bluuebunny/crossref_metadata_2025 huggingface dataset:
Aerosolized iloprost for pulmonary vasoreactivity testing in children with long‐standing pulmonary hypertension related to congenital heart disease
Authors: Limsuwan Alisa , Khosithseth Anan , Wanichkul Suthep , Khowsathit Pongsak
Published: October 2008

Background: In congenital heart disease with increased pulmonary blood flow and pressure, progressive changes in the vascular structure can lead to irreversible pulmonary hypertension (PH). Pulmonary hemodynamic parameters are used to determine whether surgical correction is no longer indicated. In this study, aerosolized iloprost was used to assess pulmonary vasoreactivity in children with long‐standing PH related to congenital heart disease. Methods: Children with long‐standing and severe PH secondary to congenital heart disease were included in this study. Various hemodynamic parameters were measured before and after iloprost inhalation (0.5 μg/kg), and vascular resistance was determined. Responders to the iloprost test were defined as those with a decrease in both pulmonary vascular resistance (PVR) and pulmonary‐to‐systemic vascular resistance ratio (Rp/Rs) of >10%. Results: Eighteen children aged between 7 months and 13 years with long‐standing and severe PH secondary to congenital heart disease were studied. Thirteen children had a positive response, resulting in a mean (± SD) decrease of PVR from 9.3 ± 4.6 to 4.6 ± 2.7 Wood U · m2 (P < 0.001), and a mean decrease of Rp/Rs from 0.54 ± 0.37 to 0.24 ± 0.14 (P = 0.005). Conclusions: Iloprost‐induced pulmonary vasodilator responses vary among children with PH related to congenital heart disease. The use of inhale iloprost in the cardiac catheterization laboratory results in pulmonary vasoreactivity for some of these children particularly a reduction in PVR and the pulmonary‐to‐systemic vascular resistance ratio. © 2008 Wiley‐Liss, Inc.
Transcatheter membranous ventricular septal defect closure through a mechanical aortic prosthesis using the Amplatzer membranous ventricular septal defect occluder
Authors: Noble Stéphane , Ibrahim Réda
Published: October 2008

An iatrogenic ventricular septal defect (VSD) after aortic valve replacement is rare, but represents a significant complication. Repeat surgery to repair such a defect carries a high surgical risk. The transcatheter approach (either transvascular or transapical) could be considered as an alternative to open chest surgery. We describe the successful transcatheter closure of an iatrogenic VSD with an Amplatzer Membranous VSD Occluder in a patient with previous combined mitral and aortic mechanical valve replacements. The device was implanted through a CarboMedics mechanical valve in the aortic position. © 2008 Wiley‐Liss, Inc.
Impact of diabetes and acute coronary syndrome on survival in patients treated with drug‐eluting stents
Authors: Lee Michael S. , Jurewitz Daniel , Zimmer Raymond , Pessegueiro Antonio , Bhatia Ravi , Currier Jesse , Yeatman Larry , Tobis Jonathan M.
Published: October 2008

Background:

Diabetics who undergo percutaneous coronary intervention (PCI) are at increased risk for death, myocardial infarction, repeat revascularization, and stent thrombosis.

Methods:

Our retrospective study includes 887 consecutive patients who underwent PCI with drug‐eluting stents (DES) at UCLA Medical Center. The cohort was divided into four groups: group 1, no diabetes and no acute coronary syndrome (ACS); group 2, no diabetes and ACS; group 3, diabetes and no ACS; group 4, diabetes and ACS.

Results:

Survival at 1 year was the lowest in diabetics who presented with ACS (90% in diabetics with ACS, 95% in diabetics without ACS, 95% in non‐diabetics with ACS, and 96% in the non‐diabetics without ACS, P = 0.03). At 1 year, age, diabetes, chronic renal insufficiency, ejection fraction, and myocardial infarction were identified as independent predictors for mortality.

Conclusion:

In the DES era, diabetics who undergo PCI for ACS continue to have an excess risk of death and major adverse cardiac events at 1 year. © 2008 Wiley‐Liss, Inc.
Strategies for drug‐eluting stent treatment of bifurcation coronary artery disease in the United States: Insights from the e‐Cypher S.T.L.L.R.Trial
Authors: Suzuki Nobuaki , Angiolillo Dominick J. , Tannenbaum Mark A. , Driesman Mitchell H. , Smith Conrad , Bikkina Mahesh , Meckel Clyde R. , Morales Carlos E. , Xenopoulos Nicholaos P. , Coletta John E. , Bezerra Hiram G. , Bass Theodore A. , Costa Marco A.
Published: October 2008

Objectives: Our goal is to report the first large multicenter data for percutaneous coronary intervention (PCI) of bifurcation disease with drug‐eluting stents (DES) in the United States. Background: Bifurcation PCI remains a challenge to this date. There are limited data on outcomes of patients treated with bifurcation DES implantation, particularly in the United States. Methods: There were 161 patients with bifurcation disease [side branch (SB) ≥2‐mm] treated with ≥1 sirolimus‐eluting stents at 41 centers participating in the Stent deployment Techniques on cLinicaL outcomes of patients treated with the cypheR™stent (STLLR) trial. There was no protocol mandated strategy for bifurcation PCI. One‐year outcome data were collected. Angiographic and clinical data were adjudicated independently. Results: There were 147 patients (91.3%) treated with single stent strategy. Only 14 (8.7%) patients received sirolimus‐eluting stents implantation in both branches. Among patients with single stent strategy, double wire strategy (DW) was selected in 27 (18.4%) patients whereas single wire strategy (SW) was selected in 120 (81.6%) patients. There were 48 (32.7%) Medina 1,1,1 bifurcations treated with SW (n = 34; 70.8%) and DW (n = 14; 29.2%). There were 26 procedures started with SW which had SB dilatation during the procedure, one as a bailout (TIMI‐1 grade flow in the SB). Overall 1‐year death, myocardial infarction, and target lesion revascularization occurred in 2.4, 4.0, and 5.6%, respectively. There was no significant difference in clinical outcomes between SW and DW. SB dilatation was associated with a high rate of stent thrombosis (8.6%). Conclusions: Main branch stenting without SB protection is the most common approach utilized in the STLLR study, which may reflect contemporary DES bifurcation strategies in the Unite States. This strategy was associated with an acceptable low incidence of adverse outcomes at 1‐year. © 2009 Wiley‐Liss, Inc.
Coronary stent infections: A case series
Authors: Schoenkerman Aaron B. , Lundstrom Robert J.
Published: October 2008

Stent infection is a rare sequela of coronary stent implantation first reported fifteen years ago. Since that time, much has been learned about this dramatic disease entity by way of case report and review. Nevertheless, clinical experience with regard to the diagnosis and management of coronary artery stent infection remains limited. Here, we report 3 cases of coronary stent infections; 2 with mycotic aneurysms (seen on coronary angiography) that ruptured into an adjacent cardiac chamber, and one with purulent pericarditis. The microbiology as well as the possible mechanisms and risk factors for these infections are discussed. © 2008 Wiley‐Liss, Inc.
Successful retrograde treatment of a mid left anterior descending artery chronic total occlusion using a novel “guide parallel to wire” technique
Authors: Brilakis Emmanouil S. , Banerjee Subhash
Published: October 2008

Antegrade crossing of a chronic total occlusion adjacent to a large side branch may fail. We describe a patient in whom a chronic total occlusion of the proximal left anterior descending artery was successfully crossed retrogradely through an apical collateral after a failed antegrade crossing attempt. No balloon was long enough to reach the left anterior descending artery lesion retrogradely. A retrograde Whisper wire was snared though an antegrade left main guide catheter introduced via the radial approach. We were unable to retrieve the wire via the radial guide catheter because of wire fracture during withdrawal. Externalization of the retrograde guidewire required use of a Frontrunner catheter and removal of the antegrade guide catheter. The lesion was predilated with a retrograde balloon inserted without a guide over the retrograde wire. A 5F guide catheter was introduced next to the retrograde wire through the radial sheath (“guide parallel to wire” technique) followed by successful antegrade crossing and stenting of the mid left anterior descending artery lesion. © 2009 Wiley‐Liss, Inc.
A novel approach for percutaneous treatment of massive nonocclusive mesenteric ischemia: Tolazoline and glycerol trinitrate as effective local vasodilators
Authors: Sommer Christof M. , Radeleff Boris A.
Published: October 2008

Nonocclusive mesenteric ischemia (NOMI) generally affects patients with low cardiac output, resulting in splanchnic hypoperfusion. It includes all forms of mesenteric ischemia without vessel occlusion and makes up between 20 and 30% of all cases of acute mesenteric ischemia. We present the case of a 84‐year‐old man with a history of total atrioventricular block developing NOMI. This was diagnosed by percutaneous selective catheter arteriography (PSCA), which demonstrated remarkable abrupt termination of the jejunal vasculature and multiple severe spasms of the colonic arteries. Control PSCA after local intraarterial vasodilator therapy (LIVT) with tolazoline and glycerol trinitrate documented an excellent therapeutic result with a completely unremarkable vasculature. Although LIVT was complicated by severe cardiovascular complications inclusive of cardiac arrest with the need of cardiopulmonary resuscitation, the patient fully recovered and was discharged after implantation of a cardiac pacemaker in good clinical condition 7 days later. © 2009 Wiley‐Liss, Inc.
Evaluation of intermediate coronary stenosis with intravascular ultrasound and fractional flow reserve: Its use and abuse
Authors: Magni Valeria , Chieffo Alaide , Colombo Antonio
Published: October 2008

Clinical decision making in patients with intermediate coronary stenosis is still debated. Intravascular ultrasound (IVUS) examination and/or functional assessment of coronary stenosis by fractional flow reserve (FFR) are currently used to define the severity of such lesions. There are very few studies with a small sample size that have a head‐to‐head comparison between IVUS and FFR in the evaluation of angiographically de novo intermediate lesions. There are no randomized, controlled trials to demonstrate the superiority of IVUS versus FFR in providing improved clinical outcomes in comparison with angiography alone. However, the issue of superiority might be irrelevant, because IVUS and FFR could be complementary techniques to be used in the catheterization laboratory to provide critical anatomic and functional data that permit more accurate decisions in the management of the patient. © 2009 Wiley‐Liss, Inc.
Impact of a prolonged delivery inflation time for optimal drug‐eluting stent expansion
Authors: Kawasaki Tomohiro , Koga Hisashi , Serikawa Takeshi , Orita Yoshiya , Ikeda Shinsuke , Mito Takahiro , Gotou Yoshitaka , Shintani Yoshiaki , Tanaka Atsushi , Tanaka Hidenori , Fukuyama Takaya , Koga Nobuhiko
Published: October 2008

Purpose: We examined the importance of prolonged inflation time for optimal sirolimus‐eluting stent (SES) or paclitaxel‐eluting stent (PES) expansion. Methods: Eighty‐one de novo lesions deployed single SES or PES between April 2007 and March 2008 were divided into four groups; group 1: 21 SES deployed at 20 atm × 60 sec, group 2: 20 SES deployed with 2‐step inflation at 20 atm × 60 sec following 20 atm × 20 sec, group 3: 20 PES deployed same as group 1, group 4: 20 PES deployed same as group 2. The minimal lumen diameter (MLD) and stent expansion ratio (SER; stent cross‐ sectional area at lesion/balloon cross‐sectional area which was calculated according to the compliance chart at the same atmosphere as stent deployment) were compared between group 1 and group 2 in SES, between group 3 and group 4 in PES. Results: The MLD of post 60 sec was significantly higher than that of post 20sec (2.84 ± 0.28 mm in group 1, 2.76 ± 0.33 mm in group 2 vs. 2.54 ± 0.33 mm in group 2; P = 0.003, 0.045, respectively and 2.94 ± 0.28 mm in group 3, 3.00 ± 0.34 mm in group 4 vs. 2.69 ± 0.35 mm in group 4; P = 0.022, 0.007, respectively). The SER of post 60 sec was significantly higher than that of post 20 sec (79.3% ± 8.5% in group 1, 80.8% ± 7.8% in group 2 vs. 71.1% ± 10.2% in group 2; P = 0.014, 0.011, respectively and 81.1% ± 7.9% in group 3, 84.3% ± 9.9% in group 4 vs. 72.6% ± 10.5% in group 4, P = 0.011, 0.001, respectively). Conclusion: The prolonged delivery inflation for 60 sec may result in a more optimal stent expansion. It is therefore considered to be a useful method for deploying drug‐eluting stent. © 2008 Wiley‐Liss, Inc.
Novel technique using the Outback® LTD™ catheter for a common iliac artery occlusion
Authors: Mixon Timothy A.
Published: October 2008

We present a case of an unusual arterial – arterial anastamosis that resulted from an unsuccessful attempt at crossing a total occlusion of the common iliac artery. Subsequently, we were able to successful recanalize the artery using a modified technique with the Outback reentry catheter. © 2009 Wiley‐Liss, Inc.
Multidetector CT coronary angiography for patient triage to invasive coronary angiography: Performance and cost in ambulatory patients with equivocal or suspected inaccurate noninvasive stress tests
Authors: Menon Madhav , Lesser John R. , Hara Hidehiko , Birkett Richard , Knickelbine Thomas , Longe Terry , Flygenring Bjorn , Henry Jason , Schwartz Robert
Published: October 2008

Background: Multidetector‐CT angiography (MDCTA) differs from noninvasive stress tests by directly imaging coronary anatomy. The utility of MDCTA for invasive triage is undefined however. We evaluated MDCTA triage to invasive coronary angiography in outpatients with indeterminate or suspected inaccurate stress tests, and estimated cost savings by MDCTA in this role. Methods: Consecutive MDCTA patients were retrospectively compared with noninvasive stress tests if performed within 6 months of MDCTA. Twelve‐month clinical follow up was obtained for patients not undergoing invasive angiography, and cost using MDCTA for triage to invasive coronary angiography was calculated. Results: MDCTA was performed in 385 patients who had noninvasive stress testing. Stress tests include included treadmill (n = 37), stress echo (n = 178), and nuclear perfusion imaging (n = 170). Invasive angiography was performed in 57 (14.8%). MDCTA compared to CA showed positive and negative predictive values of 94%/100% respectively for lesions found by invasive QCA. Stress testing compared to MDCTA showed positive/negative predictive values of 100%/67% for treadmill exercise, 60%/54% for stress echo, and 59%/55% of nuclear perfusion examinations respectively. One year clinical follow up in 314 patients showed no coronary events in 98% (309) of patients. Triage to invasive angiography by MDCTA showed a 4‐fold cost reduction. Conclusions: MDCTA shows excellent performance as a triage for invasive angiography in patients with stress tests that are equivocal or thought inaccurate. A negative CTA confers good 12‐month prognosis. Substantial cost savings may accrue using MDCTA in this triage role.
Long‐term safety and durability of percutaneous septal sinus shortening (The PS3 System™) in an ovine model
Authors: Rogers Jason H. , Rahdert David A. , Caputo Gary R. , Takeda Patricia A. , Palacios Igor F. , Tio Fermin O. , Taylor Elizabeth A. , Low Reginald I.
Published: October 2008

Objectives: Chronic implants of the PS3™ system were conducted in an ovine model to assess durability and safety at up to 1 year follow‐up. Background: The long‐term durability and safety of emerging percutaneous devices for functional mitral regurgitation remain largely unknown. Methods: The PS3 system (consisting of interatrial septal and great cardiac vein devices connected by an adjustable suture bridge) was placed in eight healthy adult sheep. The mitral annular septal‐lateral dimension in systole (SLS) was acutely reduced by 15–20%. Animals were sacrificed at up to 12 months postimplant and characterized by intracardiac echocardiography, cardiac computed tomography (CT), and histopathology. In vivo forces exerted on the PS3 bridge were measured by means of a novel load cell catheter. Results: At 3, 6, and 12 months after implantation, intracardiac echocardiographic and CT showed the PS3 systems to be intact without erosion and with overall sustained reductions in the SLS. Histopathologic assessment revealed each component correctly deployed in its respective target site without evidence of erosion, thrombus, or device fracture. The SLS was 26.5 ± 1.7 mm preimplant, 22.0 ± 1.4 mm post‐PS3 (17.0% reduction), and 22.0 ± 2.1 mm at latest follow‐up. Mean forces exerted on the bridge in vivo ranged from 1.16 N to 1.87 N. Conclusions: The PS3 System demonstrated excellent biocompatibility without evidence of erosion, thrombosis, or perforation at up to one‐year follow‐up in this chronic healthy ovine model. Forces exerted in the PS3 system were relatively modest and should contribute to the durability of the device. © 2009 Wiley‐Liss, Inc.
A suture not always the ideal solution: Problems encountered in developing a suture‐based PFO closure technique
Authors: Majunke Nicolas , Baranowski Andreas , Zimmermann Wibke , Heinisch Corinna , Wilson Neil , Robertson Greg , Wunderlich Nina , Sievert Horst
Published: October 2008

Objectives: To summarize our experiences with the first‐in‐man suture‐based patent foramen ovale (PFO) closure technique. Background: PFO is often present with the occurrence of cryptogenic stroke and migraine with aura. Successful PFO closure can be performed percutaneously using catheter techniques with many different closure devices. The described novel closure system is intended to deliver, via endovascular access, a suture into the atrial septal wall tissue for closure of PFO. Methods: Eleven patients, between 22 and 58 years of age (mean 46.6 ± 9.6), who had a cryptogenic ischemic stroke, TIA, or a peripheral embolism and a PFO were considered for percutaneous closure with this technique. Results: The mean stretched diameter of the defect evaluated during balloon sizing was 8.8 ± 0.4 mm (range 7–12.5). Delivery of the suture was successful in all patients. No intraprocedural complications occurred. During the follow up, complete closure could be achieved in one patient. Six patients with significant residual shunting during follow‐up had successful closure using a conventional device. One patient was lost for follow‐up after the 3‐month visit. The residual shunt in the remaining three patients was very small and they declined to be treated with a conventional device. No complications occurred during the follow up. Conclusions: Transcatheter application of a suture for closure of PFO is technically feasible and safe. However, despite successful suturing of the septum primum to the septum secundum, the PFO did not close in most of the patients. © 2008 Wiley‐Liss, Inc.
Implantation of two self‐expanding aortic bioprosthetic valves during the same procedure—Insights into valve‐in‐valve implantation (“Russian doll concept”)
Authors: Piazza Nicolo , Schultz Carl , de Jaegere Peter P.T. , Serruys Patrick W.
Published: October 2008

Transcatheter aortic value implantation has gained acceptance as a treatment for elderly patients considered high risk for surgical aortic valve replacement. There are still, however, many unresolved clinical and technical issues. The occurrence of transcatheter aortic valve‐in‐valve implantation has been reported anecdotally. Aside from a single case report, there is little literature on this topic. This study was conducted to evaluate the procedural, imaging, and clinical outcomes of patients who underwent transcatheter valve‐in‐valve implantation with two self‐expanding aortic valve bioprostheses during the same procedure. We discuss also the potential valve of on‐line quantitative angiography for assessing the depth of valve implantation and the need to implant a second valve. © 2009 Wiley‐Liss, Inc.
Endovascular carotid artery stenting and early coronary artery bypass grafting for asymptomatic carotid artery stenosis: Long‐term outcomes and neurologic events
Authors: Ranaweera Priyantha S. , Bigelow Brian C. , Leary Megan C. , de la Torre Ralph , Sellke Frank , Garcia Lawrence A.
Published: October 2008

Background:

Optimal management of patients with asymptomatic critical carotid artery stenoses prior to coronary artery bypass grafting (CABG) has no clear consensus. Further, optimal timing for surgical coronary revascularization has not been defined after or with any carotid revascularization.

Methods:

We reviewed the data from 2002 to 2007, of all patients in our institution who underwent carotid artery stenting (CAS) for critical carotid artery stenoses, prior to CABG. Twenty patients with critical carotid disease were referred for preoperative carotid intervention prior to CABG. Carotid duplex demonstrated evidence of critical stenoses in all patients. Patients were serially assessed by a stroke neurologist before and after the procedure (immediately, at 24 hr, at 48 hr, immediately following CABG, and at 30 days). We evaluated initial procedural success as well as freedom from periprocedure stroke.

Results:

Prior to undergoing CABG, 20 patients had stents placed in a single carotid artery for unilateral asymptomatic critical carotid artery stenoses. All the procedures, except one, were performed with distal embolic protection. Patients received aspirin and clopidogrel. There were no strokes or deaths up to a mean follow up of 486 days. The mean time from CAS to CABG performed in the same hospital admission was 6.4 days. Transfusion rates were not excessive despite dual antiplatelet therapy.

Conclusion:

In a real‐world setting, endovascular extracranial CAS for asymptomatic carotid artery stenosis by experienced operators, prior to CABG was safe and permitted early coronary revascularization without increased risk of strokes or death in this high‐risk cardiovascular patient population. © 2009 Wiley‐Liss, Inc.
Treatment of aortic arch aneurysm with a NuMED‐covered stent and restoration of flow to excluded left subclavian artery: Perforation and dilation of e‐PTFE can be done!
Authors: Tsai Shane F. , Hill Sharon L. , Cheatham John P.
Published: October 2008

We describe a case using a NuMED‐covered Cheatham‐Platinum (CP) stent (NuMED, Hopkinton, NY) to treat an aneurysm after previous balloon angioplasty and bare stent implantation for coarctation of the aorta (CoA). Exclusion of the left subclavian artery (LSCA) was anticipated. After wire perforation of the covered CP stent, balloon angioplasty was performed through a stent cell to recannulize the LSCA. © 2009 Wiley‐Liss, Inc.
Successful percutaneous closure of coronary artery fistula with angiographic follow‐up at 6 months
Authors: Hendry Cara , Mahadevan Vaikoms , Fath‐Ordoubadi Farzin
Published: October 2008

Congenital coronary artery fistula can present later in life. We describe a case in a 56 year old, who was managed percutaneously with coil embolization leading to complete closure of the fistula, which was confirmed by follow‐up angiography at 6 months. © 2008 Wiley‐Liss, Inc.
Amplatzer occlusion of accessory ventriculopulmonary connections
Authors: Petko Colin , Gray Robert G. , Cowley Collin G.
Published: October 2008

Background: Children with complex congenital heart disease often require staged palliation to regulate systemic and pulmonary blood flow. Accessory sources of pulmonary blood flow including aortopulmonary collaterals, aortopulmonary shunts, and ventriculopulmonary connections following Glenn or Fontan palliation can be associated with elevated central venous pressures and persistent pleural drainage. Occlusion of accessory ventriculopulmonary connections in this setting has traditionally been accomplished surgically. Objective: To review the efficacy of Amplatzer devices in transcatheter occlusion of accessory ventriculopulmonary connections in children with complex congenital heart disease. Methods: Patients were identified and their records retrospectively reviewed for indication, procedural details, and clinical efficacy and outcome. Results: Between December 2004 and March 2008, seven patients underwent occlusion of accessory ventriculopulmonary connections using an Amplatzer Septal Occluder (3), an Amplatzer Duct Occluder (3), or an Amplatzer Vascular Plug (1). Underlying single ventricle physiology was present in six of these patients. The site of occlusion was the right ventricle to pulmonary artery (Sano) conduit in two patients, the native main pulmonary artery in three patients, the pulmonary valve in one patient, and a left ventricle to pulmonary artery homograft in one patient with biventricular physiology. There were no complications associated with these procedures. Conclusions: Amplatzer occlusion devices provide a safe and effective means of eliminating accessory ventriculopulmonary connections in children who have undergone surgical palliation of congenital heart disease. © 2008 Wiley‐Liss, Inc.
A comparison of the mechanical performance characteristics of seven drug‐eluting stent systems
Authors: Schmidt W. , Lanzer P. , Behrens P. , Topoleski L.D.T. , Schmitz K.‐P.
Published: October 2008

Objectives: Mechanical properties of drug eluting stents (DES) will be measured to provide comparable numerical data to assess deliverability, and thus clinical performance. Background: DES are routinely used in coronary interventions to reduce the rates of restenosis and target vessel revascularizations. Current research is primarily concerned with issues related to late stent thrombosis. However, mechanical properties of DES are a critical determinant of deliverability, and consequently the ultimate arbiter of their clinical performance. Methods: Mechanical properties (pushability, trackability, crossability) were measured under standardized in‐vitro conditions. The vessel models were derived from typical vessel anatomy but adapted to the individual tests. Additionally, profile and bending forces of the stent segment of the delivery system were measured. Seven different commercially available balloon‐expandable coronary DES systems were included. All stents were 3.0 mm diameter with a stent length from 14 to 18 mm. Results: The pushability expressed as the ratio of distal force at a specific proximal push force (4N) ranged between 38.66 and 18.53%. The trackability as the mean track‐forces ranged from 0.551 N to 1.137 N. One stent system could not pass this test. The mean crossing forces at a 1.4 mm stenosis model ranged from 0.038 N up to 0.103 N. The mean crimped stent profiles ranged from 1.055 mm to 1.198 mm and the bending stiffness of the crimped stent was 17.22 to 47.20 Nmm2. Conclusion: Better understanding of mechanical properties of DES shall improve tactile skills of the interventionists during PCI and to improve criteria for DES selection in specific clinical settings. © 2008 Wiley‐Liss, Inc.
Use of magnetic guidewire navigation in the treatment of lower extremity peripheral vascular disease: Report of the first human clinical experience
Authors: Iyengar Srinivas , Gray William A.
Published: October 2008

The use of a magnetic navigation system (MNS) to facilitate catheter placement in electrophysiologic procedures has been increasingly documented over the past decade. Recently, the utilization of MNS to aid guidewire directionality in complex coronary lesions has also been described. Given the multifaceted ability of MNS to be applied to varying vascular beds, we describe the successful employment of this modality to facilitate treatment of lower extremity peripheral arterial disease in a symptomatic male with gangrenous toe ulceration. © 2009 Wiley‐Liss, Inc.
Concomitant renal and iliac fibromuscular dysplasia
Authors: Chin Ashley , Ntsekhe Mpiko
Published: October 2008

Fibromuscular dysplasia (FMD) usually involves the renal arteries and is an important cause of secondary hypertension in younger women. We report an unusual case of FMD in a middle‐aged woman, not only involving both the renal and iliac arteries but also presenting in a pattern more typical of atherosclerosis. © 2009 Wiley‐Liss, Inc.
Percutaneous coronary intervention for a right coronary artery stent occlusion using retrograde delivery of a sirolimus‐eluting stent via a septal perforator
Authors: Utunomiya Makoto , Katoh Osamu , Nakamura Shigeru
Published: October 2008

In percutaneous coronary intervention for chronic total occlusion (CTO), the retrograde approach is an advanced technique. To improve the long‐term patency rate, stent implantation is necessary for CTO, however, antegrade stent delivery to the lesion is contraindicated in cases where there is an anomalous origin or deviation of the coronary artery, or the edge of a previously implanted stent extends into the aorta. We report a successful case of retrograde stent implantation via a septal perforator in a patient with marked deviation of the RCA origin. In this case, antegrade stent implantation was difficult because antegrade catheter insertion carried a risk of crush deformation of an ostial stent. © 2009 Wiley‐Liss, Inc.
Percutaneous coronary interventions in octogenarians: Acute and 12 month results in a large single‐centre experience
Authors: Varani Elisabetta , Aquilina Matteo , Balducelli Marco , Vecchi Giuseppe , Frassineti Valeria , Maresta, Aleardo
Published: October 2008

Objectives: To review the results of PCI in patients aged ≥80 years. Background: Octogenarians represent a growing proportion of patients treated with PCI; in this subset of high‐risk patients, the role of complete revascularization is still controversial. Methods: We examined in‐hospital, 30 days, and 12‐month events in 356 patients aged ≥80 years submitted to PCI from 2004 to 2006 and 754 patients aged <80 years treated in 2006. Results: Octogenarians had a higher risk profile. A complete revascularization was obtained in 48% of them and in 65% of younger patients (P < 0.001); glycoprotein IIb/IIIa inhibitors (GPI) use was common in both groups (43 vs. 46.5%). In‐hospital mortality was higher in octogenarians (3.9 vs. 1.3%, P = 0.01) as well as vascular complications (2.8 vs. 1%, P = 0.058). Mortality resulted 5.9 vs. 1.2% at 30 days (P < 0.001), and 16.3 vs. 3.9% at 12 months (P <0.001) in the two groups whereas repeat revascularization procedures did not differ (9.3 vs. 8.4%, respectively). In patients aged ≥80, there was no difference in 12 months total events (20 vs. 28%, P = 0.07) and repeat revascularizations (8 vs. 10%, P = 0.498) in completely or uncompletely revascularized subjects. At multivariate analysis age (P = 0.002), diabetes (P = 0.002), three vessel disease (P = 0.020) and procedural success (P = 0.002) were independent predictors of total events at 12 months. Conclusions: In our experience, frequent GPI use and multivessel PCI in 41% of ≥80 years‐old patients resulted in good immediate and mid‐term clinical outcomes, irrespective of the completeness of revascularization achieved. © 2009 Wiley‐Liss, Inc.
A novel 0.010‐inch guidewire for crossing jailed sidebranches
Authors: Otsuka Yoritaka
Published: October 2008

Complete occlusion of a side branch sometimes occurs due to a jailed‐stent during treatment of bifurcation lesions. In this report, we describe a novel 0.010‐inch coronary guidewire (Decillion™) that is effective for crossing a completely occluded side branch through the jailed‐stent strut, whereas another standard 0.014‐inch guidewire was unable to cross the same lesion. This novel 0.010‐inch guidewire may be useful for crossing of completely occluded side branches that are difficult to cross through the stent strut after stent implantation. © 2009 Wiley‐Liss, Inc.
Chronotropic impairment after surgical or percutaneous closure of atrial septal defect
Authors: Massin Martial M. , Dessy Hugues , Malekzadeh‐Milani Sophie‐Guiti , Khaldi Karim , Topac Beyhan , Edelman Raymond
Published: October 2008

Background:

In previous studies, an attenuated heart rate response to exercise has been noted in patients after surgical closure of atrial septal defect. The aim of this study was to compare the prevalence of chronotropic impairment after surgical and percutaneous closure of atrial septal defect.

Methods:

Thirty‐eight pediatric patients who underwent a surgical (group A, n = 18) or transcatheter closure (group B, n = 20) of atrial septal defect in our institution were prospectively included in the study. Treadmill exercise testing was performed using the Bruce walking treadmill protocol to voluntary exhaustion, with continuous monitoring of heart rate and oxygen consumption.

Results:

All the children were in sinus rhythm, and had normal values for peak oxygen uptake and endurance time. Exercise heart rate was significantly lower than normal in group A at the end of stage 2 (Z‐score = −0.71 ± SD 1.02), and in both groups at the end of stage 3 (Z‐score = −2.06 ± 1.76 in A and −1.00 ± 0.71 in B) and at peak exercise (Z‐score = −2.78 ± 2.14 in A and −0.81 ± 0.75 in B). However, the heart rate response to exercise was significantly less attenuated in group B than in group A. Moreover, maximal heart rate was <−2 SD in 8/18 surgical patients but in no patient of the group B.

Conclusion:

The chronotropic impairment is significantly less important after transcatheter closure of atrial septal defect than after surgical closure. It is an additional argument in favor of the interventional catheterization. © 2009 Wiley‐Liss, Inc.
Rheolytic thrombectomy in patients with massive and submassive acute pulmonary embolism
Authors: Chechi Tania , Vecchio Sabine , Spaziani Gaia , Giuliani Gabriele , Giannotti Federica , Arcangeli Chiara , Rubboli Andrea , Margheri Massimo
Published: October 2008

Objectives: To appraise the impact of AngioJet rheolytic thrombectomy (RT) on angiographic and clinical endpoints in patients with acute pulmonary embolism (PE). Background: The management of patients with acute PE and hemodynamic compromise, based mainly on anticoagulant and thrombolytic therapies, is challenging and still suboptimal in many patients. In such a setting, mechanical removal of thrombus from pulmonary circulation holds the promise of significant clinical benefits, albeit remains under debate. Methods: We retrospectively report on 51 patients referred to our catheterization laboratory and treated with AngioJet RT. Patients were classified according to the degree of hemodynamic compromise (shock, hypotension, and right ventricular dysfunction) to explore thoroughly the degree of angiographic pulmonary involvement (angiographic massive PE was defined as the presence of a Miller index ≥ 17) and the impact on angiographic (obstruction, perfusion, and Miller indexes) and clinical (all‐cause death, recurrence of PE, bleeding, renal failure, and severe thrombocytopenia) endpoints of AngioJet RT. Results: Angiographic massive PE was present in all patients with shock, whereas patients with right ventricular dysfunction and hypotension showed a similar substantial pulmonary vascular bed involvement. Technical success was obtained in 92.2% of patients, with a significant improvement in obstruction, perfusion and Miller indexes in each subgroup (all P < 0.0001). Four patients reported major bleedings and eight (15.7%) died in‐hospital. Laboratory experience was significantly associated to a lower rate of major bleedings. All survivors were alive at long‐term follow‐up (35.5 ± 21.7 months) except three who expired due to cancer and acute myocardial infarction. Conclusions: In experienced hands AngioJet RT can be operated safely and effectively in most patients with acute PE, either massive or submassive, and substantial involvement of pulmonary vascular bed. © 2009 Wiley‐Liss, Inc.
Is routine ultrasound guidance really necessary for closure of patent foramen ovale using the Amplatzer PFO occluder?
Authors: Fateh‐Moghadam Suzanne , Steeg Martin , Dietz Rainer , Bocksch Wolfgang
Published: October 2008

Objectives:

The aim of the study was to evaluate safety, efficacy, and long‐term clinical outcome of percutaneous closure of patent foramen ovale (PFO closure) in a low volume center using the Amplatzer PFO occluder without echocardiographic guidance.

Background:

Most centers perform PFO closure either by transesophageal echocardiography (TEE) or intracardiac echocardiography (ICE) guidance for optimal device selection. As TEE is poorly tolerated by patients in supine position and ICE is a costly alternative that increases vascular access complications, we wanted to assess the safety and efficacy of PFO closure by fluoroscopic guidance only.

Methods:

Before PFO closure, all patients had a diagnostic contrast‐TEE and morphological classification of PFO. All PFO closures were performed using the 25‐mm Amplatzer PFO occluder with fluoroscopic guidance only. Intraprocedural echocardiography was replaced by right atrial opacification using contrast angiography. Contrast TEE was done after 6 weeks, contrast TTE after 3, 6, and 12 months postprocedural.

Results:

In all 92 patients (52.4 ± 1.5 years), a 25‐mm Amplatzer PFO occluder was implanted in the correct position. Total fluoroscopic time was 8.4 ± 0.6 minutes and the application of contrast medium was 122.5 ± 5.8 mL. By contrast‐TEE, 12 patients (13 %) showed a small residual shunt (grade 1). During follow‐up (2.09 ± 0.13 years) two patients (2.1%) suffered from a recurrent event (TIA in both cases).

Conclusions:

Percutaneous closure of PFO using the 25‐mm Amplatzer PFO occluder guided by fluoroscopy only is a safe and efficacious intervention for nearly all patients. © 2009 Wiley‐Liss, Inc.
In vivo validation of CAAS QCA‐3D coronary reconstruction using fusion of angiography and intravascular ultrasound (ANGUS)
Authors: Schuurbiers Johan C.H. , Lopez Nieves Gonzalo , Ligthart Jurgen , Gijsen Frank J.H. , Dijkstra Jouke , Serruys Patrick W. , Van der Steen Antonius F. , Wentzel Jolanda J.
Published: October 2008

Objectives:

The CAAS QCA‐3D system (Pie Medical Imaging BV, the Netherlands) was validated against 3D reconstructions based on fusion of angiography and intravascular ultrasound (ANGUS), allowing slice by slice validation of the lumen areas and 3D geometric values.

Background:

Accurate online 3D reconstruction of human coronary arteries is of outmost importance during clinical practice in the catheterization laboratory. The CAAS QCA‐3D system provides technology to 3D reconstruct human coronary arteries based on two or more angiographic images, but was not validated in realistic arteries before.

Methods:

Ten patients were imaged using biplane angiography and an ECG gated (TomTec) intravascular ultrasound (IVUS) pullback (stepsize 0.5 mm, Boston Scientific). The coronary arteries were 3D reconstructed based on (a) fusion of biplane angiography and IVUS (ANGUS) and (b) CAAS QCA‐3D using the biplane angiography images. For both systems the length, the curvature and the lumen areas at 0.5 mm spacing were calculated and compared.

Results:

Bland‐Altman analysis indicated that the CAAS QCA‐3D system underestimated the lumen areas systematically by 0.45 ± 1.49 mm2. The segment length was slightly underestimated by the CAAS QCA‐3D system (62.1 ± 11.3 vs. 63.2 ± 11.4 mm; P < 0.05), while the curvature of the analyzed segments were not statistically different.

Conclusions:

The CAAS QCA‐3D system allows 3D reconstruction of human coronary arteries based on biplane angiography. Validation against the ANGUS system showed that both the 3D geometry and lumen areas are highly correlated which makes the CAAS QCA‐3D system a promising tool for applications in the catheterization laboratory and opens possibilities for computational fluid dynamics. © 2009 Wiley‐Liss, Inc.
Continuous epoprostenol therapy and septal defect closure in a patient with severe pulmonary hypertension
Authors: Hirabayashi Aki , Miyaji Katsumasa , Akagi Teiji
Published: October 2008

A 31‐year‐old woman with exertional dyspnea diagnosed as having atrial septal defect (ASD) with severe pulmonary hypertension (PH). Intravenous epoprostenol therapy was started to improve PH. Although pulmonary arterial pressure decreased, her symptoms remained in class III of WHO functional class, probably because of exacerbation of the left‐to‐right shunt caused by the reduction of pulmonary vascular resistance (PVR). Transcatheter atrial septal closure was therefore performed. Soon after the procedure, additional reduction in pulmonary arterial pressure was achieved. Her symptoms improved and oxygen inhalation was discontinued. One year after the procedure, although intravenous epoprostenol was still required, her symptoms had improved to class I of WHO functional class without exacerbation of PH. Transcatheter atrial septal closure after lowering PVR by intravenous epoprostenol would be a novel therapy for patients with ASD accompanied by PH. © 2009 Wiley‐Liss, Inc.
Novel self‐expanding stent system for enhanced provisional bifurcation stenting: Examination by StentBoost and intravascular ultrasound
Authors: Agostoni Pierfrancesco , Verheye Stefan
Published: October 2008

A 62‐year‐old man underwent percutaneous coronary intervention of a bifurcation lesion (Medina type 010) involving the mid‐left anterior descending coronary artery and an important first diagonal branch with a novel stent specifically designed for bifurcations, the Stentys coronary bifurcation system. This is a self‐expanding nitinol stent, with Z‐shaped struts linked by interconnections that can be disconnected (in prespecified points every 1.5 mm all around the circumference and the length of the stent) at the level of the ostium of the side branch, simply by inflating an angioplasty balloon tracked to the ostium of the side branch, through the stent struts. The steps required for deployment of the stent and the final result obtained were evaluated by intravascular ultrasound examination and StentBoost Subtract, a specific X‐ray stent‐enhancing visualization technique. © 2009 Wiley‐Liss, Inc.
A new 0.010‐inch guidewire and compatible balloon catheter system: The IKATEN registry
Authors: Matsukage Takashi , Yoshimachi Fuminobu , Masutani Motomaru , Katsuki Takaaki , Saito Shigeru , Takahashi Akihiko , Iida Kunihiko , Katahira Yoshiaki , Michishita Ichiro , Tanabe Kengo , Kan Yoshifumi , Ikari Yuji
Published: October 2008

Objective:

To evaluate the safety and feasibility of a new 0.010‐inch guidewire and a specialized balloon catheter for the 0.010‐inch guidewire in routine percutaneous coronary intervention (PCI).

Background:

Several reports have shown that a new 0.010‐inch system is effective for specific situations where reduction of catheter size may be necessary. However, the safety of this system in routine PCI is unknown.

Methods:

The IKATEN registry is a prospective, multicenter, nonrandomized registry study. Patients who underwent elective PCI with a 0.010‐inch guidewire and its associated balloon catheter as primary devices were enrolled. The coprimary endpoints were clinical success and device success rates. The secondary endpoints were major adverse cardiac events (MACE) and bleeding complications.

Results:

A total of 133 patients with 148 lesions were enrolled. The majority were male (75.3%), and mean age was 68 ± 10 years. Type B2/C lesions comprised 60% of the lesions, prevalence of chronic total occlusion (CTO) was 16.9%, and bifurcation lesions were found in 22.3% of patients. A transradial approach was used in 79.7% of patients, and the average guiding catheter size was 5.1 ± 0.4 Fr. Clinical success rate was 99.2%, and device success rate was 99.3%. Device failure occurred only in one case of chronic total occlusion because of unsuccessful guidewire passage. No MACE or bleeding complications were reported except for a small hematoma at the puncture site in one patient. Stent delivery success rate on 0.010‐inch guidewire was 93.9% because of failure of stent balloon to pass eight lesions.

Conclusion:

The IKATEN registry data suggest that the 0.010‐inch system is safe and its use is feasible in routine PCI including bifurcation and CTO lesions. © 2009 Wiley‐Liss, Inc.
Neointimal regression‐induced incomplete coverage of a bare‐metal stent in the left main trunk: Serial angiographic and angioscopic evidence obtained by 5‐year follow‐up
Authors: Ichikawa Minoru , Mishima Masayoshi
Published: October 2008

Very late stent thrombosis (VLST), a rare complication of stenting, has been reported to develop more frequently at later than 1 year after the deployment of the drug‐eluting stent (DES) compared with the bare‐metal stent (BMS). However, the causes for the difference in the incidence remain unknown. Serial angioscopy on 1,591 and 1,952 days after BMS deployment in a Japanese male patient with acute myocardial infarction revealed incomplete neointimal coverage (INC) without the development of cardiovascular event. Therefore, the potential development of VLST remains undeniable in BMS‐deployed patients who had INC. © 2009 Wiley‐Liss, Inc.
Outcome of patients treated by a novel thin‐strut cobalt‐chromium stent in the drug‐eluting stent era: Results of the SKICE (Skylor in real world practice) registry
Authors: Burzotta Francesco , Trani Carlo , Todaro Daniel , Mazzari Mario Attilio , Porto Italo , De Vita Maria , Brugaletta Salvatore , Coroleu Santiago Federico , Niccoli Giampaolo , Leone Antonio Maria , Giammarinaro Maura , Mongiardo Rocco , Schiavoni Giovanni , Crea Filippo
Published: October 2008

Objectives: To investigate the outcome of patients undergoing percutaneous coronary interventions (PCI) with implantation of a new thin‐strut cobalt‐chromium bare‐metal‐stent (BMS) in the drug‐eluting‐stent (DES) era. Background: Despite the contemporary penetration of DES in the clinical practice, a relevant percentage of patients are still treated by BMS. Data on clinical outcome of novel BMSs are lacking. Methods: This is a single‐centre‐registry enrolling patients treated by Skylor™ stent implantation. During the study, the criteria for BMS selection adopted at our institution (“internal” criteria) were as follows: (1) limited compliance to prolonged double antiplatelet therapy, (2) ST‐elevation myocardial infarction (STEMI) or saphenous vein grafts (SVG) interventions, and (3) in the absence of these conditions, noncomplex (no bifurcations, no chronic total occlusions) lesions considered at low restenosis risk on the basis of arbitrary angiographic criteria (short lesions, large vessels). Primary and secondary end‐points were respectively major adverse cardiovascular events (MACE) and target vessel failure (TVF) up to 9‐month. Results: A total of 150 patients were treated with Skylor™ stent on 169 lesions. At 9‐month follow‐up, MACE occurred in 12 patients (8.0%) and TVF in 21 lesions (12.4%). By multivariable analysis, the predictors of MACE were Euroscore≥9 and ejection fraction < 30% while the predictors of TVF were the absence of the angiographic criteria of low restenosis risk and ejection fraction < 30%. Conclusions: In the DES era, the use of a last‐generation BMS in patients with limited compliance to double antiplatelet therapy, STEMI or SVG interventions, and noncomplex angiographic lesions may be associated with acceptable clinical outcome. © 2009 Wiley‐Liss, Inc.
Phase Transformation of Iron Oxide Nanoparticles by Varying the Molar Ratio of Fe2+:Fe3+
Authors: Alibeigi S. , Vaezi M. R.
Published: October 2008

Co‐precipitation from a solution of ferrous/ferric mixed salt with the ratio of Fe2+:Fe3+ = 1:2 in air atmosphere is not a reliable method to synthesize magnetite (Fe3O4) nanoparticles because of the fact that Fe2+ oxidizes to Fe3+ and the molar ratio of Fe2+:Fe3+ changes. Therefore, the phase composition changes from magnetite to maghemite (γ‐Fe2O3). The influence of the initial molar ratio of Fe2+:Fe3+ on the phase composition of nanoparticles, their crystallinity and magnetic properties was studied. Experimental data from XRD, FTIR, SEM, and VSM reveal that the appropriate method to synthesize magnetite nanoparticles is reverse precipitation from only ferrous salt. It is found that by decreasing the synthesis temperature and by increasing the concentration of alkaline solution and the ratio of Fe2+:Fe3+ the crystallinity and the specific saturation magnetization (σs) are increased.