bluuebunny/crossref_metadata_2025 huggingface dataset:
Catheter and Guidewire Used to Cross a Spiral Dissection of the Right Coronary Artery
Authors: IANNONE LIBERATO A. , KEARY PATRICIA , MEYER REBECCA
Published: June 2007

Intimal dissection and disruption with closure of a tortuous right coronary artery during elective coronary angioplasty can be especially difficult to address. We describe the use of the Probing CatheterTM, in conjunction with the GlidewireTM, to recross a postcoronary angioplasty dissection and occlusion in an elderly female who was considered not to be a candidate for coronary bypass surgery.
Percutaneous Transvenous Mitral Valvuloplasty, Percutaneous Transluminal Coronary Angioplasty, and Coronary Thrombolysis Applied Successfully to One Patient
Authors: BENIT EDOUARD , VROLIX M. D. MATTY , GLAZIER JAMES J. , SIONIS DIMITRIS , WERF FRANS VAN DE
Published: June 2007

The present report describes a patient with severe mitral stenosis and coronary artery disease who was successfully treated by combined percutaneous mitral valvuloplasty and coronary angioplasty. A few days following these procedures, the patient, probably as a result of thrombus embolization in the LAD artery, developed signs of an evolving anterior myocardial infarction and was successfully treated with intravenous thrombolytic therapy. This case demonstrates the feasibility of the combined appliance of interventional techniques in selected patients as an alternative to cardiac surgery.
Outcome Following Coronary Balloon Angioplasty in Young Adults Aged 35 Years or Less
Authors: GLAZIER JAMES J. , PIESSENS JAN , VERGAUWEN BERNADETTE , STAMMEN FRANCIS , VROLIX MATTY C. , DE GEEST HILAIRE , WILLEMS JOS L.
Published: June 2007

The natural history of symptomatic young patients with coronary artery disease is often far from benign. Follow‐up studies of young patients who have undergone coronary bypass graft surgery show frequent recurrence of symptoms and need for reoperation. Prompted by these considerations, we reviewed the records of 23 consecutive patients aged ≤ 35 years with symptomatic coronary artery disease, who underwent coronary balloon angioplasty at our center between August, 1984 and November, 1989. Mean patient age was 32 (3) (mean [SD]) years. Acute myocardial infarction was the first symptom of coronary artery disease in 7 (30%) of the 23 patients. At the time of angioplasty, 17 (74%) patients, had functional Class 3 or 4 anginal symptoms. Eight (35%) had multivessel coronary artery disease (stenoses ≥ 70% in two or more major coronary arteries). Overall, a total of 36 critical coronary lesions were identified in 32 vessels of the 23 patients (mean of 1.6 lesions and 1.4 diseased vessels per patient). At angioplasty, dilatation of 31 lesions in 27 vessels was attempted. Multilesion angioplasty was attempted in 7 (30%) patients. Successful dilatation was achieved in 29 of the 31 (94%) lesions, and 25 of the 27 (93%) vessels. Primary clinical success (successful dilatation of all attempted lesions without any complications) was achieved in 21 of 23 (91%) patients. Three of the 21 patients with successful initial angioplasty had repeat angioplasty for restenosis. In all three, repeat angioplasty was performed 3 months after initial angioplasty and was successful. At a mean follow‐up of 25 (16) (range 5–71) months, 18 of the 21 patients with successful initial angioplasty have remained asymptomatic following one (15 patients) or two (three patients) angioplasty procedures; one patient underwent elective coronary bypass surgery and one patient had a fatal myocardial infarction. Taking into account the often accelerated atherosclerotic disease process in young adults with clinical coronary artery disease, these data suggest coronary balloon angioplasty should be considered favorably in selected young patients with symptomatic obstructive coronary artery disease.
Experimental Studies on Coronary Laser Angioplasty
Authors: TSUJI YOSHIHIKO , OKADA MASAYOSHI , TSUKUBE TAKUROU , MUKAI TOMOICHIROU , MORIMOTO MASATO , YOSHIDA MASATO , NAKAMURA KAZUO
Published: June 2007

To establish the method of coronary laser angioplasty using the argon laser, we investigated the optimal condition of laser ablation and the relationship between the size of laser probe and the diameter of the vessel. First, the relationship between laser energy and tissue reaction to the laser was examined using human cadaveric arteries. Subsequently, we recognized that repeated laser ablation is the optimal method with each shot being limited to 5–10 watts (W) in output and 2 seconds of ablation time when using a metal tip probe (MTP) of 1.5 mm in diameter. According to the experimental condition described above, we examined the response of normal coronary arteries to the laser in vivo. If the size of MTP was not suitable for the diameter of the vessel, thermal constriction of the coronary artery was observed; MTP/vessel diameter ratio should be 0.7 or less to avoid vessel constriction by thermal damage from the laser. Neither perforation nor spasm of the coronary artery was found in this experiment. In addition, the ablated area on the coronary artery was healed completely without thrombus formation and coronary stenosis, and it was covered with new endothelium 8 weeks after laser thermal ablation.
Successful Treatment of Massive Pulmonary Embolism by Combined Mechanical and Thrombolytic Therapy
Authors: SIGMUND MARTIN , RUBART MICHAEL , DAHL JUERGEN VOM , UEBIS RAINER , HANRATH PETER
Published: June 2007

In two patients with massive pulmonary embolism and cardiogenic shock requiring mechanical ventilation and prolonged external cardiac massage, occluded pulmonary arteries were recanalized by primary mechanical fragmentation of thrombi using a percutaneously inserted catheter followed by fibrinolytic therapy. The hemodynamic and respiratory parameters rapidly and greatly improved. Pulmonary angiography before discharge revealed normal results in both patients. No central neurological abnormalities were detected. It is concluded that patients with cardiogenic shock due to massive pulmonary embolism may benefit from immediate mechanical thrombus fragmentation followed by fibrinolysis when thrombolysis or surgical embolectomy are strictly contraindicated or not available.
Percutaneous Coronary Angioplasty in 1,001 Multivessel Coronary Disease Patients: An Analysis of Different Patient Subsets
Authors: DORROS GERALD , IYER SRIRAM S. , HALL PATRICK , MATHIAK LYNNE M.
Published: June 2007

The prospectively collected data of 1,001 multivessel coronary disease patients who underwent percutaneous transluminal coronary angioplasty (PTCA) was analyzed after categorization into single vessel angioplasty (SVA; group I) and multiple vessel angioplasty (MVA; group II) PTCA groups, which were each compartmentalized into “simple” (group A) and “complex” (group B) cohorts. Patients were assigned to the SVA or MVA group according to the physician's pre‐PTCA assessment of how many lesions would be attempted (intention to treat) and not the number of lesions actually attempted. A “simple” patient was more likely than a “complex” patient to be clinically improved after PTCA whether or not the patient had a single dilatation (90% vs 78%; P < 0.05) or multiple dilatations (97% vs 94%; P < 0.05). Similarly, a lesion(s) was more likely to be successfully dilated in the “simple” than in the “complex” group (SVA: 90% vs 82%, P < 0.05; MVA: 97% vs 91%, P < 0.05). In addition, occluded vessels in the MVA group were more likely to be recanalized than in the SVA group (73% vs 44%, P < 0.05). Group I‐A patients had a significantly increased (10%) incidence of emergency bypass surgery. Follow‐up, at 84 months, showed that “simple” cohorts had a better survival than the “complex” cohorts (MVA: 95% vs 71%, P < 0.05; SVA: 90% vs 72%, P < 0.05); and, nearly two thirds of all successful PTCA patients were angina free. The acute outcome of PTCA in multivessel coronary disease patients is most likely to be successful in “simple” patient cohorts regardless of the number of lesions dilated. Thus, patients with isolated lesions and no concomitant problems should be part of the interventionist's initial multivessel experience with more complex situations being attempted only after refinement of his/her interventional skills. (J Interven Cardiol 1991:4:2)
Rotavirus‐Associated Necrotizing Enterocolitis After Cardiac Catheterization in Infants
Authors: MELIONES JON N. , SHOPE THOMAS C. , ROSENTHAL AMNON , PALMISANO JOHN M.
Published: June 2007

Necrotizing enterocolitis is common in preterm and low birth weight infants but rare beyond the neonatal period. Various infectious agents including bacterial and viral organisms have been implicated in its pathogenesis. Rotavirus has recently been shown to be associated with necrotizing enterocolitis. In this report we describe two infants with congenital cardiac disease who developed fulminating necrotizing enterocolitis after cardiac catheterization. Both infants were beyond the newborn period and developed enterocolitis during an epidemic of rotaviral infection. We postulate a relationship between rotavirus infection and the development of necrotizing enterocolitis in older infants with congenital heart disease after cardiac catheterization.
Interventional Approach to Intimal Proliferation in a Saphenous Vein Graft
Authors: VROLIX MATTY , SIONIS DMITRIS , PIESSENS JAN , GLAZIER JAMES J. , PAUWELS PATRICK , DE GEEST HILAIRE
Published: June 2007

This case report describes a patient presenting with a diffuse filiform narrowing of a saphenous vein bypass graft. Since the patient was a poor surgical candidate, the graft failure was treated by conventional balloon angioplasty. Although initially successful, a local, eccentric restenotic lesion reappeared 4 months later; a directional atherectomy of the graft was performed and resulted in a long‐lasting clinical and angiographic success. Although preliminary findings report a similar high restenosis rate for atherectomized grafts, as compared to conventional angioplasty, this case report suggests that such combined mechanical techniques merit further study.
Femoral Arterial Hemostasis Using a Collagen Plug After Coronary Artery Stent Implantation
Authors: GIBBS J.S.R. , SLADE A.K.B. , BLAKE J. , NORDREHAUG J.E. , RICKARDS A.F. , BULLER N.P. , SIGWART U.
Published: June 2007

We have investigated the safety and efficacy of sealing the femoral arterial puncture site using purified bovine collagen in the catheter laboratory immediately after coronary stent implantation. Ten consecutive patients, mean age 64.6 years, pretreated with heparin, aspirin, and dextran underwent the insertion of a collagen plug immediately after coronary stent implantation. The mean activated clotting time was 512 seconds (range 320–999). Femoral arterial hemostasis was achieved before leaving the catheterization laboratory in nine of ten patients. Seven of these patients received additional mild groin compression with an air cushion compression device after hemostasis was successful. One of ten patients had persistent bleeding after delivery of the collagen plug and later required blood transfusion. The collagen plug may be a useful adjunct to obtaining hemostasis following coronary stent implantation, but further trials are required to test its reliability in fully anticoagulated patients.
Nonoperative Closure of the Patent Ductus Arteriosus: The Frankfurt Experience
Authors: SCHRÄDER RAINER , KNEISSL GEORG DIETER , SIEVERT HORST , BUSSMANN WULF‐DIRK , KALTENBACH MARTIN
Published: June 2007

Nonoperative closure of patent ductus arteriosus (PDA) by means of Ivalon® plugs (according to the technique of Porstmann) was performed in 101 patients. Sixty‐five patients were symptomatic, the Qp/Qs ratio exceeded 1.5 in 56 patients, and pulmonary hypertension (mean pulmonary artery pressure > 20 mmHg) was present in 50 patients. In 100/101 patients the PDA could be closed successfully. Ninety‐nine patients were without any evidence of residual left‐to‐right shunt. In one patient a hemodynamically insignificant left‐to‐right shunt was found with color Doppler echocardiography. Complications were pulmonary embolism due to plug dislocation in two patients (12th and 14th patient; 2 and 7 weeks after the procedure, respectively). One of these patients underwent elective surgery with patch closure of the ductus and removal of the embolized plug. In the other patient the ductus was successfully closed with a second larger plug while the first plug was left in a peripheral pulmonary artery. Surgical revision of the femoral artery was required in six and blood transfusion in two patients. Deep venous thrombosis developed in two patients. During follow‐up (total follow‐up time more than 200 patient years) no late complications were observed. In conclusion, transfemoral catheter closure of PDA by means of Ivalon® plugs is an effective method. It is applicable to adolescents and adults with a low complication rate. The ductus can be closed without residual left‐to‐right shunt. Long‐term results are excellent.
Dissection Following Balloon Angioplasty of Aortic Coarctation: Review of the Literature
Authors: ERBEL R. , GÖRGE G. , GERBER T. , GE J. , THELEN M. , RUMPELT H.J. , MEYER J.
Published: June 2007

Balloon angioplasty of the coarctation of the aorta can result in intimal or medial or even adventitial dissections as demonstrated by in vitro studies and animal experiments. As a typical sign of stretching of the aortic wall, patients complain of pain during the angioplasty procedure. In the literature, aortic wall rupture and ventricular fibrillation during the procedure are reported. Additional sudden deaths can occur within 40 hours after the procedure. Mortality ranges from 0.1% to 2.5%. By transesophageal echocardiography, monitoring of balloon angioplasty, control of the positioning of the balloon, and control of the results and detection of complications are possible. Intimal as well as medial dissections can be detected with observed healing for intimal but also medial dissections. In order to avoid the patient's discomfort, intraaortic ultrasound will be used in the future, when major methodological improvements are done. Computed tomography demonstrates medial dissections but is not able to visualize intimal dissections. Using computed tomography and magnetic resonance after angioplasty of the coarctation of the aorta, irregularities are described in up to 17% of the patients. For angiography, a low detection rate of medial dissections has to be expected, when not biplane angiographies of the whole thoracic aorta are performend. Medial dissections can be seen, but intimal dissections are missed. In conclusion, a review of the literature demonstrates a high incidence of intimal and medial dissections after angioplasty of the coarctation of the aorta with spontaneous healing in most patients. As is the way with coronary angioplasty, aortic wall ruptures are rare, but stand‐by surgery is necessary.
Peripheral Percutaneous Aspiration Thrombectomy and Angioplasty Following Failed Lytic Therapy For Acute Popliteal Artery Occlusion
Authors: LI GEORGE , NGUYEN LOI , SMALLING RICHARD W.
Published: June 2007

Prompt diagnosis and therapy is required for acute arterial limb occlusions. Intraarterial thrombolysis is often successful, but surgical revascularization is required for failed reperfusion. Critically ill patients can have significant morbidity and mortality associated with surgical therapy. Percutaneous catheter aspiration of thrombus followed by balloon angioplasty successfully reperfused an occluded popliteal artery after failure of intraarterial thrombolysis in a severely ill patient. Invasive cardiologists should be familiar with catheter‐based thrombus removal techniques.
Transcatheter Closure of the Patent Ductus Arteriosus in Adults
Authors: VERIN VITALI , K. PANDE ABHAY , METER BERNHARD
Published: June 2007

Three techniques of percutaneous transcatheter closure of the patent ductus arteriosus are presented along with a review of the literature.
Treatment of Coronary Artery Disease: Sisyphus’Work?
Authors: UMANS V.A.W.M. , STRAUSS B.H. , SERRUYS P.W.
Published: June 2007

A 37‐year‐old male with a hyperlipidemia type Ha underwent three conventional percutaneous transluminal coronary angioplasty procedures and three surgical revascularizations for recurrent restenosis of the saphenous vein bypass graft. Despite these interventions, a long‐term success was never achieved. Stern implantation at the site of a rerestenosis was successful. However, a second stent implantation to prevent further progression of another previously nonmanipulated atheromateous lesion resulted in a stenosis within the stent for which a new surgical intervention was indicated. At surgery the stented graft was replaced by a fresh venous graft. The partly removed venous graft containing the two stents provides a unique opportunity to study the long‐term histologic effects of intravascular stentin.
Tissue Ablation With Excimer Laser and Multiple Fiber Catheters: Effects of Optical Fiber Density and Fluence
Authors: KVASNICKA JAN , NAKAMURA FUMITAKA , LANGE FRANCOISE , GESCHWIND HERBERT J.
Published: June 2007

This study was performed to assess the ablational properties of 1.4‐, 1.7‐, and 2.0‐mm wire‐guided multiple fiber catheters coupled to a XeCl excimer laser. Samples of postmortem human aorta were irradiated in blood at fluences of 40, 50, and 60 mJ/mm2. Our results indicate that: 1) an increase in the active irradiation coverage results in an increase in the ablation efficiency; 2) the ablation efficiency is not fluence related using the 1.4‐ or 1.7‐mm multiple fiber catheter but efficiency is fluence dependent using the 2.0‐mm multiple fiber catheter; 3) the depth of tissue ablated with a multiple fiber catheter depends primarily upon the proportion of the active irradiation coverage at the catheter tip: 4) the 2.0‐mm multiple fiber catheter induces craters surrounded by a larger zone of tissue damage than that observed with the 1.4‐ or 1.7mm multiple fiber catheter; and 5) the 2.0‐mm multiple fiber catheter should be used cautiously for laser angioplasty because of its high penetration and its risk of arterial wall damage. (J Interven Cardiol 1992; 5:263–273)
Percutaneous Angioplasty of Chronic Obstruction of Peripheral Arteries by a Temperature‐Controlled Nd:YAG Laser System
Authors: UCHIDA YASUMI , FUJIMORI YOSHIHARU , TOMARU TAKANOBU , OSHIMA TOMOMITSU , HIROSE JUNICHI
Published: June 2007

The feasibility of an Nd: YAG laser system with automatic control of hot‐tip probe temperature was examined in 15 segments (14.7 ± 6 cm in length) of iliofemoral arteries from 13 patients. The hot‐tip temperature to be attained and the upper limit temperature at which lasing was to be stopped were preset. A catheter with a 1.8‐mm hot‐tip probe was introduced into the obstructed segment and angioplasty (lasing time 5–10 sec) was performed under angioscopic guidance. Recanalization was observed in all segments without obvious complications. No thermal effects below 50°C, coagulation at 100°C, carbonization at 200°C, or sticking of the hot‐tip to the luminal surface at 300°C or over, were observed by angioscopy. Rapid recanalization was obtained between 200°C and 300°C. The results indicate that this novel laser system is feasible and hot‐tip temperature between 200°C and 300°C is ideal for treatment of chronic arterial obstruction in Japanese patients. (J Interven Cardiol 1992; 5:301–308)
Rotational Angioplasty and Directional Atherectomy to Treat Complex Lesions of the Right Coronary Artery
Authors: GONSCHIOR PETER , NERLICH ANDREAS , BAURIEDEL GERHARD , SIMPSON LINDI , MACK BRIGITTE , HÖFLING BERTHOLD
Published: June 2007

A combination of interventional devices including the RotablatorR and directional coronary atherectomy (DCA) was used to treat a 39‐year‐old patient with a complex lesion of the right coronary artery. The devices enabled the recanalization and reconstruction of the diseased vessel without laceration or dissection, leaving a smooth‐edged segment. The histological analysis of the tissue obtained from DCA revealed no predictors of restenosis, like highly cellular material or media. Thus, combination of mechanical interventional devices allowed to treat a highly complex lesion without lacerating the vessel and leaving an excellent acute and long‐term outcome. (J Interven Cardiol 1992; 5:315–321)
Hockey Stick Guiding Catheter
Authors: MEHTA SAMEER , MARGOLIS JAMES R.
Published: June 2007

Guiding catheter strategies form an important component of successful PTCA. Selection of appropriate guiding catheters is essential for providing adequate back‐up support and visualization. Hockey stick guiding catheters are an excellent choice for performing PTCA of the right coronary artery and for saphenous vein grafts. (J Interven Cardiol 1992; 5:331–336)
The Treatment of Aortic Stenosis: Is Valvuloplasty Ever an Alternative to Surgery?
Authors: DEITHRICH EDWARD B.
Published: June 2007

The desire to extend the principle of balloon angioplasty to cardiac valve disease is Understundable and commendable. Aortic valvuloplasty is associated, however, with an excessive complication rate, as reported by the Mansfield Scientific Aortic Valvuloplasty Registry (20.5% overall, including a 4.9% death rate within 24 hours and an additional 2.6% rate within 7 days for a 7.5% 1‐week mortality). In contrast, the operative mortality for aortic valve replacement now ranges from 3%‐5%, with periopercitive complications far less than the one in five associated with valvuloplasty. Even if the two procedures had equivalent morbidity arid mortality rates, the high incidence of resteriosis (30%‐60% range at 6 months) for the balloon technique precludes its widespread use for aortic stenosis. Despite the poor mid‐ and long‐term results for balloon valvuloplasty, the procedure may have limited application in some clinical situations. Indeed, there are patients with concomitant systemic illnesses or advanced age (> 80 years) who would not be good surgical candidates. In particular, valvular balloon dilation may be useful in bridging a seriously ill patient to a condition more favorable for replacement therapy. With few exceptions, however, valve replacement remains the gold standard, for treatment of adult aortic stenosis.
The Bard Rotary Atherectomy System (BRAS): Initial Experience in Patients with Peripheral Vascular Disease
Authors: AGMON MOSHE , SCHEINOWITZ MICKEY , BEITNER SHLOMO , BAYER IZHACK , RATH SHMUEL , ELDAR MICHAEL , BATTLER ALEXANDER
Published: June 2007

Sixteen patients with a mean age of 65.4 ± 9.8 years and suffering from peripheral vascular disease underwent peripheral atherectomy using a new mechanical device—the BARD Rotary Atherectomy System (BRAS). The BRAS is an “over the wire” system that consists of a spiral guidewire and a handheld motor drive unit, which rotates at 1,500 rpm. Prior to the procedure angiography demonstrated the presence of 18 obstructions (1 tibial, 2 popliteal, 15 superficial femoral arteries) with a mean stenosis of 95.7 ± 8%. Successful atherectomy was achieved in 16 of 18 lesions and resulted in an 89% immediate success rate and a significant (P < 0.01) reduction of stenosis to 37.8 ± 12.5%. There were no significant complications. The excised and removed material embedded over the spiral guidewire demonstrated the presence of fibrotic tissue, fatty lesions, and calcium deposits. Medial or adventitial layers were not present in the removed atherosclerotic material. Mean ABI was significantly (P < 0.01) increased from 0.38 ± 0.17 to 0.55 ± 0.21 following atherectomy. Angiographic follow‐up obtained in ten patients 8.8 ± 5.2 months following the procedure demonstrated restenosis in six of those ten patients. The ABI at this time remained unchanged. These results demonstrated that the new BRAS mechanical atherectomy system is feasible and safe for recanalization of severely stenosed arteries in patients with peripheral vascular disease.
Coronary Angiography with 5 French Diagnostic Catheters May Miss an Ostial Left Main Stenosis
Authors: FELD HARRY , FISHER MARK , SHANI JACOB
Published: June 2007

Critical ostial left main disease may lead rapidly to sudden death and is, therefore, of paramount importance to diagnose. While the number of cardiac catheterizations is increasing, government and third party reimbursement sources are imposing pressure to perform more studies in an outpatient setting, as the economic resources for medical procedures are shrinking. Outpatient cardiac catheterization requires the patient to ambulate within several hours after the procedure. In order to allow patients to safely ambulate early after their procedures, 5 French catheters are often used (whether the femoral or brachial approach is used) rather than the standard 7 French catheters. We describe a patient with an ostial left main stenosis that was not visualized when coronary arteriography was performed using a diagnostic 5 French catheter. Selective intubation of the left main coronary artery was easily achieved without damping of the pressure tracing. Selective coronary angiography did not demonstrate the ostial stenosis, and there appeared to be a normal amount of contrast refluxing into the aortic root. When the patient returned for an angioplasty and a guiding angiogram was performed with an 8 French catheter, an ostial stenosis was evident with coronary angiography. (J Interven Cardiol 1993; 6:131–136)
Is The Left Main Angulated, Stenosed, or “Bent” by the Guiding Catheter?
Authors: SHIH ANDREW , TALLEY J. DAVID , SMITH STEVEN M. , GODLEWSKI KRYSTOF , JOSEPH S. ABRAHAM , PRINCE CHARLES R.
Published: June 2007

Exact angiographic and identification of significant stenosis of the left main coronary artery is imperative prior to performing elective percutaneous transluminal coronary angioplasty. A patient is presented with an apparent angiographically significant, but physiologically insignificant, left main stenosis. Both angiographic and physiological methods of detecting “false positive and negative” left main stenoses are discussed. (J Interven Cardiol 1993; 6:165–168)
Percutaneous Coronary Angioplasty in Patients Over 75 Years Old: Immediate and Mid‐term Results
Authors: GUENICHE C. , TABONE X. , SLAMA M. S. , METZGER J. Ph. , MOTTÉ G. , VACHERON A.
Published: June 2007

Ninety‐five patients 75 years or older (range 75–90, mean 79) underwent PTCA from 1987 to 1991. Forty‐two patients were 80 years or older. Forty‐four had prior MI, 5% had prior coronary bypass surgery (CBS), 13% had a prior history of recent cardiac failure, and 81% (77/95) presented with unstable angina, refractory to intravenous treatment in 31 cases. The mean left ventricular ejection fraction was 62% (range 34%–80%). Thirty‐nine percent had single vessel disease, 41% had two vessel disease, and 20% had three vessel disease. Coronary calcifications were present in 28%. A single vessel was dilated in 81 patients, two vessels in 14 patients; complete revascularization was achieved in 41%. The clinical angiographic primary success rate was 79% (75/95). There were five procedural deaths, five MI, five CBS and, ten hematomas. Follow‐up data were obtained in 100% cases, with a mean follow‐up duration of 12 months (ranging from 1–36). There were four deaths, one MI, and two CBS. Twenty percent (15/74) of patients had a second PTCA with a 73% success rate. Finally, 70% of the initial population was asymptomatic after first or second PTCA at mid‐term follow‐up. We conclude that PTCA is safe and effective in elderly patients, with 70% clinical success rate at mid‐term follow‐up in spite offrequent incomplete revascularization limited to the culprit lesion. (J Interven Cardiol 1993; 6:169–174)
Fractional Flow Reserve: The Ideal Parameter for Evaluation of Coronary, Myocardial, and Collateral Blood Flow by Pressure Measurements at PTCA
Authors: H.J. PIJLS NICO , DE BERNARD , EL MAMDOUH , J.R.M. BONNIER HANS , HEYNDRICKX GUY R. , JAN WILLEM BECH G. , KOOLEN JACQUES J. , ROLFMICHELS H. , A.L.E. BRACKE FRANK , WIJNS WILLIAM
Published: June 2007

To overcome the fundamental limitations of coronary arteriography to assess the functional significance of coronary artery disease, it is necessary to obtain direct information about coronary blood flow. Recently we validated three pressure flow equations, which enable calculation of maximum coronary, myocardial, and collateral flow by merely measuring aortic, central venous, and distal coronary pressures under the condition of maximum vasodilation and using an ultra thin pressure monitoring guide wire for distal coronary pressure recording. In this paper, the first clinical experiences of this method are described. For that purpose, the concept of fractional flow reserve (FFR) is important. Fractional coronary flow reserve (FFRcor) is defined as the maximum achievable blood flow in a stenotic artery, divided by normal maximum flow in that same artery, i.e. maximum flow in that artery in the case that it would be completely normal. Fractional myocardial flow reserve (FFRmyo) is defined in a similar way, and recruitable collateral blood flow is expressed as a fraction of normal maximum myocardial flow. Fractional flow reserve, defined in this way, is easy to obtain at percutaneous transluminal coronary angioplasty (PTCA) by the pressure‐flow equations, is independent of pressure changes, applicable to three vessel disease, and enables calculation of the separate contribution of coronary and collateral flow to total myocardial perfusion. In 18 patients a very close correlation was demonstrated between FFRmyo, calculated by pressure recordings at PTCA by the first pressure flow equation, and FFRmyo obtained by positron emission tomography, which is considered the gold standard for myocardial perfusion. In 60 other patients, maximum recruitable collateral blood flow at balloon inflation (Qc/QN) was calculated according to the third pressure‐flow equation and correlated to the presence or absence of ischemia. It could be demonstrated that QC/QN exceeds 22% in all 23 patients without ischemia, whereas Qc/QN was less than 22% in 34 out of 37 patients who experienced ischemia during balloon inflation. This margin value of 22% is very close to the theoretically expected value of 20%. based upon a coronary flow reserve of 5 under standard physiologic conditions. It can be concluded that the concept of fractional flow reserve provides a rapid, accurate, and elegant way for quantitative assessment of maximum coronary and myocardial blood flow before and after PTCA. Moreover, this is the first method that enables quantitative calculation of collateral blood flow in clinical practice. (J Interven Cardiol 1993; 6:331–344)
Percutaneous Angioscopy in Patients with Restenosis After Excimer Laser Coronary Angioplasty
Authors: NAKAMURA FUMITAKA , KVASNICKA JAN , DECOSTER HANS L. , GESCHWIND HERBERT J.
Published: June 2007

Coronary angioscopy was performed in two patients with restenosis after excimer laser coronary angioplasty to improve our knowledge of restenosis after excimer laser angioplasty. The characteristics of the angioscopic findings in restenosis after excimer laser angioplasty consisted of smooth white plaques, which were distinctly different from the yellow plaques commonly observed in primary lesions. These findings indicate that restenosis in these patients after excimer laser angioplasty may be associated with smooth muscle cell proliferation and fibrosis.
Aneurysm of the Left Main Coronary Artery
Authors: JOSEPH ABRAHAM , HARRIS GARY J. , GOAD JOHN , TALLEY J. DAVID , POLLOCK SAMUEL B.
Published: June 2007

Aneurysms of the left main coronary artery are rare; the estimated incidence is < 0.1%. They are usually associated with atherosclerotic coronary artery disease, and are incidental discoveries at the time of cardiac catheterization for the evaluation of cardiac symptoms. This report describes the clinical course of a patient with an isolated left main coronary artery aneurysm and generalized atherosclerosis.
Pigs, Dogs, Baboons, and Man: Lessons for Stenting from Animal Studies
Authors: SCHWARTZ ROBERT S. , HOLMES DAVID R.
Published: June 2007

A new era in interventional cardiology has arrived with the widespread use of intracoronary stents. These devices have not only markedly improved the safety of dilatation, but have also limited restenosis through achievement of a larger postprocedure lumen. Much work remains in furthering this technology, since two major limitations are thrombosis and neointimal hyperplasia that still cause restenosis. Stent placement in animals provides insight into both of these areas. The volume of neointima is directly proportional to the depth of injury induced by the stent in at least three species: the pig, baboon, and dog. Across each species, a numerically different slope exists for the injury‐neointimal thickness regression. Treatments to limit hyperplasia within a species do not change this slope, but instead alter the y‐intercept. Stent thrombosis in animal models consists principally of platelet‐rich thrombi. The time course of thrombus appears to differ across pigs and baboons. Antiplatelet agents limit, but do not eliminate the problem in animals, suggesting that newer and more potent antiplatelet agents may improve scent thrombosis in clinical trials. The future of stent technology lies in developing an antithrombotic device that also eliminates neointimal hyperplasia. Intense studies of animal models and improved understanding of their pathophysiology will facilitate this progress.
Hospital Resource Utilization During Coronary Artery Bypass Surgery
Authors: MAULDIN PATRICK D. , BECKER EDMUND R. , PHILLIPS VICTORIA L. , WEINTRAUB WILLIAM S.
Published: June 2007

Objective: To predict hospital resource utilization for coronary surgery (CABG) from preoperative characteristics and to determine the influence of previous CABG on the results. Design: Two analyses of the data were used to predict hospital costs: I) a univariate analysis of each preoperative variable; and 2) a multivariate analysis of preoperative variables, and interaction terms with previous CABG. Patients: A sample of 418 patients who received CABG at Emory University during 1990. Results: From the multivariate analysis, the determinants of costs were previous CABG (P = 0.0653). female sex (P = 0.1005), diabetes (P = 0.0805), older age (P = 0.0062), and a combination of previous CABG with female sex (P = 0.0017), previous myocardial infarction (P = 0.0636), low ejection fraction (P = 0.0001), and younger age (P = 0.0363). For the univariate analysis, the determinants of increased costs were similar to those from the multivariate analysis. Conclusion: The correlation between patients with potential medical difficulties or previous cardiovascular surgery show a positive impact on higher hospital costs.
Third‐ and Fourth‐Generation Implantable Cardioverter Defibrillators: Current Status and Future Development
Authors: SAKSENA SANJEEV , DIAZ MARIA L. , VARANASI SANKAR , MATHEW PHILIP , BERG JULIE , KROL RYSZARD B. , KAUSHIK RAJ R.
Published: June 2007

Implantable cardioverter defibrillator (ICD) therapy has become the mainstay of therapy for patients with a history of sudden cardiac death or life‐threatening Ventricular arrhythmias. The current generation of ICDs used for secondary prevention combines features for tachycardia reversion with demand ventricular pacing, antitachycardia pacing, programmable shock therapy, and tachycardia events memory. Although demand pacing and defibrillation is indicated for primary prevention usage of ICDs, the application of antitachycardia pacing modes is more controversial. High energy cardioversion and defibrillation shocks remaining the mainstay of sudden death prevention will be redefined as more effective defibrillation shock modes and lead systems are developed. Fourth‐generatioti ICD systems accomplished a significant reduction of device size and almost universal success using an endocardial lead configuration and pectoral implant. A variety of new directions of ICD therapy in clinical practice such as primary prevention applications and the adjunctive role of antiarrhythmic drug therapy are currently being examined in clinical trials. The concepts underlying initiation of tachyarrhythmias are being studied to develop new approaches to tachycardia prevention. These include rate support, subthreshold stimulation, and multiple site pacing. The current developments of ICD therapy promise continued growth of this technology.
Randomized Trial Comparing Two Devices: The Palmaz‐Schatz Stent and the Strecker Stent in Bail‐Out Situations
Authors: REIFART N. , HAASE J. , MASSA Th. , PREUSLER W. , SCHWARZ F. , STÖRGER H. , VANDORMAEL M. , HOFMANN M.
Published: June 2007

To assess whether differences in design (geometry, flexibility) and material (electrostatic behavior) may influence the acute and late outcome following intracoronary stent implantation in the treatment of acute or threatened closure after prolonged balloon inflations, 50 patients were randomized to receive either a Palmaz‐Schatz stent (n = 25) or a Strecker stent (n = 25).
A Comparison of Hemostatic Parameters in Hypothermic Versus Normothermic Cardiopulmonary Bypass
Authors: JOSEPH G. , JOSEPH A. , TALLEY  , YUSSMAN Z. , KUPERSMITH J. , VOGEL R.
Published: June 2007

Ten patients who underwent PCPS (group A) at our institution were evaluated for hemostatic abnormalities and compared to an age matched population undergoing open CPB (group B) to study the effects of CPB independent of the effects of hypothermia. Both groups had hemostatic parameters measured prior to, 1 hour after, and 16–24 hours following completion of the procedure. The mean duration of perfusion for group A was 53.7 ± 13.5 minutes and group B 108.1 ± 26.5 minutes (P < 0.0001). There were no significant differences in hemoglobin, platelet count, coagulation factors, and tests of in vitro platelet function between groups A and B at the different time points. While bleeding times for group B returned to baseline within an hour following bypass, they remained significantly prolonged in group A 24 hours later (P = 0.02). Conclusion: Normothermic bypass used during PCPS results in platelet function abnormalities similar to open hypothermic CPB suggesting the dominant role of the membrane oxygenator over hypothermia in inducing the platelet dysfunction.
Statistical Analysis of Invasive Cardiology for Austria in 1992 as an Approach to Quality Assessment
Authors: MÜHLBERGER V. , PROBST P. , PACHINGER O.
Published: June 2007

Quality Control in Interventional Cardiology requires perfect documentation. We, therefore, report a mutual controlling system, which has been initiated in Austria 3 years ago. An all round inquiry within all the 28 Austrian catheterization laboratories was successful with a feedback rate of 100%, controlled by visiting the centers, random tests, and several phone calls. This year was the first time that an entire European country followed the guidelines for statistical documentation that the European Society of Cardiology has suggested. Within the year 1992, 3,780 percutaneous coronary ungioplasties were performed in Austria, which is 19.7% more, compared to the year before. At the same time 18,806 coronary angiographies, 102 percutaneous valvuloplasties, and 138 electrophysiological ablations took place. Austria reached 84% of the number of angiographies and 50% of the percutaneous transluminal coronary angioplasty (PTCA) numbers, the World Health Organization (WHO) has provided for a country of 7.82 million inhabitants. One hundred and fifty‐two “new devices” (stent/n = 89, atherectomy/n = 44, laser/n = 6, etc.) were used during this year, which was 4.0% of all PTCA procedures. Angioscopy (n = 11) and intracoronary ultrasound (n = 82) accounted for another 2.5% of “new devices”. Complication rate was 0.48% hospital deaths, 0.93% emergency bypass surgery, and 1.88% myocardial infarction in 3,780 PTCAs. The individual data of each center were treated confidentially and anonymously and the e valuated questionnaire was sent back to the respective center only, including an individual recommendation for quality improvement. We believe, that this campaign is a valuable and successful first step for quality control in interventional cardiology. We are looking forward corn‐paring our results with those of other European countries and with our own results next year.
Preserved Vasodilator Response to Acetylcholine in Atherosclerotic Coronary Arteries Before and After PTCA
Authors: MACCHI ANDREA , XUEREB ROBERT G. , XUEREB MARIOSA , VICEDOMINI GABRIELE , MARGONATO ALBERTO , CARANDENTE ORAZIO , CHIERCHIA SERGIO L.
Published: June 2007

The vascular response to local administration of acetylcholine is used, clinically, to assess endothelial function in vivo. However, whether this response predominantly reflects the functional state of the vascular endothelium, or rather results from smooth muscle reactivity per se is not clear. In 15 patients with chronic stable angina and angiographically significant coronary disease, we studied the effects of increasing doses of intracoronary acetylcholine (5, 10, 30, 50, and 80 μg) and nitroglycerin (200 μg) on coronary vascular tone. In three patients the protocol was perfrnned at the time of diagnostic coronary angiographv and 7 and 24 hours after angioplasty. The remaining five underwent acetylcholine administration before and after percutaneous transluminl coronary angioplasty (PTCA). We quantitatively assessed the diameter of 54 coronary arterial segments; 12 stenotic segments, 13 post‐PICA segments with residual irregularities, 18 reference segments of the ranee arteries taken proximal to the stenosis or to the dilatation site, and II remote segments ofnonstenotic vessels. They all showed a bimodal response to acetylcholine. At the lowest concentration (5 μg) the agent invariably caused dilatation (9.22 ± 6.55%), which was not significantly different in the various segments and was always less than that induced by nitroglycerin (24.56 ± 12.82%, P < 0.0001). At the highest doses (50 or 80 μg) acetylcholine always induced vasoconstriction, which was significantly more pronounced in the post‐PTCA (‐31.54 ± 10.65%) and stenotic segments (‐23.08 ± 11.88%) than in the reference and remote segments (respectively, ‐14.88 + 7.63% and ‐ 18.67 + 8.37%, P < 0.05). We conclude that: (l) some degree of endothelial dependent vasodilatation is preserved even in the presence of atheroma and intimal injury induced by angioplasty; (2) atheroma and especially acute intimal injury augment the vasoconstrictor response to high dose acetylcholine, the effect being most probably mediated by primary smooth muscle supersensivity: (3) since acetylcholine has direct and endothelium‐mediated vasoactive effects, this agent may not be the ideal one for testing endothelial integrity. (J Interven Cardiol 1994; 7:57–64)
Intracoronary Stents: A Review of the Experience with Five Different Devices in Clinical Use
Authors: DE JAEGERE PETER P. , DE FEYTER PIM J. , VAN DER GIESSEN WILLEM J. , SERRUYS PATRICK W.
Published: June 2007

Atherosclerotic cardiovascular disease remains one of the most important causes of morbidity and mortality in the industrialized world. Treatment is basically aimed at palliation and consists of either pharmacological intervention or revascularization. The first significant advances in the latter were largely surgical. However, the pressing need for treatment with less invasive and potentially less expensive techniques, have stimulated the development of nonsurgical revascularization techniques. Percutaneous transluminal coronary balloon angioplasty, which was first performed by Andreas Gruentzig in 1977, is one of the most successful examples and provided the stimulus for a rapid technological growth of interventional cardiology. It is now widely accepted as a safe and effective treatment of obstructive coronary artery disease. However, the risk of abrupt vessel closure during or immediately after the intervention and the risk of late luminal renarrowing or restenosis continue to compromise its overall safety and efficacy. To improve the immediate and long‐term results of balloon angioplasty, a number of new technologies such as intracoronary stenting, directional or rotational atherectomy, and laser therapy have been developed and represent the leading edge in the battle against atherosclerosis. The purpose of this paper is to review the experience and results of the various types of stents in clinical use.
Preliminary Experience with Intravascular Ultrasound Guided Palmaz‐Schatz Coronary Stenting: The Acute and Short‐Term Results on a Consecutive Series of Patients
Authors: HALL PATRICK , COLOMBO ANTONIO , ALMAGOR YARON , MAIELLO LUIGI , NAKAMURA SHIGERU , MARTINI GIOVANNI , TOBIS JONATHIN M.
Published: June 2007

The purpose of this study was to prospectively test the hypothesis that systemic anticoagulation is not needed following coronary stenting when adequate stern expansion is achieved and documented and other flow limitations eliminated. Intravascular ultrasound (IVUS) was used to confirm adequate stent expansion, which was defined as good plaque compression together with the achievement of an intrastent lumen cross‐sectional area (CSA) that was > 40% of the average reference vessel CSA. In this prospective study, Palmaz‐Schatz coronary stenting was performed on 343 lesions in 263 consecutive patients. Primary stenting was successful in 254 patients (96.6%) and 332 lesions (96.8%). All patients with successful primary stenting underwent IVUS imaging except nine patients (13 lesions) that did not have an IVUS evaluation for technical reasons and three patients (4 lesions) in which IVUS was unsuccessful. The initial IVUS performed after achieving an acceptable angiographic result revealed inadequate scent expansion in 191 patients (79%) and 244 lesions (77%). After further dilatation, final adequate stent expansion was accomplished in 230 patients and 301 lesions. These patients were treated with Ticlopidine 250 mg twice per day for 2 months and did not receive postprocedure anticoagulation. There was one acute stent thrombosis (0.3%) that occurred in a lesion with slow flow and an inadequately expanded stent. There was no subacute stent thrombosis and no bleeding or vascular complications. We conclude that when adequate stent expansion is achieved and confirmed and other flow limiting lesions eliminated, that systemic anticoagulation after the stent procedure is not necessary.
Self‐Expanding Stents for Emergency Treatment of Acute Vessel Closure Following Coronary Angioplasty: Immediate and Long‐Term Results
Authors: NORDREHAUG JAN‐ERIC , PRIESTLY KIM A. , CHRONOS NICHOLAS A.F. , RICKARDS ANTHONY F. , BULLER NIGEL P. , SIGWART ULRICH
Published: June 2007

Intracoronary stents may be used to treat acute coronary occlusion following balloon angioplasty. We report the immediate and long‐term results of emergency implantation of the self‐expanding scent (Wallstent) in 39 patients with acute vessel closure. Stents were successfully deployed in 38 patients (97%). Procedural complications occurred in 14 patients (36%); one patient died, two required emergency coronary artery bypass graft surgery, nine sustained myocardial infarcts (one Q wave), and two had acute stent thrombosis successfully treated by intracoronary throtnbolysis and repeat angioplasty. Four patients (10%) had femoral artery bleeding, two required surgery. Angiographic follow‐up was performed after 6 months in all 34 eligible patients, or earlier for symptoms. Two patients died prior to follow‐up angiography. The stented segment was widely patent in 27 of the 34 patients (79%); restenosis within the stent was detected in 4 (12%) and thrombotic stent occlusion occurred in three (9%). Twenty‐six of the 39 patients (67%) were free from major cardiac events and sytnptoms at 1 year. These results suggest that the self‐expanding stent provides an attractive alternative to emergency surgery for the treatment of acute coronary occlusion following coronary angioplasty.