ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1989.tb00767.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

Following successful application in chronic peripheral artery occlusions, rotational angioplasty was refined and miniaturized for application in patients with chronic coronary artery occlusions. The new catheter system comprises a motor‐driven rotating inner steel catheter made up of several steel coils providing maximum elasticity and complete torque control with an olive‐like rounded tip (1.0–1.7 mm). The catheter has a lumen for contrast injection and a shielding plastic tube. It is introduced through a conventional 8 Fr guiding catheter. The slowly rotating (200 RPM) catheter passes nontraumatically through the occlusions, thus creating a new channel with smooth contours in a “remodeling” fashion. Once the channel (diameter 1–1.5 mm) is confirmed angiographically, balloon angioplasty is performed over an exchange wire in conventional technique. The new technique was applied to patients with chronic coronary occlusions. Reopening was first attempted with conventional guidewire technique. If the occlusion could be probed with the guidewire, patients were excluded from the study. Twenty patients in whom the occlusion could not be probed with a wire were studied: 1 ACVB, 2 LAD, and 17 RCA. Average duration of occlusion was 7.4 months; it exceeded 3 months in 15/20 and 6 months in 12/20 patients. Successful reopening was achieved in 9/20 (3 from the first 10, 6 from the second 10 patients). No vessel wall perforation or any other severe complication was encountered. Residual stenosis diameter ranged from 30%–70%. Duration of occlusion was similar among patients from the successful and unsuccessful group. It is concluded that with low speed rotational angioplasty reopening of chronic coronary artery occlusions can be achieved in a considerable part of patients in whom conventional technique is unsuccessful. (J Interven Car

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1989.tb00768.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

Bifurcation stenoses have been recognized to be at a “high risk” for acute closure during percutaneous transluminal coronary angioplasty. Development of advanced techniques using simultaneous (“kissing”) balloon inflation or sequential balloon inflations, using two guidewires to preserve access to both branches while avoiding the trauma produced by inflating two balloons in a small artery simultaneously, has allowed safe and effective dilatation of bifurcation stenoses. Little is known, however, about the restenosis rate and pattern of bifurcation stenoses. This article reports on 44 patients who were treated successfully using the sequential inflation technique on their bifurcation stenoses. A total of 88 lesions were dilated. Restenosis occurred in 25 of the 88 lesions (28%) within 8.5 ± 2.25 months. Eleven patients had restenosis in one vessel while seven patients had restenosis in both branches (18 of 44–41%). All 18 underwent a second PTCA attempt and 15 patients had successful repeat PTCA. Thus, the primary restenosis rate in bifurcation stenosis is acceptably low, occurring in both branches in a minority of cases (7/18). The total restenosis rate is no greater than expected with single vessel PTCA. Repeat PTCA is usually easily accomplished with good secondary success, aided by the fact that the majority of the restenoses involve only one rather than both branches of the bifurcation stenosis. (J Interven Cardio

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1989.tb00769.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

Arterial injury during routine percutaneous trans‐luminal coronary angioplasty (PTCA) may stimulate clotting mechanisms. Excessive (i.e., angiographically visible) arterial trauma might accordingly predispose to a greater tendency for thrombosis. This study evaluates whether arterial trauma (i.e., angiographically visible intimal tears and arterial dissections) is related to evidence of active thrombosis. Fibrinopeptide A (FPA), a sensitive marker of thrombin activity, was measured in 79 patients undergoing elective PTCA immediately following angioplasty, as well as prior to hospital discharge (mean 2 days post‐PTCA). Levels>2.0 ng/mL were considered elevated. Intimal tears were visualized in 41 patients. Of these 41, 31 had elevated FPA levels (sensitivity = 0.76). This association between FPA elevation and intimal tears was significant (P = 0.033). Of the remaining 38 patients without intimal tears, 20 had elevated FPA levels (specificity = 0.47). Concomitant arterial dissection, as well as an intimal tear, was found in four patients with elevated FPA and in one patient with normal FPA. Conclusion. Arterial trauma during PTCA is accompanied by a greater degree of ongoing thrombosis. Although FPA elevation was not specific for intimal tears, a highly significant association with intimal tears was observed. Further study may yield even more specific hematologic parameters on ongoing early thrombosis following PTCA, particularly in patients with intimal tears. (J Interven Cardiol 1989:

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1989.tb00770.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

We studied the safety and efficacy of thrombolytic therapy for acute myocardial infarction initiated prior to ambulance transport. Two treatment regimens were compared in a prospective design: 40 patients (group A) received intravenous streptokinase 5 ± 105IU (SK‐IV) prior to and during ambulance transport and were compared with 36 patients (group B) in whom the same dosage of streptokinase was given after arrival in our hospital. In all patients immediate coronary angiography was performed, followed by intracoronary streptokinase administration. Infarct size was assessed by cumulative release of α‐hydroxybutyrate dehydrogenase. Apart from three episodes of ventricular fibrillation no procedure‐related complications occurred during transport. Median time to SK‐IV was 70 minutes in group A versus 125 minutes in group B (P<0.001). At first visualization the infarct‐related vessel was patent in 23 patients (58%) in group A and in 6 patients (17%) in group B (P<0.001). Anterior wall infarction median infarct size in group A was 32% smaller than that in group B (P<0.05). We conclude that SK‐IV started before ambulance transport is safe, accelerates early reperfusion rate, and consequently leads to a further limitation of infarct size in patients with anterior wall infarction. (J Interven Car

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1989.tb00771.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

Although implantation of defibrillator patch electrodes (DP) has been shown not to impair systolic function, their influence on diastolic function has not been elucidated. The aim of this study was to examine left ventricular filling sequentially in a group of patients before and after DP implantation. Doppler evaluation of mitral diastolic flow was used to assess left ventricular (LV) filling. Studies were performed preoperatively, after attaining hemodynamic stability postoperatively, and at subsequent follow‐up (mean 9 weeks) in 13 patients. Patients undergoing cardiac surgery other than DP implantation and coronary artery bypass grafting were excluded, as were those with significant valvular heart disease. Immediately postoperatively, there was a reduction of deceleration time (0.26 ± 0.02 to 0.21 ± 0.01 sec, P<0.05), consistent with mild impairment of LV filling, but the remaining parameters remained unchanged. At late follow‐up, significant increases were recorded in time to peak filling (0.17 ± 0.01 to 0.25 ± 0.03 sec, P<0.01), isovolumic relaxation time (0.07 ± 0.01 to 0.13 ± 0.02 sec, P<0.005), while peak passive filling velocity decreased (1.02 ± 0.09 to 0.82 ± 0.07 m/sec, P<0.05), all consistent with impairment of LV filling. We conclude that implantation of DP is associated with detectable impairment of LV filling at 2 months after surgery. (J Interven Cardi

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1989.tb00772.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1989.tb00773.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1989.tb00774.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY