ISSN:0098-6569    

DOI:10.1002/ccd.1810340402

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

年代:1995

数据来源: WILEY

摘要:

AbstractThis report represents the first guidelines for prevention, diagnosis, and treatment of anaphylactoid reactions to contrast media occurring specifically during cardiac catheterization. The incidence of contrast media complications in the catheterization laboratory is 0.23% with 1 death per 55,000. Anaphylactoid reactions are nonimmune mediated, but histamine release and other mediators produce a clinical presentation indistinguishable from anaphylaxis. In patients with known previous reactions, pretreatment with steroids and diphenhydramine and the use of nonionic contrast media have significantly reduced the potential of recurrent reaction. Minor reactions such as limited urticaria may be watched for progression or treatment with diphenhydramine, whereas more serious reactions such as angioedema or laryngeal edema require airway stability and ephinephrine administration. Shock should be vigorously treated simultaneously with intravenous epinephrine and large volumes of normal saline. If the patient can be stabilized, the study should be completed as histamine, leukotrienes, and other vasoactive products should be relatively depleted.

ISSN:0098-6569    

DOI:10.1002/ccd.1810340403

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.1810340404

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

年代:1995

数据来源: WILEY

摘要:

AbstractProlonged intravascular infusion of urokinase has proven beneficial in reestablishing patency of chronically occluded peripheral arteries and saphenous vein grafts. This study was performed to assess the efficacy and safety of prolonged urokinase infusions as a prelude to angioplasty in chronically occluded native coronary arteries, that had failed standard angioplasty techniques. Twenty‐five patients with objective evidence for ischemia in the distribution of a chronic coronary occlusion were referred for percutaneous intervention. Patients were assessed for any potential exclusions from lytic therapy. Urokinase infusion through both a SOS wire and a stable guiding catheter was continued at 100,00–240,000 units/hr for 8–25 hr; patents then underwent attempted balloon angioplasty. Mean duration of urokinase infusion was 20.6 ± 7.7 hr (total dose 163,000 ± 52,447 units/hr). Fibrinogen levels dropped slightly with this (300 ± 129 to 203 ± 81 mg/dl,P= 0.02). Angiography posturokinase showed improvement in 7 (28%) with regard to coronary flow (± 1 TIMI‐grade). Angioplasty was successful in 13 (52%), with final angiographic result revealing thrombus in 5 (20%), or dissection 8 (32%). The infusions were well‐tolerated with a low incidence of chest pain, 2 (8%); or ischemic ECG response, 2 (8%); myocardial infarction, 2 (8%); or significant bleeding 2 (8%). All patients survived the procedure, with a length‐of‐hospital stay = 5.1 ± 4 days. Use of prolonged preangioplasty intracoronary urokinase infusion can be done safely with success in roughly one‐half of patients with chronic total native coronary occlusions who have failed prior attempts at percutaneous intervention. A larger more rigorously designed protocol is required to make specific recommendations about technique, cost, an

ISSN:0098-6569    

DOI:10.1002/ccd.1810340405

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.1810340406

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

年代:1995

数据来源: WILEY

摘要:

AbstractTo evaluate the efficacy, safety, and long‐term results of atherectomy using the Transluminal Extraction catheter (TEC®), patients with diseased saphenous vein grafts were enrolled in a prospective nonrandomized trial. Patients were followed to hospital discharge for acute complications and underwent routine 6‐mo reevaluation with repeat cardiac catheterization to assess restenosis.Atherectomy was performed on 650 graft lesions in 538 consecutive patients (male 81%; mean age 66 yr; range 37–81). Mean graft age was 8.3 yr; (range 0.3–20) with 85% of grafts>3 yr of age. Complex lesion morphology included thrombus (28%), ulceration (13%), and eccentricity (50%). Lesion success was achieved in 606 lesions (93%) with clinical success in 479 patients (89%). Lesion success was achieved in 90% of thrombus containing lesions, 97% of ulcerated lesions, and 97% of grafts>3 yr. Complications included nonfatal myocardial infarction in 4 (0.7%) of patients, emergency bypass surgery in 2 (0.41%), and in‐hospital death in 17 patients (3.2%). Angiographic follow‐up at 6 mo was obtained from 268 lesions in 227 patients. The overall lesion angiographic restenosis rate was 60%.TEC® atherectomy can be performed in patients with diseased saphenous vein grafts with high primary success and low complication rates. It is suitable for use in aged grafts, particularly in the presence of thrombus and ulcerations, and may be superior to balloon angioplasty alone in this grou

ISSN:0098-6569    

DOI:10.1002/ccd.1810340407

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.1810340408

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

年代:1995

数据来源: WILEY

摘要:

AbstractA total of 110 half (disarticulated) Palmaz‐Schatz coronary stents were implanted in 102 patients. Procedural success rate was 98%. Elective stenting was performed in five patients. The others received half stents for bail‐out situations, including short dissections, relapsing stenoses, dissections not adequately covered by a full stent, ostial stenoses, and thrombus containing lesions. Seventeen patients received no anticoagulation except aspirin. Complications included one procedural death, three acute occlusions (resulting in one Q and two non‐Q wave myocardial infarctions), and one non‐Q wave infarction related to side branch closure.Stenting with the half Palmaz‐Schatz coronary stent is an effective technique. It allows stenting in situations where a full stent may not be ideally suited. Use of only half a stent reduces thrombogenicity and hal

ISSN:0098-6569    

DOI:10.1002/ccd.1810340409

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

年代:1995

数据来源: WILEY

摘要:

AbstractIn order to compare the efficacy of two different stent types in case of bailout stenting, 65 patients, with abrupt or threatened vessel closure following coronary angioplasty, were randomly assigned to either Wiktor (Medtronic Inc., Minneapolis, MN, 33 patients) or Palmaz‐Schatz (Johnson&Johnson Interventional, Warren, NJ, 32 patients) stent implantation. Stenting was technically feasible in all except one patient and immediately successful in reverting ischemia and vessel closure in 60 patients (92%). At hospital discharge, complication rates were comparable: early vessel closure, 18% (Wiktor) versus 13% (Palmaz‐Schatz) (P=0.53); any clinical event (such as death, myocardial infarction, and surgical revascularization): 18% (Wiktor) versus 22% (Palmaz‐Schatz) (P=0.71). At 6 months follow‐up, these complication rates remained equal: restenosis, 38% (Wiktor) versus 27% (Palmaz‐Schatz) (P=0.42); any clinical and angiographic (vessel closure and restenosis) event: 45% (Wiktor) and 41% (Palmaz‐Schatz) (P=0.69). Baseline, direct postprocedural, and follow‐up quantitative coronary analysis data were similar, with, however, an exception for the postprocedural residual stenosis [28% (24‐32%) (Wiktor) and 21% (18‐23%) (Palmaz‐Schatz] (means and 95% confidence intervals). In conclusion, despite a discrete postprocedural angiographic benefit observed with the Palmaz‐Schatz stent, the long‐term clinical and angiographic outcome is similar in both treatment groups. The choice whether to implant a Wiktor or Palmaz‐Schatz stent may probably be left to the discretion of the operator and his experience w

ISSN:0098-6569    

DOI:10.1002/ccd.1810340410

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

年代:1995

数据来源: WILEY

摘要:

AbstractIntravascular ultrasound (IVUS) allows accurate assessment of stent deployment, its use being confined to the use of 8 French (F) guiding catheters. We evaluated the feasibility of combining transradial artery Palmaz‐Schatz stent implantation through 6F guiding catheters with IVUS for assessment of stent diameter after delivery at moderate inflation pressures (10‐12 atmospheres [atm]) with compliant balloons and after high pressure dilatations with balloons of intermediate compliance. In 8 consecutive patients, 12 stents were delivered with Scimed® ExpressTMballoon catheters at 10‐12 atm followed by IVUS (EndoSonics® CathScanner; Visions® FX 3.5F 20 MHz transducer). An ultrasound study was repeated after high pressure dilatations (16‐20 atm) with Schneider® Magical SpeedyTMballoon catheters. The balloon diameters were derived from manufacturer provided specifications. In all patients the transducer could easily be advanced through the guiding catheters. Reference diameter of the stented segment was 3.7 ± 0.5 mm (2.7‐4.5) and the diameter of Scimed® ExpressTMballoons during inflation was 4.0 ± 0.3 mm (3.6‐4.7). Stent diameter was 3.0 ± 0.1 mm (2.8‐3.2) (P<0.001 compared to the reference and the balloon diameter). The diameter of the Schneide® Magical SpeedyTMballoons at secondary dilatations with 16 ± 3 atm (14‐20) was 4.1 ± 0.4 mm (3.3‐4.5) (P= 0.50 compared to the initial balloon diameter). Final stent diameter was 3.3 ± 0.4 mm (2.9‐4.1) (P= 0.02 compared to the initial stent diameter). All stents were symmetrically deployed and well apposed. No damage to vessel or stents was detected after passage of the transducer. Thus ultrasound guided stenting via 6F guiding catheters is feasible, and high pressure dilatations with balloons of intermediate compliance results in better stent expansion than after 10‐12 atm inflations

ISSN:0098-6569    

DOI:10.1002/ccd.1810340411

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

年代:1995

数据来源: WILEY