bluuebunny/crossref_metadata_2025_split huggingface dataset:
Usefulness of translesional pressure gradient and pharmacological provocation for the assessment of intermediate renal artery disease
Authors: Jones Noah J. , Bates Eric R. , Chetcuti Stanley J. , Lederman Robert J. , Grossman P. Michael 
Published: August 2006

AbstractObjective:We sought to determine the hemodynamic significance of intermediate RAS by measuring translesional systolic pressure gradients (TSPG), using a pressure‐sensing guidewire at baseline and after acetylcholine (ACh) induced hyperemia, following selective renal artery angiography.Background:Renal artery stenosis (RAS) is a cause of reversible hypertension and nephropathy. Stenting effectively relieves RAS, however improvement in blood pressure control or renal function is variable and unpredictable. Hemodynamic significance is usually present with RAS when diameter stenosis is >75%, but is less predictable in intermediate (30%–75%) RAS.Methods:Twenty‐two patients (26 renal arteries) with uncontrolled hypertension underwent invasive hemodynamic assessment because of intermediate RAS, defined as radiocontrast angiographic diameter stenosis (DS) between 30% and 75% (quantitative DS was measured prospectively). Translesional pressure gradients were measured using a 0.014” pressure‐sensing wire. Hyperemia was induced by administration of intrarenal ACh.Results:Visual and measured angiographic lesion severity did not correlate with TSPG either at baseline (visual DS, R2 = 0.091, P = 0.13; measured DS, R2 = 0.124, P = 0.07) or with hyperemia (visual DS, R2 = 0.057, P = 0.24; measured DS, R2 = 0.101, P = 0.12). Baseline and maximal hyperemic gradient did correlate (R2 = 0.567; P < 0.05). Pharmacological provocation produced a significant increase in TSPG (mean; baseline, 18 ± 21 vs. hyperemia, 34 ± 41 mm Hg; P < 0.05). A hemodynamically significant lesion (TSPG > 20 mm Hg) was found in 14/26 (54%) arteries (13 patients); 13 (60%) patients subsequently underwent renal artery stenting for hemodynamically significant RAS. At follow‐up (at least 30 days), there was a significant decrease in systolic blood pressure (mean; 167 ± 24 vs. 134 ± 19 mm Hg; P < 0.001).Conclusions:Intrarenal administration of ACh induces hyperemia and can be used to unmask resistive renal artery lesions. Gradient measurement and induced hyperemia may be warranted in the invasive assessment of intermediate renal artery stenoses, rather than relying on stenosis severity alone. Further study is needed to determine whether translesional pressure gradients and pharmacological provocation predict clinical benefit after renal artery stenting. © 2006 Wiley‐Liss, Inc.
Prevalence of unfavorable angiographic characteristics for percutaneous intervention in patients with unprotected left main coronary artery disease
Authors: Ragosta Michael , Dee Sandra , Sarembock Ian J. , Lipson Lewis C. , Gimple Lawrence W. , Powers Eric R. 
Published: August 2006

AbstractObjectives:The goal of this study was to determine the proportion of patients with left main coronary disease (LMCD) with unfavorable characteristics for percutaneous coronary intervention (PCI).Background:Published series suggest that LMCD can be treated percutaneously, however, the proportion of patients in whom PCI is an option based on angiographic criteria is unknown.Methods:In 13,228 consecutive coronary angiograms, 476 (3.6%) patients had ≤60% stenosis of the left main. In 232 patients with unprotected LMCD, the clinical characteristics and angiograms were reviewed with six features chosen as “unfavorable” for PCI: (1) Bifurcation LMCD, (2) occlusion of a major coronary, (3) ejection fraction <30%, (4) occlusion of a dominant RCA, (5) left dominant circulation, and (6) coexisting three‐vessel disease. Treatment modality and 1 year mortality were determined.Results:The mean age was 69 years and 68% were male. Unfavorable characteristics were common with at least one unfavorable characteristic seen in 80%. Bifurcation disease was the most common unfavorable characteristic observed (53%) and coexisting three‐vessel disease was seen in 38%. Treatment consisted of CABG in 205 (88%), medical therapy in 24 (10%) and PCI in 3 (1%). Among patients referred for CABG, 1 year survival was 88% with similar rates of survival for those with favorable characteristics (86%) compared to those with at least one unfavorable characteristic (88%).Conclusions:Most patients with LMCD have at least one unfavorable characteristic for PCI suggesting that PCI may be a technically difficult option for most patients with LMCD. © 2006 Wiley‐Liss, Inc.
Direct thrombin inhibition appears to be a safe and effective anticoagulant for percutaneous bypass graft interventions
Authors: Kao John , Lincoff A. Michael , Topol Eric J. , Madrid Antonio , J. Price Matthew , Sawhney Neil , Teirstein Paul S. 
Published: August 2006

AbstractBackground: Percutaneous coronary interventions (PCI) of coronary artery bypass grafts (CABG) are associated with worse outcomes compared with those of native coronary PCI. Little is known concerning the use of direct thrombin inhibition during CABG intervention. The objective of this report is to examine the safety and efficacy of bivalirudin with GPIIb/IIIa blockade inhibition in patients undergoing CABG PCI. GP IIb/IIIa use was provisional in REPLACE‐2 and planned in REPLACE‐1. Methods and Results: A post hoc analysis of patients undergoing CABG PCI in the REPLACE‐1 and ‐2 trials was performed. In REPLACE‐1, patients were randomized to either heparin or bivalirudin, with GP IIb/IIIa inhibitor use at the operator's discretion. In REPLACE‐2, patients were randomized to heparin plus GP IIb/IIIa inhibition versus bivalirudin with provisional GP IIb/IIIa blockade. In both studies, randomized treatment groups were well matched. In unadjusted and logistic regression analysis, there were no significant differences in the combined endpoint of death, myocardial infarction, urgent revascularization, or major bleeding when patients were treated with either heparin or bivalirudin. Individual safety and efficacy endpoints were also similar. Minor bleeding was significantly reduced in patients treated with bivalirudin (14.8% vs. 22.7%, P = 0.037). Follow‐up data available from the REPLACE‐2 trial at 12 months found similar efficacy between groups with a trend towards decreased 12 month mortality in the bivalirudin vs. heparin groups (4.2% vs. 7.8%, P = 0.16).CONCLUSION: CABG PCI using bivalirudin with provisional GPIIb/IIIa inhibition appears to provide similar safety and efficacy to heparin with GPIIb/IIIa inhibition. © 2006 Wiley‐Liss, Inc.
A modified balloon crush approach improves side branch access and side branch stent apposition during crush stenting of coronary bifurcation lesions
Authors: Collins Nicholas , Dzavik Vladimir 
Published: August 2006

AbstractObjectives: Despite the advent of drug eluting stents and newer interventional techniques designed to treat the main vessel and side branch in bifurcation stenoses, optimal treatment of the side branch remains problematic. We aimed to assess the feasibility of a modified balloon crush technique for percutaneous treatment of coronary bifurcation stenoses. Background: Use of the crush technique in bifurcation stenoses remains limited by access to the side branch after main vessel stent deployment, as well as limitations of side branch stent deployment. The modified balloon crush technique aims to improve side branch access and stent apposition. Methods: The modified balloon crush is similar to the previously described balloon crush technique. Following side branch stent deployment, a balloon positioned in the main vessel is deployed to crush the proximal side branch stent. A guide wire is then placed into the side branch with a subsequent high‐pressure balloon inflation at the side branch ostium. This opens the stent struts at the ostium of the side branch, facilitating future passage of the guide wire following main vessel stent deployment, prior to kissing balloon inflation. Results: We performed this modification of the crush technique safely in 10 patients. We were successful in obtaining side branch access in nine of ten patients following initial main vessel stent deployment. In the only failure, there was a 90° angle between the main vessel and side branch. Conclusions: The modified balloon crush technique can be safely performed, while optimizing side branch access and side branch stent apposition. © 2006 Wiley‐Liss, Inc.
Acute coronary artery thrombosis and a giant coronary artery aneurysm: An atypical combination and an unconventional catheter‐based intervention
Authors: Madsen Esben Hjorth , Villadsen Anton Boel , Frøbert Ole 
Published: August 2006

AbstractCoronary artery aneurysm is an unusual finding at coronary arteriography. We present a case of acute myocardial infarction and a giant aneurysm of the left circumflex coronary artery (CX) in a 70‐year‐old male with hypertension. The culprit lesion was a thrombus occupying the aneurysm and the distal CX. By an unconventional manoeuvre the thrombus was aspirated via the 7 French guiding catheter. After stent implantation in the distal CX a thrombolysis in myocardial infarction 3 flow was achieved and still present at 2‐month follow‐up. The patient was prescribed aspirin and clopidogrel as a life‐long therapy. © 2006 Wiley‐Liss, Inc.
Improved survival with drug‐eluting stent implantation in comparison with bare metal stent in patients with severe left ventricular dysfunction
Authors: Gioia Giuseppe , Matthai William , Benassi Alberto , Rana Hamza , Levite Howard A. , Ewing Lannae G. 
Published: August 2006

AbstractOBJECTIVE: We examined the efficacy of drug‐eluting stent (DES) implantation (Sirolimus or Paclitaxel) in patients with ischemic cardiomyopathy and severe left ventricular (LV) dysfunction and compared the outcome with a similar group of patients undergoing bare metal stent (BMS) implantation. BACKGROUND: Patients with severe LV dysfunction are a high risk group. DES may improve the long term outcomes compared with BMS. METHODS: One hundred and ninety one patients (23% women) with severe LV dysfunction (LV ejection fraction ≤35%) underwent coronary stent implantation between May 2002 and May 2005 and were available for follow‐up. One hundred and twenty eight patients received DES (Sirolimus in 72 and Paclitaxel in 54) and 63 patients had BMS. Patients with acute S‐T elevation myocardial infarction (STEMI) were excluded. The primary endpoint was cardiovascular mortality. A composite endpoint of major adverse cardiac events (MACE) including cardiovascular mortality, myocardial infarction (MI), and target vessel revascularization (TVR) was the secondary endpoint. RESULTS: Mean follow‐up was 420 ± 271 days. No differences were noted in age (69 ± 10 years vs. 70 ± 10 years, P = NS), number of vessel disease (2.3 ± 0.7 vs. 2.2 ± 0.8, P = NS), history of congestive heart failure (47% vs. 46%, P = NS), MI (60% vs. 61%, P = NS), or number of treated vessels (1.3 ± 0.5 vs. 1.3 ± 0.6, P = NS) for the DES and BMS group, respectively. Diabetes was more common among DES patients (45% vs. 25%, P = 0.01). The left ventricular ejection fraction (LVEF) was similar between the two groups (28% ± 6% vs. 26% ± 8%, P = NS for the DES and BMS, respectively). During the follow‐up, there were a total of 25 deaths of which two were cancer related (2 in DES group). There were 23 cardiac deaths, 8/126 (6%) which occurred in the DES group and 15/63 (24%) in the BMS group (P = 0.05 by log‐rank test). MACE rate was 10% for the DES group and 41% for the BMS group (P = 0.003). NYHA class improved in both groups (from 2.5 ± 0.8 to 1.7 ± 0.8 in DES and from 2 ± 0.8 to 1.4 ± 0.7 in the BMS, P = NS). CONCLUSION: Compared with bare‐metal stents, DES implantation reduces mortality and MACE in high risk patients with severe left ventricular dysfunction. © 2006 Wiley‐Liss, Inc.
Comparison of transendocardial and retrograde coronary venous intramyocardial catheter delivery systems in healthy and infarcted pigs
Authors: Baklanov D.V. , Moodie K.M. , McCarthy F.E. , Mandrusov E. , Chiu J. , Aswonge G. , Cheng J. , Chow M. , Simons M. , de Muinck E.D. 
Published: August 2006

AbstractWe compared two routes for myocardial delivery of therapeutics, transendocardial (TE) delivery with an intramyocardial injection catheter, and retrograde coronary venous (RCV) delivery with a balloon occlusion catheter in the interventricular vein. Methods: TE and RCV injection of 15 μm, neutron‐activatable microspheres was compared in healthy pigs (Group I, n = 3), pigs with a 1‐week‐old myocardial infarction (MI; group II, n = 5), and pigs with a 2‐weeks‐old MI (group III, n = 4). The MI was induced by a 1‐hr balloon occlusion in the LAD. Both methods were compared in the same animal using different microspheres. The RCV catheter allowed for continuous measurement of distal pressure and 2.5 × 106 microspheres were injected in 10 ml at 300 mmHg above balloon occlusion pressure. The TE injections were targeted to the infarct zone and 2.5 × 106 microspheres were distributed over 10 injections of 200 μl. Results: The retention of microspheres decreased with increase in MI age, but was comparable between devices within the groups. RCV delivery resulted in (14.3 ± 0.9)% microsphere retention in Group I, (10.3 ± 0.2)% in Group II, and (6.4 ± 0.1)% in group III (P < 0.05 versus group I). Microsphere retention after TE was (15.1 ± 0.7)% in group I, (18.9 ± 0.6)% in group II, (4.1 ± 0.1)% in Group III (P < 0.05 versus groups I and II). The RCV catheter delivered primarily to midventricular, antero‐septal segments, whereas TE targeted apical areas predominantly. Conclusions: Delivery efficacy was comparable between devices in each group however RCV targeted midventricular areas whereas TE targeted apical areas. © 2006 Wiley‐Liss, Inc.
A randomized, double‐blind, placebo‐controlled, multicenter, pilot study of the safety and feasibility of catheter‐based intramyocardial injection of AdVEGF121 in patients with refractory advanced coronary artery disease
Authors: Fuchs Shmuel , Dib Nabil , Cohen Barry M. , Okubagzi Petros , Diethrich Edward B. , Campbell Ann , Macko Jennifer , Kessler Paul D. , Rasmussen Henrik S. , Epstein Stephen E. , Kornowski Ran 
Published: August 2006

AbstractBackground:The experience with direct myocardial injection of adenovirus encoding angiogenic growth factor is limited to invasive surgical approach. Accordingly, we sought to evaluate, for the first time, in a randomized, double‐blind, placebo‐controlled, phase I pilot study the safety and feasibility of percutaneous catheter‐based intramyocardial delivery of a replication‐deficient adenovector encoding the 121‐amino‐acid isoform of vascular endothelial growth factor (AdVEGF121).Methods:Ten “no‐option” patients with severe coronary artery disease were randomized (2:1) to receive AdVEGF121 (4 × 1010 pu) or placebo as fifteen 100 μL, evenly distributed, endomyocardial injections using a nonflouroscopic, 3‐dimensional mapping and injection (NOGA) catheter‐based system.Results:Injection procedure was successfully completed in all cases and was associated with no major adverse events. AdVEGF121 was considered potentially associated with a single serious adverse event of transient moderate fever. Elevated postprocedure CK and CK‐MB fraction levels were recorded in two placebo‐treated and three AdVEGF121‐treated patients; all CK measured values were <1.5 times upper limit of normal. All adenoviral cultures (urine and throat swab) were negative 24‐hr after dosing, and no significant changes in serial plasma VEGF levels were noted over time. At 12 months follow‐up, no cancers, proliferative retinal changes, or significant abnormalities in hepatic, renal or hematological indices were observed.Conclusions:Percutaneous, catheter‐based AdVEGF121 intramyocardial injection is a practical, feasible, and potentially safe approach for intramyocardial gene transfer. A larger randomized, phase II efficacy study is warranted. © 2006 Wiley‐Liss, Inc.
Pivotal, randomized U.S. study of the Symbiot™ covered stent system in patients with saphenous vein graft disease: Eight‐month angiographic and clinical results from the Symbiot III trial
Authors: Turco Mark A. , Buchbinder Maurice , Popma Jeffrey J. , Weissman Neil J. , Mann Tift , Doucet Serge , Johnson Warren L. , Greenberg Joel D. , Leadley Katrin , Russell Mary E. 
Published: August 2006

AbstractObjectives: The purpose of this study was to evaluate the clinical and angiographic outcomes of the Symbiot ePTFE covered stent versus bare metal stents (BMS) for the treatment of saphenous vein graft (SVG) disease. Background: The Symbiot stent was developed to reduce periprocedural complications, by potentially preventing distal embolization, and to serve as a possible barrier to cell migration, thus reducing restenosis. Methods: Symbiot III is a prospective, randomized trial of 400 patients at 45 US sites, with 201 patients in the Symbiot group and 199 in the BMS group. Randomization was stratified based on the intended use of embolic protection devices and glycoprotein IIb/IIIa inhibitors. The primary endpoint was percent diameter stenosis (%DS) as measured by quantitative coronary angiography at 8 months. Secondary endpoints included MACE (cardiac death, MI, TVR). Results: The groups were well matched for all baseline clinical and lesion characteristics. At 8 months, %DS was comparable between groups (30.9% Symbiot, 31.9% BMS, P = 0.80). Although the rates of binary restenosis in the stented segment were similar (29.1% Symbiot, 21.9% BMS, P = 0.17), more patients in the Symbiot group had binary restenosis at the proximal edge (9.0% Symbiot, 1.8% BMS, P = 0.0211). There was no difference in the incidence of MACE between groups (30.6% Symbiot, 26.6% BMS, P = 0.43). Conclusions: This study failed to show an advantage for the Symbiot stent in the treatment of degenerated SVGs. This PTFE covered stent does not appear to act as a barrier to prevent restenosis. © 2006 Wiley‐Liss, Inc.
Very late stent thrombosis of a sirolimus‐eluting stent
Authors: Henderson David , Gunalingam Brendan 
Published: August 2006

AbstractWe report the case of a 67‐year‐old man who presented with a non‐stent thrombosis non‐ST‐elevation acute myocardial infarction 41 months after implantation of a sirolimus‐eluting stent in his left circumflex coronary artery. Coronary angiography revealed stent thrombosis. © 2006 Wiley‐Liss, Inc.
Stent‐assisted detachable coil embolization of pseudoaneurysms in the coronary circulation
Authors: Maroo Anjli , Rasmussen Peter A. , Masaryk Thomas J. , Ellis Stephen G. , Lincoff A. Michael , Kapadia Samir 
Published: August 2006

AbstractPseudoaneurysms in the coronary circulation are an uncommon occurrence that can develop spontaneously in the setting of atherosclerosis or can develop after catheter‐based coronary interventions. The natural history, clinical outcome, and optimal therapy for pseudoaneurysms in the coronary circulation are not clearly established. Recent advances in the techniques and technologies used for endovascular treatment of intracranial aneurysms may be applicable to the management of coronary aneurysms and pseudoaneurysms. We present a case of spontaneous coronary pseudoaneurysm formation after paclitaxel drug‐eluting stent implantation and a case of pseudoaneurysm formation in a saphenous vein graft that were both successfully treated with stent‐assisted detachable coil embolization. © 2006 Wiley‐Liss, Inc.
Subcutaneous administration of nitroglycerin to facilitate radial artery cannulation
Authors: Pancholy Samir B. , Coppola John , Patel Tejas 
Published: August 2006

AbstractObjectives: To study the effect of sublingual versus subcutaneous nitroglycerin on radial artery spasm caused by failed access attempts. Background: Radial artery spasm is the leading reason for failed radial access. We studied the efficacy of systemic versus local nitroglycerin in relieving radial artery spasm caused by needle entry resulting in failed cannulation. Methods: Fifty‐two consecutive patients were studied. All patients had failed attempt at radial artery cannulation, resulting in loss of radial pulse. Patients were divided in three groups, group I (n = 11), observed without additional treatment, group II (n = 20), administered 400 mcg of sublingual nitroglycerin, and group III (n = 21), administered 400 mcg of subcutaneous nitroglycerin at the site of the lost radial pulse. All patients were monitored for the return of radial pulse. Demographics, hemodynamics, and time to return of radial pulse as well as ability to successfully cannulate the radial artery were recorded. Results: Seventy‐two percent of group I patients, 90% of group II patients, and 100% of group III patients had re‐establishment of radial pulse. The time to return of radial pulse was significantly shorter for group III compared with that for group II (3 ± 1 min vs. 8 ± 1 min respectively, P < 0.001). Re‐establishment of radial pulse was faster in group II and group III compared with that in group I (18 ± 5 min, P < 0.001). Systolic blood pressure changes and headaches were less common in group III. Conclusion: Subcutaneous administration of nitroglycerin is superior in facilitating radial artery cannulation after initial failed attempt. © 2006 Wiley‐Liss, Inc.
Synchronous carotid stenting and cardiac surgery: An initial single‐center experience
Authors: Oscar Mendiz , Carlos Fava , León Valdivieso , Eduardo Dulbecco , Héctor Raffaelli , Gustavo Lev , Roberto Favaloro 
Published: August 2006

AbstractConcurrent severe carotid and cardiac disease is a challenging situation where staged surgery is probably the most common strategy, although it is still controversial. We report in‐hospital and midterm outcome of 30 patients who received carotid stenting and synchronous cardiac surgery. All received carotid stenting under aspirin and regular unfractioned heparin (UFH) and were immediately transferred to the operating room for coronary and/or cardiac valve surgery. All patients received aspirin and clopidogrel once bleeding was ruled out, after surgery. In‐hospital complications were: three surgical related deaths, one TIA, and no patient suffered stroke or myocardial infarction. Hospital stay was 14 ± 11.8 days. Survivors were followed for 18.4 ± 14 months. There were two non‐related deaths, but no stroke nor cardiac or carotid reinterventions. In conclusion, this small series showed that synchronous carotid stenting and cardiac surgery was feasible with an acceptable complication rate in a high‐surgical‐risk population which could not undergo staged procedures. © 2006 Wiley‐Liss, Inc.