAEL , ROGUIN ARIEL
Published: June 2007

The nitinol self‐expanding coil stent is unique in its mechanism of deployment and in the way radial arterial expansion is achieved, characterized by a combination of self‐ and balloon‐assisted expansion, and long‐term outside radial expansion force on the vessel wall. The initial acute and long‐term angiographic results in the first cohort of patients with simple and complex lesion morphology are presented. Eighty‐six self‐expanding nitinol coronary stents were implanted in 62 consecutive patients in our center. There were nine chronic total occlusions and 53 patients with suboptimal results. After stent deployment, within‐stent balloon dilatation to the nominal stent size at pressures ranging between 12 and 14 atm were performed in all cases. Angioplasty increased the minimal lumen diameter (MLD) from 1.04 ± 0.73 mm at baseline to 2.24 ± 0.57 mm; stent deployment further increased MLD to 2.43 ± 0.48 mm, and within‐stent balloon dilatation to 2.87 ± 0.62 mm. During follow‐up, five patients required target lesion revascularization; there was one noncardiac death, but no myocardial infarctions. In 37 patients, angiography was done 6‐9 months post stenting. Restenosis was detected in six patients; the MLD was 2.30 ± 0.98 mm, and the stent diameter 3.05 ± 0.60 mm. These represent favorable long‐term results of this new stent.

The experimental and clinical results of the self‐expanding nitinol coil stent have been reviewed. Animal data have shown that the stent is safe and provokes a mild proliferative response, similar to previously studied balloon‐expandable stents. Data from femoral and popliteal arteries are supportive of long‐term patency in these arteries, which are typically associated with unfavorable results from other stents. Data from coronary implantations in patients show that the stent can be safely used to treat coronary lesions of both simple and complex natures. Long‐term results of these patients compare favorably with existing data in similar lesions using other stents. A larger clinical trial using the new flat wire design stent is required to test whether further stent expansion may contribute to low restenosis rates.