ISSN:0098-6569    

DOI:10.1002/ccd.1810340102

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1995

数据来源: WILEY

摘要:

AbstractPre‐existing intracoronary thrombus has been associated with an increased risk of percutaneous transluminal coronary angioplasty (PTCA) failure. Whether intracoronary thrombus is an independent risk factor for failure is uncertain, as conflicting data exist in the literature. Additionally, given advances in patient selection and angioplasty ballon design, it is uncertain whether the current risk posed by intracoronary thrombus is as substantial as that in the early angioplasty experience.The primary objective of this study was to first assess whether pre‐existing coronary thrombus was an independent predictor of angioplasty failure and if so, whether the risk due to thrombus had changed from the early angioplasty experience to the present time. Our prospectively collected angioplasty data base was used to identify individuals undergoing single‐vessel angioplasty of a thrombus‐containing segment from January 1, 1984 through December 1, 1991. Univariate and multivariate stepwise logistic regression techniques were utilized to analyze clinical, angiographic, and procedural characteristics associated with angioplasty failure. The study period was divided into three separate time periods and these used as variables in our multivariate analysis.In the study population that consisted of 2,699 patients with single‐vessel angioplasty, univariate analysis demonstrated that among many factors, thrombus was importantly associated with angioplasty failure (P<0.0001). A multivariate logistic model of angioplasty failure was developed and thrombus achieved independent predictive significance in this model. Analysis with respect to time showed no variation in the importance of thrombus between our earliest angioplasty experience and that achieved in the last 2 years of the study period.Pre‐existing coronary thrombus is a risk factor for angioplasty failure which is independent of other clinical, anatomic, and procedural factors. The importance of this risk factor has not changed in our practice between 19

ISSN:0098-6569    

DOI:10.1002/ccd.1810340103

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1995

数据来源: WILEY

摘要:

AbstractClinical experience with the use of intracoronary tissue plasminogen activator (t‐PA) is limited. We therefore undertook this study to document current clinical usage of intracoronary t‐PA during a 2‐yr period in a multicenter registry. Intracoronary t‐PA was utilized on 206 occasions in 198 patients (154 men and 44 women; mean age, 59 ± 12 yr). The mean dose of intracoronary t‐PA was 31 ± 15 mg. Indications for use included acute myocardial infarction (MI) (n = 83), preexisting thrombus with (n = 49) or without (n = 41) percutaneous transluminal coronary angioplasty (PTCA), unstable angina (n = 14), abrupt vessel closure (n = 11), and post‐PTCA “clean‐up” (n = 8). The Thombolysis in Myocardial Infarction (TIMI Phase I) criteria were used to assess perfusion and degree of thrombus formation. Overall, the mean TIMI flow grade increased from 1.2 ± 1.1 before treatment to 2.3 ± 1.0 after treatment (P<0.0001); the mean TIMI thrombus grade decreased from 3.2 ± 1.0 before treatment to 1.6 ± 1.4 after treatment (P<0.0001). Complications included bleeding (9.2%), MI (17.6%), need for coronary artery bypass grafting (CABG) (9.2%), need for repeat PTCA/atherectomy/stents (4.9%), and ventricular fibrillation (1.7%, all associated with opening totally occluded vessels). There were 14 subsequent in‐hospital deaths: 13 of the patients who died had originally presented with MI; the other had experienced abrupt vessel closure during a PTCA procedure.Intracoronary t‐PA appears to be effective in improving distal flow and decreasing thrombus burden; however, intracoronary delivery of t‐PA has associated risks. Further prospective evaluations of intracoronary t‐PA will be necessary to determine the optimal clinical situations for its use, as well

ISSN:0098-6569    

DOI:10.1002/ccd.1810340104

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1995

数据来源: WILEY

摘要:

AbstractTo determine if slow inflation or slow deflation (compared to standard rapid inflation/ deflation) would minimize coronary arterial dissection, we randomized 162 lesions from 136 patients undergoing coronary angioplasty with polyolefin copolymer balloons to slow oscillating (1 atmosphere/20 sec) vs. rapid (over 30 sec) inflation and slow (over 15 sec) vs. rapid deflation. The incidence of any dissection was nearly identical in the four inflation/deflation groups. The incidence of severe dissection, however, was significantly higher for the slow inflation/slow deflation group compared to the other three groups (38% vs. 15%,P= .024). For angioplasty performed with polyolefin copolymer balloons, slow deflation combined with slow oscillating inflation is associated with more frequent severe dissections.

ISSN:0098-6569    

DOI:10.1002/ccd.1810340105

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1995

数据来源: WILEY

摘要:

AbstractWe undertook a randomized controlled trial comparing VasoSealTM, a collagen vascular hemostasis device (VHD), with manual compression to assess its role and potential cost savings in the PTCA population. Of 460 patients, 359 were excluded due to clinical instability (30%), groin problems (18%), suboptimal PTCA result (15%), and other reasons (37%). The remaining 101 patients were randomized to either VHD (51) or manual compression (50). Hemostasis time, time to ambulation, duration of hospital stay, and nursing time and intensity were significantly reduced in the VHD group. There were no major groin complications in either treatment arm but there was a trend toward more minor groin complications in the VHD patients. The application of VasoSealTMreduced resource use in this randomized study and may translate into significant cost reductions in the general coronary angioplasty population.

ISSN:0098-6569    

DOI:10.1002/ccd.1810340106

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1995

数据来源: WILEY

摘要:

AbstractWe discuss a unique case of an angiosarcoma which arose in an atherosclerotic coronary artery. It was widely metastatic. We describe the angiographic findings and their differential diagnosis, and briefly discuss this relatively common cardiac malignancy.

ISSN:0098-6569    

DOI:10.1002/ccd.1810340107

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1995

数据来源: WILEY

ISSN:0098-6569    

DOI:10.1002/ccd.1810340108

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1995

数据来源: WILEY

摘要:

AbstractMitral incompetence (MR) is a complication of balloon mitral valvuloplasty. There are few reports of long‐term outcome. We beleive this is the first report in the literature of complete resolution during follow‐up of severe mitral regurgitation resulting from balloon valvulopla

ISSN:0098-6569    

DOI:10.1002/ccd.1810340109

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1995

数据来源: WILEY

ISSN:0098-6569    

DOI:10.1002/ccd.1810340110

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1995

数据来源: WILEY

摘要:

AbstractRetroperitoneal hemorrhage and associated hematoma is a rare but potentially life threatening complication of cardiac catheterization and coronary artery interventions. This case presents the potential diagnostic utility of a supine film of the abdomen for early identification of a retroperitoneal hematoma in a patient following acute infarction PTCA.

ISSN:0098-6569    

DOI:10.1002/ccd.1810340111

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1995

数据来源: WILEY