bluuebunny/crossref_metadata_2025_split huggingface dataset:
Percutaneous aortic valve implants under sedation: Our initial experience
Authors: Behan Miles , Haworth Peter , Hutchinson Nevil , Trivedi Uday , Laborde Jean‐Claude , Hildick‐Smith David 
Published: October 2008

AbstractObjectives:We have developed an approach where percutaneous aortic valve (PAVI) procedures are done under remifentanil‐based sedation administered by an anesthetist. We report here our initial experience.Background:Percutaneous aortic valve implantation is proving to be an effective treatment for aortic stenosis in patients with significant comorbidity precluding surgical aortic valve replacement. Most PAVIs have been done under general anesthetic with transoesophageal echocardiography (TOE). General anesthesia in this patient group is hazardous and associated with significant complications.Methods and Results:CoreValve implantation was performed via the retrograde approach in 12 patients at our cardiothoracic center between December 2007 and May 2008. Three had the procedure under general anesthetic and nine under sedation. There were no differences between the groups in terms of comorbidities and clinical characteristics. The procedure was visualized using fluoroscopic aortic calcification coupled with multiple small volume aortograms. One patient converted from sedation to general anesthetic during the procedure. One patient in the general anesthetic group died from respiratory complications. There were no significant differences in procedural success, procedure time, or hospital stay between the two groups.Conclusion:Percutaneous aortic valve implantation can, in the majority of cases, be performed under remifentanil‐based sedation. Our initial experience suggests that this should result in a shorter implant procedure time, reduced stay in high dependency areas, and shorter time to hospital discharge. © 2008 Wiley‐Liss, Inc.
Transient contrast encephalopathy after carotid artery stenting mimicking diffuse subarachnoid hemorrhage: A case report
Authors: Fang Hsiu‐Yu , Kuo Yeh‐Lin , Wu Chiung‐Jen 
Published: October 2008

AbstractSeveral types of brain injury incurred during carotid artery stenting (CAS), such as embolic injury, hemodynamic events, and hemorrhage. Rapid differential diagnosis is important for decision making, and may help to avoid subsequent complications. Here, we describe a case with severe triple vessel coronary artery disease, who underwent right coronary artery (RCA) stenting and ad hoc left CAS. Patient developed neurological deficit two hours after the procedure. Brain computed tomography (CT) revealed diffuse cortical enhancement similar to subarachnoid hemorrhage (SAH). Patient recovered dramatically with complete resolution of contrast enhancement after four days of conservative treatment, final diagnosis was a rare reported case of transient contrast encephalopathy. © 2008 Wiley‐Liss, Inc.
In vitro and in vivo studies on thermistor‐based intracoronary temperature measurements: Effect of pressure and flow
Authors: Cuisset Thomas , Beauloye Christophe , Melikian Narbeh , Hamilos Michalis , Sarma Jaydeep , Sarno Giovanna , Naslund Maria , Smith Leif , Van de Vosse Frans , Pijls Nico HJ , De Bruyne Bernard 
Published: October 2008

AbstractBackground:Intracoronary thermography has been proposed to detect vulnerable plaques. We hypothesized that changes in coronary pressure and flow in the coronarytree may interfere with the temperature measurements obtained with thermistors.Methods and Results:First, a very close correlation was found in vitro between the temperature measured by a thermocouple and by a thermistor‐based temperature measuring guide wire (PressureWire, PW) over a large temperature range. Second, the PW was tested in a vitro low pressure model of “hot plaque”. The sensor of the PW could detect changes in temperature of the wall of 0.5°C as long as the distance from the wall was less than 0.5 mm and the flow less than 60 mL/min. Third, in 18 patients with an acute myocardial infarction, intracoronary pressure and temperature variations were assessed. Although crossing the occlusion, the temperature rose by 0.059 ± 0.02°C and this increase was correlated with the distal coronary pressure (r = 0.72, P < 0.001). Fourth, a balloon coronary occlusion (BCO) with the sensor distally in the distal part of the vessel (low flow/low pressure conditions) systematically induced an increase in temperature (0.14 ± 0.07°C) while with the sensor proximally to the balloon occlusion (low flow/normal pressure conditions), no change occurred.Conclusion:Taken together these observations suggest that thermistor‐based sensors are not suited for assessing thermal heterogeneity in the vascular wall and that the data obtained so far in patients with acute coronary syndromes might have been flawed by pressure (and flow) artifacts. © 2009 Wiley‐Liss, Inc.
Antiplatelet drug response variability and the role of platelet function testing: A practical guide for interventional cardiologists
Authors: Angiolillo Dominick J. , Suryadevara Siva , Capranzano Piera , Zenni Martin Z. , Guzman Luis A. , Bass Theodore A. 
Published: October 2008

AbstractAntiplatelet therapy is the cornerstone of treatment for patients with acute coronary syndrome and is also of particular importance in those who undergo percutaneous coronary intervention with stent implantation. Dual antiplatelet therapy with aspirin and clopidogrel is associated with improvement in long‐term clinical outcomes in such patients and is presently the antiplatelet therapy of choice for secondary prevention of thrombotic events. However, a significant number of patients experience recurrent events despite antiplatelet therapy. Although poor patient compliance can account for some of these events, particularly in those patients who receive a drug‐eluting stent, increasing evidence indicates that there is variability in response to antiplatelet therapy and patients who have higher levels of platelet reactivity are at increased risk for recurrent ischemic events. However, the lack of a consistent definition of inadequate platelet response, as well as the lack of a standardized measurement technique, has made it difficult to define how to treat these patients. To translate findings associated with variability in platelet response into improved patient care, it is necessary to gain a better understanding of what variable platelet response is, how it is measured, who it should be measured in, and what its clinical relevance is. The objective of this review is to evaluate the data regarding interindividual response variability to antiplatelet therapy with the aim of providing practical considerations and where possible, recommendations, regarding this topic for interventional cardiologists. © 2008 Wiley‐Liss, Inc.
Stenting of stenotic or occluded iliofemoral veins, superior and inferior vena cavae in children with congenital heart disease: Acute results and intermediate follow up
Authors: Frazer Jeffrey R. , Ing Frank F. 
Published: October 2008

AbstractObjectives:To determine the short and intermediate term outcome following systemic venous stent placement in children with congenital heart disease.Background:Patients with congenital heart disease are at risk of stenosis or occlusion of systemic veins following indwelling lines or catheterizations. Stent dilation may ameliorate symptoms and open the vessel for use during future procedures. We report our acute and intermediate results.Methods:All patients with systemic venous stent placement in the iliofemoral veins, inferior or superior vena cava at our institution between 1998 and 2006 were included. Initial and the follow‐up catheterization data were reviewed retrospectively.Results:70 stents were placed in 33 patients (36 vessels). Median age was 2.6 years (0.2–14.2) and weight 11.5 kg (3.8–78.7). 17/36 vessels (47%) were occluded requiring recanalization. Following stent delivery, the mean minimum vessel diameter increased from 3.1 ± 3.2 to 7.2 ± 3.0 mm (P < 0.001). There were no major complications. Seventeen patients and vessels had a total of 62 follow‐up catheterizations, with median length of follow‐up 4.1 years (0.7–9.3). During intermediate follow up, 7/17 vessels (41%) required additional intervention. Six patients had additional balloon dilation of existing stents, and one additional stent was placed. Vessels were further dilated to 8.4 ± 3.5 mm at the last catheterization.Conclusion:Systemic venous stents are safe and effective in recanalizing stenosed or occluded vessels. At follow‐up, reocclusion can occur, however, previously placed stents can be safely recanalized if necessary. Future studies will determine if stenting is indicated in a broader population. © 2009 Wiley‐Liss, Inc.
Aerosolized iloprost for pulmonary vasoreactivity testing in children with long‐standing pulmonary hypertension related to congenital heart disease
Authors: Limsuwan Alisa , Khosithseth Anan , Wanichkul Suthep , Khowsathit Pongsak 
Published: October 2008

AbstractBackground: In congenital heart disease with increased pulmonary blood flow and pressure, progressive changes in the vascular structure can lead to irreversible pulmonary hypertension (PH). Pulmonary hemodynamic parameters are used to determine whether surgical correction is no longer indicated. In this study, aerosolized iloprost was used to assess pulmonary vasoreactivity in children with long‐standing PH related to congenital heart disease. Methods: Children with long‐standing and severe PH secondary to congenital heart disease were included in this study. Various hemodynamic parameters were measured before and after iloprost inhalation (0.5 μg/kg), and vascular resistance was determined. Responders to the iloprost test were defined as those with a decrease in both pulmonary vascular resistance (PVR) and pulmonary‐to‐systemic vascular resistance ratio (Rp/Rs) of >10%. Results: Eighteen children aged between 7 months and 13 years with long‐standing and severe PH secondary to congenital heart disease were studied. Thirteen children had a positive response, resulting in a mean (± SD) decrease of PVR from 9.3 ± 4.6 to 4.6 ± 2.7 Wood U · m2 (P < 0.001), and a mean decrease of Rp/Rs from 0.54 ± 0.37 to 0.24 ± 0.14 (P = 0.005). Conclusions: Iloprost‐induced pulmonary vasodilator responses vary among children with PH related to congenital heart disease. The use of inhale iloprost in the cardiac catheterization laboratory results in pulmonary vasoreactivity for some of these children particularly a reduction in PVR and the pulmonary‐to‐systemic vascular resistance ratio. © 2008 Wiley‐Liss, Inc.
Transcatheter membranous ventricular septal defect closure through a mechanical aortic prosthesis using the Amplatzer membranous ventricular septal defect occluder
Authors: Noble Stéphane , Ibrahim Réda 
Published: October 2008

AbstractAn iatrogenic ventricular septal defect (VSD) after aortic valve replacement is rare, but represents a significant complication. Repeat surgery to repair such a defect carries a high surgical risk. The transcatheter approach (either transvascular or transapical) could be considered as an alternative to open chest surgery. We describe the successful transcatheter closure of an iatrogenic VSD with an Amplatzer Membranous VSD Occluder in a patient with previous combined mitral and aortic mechanical valve replacements. The device was implanted through a CarboMedics mechanical valve in the aortic position. © 2008 Wiley‐Liss, Inc.
Impact of diabetes and acute coronary syndrome on survival in patients treated with drug‐eluting stents
Authors: Lee Michael S. , Jurewitz Daniel , Zimmer Raymond , Pessegueiro Antonio , Bhatia Ravi , Currier Jesse , Yeatman Larry , Tobis Jonathan M. 
Published: October 2008

AbstractBackground:Diabetics who undergo percutaneous coronary intervention (PCI) are at increased risk for death, myocardial infarction, repeat revascularization, and stent thrombosis.Methods:Our retrospective study includes 887 consecutive patients who underwent PCI with drug‐eluting stents (DES) at UCLA Medical Center. The cohort was divided into four groups: group 1, no diabetes and no acute coronary syndrome (ACS); group 2, no diabetes and ACS; group 3, diabetes and no ACS; group 4, diabetes and ACS.Results:Survival at 1 year was the lowest in diabetics who presented with ACS (90% in diabetics with ACS, 95% in diabetics without ACS, 95% in non‐diabetics with ACS, and 96% in the non‐diabetics without ACS, P = 0.03). At 1 year, age, diabetes, chronic renal insufficiency, ejection fraction, and myocardial infarction were identified as independent predictors for mortality.Conclusion:In the DES era, diabetics who undergo PCI for ACS continue to have an excess risk of death and major adverse cardiac events at 1 year. © 2008 Wiley‐Liss, Inc.
Strategies for drug‐eluting stent treatment of bifurcation coronary artery disease in the United States: Insights from the e‐Cypher S.T.L.L.R.Trial
Authors: Suzuki Nobuaki , Angiolillo Dominick J. , Tannenbaum Mark A. , Driesman Mitchell H. , Smith Conrad , Bikkina Mahesh , Meckel Clyde R. , Morales Carlos E. , Xenopoulos Nicholaos P. , Coletta John E. , Bezerra Hiram G. , Bass Theodore A. , Costa Marco A. 
Published: October 2008

AbstractObjectives: Our goal is to report the first large multicenter data for percutaneous coronary intervention (PCI) of bifurcation disease with drug‐eluting stents (DES) in the United States. Background: Bifurcation PCI remains a challenge to this date. There are limited data on outcomes of patients treated with bifurcation DES implantation, particularly in the United States. Methods: There were 161 patients with bifurcation disease [side branch (SB) ≥2‐mm] treated with ≥1 sirolimus‐eluting stents at 41 centers participating in the Stent deployment Techniques on cLinicaL outcomes of patients treated with the cypheR™stent (STLLR) trial. There was no protocol mandated strategy for bifurcation PCI. One‐year outcome data were collected. Angiographic and clinical data were adjudicated independently. Results: There were 147 patients (91.3%) treated with single stent strategy. Only 14 (8.7%) patients received sirolimus‐eluting stents implantation in both branches. Among patients with single stent strategy, double wire strategy (DW) was selected in 27 (18.4%) patients whereas single wire strategy (SW) was selected in 120 (81.6%) patients. There were 48 (32.7%) Medina 1,1,1 bifurcations treated with SW (n = 34; 70.8%) and DW (n = 14; 29.2%). There were 26 procedures started with SW which had SB dilatation during the procedure, one as a bailout (TIMI‐1 grade flow in the SB). Overall 1‐year death, myocardial infarction, and target lesion revascularization occurred in 2.4, 4.0, and 5.6%, respectively. There was no significant difference in clinical outcomes between SW and DW. SB dilatation was associated with a high rate of stent thrombosis (8.6%). Conclusions: Main branch stenting without SB protection is the most common approach utilized in the STLLR study, which may reflect contemporary DES bifurcation strategies in the Unite States. This strategy was associated with an acceptable low incidence of adverse outcomes at 1‐year. © 2009 Wiley‐Liss, Inc.
Coronary stent infections: A case series
Authors: Schoenkerman Aaron B. , Lundstrom Robert J. 
Published: October 2008

AbstractStent infection is a rare sequela of coronary stent implantation first reported fifteen years ago. Since that time, much has been learned about this dramatic disease entity by way of case report and review. Nevertheless, clinical experience with regard to the diagnosis and management of coronary artery stent infection remains limited. Here, we report 3 cases of coronary stent infections; 2 with mycotic aneurysms (seen on coronary angiography) that ruptured into an adjacent cardiac chamber, and one with purulent pericarditis. The microbiology as well as the possible mechanisms and risk factors for these infections are discussed. © 2008 Wiley‐Liss, Inc.
Successful retrograde treatment of a mid left anterior descending artery chronic total occlusion using a novel “guide parallel to wire” technique
Authors: Brilakis Emmanouil S. , Banerjee Subhash 
Published: October 2008

AbstractAntegrade crossing of a chronic total occlusion adjacent to a large side branch may fail. We describe a patient in whom a chronic total occlusion of the proximal left anterior descending artery was successfully crossed retrogradely through an apical collateral after a failed antegrade crossing attempt. No balloon was long enough to reach the left anterior descending artery lesion retrogradely. A retrograde Whisper wire was snared though an antegrade left main guide catheter introduced via the radial approach. We were unable to retrieve the wire via the radial guide catheter because of wire fracture during withdrawal. Externalization of the retrograde guidewire required use of a Frontrunner catheter and removal of the antegrade guide catheter. The lesion was predilated with a retrograde balloon inserted without a guide over the retrograde wire. A 5F guide catheter was introduced next to the retrograde wire through the radial sheath (“guide parallel to wire” technique) followed by successful antegrade crossing and stenting of the mid left anterior descending artery lesion. © 2009 Wiley‐Liss, Inc.
A novel approach for percutaneous treatment of massive nonocclusive mesenteric ischemia: Tolazoline and glycerol trinitrate as effective local vasodilators
Authors: Sommer Christof M. , Radeleff Boris A. 
Published: October 2008

AbstractNonocclusive mesenteric ischemia (NOMI) generally affects patients with low cardiac output, resulting in splanchnic hypoperfusion. It includes all forms of mesenteric ischemia without vessel occlusion and makes up between 20 and 30% of all cases of acute mesenteric ischemia. We present the case of a 84‐year‐old man with a history of total atrioventricular block developing NOMI. This was diagnosed by percutaneous selective catheter arteriography (PSCA), which demonstrated remarkable abrupt termination of the jejunal vasculature and multiple severe spasms of the colonic arteries. Control PSCA after local intraarterial vasodilator therapy (LIVT) with tolazoline and glycerol trinitrate documented an excellent therapeutic result with a completely unremarkable vasculature. Although LIVT was complicated by severe cardiovascular complications inclusive of cardiac arrest with the need of cardiopulmonary resuscitation, the patient fully recovered and was discharged after implantation of a cardiac pacemaker in good clinical condition 7 days later. © 2009 Wiley‐Liss, Inc.
Evaluation of intermediate coronary stenosis with intravascular ultrasound and fractional flow reserve: Its use and abuse
Authors: Magni Valeria , Chieffo Alaide , Colombo Antonio 
Published: October 2008

AbstractClinical decision making in patients with intermediate coronary stenosis is still debated. Intravascular ultrasound (IVUS) examination and/or functional assessment of coronary stenosis by fractional flow reserve (FFR) are currently used to define the severity of such lesions. There are very few studies with a small sample size that have a head‐to‐head comparison between IVUS and FFR in the evaluation of angiographically de novo intermediate lesions. There are no randomized, controlled trials to demonstrate the superiority of IVUS versus FFR in providing improved clinical outcomes in comparison with angiography alone. However, the issue of superiority might be irrelevant, because IVUS and FFR could be complementary techniques to be used in the catheterization laboratory to provide critical anatomic and functional data that permit more accurate decisions in the management of the patient. © 2009 Wiley‐Liss, Inc.
Impact of a prolonged delivery inflation time for optimal drug‐eluting stent expansion
Authors: Kawasaki Tomohiro , Koga Hisashi , Serikawa Takeshi , Orita Yoshiya , Ikeda Shinsuke , Mito Takahiro , Gotou Yoshitaka , Shintani Yoshiaki , Tanaka Atsushi , Tanaka Hidenori , Fukuyama Takaya , Koga Nobuhiko 
Published: October 2008

AbstractPurpose: We examined the importance of prolonged inflation time for optimal sirolimus‐eluting stent (SES) or paclitaxel‐eluting stent (PES) expansion. Methods: Eighty‐one de novo lesions deployed single SES or PES between April 2007 and March 2008 were divided into four groups; group 1: 21 SES deployed at 20 atm × 60 sec, group 2: 20 SES deployed with 2‐step inflation at 20 atm × 60 sec following 20 atm × 20 sec, group 3: 20 PES deployed same as group 1, group 4: 20 PES deployed same as group 2. The minimal lumen diameter (MLD) and stent expansion ratio (SER; stent cross‐ sectional area at lesion/balloon cross‐sectional area which was calculated according to the compliance chart at the same atmosphere as stent deployment) were compared between group 1 and group 2 in SES, between group 3 and group 4 in PES. Results: The MLD of post 60 sec was significantly higher than that of post 20sec (2.84 ± 0.28 mm in group 1, 2.76 ± 0.33 mm in group 2 vs. 2.54 ± 0.33 mm in group 2; P = 0.003, 0.045, respectively and 2.94 ± 0.28 mm in group 3, 3.00 ± 0.34 mm in group 4 vs. 2.69 ± 0.35 mm in group 4; P = 0.022, 0.007, respectively). The SER of post 60 sec was significantly higher than that of post 20 sec (79.3% ± 8.5% in group 1, 80.8% ± 7.8% in group 2 vs. 71.1% ± 10.2% in group 2; P = 0.014, 0.011, respectively and 81.1% ± 7.9% in group 3, 84.3% ± 9.9% in group 4 vs. 72.6% ± 10.5% in group 4, P = 0.011, 0.001, respectively). Conclusion: The prolonged delivery inflation for 60 sec may result in a more optimal stent expansion. It is therefore considered to be a useful method for deploying drug‐eluting stent. © 2008 Wiley‐Liss, Inc.
Novel technique using the Outback® LTD™ catheter for a common iliac artery occlusion
Authors: Mixon Timothy A. 
Published: October 2008

AbstractWe present a case of an unusual arterial – arterial anastamosis that resulted from an unsuccessful attempt at crossing a total occlusion of the common iliac artery. Subsequently, we were able to successful recanalize the artery using a modified technique with the Outback reentry catheter. © 2009 Wiley‐Liss, Inc.
Multidetector CT coronary angiography for patient triage to invasive coronary angiography: Performance and cost in ambulatory patients with equivocal or suspected inaccurate noninvasive stress tests
Authors: Menon Madhav , Lesser John R. , Hara Hidehiko , Birkett Richard , Knickelbine Thomas , Longe Terry , Flygenring Bjorn , Henry Jason , Schwartz Robert 
Published: October 2008

AbstractBackground: Multidetector‐CT angiography (MDCTA) differs from noninvasive stress tests by directly imaging coronary anatomy. The utility of MDCTA for invasive triage is undefined however. We evaluated MDCTA triage to invasive coronary angiography in outpatients with indeterminate or suspected inaccurate stress tests, and estimated cost savings by MDCTA in this role. Methods: Consecutive MDCTA patients were retrospectively compared with noninvasive stress tests if performed within 6 months of MDCTA. Twelve‐month clinical follow up was obtained for patients not undergoing invasive angiography, and cost using MDCTA for triage to invasive coronary angiography was calculated. Results: MDCTA was performed in 385 patients who had noninvasive stress testing. Stress tests include included treadmill (n = 37), stress echo (n = 178), and nuclear perfusion imaging (n = 170). Invasive angiography was performed in 57 (14.8%). MDCTA compared to CA showed positive and negative predictive values of 94%/100% respectively for lesions found by invasive QCA. Stress testing compared to MDCTA showed positive/negative predictive values of 100%/67% for treadmill exercise, 60%/54% for stress echo, and 59%/55% of nuclear perfusion examinations respectively. One year clinical follow up in 314 patients showed no coronary events in 98% (309) of patients. Triage to invasive angiography by MDCTA showed a 4‐fold cost reduction. Conclusions: MDCTA shows excellent performance as a triage for invasive angiography in patients with stress tests that are equivocal or thought inaccurate. A negative CTA confers good 12‐month prognosis. Substantial cost savings may accrue using MDCTA in this triage role.