bluuebunny/crossref_metadata_2025 huggingface dataset:
Multicenter Evaluation of Fixed‐Wire PTCA Catheters with Modified Distal Tips: Initial and 2‐Month Follow‐Up Results
Authors: TALLEY J. DAVID , SHAWL FAYAZ , PICHARD AUGUSTO , GIAMBARTOLOMEI ALLESANDRO , OVERLIE PAUL , SIEGEL ROBERT , ROSENBERG JOEL , CATES CHRISTOPHER U. , CUMMINS FRANK , KOSINSKI EDWARD
Published: June 2007

Lesions in the distal portion of coronary arteries are technological challenges with currently available percutaneous transluminal coronary angioplasty (PTCA) equipment. A study was performed at multiple centers to determine if new “fixed‐wire” devices with a modified distal tip (a 2‐cm flexible tip and 1‐cm standard tip) would be useful in these situations. Three hundred twenty‐three patients were included in the study, 75% male, mean age 63 ± 11 years. Four hundred ninety‐three lesions were attempted; the overall success rate was 85%. Forty‐six (14.2%) clinical complications occurred including: 5 deaths (1.1%); 2 nonfatal myocardial infarctions (0.6%); and 6 emergency coronary artery bypass grafting procedures (2.6%). A device malfunction was noted in 32 patients (9.9%), and included: 8 balloon ruptures or perforations (2.0%); 6 bent or damaged tips (1.9%); and 4 shaft/manifold leaks (1.2%). Two‐month follow‐up assessment for restenosis was done in 352 of 371 (95%) patients and at that time 89% were asymptomatic, had a negative functional test, or patent PTCA site by angiography. The new fixed‐wire PTCA catheters with 1‐ and 2‐cm flexible tips hold promise for dilating lesions in distal locations with an acceptable rate of complications. Additional investigation is needed to determine their role in the treatment of coronary artery disease with PTCA.
Progress in Interventional Cardiology
Authors: Bisset Joe K. , Talley J. David
Published: June 2007

This issue of News & Views will review notable presentations from the 18th Annual Scientific Session of the North American Society of Pacing and Electrophysiology (NASPE), which took place in New Orleans, Louisiana, May 7‐10, 1997. Highlights of the meeting included presentation of the results of clinical trials using implantable cardiac defibrillators (ICDs) in patients with life‐threatening ventricular arrhythmias, and the application of interventional techniques for the treatment of atrial fibrillation (AF).
Pacemaker Therapy in Patients with Hypertrophic Obstructive Cardiomyopathy
Authors: STEELY DON , JAVIER JULIAN J. , BISSETT JOE K. , TALLEY J. DAVID
Published: June 2007

A 58‐year‐old female presented with exertional dyspnea and chest discomfort. Echocardiography showed concentric left ventricular hypertrophy with a gradient across the left ventricular outflow tract consistent with hypertrophic obstructive cardiomyopathy (HOCM). Her symptoms progressed despite the use of verapamil.
Mobilization Within Thirty Minutes of Elective Diagnostic Coronary Angiography: A Feasibility Study Using a Hemostatic Femoral Puncture Closure Device
Authors: SEIDELIN PETER H. , ADELMAN ALLAN G.
Published: June 2007

The standard procedure for obtaining hemostasis following coronary angiography is manual or mechanical compression of the femoral artery followed by 4–6 hours supine rest. The patient is then mobilized and later discharged. This consumes time and resources and may be uncomfortable for the patient. The aim of this pilot study was to determine if the Angio‐SealTM hemostatic puncture closure device (the Angio‐Seal device) allows safe, early mobilization of patients undergoing elective coronary angiography. Selected patients were randomly allocated to the the Angio‐Seal device (study group, n = 24) or standard compression techniques (control group, n = 26) after completion of the diagnostic coronary angiogram. Study group patients were mobilized 25–30 minutes after sheath removal and deployment of the Angio‐Seal device. After hemostasis in control patients, a pressure bandage was applied, and the patient was placed on bed rest for 4–6 hours. There was no age or sex difference between the study group and the control group. There were more patients with hypertension, diabetes mellitus, or obesity in the control group. Time to hemostasis was 0.5 ± 1.4 min for the study group and 42.9 ± 20.6 min for the control group (P < 0.0001). Time to mobilization was 32.5 ± 6.9 min for the study group and 322.7 ± 41.8 for the control group (P < 0.0001), with 83% and 92% (P = NS) of patients in respective groups being fully mobilized according to protocol. Complications requiring clinical intervention were seen in three patients (12.5%) in the study group and in one patient (4%) in the control group. We have shown that mobilization of patients within 30 minutes of diagnostic coronary angiography via the femoral artery is feasible using the Angio‐Seal device. The safety of this approach needs to be addressed in a larger randomized study.
A Floating Thrombus After Retrograde Gianturco Coil Embolization of a Patent Ductus Arteriosus in an Adult—Detection by Transesophageal Echocardiography
Authors: MÖHLENKAMP S. , BARTEL T. , SACK S. , RÜTTERMANN V. , SIMON H. , GE J. , HAUDE M. , SCHMALTZ A.A. , ERBEL R.
Published: June 2007

The occlusion of patent ductus arteriosus (PDA) by Gianturco coils has been performed in a growing number of patients since its introduction at the beginning of this decade. The procedure is considered to be effective and safe. Yet embolization of the coil into the pulmonary artery system and residual shunting are typical complications. In some cases a coil loop may protrude into the aortic or pulmonary artery lumen and thus may result in flow disturbances. We report a case of thrombus formation on an intraaortic coil loop after retrograde embolization of a PDA in an adult.
Coronary to Pulmonary Artery Shunt via the Bronchial Artery Demonstrated by Magnetic Resonance Imaging
Authors: AGIRBASLI MEHMET , LENHART MICHAEL B. , ARILDSEN RONALD C. , MYERS PAUL R.
Published: June 2007

We report a patient with severe chronic obstructive lung disease requiring home oxygen, in whom increased pulmonary vascular resistance was associated with collateral flow from the left coronary circumflex artery to the bronchial and pulmonary arteries. The anomaly was clearly demonstrated by magnetic resonance imaging (MRI) obtained before coronary angiography. This case suggests that MRI could play an important role in the assessment of coronary anomalies.
Left Ventricular Function Following Thrombolytic Therapy for Myocardial Infarction
Authors: FRENCH JOHN K. , HYDE THOMAS A. , WHITE HARVEY D.
Published: June 2007

The introduction of thrombolytic therapy to treat eligible patients with acute infarction has markedly reduced deaths from left ventricular (LV) failure. Following reperfusion therapy for acute myocardial infarction (MI), LV function remains the single most significant prognostic factor. Three trials have shown that LV function and survival improved in concert, following randomization to receive thrombolytic therapy. The Global Utilization of Strategies to Open Occluded Coronary Arteries study (GUSTO‐1) showed that end‐systolic volume at 90 minutes (or 180 minutes) after starting thrombolytic therapy correlates with early thrombolysis in myocardial infarction (TIMI) flow grades as well as survival.
Is the Outcome of Coronary Stenting Worse in Elderly Patients?
Authors: GAXIOLA EFRAIN , VLIETSTRA RONALD E. , BROWNE KEVIN F. , BRENNER ALAN S. , EBERSOLE DOUGLAS G. , ROMAN LYDIA , WEEKS TERESA T. , KERENSKY RICHARD A.
Published: June 2007

Initial reports of percutaneous transluminal coronary angioplasty (PTCA) in the elderly (≥: 75 years) showed a significantly lower primary success rate, higher in‐hospital mortality, and a higher risk of emergency or elective coronary artery bypass graft (CABG) compared to younger patients. There are few data concerning acute outcomes and clinical follow‐up after the use of coronary stenting in the elderly compared to < the 75‐year‐old age group. We evaluated 82 elderly patients and 280 younger patients who received Palmaz‐Schatz stents during 1995, at a time when high pressure deployment and antiplatelet therapy was routinely used. The success rate and acute major complications were not significantly different between the elderly and younger patients. Clinical events (death, myocardial infarction [MI], repeat PTCA, or CABG) during 6‐month follow‐up were also not significantly different. Coronary stenting in the elderly can be carried out with a high success rate and low incidence of acute major complications. Thus, short‐term clinical outcomes in elderly patients appear similar to results obtained in younger patients.
Spiral Coronary Artery Dissection Complicating Diagnostic Coronary Angiography: Repair With Multiple Stent Implantations
Authors: INOUE TERUO , HOSHI KAZUHIRO , MATSUNAGA RIICHIRO , YAGUCHI ISAO , MOROOKA SHIGENORI , SHIMIZU MINORU
Published: June 2007

A 62‐year‐old woman experienced a spiral coronary dissection in the right coronary artery from complicating diagnostic coronary angiography. We successfully repaired this serious complication by implanting 6 Wiktor coronary stents.
Intrapericardial Instillation of Recombinant Tissue Plasminogen Activator: A Case Report
Authors: RAHMAN ALI , ILKAY ERDOGAN , BURMA OKTAY , SAMIUYAR IHSAN , AKKUS MEHMET NECDET , OZDEMIR FERUDUN , CEKIRDEKCI AHMET
Published: June 2007

On the 43rd day after open heart surgery, pericardial effusion developed in a patient and resulted in cardiac tamponade. Since the drainage could not be obtained by subxiphoid window technique due to location of fluid and presence of fibrinous adherence and a thrombus in pericardial space, transcatheter intrapericardial recombinant tissue plasminogen activator (tPA) was instilled in the patient. Thus, the intrapericardial fibrinous adherence and the thrombus disappeared, and the effusion was drained efficiently.
Simultaneous Transcatheter Closure of Two Secundum Atrial Septal Defects Using the Amplatzer™ Septal Occluder
Authors: HIJAZI ZIYAD M. , BOVA STEVE , RHODES JONATHAN
Published: June 2007

Transcatheter closure of a single secundum atrial septal defect (ASD) is performed routinely using various investigational devices. A 37‐year‐old patient with two large secundum ASDs underwent successful simultaneous transcatheter closure using an 18‐mm and 20‐mm Amplatzer™ septal occluder device. At 3‐month follow‐up, transesophageal color Doppler echocardiography revealed one defect to be completely closed, and the other had trivial residual shunt with significant improvement in symptoms.
Head‐up Tilt Testing Predicts Syncope During Ventricular Tachycardia in Implantable Cardioverter Defibrillator Patients
Authors: SINGER IGOR , EDMONDS HARVEY L.
Published: June 2007

Implantable cardioverter defibrillator (ICD) programming is usually based on results of supine electrophysiological (EP) testing. However, EP testing does not provide any information about tolerance to ICD therapy in the upright posture. We hypothesized that in addition to the arrhythmia duration and ventricular tachycardia (VT) cycle length, cerebral perfusion may play a role in determining tolerance to tiered ICD therapy. Transcranial Doppler (TCD) and cerebral venous oxygen saturation (rCVOS) are relatively new noninvasive techniques that may be used to assess dynamic changes in cerebral blood flow and metabolism during VT. Sixteen patients with pace‐terminable VT and ICDs underwent supine (S) and upright tilt (HUT) ICD testing in conjunction with TCD and rCVOS monitoring. ICDs were programmed to deliver antitachycardia pacing, cardioversion, and defibrillation for VT, in the ascending order of aggressivity. Despite no significant differences in the induced VT cycle length (320 ± 100 msec, S, vs 330 ± 90 msec, HUT) and VT duration (14.6 ± 6.7 sec, S, vs 17 ± 9.2 sec, HUT), cerebral perfusion was more significantly impared during HUT (21 ± 10 [S] vs 29 ± 7% decrease from baseline [HUT], P < 0.001), and rCVOS decreased from baseline (5 ± 6 [S] vs 10 ± 6 [HUT] %, P < 0.001). Five of 16 patients experienced syncope during HUT and none during supine testing. At 1‐year follow‐up five patients who experienced syncope during HUT experienced at least one episode of syncope, whereas none not so identified did. We conclude that: (1) Supine ICD testing is insufficient to predict individual patient tolerance to ICD therapy; (2) HUT testing predicts tolerance to ICD therapy; and (3) noninvasive neuromonitoring techniques are useful for assessment of cerebral blood flow and metabolism during ICD testing.
Development and Pathophysiological Basis of Thrombolytic Therapy in Acute Myocardial Infarction: Part III, 1981–1985 Registries of Intracoronary Thrombolytic Therapy and Experimental Reperfusion Studies
Authors: RENTROP K. PETER
Published: June 2007

The angiographic results of intracoronary thrombolysis were correlated with various outcome parameters in three registries. The West German Registry (n = 232) showed that mortality and improvement of left ventricular function were related to recanalization and prevention of reocclusion. This registry became the core database for the Food and Drug Administration (FDA) approval of thrombolytic agents for myocardial infarction in 1982. The European Registry (n = 414) analyzed changes in left ventricular ejection fraction further. A continuous model suggested that the functional benefit of reperfusion decreases rapidly and in a nonlinear fashion with delays in treatment during the first 3 hours. Reperfusion after > 6 hours was still associated with a significant benefit, which appeared to be related to collateral flow to the infarct zone. Myocardial salvage in experimental reperfusion studies and the reperfusion injury controversy are reviewed. In experimental studies performed by our group, it was found that thrombolytic agents did not exacerbate myocardial hemorrhage or increase infarct size. The Goettingen Registry (n = 152) demonstrated that reperfusion resulted in a steeper slope of the regression line between infarct size determined by ventriculography and cumulative serial creatine kinase release. Furthermore, reperfusion was associated with transient loss of R waves and transient development of Q waves. The implications of these findings regarding the reperfusion injury controversy and assessment of infarct size are discussed. Other analyses of the Goettingen data found that flow patterns to the infarct zone at preintervention angiography correlated with the duration of angina pectoris, incidence of antianginal therapy, and baseline ejection fraction. Assessment of the reliability of the admission ECG showed that half of the patients with infarction due to occlusion of the circumflex artery lacked diagnostic changes. The Goettingen Registery followed the first group of 70 patients ever treated with intracoronary thrombolytic therapy for 3 years. Mortality was low by the standards of the time. Reperfusion was associated with sustained improvement of left ventricular function and often dramatic clinical stabilization not seen before.
Ostial Left Main Stem Stenting After Cutting Balloon Angioplasty
Authors: AMIN FOUAD R. , KURBAAN ARVINDER S. , SIGWART ULRICH
Published: June 2007

Despite major improvements in equipment and operator technique over the past two decades, percutaneous revascularization has only been used cautiously in patients with left main stem stenosis. A 73‐year‐old man presented with a history of multiple risk factors and previous cardiac surgery and was admitted with acute chest pain. Cardiac catheterization showed 80% left main stenosis, which was dilated by a cutting balloon and stented with an uneventful postprocedure course. The patient remained free of symptoms at 6‐months follow‐up. Stenting after cutting balloon angioplasty of left main stenosis is a feasible and effective procedure in patients who are unsuitable for CABG.
Treatment Strategies for Bifurcation Lesions
Authors: HAASE JÜRGEN , REIFART NICOLAUS
Published: June 2007

Percutaneous transluminal angioplasty of coronary artery bifurcations represents a still evolving field of interventional cardiology. The dilatation of stenoses located at the site of coronary bifurcations has been limited by the risk of side branch occlusion with subsequent myocardial infarction and high rates of late restenosis. The initial success rates of conventional balloon dilatation were improved by the introduction of side branch protection using two guidewires as well as the “kissing balloon” technique. The potential advantage of atherectomy techniques, however, was associated with a high incidence of acute complications. While bifurcation stenting promises to allow optimal geometric reconstruction of bifurcation lesions using multiple or single component bifurcation stents, late intimal hyperplasia remains a potential limitation of this interventional approach.
Treatment Strategies for In‐Stent Restenosis
Authors: STÖRGER HANS
Published: June 2007

In‐stent restenosis has become a significant clinical problem. It is estimated that in 1997, up to 100,000 patients with in‐stent restenosis were treated worldwide. Serial intravascular ultrasound analysis has shown that neointimal hyperplasia represents the most important cause for in‐stent restenosis, while late recoil and remodeling are neglectabe. With the recent explosion in the use of coronary stents, clinical investigation on stent restenosis has lagged behind. For example, the true prevalence of in‐stent restenosis varies with the lesion and patient subset. It is much higher in the “real world” than in selected patients who are typically controlled in most studies. Diffuse restenosis can be expected in about two‐thirds of stented patients, and it is difficult to treat because of unfavorable long‐term results. Conventional catheter‐based treatment modalities include plain balloon angioplasty (PTCA), rotational atherectomy (RA), excimer laser coronary angioplasty (ELCA), directional coronary atherectomy (DCA), and additional stent implantation. Exact individual recurrence rates for these approaches are not known and show a considerable degree of variability. Recently, brachytherapy has emerged as the most promising way to treat in‐stent restenosis.
Ultrasound Thrombolysis: An Alternative to the Pharmacological Approach
Authors: ROSENSCHEIN URI
Published: June 2007

The clinical management of intracoronary thrombosis presents a therapeutic challenge. A variety of pharmaceutical agents have been investigated as an adjunct to balloon angioplasty and stenting with no conclusive evidence to which is the best therapeutic strategy. Our group has investigated the use of therapeutic ultrasound in interventional cardiology over the last few years. Ultrasonic energy (41 KHz) is transmitted from a transducer as longitudinal vibrations of a 140‐cm long solid probe, which directs the energy into the arterial system. In the ACUTE study, consecutive patients with first infarct, only acute anterior myocardial infarction, and occluded LAD were studied. Final flow of TIMI grade 3 was achieved in 93% of the patients. During the procedure, there were no clinical or angiographic adverse events. At 6‐month follow‐up, a significant improvement of left ventricular ejection fraction was observed. There was a low clinical event rate. The Acolysis Registry followed the ACUTE trial. The purpose of this registry was to investigate coronary ultrasound thrombolysis in the different clinical settings of intracoronary thrombosis. Preliminary data (n = 51), show that 56% of the patients were treated for acute myocardial infarction, 25% for unstable angina, and 19% for diseased saphenous vein grafts (SVG). Ninety percent of the vessels were occluded (TIMI 0‐1 flow) at baseline, median age clot was 4 days. Device and procedural success was obtained in 84% and 82%, respectively. Intriguing data came from the SVG subset of patients. Angiographic analysis revealed that 75% of the SVGs were occluded prior to the procedure. Sonication led to successful recanalization in 70% of the patients. In summary, this data suggests that therapeutic ultrasound is effective and safe for inducing intracoronary thrombolysis. Ultrasound can be used to treat thrombi that are a few hours to a few weeks old. Lysis of intracoronary thrombus by ultrasound is a safe and effective procedure. Furthermore, ultrasound thrombolysis is a viable alternative to the pharmacological approach. Local application of ultrasound achieves a high success rate with minimal local or systemic adverse events.
Update on Interventions in Renal Artery Stenosis
Authors: ELTCHANINOFF HÉLÈNE , CRIBIER ALAIN
Published: June 2007

Noninvasive techniques such as ultrasound and renal scanning have improved the frequency of detection of renal artery stenosis in patients with arterial hypertension, renal insufficiency, or multivascular disease. The results of conventional balloon angioplasty on nonostial renal artery stenoses caused by fibromuscular dysplasia or atherosclerosis showed a high recurrence rate and a moderate impact on the management of hypertension. In patients with ostial lesions, the results of angioplasty were disappointing with low initial success rates and a high rate of restenosis. Other limitations of balloon angioplasty include initial failure or suboptimal result, occluding dissection, and short‐ or mid‐term restenosis. The immediate procedural results of renal artery stenting are excellent, with a low complication rate and satisfactory restenosis rate. Long‐term effects on renal function and blood pressure seem to be good. Systematic stent placement is indicated for ostial stenosis. For nonostial lesions, the indication for stent placement may be reserved for residual stenosis or dissection. The indication for a stent would probably be more liberal in cases of bilateral lesions or lesions in a solitary kidney. Multicenter studies probably will be needed to assess the indications and benefits obtained in different clinical and anatomical situations.
Update on Minimally Invasive Coronary Artery and Valvular Surgery
Authors: DUHAYLONGSOD FRANCIS G. , GLOWER DONALD D.
Published: June 2007

The introduction of minimally invasive techniques represents the most dramatic and controversial new development in cardiac surgery. Almost all minimally invasive surgery involves modified standard incisions and at least partial direct vision of the operative field. Therefore, minimally invasive cardiac surgery is defined as an operation through a smaller than usual incision. The procedures then can be divided into those with or without cardiopulmonary bypass. They can be applied in coronary artery bypass grafting or in valvular operations. Ultimately, almost all cardiac surgery could be performed in a minimally invasive fashion. However, the dominance of any type of procedure will depend on data supporting effectiveness, relative technical ease, ultimate cost savings, and improved patient outcome. Many of these data are lacking or are preliminary. Prospective, randomized comparisons are needed.
Update on Cutting Balloon Angioplasty
Authors: YAMAGUCHI TETSU , NAKAMURA MASATO , NISHIDA TAKAHIRO , HARA HISAO , ASAHARA TOSHIYUKI , TOHMA HIROKO
Published: June 2007

Cutting balloon (CB) is a unique balloon catheter with 3 or 4 metal blades on its surface making controlled endovascular surgical incisions that show promise of causing less vessel wall injury and less intimai proliferation. Multicenter randomized trials have revealed that CB angioplasty with multiple inflations achieved better lumen enlargement than single inflation and reduced coronary dissection more than plain old balloon angioplasty (POBA). Follow‐up results showed CB angioplasty had a smaller late loss and loss index, resulting in lessened restenosis and target lesion revascularization rates. The main indication of CB angioplasty is basically a noncalcified lesion with concentric plaque; however, it could be applied effectively to some lesions unsuitable for POBA including in‐stent restenosis, small vessel, long diffuse lesion, or ostial lesion. Additional evaluation would be necessary to determine the role of CB angioplasty in the stent era.
Iatrogenic Cardiovascular Complications: Part I. Semi‐Noninvasive Procedures and Diagnostic Invasive Procedures
Authors: MARAJ RAJIV , RERKPATTANAPIPAT PAIROJ , WONGPRAPARUT NATTAWUT , FRAIFELD MOISES , LEDLEY GARY S. , JACOBS LARRY E. , YAZDANFAR SHAHRIAR , KOTLER MORRIS N.
Published: June 2007

This article reviews cardiac and noncardiac complications encountered with various procedures used in cardiology practice. Some of the common complications associated with transesophageal echocardiography are hypoxia, laryngospasm, bronchospasm, and brady‐ or tachyarrhythmias. Death is a rare complication. The overall prevalence of complications associated with external cardioversion is low. Major complications include death, cardiac arrhythmias, pulmonary edema, systemic embolism, and cerebral embolism. The main indication for endomyocardial biopsy at present is to assess cardiac transplant rejection. Complications occurring most frequently are carotid artery puncture, arrhythmias, and conduction abnormalities. The most commonly occurring complications of electrophysiological studies are pneumothorax, venous thrombosis, and hypotension. Cardiac catheterization is an invaluable procedure in the assessment of patients with ischemic heart disease. Major complications include vascular complications, arrhythmias, complications due to contrast agents, and death. Central venous catheterization is used to deliver medication and parenteral nutrition and also in the hemodynamic monitoring of patients. Local infection, sepsis, noninfectious phlebitis, and catheter dislodgment are some of the more commonly occurring associated complications. Swan‐Ganz catheters are indicated for the hemodynamic monitoring of critically ill patients. Major associated complications include pneumothorax, arterial puncture, air embolism, tracheal and esophageal puncture, arrhythmias, valvular damage, infection, thrombosis, and pulmonary infarction. The use of intra‐aortic balloon pumps can be complicated by ischemia, bleeding, intraaortic balloon pump rupture, vascular complications (mainly limb ischemia), and death. Some of the common underlying mechanisms responsible for complications during interventional procedures are abrupt closure, noreflow phenomenon, coronary artery spasm, distal embolization, and side branch occlusion. The use of abciximab may be associated with an increased risk of major bleeding. Acute profound thrombocytopenia is another potential complication associated with abciximab use. Heparin usage may be associated with bleeding, thrombocytopenia, skin necrosis, osteoporosis and hypersensitivity reactions. Some of the more common complications of thrombolytic therapy are bleeding, myocardial rupture, hypotension, allergic reactions, anaphylaxis, thromboembolic complications, reperfusion arrhythmias, and splenic rupture.
Multiple Intracoronary Stenting in Native Coronary Arteries and Saphenous Vein Grafts: A Single Center Experience
Authors: VARNAVA AMANDA M. , KELLY PAUL A. , DAVIES SIMON W. , RICKARDS ANTHONY F. , SIGWART ULRICH
Published: June 2007

Objective: To determine the early and late clinical outcomes following multiple stent deployment during a single percutaneous transluminal coronary angioplasty (PTCA) procedure. Methods: All patients who received two or more stents during a single PTCA were reviewed. An analysis was made of 114 patients (mean age = 61.2 years). A total of 268 stents were deployed, range 2–6 stents per PTCA (mean = 2.4). Stenting was performed as a primary procedure in 38 patients, for arterial dissection in 44, and for threatened closure in 32. At least two stents were deployed in the same vessel in 101 (88.6%) patients. Before discharge from hospital, there were 4 (3.6%) deaths, 6 (5.2%) patients required emergency coronary artery bypass grafting (CABG), and 2 (1.8%) patients required repeat PTCA. Three (2.6%) patients sustained acute myocardial infarction (AMI). The mean follow‐up period was 10.6 months. After leaving hospital, there were no deaths, 5 (4.4%) patients required CABG, and 5 (4.4%) had a further PTCA. There was one (0.9%) AMI. The total event rate was 19.2%, which compares well with single stent trials in which event rates of 20.1% and 19.5% were reached. In addition, 19 (16.7%) patients had a recurrence of symptoms. Conclusion: It is possible to deploy multiple stents at a single intervention in the same or different vessels safely and with clinical outcomes that are similar to those in studies of single coronary stenting.
Experimental Results with a New Gold‐Coated Multicellular Stent Design: Comparison with a Conventional Slotted Tube Stent in the Coronary Overstretch Model of the Pig
Authors: SCHULZ CHRISTINA , HERRMANN R. A. , RYBNIKAR A. , ALT ECKHARD
Published: June 2007

Background: Despite major progress in coronary stenting over the past decade, the problem of restenosis remains of concern. Recent developments to reduce the incidence of restenosis have focused on modifications in stent design. The aim of the present study was to examine the implant characteristics and vascular response of a new balloon‐expandable gold‐coated stent (16 longitudinal struts per cross section) with 8 cell multicellular geometry in comparison to a conventional gold‐coated slotted tube stent (12 struts per cross section). Methods and Results: A total of 26 stents of new and conventional designs were implanted in 13 pigs using the coronary overstretch model. There were no differences in baseline angiographic and implant parameters. For the mean implant diameters of 2.39 ± 0.23 mm (multicellular design) and 2.40 ± 0.36 mm (conventional design), the metal surface of the stent accounted for a total vessel area of 25%± 1.9% and 30.7%± 1.5%, respectively (P < 0.05). Histologic follow‐up at 28 days demonstrated a 35.5% reduction in the mean vascular injury score (0.69 ± 0.79) for the multicellular versus the conventional design (1.07 ± 0.49, P = 0.04) despite comparable vascular overstretch. This was accompanied by a significant reduction in the mean neointimal area (0.7 ± 0.6 vs 1.6 ±0.7 mm2, P < 0.01) and percent diameter stenosis (13.9 ± 14.7 vs 29.6 ± 17.0, P <0.05). Histologic data at 3 months revealed similar results with respect to mean vascular injury, neointimal thickness, and percent diameter stenosis. Conclusions: The more homogenous force distribution with the multicellular stent design results in less vessel injury and reduced restenosis compared to the conventional slotted tube design. Between 1 and 3 months there was no further increase in neointimal formation indicating that the multicellular design does not induce ongoing arterial injury that could promote late neointimal formation.
Successful Rotational Atherectomy of Mid‐Saphenous Vein Graft Lesions
Authors: BENREY JAIME , MESA ANDRES , JAIN SURENDRA , GARCIA‐GREGORY JORGE A.
Published: June 2007

Rotational atherectomy has long been regarded as contraindicated for stenotic lesions within the body of saphenous vein grafts. So far, reports of rotational atherectomy in vein grafts have been concerned with ostial and distal anastomotic lesions. We report the first two cases of the successful use of the Rotablator for discrete lesions of mid‐saphenous vein grafts. No complications were encountered. One patient is doing well 6 months after the procedure, and the other patient continues to do well more than 1 yearlater.
Role of Autoperfusion Balloon in Endovascular Interventions
Authors: KIPSHIDZE NICHOLAS , CHAWLA PARAMJITH S.
Published: June 2007

The development of the autoperfusion balloon catheter provided the ability to perform prolonged balloon inflations during angioplasty procedures. For a number of years the autoperfusion balloon catheter was successfully used to treat acute complications of percutaneous coronary interventions. However, with the advent of stent implantation procedures and the use of platelet glycoprotein IIb/IIIa receptor inhibitors, the role of autoperfusion balloon angioplasty has decreased. However, the perfusion balloon may have an important role in angioplasty and/or stenting of coronary lesions with unfavorable coronary anatomy and also in carotid angioplasty. The perfusion balloon also may be helpful for the treatment of in‐stent restenosis. In the future the autoperfusion balloon or its principle may hold promise in emerging interventions, such as gene therapy and vascular brachytherapy where prolonged interrupted of coronary circulation is required.
Reperfusion of Infarct Related Artery Achieved by Direct Percutaneous Transluminal Coronary Angioplasty Counteracts Left Ventricular Remodeling after Acute Myocardial Infarction More Than Thrombolysis
Authors: GOLIA GIORGIO , VASSANELLI CORRADO , BARBIERI ENRICO , MORANDO GIORGIO , BENETELLO CLAUDIA , ANSELMI MAURIZIO , ZARDINI PIERO
Published: June 2007

The purpose of this study was to compare the effect of direct percutaneous transluminal coronary angioplasty (PTCA) and intravenous recombinant tissue plasminogen activator (rt‐PA) on left ventricular remodeling in patients with acute myocardial infarction (AMI). To address this issue, patients with AMI randomly assigned to direct PTCA or intravenous rt‐PA as part of a large multicenter study (Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries [GUSTO] IIb Angioplasty Substudy) were evaluated with two‐dimensional echocardiography at predischarge. An echocardiographic infarct size index and the end‐diastolic and end‐systolic left ventricular volumes were computed. Patients with an infarct size index equal to or higher than the mean value were considered to have a large infarction. Of 26 enrolled patients, 13 were assigned to PTCA (9 successfully reperfused: i.e., TIMI‐3 flow after PTCA) and 13 to rt‐PA (10 successfully reperfused: i.e., ST resolution after rt‐PA). In patients considered successfully reperfused, end‐systolic volumes tended to be lower in PTCA patients than in rt‐PA patients (43 ± 17 cc vs 59 ± 21 cc, P = 0.09), although there were no differences in infarct size index (7.3 ± 2.8 vs 7.0 ± 2.8) and ejection fraction (52%± 10% vs 46%± 12%). End‐systolic volume depended on infarct size index in the overall patient population (r = 0.60, P = 0.007) and in rt‐PA patients (r = 0.80, P =0.005), while no correlation was found in PTCA patients. Considering patients with large AMIs, end‐systolic volumes were higher in the four patients treated with rt‐PA than in the four patients treated with direct PTCA (P < 0.01). Considering all the 26 enrolled patients, these differences were also present, but they did not reach statistical significance. In conclusion, our results suggest that, in patients with large AMIs, adequate reperfusion obtained by direct PTCA has a more marked effect in counteracting ventricular remodeling than that obtained by systemic rt‐PA. This beneficial effect of direct PTCA, independent of any reduction in regional wall‐motion abnormalities, should be taken into account when comparing the clinical value of direct PTCA with that of systemic thrornbolysis in the treatment of AMI.
A Biodegradable Poly‐l‐lactic Acid Coronary Stent in the Porcine Coronary Artery
Authors: TAMAI HIDEO , IGAKI KEIJI , TSUJI TAKAFUMI , KYO EISHO , KOSUGA KUNIHIKO , KAWASHIMA AKIYOSHI , MATSUI SHIGEO , KOMORI HIDENORI , MOTOHARA SEIICHIRO , UEHATA HIROMU , TAKEUCHI EIJI
Published: June 2007

Although biocompatibility of biodegradable stents is controversial, stents made of high molecular weight poly‐l‐lactic acid (PLLA) are thought to be the most promising. We investigated the biocompatibility of PLLA stents histologically and angiographically in porcine coronary arteries. The Igaki‐Tamai stent is made of PLLA monofilaments (molecular mass 183 kD) with a zigzag helical coil design. Fourteen PLLA stents in 6 pigs and 9 Palmaz‐Schatz half stents in 9 pigs were implanted in 15 normocholesterolemic pigs. Stents were mounted on a delivery catheter, and were implanted percutaneously into coronary arteries. Coronary angiography was performed before and immediately after stenting, at 2 and 6 weeks in five PLLA pigs and nine Palmaz‐Schatz pigs. Histological studies were performed in PLLA pigs: 2 pigs at 2 weeks, 3 pigs at 6 weeks, and 1 pig at 16 weeks with hematoxylin‐eosin and elastica van Giesons stains. All PLLA stents were successfully delivered. No stent thrombosis was detected in either group. There were no significant differences in minimal lumen diameter (MLD) or percent diameter stenosis between the PLLA and Palmaz‐Schatz stent groups immediately after implantation, or at 2 or 6 weeks after implantation. Histological studies at 2, 6, and 16 weeks revealed no inflammation and minimal neointimal coverage on the PLLA stent struts. The PLLA stent maintained its structure for up to 16 weeks. These results suggest sufficient biocompatibility and strength of PLLA biodegradable stents in porcine coronary arteries. Clinical trial is now underway to validate the safety and usefulness of PLLA stents in humans.
Indications and Limitations of Lower Extremity Percutaneous Transluminal Angioplasty
Authors: STARCK ETHARD E.
Published: June 2007

Clinical indications are essentially those guidelines observed by moderately aggressive vascular surgeons. By using a combination of several angioplastic techniques specifically tailored to the type of occlusive material, we gain time and primary success with fewer complications. In more escalated treatments with stents, in 21% we achieve a primary clinical success rate until hospital discharge of 97% in the iliac region, 95% in the femoropopliteal region, and 89.9% in tibial angioplasty without stenting. Long‐term results decrease with luminal width and the degree of changes by the underlying atherosclerotic disease. Less invasiveness and low complication rates favor PTA over vascular surgery.
Coronary Angioplasty in Low Risk Patients with Low Dose Heparin and Immediate Withdrawal of the Femoral Sheath
Authors: BRUNEL PHILIPPE , TIROUVANZIAM ASHOK , GROSSETÊTE ROBERT , CROCHET DOMINIQUE
Published: June 2007

This study reports our preliminary experience of percutaneous coronary angioplasty with low dose heparin and immediate withdrawal of the femoral sheath. After selection, 120 patients underwent a procedure with a low dose of heparin (4,300 ± 700 IU). A total of 120 of 123 lesions (97.6%) were treated successfully by the femoral route. There were no major cardiac complications during the procedure and hospital stay. Patients were allowed to be ambulant 6 hours after the procedure. No significant bleeding occurred. There was no need for surgery relative to the approach route nor for blood transfusion. The use of low dose heparin and immediate withdrawal of the femoral sheath did not increase the risk of coronary angioplasty in these selected patients. The period of bed confinement was shortened and the patients were ambulant earlier, leading to a reduction in their hospital stay with no increase in costs.
Dual Left Anterior Descending Coronary Artery: A Rare Coronary Anomaly
Authors: OSMAN AHMED F. , SHAMAILEH QASEM , GOUSSOS YOUSSEF , WHITE CHRISTOPHER J.
Published: June 2007

We were asked to review the coronary angiogram of a patient showing a dual left anterior descending (LAD) arterial supply anomaly. This prompted a review of the database at Ochsner Foundation Hospital for congenital coronary anomalies in general and similar cases in particular. Between 1989 and 1996, 15,714 coronary catheterizations were performed. We found 134 anomalies (0.85%); the presence of a dual supply to the usual LAD territory was found in 2 patients (0.013%). In this report, we present the absolute and relative incidence of the individual patterns.
Renal Artery Aneurysm Exclusion Using a Self‐Expanding Covered Stent with a Procedural Outcome and 6‐Month Angiographic Follow‐up
Authors: NSEIR GEORGES , DORROS GERALD
Published: June 2007

A 76‐year‐old woman with prior catastrophic rupture of a splenic artery aneurysm had a renal artery aneurysm discovered during evaluation of her refractory hypertension. The aneurysm was excluded using a coronary polytetrafluoroethylene (PTFE)‐covered investigational (Symbiot) coronary stent in conjunction with coil occlusion of the inferior pole artery to preclude possible back flow into the excluded aneurysm. Six‐month angiography demonstrated a patent vessel; her serum creatinine remained stable at 1.3 mg/dL.
Percutaneous Mechanical Mitral Commissurotomy with the Metallic Valvulotome: Detailed Technical Aspects and Overview of the Results of the Multicenter Registry on 882 Patients
Authors: CRIBIER ALAIN , ELTCHANINOFF HÉLÈNE , CARLOT RAPHAËLLE , BIZET CATHERINE , GIRON CARLOS , CHASSAING STEPHAN , DERUMEAUX GENEVIEVE
Published: June 2007

Percutaneous mechanical mitral commissurotomy (PMMC) is a new technique that has been developed over the last 3 years for the treatment of mitral stenosis. The device used opens the commissures by a direct action of two parallel bars located in a metallic head screwed at the distal end of a 13Fr catheter. Opening of the bars is obtained with the use of activating pliers attached at the proximal end of the catheter. The metallic dilator and the pliers can be safely reused after sterilization. The device and the direrent steps of the procedure are detailed in this article. The results of an international registry including 882 patients are reported here. PMMC could be achieved in 863 (98%) cases. Maximal opening of the bars was 40 mm in 90% of the cases. The technique resulted in an increase of the mitral valve area from 0.94 ± 0.2 cm2 to 2.12 ± 0.4 cm2. Bilateral splitting of the commissures was achieved in 85% of the cases. Complications occurred in 33 (3.7%) patients: pericardial tamponade in 1.4% (12 cases, one death), mitral regurgitation > grade 2 in 2.1% (18 cases, surgery required in 4), and transient stroke in 0.3% (3 patients). The role of the learning curve in the occurrence of complications has been clearly demonstrated. The cost of the procedure has been markedly decreased in developing countries due to multiple reuses of the device after sterilization.
Technique and Results of Percutaneous Mitral Valvuloplasty with the Multi‐Track System
Authors: BONHOEFFER PHILIPP , HAUSSE ANA , YONGA GERALD , YUKO‐JOWI CHRISTINE , AGGOUN YACINE , SALIBA ZAKHIA , FERREIRA BEATRIZ , SIDI DANIEL , KACHANER JEAN
Published: June 2007

The Multi‐Track System is a simplified double‐balloon technique for percutaneous mitral valvuloplasty. Here we describe the technique and report the results obtained using it. The Multi‐Track catheter has a short distal tip for connection to the guidewire. This leaves the rest of guidewire free to receive other catheters. Various catheters can be introduced over the same guidewire. The balloons are introduced one after the other allowing a smaller size of vascular access and transseptal passage. Furthermore, simultaneous pressure measurements in the left atrium and left ventricle are possible through a simple venous access, allowing avoidance of arterial puncture. We used this technique worldwide between June 1994 and February 2000 for the treatment of 153 patients with mitral stenosis worldwide. In 12 cases, the procedure was done using the exclusive venous approach. The mean mitral valve area increased from 0.75 ± 0.22 to 2 ± 0.33 cm2and the mean left atrial pressure dropped from 27 ± 8 to 11 ± 4 mmHg. Four patients had a significant increase in mitral regurgitation, requiring surgical treatment in two patients. There was no mortality. The Multi‐Track system is a valid user‐friendly and cost‐effective alternative for the treatment of mitral stenosis. It is a rapid and effective procedure associated with low risks.
Long‐Term Results After Percutaneous Balloon Mitral Commissurotomy
Authors: VAHANIAN ALEC , IUNG BERNARD , CORMIER BERTRAND , MAKITA YASUHIRO , LUXEREAU PHILIPPE
Published: June 2007

We are now able to analyze follow‐up data up to 10 years after percutaneous mitral commissurotomy (PMC). In clinical terms, several large single‐center series confirm the late efficacy of the procedure in a large population, comprising a variety of patient subsets. When the immediate results are unsatisfactory, prognosis is poor and surgery should be carried out when the clinical conditions allow it. Conversely, if PMC is initially successful, the clinical results are excellent and late deterioration is mainly related to restenosis. Preliminary series have shown that repeat balloon commissurotomy may be performed successfully in such patients. The prediction of late results after balloon commissurotomy is multifactorial and based on clinical parameters, valve anatomy, and the immediate results of the procedure. Randomized studies have shown that the long‐term results of balloon commissurotomy are as good as those of surgery in patients with favorable characteristics. In the others, there has been no comparative study and patient selection should take into account the multifactorial nature of the prediction of late results. Overall, these good long‐term results have led to an increased use of balloon commissurotomy in the treatment of patients with mitral stenosis.
Coronary Artery Stenting in Vessels with Reference Diameter < 3 MM
Authors: GERMING ALFRIED , VON DRYANDER STEFAN , MACHRAOUI ABDERRAHMAN , BOJARA WALDEMAR , LAWO THOMAS , LEMKE BERND , BARMEYER JURGEN
Published: June 2007

The study included 220 consecutive patients with coronary artery stenting. In 128 patients (60.8 ± 10.2 years, 68% men), a total of 184 stents were placed in coronary vessels with a reference diameter < 3 mm (group S). One hundred thirty‐four stents were implanted in 92 patients (62.9 ± 9.8 years, 82.6% men) in vessels > 3 mm (group L). There was no significant difference according to clinical baseline characteristics. The primary end point of this retrospective study was the rate of periinterventional complications (death, stent thrombosis, myocardial infarction, urgent angioplasty, or surgical revascularization). The, secondary end point was the clinical and angiographic follow‐ups (restenosis, recurrent angina, further revascularization) after 3 months. Cardiac complications occurred in group S in two (1.6%) patients, two stent thromboses with urgent angioplasty, one Q‐wave and one non‐Q‐wave infarction. There was one (1.1%) event in group L, a stent thrombosis with Q‐wave infarction and urgent angioplasty. Angiography at 3‐month follow‐up was performed in 148 patients. Restenosis occurred in group S in 31.8% and in group L in 21.7% (NS). Data according recurrent angina and recommended surgical revascularization did not differ between both groups. In group S, significantly more angioplasties of the stented lesion were performed (23/60 patients) compared to group L (6/88) (P = 0,015). Coronary artery stenting in vessels with a reference diameter < 3 mm can be performed without a high rate of periinterventional complications. Restenosis tends to be more frequent in the small vessel group, a higher rate of reangioplasties have to be expected. The clinical follow‐up is comparable to a control group.
Experimental and Clinical Studies of Biodegradable Polymeric Stents
Authors: TSUJI TAKAFUMI , TAMAI HIDEO , IGAKI KEIJI , KYO EISHO , KOSUGA KUNIHIKO , HATA TATSUHIKO , OKADA MASAHARU , NAKAMURA TAKUJI , KOMORI HIDENORI , MOTOHARA SEIICHIRO , UEHATA HIROMU
Published: June 2007

The metallic stent has become the most common device to reduce acute occlusion and late restenosis after balloon angioplasty, but the long‐term effects of metallic stents in human coronary arteries are still unknown. To overcome several problems of conventional stenting, there have been many attempts to manufacture stents made of biodegradable materials. Although some studies have noted various degrees of inflammatory responses after biodegradable stent implantation, stents made of poly‐1‐lactic acid (PLLA) showed high biocompatibility with minimal inflammatory response and neointimal formation in porcine coronary arteries. A clinical study of PLLA self‐expanding stent implantation is underway in Japan. The initial and 6‐month results are favorable and suggest the feasibility, safety, and efficacy of the PLLA biodegradable stent in humans. However, long‐term follow‐up with larger numbers of patients will be required to validate the long‐term efficacy of PLLA stents.