bluuebunny/crossref_metadata_2025_split huggingface dataset:
Angioplasty at coronary bifurcations: Single‐guide, two‐wire technique
Authors: Oesterle Stephen N. , McAuley Bruce J. , Buchbinder Maurice , Simpson John B. 
Published: March 2007

AbstractA technique is described for angioplasty at coronary bifurcations. This simple approach utilizes a single guiding catheter, an exchange wire, and a conventional dilatation catheter and guidewire. With this “protective” guidewire technique, side branches at risk from occlusion during dilatation of a primary coronary segment can be protected and dilated secondarily; continual access to the threatened side branch is maintained with a “standby” exchange wire in the branch vessel.
Use of pulmonary artery pressure and pacing catheter during PTCA
Authors: Jacob Andrew S. , Goldbaum Thomas S. , Richard Augusto D. , Lindsay Joseph 
Published: March 2007

AbstractA balloon‐tipped pacing catheter capable of monitoring pulmonary artery pressure and providing standby right ventricular pacing was used in 20 percutaneous transluminal coronary angioplasties (PTCAs), without complication. The catheter was eily inserted in all cases (mean 85 sec) and achieved satisfactory pacing threshold in 17 patients (mean 7.5 ma). The design of this catheter theoretically reduces the risk of right ventricular perforation and tamponade, which may be increased during PTCA.
Implication of transstenotic coronary pressure gradient measurement during coronary angioplasty
Authors: Haraphongse Mant , Tymchak Wayne , Burton Jeffrey R. , Rossall Richard E. 
Published: March 2007

AbstractThe aim of this study was to establish a criterion for the success of an angioplasty based upon pressure gradients across coronary lesions. Sixty‐two percutaneous transluminal coronary angioplasties (PTCA) in 56 patients with isolated left anterior descending artery disease were examined. Pressure gradients measured before and after PTCA were expressed as normalized mean pressure gradients (NMPG) computed by dividing mean pressure gradient by mean aortic or proximal coronary artery pressure. Angiographic severity was expressed as percentage area stenosis (AS) calculated from diastolic caliper measurements of diameter of each lesion and the nearest normal adjacent segment in at least two projections. The relationship between AS and NMPG was nonlinear with a steep increase in gradients beyond a critical value of AS of about 60%. This relationship was unaffected by angiographically visualized collaterals.All except one of 65 coronary stenotic lesions with NMPG of more than 0.32 had an AS of more than 60%. Only three of 57 coronary stenoses with NMPG of less than 0.32 had severe AS (p < 0.001). The results indicate that NMPG is a reliable, practical guide to the severity of coronary stenosis and is therefore a useful measurement for assessing either the success or the residual stenosis during PTCA.
Retrograde internal mammary artery flow and resistant angina pectoris: Clues to the coronary‐subclavian steal syndrome
Authors: Niemiera Mark L. , Haft Jacob I. , Goldstein Jonathan E. , Hobson Robert W. 
Published: March 2007

AbstractA 68‐year‐old woman with persistent angina immediately following coronary bypass surgery using a left internal mammary artery graft was diagnosed as having “coronarysubclavian steal syndrome” 13 years after operation. We outline clinical and angiographic clues that will aid in the identification and diagnosis of this syndrome, which may become more common with the increased use of the mammary artery as a coronary bypass conduit.
Development of severe left ventricular outflow tract obstruction over the course of 14 years: An unusual natural history of hypertrophic obstructive cardiomyopathy
Authors: Wilson John H. , Razavi Mehdi 
Published: March 2007

AbstractA patient with hypertrophic obstructive cardiomyopathy who when first seen had a normal physial examination, chest x‐ray, and electrocardiogram, and no provokable gradient with isoproterenol at cardiac catheterization, was re‐evaluated after 14 years. At the time of re‐evaluation, she was found to have a typical systolic ejection murmur, cardiomegaly, left ventricular hypertrophy, a pseudoinfarction pattern on electrocar‐diography, and a significant subaortic gradient both by catheterization and by doppler. This case demonstrates that hypertrophic obstructive cardiomyopathy can be a progressive disease and that patients with this condition warrant careful follow‐up. Echocardiography with doppler may provide an excellent noninvasive method of following these patients.
Platypnea‐orthodeoxia: Assessment with a unique cardiac catheterization procedure
Authors: Mills Tillet J. , Seward James B. , McGoon Michael D. , Callahan Mark J. 
Published: March 2007

AbstractA case of platypnea‐orthodeoxia (orthostatic dyspnea and arterial desaturation) secondary to a patent foramen ovale in the absence of primary disease is presented. This case illustrates the use of recumbent and upright cardiac catheterization techniques for precise evaluation of the hemodynamic abnormality in this disorder.
New balloon catheter for prolonged percutaneous transluminal coronary angioplasty and bypass flow in occluded vessels
Authors: Erbel Raimund , Clas Werner , Busch U. , von Seelen Warner , Brennecke Rüdiger , Blümer H. , Meyer Jürgen 
Published: March 2007

AbstractA new balloon catheter was developed for continuous perfusion of coronary arteries during angioplasty (CPC catheter). Steerable Grüntzig balloon catheters (3.7 mm) with two lumina were formed. The first lumen was used for balloon inflation. Side holes to the second lumen proximally and distally to the balloon were created for coronary perfusion even during inflation phase. At a perfusion pressure of 120 mmHg, a flow rate of 63 ± 3ml/min with 0.9% saline and 43 ±1 ml/min with plasma expander were measured. In experiments on five dogs, dilation time until appearance of signs of ischemia could be prolonged in three of five dogs, from 30 to 40 s, 120 to 203 s, and 180 to 420 s comparing conventional and CPC balloon catheters. In 11 patients with proximal lesions, dilation time could be increased from 39.5 ± 23.9 s to 81.1 ± 36.3 s (p < 0.01) until appearance of angina pectoris. ST segment changes were observed in 10/11 patients using conventional catheters. Using CPC catheters, no ST segment changes were observed in four patients; time until appearance of ST segment changes was delayed in the other seven patients.The CPC catheter seems to be an alternative catheter in proximal lesions of the left and right coronary artery, allowing the possibility of prolonged dilation and increased safety to the patient. In case of dissection or perforation, the CPC catheter can be used for perfusion of the distal part of the coronary vessel until emergency bypass surgery.
Balloon angioplasty of coronary bifurcation lesions: The kissing balloon technique
Authors: George Barry S. , Myler Richard K. , Stertzer Simon H. , Clark David A. , Cote Gilles , Shaw Richard E. , Fishman‐Rosen Jodi , Murphy Mary 
Published: March 2007

AbstractInitial experience with the technique of “kissing balloon” angioplasty is described in 52 patients undergoing coronary angioplasty. Guiding catheters employing both the femoral and brachial approach were used in all but two of the coronary angioplasties and, in addition, the bilateral femoral approach was used in the renal and peripheral angioplasties. Initial success was achieved in 51 (98%) patients. Abrupt closure requiring urgent coronary revascularization occurred in one patient six hours following the completion of the procedure. Another patient developed a new Q‐wave on the electrocardiogram and moderate elevation of CPK‐MB fraction following the procedure due to loss of a diagonal branch. No deaths occurred in this series. Angiographic restenosis developed in ten patients. In the recurrence group, five had repeat kissing balloon angioplasty, two had repeat single vessel angioplasty, and three patients chose elective surgical revascularization.Based on our experience, the technique of kissing balloon coronary angioplasty can be performed safely utilizing the brachio‐femoral technique. The risk of major side branch occlusion can be minimized with this technique and the overall complication rate does not significantly differ from that of our experience in single vessel coronary angioplasty. Patient selection criteria are based upon the angiographic relationship of the major branch to the side branch and is important in determining the initial and long‐term success of this technique.
Coronary angioplasty at the time of initial cardiac catheterization
Authors: Feldman Robert L. , Macdonald Robert G. , Hill James A. , Conti Richard , Pepine Carl J. , Carmichael Michael J. , Knauff Daniel G. , Alexander James A. 
Published: March 2007

AbstractFollowing initial diagnostic cardiac catheterization in 20 patients with unstable angina, percutaneous transluminal angioplasty (PTCA) was successfully performed either immediately (15 patients) or later in the day (five patients). This approach offers certain clinical and financial advantages. PTCA immediately following diagnostic catheterization should probably only be performed by experienced operators and only when excellent cooperation with cardiovascular surgeons is possible.
Quantitative effects of osmotic diuresis following angiographic contrast administration
Authors: Louie Eric K. , Al‐Sadir Jafar , Emmanouel Dimitrios 
Published: March 2007

AbstractOsmotic diuresis resulting from the administration of angiographic contrast poses the potential threat of marked volume losses obligated by the renal excretion of non‐reabsorbable solute. We prospectively assessed urinary excretion of solute and water following cardiac angiography in 14 euvolemic subjects without preexisting renal disease, by a protocol that allowed each patient to serve as his own control. During the initial 6 h after the beginning of angiography, contrast administration resulted in increased total osmolar excretion from a control rate of 0.79 ± 0.09 to 1.09 ± 0.09 mOsm/min (P <.05) with a return to control values thereafter. Surprisingly, sodium, potassium, and chloride excretion rates did not differ significantly from control values. After subtraction of the molar contribution of electrolytes, urea, and creatinine from the total osmolar excretion rate, it was apparent that the “residual osmolar excretion rate” of 0.48 ± 0.05 mOsm/min was markedly elevated over the control value of 0.11 ± 0.05 mOsm/min (P <.01), reflecting the excretion of contrast agent. Despite the marked osmotic diuresis, urine output during this period (3.9 ± 0.2 cc/min) did not differ significantly from the control value of 4.0 ± 0.3 cc/min. We conclude that marked volume losses are not a necessary concomitant of contrast‐induced osmotic diuresis in the euvolemic cardiac patient without renal disease.
Evaluation of a coronary lysing system: Results of a preclinical safety and efficacy study
Authors: Leyser Larry J. , Bundy Mark A. , Abreo Fleurette , Hanley Henry G. , Fadely Donald , Walker John M. 
Published: March 2007

AbstractThe purpose of this study was to evaluate the efficacy and safety of a recently developed transluminal lysing system in the removal of coronary stenotic lesions from a human cadaver heart and in the cannulation of coronaries in the anesthetized dog.The left coronary arteries of three dogs were cannulated on separate occasions, with coronary arteriography and translation of the transluminal lysing system cutter to the distal segments of the coronary vessels performed each time. Proximal and distal coronary pressures were recorded from the guiding catheter and the transluminal lysing system cutter, demonstrating no significant pressure differential and minimal damping. Pathological examination of the dog coronaries after sacrifice demonstrated minor intimal irregularities with no significant thrombosis or vessel perforation. A significant portion of the occulsive stenotic lesions were removed from coronary vessels of a human cadaver heart with subsequent reestablishment of angiographic dye flow to the distal coronary vessels without evidence of debris loss from the transluminal lysing system cutter or the appearance of occlusions in the distal vessels.We conclude that the transluminal lysing system can be introduced into the coronary artery of a living dog on repeated occasions without causing significant coronary damage, coronary occlusive thrombosis, myocardial destruction, morbidity, or mortality; furthermore, occlusive stenotic lesions can be removed from cadaver coronary vessels by the transluminal lysing system with the establishment of angiography patency.
Anomalous unilateral single pulmonary vein mimicking partial anomalous pulmonary venous return
Authors: Rey Christian , Vaksmann Guy , Francart Charles 
Published: March 2007

AbstractWe report a case in which the clinical findings of a partial anomalous pulmonary venous return were present but with termination of the anomalous pulmonary vein into the left atrium. There was hypoplasia of the right lung, dextroposition of the heart, and a loop‐like vascular density in the right lung field. Cardiac catheterization revealed no shunt, and on pulmonary angiograms, a large common right pulmonary vein draining the entire right lung and entering the left atrium by way of a single orifice. Possible embryologic explanations include atresia of the right inferior pulmonary vein and persistence of the ipsilateral superior pulmonary vein.
The brachial artery method to transluminal internal mammary artery angioplasty
Authors: Dorros Gerald , Lewin Ruben F. 
Published: March 2007

AbstractA new catheter technique to perform angioplasty of the right or left internal mammary artery coronary graft utilizing the brachial artery approach is described. Utilization of the ipsilateral brachial artery permitted cannulation of the internal mammary artery with preformed polyurethane Teflon‐lined guide catheters. The coronary dilatation catheter was passed through the guiding catheter into the internal mammary artery. This technique permitted successful access into the ipsilateral mammary artery in eight patients, the left internal mammary artery graft in five and the right in three patients. The angioplasty procedure was successfully performed in seven of eight cases (spasm of the left internal mammary artery precluded successful dilatation catheter passage in one case). No brachial artery complications were encountered. In two cases, angioplasty was successfully performed in additional coronary vessels. Follow‐up of 1‐‐16 months (mean: 7.7 months) revealed no clinical evidence of restenosis. The ipsilateral brachial artery approach utilizing preshaped guiding catheters for visualization and introduction of dilatation catheters into the internal mammary artery graft is a safe and successful approach, and it is an acceptable alternative to the femoral technique.
Improved stability and visualization during coronary artery angioplasty using a double catheter technique
Authors: Dervan John P , Zalewski Andrew , Slysh Sonya , Goldberg Sheldon 
Published: March 2007

AbstractGuiding catheters used in coronary angioplasty can make coronary angioplasty potentially hazardous when they become positionally unstable, induce myocardial ischemia, or impair angiographic visualization. In order to avoid this problem, a double catheter technique was employed in seven patients involving nine procedures consisting of a standard 8 or 9 French angioplasty guiding catheter and a standard 7 French angiographic catheter to prevent coronary flow reduction and to permit improved coronary artery visualization. In two of the procedures, the second diagnostic catheter also permitted the prevention of potential plaque disruption by the guide catheter in the proximal right coronary artery. The predilatation stenosis was 88 ± 12%; the postdilatation stenosis was 28 ± 9%. The use of the diagnostic catheter as a second catheter prevented damping and permitted the stable disengagement of the guiding catheter from the coronary artery. This technique is most useful in patients who have proximal right coronary artery stenoses because it provides optimal visualization of the segment undergoing dilatation, avoids the potential for ischemia in more distal stenoses, and thereby allows the procedure to be performed in a controlled, unhurried manner.
Catheter‐induced intimal injury during routine coronary catheterization in dogs
Authors: Pap John M. 
Published: March 2007

AbstractThe location and progression of changes in arterial permeability and structure were studied in nine dogs over a 13‐week period following left coronary catheterization with standard coronary catheters. Changes in arterial permeability were analyzed by quantitating Evans blue dye (EBD) uptake over the aortic luminal surface (blue areas). Structural changes were assessed by light and electron microscopy. In the catheterized animals, compared to uncatheterized controls, we observed a significant increase in aortic luminal EBD uptake that was maximal 4 hours after the procedure but still present up to 13 weeks later. Microscopic analysis of “blue areas” shortly after the procedure revealed widespread endothelial denudation, platelet and leukocyte adherence, with occasional intimal avulsions, disruption of the internal elastica, and thrombi. The EBD uptake patterns in association with the electron microscopic findings in these animals suggested that 67–;–;89% of the aortic endothelium was removed by the catheter during the procedure. The proliferative response that occurred following this catheter‐induced injury produced fibrocellular intimal thickening in the aortas and left main coronary arteries of animals studied 10 to 92 days after the procedure. In the aortic root, such thickening was associated with incomplete re‐endothelialization, thrombogenicity, and grossly abnormal permeability patterns. We conclude that significant catheter‐induced intimal injury can occur during coronary angiography. In the canine model, such injury is associated with widespread fibrocellular intimal thickening and abnormal permeability that persists for at least 13 weeks after the procedure.
Recurrence after coronary angioplasty
Authors: Myler Richard K. , Shaw Richard E. , Stertzer Simon H. , Clark David A. , Fishman Jodi , Murphy Mary C. 
Published: March 2007

AbstractRecurrence (restenosis) after coronary angioplasty has undermined the initial success of the procedure and has compromised, to some extent, the attractiveness of the technique in the treatment of ischemic heart disease. Assessment of recurrence predictors has been problematic due to lack of coordination of angioplasty recurrence research and includes: incomplete angiographic documentation, variations in definitions of restenosis anatomically and the results of restenosis physiologically (ie, myocardial ischemia), the dirth of morphologic specifications of subsets under investigation and late outcome pathology, limitations in statistical analyses used, and minimal efforts to classify the available data on recurrence.A review of the literature suggests that all findings regarding recurrence after angioplasty can be organized in four categories: (1) clinical, (2) morphologic, (3) technical (or procedural), and (4) pharmacologic. The reported findings with high concordance as risk factors for recurrence after angioplasty include the clinical factors of diabetes mellitus, hyperlipidemia, and angina of short duration or unstable presentation. Morphologic factors which have been corroborated vis‐à‐vis recurrence include stenoses with diameter reduction of greater than 90% before and greater than 30% after angioplasty, residual trans‐stenotic pressure gradients of greater than 20 mmHg after angioplasty, and lesions that are diffuse, long, eccentric, or calcified. Technical factors associated with recurrence include lower balloon/vessel (or graft) ratios and the absence of (uncomplicated) “intimal dissection.” The category most deficient in research regarding recurrence after angioplasty is pharmacologic.Since there are statistically documented and reproducible factors predictive of restenosis, to ignore or minimize these findings or resist further evaluation (because of the ease and safety of performing repeat angioplasty) is to deny the opportunity to understand the mechanisms and favorably affect the incidence of recurrence. This review concludes with two major implications of the restenosis research: (1) certain clinical, technical, and pharmacologic factors, if addressed, may predictably decrease the rate of restenosis and (2) certain clinical and morphologic factors may increase the risk of restenosis; these factors may be less readily modified (eg, diabetes, lesion calcification) and thus must be considered in the decision for angioplasty.Finally, this review recommends that there be more effective coordination of angioplasty recurrence research with agreement on a single anatomic definition of restenosis with consistent physiologic correlatives, more lucid statistical presentation and improved efforts to clarify and organize the information so that meaningful conclusions regarding the causes (and therefore the prevention) of recurrence may be achieved.
Percutaneous transluminal coronary angioplasty of the “very proximal” coronary artery stenosis
Authors: Nakhjavan Fred K. , Goldman Anthony P. , Hutt Gordon H. , Wertheimer John H. , Yazdanfar Shahriar , Maranhao And Vladir , Weiner Ronald 
Published: March 2007

AbstractWe report on 11 patients with “very proximal” lesions out of a total of 300 consecutive patients who underwent percutaneous transluminal coronary angioplasty (PTCA). Eight patients had native left anterior descending (LAD) lesions and three had LAD saphenous vein grafts lesions. Lesions were considered to be “very proximal” when one half or more of the balloon was inflated in the left main coronary artery for the native LAD lesions or the aorta for the LAD coronary artery saphenous vein bypass graft (CABG) lesions. There was a mean reduction in stenosis from 88.3% (range 75–99) to 13.8% (range 0–60) and a mean reduction in transtenotic gradient from 47.2 mmHg (range 20–80) to 8.3 mmHg (range 0–20). The initial success rate was 90.9% (10 out of 11 patients) with a partial success in the other patient. No complications occurred in any of the patients. Two patients had restenosis (18.2%) at 3 months and 6 months, respectively, post‐PTCA. It is concluded that “very proximal” lesions can be successfully dilated with a high initial success rate and low complication rate. Nevertheless, these lesions may present problems with guiding catheter stability and, because of the potential risk of circumflex (CX) occlusion, this vessel may have to be protected with a second guidewire.