摘要:

While carotid endarterectomy (CEA) has been used commonly and with great effectiveness for de novo carotid occlusive lesions, its success in cases of recurrent disease has been attenuated by a higher incidence of complications and lower durability. Although interventional techniques have been introduced cautiously into the cerebrovascular system, balloon dilation for both primacy and recurrent carotid atherosclerotic disease has been successful in establishing an adequate lumen without an increase in embolic complications over surgery. Because the likelihood exists that postdilation restenosis may be as common in the carotid arteries as it is in other vascular segments, the use of intraluminal stenting may mitigate this long‐term complication, a benefit that has been demonstrated in other high flow vessels such as the aorta and iliac arteries. To begin an investigation of this hypothesis, we treated a 69‐year‐old symptomatic man who required a third intervention for recurrent carotid disease. A>90% stenosis of the distal third of his right common carotid artery was successsfully dilated, and a Palmaz stent was deployed without incident. The patient experienced no complicatons to the percutaneous procedure, and at 15 months posttreatment, he is well and asymptomatic. Although greater clinical experience must be accumulated with this new approach, intraluminal stenting following balloon dilation for recurrent carotid disease may surpass redo CEA in long‐term patency and may entail fewer procedural complications. (J Interven Cardiol 1995; 8:

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1995.tb00537.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Objective: The intraoperative and follow‐up results were compared in 67 patients with ventricular tachyarrhythmias who underwent implantation of the Ventritex Cadence defibrillator with either epicardial patch (EPI, 25 patients) or nonthoracotomy CPI Endotak (ENDO, 42 patients) defibrillation lead systems. Results: There was no significant difference between groups in age, sex, structural heart disease, ejection fraction, arrhythmia history, or drug therapy. Successful implantation was accomplished in all patients using either lead system in the ENDO group, 35 patients (83%) had a defibrillation threshold ≤ 550 V and did not require a subcutaneous patch. Intraoperatively, the defibrillation threshold was 453 ± 139 V (13 ± 9 J) for EPI and 490 ± 113 V (15 ± 8 J) for ENDO (P = NS). There were no periperative deaths in either group. At predischarge testing, the defibrillation threshold was 445 ± 183 V (14 ± 12 J) for EPI and 439 ± 133 V (13 ± 7 J) for ENDO (P = NS). During a mean follow‐up of 16 ± 8 months, there were no sudden deaths, and four patients died from congestive heart failure (3 EPI, 1 ENDO). During follow‐up, 916 spontaneous arrhythmia episodes occurred in 16 of 25 EPI patients (64%) and 967 episodes occurred in 31 of 42 ENDO patients (74%) (P = NS). The number of episodes detected as ventricular fibrillation were 192 for EPI (21%) and 232 for ENDO (24%), with first shock success in 76% and 75%, respectively; all episodes were successfully terminated by the device. In the remaining episodes detected as ventricular tachycardia, antitachycardia pacing was attempted and was successful in 672 of 724 episodes (93%) with EPI and 666 of 735 episodes (91%) with ENDO lead systems (P = NS). Acceleration of ventricular tachycardia with antitachycardia pacing occurred in 21 episodes (3%) with EPI and in 37 episodes (5%) with ENDO leads (P = NS). Conclusions: A nonthoracotomy approach using the third generation cardioverter defibrillator Cadence V‐100 is safe and effective and has clinical results that are not significantly different from epicardial defibrillation lead systems. (J Interven Card

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1995.tb00538.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

The present report describes three patients with iatrogenic left main coronary artery after aortic valve replacement. All three patients were succesfully treated by percutaneous transluminal coronary angioplasty. No clinical or angiographic signs of restenosis were seen during the long‐term follow‐up (4, 6, and 11 years). These patients show the feasibility of percutaneous transluminal coronary angioplasty in iatrogenic left main coronary artery stenosis as alternative of coronary artery bypass surgery. However, it should be only considered in patients who would otherwise be deemed inoperable, refused reoperation, and are willing to take the risk involved. (J Interven Cardiol 1995; 8:229

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1995.tb00539.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

We describe our initial experience with the “Big Skinny” angioplasty catheter, currently only available as an investigational device and in sizes of 4.5, 5, and 6 mm. Six patients with severe angina pectoris were successfully dilated with this angioplasty catheter and have remained asymptomatic up until a mean follow‐up period of 6 months. However, because of the large profile of the catheter, sufficient back‐up with an adequate guiding catheter should be obtained and predilation with a smaller angioplasty catheter should be performed. The use of this catheter may be a more simple alternative for the treatment of oversized vessel stenosis than the “hugging balloon” technique or directional atherectomy. Otherwise, it may be considered as an adjunct technique in order to optimize the angiographic result after stenting or directional atherectomy in this particular indication. (J Interven Cardiol 1995

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1995.tb00540.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Emergency cardiopulmonary support has been used in the United States since 1986. Physicians at participating centers for the National Registry of Elective Supported Angioplasty have contributed data on emergent cardiopulmonary support from their institutions. Results were analyzed to assess the benefits of cardiopulmonary support in patients with hemodynamic collapse. Patients with either cardiac arrest or hemodynamic collapse with cardiogenic shock unresponsive to pressor agents were placed emergently on cardiopulmonary support. Subsequent treatment comprised either angioplasty or surgical revascularization. Patients placed on cardiopulmonary support in<20 minutes experienced a 41% survival rate across the entire registry of the participating centers of the National Cardiopulmonary Bypass Registry. Two centers with considerable experience demonstrated a 69% survival rate. Patients treated with emergency cardiopulmonary support because of hemodynamic collapse showed improved survival over any other hemodynamic support system. Results have improved for survival with increased operator experience, particularly in the early application group. (J Interven Cardiol 1995;8:239–24

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1995.tb00541.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

The role of cardiopulmonary support (CPS) in interventional procedures is currently in evolution. The authors review the clinical applications and technical considerations involved in CPS including discussion of indications, hemodynamic effects, complications, and prophylactic versus stand‐by techniques. Use of the technique in high risk percutaneous transluminal coronary angioplasty patients is discussed. (J Interven Cardiol 1995;8:249–

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1995.tb00542.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Routine percutaneous transluminal coronary angioplasty catheters are adequate and demonstrate high success rates in balloon angioplasty with stable patients. Active hemoperfusion seems to ofter an advantage in patients with hemodynamic instability. Active hemoperfusion provides myocardial protection during coronary interventions and can be applied in conjunction with routine angioplasty equipment. When compared with other devices demonstrating clinical utility in a supported angioplasty setting, this flow adjustable active antegrade hemoperfusion pump appears reliable, simple to use, cost‐effective, and requires much less instrumentation than the more bulky CPS systems. (J Interven Cardiol 1995;8:257–

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1995.tb00543.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1995.tb00544.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Currently used left ventricular assist devices allow chronic mechanical cardiac support in the patient with end‐stage heart failure. Recognition and treatment of problems uniquely associated with this device may be increasingly important for the invasive cardiologist as application of this technology becomes more prevalent. (J Interven Cardiol 1995;8:275‐

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1995.tb00545.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1995.tb00546.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY