bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mechanical left ventricular unloading during high risk coronary angioplasty: First use of a new percutaneous transvalvular left ventricular assist device
Authors: Scholz Karl H. , Figulla Hans R. , Schweda Frank , Smalling Richard W. , Hellige Gerhard , Kreuzer Heinrich , Aboul‐Hosn Walid , Wampler Richard K. 
Published: March 2007

AbstractA new catheter mounted, transvalvular left ventricular assist device has been designed for percutaneous transfemoral access. The device, the Hemopump™ [14 French (Fr.) outer diameter], is based on a mixed flow rotary pump and is capable of flow rates of 1.5–2.2 1/min. The pump is inserted using a specialized 16 Fr. femoral introducer sheath. The first application of the percutaneous Hemopump™ in man was performed in two patients with hemodynamic compromise during high risk coronary angioplasty. In these patients, Hemopump™ support resulted in hemodynamic stabilization (increase in aortic pressure from 60/42 to 87/61 and from 80/60 to 100/70 mm Hg, respectively) and marked left ventricular unloading (decrease in pulmonary capillary wedge pressure from 25 to 10 and from 14 to 10 mm Hg) during balloon inflation. In both patients, percutaneous transluminal coronary angioplasty (PTCA) could be accomplished successfully. Using the system for periods of about 2 hr in each patient, we observed no vascular, hemorrhagic, or embolic complications. In both patients, only a minor increase in both plasma free hemoglobin and lactate dehydrogenase levels was noted. Our preliminary experiences suggest that the percutaneous Hemopump™ is safe and effective and may be a powerful alternative to other devices used for supported angioplasty.
Comparison of results of intracoronary stenting in patients with unstable vs. stable angina
Authors: Malosky Steven A. , Hirshfeld John W. , Herrmann Howard C. 
Published: March 2007

AbstractPercutaneous transluminal coronary angioplasty (PTCA) has higher complication and restenosis rates when performed in the setting of unstable angina. Balloon‐expandable intracoronary stenting is a new technique with the potential to improve the results of PTCA. In order to determine whether stenting is associated with a poorer outcome in patients with unstable angina, we retrospectively examined our experience with the Palmaz‐Schatz balloon‐expandable intracoronary stent in 105 patients. Patients were divided into 2 groups on the basis of symptoms at the time of stent insertion: group I (n = 57) had stable angina pectoris, and group II (n = 48) had unstable angina defined as pain at rest despite antianginal therapy (Braunwald class II, III). Initial (30‐d) and final (6‐mo) success rates were defined as stent insertion without myocardial infarction, need for bypass surgery, death, and significant angina.Baseline characteristics were similar, although the patients with unstable symptoms were older, more likely to be female, and had a higher incidence of postinfarction angina. A total of 136 stents were successfully delivered to 97 target sites in 92% of patients. Major complications occurred in 4 patients (4%) and were due to subacute thrombosis in 3 of them. There were no differences in complication rates between patients receiving stents electively with stable vs. unstable symptoms (2% vs. 6%, p = NS).Six‐mo. follow‐up status was ascertained in 96% of patients and revealed overall clinical success in 83% with angiographic restenosis (≥ 50% stenosis) in 28% of patients. There were no significant differences between groups in rates of restenosis, follow‐up angina class, or overall clinical success.Patients with unstable angina receiving intracoronary stents have similar complication, restenosis, and initial and final success rates as compared to stent placement in patients with stable symptoms. This finding differs from previous observations of conventional PTCA and may result from mechanical improvements in the vessel due to the stent (e.g., sealing intimal dissections) or the associated anticoagulation regimen.
On‐Line quantitative coronary analysis in clinical practice: One step closer to reality?
Authors: Ribichini Flavio , Steffenino Giuseppe , Dellavalle Antonio , Mina Paola , Cerati Riccardo , Dalmasso Marilena , Uslenghi Eugenio 
Published: March 2007

AbstractQuantitative coronary analysis is widely used in studies of progression/regression and restenosis of coronary lesions. On‐line digital systems are used in diagnostic coronary angiography, and as a guide in coronary interventions. The aim of this investigation was to test the reliability of measures obtained with one commercially available on‐line equipment. Well‐visualized coronary lesions from patient studies were analyzed for variability in single‐frame measurement. Procedural factors affecting the consistency of measurements were identified by repeated visualization of the same coronary lesion with hand‐and power‐injection of contrast in various positions in the field of the image intensifier, and by imaging of steel phantoms in the same positions. Steel phantoms closely resembling coronary lesions as encountered in practice were visualized in the most favourable radiologic setting compatible with clinical situations. Accuracy and precision of measurements were found to be worse than reported in validation studies. This may be due to a host of variables which may need to be tested in each laboratory performing on‐line quantitative coronary angiography, when data so obtained are to be used in clinical decision making or in research studies.
Effect of balloon inflation in angiographically normal coronary segments during coronary angioscopy: A quantitative angiographic study
Authors: Hamon Martial , Lablanche Jean‐Marc , Bauters Christophe , McFadden Eugène P. , Quandalle Philippe , Bertrand Michel E. 
Published: March 2007

AbstractVisualization of coronary stenoses by coronary angioscopy is facilitated by inflating an occlusive cuff located near the distal end of the device to temporarily interrupt blood flow. In animal models, this procedure induces substantial endothelial denudation. Experimental studies show that endothelial denudation may lead to neointimal hyperplasia at the denuded site. This study was designed to determine whether angioscopy was associated with significant changes in lumen diameter at the site of cuff inflation. We studied 52 consecutive patients undergoing coronary angioscopy. We measured with use of quantitative edge‐detection angiography [computer‐assisted evaluation of stenosis and restenosis (CAESAR) system] the mean and minimal lumen diameters at the site of cuff inflation localized by filming the inflated cuff during angioscopy and at control non‐instrumented segments on angiograms performed before angioscopy, after angioscopy, and at 6 months follow‐up. Follow‐up angiograms were performed in 80% of eligible patients. At follow‐up, the mean (3.22 ± 0.54 mm) and minimal (2.76 ± 0.58 mm) diameters of the segment exposed to the inflated cuff were not significantly different from the equivalent values (3.22 ± 0.58 and 2.75 ± 0.61 mm) before angioscopy. No significant changes occurred in the mean or minimal diameters of the control segments over the same period. The late change (follow‐up minus pre‐angioscopy) in mean lumen diameter at the cuff inflation site (‐0.005 ± 0.18 mm) was not significantly different from that at the control site (0.004 ± 0.20 mm). While it is impossible to determine with certainty whether inflation of the angioscopy cuff causes endothelial denudation in man, the trauma associated with balloon cuff inflation does not have detectable long‐term effects on epicardial lumen diameter.
Prolonged intragraft urokinase with a new infusion wire: Improved short‐term results
Authors: Cundey Paul E. , Whitlock R. R. , Norman Joyce , Edwards Marcia , Cundey Paul E. 
Published: March 2007

AbstractPatients with aged saphenous vein grafts and recurrent symptoms of angina are being seen with increasing frequency [Bourassa: J Am Coll Cardiol 17:1081–1083, 1991]. The treatment of these patients remains a dilemma. Direct balloon angioplasty is frequently complicated by distal embolization and early restenosis [Aureran and Gruentzig: Am J Cardiol 53:953–954, 1984]. There is evidence that thrombus plays a significant role in this occlusive process [Hartmann et al.: J Am Coll Cardiol 18:1517–1523, 1991]. Prolonged intragraft urokinase infusion with a new multiside hole infusion catheter debulks thrombus and permits balloon angioplasty without the usual complications.
Starr‐Edwards valve thrombosis detected preoperatively by transesophageal echocardiography
Authors: Pollock Stewart G. , Dent John M. , Simek Chris L. , Gimple Lawrence W. , Johns Roger A. , Kaul Sanjiv , Spotnitz William D. 
Published: March 2007

AbstractA 31‐year‐old woman developed increasing signs of congestive heart failure 15 years following placement of a mitral Starr‐Edwards mechanical valve. A preoperative transesophageal echocardiogram (TEE) demonstrated a large, obstructive valvular thrombus and the patient underwent successful reoperative valve replacement.
Peripheral vascular complications of coronary angioplasty by the femoral and brachial techniques
Authors: Johnson Lewis W. , Esente Paolo , Giambartolomei Alessandro , Grant William D. , Loin Melissa , Reger Mark J. , Shaw Claude , Walford Gary D. 
Published: March 2007

AbstractIn order to monitor the incidence and types of peripheral vascular complications in a single institution, we prospectively entered 1,579 coronary angioplasty cases into a computer data base during the years 1991 and 1992. Various periprocedural risk factors were analyzed. The patients were followed closely to identify complications that occurred outside the laboratory or after discharge from the hospital.Peripheral vascular complications occurred in 37 patients (2.37%) and included hematoma 20 (1.27%), retroperitoneal bleeding 7 (.44%), false aneurysm 6 (.38%), occlusion 1 (.06%), infection 2 (.13%), and cholesterol emboli 1 (.06%).Risk factors for complications by multivariate analysis were older age, female gender, and clinical evidence of peripheral vascular disease. Other factors potentially related to vascular trauma or bleeding tendency that were not risk factors in this series were clinical presentation, use of heparin or thrombolytic agents, blood clotting parameters, and arterial sheath size. There was no significant difference between the femoral and brachial approaches in frequency of complications (2.5% vs. 1.6%), but femoral complications tended to carry greater morbidity.
Inter‐Series differences in the restenosis rate of palmaz‐schatz coronary stent placement: Differences in demographics and post‐procedure lumen diameter
Authors: Carrozza Joseph P. , Kuntz Richard K. , Schatz Richard A. , Leon Martin , Goldberg Sheldon , Savage Michael , Fischman David , Senerchia Cynthia , Diver Daniel J. , Baim Donald S. 
Published: March 2007

AbstractRestenosis rates following Palmaz‐Schatz stenting vary between 13 and 36%. To determine whether the nearly three‐fold interseries difference in restenosis rates reflects systematic factors (demographic and procedural variables such as post‐treatment lumen diameter) rather than random variation, we pooled 486 lesions treated with the Palmaz‐Schatz coronary stent in the U.S. Multicenter Registry (n = 259) with the single‐center Beth Israel Hospital experience (n = 227) and analyzed the combined series using a continuous geometric model of restenosis.A greater proportion of lesions (66 vs. 50%; P < 0.001) in the Multicenter cohort represented restenosis after a prior intervention. The Multicenter experience also showed a smaller minimum lumen diameter following stent placement (2.61 vs. 3.43 mm; P < 0.001), higher post‐stent percent stenosis (16 vs. –2%; P < 0.001), and less acute gain (1.79 vs. 2.67 mm; P < 0.001) than lesions treated in the Beth Israel cohort. At 6‐month follow‐up, the angiographic restenosis rate (≥ 50% diameter stenosis) was significantly higher in the Multicenter group (35 vs. 27%; P = 0.05), despite the development of less absolute late loss (0.96 vs. 1.32 mm; P < 0.001). Multivariable modeling, however, showed that the only independent predictors of restenosis were a post‐procedure lumen diameter < 2.80 mm (odds ratio = 1.57; P = 0.04), diabetes mellitus (odds ratio = 3.55; P < 0.001), and prior restenosis (odds ratio = 1.84; P = 0.008).Since center (Beth Israel vs. Multicenter) was eliminated from the multivariable model after inclusion of these variables, the observed higher restenosis rate in the Multicenter series of Palmaz‐Schatz coronary stents can thus be explained in part by differences in demographics (more previously treated lesions) and procedural details (a smaller posttreatment lumen diameter). Since post‐procedure lumen diameter is a strong predictor of freedom from restenosis in the pooled experience, the probability of restenosis within a Palmaz‐Schatz stent can be decreased by obtaining a large post‐procedure lumen diameter.
Discrepancy between visual estimation and computer‐assisted measurement of lesion severity before and after coronary angioplasty
Authors: Desmet Walter , Willems Jos , Lierde Johan Van , Piessens Jan 
Published: March 2007

AbstractOne hundred fourteen coronary stenoses were quantified before and after percutaneous transluminal coronary angioplasty (PTCA) using a semi‐automated digital system. The values obtained were considered as standard for comparison with visual estimation by the PTCA operator as well as by independent consensus‐reading. The measured percent stenosis was 62.7 ± 13.7% before and 27.7 ± 12.4% after angioplasty. Before PTCA, the operator consistently overestimated stenosis severity (87.8 ± 8.5%, P < 0.0001) and consensus‐reading reduced but did not eliminate this overestimation (78.0 ± 12.3%, P < 0.05). The error in visual estimation was inversely correlated with the measured degree of stenosis: coefficients were –0.79 (P < 0.0001) and –0.51 (P < 0.0001) for operator and consensus‐readers, respectively. After PTCA, the operator underestimated the residual stenosis (21.2 ± 9.9%, P < 0.0001) but there was no systematic bias by consensusreading (29.4 ± 12.0%, NS). Again the error in visual estimation was inversely correlated with the measured degree of residual stenosis : coefficients were –0.76 (P < 0.0001) and –0.58 (P < 0.0001) for operator and consensus‐reading, respectively.In conclusion, the operator overestimates lesion severity before and underestimates moderate residual stenoses after PTCA, a problem only partially corrected by independent consensus‐readers.
Local thrombolytic therapy in superior vena cava syndrome secondary to malignant thymoma: A case report and literature review
Authors: Enders Gary C. , Sodums Marcis T. 
Published: March 2007

AbstractSuperior vena caval (SVC) obstruction due to malignant thymoma is exceedingly uncommon. We report a case of SVC syndrome where local intravenous thrombolytic therapy uncovered an SVC tumor mass not detected by high resolution computed tomography or magnetic resonance imaging scanning. Local intravenous thrombolytic therapy may be therapeutic in central venous obstruction and may facilitate the diagnosis of the underlying cause of obstruction.
Pros and cons of perfusion balloons in failed angioplasty
Authors: Foley J. Brendan , Sridhar Kumar , Dawdy John , Konstantinou Chris , Brown Robert I. G. , Penn Ian M. 
Published: March 2007

AbstractProlonged inflation with perfusion balloons is commonly used in failed angioplasty. The objective of this study was to determine the angiographic outcome of 59 consecutive patients treated with prolonged inflation with perfusion balloons as the primary treatment for failed angioplasty. Angiographic success (< 50% stenosis and normal flow) was achieved in 41%. Angiographic success was greater in the left anterior descending coronary artery (67% versus 33% for non‐left anterior descending involvement, P = .044) and was less in complex dissections (25% versus 75% for no dissection or simple dissections, P = .025). Angiographic deterioration occurred in 37.5% of the successful group and 77% of the unsuccessful group (P = .002) and was more frequent in the right coronary artery (88% versus 50% for non‐right coronary involvement, P = .007) and complex dissections (92% versus 38% for no dissection or simple dissections, P = .0001). Thus, in a group of patients with unsuccessful outcome following conventional balloon angioplasty, success with the perfusion balloon was modest. Furthermore, angiographic deterioration was frequently observed following unsuccessful prolonged inflation.
Coronary angioplasty in a patient with situs inversus totalis and a single coronary artery
Authors: Wester J. P. J. , Ernst J. M. P. G. , Mast E. G. , Plokker H. W. M. , Bal E. T. , Verzijlbergen J. F. 
Published: March 2007

AbstractA patient with congenital situs inversus totalis and a single coronary artery was referred for revascularization because of progressive disabling angina. Exercise thallium scintigraphy had disclosed ischaemia in the anterolateral, posterolateral, and inferior wall of the left ventricle. Percutaneous transluminal coronary angioplasty was performed successfully for stenoses in the right coronary artery.
Placement and angiographic patency of the strecker coronary stent
Authors: Laird John R. , Carter Andrew J. , Kufs William M. , Farb Andrew , Prewitt Kerry C. , Wortham Dale C. 
Published: March 2007

AbstractThe Strecker stent is a newer, balloon‐expandable vascular prosthesis consisting of a single tantalum filament knitted into a flexible mesh tube. To test the placement characteristics and patency of this device, we implanted 29 stents in the coronary arteries of 24 juvenile Yorkshire swine. Seventeen stents were placed in the left anterior descending artery, and 12 were placed in the left circumflex system. All stents were deployed successfully. Four animals died within the first 24 hr of anesthesia‐related complications. The remaining animals were sacrificed at 24 hr, 1 week, 2 weeks, or 4 weeks. Follow‐up angiography demonstrated the patency of all stents. There were no episodes of stent migration or side branch occlusion.The Strecker stent has several favorable characteristics, including its unique delivery system, ease of deployment, flexibility, radiopacity, and radial strength. There was 100% patency at up to 4 weeks in this animal model. Further studies are required to define whether the knitted mesh design offers any advantage over previous models.
Evaluation of the systematic use of a new type of diagnostic/interventional 6f catheters for coronary angiography and angioplasty
Authors: Chatelain Pascal , Urban Philip , Camenzind Edoardo , Verine Vitali , Hoang Vincent , Metz Damien 
Published: March 2007

AbstractCoronary angioplasty performed immediately after coronary angiography has raised interest to develop diagnostic catheters potentially usable for interventions (i.e. Diaventional™ catheters). To evaluate the performance and cost‐effectiveness of such material, we performed a prospective study in 100 consecutive patients with a > 50% pre‐angiographic likelihood of coronary angioplasty in 85 of them. Angioplasty was actually performed in 61 patients. Of the 56 (92%) immediate angioplasty procedures, 33 (59%) were performed successfully with the Diaventional™ catheter chosen initially. In 23 cases, another guiding catheter was used for technical failure (2 cases) or because of operator's choice (21 cases). Angiographic success of angioplasty procedures was 97% with Diaventional™ and 91% with “standard” guiding catheters. Based on current market prices, the costs of the systematic use of such diagnostic/interventional catheters were 11% less than the projected costs of the standard strategy.Thus, this new type of catheter is both safe and cost‐effective for the majority of coronary angioplasty procedures “at first sight.” It could become a logical first choice for diagnostic coronary angiography, when the likelihood of immediate subsequent angioplasty is high and at relatively low risk.
Fracture of a perfusion balloon catheter during coronary angioplasty
Authors: Kuan Peiliang , Ko Yu‐Lin , Tsai Chang‐Her , Lin Jiunn‐Lee 
Published: March 2007

AbstractIn a 74‐year‐old patient with increasing angina, an attempt was made to dilate an ostial stenosis in the first diagonal artery. The initial attempt with a long balloon catheter was unsuccessful. Because of chest pain associated with hypotension during balloon inflations, a second attempt with a perfusion balloon catheter resulted in fracture of this catheter's tip (14 mm long) in the artery. Bypass graft surgery was performed and the retained fragment was easily removed by arteriotomy. The patient made an uneventful recovery. © 1994 Wiley‐Liss,Inc..
Physiologic assessment of ostial left circumflex coronary artery disease using a doppler guidewire before and after rotational atherectomy facilitated angioplasty
Authors: Ling Frederick S. , Brennan Joseph J. , Cleman Michael W. , Cabin Henry S. 
Published: March 2007

AbstractIntravascular Doppler assessment of coronary flow velocity has demonstrated the physiologic significance of intermediate stenoses and the success of coronary interventions. We describe a patient where Doppler evaluation confirmed the significance of an intermediate left circumflex ostial stenosis. We also describe the Doppler flow velocity characteristics after successful rotational atherectomy facilitated angioplasty © 1994 Wiley‐Liss,Inc...
Improving results of bailout coronary stenting after failed balloon angioplasty
Authors: Metz Damien , Urban Philip , Camenzind Edoardo , Chatelain Pascal , Hoang Vincent , Meier Bernhard 
Published: March 2007

AbstractStent implantation can be a valuable alternative to emergent bypass surgery to treat established or threatening abrupt closure following coronary balloon angioplasty. To evaluate several sequentially introduced changes in our practice of bail‐out stenting, we compared the first (group I) and second half (group II) of our single center experience (n = 88). Use of bailout stenting increased over time (2% of all angioplasty procedures in group I vs. 6% in group II, P < 0.001), more often to prevent rather than to reverse abrupt closure. Technical success of stent implantation was unchanged (95% vs. 93%), and there was a decreasing trend for stent thrombosis (14% vs. 5%), in‐hospital death (5% vs. 2%), Q‐wave myocardial infarction (9% vs. 7%), and requirement for surgery (9% vs. 7%). The incidence of non‐Q‐wave myocardial infarction (29% vs. 7% P < 0.01), bleeding complications (27% vs. 7% P < 0.01), and hospital stay duration (11 ± 11 vs. 8 ± 5 days P < 0.05) decreased. Our data suggest that coronary stent implantation is currently an effective stand‐alone bailout procedure for a large majority of failed angioplasty procedures. © 1994 Wiley‐Liss,Inc..
Balloon angioplasty for treatment of in‐stent restenosis: feasibility, safety, and efficacy
Authors: Macander Peter J. , Roubin Gary S. , Agrawal Subodh K. , Cannon Adam D. , Dean Larry S. , Baxley William A. 
Published: March 2007

AbstractSixty patients with 1 or 2 stainless steel intracoronary stents (Cook, Inc.) underwent balloon angioplasty for in‐stent restenosis 1.5–13.5 months after stenting. Seventy‐five in‐stent redilatation procedures were performed. Seventy‐three restenotic lesions (97%) were successfully recrossed and dilated, reducing the mean pre‐angioplasty intrastent diameter stenosis from 77 ± 12% to 20 ± 11% residual. Although one angioplasty (1.3%) was complicated by non‐Q‐wave infarction, no angioplasty‐related death, acute closure, need for additional stenting, emergent coronary bypass surgery, side branch occlusion, or vascular sequelae occurred. Post‐procedure heparin was not used in 83% of successful cases. Most patients were discharged the day following redilatation (mean in‐hospital stay 1.7 ± 1.3 days). At 5.4 ± 3.4 months following in‐stent angioplasty, 84% of patients were in Canadian Cardiovascular Society class 0 or I. In conclusion, balloon dilatation in this stent for restenosis appears simple and efficacious in the short term, and may entail less risk than dilatation of unprotected coronary vessels. © 1994 Wiley‐Liss,Inc..