bluuebunny/crossref_metadata_2025_split huggingface dataset:
Bench top evaluation and clinical experience with the szabo technique
Authors: Vaquerizo Beatriz , Serra Antonio , Ormiston John , Miranda‐Guardiola Faustino , Webber Bruce , Fantuzzi Andres , Delgado Guillermo , Brugera Jordi 
Published: July 2011

AbstractBackground: The Szabo technique has been described as a method to ensure accurate ostial stent placement. We sought to investigate this novel technique in detail both in vitro and in vivo. Methods and Results: The technique was subjected to bench testing and also undertaken in 26 patients. Each step was recorded with cine angiography and the stents imaged by microcomputed tomography. The ostial LAD was treated in 81% and a DES was implanted in 92%. Angiographic success was 88.5% (one case of stent dislodgement). Repeat angiography was performed in 78% and restenosis observed in two patients. MACE rate at 15.5 ± 5.1 months was 13% (1 TLR, 1 MI, 1 cardiac death). Despite a seemingly excellent immediate angiographic result, we report one case of restenosis at follow up and one case of IVUS examination (performed in four patients) in which significant stent protrusion, into the proximal main vessel, was observed. In vitro bench testing confirmed a significant and asymmetric (carina side) stent protrusion into the main branch, with the last cell of the stent undergoing significant deformation. Conclusions: The Szabo technique is not a precise technique to implant a stent at the level of the ostium. The proximal end of the stent undergoes significant and asymmetric deformation, protruding into main branch. Additional concerns with this complex technique include the potential for stent damage or contamination before implantation and the risk of stent dislodgement. We conclude that there are more disadvantages than benefits to this technique which only partially addresses the difficulties encountered in the treating ostial lesions. © 2011 Wiley Periodicals, Inc.
Sequential trans‐catheter aortic valve implantation and abdominal aortic aneurysm repair
Authors: Drury‐Smith Mark , Garnham Andrew , Khogali Saib 
Published: July 2011

AbstractAortic stenosis in the elderly population is an increasing problem, with many patients being considered too high risk for surgery, and therefore being denied treatment. A percutaneous method of treatment in the form of trans‐catheter aortic valve implantation (TAVI) is becoming an increasingly attractive option in this group of patients. Although, TAVI has been shown to be successful and improve cardiovascular haemodynamics, assessment of other comorbidities in this susceptible group of patients is essential to ensure good clinical outcomes. The presence of an abdominal aortic aneurysm (AAA) in our patient was an example of an important comorbidity which could have a significant impact on the outcome of TAVI, if not managed appropriately. The increased systolic pressure post successful TAVI will result in an increased strain within the AAA with an increased risk of rupture. Therefore, a timely management strategy for the AAA was necessary. Our case is of sequential TAVI followed by Endovascular aneurysm repair (EVAR). The patient underwent uncomplicated TAVI. There was complete abolition of trans‐aortic gradient. EVAR was successfully undertaken three weeks post TAVI. The patient made an excellent recovery and remained well at six months follow‐up. Our case highlights the importance of a detailed assessment in all patients prior to consideration for TAVI and the importance of having a management strategy for both pathologies tailored to the patient. This case demonstrates the benefits of development of trans‐catheter techniques for two different conditions. Future developments including reduction of sheath size reduction and EVAR and TAVI device evolution, may enable simultaneous treatment of aortic stenosis and abdominal aortic aneurysm as a combined percutaneous procedure under local anaesthetic. © 2011 Wiley Periodicals, Inc.
Percutaneous treatment of aortic isthmus atresia
Authors: Butera Gianfranco , Heles Mohamed , Carminati Mario 
Published: July 2011

AbstractBackground: Limited data exists in the literature concerning the percutaneous treatment of complete aortic isthmus atresia. Patients and Methods: Between January 2007 and November 2010, 40 subjects underwent percutaneous treatment of aortic coarctation in our catheterization laboratory. Four out of 40 had aortic isthmus atresia with complete interruption. Median age at procedure was 48 years (range, 32–63 years). All subjects had history of arterial systemic hypertension refractory to medical treatment. Two subjects had a previous history of haemorrhagic stroke. All procedures were performed under general anesthesia and orotracheal intubation. In each case radial and femoral artery access was obtained. A radiofrequency (RF) system (Baylis MedComp Inc, Montreal, Canada) consisting of a Nykanen 0.024'' RFguidewire and coaxial microcatheter were used to perforate and cross the atretic segment. A guidewire was then snared and an artero‐arterial circuitcreated. The area was predilated by using coronary angioplasty balloons. A 12 Fr Mullins long sheath was advanced and an E‐PTFE covered 8Zig Cheatham‐Platinum stent implanted. Patients were monitored in hospital for 48–72 hr. Follow‐up was performed at 1, 3, 6, 12 months, and yearly thereafter. Results: Percutaneous recanalization of the atretic segment was performed successfully in all subjects. Mean fluoroscopy and procedure times were 30 ± 6 and 90 ± 15 min, respectively. After implantation, the gradient decreased significantly (prestent: mean value 52.25 mm Hg [range 33–70 mm Hg] versus post stent: mean value 3 mm Hg [range, 0–10 mm Hg] [P < 0.0001]). The stents were placed in the correct position in all subjects and no immediate complications occurred. During a mean follow‐up of 19 months (2–41 months), there were nosignificant complication. All subjects had arterial systemic blood pressure within the normal range. In two out of four patients single agent antihypertensive drug therapy was needed. The first patient in our series was treated conservatively and needed further stent dilation with a second procedure approach, eight months after the initial stent implantation, performed without incident. Conclusions: Our data show that use of radiofrequency energy perforation and covered CP stent implantation is a safe, effective, and promising tool for treatment of complete aortic isthmus atresia. © 2011 Wiley Periodicals, Inc.
Core valve embolization: Technical challenges and management
Authors: Sarkar Kunal , Ussia GianPaolo , Tamburino Corrado 
Published: July 2011

AbstractTranscatheter Aortic Valve Implantation with the Core Valve self expanding prosthesis can be complicated by hemodynamic instability in cases of low deployment (implant failure). The management of a low implant may necessitate repositioning the prostheses with the help of a snare catheter. Snaring can however be complicated by embolization of the prosthesis which presents a series of technical challenges that need to be addressed. We have discussed the technical issues and the approach to address them successfully in a systematic manner to ensure optimal procedural and patient outcomes. © 2011 Wiley Periodicals, Inc.
Carotid artery revascularization with distal protection in high‐surgical‐risk patients in routine clinical practice: Rationale and design of the CABANA safety surveillance program
Authors: White Christopher J. , Avula Surendra B. , Mintz Randy T. , Iskander Ayman , Chervu Arun , Feldman Robert L. , Schermerhorn Marc L. , Woo Henry H. , Hopkins L. Nelson 
Published: July 2011

AbstractBackground: Continuous improvement in carotid artery stenting (CAS) outcomes, especially for periprocedural death and stroke in high‐surgical‐risk patients, have been seen in recent randomized trials of CAS versus carotid endarterectomy and CAS registries. However, these studies use stringent inclusion/exclusion criteria for patient, institution, and physician selection. The Carotid Stenting Boston Scientific Surveillance Program (CABANA) study was initiated to evaluate periprocedural outcomes with modern versions of the Carotid Wallstent and FilterWire EZ System for operators with a wide range of clinical specialties, CAS experience and training levels, in patients with a broad range of high‐surgical‐risk conditions and lesion types. Methods: This prospective, single‐arm study enrolled 1,097 subjects with 1,098 carotid artery lesions at 99 study centers. Investigators were grouped into one of three tiers according to whether they had a high, medium, or low level of previous CAS experience and were also categorized by their CAS‐credential‐based training requirements for the CABANA study. Follow‐up at 30 days includes clinical evaluation and independent neurological and NIH stroke scale assessments. The primary endpoint rate of 30‐day composite stroke, death, and MI, as well as the rates of these individual events, will be evaluated across the overall study, by physician experience tier, and by physician training tier. Discussion: The evaluation of periprocedural CAS safety in a real‐world environment with modern devices in high‐surgical‐risk patients treated by physicians with a broad range of training and experience will better inform treatment decisions in the future. © 2011 Wiley Periodicals, Inc.
The effects of a bare metal stent on the healing of a huge coronary pseudoaneurysm: A case report
Authors: Shintani Yoshiaki , Kawasaki Tomohiro 
Published: July 2011

AbstractWe experienced a rapidly growing huge coronary pseudoaneurysm with symptomatic restenosis after rotational atherectomy. A BMS had successfully obliterated the huge coronary pseudoaneurysm at 3 months follow‐up on CTA. The OCT at 9 months follow‐up showed that the most of stent strut was covered with neo‐intima. This case suggests that BMS deployment is recommended as a useful method for treating coronary pseudoaneurysms. © 2011 Wiley Periodicals, Inc.
Transapical treatment of paravalvular leaks in patients with a logistic euroscore of more than 15%
Authors: Swaans Martin J. , Post Martijn C. , van der Ven H. A. Johan , Heijmen Robin H. , Budts Werner , ten Berg Jurien M. 
Published: July 2011

AbstractObjective: We describe the short‐term results of the patients who underwent transapical treatment of a paravalvular leak (PVL) in our centre.Background: Increasing experience with transapical aortic valve implantation has inspired us to explore this approach for prosthetic paravalvular leak reduction in high risk patients.Methods: All procedures were performed in the catheterization laboratory under general anesthesia, using a small anterolateral thoracotomy to expose the apex. Access through a 9‐French sheath was necessary to introduce the Amplatzer Vascular III plug. Three‐dimensional transesophageal echocardiography (3D‐TEE) was used to guide the operator and evaluate the severity of regurgitation postimplantation.Results: In total seven consecutive patients (mean age 72.8 ± 5.6 years, 86% male) with a history of mitral valve (n = 6) or aortic valve replacement and severe PVL, underwent transapical PVL reduction using seven plugs in total (diameter 10–14 mm). Preprocedural median logistic EuroSCORE was 28.5% (range 17.1–41.1%) and NYHA functional class was ≥3 in all patients. The procedure was successful in all patients, with a median fluoroscopic time of 18.7 min (range 10.1–29.6 min). Postprocedure 3D‐TEE showed occlusion of PVL in three patients, and significant reduction in three patients. Postprocedural complication was a hematothorax requiring surgery in one patient. Median hospitalization duration after the procedure was 5 days (range 5–59 days). At 3‐month follow‐up one patient died, functional class and LDH did not differ significantly and there was a significant increase in hemoglobin.Conclusions: Transapical paravalvular leak reduction might be a good or rather attractive alternative in high‐risk patients for major re‐do cardiac surgery. © 2011 Wiley Periodicals, Inc.
A neglected symptom of contained aortic laceration—Dysphagia aortica successfully treated by endovascular stentgrafting
Authors: Kische Stephan , Werner Dierk , Ince Hüseyin 
Published: July 2011

AbstractPurpose: Dysphagia aortica describes an esophageal swallowing disorder caused by external compression from an ectatic, tortuous, or aneurysmal thoracic aorta. Although well recognized among specialists, dysphagia aortica is rarely considered in the differential diagnosis of dysphagia. Case Report: We present the case of a 75‐year‐old woman with a history of swallowing difficulty and retrosternal pressure sensation. Her symptoms had been attributed to sliding axial hernia along with gastroesophageal reflux disease for the last 12 months. Diagnostic workup at our institution revealed a giant penetrating ulcer of the descending aorta as a culprit of esophageal compression. Expeditious endovascular stentgraft exclusion of the aneurysm was performed because of its symptomatic nature and high propensity of spontaneous rupture. On a recent consultation 2 years after the endovascular procedure, the patient confirmed a complete remission of impaired swallowing and freedom from thoracic discomfort. Conclusions: Dysphagia aortica should be considered in the numerous differential diagnoses of esophageal swallowing disorders in the elderly, as delayed identification may harbor catastrophic outcome for affected individuals. © 2011 Wiley Periodicals, Inc.
Percutaneous coronary interventions and cardiovascular outcomes for patients with chronic total occlusions
Authors: Jolicœur E. Marc , Sketch Micheal J. , Wojdyla Daniel M. , Javaheri Sean P. , Nosib Shravan , Lokhnygina Yuliya , Patel Manesh R. , Shaw Linda K. , Tcheng James E. 
Published: July 2011

AbstractObjectives: This study sought to assess the benefits of a coronary chronic total occlusion CTO recanalization after adjusting for the case‐mix and the propensity to undergo the CTO intervention in a population of patients with stable coronary artery disease. Background: The benefits of percutaneous recanalization of CTO are disputed. Methods: In 1,602 patients with a least one CTO and treated by percutaneous coronary intervention (PCI), we derived a propensity score to undergo a CTO recanalization by comparing the characteristics of patients who did (n = 346) and did not (n = 1,256) undergo a CTO PCI attempt. Among the patients who underwent a CTO PCI attempt, we identified the angiographic predictors of failure. The primary analysis was ultimately performed by looking at the association between the outcome of the CTO recanalization and the survival free of death and cardiovascular rehospitalizations. Sensitivity analyses were performed by adjusting for the propensity to undergo a CTO recanalization, for the anatomical predictors of failure, and for the extent of coronary artery revascularization achieved. Results: A successful CTO recanalization was not significantly associated with survival free of death and cardiovascular rehospitalization (HR = 0.90, 95% CI 0.64–1.25). Even more conservative hazards ratio point estimates were obtained with the sensitivity analyses. Conclusions: Successful percutaneous CTO recanalization is not associated with survival free of death and cardiovascular hospitalizations in a contemporary population of patients with symptomatic coronary artery disease. © 2011 Wiley Periodicals, Inc.
Selective pulmonary artery embolization in two patients with single ventricle and acquired pulmonary vein occlusion
Authors: Bondanza Sara , Derchi Maria , Marasini Maurizio 
Published: July 2011

AbstractAcquired pulmonary vein occlusion is a rare complication of surgical correction of complex congenital heart diseases. Associated vascular remodeling of arterial and venous vessels includes medial thickening, intimal fibrosis, and progressive development of aorto‐pulmonary collaterals. The consequent pulmonary perfusion changes impact more importantly on a low pressure circulation such as the Fontan circuit. The management of these patients is still controversial. We describe this condition in two patients with single ventricle who underwent staged cavopulmonary connection. In both cases, we found acquired occlusion of one pulmonary vein, poor antegrade flow in the involved hypoplastic pulmonary arteries due to a widespread thin collateral circulation producing a backward washout of unopacified blood flow with competitive mechanism. Percutaneous embolization of a segmental pulmonary artery was performed with restoration of a more homogeneous perfusion of both main pulmonary arteries. Extracardiac total cavopulmonary connection was successfully performed a few months later in both patients. © 2011 Wiley Periodicals, Inc.
Incidence, timing, and predictors of valve dislodgment during TAVI with the medtronic corevalve system
Authors: Van Mieghem Nicolas M. , Schultz Carl J. , van der Boon Robert MA , Nuis Rutger‐Jan , Tzikas Apostolos , Geleijnse Marcel L. , van Domburg Ron T. , Serruys Patrick W. , de Jaegere Peter PT 
Published: July 2011

AbstractObjectives: To determine the incidence, timing and predictors of periprocedural valve dislodgment with the Medtronic Corevalve System (MCS). Background: Periprocedural valve dislodgment may occur during transcatheter aortic valve implantation (TAVI). Methods: Ninety‐eight consecutive patients underwent TAVI with the MCS after a comprehensive baseline assessment including invasive angiography, echocardiography, and Multi‐Slice Computed Tomography (MSCT). The invasive monitoring charts and angiographic studies of all TAVI procedures were reviewed to determine the incidence and timing of valve dislodgment. Results: Valve dislodgment occurred in 18 patients. Patients with valve dislodgment had a larger Aortic Valve Area (0.76 ± 0.25 cm2 vs. 0.61 ± 0.19 cm2, P = 0.007), lower mean transaortic gradient (37.65 ± 14.62 mm Hg vs. 47.11 ± 16.08 mm Hg, P = 0.03) and significantly less aortic root calcification (Agatston score median 1951 AU (IQR, 799–3103) vs. 3289 AU (IQR 2097–4481), P = 0.016). A lower aortic root calcium score (Agatston score < 2359 AU) was the single independent predictor for valve dislodgment (OR 3.10, 1.09–8.84). After valve dislodgment, the valve could be successfully retrieved and implanted in the proper anatomic location in all cases. Valve dislodgment was associated with a lower incidence of post‐procedural AR ≥ 2 (11.1% vs. 34.6%, P = 0.05). There were no relevant procedural or clinical implications to valve dislodgment. Conclusions: The incidence of periprocedural valve dislodgment was 18% in these series. Less aortic root calcification appeared the single independent predictor. © 2011 Wiley Periodicals, Inc.
Transaortic transcatheter aortic valve implantation using edwards sapien valve
Authors: Bapat Vinayak , Khawaja Muhammed Z. , Attia Rizwan , Narayana Ashok , Wilson Karen , Macgillivray Kirsty , Young Christopher , Hancock Jane , Redwood Simon , Thomas Martyn 
Published: July 2011

AbstractObjectives: To evaluate feasibility and outcome of Transoartic Transcatheter Sapien valve implantation. Background: Transcatheter Aortic valve implantation (TAVI) using the Edwards SAPIEN device (Edwards LifeScience, Irvine, CA) is usually performed via the transfemoral (TF) or transapical (TA) routes. Some patients are not suitable for these approaches. We report our experience with the novel transaortic (TAo) approach via a partial upper sternotomy and discuss the advantages and future applications. Methods: Between January 2008 to March 2011 193 patients with severe aortic stenosis underwent TAVI with the Edwards SAPIEN bioprosthesis at the St. Thomas' Hospital, London. 108 patients were unable to undergo a TF‐TAVI and of those 17 were accepted for a TAo‐TAVI on the basis of anatomy, risk, LV function, and significant respiratory disease. Results: The TAo‐TAVI group (n = 17) had more prevalent respiratory disease than the TA‐TAVI group (47.0% vs. 18.7%, P = 0.011). Otherwise the groups were similar in demographics and history. Despite this the 30 day mortalities were not significantly different between the groups (TAo‐TAVI 4.3% at 30 days versus TA‐TAVI 7.7%, P = 0.670). There were no significant differences in procedural complications. Conclusions: The TA‐TAVI approach may not be desirable in patients with severe chest deformity, poor lung function or poor left ventricular function. TAo‐TAVI via a partial sternotomy is safe and feasible in these patients. © 2011 Wiley Periodicals, Inc.
Pressure‐wire based assessment of microvascular resistance using calibrated upstream balloon obstruction
Authors: Kim June‐Hong , Park Ju‐Hyun , Choo Kiseok , Song Sung‐Kook , Kim Jung‐Su , Park Young‐Hyun , Kim Jun , Chun Kook‐Jin , Han Dongcheul , Faranesh Anthony Z. , Lederman Robert J. 
Published: July 2011

AbstractObjectives: We assess microvascular integrity as a marker of myocardial viability after coronary stenting, using only a pressure guidewire. Background: Microvascular integrity generally is not assessed using pressure‐only guidewires because the transducer lies upstream of microvasculature. We partially inflate a balloon inside a coronary stent to achieve a specific normalized pressure drop at rest (distal coronary/aortic pressure = 0.8) and then infuse a vasodilator, to render the wire sensitive to microvascular function. We hypothesize that the further decline in pressure (ΔFFR0.8) predicts MRI myocardial viability. Methods: We studied 29 subjects with acute coronary syndrome including myocardial infarction. After successful culprit stenting, the resting coronary/aortic pressure was set to 0.8 using temporary balloon obstruction. ΔFFR0.8 was defined as 0.8‐(distal coronary/aortic pressures) during adenosine‐induced hyperemia. The average transmural extent of infarction was defined as the average area of MRI late gadolinium enhancement (after 2.8 ± 1.5 days) divided by the corresponding full thickness of the gadolinium enhanced sector in short axis slices, and was compared with ΔFFR0.8. Results: ΔFFR0.8 corresponded inversely and linearly with the average transmural extent of infarction (r2 = 0.65, P < 0.001). We found that a transmural extent of infarction of 0.50 corresponded to a ΔFFR0.8 threshold of 0.1, and had high sensitivity and specificity (100% and 94.4%, respectively). Conclusions: Using only an upstream pressure‐sensitive guidewire and a partially obstructing balloon during pharmacologic hyperemia, we were able to predict MRI myocardial viability with high accuracy after relief of epicardial stenosis. With further validation, this may prove a useful clinical prognostic tool after percutaneous intervention. © 2011 Wiley Periodicals, Inc.