ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1993.tb00868.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1993.tb00869.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1993.tb00870.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Very limited data on percutaneous transluminal coronary angioplasty in patients with chronic renal failure is available. We describe the short‐ and long‐term results of percutaneous transluminal coronary angioplasty (PTCA) in a group of seven patients undergoing chronic dialysis. Percutaneous transluminal coronary angioplasty was undertaken because of poorly controlled symptoms in five patients and reversible defects on thallium scintigraphy prior to major surgery in two patients. There were five men and two women, the mean age was 51 years (range 36–75). Six patients were on hemodialysis and one was receiving peritoneal dialysis. All seven patients had complicated baseline coronary stenosis morphology (AHA/ACC Class B‐1). Percutaneous transluminal coronary angioplasty was successful in four patients (57%) and associated with complications in two patients (29%) including one death. Surviving patients were followed for a mean of 6 months (range 3–23 months). Of three surviving patients with initially successful PTCA, two developed restenosis. All three patients with unsuccessful PTCA underwent bypass surgery with one late death. Patients with chronic renal failure compose a high risk population for PTCA with a reduced success rate, an increased complication rate, and a high restenosis rate. (J Interven Cardiol 1993;

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1993.tb00871.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

In vitro studies during cold pulsed‐wave laser angioplasty have demonstrated production of gas bubbles within the target tissue, creation of shock wave and formation of multi‐layer dissections accompanied by an increase in the plaque and vessel wall temperature. These processes account for certain complications of coronary lasing, including acute vessel closure, dissections, spasm, and even perforation. The traditional lasing technique in which a large number of pulses is continually emitted across the lesion, may in fact contribute to the development and acceleration of the above mentioned processes. To overcome the shortcomings we have developed a new, safe lasing technique that consists of multiple trains of a small number of pulses each. Between laser sessions the laser catheter is retracted into the guiding catheter and nitroglycerin is injected intracoronary, thus providing time for dispersion of produced gas bubbles, cooling of the target artery, and adequate coronary vasodilatation. This new technique results in a significant reduction of laser associated complications. (J Interven Cardiol 1993; 6:297

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1993.tb00872.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Severe acute myocardial infarction in young patients is plagued by high mortality. We report the case of a 25‐year‐old man, with a family history of ischemic heart disease, who was treated with acute and prolonged intracoronary urokinase infused through a miniaturized catheter engaged in a large thrombus occluding the left anterior descending artery. Rapid and stable recanalization was achieved with complete lysis of thrombotic material. (J Interven Cardiol 1993; 6:307

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1993.tb00873.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

The successful percutaneous closure by coil embolization, of a right coronary artery to superior vena cava fistula in an elderly adult, abolished the symptoms caused by the significant left to right shunt. (J Interven Cardiol 1993; 6:315–31

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1993.tb00874.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1993.tb00875.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1993.tb00876.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

To overcome the fundamental limitations of coronary arteriography to assess the functional significance of coronary artery disease, it is necessary to obtain direct information about coronary blood flow. Recently we validated three pressure flow equations, which enable calculation of maximum coronary, myocardial, and collateral flow by merely measuring aortic, central venous, and distal coronary pressures under the condition of maximum vasodilation and using an ultra thin pressure monitoring guide wire for distal coronary pressure recording. In this paper, the first clinical experiences of this method are described. For that purpose, the concept of fractional flow reserve (FFR) is important. Fractional coronary flow reserve (FFRcor) is defined as the maximum achievable blood flow in a stenotic artery, divided by normal maximum flow in that same artery, i.e. maximum flow in that artery in the case that it would be completely normal. Fractional myocardial flow reserve (FFRmyo) is defined in a similar way, and recruitable collateral blood flow is expressed as a fraction of normal maximum myocardial flow. Fractional flow reserve, defined in this way, is easy to obtain at percutaneous transluminal coronary angioplasty (PTCA) by the pressure‐flow equations, is independent of pressure changes, applicable to three vessel disease, and enables calculation of the separate contribution of coronary and collateral flow to total myocardial perfusion. In 18 patients a very close correlation was demonstrated between FFRmyo, calculated by pressure recordings at PTCA by the first pressure flow equation, and FFRmyoobtained by positron emission tomography, which is considered the gold standard for myocardial perfusion. In 60 other patients, maximum recruitable collateral blood flow at balloon inflation (Qc/QN) was calculated according to the third pressure‐flow equation and correlated to the presence or absence of ischemia. It could be demonstrated that QC/QNexceeds 22% in all 23 patients without ischemia, whereas Qc/QNwas less than 22% in 34 out of 37 patients who experienced ischemia during balloon inflation. This margin value of 22% is very close to the theoretically expected value of 20%. based upon a coronary flow reserve of 5 under standard physiologic conditions. It can be concluded that the concept of fractional flow reserve provides a rapid, accurate, and elegant way for quantitative assessment of maximum coronary and myocardial blood flow before and after PTCA. Moreover, this is the first method that enables quantitative calculation of collateral blood flow in clinical practice. (J Interven Cardiol 1993; 6:331

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1993.tb00877.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY