bluuebunny/crossref_metadata_2025_split huggingface dataset:
Internal mammary artery collateral to the external iliac artery: an angiographic consideration prior to coronary bypass surgery
Authors: Parashara Deepak K. , Kotler Morris N. , Ledley Gary S. , Yazdanfar Shahriar 
Published: March 2007

AbstractThe role of routine selective angiography of the internal mammary artery prior to myocardial revascularization is controversial. We report a patient with coronary artery disease and peripheral vascular disease in whom the left internal mammary artery supplied blood flow to the left external iliac artery via a collateral network. Thus, selective angiography of the internal mammary artery did play a major role in the proper management of this patient who required coronary bypass surgery. A major potential postoperative complication of left lower extremity ischemia may have been prevented. © 1994 Wiley‐Liss,Inc..
Absent left circumflex coronary artery
Authors: Ilia Reuben , Jafari Jamal , Weinstein Jean Marc , Battler Alexander 
Published: March 2007

AbstractThis is the first reported case of a coronary artery anomaly in which the left circumflex artery was absent. The lateral and posterior aspects of the left ventricle were supplied by a large diagonal artery and a very long right coronary artery which continued along the atrioventricular groove. © 1994 Wiley‐Liss,Inc..
Comparative study of the angiographic morphology of coronary artery lesions treated with PTCA, directional coronary atherectomy, or high‐speed rotational ablation
Authors: Stertzer Simon H. , Pomerantsev Eugene V. , Shaw Richard E. , Boucher Ralph A. , Millhouse Felix , Zipkin Robert E. , Hidalgo Benito O. , Murphy Mary C. , Hansell Heidi N. , Myler Richard K. 
Published: March 2007

AbstractTo evaluate trends in morphology‐based intervention selection, series of 110 consecutive procedures of each of three devices, percutaneous transluminal balloon coronary angioplasty (PTCA), directional coronary atherectomy (DCA), or high‐speed rotational ablation (HSRA), were reviewed. PTCA was used mainly in discrete, concentric, smooth, ACC/AHA type A and B1 lesions. PTCA was used less frequently on a bend, branching points or in calcified lesions. Using PTCA as a reference, DCA was used more often for the treatment of discrete, proximal, eccentric, and noncalcified lesions, often complicated with thrombus and located on straight segments. HSRA was used more frequently in diffuse, calcified multiple complicated and B2 + C type lesions with frequent side branches and bend points. These results suggest that directional atherectomy and rotational ablation may be helpful in expanding the capacity of the operator to approach prognostically unfavorable lesions. © Wiley‐Liss, Inc.
Prolonged intracoronary infusion of streptokinase: An alternative pharmacologic approach to extensive thrombus in native coronary artery
Authors: Kjellgren Olle , Wilentz James R. , Kaganovsky Lazar , Sherman Warren 
Published: March 2007

AbstractSeveral reports suggest that pretreatment of intracoronary thrombus with fibrinolytic agents may reduce the risk for complications during subsequent balloon angioplasty. We report a case, for the first time, of successful lysis of an extensive thrombus in a native coronary artery by administering a prolonged intracoronary infusion of streptokinase to facilitate subsequent angioplasty and discuss the management strategy when intracoronary thrombus is encountered. © Wiley‐Liss, Inc.
Video‐assisted transportal pericardial window
Authors: Selig Michael B. , Jafari Nercy , Sipes Earl 
Published: March 2007

AbstractPericardial interventions for the diagnosis and treatment of pericardial disease has been evolving since the 17th century. The controversy over opened or closed procedures, the optimal guidance modality, and techniques for the creation of pericardial windows continues to be debated. This report describes two patients who the endoscopic approach to creating a pericardial window. © Wiley‐Liss, Inc.
Directional atherectomy of left main stenoses
Authors: Laster Steven B. , Rutherford Barry D. , McConahay David R. , Giorgi Lee V. , Johnson Warren L. , Shimshak Thomas M. , Huber Kenneth C. , Hartzler Geoffrey O. 
Published: March 2007

AbstractBalloon angioplasty (PTCA) of left main (LM) stenoses is limited by frequent clinical restenosis. Directional coronary atherectomy (DCA) may be an effective alternative to PTCA due to its ability to achieve a greater postprocedural luminal diameter when treating bulky, eccentric plaques and aorto‐ostial lesions. We analyzed the acute and long‐term results following 24 DCA procedures in 22 patients with “protected” LM lesions. Acute success (residual stenosis ≤ 40%, no major ischemic complications) was 88% overall, 100% in 13 planned procedures, and 73% in 11 adjunctive DCA procedures that followed suboptimal PTCA. Mean LM stenosis was reduced from 86% to 13% (P < 0.01). There were no procedural complications directly attributed to DCA. At a mean of 24 ± 3 months, the clinical restenosis rate was 16%, survival was 100%, and event‐free survival (freedom from death, MI, or repeat lesion‐related interventions) was 89%. We conclude that DCA in protected LM lesions (1) can achieved excellent angiographic results with low procedural complication rates, (2) may succeed where PTCA yields subopitimal results, and (3) may provide late clinical outcomes superior to those of balloon angioplasty. © Wiley‐Liss, Inc.
Acute coronary occlusion during early post‐PTCA exercise testing: A rare but avoidable risk
Authors: Shah Dipen , Lal Parshottam 
Published: March 2007

AbstractWe describe here one instance of an acute occlusion of an angioplastied LAD coronary artery occurring during a treadmill stress test performed 2 d after the procedure. The occlusion occurred during the recovery period after a reasonably high level of stress was achieved without evidence of ischaemia. Similar instances described in the literature are summarized and discussed. In the light of these data, it might be prudent to avoid early post‐PTCA exercise stress testing. © Wiley‐Liss, Inc.
Intracoronary thrombus: Still a risk factor for ptca failure?
Authors: Reeder Guy S. , Bryant Sandra C. , Suman Vera J. , Holmes David R. 
Published: March 2007

AbstractPre‐existing intracoronary thrombus has been associated with an increased risk of percutaneous transluminal coronary angioplasty (PTCA) failure. Whether intracoronary thrombus is an independent risk factor for failure is uncertain, as conflicting data exist in the literature. Additionally, given advances in patient selection and angioplasty ballon design, it is uncertain whether the current risk posed by intracoronary thrombus is as substantial as that in the early angioplasty experience.The primary objective of this study was to first assess whether pre‐existing coronary thrombus was an independent predictor of angioplasty failure and if so, whether the risk due to thrombus had changed from the early angioplasty experience to the present time. Our prospectively collected angioplasty data base was used to identify individuals undergoing single‐vessel angioplasty of a thrombus‐containing segment from January 1, 1984 through December 1, 1991. Univariate and multivariate stepwise logistic regression techniques were utilized to analyze clinical, angiographic, and procedural characteristics associated with angioplasty failure. The study period was divided into three separate time periods and these used as variables in our multivariate analysis.In the study population that consisted of 2,699 patients with single‐vessel angioplasty, univariate analysis demonstrated that among many factors, thrombus was importantly associated with angioplasty failure (P < 0.0001). A multivariate logistic model of angioplasty failure was developed and thrombus achieved independent predictive significance in this model. Analysis with respect to time showed no variation in the importance of thrombus between our earliest angioplasty experience and that achieved in the last 2 years of the study period.Pre‐existing coronary thrombus is a risk factor for angioplasty failure which is independent of other clinical, anatomic, and procedural factors. The importance of this risk factor has not changed in our practice between 1984 and 1991.
Clinical experience with intracoronary tissue plasminogen activator: Results of a multicenter registry
Authors: Ferguson James J. 
Published: March 2007

AbstractClinical experience with the use of intracoronary tissue plasminogen activator (t‐PA) is limited. We therefore undertook this study to document current clinical usage of intracoronary t‐PA during a 2‐yr period in a multicenter registry. Intracoronary t‐PA was utilized on 206 occasions in 198 patients (154 men and 44 women; mean age, 59 ± 12 yr). The mean dose of intracoronary t‐PA was 31 ± 15 mg. Indications for use included acute myocardial infarction (MI) (n = 83), preexisting thrombus with (n = 49) or without (n = 41) percutaneous transluminal coronary angioplasty (PTCA), unstable angina (n = 14), abrupt vessel closure (n = 11), and post‐PTCA “clean‐up” (n = 8). The Thombolysis in Myocardial Infarction (TIMI Phase I) criteria were used to assess perfusion and degree of thrombus formation. Overall, the mean TIMI flow grade increased from 1.2 ± 1.1 before treatment to 2.3 ± 1.0 after treatment (P<0.0001); the mean TIMI thrombus grade decreased from 3.2 ± 1.0 before treatment to 1.6 ± 1.4 after treatment (P<0.0001). Complications included bleeding (9.2%), MI (17.6%), need for coronary artery bypass grafting (CABG) (9.2%), need for repeat PTCA/atherectomy/stents (4.9%), and ventricular fibrillation (1.7%, all associated with opening totally occluded vessels). There were 14 subsequent in‐hospital deaths: 13 of the patients who died had originally presented with MI; the other had experienced abrupt vessel closure during a PTCA procedure.Intracoronary t‐PA appears to be effective in improving distal flow and decreasing thrombus burden; however, intracoronary delivery of t‐PA has associated risks. Further prospective evaluations of intracoronary t‐PA will be necessary to determine the optimal clinical situations for its use, as well as the appropriate dose regimen.
Coronary dissection resulting from angioplasty with slow oscillating vs. rapid inflation and slow vs. rapid deflation
Authors: Blankenship James C. , Ford Alan C. , Henry Sheldon D. , Frey Carolin M. 
Published: March 2007

AbstractTo determine if slow inflation or slow deflation (compared to standard rapid inflation/ deflation) would minimize coronary arterial dissection, we randomized 162 lesions from 136 patients undergoing coronary angioplasty with polyolefin copolymer balloons to slow oscillating (1 atmosphere/20 sec) vs. rapid (over 30 sec) inflation and slow (over 15 sec) vs. rapid deflation. The incidence of any dissection was nearly identical in the four inflation/deflation groups. The incidence of severe dissection, however, was significantly higher for the slow inflation/slow deflation group compared to the other three groups (38% vs. 15%, P = .024). For angioplasty performed with polyolefin copolymer balloons, slow deflation combined with slow oscillating inflation is associated with more frequent severe dissections.
Coronary artery fistula coexisting with a ventricular septal defect due to a penetrating gunshot wound
Authors: Kwan Tak , Salciccioli Louis , Elsakr Ashraf , Burack Joshua , Feit Alan 
Published: March 2007

AbstractWe describe a patient who survived a penetrating gunshot wound to the chest. Cardiac evaluation including echocardiography and cardiac catheterization revealed a coronary artery fistula and a ventricular septal defect. This combination has been rarely reported in patients with penetrating cardiac injury. Follow‐up echocardiography performed 15 mo later showed persistent left‐to‐right shunt. This is the first case in the literature demonstrating the natural history of combined coronary artery fistula and ventricular septal defect without surgical correction.
Patient selection reduces thrombotic complications of emergent stenting for failed ptca
Authors: Herrmann Howard C. , Malosky Steven A. , Guidera Steven A. , Deangelo Debbie , Hirshfeld John W. 
Published: March 2007

AbstractA comparison of consecutive initial and later patients receiving emergent coronary artery stents to salvage failed PTCA procedures was made to determine whether experience with this procedure can improve patient outcome. Twenty‐six consecutive patients underwent emergent, unplanned implantation of one or more Palmaz‐Schatz coronary stents at our institution over a 3‐1/2 year period. Indications for stent insertion included impending vessel closure (decrease in TIMI flow grade and clinical evidence of ischemia) or acute occlusion (TIMI flow grade 0 or 1 and ≥99% stenosis) after PTCA. Immediate and final success (30 day) were determined, and the results in the first (Initial) 13 patients were compared to the remaining (Later) 13 patients. Baseline characteristics of the study population included a male predominance (69%) with a mean (±SD) age of 57±10 years. Conventional balloon PTCA was performed in all three native coronary arteries with an increase in mean percentage stenosis from 76±13 to 85±s14% (P<0.05). Twelve patients developed acute occlusion and 14 patients impending closure after PTCA due to the appearance of thrombus (12%), dissection (46%), or both (35%). Palmaz‐Schatz stents were successfully inserted in all patients restoring TIMI grade 3 antegrade flow; however, major complications developed in almost 50% of patients.Comparison of initial and later patients showed no differences in demographic or pre‐PTCA angiographic characteristics. Later patients had less severe stenoses post‐PTCA (before stenting) and were less likely to have thrombus present at the angioplasty site (15% vs. 77%, P<0.05). These patients were also more likely to have stents inserted for impending closure rather than acute occlusion. Patients in the later experience had fewer complications (15% vs. 77%, P<0.05) including subacute thrombosis. Final success was 23% in the initial patients and increased to 85% (P<0.05) in the later experience.We conclude that emergency coronary artery stenting with the Palmaz‐Schatz balloon‐expandable stent is an effective technique to salvage failed angioplasty procedures. Improved results and lower rates of complications were achieved by using the device for impending closure due to intimal dissection, avoiding vessels containing thrombus, and careful attention to post‐stent anti‐coagulation.
Comparative analysis of saphenous vein bypass vs. native coronary artery balloon angioplasty: Technical differences and angiographic response
Authors: Kimball Brian P. , Bui Sanh 
Published: March 2007

AbstractTo evaluate technical differences and angiographic response of saphenous vein bypass graft angioplasty in comparison to native coronary arteries, we retrospectively analyzed 54 patients undergoing this procedure at The Toronto Hospital between February 1988 and May 1993. These subjects were temporally matched to a cohort of successful native coronary angioplasties, with comparison of technical parameters, pre‐existing qualitative/quantitative (Cardiac Measurement System) stenotic morphology, and angiographic response; including changes in minimum lumen diameter.Saphenous bypass graft angioplasty utilized larger balloons (CABG, 3.27 ± 0.65 vs. native, 2.90 ± 0.37 mm, P < .05), and higher inflation pressures (CABG, 10.1 ±3.7 vs. native, 8.8 ± 2.5 atm, P < .05), although in a relative sense, balloon/artery ratios were similar (CABG, 1.09 ± 0.20 vs. native, 1.03 ± 0.15, pNS). Pre‐procedural bypass graft lesions were more complex, with more frequent ACC/AHA type B1 lesions [CABG, 24/54 (44%) vs. native, 16/54 (30%), P < .05] and luminal thrombus [CABG, 17/54 (31%) vs. native, 6/54(11%), P < .05]. Quantitative angiography revealed larger “reference” diameters within saphenous veins (CABG, 3.41 ± 0.76 vs. native, 3.04 ± 0.51 mm, P < .05), although minimum lumen diameter was less severe (CABG, 0.83 ± 0.41 vs. native, 0.77 ± 0.36, P < .05). In terms of balloon angioplasty response, greater improvemnet in luminal diameter was seen in bypass graft lesions (CABG, 1.55 ± 0.53 vs. native, 1.32 ± 0.44 mm, P < .05), with the largest changes within the “body” of the saphenous vein (ostial, 1.53 ± 0.37; body, 1.68 ± 0.50; anastomosis, 1.37 ± 0.57 mm).In conclusion, technical differences do exist during the performance of balloon angioplasty in degenerative saphenous vein bypass grafts, often dictated by morphologically complex lesions. Bypass grafts demonstrate a larger intrinsic lumen, although preexisting stenoses tend to be less severe, with greater improvement in minimum lumen diameter. Some of these differences may be attributable to intrinsic differences in the compliance characteristics of saphenous vein bypass grafts and to differing characteristics of the relatively accelerated atherosclerosis.
Femoral artery catheterization complications: A study of 503 consecutive patients
Authors: Bogart Douglas B. , Bogart Martha A , Miller John T. , Farrar Michael W. , Barr W. Kent , Montgomery Michael A. 
Published: March 2007

AbstractThis report describes a prospective randomized trial of 503 patients who underwent a cardiac catheterization or interventional procedure at a single institution. In an effort to study femoral complications postprocedure, we evaluated three methods of femoral artery hemostasis as well as 38 variables that were felt to potentially relate to local complications. Only a marginally significant relationship between the hemostasis method and complication rate was found. The factors that contributed to femoral artery complications were: restarting heparin postsheath removal, number of procedures done during one hospitalization, noncompliance of the patient with bedrest after the procedure, number of arterial punctures to initiate the procedure, and preprocedure treatment with corticosteroids.
Partial and transient relief of conduit obstruction by low‐pressure balloon dilation in patients with congenital heart disease
Authors: Sohn Sejung , Kashani Iraj A. , Rothman Abraham 
Published: March 2007

AbstractSeven patients underwent attempted low pressure balloon dilation of stenotic conduits or homografts from right ventricle to pulmonary artery (n=5), in the aortic valve position (n=1), or from right atrium to left pulmonary artery (n=1). In the right ventricle to pulmonary artery group, mean gradient reduction was only 17%. At follow‐up, two patients underwent surgical conduit replacement, one had a stent implanted at cardiac catheterization, the other two are awaiting surgical intervention. The patient with a homograft in the aortic valve position had a good initial result but restenosed within 1 year and underwent a pulmonary autograft operation. The patient with the Fontan homograft stenosis had transient obstruction relief but subsequently required stent implantation. Low‐pressure balloon dilation of conduits or homografts is only partially and transiently successful. Whether stent implantation will offer better long‐term results remains to be determined.
Repeat use of occludidng spring coils to close residual patent ductus arteriosus
Authors: Moore J. W. 
Published: March 2007

AbstractRecent studies have shown that small‐ and moderate‐size patent ductus arteriosus (PDA)may be closed with occluding spring coils. As with other percutaneous devices, a low incidence of residual PDAs has been observed in medium‐term follow‐up. This report describes experience with closing residual PDA by repeat use of occluding spring coils. © 1995 Wiley‐Liss, Inc.
Management of balloon rupture during rigid stent deployment
Authors: Keelan Edward T. , Nunez Boris D. , Berger Peter B. , Holmes David R. , Garratt Kirk N. 
Published: March 2007

AbstractBalloon rupture may occur during stent placement and will only become apparent when the stent has been manouvered across the target stenosis and deployment is attempted. Withdrawal may be complicated by displacement of the stent off the balloon. We describe two cases in which a power injector was used to momentarily inflate the balloon and partially expand the stent in place. The punctured balloon could then be withdrawn and the stent fully deployed, using a new balloon. © 1995 Wiley‐Liss, Inc.
Perforation of nontarget artery during directional coronary atherectomy
Authors: Cohen Eric A. , Naqvi Salim Z. , Fremes Steven E. 
Published: March 2007

AbstractWe report a case of perforation of an intermediate branch during attempted directional atherectomy of an ostial left anterior descending artery lesion, resulting from disruption of the cutter drive cable. Potential contributing factors and means of avoiding this complication are discussed. © 1995 Wiley‐Liss, Inc.
Importance of a non‐dominant right coronary artery occlusion presenting as sudden cardiac death with prolonged right ventricular dysfunction and malignant arrhythmias
Authors: Karim M. Asad , Wong Christopher , Armbruster Robert , Windle John , Deligonul Ubeydullah 
Published: March 2007

AbstractWe report a case of a patient who presented with sudden cardiac death secondary to a subtotal occlusion of a small non‐dominant right coronary system. Catheterization several weeks following the initial episode revealed persistent severe right ventricular dysfunction with moderate hemodynamic compensation. Continued unstable arrhythmogenic potential at this point led to placement of an AICD device. The case highlights the potential hazard and often complacency involved in dealing with benign appearing lesions as this one. © 1995 Wiley‐Liss, Inc.
Intracoronary doppler flow to monitor the results of selective saphenous vein graft thrombolytic therapy
Authors: Gershony Gary , Cishek Mary Beth , Galloway Michael 
Published: March 2007

AbstractSelective intracoronary thrombolytic therapy has recently been advocated as a technique to recanalize occluded coronary bypass grafts. We report a novel approach for monitoring the results of this treatment utilizing a coronary artery doppler flow guidewire. This approach may optimize the duration of thrombolytic treatment in these patients. © 1995 Wiley‐Liss, Inc.
Angioscopy guided intracoronary thrombolysis and stent deployment in a patient with postinfarction angina
Authors: Eltchaninoff Hélène , Cribier Alain , Letac Brice 
Published: March 2007

AbstractWe describe a case where the combined use of quantitative coronary angiography and angioscopy directed the therapeutic strategy in a patient with postinfarction angina, and helped understand the pathology underlying an unusual angiographic image at baseline and after stent implantation. © 1995 Wiley‐Liss, Inc.
“Balloon impasse”: A marker for severe mitral subvalvular disease and a predictor of mitral regurgitation in inoue‐balloon percutaneous transvenous mitral commissurotomy
Authors: Lau Kean‐Wah , Hung Jui‐Sung 
Published: March 2007

AbstractIn certain instances of percutaneous transvenous mitral commissurotomy, the Inoue catheter balloon, although deflated and properly aligned, becomes held up or checked at the mitral valve. This “balloon impasse,” observed in 13 of 760 patients undergoing the commissurotomy, reflects severe obstructive subvalvular disease even though echocardiographic evidence suggests otherwise. Our experience shows that the sign portends severe mitral regurgitation if the usual balloon sizing method is used. Such a situation occurred with four of the first six patients. In the next seven patients, the use of smaller balloon catheters (PTMC‐18 or PTMC‐20) for the initial set of stepwise dilatations averted creation of severe mitral regurgitation. When the “balloon impasse” sign is encountered during the commissurotomy procedure, the catheter selection and balloon sizing method should be judiciously altered. © 1995 Wiley‐Liss. Inc.