bluuebunny/crossref_metadata_2025 huggingface dataset:
Balloon angioplasty of a tissue conduit stenosis after surgical repair of anomalous left coronary artery
Authors: Carey Daniel , Vincent Robert N. , Brames Gregory P. , Williams Willis H. , Douglas John S.
Published: March 2007

Surgical correction of anomalous coronary arteries may result in late conduit or anastamotic stenosis. In this case report, we describe the use of coronary angioplasty to dilate a stenosis at the aortic ostium of an intrapulmonary tunnel created to correct an anomalous left coronary artery from the pulmonary artery.
© 1993 Wlley‐Liss, Inc
Urgent/Emergent percutaneous transvenous mitral commissurotomy
Authors: Wu Jong‐Jen , Chern Ming‐Shyan , Yeh Kou‐Ho , Chen Yu‐Ching , Fu Morgan , Hung Jui‐Sung
Published: March 2007

Urgent/emergent percutaneous transvenous mitral commissurotomy (PTMC) was performed in 10 patients (two men and eight women, aged 21 to 60 yr). All patients had arterial hypoxemia and four required mechanical respirators. PTMC was performed in the semi‐recumbent position in four patients. The seven patients with pliable valves (group 1) achieved good hemodynamic and echocardiographic results after PTMC, but one died 2 wk later because of sepsis complicating preexisting pneumonitis. The two pregnant patients uneventfully delivered normal babies at term. There was continued clinical improvement in the six surviving patients at last follow‐up at 11 to 39 mon (median 26). Of the three patients with calcified valves and severe subvalvular lesions (group 2), the premoribund patient in whom last‐resort PTMC created severe mitral regurgitation died 3 days later of multiple organ failure. The other two patients underwent mitral valve replacement 1–6 days later because of lack of clinical improvement due to creation of severe mitral regurgitation and ineffective mitral valve dilation, respectively. In conclusion, urgent/emergent PTMC is feasible and safe. However, its outcomes are dictated by the status of diseased mitral valve and coexisting illness.
Anomalous origin of the left main coronary artery from the right coronary artery ostium‐interarterial subtype: Angiographic definition and surgical treatment
Authors: Selig Michael B. , Jafari Nercy
Published: March 2007

Coronary artery anomalies occur infrequently compared to atherosclerotic disease; however, when they do occur, they can pose difficulty with coronary visualization and identification. Ectopic origin of the left mainstem coronary artery from the right sinus of Valsalva coursing between the great vessels is the rarest subtype of these anomalies, can be potentially serious, and presents unique problems for surgical treatment.
Mechanical left ventricular unloading during high risk coronary angioplasty: First use of a new percutaneous transvalvular left ventricular assist device
Authors: Scholz Karl H. , Figulla Hans R. , Schweda Frank , Smalling Richard W. , Hellige Gerhard , Kreuzer Heinrich , Aboul‐Hosn Walid , Wampler Richard K.
Published: March 2007

A new catheter mounted, transvalvular left ventricular assist device has been designed for percutaneous transfemoral access. The device, the Hemopump™ [14 French (Fr.) outer diameter], is based on a mixed flow rotary pump and is capable of flow rates of 1.5–2.2 1/min. The pump is inserted using a specialized 16 Fr. femoral introducer sheath. The first application of the percutaneous Hemopump™ in man was performed in two patients with hemodynamic compromise during high risk coronary angioplasty. In these patients, Hemopump™ support resulted in hemodynamic stabilization (increase in aortic pressure from 60/42 to 87/61 and from 80/60 to 100/70 mm Hg, respectively) and marked left ventricular unloading (decrease in pulmonary capillary wedge pressure from 25 to 10 and from 14 to 10 mm Hg) during balloon inflation. In both patients, percutaneous transluminal coronary angioplasty (PTCA) could be accomplished successfully. Using the system for periods of about 2 hr in each patient, we observed no vascular, hemorrhagic, or embolic complications. In both patients, only a minor increase in both plasma free hemoglobin and lactate dehydrogenase levels was noted. Our preliminary experiences suggest that the percutaneous Hemopump™ is safe and effective and may be a powerful alternative to other devices used for supported angioplasty.
Comparison of results of intracoronary stenting in patients with unstable vs. stable angina
Authors: Malosky Steven A. , Hirshfeld John W. , Herrmann Howard C.
Published: March 2007

Percutaneous transluminal coronary angioplasty (PTCA) has higher complication and restenosis rates when performed in the setting of unstable angina. Balloon‐expandable intracoronary stenting is a new technique with the potential to improve the results of PTCA. In order to determine whether stenting is associated with a poorer outcome in patients with unstable angina, we retrospectively examined our experience with the Palmaz‐Schatz balloon‐expandable intracoronary stent in 105 patients. Patients were divided into 2 groups on the basis of symptoms at the time of stent insertion: group I (n = 57) had stable angina pectoris, and group II (n = 48) had unstable angina defined as pain at rest despite antianginal therapy (Braunwald class II, III). Initial (30‐d) and final (6‐mo) success rates were defined as stent insertion without myocardial infarction, need for bypass surgery, death, and significant angina.

Baseline characteristics were similar, although the patients with unstable symptoms were older, more likely to be female, and had a higher incidence of postinfarction angina. A total of 136 stents were successfully delivered to 97 target sites in 92% of patients. Major complications occurred in 4 patients (4%) and were due to subacute thrombosis in 3 of them. There were no differences in complication rates between patients receiving stents electively with stable vs. unstable symptoms (2% vs. 6%, p = NS).

Six‐mo. follow‐up status was ascertained in 96% of patients and revealed overall clinical success in 83% with angiographic restenosis (≥ 50% stenosis) in 28% of patients. There were no significant differences between groups in rates of restenosis, follow‐up angina class, or overall clinical success.

Patients with unstable angina receiving intracoronary stents have similar complication, restenosis, and initial and final success rates as compared to stent placement in patients with stable symptoms. This finding differs from previous observations of conventional PTCA and may result from mechanical improvements in the vessel due to the stent (e.g., sealing intimal dissections) or the associated anticoagulation regimen.
On‐Line quantitative coronary analysis in clinical practice: One step closer to reality?
Authors: Ribichini Flavio , Steffenino Giuseppe , Dellavalle Antonio , Mina Paola , Cerati Riccardo , Dalmasso Marilena , Uslenghi Eugenio
Published: March 2007

Quantitative coronary analysis is widely used in studies of progression/regression and restenosis of coronary lesions. On‐line digital systems are used in diagnostic coronary angiography, and as a guide in coronary interventions. The aim of this investigation was to test the reliability of measures obtained with one commercially available on‐line equipment. Well‐visualized coronary lesions from patient studies were analyzed for variability in single‐frame measurement. Procedural factors affecting the consistency of measurements were identified by repeated visualization of the same coronary lesion with hand‐and power‐injection of contrast in various positions in the field of the image intensifier, and by imaging of steel phantoms in the same positions. Steel phantoms closely resembling coronary lesions as encountered in practice were visualized in the most favourable radiologic setting compatible with clinical situations. Accuracy and precision of measurements were found to be worse than reported in validation studies. This may be due to a host of variables which may need to be tested in each laboratory performing on‐line quantitative coronary angiography, when data so obtained are to be used in clinical decision making or in research studies.
Effect of balloon inflation in angiographically normal coronary segments during coronary angioscopy: A quantitative angiographic study
Authors: Hamon Martial , Lablanche Jean‐Marc , Bauters Christophe , McFadden Eugène P. , Quandalle Philippe , Bertrand Michel E.
Published: March 2007

Visualization of coronary stenoses by coronary angioscopy is facilitated by inflating an occlusive cuff located near the distal end of the device to temporarily interrupt blood flow. In animal models, this procedure induces substantial endothelial denudation. Experimental studies show that endothelial denudation may lead to neointimal hyperplasia at the denuded site. This study was designed to determine whether angioscopy was associated with significant changes in lumen diameter at the site of cuff inflation. We studied 52 consecutive patients undergoing coronary angioscopy. We measured with use of quantitative edge‐detection angiography [computer‐assisted evaluation of stenosis and restenosis (CAESAR) system] the mean and minimal lumen diameters at the site of cuff inflation localized by filming the inflated cuff during angioscopy and at control non‐instrumented segments on angiograms performed before angioscopy, after angioscopy, and at 6 months follow‐up. Follow‐up angiograms were performed in 80% of eligible patients. At follow‐up, the mean (3.22 ± 0.54 mm) and minimal (2.76 ± 0.58 mm) diameters of the segment exposed to the inflated cuff were not significantly different from the equivalent values (3.22 ± 0.58 and 2.75 ± 0.61 mm) before angioscopy. No significant changes occurred in the mean or minimal diameters of the control segments over the same period. The late change (follow‐up minus pre‐angioscopy) in mean lumen diameter at the cuff inflation site (‐0.005 ± 0.18 mm) was not significantly different from that at the control site (0.004 ± 0.20 mm). While it is impossible to determine with certainty whether inflation of the angioscopy cuff causes endothelial denudation in man, the trauma associated with balloon cuff inflation does not have detectable long‐term effects on epicardial lumen diameter.
Prolonged intragraft urokinase with a new infusion wire: Improved short‐term results
Authors: Cundey Paul E. , Whitlock R. R. , Norman Joyce , Edwards Marcia , Cundey Paul E.
Published: March 2007

Patients with aged saphenous vein grafts and recurrent symptoms of angina are being seen with increasing frequency [Bourassa: J Am Coll Cardiol 17:1081–1083, 1991]. The treatment of these patients remains a dilemma. Direct balloon angioplasty is frequently complicated by distal embolization and early restenosis [Aureran and Gruentzig: Am J Cardiol 53:953–954, 1984]. There is evidence that thrombus plays a significant role in this occlusive process [Hartmann et al.: J Am Coll Cardiol 18:1517–1523, 1991]. Prolonged intragraft urokinase infusion with a new multiside hole infusion catheter debulks thrombus and permits balloon angioplasty without the usual complications.
Starr‐Edwards valve thrombosis detected preoperatively by transesophageal echocardiography
Authors: Pollock Stewart G. , Dent John M. , Simek Chris L. , Gimple Lawrence W. , Johns Roger A. , Kaul Sanjiv , Spotnitz William D.
Published: March 2007

A 31‐year‐old woman developed increasing signs of congestive heart failure 15 years following placement of a mitral Starr‐Edwards mechanical valve. A preoperative transesophageal echocardiogram (TEE) demonstrated a large, obstructive valvular thrombus and the patient underwent successful reoperative valve replacement.
Peripheral vascular complications of coronary angioplasty by the femoral and brachial techniques
Authors: Johnson Lewis W. , Esente Paolo , Giambartolomei Alessandro , Grant William D. , Loin Melissa , Reger Mark J. , Shaw Claude , Walford Gary D.
Published: March 2007

In order to monitor the incidence and types of peripheral vascular complications in a single institution, we prospectively entered 1,579 coronary angioplasty cases into a computer data base during the years 1991 and 1992. Various periprocedural risk factors were analyzed. The patients were followed closely to identify complications that occurred outside the laboratory or after discharge from the hospital.

Peripheral vascular complications occurred in 37 patients (2.37%) and included hematoma 20 (1.27%), retroperitoneal bleeding 7 (.44%), false aneurysm 6 (.38%), occlusion 1 (.06%), infection 2 (.13%), and cholesterol emboli 1 (.06%).

Risk factors for complications by multivariate analysis were older age, female gender, and clinical evidence of peripheral vascular disease. Other factors potentially related to vascular trauma or bleeding tendency that were not risk factors in this series were clinical presentation, use of heparin or thrombolytic agents, blood clotting parameters, and arterial sheath size. There was no significant difference between the femoral and brachial approaches in frequency of complications (2.5% vs. 1.6%), but femoral complications tended to carry greater morbidity.
Inter‐Series differences in the restenosis rate of palmaz‐schatz coronary stent placement: Differences in demographics and post‐procedure lumen diameter
Authors: Carrozza Joseph P. , Kuntz Richard K. , Schatz Richard A. , Leon Martin , Goldberg Sheldon , Savage Michael , Fischman David , Senerchia Cynthia , Diver Daniel J. , Baim Donald S.
Published: March 2007

Restenosis rates following Palmaz‐Schatz stenting vary between 13 and 36%. To determine whether the nearly three‐fold interseries difference in restenosis rates reflects systematic factors (demographic and procedural variables such as post‐treatment lumen diameter) rather than random variation, we pooled 486 lesions treated with the Palmaz‐Schatz coronary stent in the U.S. Multicenter Registry (n = 259) with the single‐center Beth Israel Hospital experience (n = 227) and analyzed the combined series using a continuous geometric model of restenosis.

A greater proportion of lesions (66 vs. 50%; P < 0.001) in the Multicenter cohort represented restenosis after a prior intervention. The Multicenter experience also showed a smaller minimum lumen diameter following stent placement (2.61 vs. 3.43 mm; P < 0.001), higher post‐stent percent stenosis (16 vs. –2%; P < 0.001), and less acute gain (1.79 vs. 2.67 mm; P < 0.001) than lesions treated in the Beth Israel cohort. At 6‐month follow‐up, the angiographic restenosis rate (≥ 50% diameter stenosis) was significantly higher in the Multicenter group (35 vs. 27%; P = 0.05), despite the development of less absolute late loss (0.96 vs. 1.32 mm; P < 0.001). Multivariable modeling, however, showed that the only independent predictors of restenosis were a post‐procedure lumen diameter < 2.80 mm (odds ratio = 1.57; P = 0.04), diabetes mellitus (odds ratio = 3.55; P < 0.001), and prior restenosis (odds ratio = 1.84; P = 0.008).

Since center (Beth Israel vs. Multicenter) was eliminated from the multivariable model after inclusion of these variables, the observed higher restenosis rate in the Multicenter series of Palmaz‐Schatz coronary stents can thus be explained in part by differences in demographics (more previously treated lesions) and procedural details (a smaller posttreatment lumen diameter). Since post‐procedure lumen diameter is a strong predictor of freedom from restenosis in the pooled experience, the probability of restenosis within a Palmaz‐Schatz stent can be decreased by obtaining a large post‐procedure lumen diameter.
Discrepancy between visual estimation and computer‐assisted measurement of lesion severity before and after coronary angioplasty
Authors: Desmet Walter , Willems Jos , Lierde Johan Van , Piessens Jan
Published: March 2007

One hundred fourteen coronary stenoses were quantified before and after percutaneous transluminal coronary angioplasty (PTCA) using a semi‐automated digital system. The values obtained were considered as standard for comparison with visual estimation by the PTCA operator as well as by independent consensus‐reading. The measured percent stenosis was 62.7 ± 13.7% before and 27.7 ± 12.4% after angioplasty. Before PTCA, the operator consistently overestimated stenosis severity (87.8 ± 8.5%, P < 0.0001) and consensus‐reading reduced but did not eliminate this overestimation (78.0 ± 12.3%, P < 0.05). The error in visual estimation was inversely correlated with the measured degree of stenosis: coefficients were –0.79 (P < 0.0001) and –0.51 (P < 0.0001) for operator and consensus‐readers, respectively. After PTCA, the operator underestimated the residual stenosis (21.2 ± 9.9%, P < 0.0001) but there was no systematic bias by consensusreading (29.4 ± 12.0%, NS). Again the error in visual estimation was inversely correlated with the measured degree of residual stenosis : coefficients were –0.76 (P < 0.0001) and –0.58 (P < 0.0001) for operator and consensus‐reading, respectively.

In conclusion, the operator overestimates lesion severity before and underestimates moderate residual stenoses after PTCA, a problem only partially corrected by independent consensus‐readers.
Local thrombolytic therapy in superior vena cava syndrome secondary to malignant thymoma: A case report and literature review
Authors: Enders Gary C. , Sodums Marcis T.
Published: March 2007

Superior vena caval (SVC) obstruction due to malignant thymoma is exceedingly uncommon. We report a case of SVC syndrome where local intravenous thrombolytic therapy uncovered an SVC tumor mass not detected by high resolution computed tomography or magnetic resonance imaging scanning. Local intravenous thrombolytic therapy may be therapeutic in central venous obstruction and may facilitate the diagnosis of the underlying cause of obstruction.
Pros and cons of perfusion balloons in failed angioplasty
Authors: Foley J. Brendan , Sridhar Kumar , Dawdy John , Konstantinou Chris , Brown Robert I. G. , Penn Ian M.
Published: March 2007

Prolonged inflation with perfusion balloons is commonly used in failed angioplasty. The objective of this study was to determine the angiographic outcome of 59 consecutive patients treated with prolonged inflation with perfusion balloons as the primary treatment for failed angioplasty. Angiographic success (< 50% stenosis and normal flow) was achieved in 41%. Angiographic success was greater in the left anterior descending coronary artery (67% versus 33% for non‐left anterior descending involvement, P = .044) and was less in complex dissections (25% versus 75% for no dissection or simple dissections, P = .025). Angiographic deterioration occurred in 37.5% of the successful group and 77% of the unsuccessful group (P = .002) and was more frequent in the right coronary artery (88% versus 50% for non‐right coronary involvement, P = .007) and complex dissections (92% versus 38% for no dissection or simple dissections, P = .0001). Thus, in a group of patients with unsuccessful outcome following conventional balloon angioplasty, success with the perfusion balloon was modest. Furthermore, angiographic deterioration was frequently observed following unsuccessful prolonged inflation.
Coronary angioplasty in a patient with situs inversus totalis and a single coronary artery
Authors: Wester J. P. J. , Ernst J. M. P. G. , Mast E. G. , Plokker H. W. M. , Bal E. T. , Verzijlbergen J. F.
Published: March 2007

A patient with congenital situs inversus totalis and a single coronary artery was referred for revascularization because of progressive disabling angina. Exercise thallium scintigraphy had disclosed ischaemia in the anterolateral, posterolateral, and inferior wall of the left ventricle. Percutaneous transluminal coronary angioplasty was performed successfully for stenoses in the right coronary artery.
Placement and angiographic patency of the strecker coronary stent
Authors: Laird John R. , Carter Andrew J. , Kufs William M. , Farb Andrew , Prewitt Kerry C. , Wortham Dale C.
Published: March 2007

The Strecker stent is a newer, balloon‐expandable vascular prosthesis consisting of a single tantalum filament knitted into a flexible mesh tube. To test the placement characteristics and patency of this device, we implanted 29 stents in the coronary arteries of 24 juvenile Yorkshire swine. Seventeen stents were placed in the left anterior descending artery, and 12 were placed in the left circumflex system. All stents were deployed successfully. Four animals died within the first 24 hr of anesthesia‐related complications. The remaining animals were sacrificed at 24 hr, 1 week, 2 weeks, or 4 weeks. Follow‐up angiography demonstrated the patency of all stents. There were no episodes of stent migration or side branch occlusion.

The Strecker stent has several favorable characteristics, including its unique delivery system, ease of deployment, flexibility, radiopacity, and radial strength. There was 100% patency at up to 4 weeks in this animal model. Further studies are required to define whether the knitted mesh design offers any advantage over previous models.
Evaluation of the systematic use of a new type of diagnostic/interventional 6f catheters for coronary angiography and angioplasty
Authors: Chatelain Pascal , Urban Philip , Camenzind Edoardo , Verine Vitali , Hoang Vincent , Metz Damien
Published: March 2007

Coronary angioplasty performed immediately after coronary angiography has raised interest to develop diagnostic catheters potentially usable for interventions (i.e. Diaventional™ catheters). To evaluate the performance and cost‐effectiveness of such material, we performed a prospective study in 100 consecutive patients with a > 50% pre‐angiographic likelihood of coronary angioplasty in 85 of them. Angioplasty was actually performed in 61 patients. Of the 56 (92%) immediate angioplasty procedures, 33 (59%) were performed successfully with the Diaventional™ catheter chosen initially. In 23 cases, another guiding catheter was used for technical failure (2 cases) or because of operator's choice (21 cases). Angiographic success of angioplasty procedures was 97% with Diaventional™ and 91% with “standard” guiding catheters. Based on current market prices, the costs of the systematic use of such diagnostic/interventional catheters were 11% less than the projected costs of the standard strategy.

Thus, this new type of catheter is both safe and cost‐effective for the majority of coronary angioplasty procedures “at first sight.” It could become a logical first choice for diagnostic coronary angiography, when the likelihood of immediate subsequent angioplasty is high and at relatively low risk.
Fracture of a perfusion balloon catheter during coronary angioplasty
Authors: Kuan Peiliang , Ko Yu‐Lin , Tsai Chang‐Her , Lin Jiunn‐Lee
Published: March 2007

In a 74‐year‐old patient with increasing angina, an attempt was made to dilate an ostial stenosis in the first diagonal artery. The initial attempt with a long balloon catheter was unsuccessful. Because of chest pain associated with hypotension during balloon inflations, a second attempt with a perfusion balloon catheter resulted in fracture of this catheter's tip (14 mm long) in the artery. Bypass graft surgery was performed and the retained fragment was easily removed by arteriotomy. The patient made an uneventful recovery. © 1994 Wiley‐Liss,Inc..
Physiologic assessment of ostial left circumflex coronary artery disease using a doppler guidewire before and after rotational atherectomy facilitated angioplasty
Authors: Ling Frederick S. , Brennan Joseph J. , Cleman Michael W. , Cabin Henry S.
Published: March 2007

Intravascular Doppler assessment of coronary flow velocity has demonstrated the physiologic significance of intermediate stenoses and the success of coronary interventions. We describe a patient where Doppler evaluation confirmed the significance of an intermediate left circumflex ostial stenosis. We also describe the Doppler flow velocity characteristics after successful rotational atherectomy facilitated angioplasty © 1994 Wiley‐Liss,Inc...
Improving results of bailout coronary stenting after failed balloon angioplasty
Authors: Metz Damien , Urban Philip , Camenzind Edoardo , Chatelain Pascal , Hoang Vincent , Meier Bernhard
Published: March 2007

Stent implantation can be a valuable alternative to emergent bypass surgery to treat established or threatening abrupt closure following coronary balloon angioplasty. To evaluate several sequentially introduced changes in our practice of bail‐out stenting, we compared the first (group I) and second half (group II) of our single center experience (n = 88). Use of bailout stenting increased over time (2% of all angioplasty procedures in group I vs. 6% in group II, P < 0.001), more often to prevent rather than to reverse abrupt closure. Technical success of stent implantation was unchanged (95% vs. 93%), and there was a decreasing trend for stent thrombosis (14% vs. 5%), in‐hospital death (5% vs. 2%), Q‐wave myocardial infarction (9% vs. 7%), and requirement for surgery (9% vs. 7%). The incidence of non‐Q‐wave myocardial infarction (29% vs. 7% P < 0.01), bleeding complications (27% vs. 7% P < 0.01), and hospital stay duration (11 ± 11 vs. 8 ± 5 days P < 0.05) decreased. Our data suggest that coronary stent implantation is currently an effective stand‐alone bailout procedure for a large majority of failed angioplasty procedures. © 1994 Wiley‐Liss,Inc..
Balloon angioplasty for treatment of in‐stent restenosis: feasibility, safety, and efficacy
Authors: Macander Peter J. , Roubin Gary S. , Agrawal Subodh K. , Cannon Adam D. , Dean Larry S. , Baxley William A.
Published: March 2007

Sixty patients with 1 or 2 stainless steel intracoronary stents (Cook, Inc.) underwent balloon angioplasty for in‐stent restenosis 1.5–13.5 months after stenting. Seventy‐five in‐stent redilatation procedures were performed. Seventy‐three restenotic lesions (97%) were successfully recrossed and dilated, reducing the mean pre‐angioplasty intrastent diameter stenosis from 77 ± 12% to 20 ± 11% residual. Although one angioplasty (1.3%) was complicated by non‐Q‐wave infarction, no angioplasty‐related death, acute closure, need for additional stenting, emergent coronary bypass surgery, side branch occlusion, or vascular sequelae occurred. Post‐procedure heparin was not used in 83% of successful cases. Most patients were discharged the day following redilatation (mean in‐hospital stay 1.7 ± 1.3 days). At 5.4 ± 3.4 months following in‐stent angioplasty, 84% of patients were in Canadian Cardiovascular Society class 0 or I. In conclusion, balloon dilatation in this stent for restenosis appears simple and efficacious in the short term, and may entail less risk than dilatation of unprotected coronary vessels. © 1994 Wiley‐Liss,Inc..
Ticlopidine and subcutaneous heparin as an alternative regimen following coronary stenting
Authors: Barragan P. , Sainsous J. , Silvestri M. , Bouvier J. L. , Comet B. , Siméoni J. B. , Charmasson C. , Bremondy M.
Published: March 2007

Subacute thrombosis of coronary stents may occur up to the end of the first month after their implantation and remains the major problem associated with the technique. A cohort of 238 patients with placement of one or more stents in 244 arteries was monitored for this period. All patients were given 500 mg/day of ticlopidine (started 3 days before) and a push dose of 10,000 IU of heparin during the procedure, then 1,000–1,500 IU/hr for 20 hr. Following removal of the arterial introducer, they were kept on subcutaneous heparin for 1 week and ticlopidine (500 mg/day) for 3–6 months. Nine patients (3.8%) showed evidence of thrombosis at 7 days. The overall thrombosis rate at 30 days was 4.2% (3.5% for elective stents, as compared with 7.9% associated with occlusive dissections). Emergency treatment by further angioplasty (8 cases) and intracoronary thrombolysis (5 cases) was undertaken. Complications were as follows: 5 deaths (2%), 3 Ml (1.2%), 2 non‐Q Ml (1.7%). Three predictive factors for subacute thrombosis were identified: age <70 (p = 0.00006), unstable angina (p = 0.006) and arterial diameter less than 3 mm (p = 0.043). The peripheral vascular complication rate was 4.6%. This study suggests that preventive treatment with ticlopidine appears to reduce the incidence of sub‐acute thrombosis of stents in patients >70 years of age. Furthermore, the combination of ticlopidine and heparin facilitates laboratory monitoring after stenting. Stenting is thought to represent definitive treatment in situations where placement for occlusive dissection is the indication. © 1994 Wiley‐Liss,Inc..
Stenting the distal anastomotic site of the left internal mammary artery graft: a case report
Authors: Hadjimiltiades Stavros , Gourassas John , Louridas George , Tsifodimos Dimitrios
Published: March 2007

The major problem associated with the long‐term patency of the internal mammary artery graft is the early occurrence of stenosis usually at its distal anastomotic site; its management by balloon angioplasty has been associated with a high success rate. We report the case of an unsuccessful balloon angioplasty of an anastomotic stenosis of a left internal mammary artery graft that was successfully managed by stenting with one‐half of a Palmaz‐Schatz stent. © 1994 Wiley‐Liss,Inc..
Self‐Expandable nitinol stent for cardiovascular applications: canine and human experience
Authors: Beyar Rafael , Shofti Rona , Grenedier Ehud , Henry Michel , Globerman Oren , Beyar Mordechai
Published: March 2007

The initial experimental and clinical experience with the cardiovascular self‐expandable Nitinol stent (vascular and coronary versions) is described. The stent is designed as a helical coil with two terminal balls that are used for restraining it on the delivery catheter. Upon release, the stent self‐expands immediately. A temporary stent version continues with a long wire that can be removed by pulling it as a straight wire through a small profile catheter. The stent uncoils in its own groove upon removal, a relatively atraumatic procedure. The stents have been studied in dogs and in peripheral arteries in patients. The results show a transient nonocclusive proliferative response to the stent that is maximal at 3–6 mo. The removability of the permanent stent has been proven in dogs. The preliminary results in patients are encouraging and demonstrate its feasibility for permanent and potentially temporary arterial support. © 1994 Wiley‐Liss,Inc..
Angiographic evaluation of a carotid‐subclavian bypass graft in a patient with subclavian artery stenosis and left internal mammary artery bypass graft
Authors: Rossum Alfred C. , Weinstein Eric , Holland Matthew
Published: March 2007

The incidence of coronary subclavian steal syndrome is estimated to be 0.4%. When revascularization is necessary, the preferred technique is the carotid‐subclavian bypass graft. Failure of a carotid‐subclavian graft is rare. We present a patient with subclavian stenosis who required reevaluation of both the carotid subclavian conduit and the left internal mammary bypass graft. A combined femoral and left brachial approach is recommended for evaluating the carotid‐subclavian graft and left internal mammary artery graft in patients with bypassed subclavian artery stenosis and prior myocardial revascularization. © 1994 Wiley‐Liss,Inc..
A dual‐purpose angioplasty‐drug infusion catheter for the treatment of intragraft thrombus
Authors: Hong Mun K. , Wong S. Chiu , Popma Jeffrey J. , Kent Kenneth M. , Pichard Augusto D. , Satler Lowell F. , Mintz Gary S. , Nikonow Karen , Leon Martin B.
Published: March 2007

An investigational angioplasty‐drug infusion catheter (Transport, CardioVascular Dynamics, Irvine, CA) was used to treat a saphenous vein graft stenosis associated with a thrombus. The catheter was successfully used both to infuse urokinase at the site of angioplasty and to perform effective angioplasty, demonstrating the feasibility and utility of a dual‐purpose angioplasty catheter capable of angioplasty and/or local drug infusion with the same catheter. © 1994 Wiley‐Liss,Inc..
Mediastinal arteriovenous fistulae in the adult: case report and review of the literature
Authors: Borik Anne , Battista David , Granato Jerome E. , Fallert Michael A. , Grill Howard P.
Published: March 2007

An adult with an asymptomatic mediastinal arterio‐venous fistula is presented. The diagnosis was established using angiography and oximetry after noninvasive imaging failed to identify the source of a continuous murmur. The literature is reviewed. © 1994 Wiley‐Liss,Inc..
Coronary angioplasty through a new 6 french guiding catheter
Authors: Resar Jon R. , Prewitt Kerry C. , Wolff Matthew R. , Brinker Jeffrey A.
Published: March 2007

Coronary angioplasty through smaller‐diameter guiding catheters using predominantly fixed‐wire balloon systems has been possible, but has had some limitations. The purpose of this prospective, nonrandomized study was to investigate the results of percutaneous transluminal coronary angioplasty using a new 6F guiding catheter with over‐the‐wire balloon systems. Coronary angioplasty using over‐the‐wire balloon systems through a new 6F guiding catheter was evaluated in 79 lesions in 70 patients and then compared to randomly selected procedures using 7F guiding catheters in 70 patients performed over the same time period. Coronary angioplasty through 6F guiding catheters and over‐the‐wire balloons including 8 long (30‐mm) and 3 perfusion balloons was successful in 94.9% of lesions and in 94% of patients. Coronary angioplasty through 7F guiding catheters was successful in 97.5% of lesions and in 97.1% of patients, respectively. Success rates between 6F and 7F guiding catheter groups were similar overall and for proximal, mid, distal, or complex (total, subtotal, or length > 10‐mm) lesions. There were no failures to withdraw the deflated balloon into the 6F guiding catheter. Vessel opacification after dilatation with the guidewire across the lesion was similar between the 6F and 7F guiding catheter groups. The mean change in hematocrit for the 6F procedures (−1.4±3.7%) was significantly lower than for the 7F procedures (−3.3±3.2%, P<0.001). Coronary angioplasty using a variety of over‐the‐wire balloon catheters through a new 6F guiding catheter is feasible with success rates comparable to 7F guiding catheters. Angioplasty with this 6F guiding catheter reduces procedural blood loss compared to larger‐lumen guiding catheters. © 1994 Wiley‐Liss,Inc..
Optimal data acquisition for volumetric intracoronary ultrasound
Authors: Dhawale Paritosh J. , Wilson David L. , Hodgson John Mc B.
Published: March 2007

Three‐dimensional analysis using intracoronary ultrasound (ICUS) pull‐back data provides the unique ability to quantitate lumen and atherosclerotic plaque volumes. Optimal data acquisition parameters for volumetric acquisition were established using simulations on computer phantoms of stenotic arteries. Eleven computer phantoms were generated using cross‐sectional area data from quantitative angiography of stenotic coronary arteries. Three methods of data acquisition were simulated: conventional manual pull‐back; motorized pull‐back; and manual pull‐back with measured displacement. Effects of pull‐back velocity and cardiac gating on cross‐sectional area profiles and volumes were studied. Cardiac gating eliminated errors introduced by vessel deformation within a cardiac cycle. With cardiac gating, pull‐backs with mean velocities up to 1.2 mm/sec allowed reconstruction of cross‐sectional area profiles within 5% RMS error. With faster pull‐backs, cardiac gating resulted in sparse spatial sampling and significant errors in cross‐sectional area profiles.

The accuracy of both motorized and measured required equal displacements of the catheter proximal and distal ends. This assumption was validated with in vitro experiments where X‐ray fluoroscopy was used to measure the displacement of the imaging tip. Excellent correlation was found between the two displacements (r = 0.99). Finally, slow pull‐backs were performed by 3 operators, and pull‐back velocities were measured. It was found that mean pull‐back velocities as low as 0.8 mm/sec were achievable. From our simulations, we predict that accurate volumetric analysis requires cardiac gated, calibrated, slow (< 1.2 mm/sec) pull‐backs. © 1994 Wiley‐Liss,Inc..
Percutaneous deployment of a polytetrafluoroethylene (ptfe) graft to repair a pseudoaneurysm produced by a graft to graft anastomotic dehiscence
Authors: Dorros Gerald , Bates Mark , Kumar Krishna
Published: March 2007

Arterial injuries, creating a pseudonauerysm or arteriovenous fistula have, in the main, been managed through surgical ligation of the involved segments, arterial reconstruction, embolization of the involved artery, and percutaneous placement of a stented graft [Marin ML, et al: J Vasc Surg 18:299–302, 1993].

This communication describes the percutaneous repair of a large popliteal pseudoaneurysm created by dehiscence of the anastomotic suture line of a composite polytetrafluoroethylene (PTFE) femoropopliteal and a popliteal‐posterior tibial graft using a PTFE graft without stent assistance. © 1994 Wiley‐Liss,Inc..
Quantitation of in vitro coronary artery calcium using ultrafast computed tomography
Authors: Mahaisavariya Paiboon , Detrano Robert , Kang Xingping , Garner Dan , Vo Anthony , Georgiou Demetrios , Molloi Sabee , Brundage Bruce H.
Published: March 2007

Ultrafast computed tomography (UFCT) has the potential to quantify coronary hydroxyapatite (HAP). However, no definitive studies validating this technique are available. We constructed a human chest phantom model with coronary arteries represented by cylindrical holes containing: (1) calcium chloride solutions, (2) a block of HAP immersed in paraffin (without partial volume effect), and (3) HAP granules embedded in a gelatin matrix (with partial volume effect). We scanned this model to determine the relationship between measured CT number per voxel and density of the calcium per voxel. The relationships between CT number and concentration of calcium chloride was linear (r = 0.992 to 0.999). Using a commercially available standard bone mineral phantom, we were able to estimate the concentration of HAP to an accuracy from 94 to 97% when partial volume effects were absent. However, when partial volume effects were present, two methods of estimating HAP produced significant errors (1 to 384%, and 17 to 52%). We conclude that significant partial voluming errors degrade the accuracy of HAP quantitation and that further evaluation and corrections are needed before such quantitation is clinically applied. © 1994 Wiley‐Liss,Inc..
CAAS II: A second generation system for off‐line and on‐line quantitative coronary angiography
Authors: Gronenschild Ed , Janssen Johan , Tijdens Folkert
Published: March 2007

The Cardiovascular Angiography Analysis System (CAAS) has been completely redesigned and transferred to a modern platform. The user‐friendly environment together with a number of image processing techniques and tools allow easy and fast analysis of cardiovascular angiographic images. These images are obtained either on‐line by means of a frame grabber hooked on the video output of the X‐ray equipment or off‐line by digitising 35‐mm cine film frames. In addition, images can be acquired more directly by means of a network link. Images stored on disk in different formats, including MS‐DOS, can also be analysed. Accurate and reliable quantitative analysis of coronary stenoses and assessment of their related functional significance may offer the clinician a tool in a stratification of patients at risk. The semireal‐time environment will make it possible for the cardiologist to quickly respond to the results of recanalisation procedures while the patient is still in the catheterisation laboratory. The addition of a video front end makes the system available to all clinically relevant X‐ray imaging equipment. A detailed comparison with the former CAAS on the basis of analysis of 40 arterial segments in routinely acquired cineangiograms demonstrated no statistically significant differences between the two analysis systems. Repeated analysis of the same segments yielded inter‐ and intraobserver variabilities for the obstruction diameter of 0.096 and 0.108 mm, respectively. For the computed reference diameter the values are 0.099 and 0.096 mm, respectively, and for the percentage diameter stenosis 4.67 and 5.37%, respectively. © Wiley‐Liss, Inc.
Use of cutoff pigtail catheters with intraluminal guidewires in interventional procedures in congenital heart disease
Authors: Verma Rajiv , Keane John F.
Published: March 2007

Advances in interventional cardiac catheterization have necessitated technique modifications to ensure patient safety while allowing data acquisition. The use of cutoff pigtail catheters over guidewires for pressure recordings and angiography exemplifies such a modification. The primary purpose of this study was to ascertain contast volume and flow rates achievable using such a system. A total of 140 used catheters of various sizes, with intraluminal guidewires (0.035 inch in 6, 7, and 8F; 0.025 inch in 5F) were subjected ot contast injectins at increasing rates and volumes until rupture occurred. The 7F catheters allowed volume delivery at 15–40 ml at 15 ml/sec, 8F catheters 40 ml at 30 ml/sec, and 5 and 6F catheters 10 ml/sec. All ruptured within 3 cm of the hub, at⩾900 PSI. A review of 737 clinical procedures revealed adequate pressure recordins and angiogrphic detail inall, uncomplicated save for one intracardiac wire dislodgement. © Wiley‐Liss, Inc.
Gianturco‐Roubin stent placement for variant angina refractory to medical treatment
Authors: Lopez J. Alberto , Angelini Paolo , Leachman D. Richard , Lufschanowski Roberto
Published: March 2007

A 43‐yr‐old man with mild, fixed obstruction of the left anterior descending (LAD) coronary artery and severe, uncontrolled variant angina underwent placement of an endovascular stent to preserve patency of the artery. The decision for stent placement was based on several factors, including refractoriness to medical treatment and standard balloon angioplasty, documented spasm localized to the proximal LAD lesion, and the morbidity, mortality, and costs associated with the surgical approach in this type of patient. At follow‐up, there was moderate restenosis of the stented coronary segment; the vasospastic angina syndrome had totally resolved. © Wiley‐Liss, Inc.
Treatment of intracoronary thrombus with local urokinase infusion using a new, site‐specific drug delivery system: The Dispatch™ catheter
Authors: McKay Raymond G. , Fram Daniel B. , Hirst Jeffrey A. , Kiernan Francis J. , Primiano Charles A. , Rinaldi Michael J. , Azrin Michael A. , Mitchel Joseph F. , Waters David D.
Published: March 2007

Background: The presence of intracoronary thrombus significantly increases the risk of conventional balloon angioplasty because of a high incidence of abrupt closure, distal embolization, and no‐reflow phenomenon. The purpose of this study was to assess a new technique for treating intracoronary thrombus consisting of the local delivery of urokinase directly to the angioplasty site with a novel, catheter‐based, drug delivery system. Methods: The Dispatch catheter is a new local, drug‐delivery device that allows for the prolonged infusion of therapeutic agents at an angioplasty site while still maintaining distal coronary perfusion. Six patients with angiographic or clinical evidence of intracoronary thrombus were treated with 150,000 units of urokinase over a 30‐min period using this device prior to or following conventional balloon angioplasty and/or directional atherectomy. Results: Successful delivery of urokinase directly to the angioplasty site was achieved in all 6 patients without hemodynamic or electrocardiographic compromise. In all six cases, local urokinase therapy resulted in complete dissolution of angiographic intracoronary thrombus and/or reduction of the coronary stenosis. Limited ischemia due to sidebranch occlusion by the catheter's coils was noted in one patient. Distal embolization or no‐reflow phenomenon were not observed in any case. CONCLUSION: The local drug‐delivery catheter used in this study was able to successfully and rapidly achieve intracoronary thrombolysis by delivering limited quantities of urokinase directly to the angioplasty site, while still maintaining distal coronary perfusion. This technique of local, thrombolytic drug delivery may be useful in the percutaneous treatment of intracoronary thrombus and thrombus‐containing stenoses. © Wiley‐Liss, Inc.
Restenosis presented with unstable angina and myocardial infarction: One explanation for late cardiac events following directional coronary atherectomy
Authors: Hwang Ming H. , Lewis Bruce E. , Hsieh Annming , Jones Paul A. , Leya Ferdinand , Loeb Henry S.
Published: March 2007

Three cases of restenosis after directional coronary atherectomy (DCA) presented with unstable angina and then myocardial infarction. Two of them were complicated with malignant ventricular dysrhythmia. A total or subtotal thrombotic occlusion at the DCA site was shown. This fulminating course of restenosis could partially explain the higher late cardiac morbidity and mortality after DCA than after percutaneous transluminal balloon angioplasty. © Wiley‐Liss, Inc.
Serial angiographic appearance of healing dissection after balloon angioplasty
Authors: Amin Nishith , De Vito Dabbs Annette , Gilchrist Ian C.
Published: March 2007

In this report we describe the case of a patient with a significant coronary artery dissection following percutaneous transluminal coronary angioplasty (PTCA) in whom serial coronary arteriograms were obtained over a 6‐week period. These demonstrated healing of the dissected vessel and correlated with abatement of the patient's angina. © Wiley‐Liss, Inc.
Acute myocardial infarction in a young adult due to solitary giant cell arteritis of the coronary artery diagnosed antemortemly by primary directional coronary atherectomy
Authors: Saito Shigeru , Arai Hidekazu , Kim Kunikane , Aoki Naoto
Published: March 2007

It has been reported sporadically that several types of coronary arteritis can result in myocardial infarction. Recently, we treated a 27‐year‐old with acute anterior myocardial infarction. Primary directional coronary atherectomy was performed in order to recanalize the totally occluded coronary artery. The atherectomized tissue consisted of thrombi and intima infiltrated with inflammatory cells and multinucleated giant cells. Underlying diseases which can result in giant cell arteritis were excluded. This report documents that coronary arteritis can induce acute myocardial infarction, and that directional coronary atherectomy can be an effective tool in the diagnostic method for coronary arteritis. © Wiley‐Liss, Inc.
Reversible coronary artery kinking caused by cardiopulmonary support
Authors: Gershony Gary
Published: March 2007

Cardiopulmonary support is utilized to provide optimal hemodynamic stability in high risk patients undergoing percutaneous transluminal coronary angioplasty. This report describes a patient undergoing supported angioplasty in whom multiple new severe stenoses were noted following coronary dilation and that were completely reversed by discontinuing cardiopulmonary support. © Wiley‐Liss, Inc.
Iliac compression: A rare hindrance to percutaneous mitral valvuloplasty
Authors: Munclinger M. J. , Patel J. J. , Mitha A. S.
Published: March 2007

Percutaneous mitral valvuloplasty using the Inoue technique was complicated by the failure to pass the dilator or balloon catheter above the vertebral level of L5 due to compression of the right common iliac vein by the right common iliac artery. The procedure was accomplished when a long sheath was used to pass the Inoue balloon catheter beyond the obstruction. © Wiley‐Liss, Inc.