ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1990.tb00971.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

Rethrombosis may be a major determinant of poor outcome after angioplasty. Fibrinopeptide A, a marker of thrombin activity, was measured in 79 patients after coronary angioplasty to assess for association with subsequent cardiac events. Fibrinopeptide A levels were drawn postangioplasty on heparin and prior to discharge off heparin. Levels greater than 2.0 ng/mL were considered elevated. During 6‐month follow‐up, recurrence of stenosis occurred in 14 out of 51 patients (27%) with elevated levels, requiring repeat angioplasty or bypass surgery. One more patient showed angiographic evidence of recurrence (at least 30% increase in stenosis) not severe enough to require revascularization. Fibrinopeptide A was elevated in this patient. There were three late cardiac deaths and one acute myocardial infarction, all in patients with elevated fibrinopeptide A. An additional five patients had an abnormal stress test without subsequent cathe‐terization to assess recurrences; four of them had elevated fibrinopeptide A. In total, there were 22 out of 51 patients (43%) with elevated fibrinopeptide A levels with adverse outcomes, as compared with 6 out of 28 (21%) with normal levels (P = 0.05). Thus, an elevated fibrinopeptide A early after angioplasty may be a marker for a group at greater risk for reste

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1990.tb00972.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

Percutaneous transluminal coronary angioplasty may be complicated by the occurrence of major coronary artery dissection, which may precipitate critical myocardial ischemia, necessitating urgent surgical intervention. We report two cases of massive dissection following angioplasty, in which novel methods were used to stabilize arterial integrity. In the first, laser balloon angioplasty was used to repair the dissection; in the other, a coronary stent was inserted. In both cases, coronary artery patency was achieved with reperfusion of the distal coronary bed, thus avoiding the need for acute surgical intervention. Both patients are free of limiting symptoms at follow‐u

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1990.tb00973.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

Large controlled mortality studies with streptokinase, APSAC or tissue plasminogen activator (tPA) have conclusively shown that thrombolytic therapy within 6 hours after symptom onset improves survival after acute myocardial infarction. There is evidence of benefit even for patients treated between 7–24 hours after pain onset, suggesting that early recanalization of the infarct‐related artery is not the only mechanism by which thrombolysis improves survival. There is no apparent upper age limit for thrombolytic therapy. Serious side effects are generally rare and not age dependent. Inclusion criteria as well as concomittant adjuvant therapy were different in the various trials. Furthermore, the 95% confidence intervals for mortality reduction by different thrombolytic agents are overlapping. To evaluate their relative efficacy and safety direct head‐to‐head comparison is

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1990.tb00974.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

The proliferation of sophisticated endovascular interventions is mandating more definitive and comprehensive documentation of atherosclerotic lesions and the results of the interventional devices used in their removal. A technique with a potential to fulfill these goals, intravascular ultrasound imaging (IVUS), was evaluated against pressure gradients, arteriography, and femoral‐radial indices in 11 patients with stenotic iliac lesions. The two‐dimensional, real‐time scans were useful in measuring pre‐and posttreatment cross‐sectional diameters and luminal areas for procedural assessment. Furthermore, the ultrasound scans clearly identified arterial wall calcifications, iliac veins, soft plague formations, dissections, synthetic graft anastomoses, and intravascular stents, often with definition superior to arteriography. The IVUS technique was useful in selecting interventional therapies, in particular, the need for stent implantation to control intimal flaps. Further, IVUS demonstrated its ability as a substitute for contrast arteriography in a twelfth patient with an iliac stent in whom a protocol‐dictated follow‐up arteriogram was co

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1990.tb00975.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

Streptokinase (SK) and tissue plasminogen activator (alteplase [tPA]) are by far the most intensively studied thrombolytic agents, but only recently a direct head‐to‐head comparison (GISSI‐2 Trial, in which 12,490 patients have been randomized) has become available to the scientific community. This trial, with its international extension (the International tPA/SK Mortality Trial) recruited more than 20,000 patients, showed that the two drugs tested (SK and tPA) were substantially comparable as far as the clinical events were considered. ISIS‐3, the largest randomized clinical trial ever performed, compares SK, tPA, and APSAC in a factorial design. Its results will be available before spring, 1991. It is likely that these two studies, if the results will be consistent, will give a definitive answer about comparison among thrombolytic drugs. As a consequence of that achievement, the interest of the scientific community will possibly be directed towards the long‐term prevention of the infarct complications, namely ventricular remodeling and infarct expansion or life‐threatening

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1990.tb00976.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

Changes in a coronary artery thrombus resulting from platelet activation may affect the speed of thrombolysis and the frequency of reocdusion after thrombolytic therapy. In studies performed in canine models, we have found that selected thromboxane and serotonin receptor antagonists given in combination markedly enhance the thrombolytic effect of tissue plasminogen activator, probably by preventing further platelet activation and their incorporation into a thrombus during thrombolytic therapy. The combination of a thromboxane and serotonin receptor antagonist given with heparin and tissue plasminogen activator is effective in delaying or preventing reocdusion after discontinuation of tissue plasminogen activation in experimental canine models in whom coronary artery thrombosis has been induced by an indwelling copper coil.

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1990.tb00977.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1990.tb00978.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1990.tb00979.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY