ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1990.tb00963.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

Seventy‐six patients presenting within 6 hours of the onset of an acute myocardial infarction were randomized to either treatment with 1.5 million units of Streptokinase or 100 mg of recombinant tissue plasminogen activator intravenously. Patients not demonstrating clinical reperfusion within 1 hour were taken emergently for “salvage” angioplasty or coronary bypass surgery. Those patients demonstrating clinical reperfusion underwent early (12 to 72 hours) elective angiography and either elective angioplasty or bypass surgery. The mean time from pain onset to treatment was 149 minutes in the Streptokinase group and 134 minutes in the recombinant tissue plasminogen activator group (P = NS). There were no statistical differences between groups with regard to prior myocardial infarction, infarct location, prior coronary bypass surgery and Killip classification. Clinical reperfusion was demonstrated in 56% of the Streptokinase group and 53% of the recombinant tissue plasminogen activator group (P ‐ NS). Angiographic patency was demonstrated in 70% of the Streptokinase group and 66% of the recombinant tissue plasminogen activator group (P = NS). Left ventricular ejection fraction at discharge was no different: 47% in the Streptokinase group and 43% in the recombinant tissue plasminogen activator group (P = NS). Recurrent ischemic events were found more often in the recombinant tissue plasminogen activator group, 18%, versus the Streptokinase group 3% (P = 0.05). Treatment outcomes did not differ between groups. There was one (3%) death in the Streptokinase group versus two (6%) deaths in the recombinant tissue plasminogen activator group (P = NS). There was a trend toward a greater need for emergent coronary bypass surgery after attempted angioplasty in the recombinant tissue plasminogen activator group, four of 18 patients (22%) versus one of 23 patients (4%) in the Streptokinase group (P = 0.14). In summary, in the setting of acute myocardial infarction treated by thrombolysis, those patients treated with recombinant tissue plasminogen activator experienced significantly more recurrent ischemic events and required emergent coronary bypass surgery more frequently for failed angioplasty compared to those treated with Streptokinase. The results suggest there may be agent specific increases in complications dependent upon the thrombolytic agent of choice when salvage or early coronary angioplasty

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1990.tb00964.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

Due to the recent emergence of adjunctive techniques such as cardiopulmonary bypass support, left main angioplasty may become more routinely applied in the near future. In order to choose the best possible therapy, a precise risk assessment will be desirable. Twenty‐two left main angioplasties were thus reviewed and patients were divided in two groups according to a risk score adapted from a previously published jeopardy score. Group I included patients with a risk score ≤ 6 and group II patients with a risk score>6. A cutoff criterion of six points was chosen because it represents the maximal amount of myocardium put at jeopardy from a single coronary stenosis. The success rate of the procedure was 77% and was similar in both groups. Of the 12 patients in group I, two patients underwent in‐hospital bypass surgery and one of them died. Among the ten patients of group II, one sustained a myocardial infarction, three underwent acute surgery, and one patient died postoperatively. After a mean follow‐up of 41 months, the total mortality rate was 17% in group I and 30% in group II. The long‐term event‐free survival rate was 75% in group I and 10% in group II (P = 0.004). The risk score was found to be a potentially important predictor of sustained success (long‐term success: 4.4 ± 2.9 vs no long‐term success: 8.3 ± 3.4; P = 0.01), although sophisticated statistical analysis was limited by the small number of patients. Thus, in patients with a low risk score, angioplasty seems to be an appropriate treatment while it appears that surgery should remain the standard therapy for patients with a calculated high risk score. However, the clinical significance of this new risk score remains to be determined with more elaborate statistical analysis applied to a larger n

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1990.tb00965.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

Sixteen balloon expandable Medtronic Wiktor tantalum stents were implanted in the major coronary arteries of six minipigs, which were maintained on a normal diet and given 500 mg aspirin per day. Angiographic and histologic examinations were performed 6 and 26 weeks after implantation. Angiographically reviewed, stenting increased the inner diameter of the coronary arteries from 2.61 ± 0.44 to 3.02 ± 0.34 mm (n = 16, P ≤ 0.001). Six weeks later, this value was reduced from 2.98 ± 0.35 to 2.33 ± 0.46 mm (n = 9, P ≤ 0.05), and between 6 and 26 weeks, an increase from 2.17 ± 0.44 to 2.93 ± 0.40 mm occurred (n = 6, P ≤ 0.05). Histologic evaluation at 26 weeks after stent implantation revealed an increase of the cross‐sectional area of the total vessel from 4.30 ± 1.09 to 5.50 ± 1.67 mm2(n = 9; P ≤ 0.01). This was due to widening of the total vessel and intimal proliferation, which amounted to 1.19 ± 0.46 mm2within the stented segment, as compared to 0.03 ± 0.03 mm2in control sections (P ≤ 0.01). The areas of free vessel lumen, media muscularis, and adventitia remained unchanged. In 15 of the 16 hislologically examined coronary arteries, the internal elastica was fractured at the site of stent implantation. Twelve stents had also penetrated through the external elastica without evidence of wall hemorrhage. Thirteen out of 16 stents were angiographically followed, of which 12 were patent at the final reangiography. In one animal, acute thrombosis of the stented vessel after guidewire induced coronary artery spasm caused chronic right heart failure due to right ventricular myocardial infarction. Sudden death occurred in another pig 2 hours after successful implantation of three grossly oversized stents (inner vessel diameter: 2.4 ± 0.2 mm, stent diameter 3.2 ± 0.5 mm). Autopsy revealed extensive dissections of the media with subsequent vessel occlusion. It is concluded that Medtronic Wiktor stents can be placed easily, even in more distal or curved coronary arteries. Despite antiaggregational medication, intimal proliferation is observed early after implantation, reaches a maximum at about 6 weeks, and is followed by a regression 26 weeks poststenting. At 26 weeks follow‐up, the free vessel lumen at the stent site was not significantly reduced as compared to control segments. Proper adjustment of internal vessel diameter and stent diameter is necessary to prevent major dissections

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1990.tb00966.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

Simultaneous recordings of left ventricular (LV) and central aortic pressures (AO) provide the greatest accuracy for determination of the transaortic pressure difference. We describe a very simple technique for simultaneous measurement of LV and AO pressures using a new, dual lumen pressure monitoring catheter. Using this device, we compared simultaneous LV and AO as well as LV and femoral artery (FA) pressures before and after aortic valvuloplasty in seven consecutive patients. The difference between the mean aortic gradient or aortic valve area determined by the LV‐AO and LV‐FA measurement techniques was not statistically significant. Our initial experience with the double lumen pigtail catheter indicates that this device facilitates direct measurement of the LV‐AO pressure gradient and eliminates the need for two arterial punctures, a transseplal approach or alignment of LV and FA pressure c

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1990.tb00967.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

A practical, simple and cheap technique using a guidewire loop for transvenous measurement of the size of a patent foramen ovate is presented. We applied this device in four patients without complication. To clear a suspected cause of paradoxical embolism was the indication of this procedure. Sizes between 16 and 4 mm were documented. We conclude that this technique may be of value in determining criteria for surgical closure or for the evaluation of transcatheter obliteration in hemodynamically nonrelevant atrial septal defects.

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1990.tb00968.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY

摘要:

In three patients undergoing mitral balloon valvuloplasty for mitral stenosis transesophageal echocardiography was performed before, immediately after, and 6 months after the procedure. In the one patient with persistent hemodynamically favorable result, the spontaneous echocardiographic contrast, which was seen in all three preoperatively, did not recur; in the other two patients the phenomenon was observed again after 6 months. We conclude that the disappearance of spontaneous echocardiographic contrast might be a functional morphological measure of sustained hemodynamic improvement after balloon mitral valvuloplasty.

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1990.tb00969.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.tb00970.x

出版商:Blackwell Publishing Ltd    

年代:1990

数据来源: WILEY