bluuebunny/crossref_metadata_2025_split huggingface dataset:
Multiple stent fractures at the site of coronary artery bypass insertion
Authors: Hetterich Holger , Rieber Johannes 
Published: October 2008

AbstractDrug eluting stents have led to a substantial reduction of in‐stent restenosis. Stent fracture (SF) is an important cause for the cases of restenosis which still occur. Sites of increased vessel movement, long stents, and overlapping stents have been observed to be more prone to fracture. We report the case of a patient with multiple drug eluting SFs at the site of coronary artery bypass insertion. The decision to implant stents at the site of bypass insertion should be made carefully. SF should be considered when gaps between previously implanted stents are observed. © 2008 Wiley‐Liss, Inc.
Electrosurgical energy in combination with a transseptal needle: A novel method for the creation of an atrial communication in hypoplastic left heart syndrome with intact atrial septum
Authors: Gordon Brent M. , Levi Daniel S. , Shannon Kevin M. 
Published: October 2008

AbstractNeonates with hypoplastic left heart syndrome (HLHS) and intact atrial septum (IAS) usually present with severe acidosis and hypoxemia that necessitate immediate intervention to create an atrial septal defect (ASD). Transcatheter creation of an ASD in these patients requires transseptal puncture of a thickened atrial septum in the setting of a very small left atrium. We report on a novel method of perforating the atrial septum using radio‐frequency energy in combination with a transseptal needle to facilitate transseptal puncture and subsequent stent placement in a very thick atrial septum of a newborn with HLHS/IAS and a small left atrium. © 2008 Wiley‐Liss, Inc.
PCI versus CABG for multivessel coronary disease in diabetics
Authors: Tarantini Giuseppe , Ramondo Angelo , Napodano Massimo , Favaretto Enrico , Gardin Arianna , Bilato Claudio , Nesseris Georghios , Tarzia Vincenzo , Cademartiri Filippo , Gerosa Gino , Iliceto Sabino 
Published: October 2008

AbstractObjectives: To explore the clinical performance of a strategy of revascularization by percutaneous coronary intervention (PCI) with drug‐eluting stent (DES) in diabetic patients with multivessel disease (MVD) compared with coronary artery bypass graft (CABG), when it is based on clinical judgment. Background: Diabetes mellitus (DM) is a major risk factor for poor outcome after PCI. However, PCI may result in better outcome if the choice of revascularization (PCI versus CABG) is based on the physician decision, rather than randomization. Limited experiences have compared revascularization by DES‐PCI versus CABG in DM patients with MVD. Methods: From August 2004 to August 2005, 220 consecutive DM patients with MVD underwent DES‐PCI (93) or CABG (127) at our Institution. The type of revascularization was dependent on patient and/or physician choice. Major adverse cardiac and cerebrovascular events (MACCE) included death, myocardial infarction, repeat coronary revascularization, and stroke. Results: Compared with PCI patients, CABG patients had higher prevalence of 3‐vessel disease (P < 0.001), significant LAD involvement (P < 0.001), presence of total occlusions (P = 0.04), collateral circulation (P < 0.001). At 2‐year follow‐up, MACCE were not different between CABG group and DES‐PCI group (OR 1.2; P = 0.6) and, only when the clinical judgment on the revascularization choice was excluded at propensity analysis, DES‐PCI increased the risk of 24‐month MACCE in total population (OR 1.8; P = 0.04). Conclusions: For patients with DM and MVD, a clinical judgment‐based revascularization by DES‐PCI is not associated with worse 2‐year outcome compared with CABG. © 2008 Wiley‐Liss, Inc.
Percutaneous coronary intervention in anticoagulated patients via radial artery access
Authors: Helft Gérard , Dambrin Grégoire , Zaman Azfar , Le Feuvre Claude , Barthélémy Olivier , Beygui Farzin , Favereau Xavier , Metzger Jean‐Philippe 
Published: October 2008

AbstractObjectives: To assess safety and feasibility of using radial artery access for percutaneous coronary intervention (PCI) in patients on oral anticoagulation without interrupting therapy. Background: The radial artery approach for PCI is intuitively attractive for patients receiving chronic oral anticoagulation with vitamin K antagonists (VKAs) but little data exist concerning feasibility or safety of this approach in this population. The main advantage of this strategy would be to avoid bridging therapy with heparin that increases risk of thrombotic and bleeding events. Methods: In this prospective observational study, 50 consecutive patients referred for coronary angiography underwent PCI without interrupting oral anticoagulant therapy. The main outcome measures were bleeding and thrombotic complications. Results: The indications for permanent oral anticoagulation were as follows: atrial fibrillation in 62%, mechanical prosthesis in 24%, and venous thromboembolism in 14%. Seventy‐two percent were elective cases and 28% presented with acute coronary syndromes. PCI was performed with an INR range of 1.4–3.4 with mean of 2.2 ± 0.6. Seventy‐six percent of the patients were on dual antiplatelet therapy before the procedure. No thrombotic events or excess bleeding were observed at 1 month. Only one patient had a minor hemorrhage 8 days after procedure. Conclusions: This series suggests that for patients treated with VKAs, the use of radial artery access is feasible and safe for PCI on dual antiplatelet therapy without interrupting oral anticoagulant treatment. © 2008 Wiley‐Liss, Inc.
A modified technique of stent fenestration of the interatrial septum improves patients with pulmonary hypertension
Authors: Troost Els , Delcroix Marion , Gewillig Marc , Van Deyk Kristien , Budts Werner 
Published: October 2008

AbstractAims: A significant number of patients with pulmonary hypertension are resistant to medical therapy. We wanted to evaluate whether the modified technique of stent fenestration of the interatrial septum would be feasible and safe, and offer clinical benefit. Methods and Results: The medical records of all patients with pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension who underwent a stent fenestration of the interatrial septum between 2001 and 2008 were reviewed. In all fifteen patients (12 female, mean age 48.2 ± 20.5 years) a successful fenestration procedure could be performed. Median follow‐up time between diagnosis and fenestration was 2.3 years (range from 0.5 to 18.6 years). Mean event free survival since diagnosis and after septostomy was 9.8 ± 2.9 and 3.2 ± 0.8 years, respectively. When one extreme outlier was excluded, the 6 min walk distance improved significantly from 309 ± 69 m immediately before fenestration to 374 ± 84 m, 3–4 months after fenestration (n = 8, paired t‐test, P = 0.03). No stent occlusion occurred. Conclusion: The modified stent fenestration technique is feasible and safe in patients with severe pulmonary hypertension. In a selected group of patients, functional capacity might improve although disease progression continues. © 2008 Wiley‐Liss, Inc.
Persistent venous valves correlate with increased shunt and multiple preceding cryptogenic embolic events in patients with patent foramen ovale: An intracardiac echocardiographic study
Authors: Rigatelli Gianluca , Dell'Avvocata Fabio , Braggion Gabriele , Giordan Massimo , Chinaglia Mauro , Cardaioli Paolo 
Published: October 2008

AbstractBackground:It has been suggested that prominent Eustachian valve (EV) and Chiari's network (CN) predispose to paradoxical embolism but their presence in patients with presumed paradoxical stroke is not always easily detectable by transesophageal echocardiography (TEE). We sought to prospectively assess the frequency of EV/CN as assessed by intracardiac echocardiography (ICE) in patients submitted to patent foramen ovale (PFO) transcatheter closure in order to investigate their role in determining shunt severity and risk of multiple paradoxical embolisms.Methods:Over a 36‐month period, we prospectively enrolled 98 consecutive patients (mean age 37 ± 12.5 years, 68 females) with previous stroke referred to our center for PFO catheter‐based closure. All patients underwent transcranial Doppler ultrasound (TC‐D), TEE and ICE‐guided transcatheter closure.Results:After ICE study and measurements, a prominent EV or CN were diagnosed on ICE in 72 patients (73.4%), whereas in 45 (45.9%, P < 0.01) on TEE. Patients with EV/CN had more frequently a curtain pattern on TC‐D, a larger right‐to‐left shunt, and recurrent cerebral paradoxical embolisms before closure. EV/CN and medium‐large shunt on TEE were the strongest predictors of recurrent paradoxical embolisms.Conclusions:This study suggests that EV and CN have a deep impact on the pathophysiology of paradoxical embolism: EV and CN should be considered as adjunctive risk factors for paradoxical embolism in the decision‐making process involving PFO patients. © 2008 Wiley‐Liss, Inc.
Stenting of a stenosed major aortopulmonary collateral artery in a baby with pulmonary atresia and a ventricular septal defect: Rescue from critical hypoxia in the immediate postoperative stage of unifocalization supported by extracorporeal membrane oxygenation
Authors: Tomita Hideshi , Matsuoka Takashi , Uemura Shigeru 
Published: October 2008

AbstractA 4‐month baby with pulmonary atresia, ventricular septal defect, major aortopulmonary collateral arteries (MAPCAs) and an extremely hypoplastic central pulmonary artery developed critical hypoxia following right unifocalization combined with a right Blalock‐Taussig shunt. To increase pulmonary blood flow we stented the left lower MAPCA during extracorporeal membrane oxygenation (ECMO) support. He was successfully weaned from ECMO 2 days after stenting. Percutaneous intervention for a stenosed MAPCA is an effective means of increasing pulmonary blood flow in critically hypoxic patients following unilateral unifocalization, even in the immediate postoperative stage. © 2008 Wiley‐Liss, Inc.
External‐to‐internal iliac artery endografting for the exclusion of iliac artery aneurysms: An alternative technique for preservation of pelvic flow?
Authors: van Groenendael Laura , Zeebregts Clark J. , Verhoeven Eric L.G. , van Sterkenburg Steven M.M. , Reijnen Michel M.P.J. 
Published: October 2008

AbstractPurpose:The purpose of this study was to describe an alternative endovascular procedure to exclude iliac artery aneurysms, preserving perfusion to the internal iliac artery.Cases:Two patients, considered unfit for open repair, underwent endovascular repair of iliac artery aneurysms. One of these occurred after previous placement of a bifurcated prosthesis. In both cases the aneurysms were excluded using a nitinol stent covered with expanded polytetrafluoroethylene from the external to the internal iliac artery. Using this technique, the internal iliac arteries were perfused in a retrograde manner. Both interventions were technically successful. The external‐to‐internal endograft remained patent after 6 and 16 months, respectively.Conclusion:Endovascular placement of a stent‐graft from the external iliac artery into the internal iliac artery may offer an alternative and minimal invasive alternative for the management of common and internal iliac artery aneurysms. With the use of this technique, pelvic perfusion is preserved. Further studies are warranted to appraise the advantages and risk of this approach for iliac artery aneurysms. © 2009 Wiley‐Liss, Inc.
Impact of anticoagulation regimens on sheath management and bleeding in patients undergoing elective percutaneous coronary intervention in the STEEPLE trial
Authors: Gallo Richard , Steinhubl Steven R. , White Harvey D. , Montalescot Gilles ,   for the STEEPLE Investigators
Published: October 2008

AbstractObjective: To evaluate the impact of sheath management on bleeding rates. Background: The procedural characteristics and anticoagulant regimen determine the frequency of postoperative bleeding complications following percutaneous coronary intervention (PCI). Methods: This subanalysis of the SafeTy and Efficacy of Enoxaparin in PCI patients, an internationaL randomized Evaluation (STEEPLE) trial evaluated the relative impact of enoxaparin or unfractionated heparin (UFH) on the rate of non‐coronary artery bypass graft‐related major and minor bleeding, according to sheath management procedures in 3,528 patients undergoing elective PCI with a femoral approach. Results: Sheaths were removed at a median time of 54 min with enoxaparin 0.5 mg/kg, compared with 3 hr 14 min with enoxaparin 0.75 mg/kg and 2 hr 24 min with UFH. Early sheath removal (within 30 min from the end of PCI) was associated with reduced bleeding in patients receiving 0.5 or 0.75 mg/kg enoxaparin compared with UFH (enoxaparin 0.5 mg/kg: 4.9% vs. 10.8%; P < 0.001; enoxaparin 0.75 mg/kg: 5.0% vs. 10.8%; P < 0.001). Compared with UFH, major and minor bleeding was halved when enoxaparin (0.5 mg/kg and 0.75 mg/kg) was used in combination with a closure device (4.4% and 5.3% vs. 10.5% with UFH) or smaller (<7 Fr) sheath sizes (4.9% and 6.0% vs. 9.3%). Conclusion: This analysis shows that early sheath removal can be performed safely following elective PCI in patients receiving enoxaparin. Enoxaparin use was associated with less major and minor bleeding compared with UFH, when either a closure device or a smaller sheath size was used. © 2009 Wiley‐Liss, Inc.
Outcomes with drug‐eluting stents versus bare metal stents in acute ST‐elevation myocardial infarction: Results from the Strategic Transcatheter Evaluation of New Therapies (STENT) Group
Authors: Brodie Bruce R. , Stuckey Thomas , Downey William , Humphrey Angela , Nussbaum Marcy , Laurent Sherry , Bradshaw Barbara , Metzger Chris , Hermiller James , Krainin Fred , Juk Stanley , Cheek Barry , Duffy Peter , Simonton Charles A. ,   for the Strategic Transcatheter Evaluation of New Therapies (STENT) Group
Published: October 2008

AbstractObjectives:This study compares outcomes with drug‐eluting stents (DES) versus bare metal stents (BMS) in patients with ST‐elevation myocardial infarction (STEMI).Background:DESs have been effective in elective percutaneous coronary intervention (PCI), but their safety and efficacy in patients with STEMI have not been well studied.Methods:The STENT Registry is a multicenter United States registry evaluating outcomes of DES. Our study population includes patients with STEMI treated with either a DES or BMS who completed 9‐month or 2‐year follow‐up. Outcomes were adjusted using propensity score analysis.Results:DES patients were younger, had less prior infarction and prior bypass surgery, but had smaller vessels and longer lesions. After adjusting for differences in baseline variables, there were no significant differences between DES and BMS in death, reinfarction, or major adverse cardiac events (MACE). DES had lower rates of stent thrombosis at 9 months (1.0% vs. 2.7%, HR 0.40 [0.17–0.95]) and lower rates of target vessel revascularization (TVR) at 9 months (4.0% vs. 7.5%, HR 0.55 [0.34–0.88]) and 2 years (8.0% vs. 11.3%, HR 0.57 [0.35–0.92]). There was a nonsignificant increase in stent thrombosis with DES versus BMS from 1 to 2 years (1.1% vs. 0.3%, P = 0.28).Conclusions:Our data suggest that DES used with primary PCI for STEMI are more effective than BMS in reducing TVR and are safe for up to 2 years. Whether DES are safe beyond 2 years and whether the reduction in TVR is enough to justify their use in STEMI will have to wait for the results of large randomized trials. 2008 Wiley‐Liss, Inc.
Percutaneous closure of an iatrogenic atrial septal defect
Authors: Sur James P. , Pagani Francis D. , Moscucci Mauro 
Published: October 2008

AbstractThe use of the Tandem Heart™ percutaneous ventricular assist device (Tandem Heart pVAD, Cardiac Assist technologies, Pittsburgh, PA) as a bridge to recovery or to other cardiopulmonary support systems has been rising. One requirement for placement of this device is an intraatrial septostomy which is usually closed during the surgical insertion of more permanent ventricular assist devices. We present a case of a 62‐year‐old man with a residual acquired atrial septal defect (ASD) from Tandem Heart™ placement, which could not be closed surgically during insertion of left and right ventricular assist devices. The patient remained intubated and hypoxemic after removal of his right ventricular assist device due to the presence of persistent right to left shunting. With closure of the ASD using an 8‐mm Amplatzer® septal occluder (ASO; AGA Medical Corp., Golden Valley, MN) the patient stabilized and was successfully extubated. © 2009 Wiley‐Liss, Inc.
Left main coronary artery compression from right pulmonary artery stenting
Authors: Hamzeh Rabih K. , El‐Said Howaida G. , Moore John W. 
Published: October 2008

AbstractComplications related to pulmonary artery stenting include stent migration, jailing of vessels, vessel rupture, and compression of surrounding structures. Compression of the left main coronary artery (LMCA) as a result of stent placement in the right pulmonary artery (RPA) is extremely rare. We present two patients post repair of congenital heart disease who suffered LMCA compression following RPA stenting. The first patient experienced acute coronary insufficiency in the cardiac catheterization laboratory, whereas the second patient had a more chronic course. We also present a third patient who had a CT angiogram that demonstrated a close spatial relationship between the RPA and the LMCA. Based on our previous experiences, we felt that this patient was at significant risk for LMCA compression if the RPA were stented. Coronary compression is rare complication of pulmonary artery stenting but should be considered in cases with history of repaired congenital heart disease. © 2009 Wiley‐Liss, Inc.
Occupational health hazards in the interventional laboratory: Time for a safer environment
Authors: Klein Lloyd W. , Miller Donald L. , Balter Stephen , Laskey Warren , Naito Neil , Haines David , Ross Allan , Mauro Matthew A. , Goldstein James A. 
Published: October 2008

AbstractOver the past 30 years, the advent of fluoroscopically guided interventional procedures has resulted in dramatic increments in both X‐ray exposure and physical demands that predispose interventionists to distinct occupational health hazards. The hazards of accumulated radiation exposure have been known for years, but until recently the other potential risks have been ill‐defined and under‐appreciated. The physical stresses inherent in this career choice appear to be associated with a predilection to orthopedic injuries, attributable in great part to the cumulative adverse effects of bearing the weight and design of personal protective apparel worn to reduce radiation risk and to the poor ergonomic design of interventional suites. These occupational health concerns pertain to cardiologists, radiologists and surgeons working with fluoroscopy, pain management specialists performing nonvascular fluoroscopic procedures, and the many support personnel working in these environments.This position paper is the work of representatives of the major societies of physicians who work in the interventional laboratory environment, and has been formally endorsed by all. In this paper, the available data delineating the prevalence of these occupational health risks is reviewed and ongoing epidemiological studies designed to further elucidate these risks are summarized. The main purpose is to publicly state speaking with a single voice that the interventional laboratory poses workplace hazards that must be acknowledged, better understood and mitigated to the greatest extent possible, and to advocate vigorously on behalf of efforts to reduce these hazards. Interventional physicians and their professional societies, working together with industry, should strive toward the ultimate zero radiation exposure work environment that would eliminate the need for personal protective apparel and prevent its orthopedic and ergonomic consequences. © 2008 Wiley‐Liss, Inc.
Long‐term mortality after bolus‐only administration of abciximab, eptifibatide, or tirofiban during percutaneous coronary intervention
Authors: Marmur Jonathan D. , Poludasu Shyam , Lazar Jason , Cavusoglu Erdal 
Published: October 2008

AbstractObjective:To evaluate the long‐term mortality after bolus‐only administration of abciximab, eptifibatide, and tirofiban during percutaneous coronary intervention (PCI).Background:Studies on platelet glycoprotein IIb/IIIa receptor inhibitors (GPI) administered as bolus‐only during PCI suggest that this strategy may be similar in efficacy, safer, and more cost‐effective compared to a bolus plus infusion of GPI.Methods:We evaluated 864 patients (abciximab = 274, eptifibatide = 361, and tirofiban = 229) who underwent PCI with a bolus‐only regimen during January 2003 to August 2005.Results:After a median follow up of four (interquartile range, 3–4.5) years, there were a total of 95 (11%) deaths. The survival rate was 83% in the abciximab group, 91% in the eptifibatide group, and 93% in the tirofiban group (P = 0.003 by log‐rank test). After adjustment for baseline clinical and procedural characteristics using a Cox proportional hazards model, the abciximab group had a significantly higher mortality compared to the eptifibatide group (P = 0.003; Hazard ratio (HR) for eptifibatide compared to abciximab was 0.49 (95% confidence intervals [CI]: 0.30–0.78). The long‐term mortality was not significantly different in the tirofiban group compared to the abciximab group (P = 0.33) or the eptifibatide group (P = 0.20), perhaps because of shorter follow‐up period and fewer patients in the tirofiban group.Conclusion:When given as bolus‐only during PCI, eptifibatide may improve long‐term survival compared to abciximab. © 2009 Wiley‐Liss, Inc.
Hemolysis induced pancreatitis after orbital atherectomy in a heavily calcified superficial femoral artery
Authors: Mehta Sameer K. , Laster Steven B. 
Published: October 2008

AbstractOrbital atherectomy represents a newly developed technology for the endovascular treatment of peripheral artery disease. There is currently limited data with regards to the safety and efficacy of this treatment. Herein, we describe a case where orbital atherectomy was utilized to treat a heavily calcified superficial femoral artery, and describe a previously unreported side effect of orbital atherectomy, hemolysis induced pancreatitis. © 2008 Wiley‐Liss, Inc.