bluuebunny/crossref_metadata_2025 huggingface dataset:
Coronary spasm in patients with coronary ectasia
Authors: Suzuki Hiroshi , Takeyama Youichi , Hamazaki Yuji , Namiki Atsuo , Koba Shinji , Matsubara Hitoshi , Hiroshige Juichi , Murakami Mikitaka , Katagiri Takashi
Published: March 2007

The incidence of coronary ectasia (CE) and the relationship between CE and coronary spasm that was said not to be apt to occur in patients with CE were studied. The study consisted of 1,373 patients (including 1,008 patients with ischemic heart disease) who underwent cardiac catheterization. In 74 patients with CE, coronary spasm was tested in 33 patients subjected to acetylcholine (ACh) provocation and in 17 patients subjected to ergonovine (Ergo) provocation.

CE was found in 74 patients (5.4%), and its incidence was significantly higher (6.7%) in patients with ischemic heart disease. In addition, ACh and Ergo provocation tests gave positive results in 12 (36%) and 4 patients (24%), respectively. Spasm was not provoked as frequently in the ectatic portion as elsewhere. In addition, spasm was often found at the borders of the ectatic portion in both provocation tests.

The incidence of coronary ectasia was higher than that described in previous reports, and coronary spasm was more often observed at the borders between ectatic and normal portions than elsewhere.
Percutaneous transluminal angioplasty of anomalous right coronary artery arising from the ascending thoracic aorta
Authors: Yeoh Joon‐Kuan , Ling Lieng‐Hsi , Maurice Choo
Published: March 2007

Coronary arteries with anomalous aortic origin are infrequently encountered in patients undergoing cardiac catheterization and pose potential technical difficulties for performing both diagnostic and angioplasty procedures. Percutaneous transluminal coronary angioplasty (PTCA) of atherosclerotic disease in anomalous right coronary artery (RCA) has been described in only a few reports. In all the cases reported to date, the anomalous vessel arose from the left sinus of Valsalva. We report a case of a technically straight‐forward PTCA performed in an anomalous RCA arising from the anterior aspect of the ascending thoracic aorta. © 1994 Wiley‐Liss,Inc..
Anomalous origin of the right coronary artery from the ascending aorta above the noncoronary sinus of valsalva
Authors: Ilia Reuben , Abu‐Ful Akram , Gueron Mosche
Published: March 2007

We describe a patient with an unusual coronary anatomic variant in which the right coronary artery originates from the ascending aorta above the noncoronary aortic sinus of Valsalva. © 1994 Wiley‐Liss,Inc..
The impact of balloon material and lesion characteristics on the incidence of angiographic and clinical complications of coronary angioplasty
Authors: Raymenants Erwin , Bhandari Suman , Desmet Walter , Scheerder Ivan De , Reniers Romain , Willems Jos Louis , Piessens Jan H.
Published: March 2007

To assess the importance of balloon material used for percutaneous transluminal coronary angioplasty (PTCA), we compared the complication rates observed with low compliant plastomer (PM 300), intermediately compliant polyethylene (PE 600), and highly compliant polyolefin copolymer (POC) balloons. In a total of 1,650 procedures, one of these balloon materials was used to dilate 2,040 lesions. The dissection rate tended to be slightly lower with the use of more compliant balloon material. The total clinical complication rate (death, emergency coronary surgery, myocardial infarction, need for bail‐out stenting or for prolonged heparin treatment, abrupt out‐of‐laboratory vessel closure) was 8.1%, 7.4%, and 4.2% in the procedures exclusively performed with PM 300 (N = 653), PE 600 (N = 543) and POC (N = 454) balloons, respectively (P=0.03). In multivariate analysis, the use of less compliant balloon material emerged as an independent correlate of clinical complications (P=0.007). However, the predictive power of the lesion complexity (B2, C versus A, B1) was four times stronger. In contrast to current concerns, the use of compliant balloon material seems at least as safe as the use of less compliant material. © 1994 Wiley‐Liss,Inc..
Discordance in the predictors of mortality vs. those of ischemic complications following transcatheter coronary intervention
Authors: Lindsay Joseph , Pinnow Ellen E. , Reddy Venugopal M. , Pichard Augusto D.
Published: March 2007

Outcomes of percutaneous transluminal coronary angioplasty (PTCA) depend upon the skill of the angioplasty team and on the characteristics of the patient population. Comparisons of outcomes from different laboratories must take into account the latter. A discordance may exist between the baseline predictors of death in hospital following PTCA and those for periprocedural ischemia. Baseline clinical and procedural characteristics of 3,725 patients who underwent PTCA during 1991 and 1992 were compared with complications by multivariate analysis. The age of the patient and the occurrence of an Ml within the previous 30 days were the most powerful independent predictors of death. Ischemic complications were not independently associated with these factors. Emergency CABG was associated independently with target lesion complexity and abrupt reclosure, with unstable angina or attempted saphenous vein graft dilatation. Thus, mortality may more directly reflect baseline clinical characteristics than the skill of operators in avoiding ischemic complications. © 1994 Wiley‐Liss,Inc..
Angiographic evidence of right coronary bridging
Authors: Woldow Andrew B. , Goldstein Steven , Yazdanfar Shahriar
Published: March 2007

Systolic constriction of the left anterior descending coronary artery is a well‐recognized angiographic and autopsy finding. The etiology of this phenomenon is an intramural course of the coronary artery. Even though there has been autopsy evidence of an intramural course of the right coronary artery, this rare finding has not been associated with systolic constriction, “bridging” on coronary angiography. There is evidence that strenuous exercise can induce ischemia in an intramural left coronary artery. We therefore present a case report of angiographic evidence of systolic constriction of the right coronary artery. © 1994 Wiley‐Liss,Inc..
Iliocaval reconstruction with metallic stents
Authors: Roy Sumit , Baijal Sanjay S. , Rastogi Harsh
Published: March 2007

Percutaneous stenting is now the preferred first line of treatment for occlusive lesions of the great veins. A case is presented in which multiple metallic stents were used to reestablish communication between the suprahepatic inferior vena cava and both iliac veins. The clinical result was satisfactory: venous claudication was relieved, and the progress of chronic venous insufficiency arrested. Stent implantation offers a minimally invasive therapeutic option even when extensive revascularisation is indicated. © 1994 Wiley‐Liss,Inc..
Rotational coronary atherectomy with adjunctive balloon angioplasty for the treatment of ostial lesions
Authors: Zimarino Marco , Corcos Thierry , Favereau Xavier , Commeau Philippe , Tamburino Corrado , Spaulding Christian , Guérin Yves
Published: March 2007

Conventional balloon angioplasty (PTCA) of ostial lesions (OL) is associated with suboptimal results and a higher complication rate. Partial plaque ablation with rotational atherectomy (RA) before PTCA might improve results. This approach was used in 63 patients (pts) (mean age 64±10 yrs; 44 men, 19 women) with 69 OL. There were 15 aorto‐OL and 54 branch‐OL. Calcification was more frequent in aorto‐OL than in branch‐OL (67% vs. 35%, P< 0.05). Mean burr size was 1.8±0.3 mm. Burr‐artery ratio was 0.74±0.10. Adjunctive PTCA was systematically performed.

Procedural success was achieved in 58 pts (92%): 14 aorto‐OL (93%) and 50 branch‐OL (93%) were successfully treated; major complications occurred in 1 (7%) aorto‐OL and 1 (2%) branch‐OL. Uncomplicated failure occurred in three cases. Minimal lumen diameter (MLD) increased from 0.69±0.31 mm before RA to 1.43±0.28 mm after RA (P<0.001) and 2.16±0.29 mm after PTCA (P<0.001). Diameter stenosis (DS) decreased from 75±13% before RA to 32±12% after RA (P<0.001) and 14±10% after PTCA (P<0.001). All successfully treated pts underwent repeat angiography 24 h later and exercise testing or repeat cardiac catheterization >6 mo later. At 24 h repeat angiography, DS was 17±15% (P=NS vs. after PTCA); no lesion had a DS ≥ 50%. Follow‐up coronary angiography was performed in 30 pts (52%) who had abnormal stress testing: 13 pts (43%) showed angiographic restenosis in at least one successfully treated OL.

In conclusion, RA with adjunctive PTCA is a safe and effective treatment of OL. It is associated with higher success and lower major complications rates when compared with conventional PTCA. Restenosis remains a major limitation of all percutaneous approaches. © Wiley‐Liss, Inc.
Initial experience with the Europass™: A new ultra‐low profile monorail balloon catheter
Authors: Zimarino Marco , Corcos Thierry , Favereau Xavier , Tamburino Corrado , Toussaint Marcel , Spaulding Christian , Guérin Yves
Published: March 2007

One of the causes for percutaneous transluminal coronary angioplasty (PTCA) failure is the inability to cross the lesion with the balloon catheter after guidewire positioning. The Europass™ coronary angioplasty catheter is a monorail Duralyn™ balloon catheter developed to enhance lesion crossability and to overcome this limitation. This system was evaluated in 50 patients in which target lesions were chronic total coronary occlusions (12 cases) or stenoses that could not be reached or crossed by other new monorail balloon catheters. Overall procedural success was obtained in 49/50 patients (98%), using a single Europass™ balloon catheter in 46/50 patients (92%), with no in‐hospital complications.

Its low profile, small distal shaft, and excellent trackability allowed successful angioplasty in cases where other catheters failed. This balloon catheter represents a significant advance in angioplasty technology and can be considered as a first‐choice device for a safe and expeditious single‐operator procedure. © Wiley‐Liss, Inc.
Quantification of intracoronary volume by videodensitometry: Validation study using fluid filling of human coronary casts
Authors: Haase Jürgen , Slager Cornelis J. , Keane David , Foley David P. , Boer Ad Den , Doriot Pierre A. , Serruys Patrick W.
Published: March 2007

Changes in intracoronary volume reflect the hemodynamic significance of progression or regression of diffuse coronary artery disease where intracoronary catheters cannot be applied for direct measurements due to small vessel dimensions. We have validated the videodensitometric measurement of intracoronary volume with epoxy casts of postmortem human coronary arteries. The volume of 31 coronary segments (cross‐sectional areas in a range of 2–13 mm2) measured by fluid‐filling using a precision dispenser was compared with the respective single plane intracoronary volume assessments obtained by the videodensitometric algorithm of the new generation Cardiovascular Angiography Analysis System (CAAS II). The true and measured values of volume were compared by calculation of the mean of the signed differences ± standard deviation and by linear regression analysis. Videodensitometric measurement of intracoronary volume correlate well with fluid‐filling of human coronary artery casts (correlation coefficient: r = 0.99, y = 1.96 + 0.99x, standard error of estimate: SEE = 3.96) with a significant trend towards overestimation of true volume values (mean difference = 1.73 ± 3.64 mm3, P<0.05). Intracoronary volume estimations can be used to measure changes of luminal dimensions of coronary arteries and may offer a new approach to assessment of progression or regression of diffuse coronary artery disease. © Wiley‐Liss, Inc.
Peripheral arterial angioplasty balloons as adjuncts to percutaneous coronary revascularization
Authors: Feldman Ted , Carroll John D. , Follman Duane F. , Al‐Hani Arfan , Levin Thomas N.
Published: March 2007

Although PTCA balloon technology has improved dramatically since the first catheters were introduced over a decade ago, some limitations remain. The largest conventional balloon size available is 4.0 mm diameter. Larger size balloons are sometimes necessary for saphenous vein graft dilatation or in very large native coronary arteries. Also, adjunctive balloon angioplasty is used frequently after atherectomy and other coronary device therapy. Current generation balloons are not always necessary in this setting, since a large luman has already been established. Thus, it has become useful in our laboratory to use peripheral arterial angioplasty balloons for both large coronary vessel dilatation, and also for adjunctive dilatation after device use. We describe our initial experience with peripheral arterial angioplasty balloons as adjuncts to percutaneos coronary revascularization. © Wiley‐Liss, Inc.
Coronary artery ectasia: Local pathology or diffuse disease?
Authors: Williams Michael J. A. , Stewart Ralph A. H.
Published: March 2007

It is not known whether general or local factors influence the pathogenesis of coronary ectasia. We analyzed prospectively coronary angiograms from 2,186 consecutive patients with 32 patients (1.5%), identified as having coronary artery ectasia. Sixteen subjects had coronary ectasia in more than one segment of the same or a different artery. In 20 of 72 (28%) ectatic segments there was a proximal, related stenosis. In these cases ectasia was more often saccular than fusiform (16 vs. 4) compared to ectasia without a proximal, related stenosis (21 vs. 31, P = 0.003), and the mean length of the ectatic segment was shorter (8.0 vs. 15.1mm, P = 0.013). Subjects with ectasia after a stenosis often had other ectatic segments unrelated to stenoses. The high incidence of multisegment involvement suggests that coronary ectasia results from a diffuse abnormality of the vessel wall. In predisposed individuals localized ectasia may follow a stenosis, suggesting poststenotic dilatation. © Wiley‐Liss, Inc.
Restenosis following subclavian artery angioplasty for treatment of coronary‐subclavian steal syndrome: Definitive treatment with Palmaz‐stent placement
Authors: Mufti Shahid I. , Young Kevin R. , Schulthesis Thomas
Published: March 2007

We report a case of progressive angina pectoris 4 years post coronary bypass surgery, in which the left internal mammary artery (LIMA) was grafted to the native left anterior descending coronary artery. The coronary‐subclavian steal phenomenon was proven angiographically with retrograde reflux through the LIMA graft into the distal subclavian vessel, downstream from a critical stenosis at the origin of the subclavian artery. After initially successful angioplasty of the ostial subclavian lesion, restenosis and return of angina prompted repeat dilatation and placement of a Palmaz 154‐M stent. Follow‐up catheterization has demonstrated persistent patency at the stented site and absence of coronary steal. © Wiley‐Liss, Inc.
Comparison of three coronary stents: Clinical and angiographic outcome after elective placement in 134 consecutive patients
Authors: Maclsaac Andrew I. , Ellis Stephen G. , Muller David W. , Topol Eric J. , Whitlow Patrick L.
Published: March 2007

One hundred and thirty‐four consecutive patients undergoing elective coronary stenting were studied to assess the relative performance of Palmaz‐Schatz (PS), Gianturco‐Roubin (GR), and Wiktor (W) stents. Eighty‐six percent of patients underwent follow‐up angiography. Initial and follow‐up angiograms were assessed by a central angiographic core laboratory. Attempts were made to place 81 Palmaz‐Schatz (PS) stents, 21 Giant‐urco‐Roubin (GR), and 32 Wiktor (W) stents. PS stents were less frequently successfully deployed (88% PS vs. 100% GR vs. 97% W; P = 0.03). The final percent stenosis was greater with the GR stent (32% GR vs. 14% PS vs. 19% W; P < 0.001). The restenosis rate was lower in the PS group (PS 48.2% vs. GR 66.7% and W 68.4%; P = 0.044). After accounting for the effect of prior restenosis (P = 0.005) and saphenous vein site (P = 0.006) in muitivariate testing, lesion severity at follow‐up was still less with the Palmaz‐Schatz stent (P = 0.037). © Wiley‐Liss, Inc.
Rationale and application of coronary transstenotic pressure gradient measurements
Authors: De Bruyne Bernard , Paulus Walter J. , Pijls Nico H. J.
Published: March 2007

Presence, extent, and evolution of atherosclerotic coronary narrowings, as well as the anatomic possibilities for revascularization, can be reliably defined at (and only at) selective coronary angiography. The latter remains, therefore, the pivotal diagnostic tool for patients with suspected coronary artery disease. However, in spite of the increasing availability of on‐line quantitative coronary angiography, it still holds that the functional (physiologic) consequences of an epicardial coronary narrowing cannot be completely derived from geometric (anatomic) information. Clinical decision making can be particularly difficult in lesions of intermediate severity (40–70% diameter reduction), in postinterventional segments, and in some particular anatomic settings, namely, ostial stenoses, bifurcation lesions, and diffuse atherosclerotic disease. This has led to an explosive growth of new methods for assessing the physiological significance of coronary narrowings documented at angiography. Among them, Doppler blood flow velocitometry and transstenotic pressure gradient measurements have emerged as the only techniques easily applicable in most catheterization laboratories. Here, we briefly review the clinical interest of measuring transstenotic pressure gradients. © Wiley‐Liss, Inc.
Severe mitral incompetence following balloon mitral valvuloplasty: Complete resolution during follow‐up
Authors: Kannan P. , Jeyamalar R.
Published: March 2007

Mitral incompetence (MR) is a complication of balloon mitral valvuloplasty. There are few reports of long‐term outcome. We beleive this is the first report in the literature of complete resolution during follow‐up of severe mitral regurgitation resulting from balloon valvuloplasty.
The “dented bladder”: Diagnosis of a retroperitoneal hematoma
Authors: Chambers Charles E. , Griffin David C. , Omarzai Reza K.
Published: March 2007

Retroperitoneal hemorrhage and associated hematoma is a rare but potentially life threatening complication of cardiac catheterization and coronary artery interventions. This case presents the potential diagnostic utility of a supine film of the abdomen for early identification of a retroperitoneal hematoma in a patient following acute infarction PTCA.
A dual blood supply protects the right gastroepiploic arterial graft: Report of two cases
Authors: Hashimoto Hideki , Isshiki Takaaki , Ikari Yuji , Hara Kazuhiro , Saeki Fumihiko , Tamura Tsutomu , Yamaguchi Tetsu , Suma Hisayoshi
Published: March 2007

We report two cases whose right gastroepiploic arterial bypass grafts were protected by a dual blood supply due to the anatomical anastomosis between the celiac and the superior mesenteric artery systems. This unique characteristic of the graft adds an advantage for its use as a graft conduit.
Dual guiding catheters for saphenous venous graft protection during native coronary angioplasty
Authors: Freund Neil , Holland Matthew R.
Published: March 2007

The simultaneous use of two guiding catheters during angioplasty has been previously described for native coronary artery bifurcation lesions. We describe a case in which a dual guiding catheter, dual guidewire technique is used for angioplasty of a native vessel lesion spanning the anastomotic site of a sequential saphenous vein graft.
Kinetics of drugs delivery to the arteriall wall via polyurethane‐coated removable nitinol stent: Comparative study of two drugs
Authors: Dev Vishva , Eigler Neal , Sheth Sushil , Lambert Tom , Forrester James , Litvack Frank
Published: March 2007

Polymer‐coated removable stents were used to deliver 14C‐labeled etretinate and 3H‐labeled forskolin to the vessel wall in 31 New Zealand White rabbits to study their kinetics. Stents loaded with etretinate (n = 8) and forskolin (n = 14) were implanted in the rabbit carotid arteries, and the animals were euthanized at different time intervals. Drug levels were measured in the media and adventitia of the stented segment, in distant tissues, and in blood. In four rabbits, forskolin‐loaded stents were percutaneously retrieved 2 hr after implantation in the carotid artery, and the tissue and blood levels were determined 2 and 24 hr after retrieval. In seven rabbits etretinate‐loaded stents were retrieved 72 hr after implantation in abdominal aorta, and drug levels were measured in the tissues and blood immediately after and at 1 and 4 days after retrieval.

Levels of etretinate in the vessel wall peaked at 24 hr (250 ng/mg) and remained high up to 72 hr (185 ng/mg) after stent placement. Levels of forskolin peaked within 2 hr of stent placement (135 ng/mg) and rapidly declined to 4.9 ng/mg at 24 hr with the stent in situ. About 50% (1.4 mg) of the original etretinate remained in the stent at 72 hr compared to about 5% (0.08 mg) of forskolin at 24 hr. Ratio of peak drug levels in the vessel wall to those in the blood was 6,000 for etretinate and 780 for forskolin. After stent removal at 72 hr, levels of etretinate in the aortic wall declined from 74 ng/mg to 29 ng/mg at 1 day and to 14 ng/mg at 4 days. Levels of forskolin declined rapidly within 2 hr of stent removal from 134 ng/mg to 1.2 ng/mg and further to 0.12 ng/mg within 24 hr. Polymer‐coated stents could be used for local drug delivery to the vessel wall. Kinetics of delivery and washout vary between drugs.
Myocardial bridging involving more than one site of the left anterior descending coronary artery: An uncommon cause of acute ischemic syndrome
Authors: Mazzù Antonio , Tano Giuseppe Di , Cogode Riccardo , Presti Giacomo Lo
Published: March 2007

An infrequent angiographic finding is reported of myocardial bridging involving more than one site of the left anterior descending coronary artery in a symptomatic patient with ischemia exacerbated by nitroglycerin administration. Beta‐blocker therapy alone was followed by a favorable long‐term outcome.
Activated clotting times in acute coronary syndromes and percutaneous transluminal coronary angioplasty
Authors: Wilson James M. , Dougherty Kathryn G. , Ellis Karen O. , Ferguson James J.
Published: March 2007

A discrete fall in the ACT (activated coagulation time) has been observed in patients with known activation of the coagulation cascade. Injury to the coronary artery resulting in thrombin activation, whether spontaneous as in the case of acute myocardial infarction or planned as with percutaneous transluminal coronary angioplasty (PTCA), may there‐fore be reflected in a change in ACT values. We reviewed the records of patients under‐going PTCA at St. Luke's Episcopal Hospital/Texas Heart Institute from January 1990 through December 1992 for information regarding ACT values and clinical events. A total of 469 patients, whose record contained adequate information for study inclusion, were divided into four separate groups: acute myocardial infarction (group I, n = 62), unstable angina with heparin therapy that was withdrawn at least 4 hr prior to PTCA (group II, n = 102), unstable angina with heparin therapy continued until the time of PTCA (group III, n = 154), and stable angina undergoing elective PTCA (group IV, n = 151). Heparin was discontinued 12–15 hr after the procedure in all but group I where anticoagulation was often maintained up to 72 hr. ACT values were measured prior to the PTCA procedure (baseline), after the initial heparin bolus of 10,000 U (postheparin) and ∼ 12–18 hr after the procedure (heparin withdrawal). The “baseline” ACT was significantly lower in patients with unstable angina (93 ± 13 sec) or acute myocardial infarction (78 ± 9 sec) who had their baseline value obtained off of heparin therapy than in patients with stable angina (136 ± 21 sec) or those receiving heparin at the time of baseline measurement (135 ± 14 sec,P< 0.001). All patients with unstable coronary syndromes had a blunted response to heparin (group 1–189 sec, group II‐221 sec, group III‐248 sec). Although groups I‐III were not significantly different compared to one another, each was significantly lower than group IV whose past heparin ACT was 279 sec. Heparin withdrawal ACT values fell within the ranges seen in patients with unstable coronary syndromes untreated with heparin in all but group I (whose heparin therapy was continued through the time of the 12–18‐hr postprocedure measurement time). Recurrent ischemic events were seen with increased frequency (16.6%) only in patients with unstable angina whose heparin therapy was interrupted prior to PTCA.

In conclusion, low baseline ACT values and a blunted ACT response to heparin are associated with clinical syndromes known to result from thrombus formation. The possibility that the ACT may be of value in reflecting thrombus activity requires prospective evaluation.
Echocardiographic predictors of candidacy for successful transcatheter atrial septal defect closure
Authors: Rosenfeld Howard M. , Van Der Velde Mary E. , Sanders Stephen P. , Colan Steven D. , Parness Ira A. , Lock James E. , Spevak Philip J.
Published: March 2007

We reviewed pre‐closure echocardiograms on all patients undergoing transcatheter atrial septal defect (ASD) closure with the Bard double‐umbrella occluder device aided by simultaneous transesophageal echocardiography to determine precatheterization predictors of outcome. Transesophageal echocardiograms were performed on 28 of 132 patients (22%) undergoing device closure (age = 3–72 years, mean = 14 years; weight = 15–68 kg, mean = 35 kg). Three devices were removed because of unstable position. Of the remaining 25 patients, 21 had effective closure (residual flow diameter ≤ 3 mm) and 18 had favorable arm position (device arm on proper side of the septum and not in contact with an atrioventricular valve leaflet).

Only ASD size predicted effective closure. All patients with a maximum defect size of < 13 mm had effective closure. Among the 17 patients with defects ≥ 13 mm, 10 had effective closure, 4 had significant residual flow, and 3 had devices removed for unstable position. Atrial dimensions and rim size did not predict effective closure. There were no pre‐closure predictors of favorable arm position which was associated only with the size of the device implanted.
Damage to the collateral circulation by ptca of an occluded coronary artery
Authors: Pijls Nico H. J. , Bracke Frank A. L. E.
Published: March 2007

In this report, a patient is described with an occluded left circumflex artery, in whom the corresponding myocardium was protected at rest by sufficient collateral circulation. Because of angina pectoris class III, a PTCA of that occluded vessel was performed, complicated by a large dissection. Recruitable collateral flow, assessed from pressure calculations by a new technique, suddenly decreased at the very moment of dissection. This was accompanied by resting pain and ischemia on the ECG. This case report confirms the hypothesis that the collateral circulation can be damaged by PTCA and emphasizes that every PTCA implies a definite risk, even in case of an occluded coronary artery filled by collaterals.
Reduction of femoral arterial bleeding post catheterization using percutaneous application of fibrin sealant
Authors: Ismail Suad , Combs Matthew J. , Goodman Norman C. , Teotia Sumeet S. , Teates Charles D. , Abbott Robert D. , Fechner Robert E. , Nolan Stanton P. , Powers Eric R. , Spotnitz William D.
Published: March 2007

The number of cardiac catheterizations performed yearly is growing with correspondingly increasing amounts of morbidity, complications, and hospital costs. This study suggests that fibrin sealant instillation via an arterial sheath at the completion of femoral catheterization may improve hemostasis. Results using fibrin sealant in 12 unheparinized dogs documented significant reductions (McNemar's exact test) versus control for groin ecchymoses (1 versus 8,P= .008) and radiolabeled hematoma formation (0 versus 7,P= .016). Also swelling was less in the fibrin sealant treated groins when compared to control groins (1 versus 6,P= .125), but failed to reach statistical significance. Results in eight heparinized dogs (activated clotting time 374 ± 22, mean ± SEM) revealed a statistically significant reduction in signs of gross bleeding in the fibrin sealant‐treated groins (1 versus 8,P= .016). This method may contribute to reduced morbidity, complications, and length of hospitalization. It may also allow for earlier patient mobilization after cardiac catheterization.
Coronary stenting without anticoagulation
Authors: Mehan Vivek K. , Salzmann Christian , Kaufmann Urs , Meier Bernhard
Published: March 2007

Stents are useful bail‐out devices in coronary angioplasty. They are also used electively for situations associated with poor angioplasty results (e.g., restenotic lesions, venous grafts) and may reduce restenosis rates. However, the significant incidence of stent thrombosis necessitated aggressive anticoagulation with associated hemorrhagic complications. This remains a major limitation of stenting. We present our experience of stenting with half (disarticulated) Palmaz‐Schatz coronary stents in eight consecutive patients, managed with aspirin alone. No patient experienced acute or subacute stent thrombosis.
Coronary artery stenting for acute closure complicating primary angioplasty for acute myocardial infarction
Authors: Walton Antony S. , Oesterle Stephen N. , Yeung Alan C.
Published: March 2007

We report a case of progressive right coronary artery dissection complicating direct angioplasty for an acute inferior myocardial infarct, with successful bail‐out stenting of the affected vessel.
Retrieval of occluding unexpanded palmaz‐schatz stent from a saphenous aorto‐coronary vein graft
Authors: Rozenman Yoseph , Burstein Moshe , Hasin Yonathan , Gotsman Mervyn S.
Published: March 2007

The Palmaz‐Schatz coronary stent is used frequently to reduce the rate of restenosis of balloon angioplasty in saphenous vein grafts. In many European centers, the stent, manually crimped on a balloon, is advanced across the stenosis without a protective sheath. This report describes a patient in whom an attempt to deploy a stent in the orifice of a saphenous vein graft was complicated by dislodgement of the unexpanded stent from the balloon. The unexpanded stent caused immediate occlusion of the vein graft and severe ischemic symptoms. The stent was retrieved by inflation of another balloon in the graft, distal to the stent, pulling the balloon toward the guiding catheter, and then withdrawing the whole system.
Successful transcatheter management of palmaz stent embolization after superior vena cava stenting
Authors: Bartorelli Antonio L. , Fabbiocchi Franco , Montorsi Piero , Loaldi Alessandro , Tamborini Gloria , Sganzerla Paolo
Published: March 2007

A 34‐year‐old patient with benign superior vena cava syndrome (SVCS) was treated with thrombolytic therapy, balloon angioplasty, and placement of two peripheral Palmaz stents. Embolization of one stent to the right atrium occurred 10 min after successful implantation. This serious complication was successfully managed by percutaneous transcatheter technique with retrieval from the right atrium and subsequent deployment into the right external iliac vein of the lost stent. Complete resolution of SVCS symptoms occurred within 24 hr and moderate superior vena cava restenosis was successfully dilated 8 months later. At 12‐month follow‐up the patient continues to be asymptomatic.
Alterations in reference vessel diameter following intracoronary stent implantation: Important consequences for restenosis based on percent diameter stenosis
Authors: Foley J. Brendan
Published: March 2007

The scaffolding effect of stent implantation has the potential to alter vascular geometry and dimensions. The objective of this study was to determine the impact of intracoronary stent implantation on the reference vessel diameter and the consequences of this on the frequency of restenosis applying the binary definitions of restenosis based on percent diameter stenosis. Routine angiographic follow‐up was performed in 79/80 consecutive patients who had a single elective Palmaz‐Schatz stent implanted in denovo lesions in native coronary arteries 6.5±3.4 mo after the index procedure. Complete quantitative angiographic follow‐up was available in 78 (98%). The mean reference vessel diameter was 2.9±0.6 mm preprocedure, increased to 3.1±0.5 mm immediately poststent implantation and was 2.6±0.6 mm at follow‐up (F = 6.45, P = 0.0001, ANOVA for repeated measures). In view of the varying reference vessel diameter, percent diameter stenosis postangioplasty and at follow‐up was determined by two methods: (1) automatically by the quantitative coronary angiographic analysis system and (2) by expressing the minimal luminal diameter postangioplasty and at follow‐up as a function of the original preprocedural reference vessel diameter. The restenosis rate was significantly greater for all definitions of restenosis when the minimal luminal diameter was determined as a function of the original preprocedure reference vessel diameter (e.g., 34% vs. 18% for the ⩾50% criterion, P = 0.018). Stent implantation results in alterations in reference vessel diameter, which have important consequences for the frequency of restenosis presented as a binary variable based on percent diameter stenosis. © 1995 Wiley‐Liss, Inc.
Transcatheter closure of an aortopulmonary window with a modified double umbrella occluder system
Authors: Stamato Theresa , Benson Lee N. , Smallhorn Jeffrey F. , Freedom Robert M.
Published: March 2007

Transcatheter occlusion of a small aortopulmonary window was successfully performed in a child using a double umbrella occluding device. The delivery system was adapted for use through a small sheath from a transvenous approach. Transcatheter closure is feasible in appropriately selected aortopulmonary windows. © 1995 Wiley‐Liss, Inc.
High balloon dilatation pressures in percutaneous transluminal coronary angioplasty are not associated with higher rate of significant complications
Authors: Ebersole Douglas G. , Rubal Bernard J.
Published: March 2007

To examine the results of high balloon dilatation pressures during percutaneous transluminal coronary angioplasty (PTCA), we retrospectively reviewed 482 angioplasty cases from our institution and divided them into three groups by the peak inflation pressure used during the procedure. Group one was defined by inflation pressures of 1–6 atmospheres (atm), group two by 7–12 atm, and group three by 13–20 atm. There were 166 patients in group 1 (34.4%), 235 in group 2 (48.8%), and 81 (16.8%) in group 3. The success rates were not statistically different; 90% in group 1, 96% in group 2, and 95% in group 3. Large dissections occurred in 27 patients in group 1 (16.3%), 19 in group 2 (8.1%), and 4 (4.9%) in group 3 (P > 0.006). There were no differences in the rates of death (1.2% vs. 0.9% vs. 1.2%), myocardial infarction (3.0% vs. 1.3% vs. 3.7%), or in‐hospital CABG (3.0% vs. 1.7% vs. 1.2%) in groups 1, 2, and 3, respectively. Six‐mo target vessel revascularization rates also were not different: 19% vs. 13% vs. 18%. In summary, selectively using high balloon pressures during PTCA does not result in increased complications. © 1995 Wiley‐Liss, Inc.

This article is a US Government work and, as such, is in the public domain in the United States of America.
Subintimal wire position during angioplasty of a chronic total coronary occlusion: Detection and subsequent procedural guidance by intravascular ultrasound
Authors: Kimura Bruce J. , Tsimikas Sotorios , Bhargava Valmik , Demaria Anthony N. , Penny William F.
Published: March 2007

We report a case of intravascular ultrasound (IVUS) imaging of a chronic total coronary artery occlusion angioplasty initially complicated by subintimal wire penetration. IVUS provided unique images of wire position and a “double‐barrel” lumen that complemented angiographic data in initial diagnosis and in subsequent guidance of the procedure. © 1995 Wiley‐Liss, Inc.
Cost comparison between two modes of palmaz schatz coronary stent implantation: Transradial bare stent technique vs. transfemoral sheath‐protected stent technique
Authors: Kiemeneij Ferdinand , Hofland Jan , Laarman Gert Jan , van der Elst Daniëlle Hupkens , Lubbe Harry Van Der
Published: March 2007

Coronary Palmaz Schatz stent implantation is usually performed by using the sheath protected stent delivery system (SDS) via the percutaneous transfemoral route. However, downsizing of PTCA equipment made transradial coronary stenting feasible. Bare stent implantation, 6F technique, increased patient mobility, reduced vascular complications and reduced hospital stay may increase cost effectiveness of this novel technique.

Two well‐documented patient groups selected for elective single vessel and single lesion Palmaz Schatz stent implantation were retrospectively compared. Group A (transradial stenting; n = 35) was compared to Group B (transfemoral stenting; n = 25) derived from the Benestent population, included in our hospital. A comparison was made for three areas of interest: (1) procedural consumption of material (the number of guiding catheters, guidewires, balloon catheters and stents), (2) postprocedural need for diagnostic and therapeutic procedures for stent‐related complications, and (3) duration of hospital stay. Differences between these subjects in Group A and B were translated to hospital costs.

Although more guiding catheters were used in group A (1.69 ± 0.87 vs. 1.08 ± 0.28; P=0.001), the use of the SDS contributed importantly to higher material costs in group B (cost reduction in group A; 13%). Less patients in group A required diagnostic (2 vs. 7; P=0.027) and therapeutic (0 vs. 5; P=0.01) procedures for bleeding complications (cost reduction; 93%). Hospitalization in Group A was shorter (6.4 ± 4.7 vs. 11.6 ± 9.9 days; P=0.005), caused by early and safe mobilization, less vascular complications, and preprocedural adjustment on coumadin (cost reduction; 45%). Overall, the mean cost per patient in group A was 67% of these costs in group B.

Significant savings were realized with the transradial bare stent technique, by reduction of costs for angioplasty material, diagnostic and therapeutic procedures for stentrelated complications and hospital stay. © 1995 Wiley‐Liss, Inc.
Assessment of collateral flow during balloon coronary occlusion by intracoronary blood flow velocity analysis
Authors: Piek Jan J. , Koch Karel T. H. , van Liebergen Rob , Peters Ron J. G. , David George K.
Published: March 2007

Coronary blood flow velocity analysis of the contralateral and of the ipsilateral artery can be used to assess collateral flow during controlled balloon coronary occlusion. Coronary blood flow velocity assessment in combination with measurement of aortic pressure and coronary wedge pressure permits expression of the development of the collateral circulation in terms of flow and resistance. The application of both techniques is illustated in two patients. © 1995 Wiley‐LIss, Inc.
Responses of systemic and pulmonary veins to the presence of an intravascular stent in a swine model
Authors: Hosking Martin , Redmond Mary , Allen Lila , Broecker Lother , Keaney Marilyn , Lebeau Julie , Walley Virginia
Published: March 2007

The outcome of stent implantion for children with pulmonary venous obstruction has been characterized by late reocclusion associated with a marked vessel neointimal proliferation. The purpose of this study was to compare the responses of the systemic vein and pulmonary vein to the presence of an intravascular stent, using a Yorkshire swine (N = 10) model. Under cardiopulmonary bypass, a single Palmaz stent was placed in the inferior vena cava (IVC) and right lower pulmonary vein (PV) with sacrifice at 4.9–6.1 months. Angiography and hemodynamic data were determined at 1 and 3 months post‐stent implant and prior to euthanasia. All stents were found to be patent, with no difference in degree of thrombosis or neointimal formation. No statistical difference was found in the initial and final stent diameter for both inferior vena cava and pulmonary vein stents (PV initial 6.8±0.9; final 7.1±0.6) (IVC initial 10.4±1.2; final 10.4±1.2). Electron microscopy demonstrated smooth endothelialization of both pulmonary and systemic venous stent devices. No thrombosis was found on gross morphology. The data indicate that there is no intrinsic difference in the response of the pulmonary vein to the presence of a stent device. The clinical experience of restenosis following stent implantation for pulmonary vein stenosis appears to be more related to variables of final stent diameter combined with the marked intrinsic abnormal vessel architecture, as seen with this condition. © 1995 Wiley‐Liss, Inc.
Critical role of pulmonary angiography in the diagnosis of pulmonary emboli following cardiac surgery
Authors: Ramos Roque S. , Salem Bakr I. , Haikal Maged , Gowda Siddhesh , Coordes Cordie , Leidenfrost Ronald
Published: March 2007

This study was conducted to identify patients at high risk of the development of Pulmonary Embolism (PE) after open heart surgery, to evaluate pertinent diagnostic methods, and to assess the mortality associated with this complication. We evaluated the records of 2,551 consecutive patients who underwent open heart surgery over a 10‐year period to identify those patients in whom PE developed. All surgical reports, ventilation/perfusion scans, pulmonary angiograms, and autopsies from the same period were also reviewed. Preoperative and postoperative risk factors for pulmonary embolism were also analyzed, as well as the outcome of this complication in each type of surgical procedure.

Pulmonary embolism was identified in 69 (2.7%) patients after open heart surgery, in 43 (62.3%) of whom the diagnosis was established within the first week of surgery. Factors associated with high incidence for PE were hyperlipidemia, congestive heart failure and heparin‐induced thrombocytopenia (P <0.001); obesity and prolonged mechanical ventilation (P <0.005); and prior right heart catheterization by the femoral approach and prior PE and/or deep vein thrombosis (P <0.05). The diagnosis of PE was established by a high‐probability ventilation/perfusion scan in 25 patients, by pulmonary angiography in 42 (29 of whom had prior V/Q scan read as intermediate or low probability for PE) and by autopsy in two patients. The mortality rate in patients who had PE was 7.2%, while in those without this complication it was 3.2%.

These findings suggest that aggressive approach for the diagnosis of PE by pulmonary angiography whenever the V/Q scan is not read as high probability is crucial in patients with recent open heart surgery; such approach may identify patients with PE at an early stage and may have an impact in reducing mortality incurred by this complication. This diagnostic assessment should be emphasized in the perioperative period, especially in patients with multiple significant and identifiable risk factors for PE. © 1995 Wiley‐Liss, Inc.
Perforation of a side branch of the right coronary artery during selective coronary angiography using 5 french judkins catheters
Authors: Schöbel Wolfgang Andreas , Voelker Wolfram , Karsch Karl Rüdiger
Published: March 2007

In this case report the first known case of a perforation of a side branch of the right coronary artery during diagnostic coronary angiography using 5 French Judkins catheters is described which occurred by selective intubation. Although catheter placement was controlled by contrast test injection the catheter occasionally intubated the conus artery superselectively just prior to the diagnostic injection. Thus, perforation of small side branches may be encountered especially by the use of 5 French Judkins catheters. © 1995 Wiley‐Liss, Inc.
Intracoronary stenting of a coronary occlusion resulting from an aortic dissection
Authors: Ikari Yuji , Hara Kazuhiro , Tamura Tsutomu , Hara Hidehiko , Saeki Fumihiko , Kikawa Ikutarou , Wanibuchi Yasuhiko , Yamaguchi Tetsu
Published: March 2007

Acute myocardial infarction secondary to aortic dissection may occur due to compression of the coronary arteries by a hematoma or extension of the dissection into the coronary arterial wall. We report a patient with this condition who was successfully treated by Palmaz‐Schatz stenting, providing an alternative to thrombolysis or angioplasty. © 1995 Wiley‐Liss, Inc.
Mitral dilatation with the multi‐track system: An alternative approach
Authors: Bonhoeffer Philipp , Piéchaud Jean‐Francois , Sidi Daniel , Yonga Gerald , Jowi Christine , Joshi Mark , Mugo Michael , Kachaner Jean , Parenzan Lucio
Published: March 2007

We developed a simple and versatile new technique (Multi‐Track) for percutaneous mitral valvotomy using two separate balloon catheters positioned on a single guidewire. The first catheter, with only a distal guidewire lumen and a proximal balloon, is introduced over the guidewire into the vein and then advanced into the mitral valve orifice. Subsequently, a normal balloon catheter running on the same guidewire is inserted and lined up with the first catheter so the two are positioned side by side. The balloons are then inflated simultaneously.

The technique was applied in 12 patients between 10 and 44 years of age (mean, 27.1) and weighing 24–80 kg (mean, 50.3). Valve area increased from 0.66 cm2 (range, 0.3–0.9 cm2) to 1.97 cm2 (range, 1.3–3.1 cm2) and mean left atrial pressure dropped from 31 mmHg (range, 18–52 mmHg) to 12 mmHg (range, 5–22 mmHg).

Mitral dilatation with the Multi‐Track system gives results comparable to those with previously described techniques and uses simpler and less costly catheters. © 1995 Wiley‐Liss, Inc.
Transcatheter closure of large atrial septal defects with the babic system
Authors: Sievert Horst , Babic Uros U. , Ensslen Roland , Scherer Detlef , Spies Hans , Wiederspahn Thomas , Zeplin Harald E.
Published: March 2007

An improved 10 Fr version of the atrial septal defect (ASD) occlusion system consisting of two umbrellas for transvenous introduction over the long veno‐arterial guide‐wire was used to attempt closure in five adult patients with large defects (26–35 mm). The umbrellas are made of nitinol wire frame and a thin membrane of microporous polyurethane. Supported by the metal cannula and guided by selective left atriography, the umbrellas of 45–60 mm were placed individually into the atria and screwed together at the septum level by means of a torquer catheter. Positioning and screwing on, unscrewing, separating, and repositioning the umbrellas up to 17 times were needed to anchor the prosthesis correctly in a patient. The prosthesis could be implanted primarily in all patients (in one at second session). Dislodgement of a 60 mm prosthesis and left atrial perforation with a 55 mm prosthesis required surgery in two patients 8 hours and 2 weeks post procedure, respectively. A single umbrella‐arm fracture was noticed in one patient 4 months after the implantation. All five patients were free of symptoms at follow‐up after 7–10 months. Transcatheter closure of large ASDs is technically feasible with this system. The morbidity is mainly associated with the implantation of very large umbrellas. © 1995 Wiley‐Liss, Inc.