摘要:

The prospectively collected data of 1,001 multivessel coronary disease patients who underwent percutaneous transluminal coronary angioplasty (PTCA) was analyzed after categorization into single vessel angioplasty (SVA; group I) and multiple vessel angioplasty (MVA; group II) PTCA groups, which were each compartmentalized into “simple” (group A) and “complex” (group B) cohorts. Patients were assigned to the SVA or MVA group according to the physician's pre‐PTCA assessment of how many lesions would be attempted (intention to treat) and not the number of lesions actually attempted. A “simple” patient was more likely than a “complex” patient to be clinically improved after PTCA whether or not the patient had a single dilatation (90% vs 78%; P<0.05) or multiple dilatations (97% vs 94%; P<0.05). Similarly, a lesion(s) was more likely to be successfully dilated in the “simple” than in the “complex” group (SVA: 90% vs 82%, P<0.05; MVA: 97% vs 91%, P<0.05). In addition, occluded vessels in the MVA group were more likely to be recanalized than in the SVA group (73% vs 44%, P<0.05). Group I‐A patients had a significantly increased (10%) incidence of emergency bypass surgery. Follow‐up, at 84 months, showed that “simple” cohorts had a better survival than the “complex” cohorts (MVA: 95% vs 71%, P<0.05; SVA: 90% vs 72%, P<0.05); and, nearly two thirds of all successful PTCA patients were angina free. The acute outcome of PTCA in multivessel coronary disease patients is most likely to be successful in “simple” patient cohorts regardless of the number of lesions dilated. Thus, patients with isolated lesions and no concomitant problems should be part of the interventionist's initial multivessel experience with more complex situations being attempted only after refinement of his/her interventi

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1991.tb01015.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

Over a 2‐year period 192 patients with acute myocardial infarction (AMI) were transported by helicopter and treated with recombinant tissue‐plasminogen activator (tPA). All patients were entered into the Thrombolysis in Myocardial Infarction‐Phase II (TIMI II) trial. Eighty‐two of these patients were treated with tPA after aeromedical transport to a tertiary care center. One hundred ten patients had tPA treatment initiated by the flight crew prior to transport. The flight crews initiated therapy 28 ± 11 minutes after arrival at the sending hospital. The post‐flight treated patients received the tPA bolus 82 ± 20 minutes after arrival at the sending hospital (P<.0001), and 41 ± 18 minutes after arrival at the receiving hospital (P<.0001). Based on enzyme and electrocardiographic changes, all patients in the study had a confirmed diagnosis of AMI before discharge. Patients with inferior myocardial infarction (MI) treated with tPA in‐flight were more likely to suffer from bradycardia and hypotension requiring atropine injection during transport than the post‐flight treated patients or inflight treated patients with anterior MI. There was no in‐flight mortality in either group. Our experience indicates that patients with AMI can be transported safely during tPA therapy. Also, a trained team whose sole responsibility is the early evaluation and initiation of therapy in a patient with AMI can function as accurately and significantly more rapidly than tertiary care emergency department and ICU personnel following i

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1991.tb01016.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

The factors that could reduce the size of particles generated by peripheral (8 Fr) and coronary (5 Fr) Kensey catheters (KC) in calcified and noncalcified atheroma were investigated. Fresh endarterectomy specimens (72 calcified, 72 noncalcified) were inserted in a flow circuit and randomized to undergo simulated dynamic angioplasty using 5 Fr or 8 Fr KC at a range of predetermined cam speeds (20,000–80,000 rpm) and flow rates (18–60 mL/min). Atherectomy as measured by weight loss from the specimen was greater in noncalcified lesions, 21.4 ± 4.5 mg and 14.9 ± 3.8 mg, respectively (P<0.001). In calcified atheroma, the atherectomy was asymmetrical in 38 out of 72 specimens but in only 12 of 72 noncalcified lesions (P<0.01). Overall, 65%± 3.9% of collected particles were smaller than 5 μm and 86.8%± 9.1% were smaller than 35 μm. In the remaining 13.2%± 8.9% of particles larger than 35 μm, significant differences were detected between the maximum particle size in each group. Larger particles were generated from calcified atheroma. In noncalcified lesions, increasing cam speed reduced maximum particle size from 890 to 170 μm (P<0.001). Although a higher flow rate and the use of 5 Fr catheter have also significantly reduced the particle size, their effect was less than that exerted by cam speed. In calcified atheroma, cam speed was the only factor observed to influence the maximal particle size, reducing it from 1,260 to 381 μm (P<0.001). In conclusion, although the majority of particles resulting from the use of KC were small, a proportion of large particles was also detected. Their size could be significantly reduced by careful adjustment of the operating parameters. These results are important for future application of KC in coronary dynamic angioplasty. However, the impact of reducing particle size on the risk of embolism in vivo requires

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1991.tb01017.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

Seven patients (four adults, three children) with discrete subaortic membranous stenosis underwent balloon dilatation procedures using a single or double balloon technique with reduction in systolic gradient across the membrane from 100.42 ± 19.23 to 29.14 ± 72.54 mmHg (P<0.001). Echocar‐diography demonstrated thin membranes in all the patients and postprocedure torn fragments could be visualized. The excellent hemodynamic benefits are sustained during 4–24 months follow‐up. The results indicate that transluminal balloon dilatation can be a safe and effective treatment for thin subaortic m

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1991.tb01018.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

Laser angioplasty using a spherical lensed fiber‐tip laser delivery catheter and a 200 μm bare silica fiber tip was performed in occluded atherosclerotic iliac arteries of miniature swine. Group I consisted of 8 animals with 11 totally occluded arteries in which the bare silica fiber was used. Group II included 22 animals with occlusive lesions in 41 arteries in which the silica lens tip was used. In vivo laser angioplasty was performed in both groups using an argon ion laser delivering 2 to 3 watts of power in 1 to 5 second intervals. Successful recanalization occurred in 7/11 (64%) in group I arteries and 35/41 (85%) in group II arteries. Vascular perforation occurred in 36% (4/11) in group I compared to 10% (4/41) in group II (P<0.05). Mechanical perforation due to the bare fiber alone accounted for 50% of the perforations in group I and did not occur with the silica lens‐tip device (group II). We conclude that the atraumatic lensed fiber is more effective in recanalizing occlusive lesions and is a safer delivery system than the bare silica f

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1991.tb01019.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

Necrotizing enterocolitis is common in preterm and low birth weight infants but rare beyond the neonatal period. Various infectious agents including bacterial and viral organisms have been implicated in its pathogenesis. Rotavirus has recently been shown to be associated with necrotizing enterocolitis. In this report we describe two infants with congenital cardiac disease who developed fulminating necrotizing enterocolitis after cardiac catheterization. Both infants were beyond the newborn period and developed enterocolitis during an epidemic of rotaviral infection. We postulate a relationship between rotavirus infection and the development of necrotizing enterocolitis in older infants with congenital heart disease after cardiac catheterization.

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1991.tb01020.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

The feasibility of using radiofrequency energy for potential ablation of atrial tachycardia foci was assessed by performing transcatheter ablation in the right atrium in 11 closed‐chest dogs. Single‐pulsed radiofrequency (750 kHz) energy was delivered to the right atrium (29–254 J) between the tip electrode of a standard 6 Fr quadripolar catheter and a chest patch electrode. There were no significant arrhythmias or complications noted. Dogs were sacrificed 0–29 days after ablation to assess acute and subacute effects of this technique. Of 47 attempted ablations, 36 well‐delineated coagulative lesions were identified. The lesions had a mean dimension of 5.2 ± 0.57 mm (± SE) in length, 3.9 ± 0.27 mm in width, and 2.6 ± 0.17 mm in depth. Transmural necrosis was noted in 6 of 36 lesions (17%) without perforation. A thin layer of mural thrombus was found in 5 of 36 lesions (14%). Thus, this technique appears to be feasible and relatively safe for right atrial ablations in a short‐term follow‐up period. The potential application of this method to ablate right atrial tachycardia foci needs to be fur

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1991.tb01021.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

This case report describes a patient presenting with a diffuse filiform narrowing of a saphenous vein bypass graft. Since the patient was a poor surgical candidate, the graft failure was treated by conventional balloon angioplasty. Although initially successful, a local, eccentric restenotic lesion reappeared 4 months later; a directional atherectomy of the graft was performed and resulted in a long‐lasting clinical and angiographic success. Although preliminary findings report a similar high restenosis rate for atherectomized grafts, as compared to conventional angioplasty, this case report suggests that such combined mechanical techniques merit further stud

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1991.tb01022.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1991.tb01023.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1991.tb01024.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY