bluuebunny/crossref_metadata_2025 huggingface dataset:
Metallic Surface Treatment Using Electrochemical Polishing Decreases Thrombogenicity and Neointimal Hyperplasia of Coronary Stents
Authors: DE SCHEERDER IVAN , SOHIER JÜRGEN , WANG KAI , VERBEKEN ERIC , ZHOU XIOU R. , FROYEN LUDO , VAN HUMBEECK JAN , PIESSENS JAN , VAN DE WERF FRANS
Published: June 2007

An abundant healing response resulting in a more pronounced neointimal hyperplasia compared to conventional balloon angioplasty remains the most important clinical problem after coronary stent implantation. In the present study the potential beneficial effect of metal surface treatment using electrochemical polishing on stent thrombogenicity and neointimal hyperplasia was evaluated in a rat A‐ V model and a porcine coronary model. An electrochemical polishing system was developed to improve surface characteristics of stainless steel stents. Topographic scanning of the stent surface using a profilometer type Taylor Holson Form Taylsurf 120L showed a significant effect on R, (arithmetic mean of the roughness height) (0.14 vs 0.04 μm: P < 0.001) and Rt (maximum rouhgness height between a peak and a valley for the sampling length) (1.44 vs 0.43 μm: P < 0.001). Thrombogenicity of polished stents (n = 6) was compared to nonpolished stents (n = 5) in a rat A ‐ V shunt model using 125I fibrinogen and 51Cr‐labeled platelets. Total clot weight after 30 minutes was significantly lower in the polished stents (32.1 + 2.8 vs 18.1 + 4.4: P < 0.001). Also 125I fibrinogen deposition was significantly lower in the polished stents (1.30 + 0.07 vs 0.66 + 0.04: P < 0.001). Platelet deposition, however, was not significantly reduced (12.7 + 3.4 vs 9.87 + 1.9, NS). Subsequently, the effect of electrochemical polishing on neointimal hyperplasia was evaluated in a porcine coronary model. Polished (n =10) and nonpolished stents (n =10) were randomly implanted in the right coronary artery of healthy pigs. Neointimal hyperplasia was significantly decreased in the polished stents (0.6 + 0.28 vs 0.9 + 0.34 mm2: P <0.01). Electrochemical polishing oj coronary stents results in decreased thrombogenicity and neointimal hyperplasia after stent implantation in different animal models.
Balloon to Artery Ratio, Not Inflation Pressure, Correlates with Adequate Stent Deployment: Size Is More Important than Pressure
Authors: FUJISE KENICHI , YHIP PETER A. , ANDERSON H. VERNON , SCHROTH GEORGE , ROSALES OSCAR , SMALLING RICHARD W.
Published: June 2007

To investigate the relative importance of balloon to artery ratio (BAR) and poststent inflation pressure (IP), we retrospectively analyzed the IVUS (intravascular ultrasound) data available for patients (n = 30) who underwent coronary stent implantations (n = 31) between May 1993 and April 1996 under various stent deployment strategies. Choice for sizing of the postdilatation balloon varied widely with BAR ranging from 0.7.5 to 1.34 (mean = 1.07 ± 0.14). IP also varied profoundly from 4 to 22 atm (mean = 14.7 ± 3.7 atms). Although there was no uncovered dissection or subintimal hemorrhage by IVUS, the adequacy of the stent deployment as assessed by relative stent expansion (RSE) varied significantly from 44.0% (very poor deployment) to 141.7% (overstretching of the arterial segment). Strikingly, BAR, not IP, correlated significantly with RSE (correlation coefficient [CC] of BAR =0.77, P <0.0001; CC of IP =0.13, P > 0.5; stepwise linear regression analysis). No stent postdilated by a balloon with a BAR of ≤ 1.0 achieved a RSE of 100%, while BARS ≤ 1.2 uniformly resulted in RSEs ≤ 100%. In contrast, despite postdilation IP of ≤ 15 atm, only 6 (33.3%) of 18 stem achieved RSE > 100%. Moreover, high RSEs were obtained by IP as low as 8 atms. Thus, BAR was much more strongly correlated with RSE, an index of optimal stent deployment, while IP was not correlated with RSE. These data suggest that BAR may be more important than IP for maximal stent implantation in the majority of patients. However, further larger scale, prospective studies are required to determine the importance of BAR versus IP to achieve optimal stent deployment.
Direct Coronary Stenting in Noncomplex and Noncalcified Lesions: Immediate and Mid‐term Results of a Prospective Registry
Authors: BEDOSSA MARC , COMMEAU PHILIPPE , LECLERCQ CHRISTOPHE , HURET BRUNO , FRANÇOIS MORELLE JEAN , BENOIT PIERRE OLIVIER , LE BRETON HERVÉ
Published: June 2007

Stenting of coronary arteries is currently used in clinical practice. The aim of this prospective registry was to assess the feasibility and the safety of stent implantation without balloon predilatation in noncomplex and noncalcifed lesions. One hundred six stents were implanted in 85 patients who underwent percutaneous coronary angioplasty (PTCA) of native vessels (n = 95) or bypass grafts (n = 11). The lesions were type A (21%) or B1 (79%). The stent was a tubular or a coil stent in 71 ± and 29% of the cases, respectively. The angiographic success rate was 94%. The maximal pressure was 12.1 ± 2.1 atm. In only 7 cases, it was not possible to cross the stenosis with the stent, necessitating retrieval of it and predilation with a balloon before stent implantation. Three dissections after stent implantation were treated by a second stent implantation. The primary success rate was 98% (no acute closure or myocardial infarction). A clinical follow‐up was obtained in 98% of patients with a mean delay of 6 ± 0.5 months. Eighty‐one percent of patients were asymptomatic. The target lesion revascularization rate was 9.4%. Four patients underwent a new PTCA and four patients a coronary artery bypass graft surgery. This technique of stent implantation appears to be safe with good immediate and midterm results. A prospective randomized trial comparing this technique to the standard technique of stent delivery in noncomplex lesions is currently ongoing with an intravascular ultrasound substudy.
Pharmacology of GP IIb‐IIIa Platelet Inhibitors, Part IV
Authors: TALLEY J. DAVID
Published: June 2007

The introduction of GP IIb‐IIIa inhibitors is one of the most important developments in the treatment of acute coronary syndromes and acute complications of percutaneous coronary syndromes. To date, three parenteral GP IIb‐IIIa inhibitors: abciximab, eptifibatide, and tirofiban have been approved for clinical use. These three agents have different pharmacological characteristics and associated pharmacodynamic and safety profiles. Currently, there is no standardized assay for measurement of inhibition of platelet aggregation, making direct comparisons qf pharmacodynamic properties of GP IIb‐IIIa inhibitors impossible. The most common safety concerns with this class of agents are bleeding and thrombocytopenia.
Accomplishments and Perspectives with Retrograde Nontransseptal Balloon Mitral Valvuloplasty
Authors: STEFANADIS CHRISTODOULOS I. , STRATOS COSTAS G. , LAMBROU SPYROS G. , TOUTOUZAS PAVLOS K.
Published: June 2007

Retrograde nontransseptal balloon mitral valvuloplasty (RNBMV) is a transarterial technique of mitral valvuloplasty, developed with the aim to avoid complications associated with transseptal catheterization. Between April 1988 and December 1999, RNBMV has been attempted in 393 patients with symptomatic mitral stenosis (aged 44 ± 11 years, 322 women, mean echocardiographic score 7.7 ± 1.9) at the University of Athens, Greece. The procedure was completed in 392 cases. Technical success (gain in mitral valve area ≥ 50% with final mitral valve area ≥ 1.5 cm2, and absence of postprocedural mitral regurgitation grade > 2+) was achieved in 344 (87.5%) patients. Unfavorable predictors for immediate outcome included the echocardiographic score (P < 0.001). male gender (P = 0.005), and preprocedural mitral regurgitation (P = 0.003). Complications included death (0.3%), severe mitral regurgitation (3.1%), and femoral artery injury (0.8%). No cases of cardiac peqoration or tamponade have occurred with RNBMV. Patients with a successful immediate outcome were followed clinically for 4.8 ± 2.8 years (maximum 12 years). Event‐free (freedom from cardiac death, mitral valve replacement, redo valvuloplasty, and recurrence of NYHA Class > II) survival rates at 1, 2, 5, and 12 years post‐RNBMV were 99.7 ± 0.3%, 96.1 ± 1.1%, 84.7 ± 2.2%. and 67.6 ± 4.8%, respectively. The echocardiographic score (P < 0.001) and the postprocedural mitral valve area (P < 0.001) were significant independent predictors of long‐term outcome following RNBMV. Experience with RNBMV has fulfilled expectations regarding lowering of the risk of occurrence of specific cardiac complications encountered during mitral valvuloplasty, and reveals this approach as a safe and efficient alternative to the more commonly used antegrade technique.
Mitral Regurgitation After Percutaneous Mitral Valvotomy
Authors: CARL BLOCK PETER
Published: June 2007

Mitral regurgitation (MR) after percutaneous mitral balloon valvotomy (PMV) is commonly an end point and may be a significant complication. Some increase in MR occurs in more than half of patients undergoing PMV. An increase > 2 grades occurs in 3%–1.5% of patients, and < 5% have severe MR as a complication. MR is a significant predictor for late cardiac events and preexisting MR before PMV is also associated with poor late outcome. Mild increases in MR are due to stretching of the annulus, excess commissural tearing, or papillary muscle trauma. Mild MR frequently disappears at follow‐up and rarely increases. Risk factors for development of MR have varied among multiple studies. Balloon oversizing and entrapment/tearing of chordae by the balloon(s) are mechanical factors. Most predictors are related to the pathologic anatomy of the mitral valve. Older age, a larger end‐systolic volume index, and lower ejection fraction may be independent predictors of progression of MR. Subvalvular disease and valve thickening have also been identified as predictors. A recently described “scoring” system for predicting MR considers the distribution of anterior and posterior leaflet thickening, extent of commissural calcification/fibrosis, and degree of subvalvular disease. “Even” calcification/thickening produces a “lower” or “better” score than “uneven” distribution. Bicommissural calcification and thickening and shortening of chordae all predict bad outcome. Thus careful echocardio‐graphic evaluation of mitral valve pathoanatomy pre‐PMV can identify most predictors of the development of MR.
What Can Be Expected of Balloon Aortic Valvuloplasty in Adults?
Authors: ELTCHANINOFF HÉLÉNE , GIRON CARLOS , CARLOT RAPHAËLLE , BIZET CATHERINE , CHASSAING STEPHAN , CRIBIER ALAIN
Published: June 2007

Introduced more than 15 years ago, balloon aortic valvuloplasty (BAV) has clearly delineated indications and limitations. Although, aortic valve replacement is undoubtedly the treatment of choice for healthy patients with aortic stenosis, BAV has been demonstrated as a valuable and safe palliative procedure for patients considered too risky or old for current day surgery. Between January 1991 and December 1999, 858 patients (mean age 76 ± 11 years, 479 [57%] women) underwent BAV at our center. Indications for BAV were contraindication to surgery in 16.2% of the patients, high risk in 40.4%, refusal of surgery in 10.7%, personal decision in 18.5%, and other in 14.2%. The mean gradient decreased from 65 ± 23 to 27 ± 12 mmHg and the valve area increased from 0.56 ± 0.19 cm2 to 1.0 ± 0.38 cm2. Eleven (1.1%) patients died during the procedure. The other severe complications were complete AV block in 18 (1.8%) patients, stroke in 8 (0.8%), tamponade in 6 (0.6%), and massive aortic insufficiency in 4 (0.4%). In conclusion, BAV does not replace valve replacement, even in the elderly. All those who can be operated on, should be. However, if surgical intervention is not considered reasonable, BAV offers good immediate results with an acceptable complication rate. Furthermore, previous published series have demonstrated that BAV is particularly indicated in specific subgroups, such as very old patients with high operative risk, end‐stage heart failure, cardiogenic shock, or general anesthesia for noncardiac surgery.
Coronary Stenting of Aorto‐Ostial Saphenous Vein Graft Lesions
Authors: HORLITZ MARC , AMIN FOUAD R. , SIGWART ULRICH , CLAGUE JONATHAN R.
Published: June 2007

Treatment of aorta‐ostial saphenous vein graft lesions by conventional balloon angioplasty or other techniques (laser angioplasty, atherectomy) is limited by high restenosis rates. This study is designed to evaluate acute results and long‐term follow‐up of high risk patients undergoing stent implantation at aorto‐ostial locations of vein graft orifices. Between July 1993 and July 1999 coronary stents were placed in 30 ostial lesions in 30 patients. Procedural success was achieved in the absence of any major complications in 27 patients (90%). Clinical follow‐up was obtained in all 27 patients after 17.7 months. Clinical restenosis occurred in 10 patients (38.5%). A total of 18 patients (69.2%) underwent repeat angiography. Angiographic restenosis was present in 10 patients. Treatment of saphenous vein graft lesions can be accomplished safely and effectively using intracoronary stent implantation. Results are superior to those described for conventional balloon angioplasty or other adjunctive techniques.
Treatment of Palmaz‐Schatz In‐stent Restenosis: 6–Month Clinical Follow‐up
Authors: TAN HUAY‐CHEEM , CROWLEY JAMES , TCHENG JAMES E. , SNG LI‐WAH , SKETCH MICHAEL H. , PHILLIPS HARRY R. , PETER ROBERT H. , BEHAR VICTOR S. , STACK RICHARD S. , ZIDAR JAMES P.
Published: June 2007

To identify predictors of Palmaz‐Schatz in‐stent restenosis and determine outcomes of treatment, we assessed 6–month outcomes in 402 patients who had coronary intervention with stent placement; 60 (15%) developed angiographic and clinical evidence of restenosis. Predictors of restenosis included family history of cardiovascular disease, prior bypass surgery, nonelective stenting, stenting of a vein graft, and multiple stents. Of 60 patients with stent restenosis, 47 had repeat percutaneous intervention and 10 had bypass surgery; only 1 of these 10 patients developed symptoms requiring repeat revascularization. Of the 47 with repeat percutaneous intervention, 32 (68%) had conventional balloon angioplasty; the others had perfusion balloon catheters, laser ablation, and repeat coronary stenting. During follow‐up, 22 (47%) of these 47 patients suffered recurrent angina, myocardial infarction, or death. A third revascularization procedure was performed in 14 (30%), including 5 referred for bypass. This study shows the limitations of percutaneous modalities for patients with Palmaz‐Schatz in‐stem restenosis. Such patients are likely to have recurrent symptoms and to undergo repeat target‐vessel revascularization.
Placement of Intracoronary Stents Mounted on “Over the Wire” Balloon Catheters Without Using Long Guidewires
Authors: ANTONELLIS IOANNIS P. , PATSILINAKOS SOTIRIOS P. , PAMBOUKAS CONSTANDINOS A. , KRANIDIS ATHANASIOS J. , BONOU MARIA , KOSTOPOULOS KONSTANTINOS G. , MARGARIS NIKOLAOS G. , TAVERNARAKIS ANTONIOS G. , ROKAS STYLIANOS G.
Published: June 2007

The aim of this study is to investigate the feasibility, effectiveness, and safety of placement of intracoronary stents mounted on “over the wire” balloon catheters without using long guidewires. Fifteen consecutive patients underwent GR II stent placement. Over the wire balloon catheters and short guidewires were used. The new method was successful in 14 of 15 cases. No complications were observed. This novel technique using a short (instead of long) guidewire to place intracoronary stents mounted on over the wire balloon catheters was successful, and more convenient. (J Interven Cardiol 2000; 13:27–30)
Coronary Artery Spasm Induced by Ergonovine in an Infarct Related Coronary Artery Late After Primary Angioplasty
Authors: YOSHITOMI YUJI , KOJIMA SHUNICHI , SUGI TOSHIHIKO , MATSUMOTO YUJI , YANO MICHIKO , KURAMOCHI MORIO
Published: June 2007

We report two cases with induced coronary spasm of the culprit lesion in the infarct related coronary artery in the chronic phase after primary percutaneous transluminal coronary angioplasty (PTCA). To our knowledge, there are few data on the response of the angioplasty site to ergonovine in human coronary arteries after primary PTCA. It is important to note that chest pain recurring after successful primary PTCA is not automatically related to restenosis, and coronary spasm in patients with previous myocardial infarction, should also be considered. (J Interven Cardiol 2000;31–34)
Early Postinterventional Stent Stenosis of a Ductus Stent Implanted for Palliation in a Newborn with Pulmonary Atresia with Intact Ventricular Septum: Successful Management with Bailout Stenting
Authors: PEUSTER MATTHIAS , FINK CHRISTOPH , PAUL TH. , HAUSDORF G.
Published: June 2007

A newborn with pulmonary atresia with intact ventricular septum (PA‐IVS) was treated with radiofrequency current perforation of the atretic pulmonary valve. As the right ventricle was hypoplastic (z‐value of the tricuspid valve: —4) the arterial duct was stented with a Gianturco‐Roubin GR II stent. Early postinterventionally, the patient became cyunotic and compromised blood flow across the stented ductus arteriosus despite adequate stent position was detected echographically. The newborn was treated successfully with the implantation of a Palmaz stent (Johnson & Johnson Interventional Systems, Warren, NJ, USA) into the obstructed Gianturco‐Roubin GR II stent. The Gianturco‐Roubin GR II stents might be associated with the risk of early stent stenosis after implantation in actively contracting tissues like the ductus arteriosus. In patients with early stent stenosis after ductal stenting, bailout implantation of a subsequent stent can be performed. Transcatheter procedures can be effective means for therapy of PA‐IVS. (J Interven Cardiol 2000;13:39–44)
Catheter Closure of Coronary Artery Fistulas
Authors: QURESHI SHAKEEL A. , TYNAN MICHAEL
Published: June 2007

Coronary artery fistulas are rare and vary widely in their morphological appearance and presentation. This paper presents experience of catheter closure of coronary artery fistulas in 40 patients. Catheter closure was performed with a variety of techniques, including detachable balloons, stainless steel coils, controlled‐release coils, controlled‐release patent ductus arteriosus (PDA) coils, and Amplatzer PDA plug. The vast majority of the fistulas were occluded with coils and in particular, controlled‐release coils. Successful occlusion of the fistula was achieved in 39 (97%) of 40 patients. In one patient, the detachable balloon deflated prematurely and the patient underwent elective surgery. One 4‐month‐old infant died approximately 6 hours after the procedure. Immediate occlusion of the coronary artery fistula occurred in 33 (82%) of patients and late occlusion in 4 patients. Thus overall, total occlusion was achieved in 37 (97%) of 39 patients. The main complication was embolization of the occlusion device, which occurred in 6 (17%) of cases. In one of these cases, a detachable balloon deflated prematurely, and in five patients, coils embolized and were retrieved. In one of the patients, all six coils embolized 24 hours after the procedure but were retrieved, and further coils were implanted successfully. Controlled‐release coils have made an important contribution to the technique of catheter closure of coronary artery fistulas. Catheter closure of these fistulas is an acceptable alternative to the standard surgical treatment.
Occlusion of Interatrial Communications with the Amplatzer Device: Experience in 48 Consecutive Patients
Authors: BROCKMEIER KONRAD , SCHMIDT KLAUS G. , ULMER HERBERT E. , GORENFLO MATTHIAS
Published: June 2007

Both secundum atrial septal defect (ASD) and patent foramen ovale (PFO) have been closed interventionally using several different occluding devices. At a single institution we strived for interventional occlusion of interatrial communications using the Amplatzer device exclusively. During a study period of 22 months, we studied 48 patients ranging in age from 1 to 48 years with an ASD (n = 45) or a PFO (n = 3). Successful implantation of an Amplatzer device was possible in 92% of the patients, and 95% of these patients had a complete early closure of their defect. There were no complications related to the procedure. We conclude that interventional closure of interatrial communications with the Amplatzer device is feasible and safe for selected patients.
Echocardiography Before, During, and After Interventions
Authors: WEIL JOCHEN , RAZEK VIT , LÊ TRONG‐PHI
Published: June 2007

Before intervention, a detailed echocardiographic examination is mandatory for the decision whether this procedure will be necessary, possible, and safe. During intervention, transesophageal echocardiography (TEE) is needed for the continuous monitoring of the procedure, immediate assessment of results, and complications. TEE results in a significant reduction of fluoroscopy time. After intervention, echocardiography provides information on long‐term results and newly developed complications.
Issues in Transcatheter Treatment of Critical Aortic Stenosis in the Newborn Infant
Authors: PIÉCHAUD JEAN‐FRANÇOIS
Published: June 2007

Critical aortic valve stenosis is not a frequently seen disease. In most cases, these patients are in critical condition. Transcatheter dilatation is one of the therapeutic options for treatment. This article addresses important issues in transcatheter dilatation in the newborn infant
Intravascular Ultrasound‐Guided Stenting in Long Lesions: An Insight into Possible Mechanisms of Restenosis and Comparison of Angiographic and Intravascular Ultrasound Data from the MUSIC and RENEWAL Trials
Authors: NAGEH THURAIA , DE BELDER ADAM J. , THOMAS MARTYN R. , WAINWRIGHT RAY J.
Published: June 2007

The high restenosis rates in long stents may be related to suboptimal stent deployment. In an attempt to understand the potential components associated with restenosis in long stents, this study compares angiographic and intravascular ultrasound (IVUS) data from the MUSIC and RENEWAL studies where IVUS was used to optimize stent deployment in short (< 1.5 mm) and long (> 20 mm) coronary lesions, respectively. The RENEWAL study, a randomized trial, compared the NIR stent and Wallstent in long (< 20 mm) coronary lesions and used on‐line visual IVUS criteria to optimize stent expansion. Detailed analysis of IVUS data was performed off line. Angiographic and IVUS data from this study was compared to that from the MUSIC study. Initial stent deployment was deemed optimal by the operator after visual angiographic and IVUS assessment in SO of 70 lesions. In the remaining 20 lesions further balloon inflations were required to optimize stent apposition that led to an average gain in minimal in‐stent luminal area (MISA) of 15.9% (P < 0.01). Off‐line IVUS data analysis showed that the number reaching “MUSIC criteria” for optimal stent deployment preredilatation was 8 (11.4%) of 70 and 14 (20%) of 70 postredilatation. The ratio of MISA/MRAprox (mean proximal reference area) was 0.69 in RENEWAL. At 6‐month follow‐up, the angiographic restenosis rate in RENEWAL was 36% and target lesion revascularization (TLR) rate was 7.8%, compared with MUSIC'S 9.7% and 4.5%, respectively. In conclusion, angiographic assessment of stent deployment in long lesions is limited. On‐line visual IVUS with further balloon inflations to improve stent apposition led to a signifcant gain in MISA, but the MISA/MRAprox, ratio remained suboptimal. Therefore, suboptimal stent deployment due to constraint by lesion resistance may be an important mechanism underlying the high restenosis rates in long stents.
Successful Thrombus Removal Using 6Fr Hydrolyser Thrombectomy Catheter in Acute Myocardial Infarction via Radial Artery
Authors: YINGFENG LIU , NAKAMURA SHIGERU , TANIGAWA JUN , NAKAGAWA ATSUSHI , KITANO KATSUYA , KITAGAWA MOTOAKI , TAKAHASHI HIDEYUKI , MATOBA YOSHIKI , KATOH OSAMU
Published: June 2007

The 6Fr Hydrolyser thrombectomy catheter for acute myocardial infarction (AM) successfully removed a massive thrombus in the coronary artery in three patients. The 6Fr Hydrolyser catheter could be advanced into the right coronary artery with bare‐wire methods via a 6Fr sheath at the radial artery. This approach suggests that the device can be an alternative method for thrombolysis in selected AMI patients with massive thrombus in the coronary artery.
Renal Artery Stenosis and Ischemic Nephropathy
Authors: Joyce James D. , JOYE JAMES D. , ZARGHAMEE SHARZAD , ST. GOAR FREDERICK G.
Published: June 2007

Renal artery stenosis (RAS), in its most severe form, can result in diminished renal function and loss of kidney mass. The prevalence of ischemic nephropathy is greatly under‐appreciated in the elderly population and is the source of substantial morbidity and mortality. Diagnostic tests for RAS in patients with renal insufficiency are problematic, and medical therapy does little to slow the natural progression of the disease. Renal artery stenting can achieve long‐term vessel patency and has been shown to preserve renal function. Proper technique and careful case selection are critical to the success of such procedures. Large‐scale trials are needed to clearly identify groups of patients who will benefit most from percutaneous revascularization.
Endovascular Stent‐Grafts for the Repair of Infrarenal Abdominal Aortic Aneurysms: A Brief Review
Authors: ARKO FRANK R. , NEWMAN CHRISTINE , FOGARTY THOMAS J.
Published: June 2007

In the United States nearly 1.5 million people have abdominal aortic aneurysms (AAAs). The natural history of AAAs is to enlarge and rupture. Rupture of an AAA results in an estimated 15,000 deaths per year. The major objective in the treatment of AAAs is to prevent aneurysm rupture and death. Endoluminal grafting for the treatment of aortic aneurysms is the most exciting topic in vascular surgery today. It is anticipated that approximately half of all aneurysms in the infrared abdominal and descending thoracic aorta will be repaired endovascularly in the future. Despite the enthusiasm for this technology, there are unanswered questions like the long‐term fate of the device, management of endoleaks, and the ability to protect the patient from subsequent rupture. This article describes the two FDA approved devices in clinical use today and the indications, techniques, and potential pitfalls of endoluminal stent‐grafting for the treatment of AAAs.
Clinical Management of Patients with Coronary Syndromes and Negative Fractional Flow Reserve Findings
Authors: HERNÁNDEZ GARCÍA JOSÉ MARÍA , ALONSO‐BRIALES JUAN H. , JIMÉNEZNAVARRO MANUEL , GÓMEZ‐DOBLAS JUAN JOSÉ , BAILÓN ISABEL RODRÍGUEZ , DE TERESA GALVÁN EDUARDO
Published: June 2007

Aims: New interventional techniques to diagnose coronary artery stenosis, such as calculation of myocardial fractional flow reserve (FFR) with a guidewire and pressure transducer, provide a functional assessment of coronary lesions. The present study was designed to investigate the occurrence of cardiac events in patients with coronary syndromes and negative FFR findings in moderately severe coronary stenosis in order to determine the usefulness of this technique in predicting coronary events during follow‐up for problems commonly encountered in clinical practice. A further objective was to evaluate the safety of deferring angioplasty in patients with a negative FFR result. Methods: We studied 43 patients with 44 moderately severe coronary artery stenoses on angiography and FFR ≤ 0.75. Mean age of the patients was 58 ± 11.4 years. The indications for coronary angiography included recent unstable angina in 24 (55.8%) patients, recent acute myocardial infarction in 10 (23.2%) patients, 5 (11.6%) patients with a coronary stent who had symptoms of uncertain cause, and stable angina in 4 (9.3%) patients. Results: During a mean follow‐up period of 10.7 ± 5.9 months, clinical events (unstable angina) occurred in five patients. In three patients, the initially investigated artery was involved, and in the two patients who required coronary revascularizatian, unstable angina was related with an artery different from the one studied initially. Conclusions: Patients with recent coronary syndromes and negative FFR findings in moderately severe coronary stenosis were unlikely to have cardiac events during a 10‐month follow‐up period. Our findings suggest that FFR is a potentially useful indicator of the likelihood of cardiac events and thus represents a useful aid in clinical decision‐making in the hentodynamics laboratory. This diagnostic technique also is potentially useful in identifying patients for whom angioplasty can be safely deferred.
Clinical Evaluation and Options for Infrainguinal Atherosclerosis Therapy: When to Intervene?
Authors: JAFF MICHAEL R.
Published: June 2007

Cardiologists have gained considerable experience and expertise in the diagnosis and management of coronary artery disease. Interventional therapy has now become a standard cornerstone of therapy for coronary artery disease, and endoluminal stents are being used in over 70% of all coronary interventions. Diagnosis and treatment of peripheral arterial disease (PAD) has recently gained momentum. In the past, vascular surgeons and interventional radiologists were the classic caregivers for PAD patients, with an interest in deciding between intervention or no intervention. In addition, the majority of PAD patients had few medical resources since many medical specialists did not view PAD us important for many reasons, such as: (1) few effective options for the management of patients with PAD, (2) PAD did not represent a significant health hazard to patients, (3) few patients actually suffered from PAD, and (4) patients did not view PAD as a significant limitation in their quality of life. Over the past decade, a new medical specialty, vascular medicine, had dedicated itself to the comprehensive management of these complex patients. Vascular medicine specialists are predominantly internists and cardiologists. These physicians not only view PAD as an important medical issue, they understand the increasing prevalence of PAD among the “baby‐boomer” generation, the shortened life‐expectancy of patients with PAD, and the marked reduction in the quality of life among PAD patients. Most importantly, vascular medicine physicians are now aware of several effective options for patients with PAD.
Diffuse In‐Stent Restenosis
Authors: STÖRGER HANS
Published: June 2007

Stent restenosis, especially the diffuse pattern, has developed into a significant clinical and economical problem. It has been estimated that up to 250,000 patients developed in‐stent restenosis in 2,000 alone, two thirds of them can be expected to have diffuse in‐stent restenosis, which is difficult to treat because of high recurrence rates. None of the conventionally available interventional treatment modalities provides optimal long‐term results. Intravascular radiation therapy is currently the only effective percutaneous therapy, for combating in‐stent restenosis. Late thrombotic complications have largely been eliminated by extended antiplatelet regimens. Geographical miss, a major reason for recurrence of in‐stent restenosis after brachytherapy, can be reduced by an improved radiation technique. The first preliminary data on drug‐eluting stents, showing only minimal neointimal proliferation at 6‐month postimplantation, could represent a major breakthrough in the quest to solve restenosis.
Catheter Closure of Atrial Septal Defects and Patent Foramen Ovale in Patients with an Atrial Septal Aneurysm Using Different Devices
Authors: KRUMSDORF ULRIKE , KEPPELER PATRICK , HORVATH KATRIN , ZADAN ELISABETH , SCHRADER RAINER , SIEVERT HORST
Published: June 2007

Background: Atrial septal aneurysm is frequently associated with patent foramen ovale (PFO) and atrial septal defects (ASD). Moreover, a relationship between atrial septal aneurysm and embolic cerebrovascular events has been suggested. The aims of this study were to analyze morphological and functional characteristics of atrial septal aneurysm in PFO and ASD patients and to assess the feasibility and eficacy of different devices for transcatheter closure and the influence of atrial septal aneurysm. Methods: Between March 1997 and May 2000 transcatheter ASD or PFO closure was attempted in 63 patients (mean age 47 ± 13 years) with an atrial septal aneurysm using one of the following devices: Angelwings (n = 3), Cardioseal (n = 5), Cardioseal‐Starflex (n = 7), Amplatzer (n = 11), Amplatzer‐PFO (n = 5), PFO‐Star (n = 25), or Helex (n = 7). Results: Implantation was primarily successful (after the first or second attempt) in all patients. One PFO‐Star device embolized 12 hours after the procedure. During follow‐up (0.6–37 months, mean 10.4 ± 9.2) a residual shunt could be detected by transesophageal echocardiography after 2 weeks in four patients and after 6 months in one patient. Three PFO patients had cerebrovascular events after implantation. Two patients had a transient ischemic attack (TIA) and one patient a stroke. A thrombus formation on the device detected in three patients disappeared after antithrombotic therapy. Conclusion: We conclude that ASDs and PFOs with an associated atrial septal aneurysm can be closed with different available devices. There seem to be no additional risks compared with patients without atrial septal aneurysm. (J Interven Cardiol 2001;14:49–55)
Clinical Trials of Glycoprotein IIb/IIIa Inhibitors
Authors: DAVIDTALLEY J.
Published: June 2007

Glycoprotein (GP) IIb/IIIa inhibitors were developed to block platelet aggregation and potentially to abolish thrombus formation. Clinical trials have demonstrated that GP IIb/IIIa inhibitors are more potent antithrombotic agents than aspirin and heparin alone. GP IIb/IIIa inhibitors reduce short‐ and long‐term complications of percutaneous revascularization. These agents also are effective as adjuncts to various treatment strategies for the management of patients with unstable angina (UA) or non‐Q‐wave myocardial infarction (NQMI). Furthermore, recent clinical trials with a small number of patients suggest that GP IIb/IIIa inhibitors in combination with low‐dose fibrinolytics are safe and effective for the treatment of ST segment elevation myocardial infarction. The clinical trials of GP IIb/IIIa inhibitors summarized here examined different patient populations managed under different strategies. Moreover, these agents have different indications for clinical use and varying safety profiles. (J Interven Cardiol 2001;14:129–142)
Improved Outcomes Associated with Stenting in the Healthcare Cost and Utilization Project
Authors: MAYNARD CHARLES , EVERY NATHAN R. , CHAPKO MICHAEL K. , RITCHIE JAMES L.
Published: June 2007

Recent results from Medicare indicated that both hospital mortality and the use of same admission coronary artery bypass graft (CABG) surgery were lower in patients receiving stents, and that stenting did not alter the finding of improved outcomes at high volume centers. The purpose of this report is to compare outcomes in a national sample of patients of all ages receiving stents with those undergoing conventional balloon angioplasty. A second purpose is to evaluate the volume outcome hypothesis. This study included 100,318 angioplasties from 191 hospitals in 19 states; 43,966 (44%) involved stent placement. The major outcomes of interest were same admission hospital death and same admission CABG surgery. In comparison to patients with conventional angioplasty, patients receiving stents were younger, less often female and nonwhite, and had less diabetes and hypertension. In the group without infarction, hospital mortality was lower in the stent group (0.7% vs 0.9%, P = 0.01), as was the use of same admission bypass surgery (1.4% vs 2.7%, P < 0.0001). The same pattern was true for myocardial infarction; hospital mortality (2.7% vs 4.2%, P < 0.0001) and bypass surgery rates (1.6% vs 5.3%, P < 0.0001) were lower in the stent group. These results persisted after adjustment for important predictors of outcome. In general, outcomes were better in high volume centers, although in the stent group, there was no clear relationship between volume and outcome. These results support earlier findings that hospital mortality and particularly same admission surgery rates are lower with stenting. Although the volume outcome association for stenting was less clear in this study than in Medicare, these results do not mean that the fundamental volume outcome relationship has been changed by stenting. (J Interven Cardiol 2001;14:159–164)
Neurological Aspects of Patent Foramen Ovale: In Search of the Optimal Treatment
Authors: ROSIN LUDGER
Published: June 2007

Although paradoxical embolism through a patent foramen ovale (PFO) has become an established cause of cerebral ischemia in younger patients without other obvious causes of stroke, the therapeutic options have not been investigated satisfactorily. There are still uncertainties about the natural history of PFO patients after suffering a stroke, and diagnostic criteria proving a causal and not incidental relation to the embolic event are not established. The stroke recurrence has been evaluated in several studies in a heterogeneous population and seems as low as 1.9% per year. Secondary prophylactic treatment has become a matter of discussion since efforts were made to close the PFO either surgically or by percutaneous transcatheter methods. Foramen closure seems to be effective in eliminating the mechanism of paradoxical embolism but its benefit‐risk ratio has yet to be established. Following the goals of evidence‐based medicine, none of the therapeutic options can be recommended. Fortunately, the issue has gone to trial and there are two studies underway to compare foramen closure to medical therapy. (J Interven Cardiol 2001;14:197–202)
An Unusual Encounter of a “Cobra” in the Heart: Rare Appearance of an Amplatzer Septal Occluder
Authors: YIP WILLIAM C. L. , CHAN KIT‐YEE
Published: June 2007

This article presents the unusual appearance of a “cobra”
due to “acute bending”
of the proximal part and partial opening of the distal part of the left atrial disk of an Amplatzer Septal Occluder during the process of transcatheter closure of a secundum atrial septal defect in a 6‐year‐old boy. The possible reasons and method to overcome this technical problem, which resulted in successful occlusion of the atrial septal defect, are discussed. (J Interven Cardiol 2001;14:215–218)
Catheter Closure of the Persistent Foramen Ovale: Mid‐Term Results in 162 Patients
Authors: BEITZKE ALBRECHT , SCHUCHLENZ HERWIG , GAMILLSCHEG ANDREAS , INGOLF STEIN JÖRG , WENDELIN GERALD
Published: June 2007

Four different types of occluder systems were used to close a persistent foramen ovale (PFO) in 162 patients with paradoxical embolic events. Ninety‐eight patients had ischemic stroke, 60 transient ischemic attacks (TIA) or prolonged reversible ischemic neurological deficit (PRIND), and 4 had peripheral arterial embolism. The age of the patients was 40.2 ± 11.9 years and the ischemic event had happened 7 ± 10 months before device closure. CardioSeal and Amplatzer occluders were the most commonly used devices (73 and 77 cases, respectively). Implantations were successful in all patients. Serious catheter‐related complications included two device embolizations and two venous bleedings. Six patients had documented supraventricular arrhythmias within the first month after implantation, which disappeared spontaneously within some weeks without therapy in three patients; the other three patients with atrial fibrillation needed conversion to sinus rhythm. Residual leaks were found in 5 out of 116 patients who had been followed by transesophageal echocardiography (TEE) and one leak was closed by a second device. During a follow‐up period of 19.4 ± 16.2 months per patient, TIA and PRIND occurred in 3 of 116 patients. Interventional closure of PFO is a simple, effective and quick method that is superior to surgery and avoids the problems of life‐long anticoagulation. (J Interven Cardiol 2001;14:223–230)
Closure of Atrial Septal Defects in Adult Patients: Justification of the “Tipping Point”
Authors: LANDZBERG MICHAEL J.
Published: June 2007

The “tipping point”, favoring closure of hemodynamically significant atrial septal defects (ASDs) in the adult, has occurred and is supported by strong clinical data, especially in patients who present with symptoms. Echocardiographic evidence of right ventricular volume overload as a correlate of significant left‐to‐right intracardiac shunting remains a prerequisite to determine need for closure, even in patients with child‐bearing potential. No patient appears too old to achieve benefit from closure of such defects. Modern therapeutics for pulmonary vascular disease may allow extension of these techniques to an increasingly threatened population, with care best coordinated and offered in appropriate centers of expertise. (J Interven Cardiol 2001; 14:267–270)
Brain phylogeny, ontogeny and dysfunction: integrating evolutionary, developmental and clinical perspectives in cognitive neuroscience
Authors: Hannan Anthony J.
Published: June 2007

Objective:

One of the most popular approaches in cognitive neuroscience has been to study the normal adult human brain. However, there are likely to be limits to the knowledge that can be obtained from such studies. If we assume that no single approach can ever provide us with knowledge of causative processes whereby the mind emerges from the brain, then we need to consider how to combine more disparate approaches. I aim to illustrate here how the parallel study of brain phylogeny, ontogeny and dysfunction may bring us towards an integrative understanding of fundamental aspects of cognitive neuroscience.

Methods:

A review of published literature in these research areas was carried out and representative articles selected.

Results:

Comparative approaches, utilizing the extraordinary behavioural abilities as well as the structural and functional variants that evolution has thrown up across diverse groups of species, can inform the core neural systems that may be necessary and sufficient to support specific cognitive processes. Similarly, detailed studies of human brain development, focusing on structural and functional maturation correlated with temporal mapping of cognitive processes as they come ‘on-line’, may provide unique mechanistic insights. Finally, the study of brain dysfunction in neurological and psychiatric disorders such as Huntington’s disease, Alzheimer’s disease, schizophrenia and depression, may have the beneficial side-effect of greatly enhancing our understanding of healthy brain function.

Conclusion:

Each approach has its own epistemological advantages and disadvantages, but combined they may lead to more sophisticated, and empirically testable, models. In this review, I outline evidence for their utility, illustrate the approaches using specific examples and suggest how new advances in fields such as genomics, neurophysiology and neuroimaging may provide unprecedented opportunities in cognitive neuroscience.
On the correlation/constitution distinction problem (and other hard problems) in the scientific study of consciousness
Authors: Miller Steven M.
Published: June 2007

Objective:

In the past decade, much has been written about ‘the hard problem’ of consciousness in the philosophy of mind. However, a separate hard problem faces the scientific study of consciousness. The problem arises when distinguishing the neuralcorrelatesof consciousness (NCC) and the neuralconstitutionof consciousness. Here, I explain this correlation/constitution distinction and the problem it poses for a science ofphenomenalconsciousness. I also discuss potential objections to the problem, outline further hard problems in the scientific study of phenomenal consciousness and consider the ontological implications of these epistemological issues.

Methods:

Scientific and philosophic analysis and discussion are presented.

Results:

The correlation/constitution distinction does indeed present a hard problem in the scientific study of phenomenal consciousness. Refinement of the ‘NCC’ acronym is proposed so that this distinction may at least be acknowledged in the literature. Furthermore, in addition to the problem posed by this distinction and to ‘the hard problem’, the scientific study of phenomenal consciousness also faces several other hard problems.

Conclusion:

In light of the multiple hard problems, it is concluded that scientists and philosophers of consciousness ought to (i) address, analyze and discuss the problems in the hope of discovering their solution or dissolutionand(ii) consider the implications of some or all of them being intractable. With respect to the latter, it is argued that ultimate epistemic limits in the study of phenomenal consciousness pose no threat to physicalist or materialist ontologies but do inform our understanding of consciousness and its place in nature.
Studies of caloric vestibular stimulation: implications for the cognitive neurosciences, the clinical neurosciences and neurophilosophy
Authors: Miller Steven M. , Ngo Trung T.
Published: June 2007

Objective:

Caloric vestibular stimulation (CVS) has traditionally been used as a tool for neurological diagnosis. More recently, however, it has been applied to a range of phenomena within the cognitive neurosciences. Here, we provide an overview of such studies and review our work using CVS to investigate the neural mechanisms of a visual phenomenon – binocular rivalry. We outline the interhemispheric switch model of rivalry supported by this work and its extension to a metarivalry model of interocular-grouping phenomena. In addition, studies showing a slow rate of binocular rivalry in bipolar disorder are discussed, and the relationship between this finding and the interhemispheric switch model is described. We also review the effects of CVS in various clinical contexts, explain how the technique is performed and discuss methodological issues in its application.

Methods:

A review of CVS and related literature was conducted.

Results:

Despite CVS being employed with surprising effect in a wide variety of cognitive and clinical contexts, it has been a largely underutilized brain stimulation method for both exploratory and therapeutic purposes. This is particularly so given that it is well tolerated, safe, inexpensive and easy to administer.

Conclusion:

CVS can be used to investigate various cognitive phenomena including perceptual rivalry, attention and mood, as well as somatosensory representation, belief, hemispheric laterality and pain. The technique can also be used to investigate clinical conditions related to these phenomena and may indeed have therapeutic utility, especially with respect to postlesional disorders, mania, depression and chronic pain states. Furthermore, we propose that based on existing reports of the phenomenological effects of CVS and the brain regions it is known to activate, the technique could be used to investigate and potentially treat a range of other clinical disorders. Finally, the effects of CVS (and its potential effects) on several phenomena of interest to philosophy suggest that it is also likely to become a useful tool in experimental neurophilosophy.