ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1993.tb00842.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

The present study was intended to evaluate the acute and short‐term hemodynamic, angiographic, and pathological response to balloon‐expandable stent treatment of experimental coarctation of the aorta. A discrete thoracic coarctation was surgically created in six mongrel dogs (two adults, four puppies). Two months postoperatively all six dogs (8.9–30 kg) underwent left heart catheterization and coarctation stenting performed through a femoral artery cutdown. A Palmaz PS‐30 stent was advanced to the coarctation through a 10French sheath, and expanded with an angioplasty balloon chosen to equal the diameter of the proximal aorta (9–12 mm). Stent implantation was successful in each dog. The systolic pressure gradient decreased from 26.3 ± 9.1 mmHg (mean ± SE) to 0.5 ± 0.5 mmHg (P = 0.04), and the coarctation diameter improved from 50 ± 6% to 82 ± 6% of the diameter of the proximal descending aorta (P<0.01). Follow‐up catheterization 4–7 weeks after stenting documented no stent migration, early restenosis, thrombosis, obstruction of arterial side branches, or aneurysm formation. Pathological evaluation of the explanted segments of stented aorta documented that by 6–7 weeks the stents are covered by a neointima composed of intimal proliferation and fibrosis with an endothelial cell surface. These data suggest that balloon‐expandable stainless steel stents provide excellent acute and short‐term relief of coarctation in this experimental model. Larger and longer‐term studies are needed to better assess the incidence of restenosis or aneurysm formation following stenting o

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1993.tb00843.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Cardiac catheterization and selective coronary angiography were performed in ten patients with intracardiac tumors [left atrial myxoma (7), right atrial myxoma (1), angiosarcoma of right heart (1), and right ventricular tumor (1)]. The patient with angiosarcoma had characteristic hemodynamics suggesting cardiac compression. The coronary arteriographic finding included: neovascularization (8); filling defect due to emboli (1); and displacement of coronary artery (1). Tumor neovascularization from branches of the left circumflex or right coronary artery was invariably observed in patients with myxoma. We conclude that invasive studies are safe, provide additional information of academic interest, and occasionally aid in the diagnosis.(J Interven Cardiol 1993; 6:125–12

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1993.tb00844.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Critical ostial left main disease may lead rapidly to sudden death and is, therefore, of paramount importance to diagnose. While the number of cardiac catheterizations is increasing, government and third party reimbursement sources are imposing pressure to perform more studies in an outpatient setting, as the economic resources for medical procedures are shrinking. Outpatient cardiac catheterization requires the patient to ambulate within several hours after the procedure. In order to allow patients to safely ambulate early after their procedures, 5 French catheters are often used (whether the femoral or brachial approach is used) rather than the standard 7 French catheters. We describe a patient with an ostial left main stenosis that was not visualized when coronary arteriography was performed using a diagnostic 5 French catheter. Selective intubation of the left main coronary artery was easily achieved without damping of the pressure tracing. Selective coronary angiography did not demonstrate the ostial stenosis, and there appeared to be a normal amount of contrast refluxing into the aortic root. When the patient returned for an angioplasty and a guiding angiogram was performed with an 8 French catheter, an ostial stenosis was evident with coronary angiography.(J Interven Cardiol 1993; 6:131–13

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1993.tb00845.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

We studied the follow‐up of 147 patients who underwent catheter ablation because of drug resistant supraventricular tachyarrhythmias. Direct current (DC) ablation was performed in 116 patients, while 31 patients underwent radiofrequency (RF) ablation. In 101 patients (87%) with DC ablation and in 28 patients (90%) with RF ablation, complete atrioventricular (AV) block was achieved initially. Fifteen patients (13%) with DC ablation and three patients (11%) with RF ablation resumed AV conduction. Serious complications occurred in eight patients (7%) with DC ablation and in none of the patients with RF ablation. During the mean follow‐up of 45 ± 24 months, 13 patients died (11%) who underwent DC ablation; during the mean follow‐up of 11 ± 3 months, no patient died who had had RF ablation. Transcatheter ablation using DC or RF is an effective treatment in patients with drug resistant supraventricular arrhythmias, providing a beneficial long‐term outcome including an improved quality of life. Although the risk of complications is low, this procedure should be reserved for patients with supraventricular arrhythmias who do not respond to conventional drug therapy. (J Interven Cardiol 1993;

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1993.tb00846.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Mechanical stimulation is a known cause of arterial spasm. Since stent implantation in the coronary arteries imparts mechanical trauma, we investigated, in an animal model that simulates human coronary anatomy and physiology, the frequency of occurrence and factors that influence the development of spasm. In 28 Hanford miniature swine, 9 of which were atherosclerotic and 19 of which were nonatherosclerotic, spasm occurred in 15 (54%). Stent‐induced spasm directly caused the death of one animal and was implicated in the death of two others. Factors that significantly contributed to coronary spasm were the stent: artery ratio (more spasm with oversized stents) and the size of the artery (more spasm with smaller arteries). There was a trend toward more spasm in atherosclerotic arteries. Spasm occurred despite the use of antispasmodic agents before, during, and after the scenting procedure. Our data suggest that coronary artery spasm may be an important clinical accompaniment to stent implantation in man and may be minimized by the judicious selection of stent size to avoid overdistention of the artery and the avoidance of stent placement in smaller arteries. (J Interven Cardiol 1993; 6:149–

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1993.tb00847.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Ultrasonic energy has been shown to ablate atherosclerotic plaques and arterial and venous thrombi. We used an ultrasonic angioplasty device developed by our group in ten patients with totally occluded femoral artery during surgical bypass. Ultrasonic angioplasty was performed with a 130‐cm long and 0.8‐cm diameter titanium probe with a 2‐ or 2.5‐mm titanium ball‐tip. In one patient, angioplasty could not be performed. Angiographic and angioscopic examination were performed before and after angioplasty in nine patients. Before ultrasound recanalization, angioscopic examination showed that the proximal end of the occlusion was formed by atheromatous material in 3 cases, red thrombus in 3 cases, and white thrombus in 3 cases. After ultrasound recanalization, angioscopy showed residual stenosis at the site of entry in only one case. In three other cases, the artery was free of residual stenosis without persistent clot. In the five other patients, a residual stenosis was present beyond the proximal occlusion point with some fibrin mesh and small clots. At angiography, flow was restored in 4 cases; in 4 patients flow rate of entry was slow in the distal segment; and in 1 patient, the distal arterial bed could not be opacified. Altogether, ultrasonic angioplasty was able to recanalize a complete occlusion in nine out of ten patients, with partial or complete dissolution of clots and with no complication. At its present stage of development, adjunctive balloon angioplasty would be needed in most cases to obtain unrestricted flow and unsignificant residual stenosis. The limited maneuverability of the probe and the relatively small size of the ball‐tip may explain that all clots could not be treated. When those limitations are overcome, ultrasonic angioplasty could become very useful because of the combination of its mechanical effects and thrombus dissolution capabilities.(J Interven Cardiol 1993

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1993.tb00848.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Exact angiographic and identification of significant stenosis of the left main coronary artery is imperative prior to performing elective percutaneous transluminal coronary angioplasty. A patient is presented with an apparent angiographically significant, but physiologically insignificant, left main stenosis. Both angiographic and physiological methods of detecting “false positive and negative” left main stenoses are discussed. (J Interven Cardiol 1993; 6:165

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1993.tb00849.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Ninety‐five patients 75 years or older (range 75–90, mean 79) underwent PTCA from 1987 to 1991. Forty‐two patients were 80 years or older. Forty‐four had prior MI, 5% had prior coronary bypass surgery (CBS), 13% had a prior history of recent cardiac failure, and 81% (77/95) presented with unstable angina, refractory to intravenous treatment in 31 cases. The mean left ventricular ejection fraction was 62% (range 34%–80%). Thirty‐nine percent had single vessel disease, 41% had two vessel disease, and 20% had three vessel disease. Coronary calcifications were present in 28%. A single vessel was dilated in 81 patients, two vessels in 14 patients; complete revascularization was achieved in 41%. The clinical angiographic primary success rate was 79% (75/95). There were five procedural deaths, five MI, five CBS and, ten hematomas. Follow‐up data were obtained in 100% cases, with a mean follow‐up duration of 12 months (ranging from 1–36). There were four deaths, one MI, and two CBS. Twenty percent (15/74) of patients had a second PTCA with a 73% success rate. Finally, 70% of the initial population was asymptomatic after first or second PTCA at mid‐term follow‐up. We conclude that PTCA is safe and effective in elderly patients, with 70% clinical success rate at mid‐term follow‐up in spite offrequent incomplete revascularization limited to the culprit lesion. (J Interve

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1993.tb00850.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.tb00851.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY