ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1991.tb01002.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

Balloon angioplasty of the coronaries is still limited by the problems of acute complication and restenosis. Percutaneous directional atherectomy was conceived as a method to remove obstructive material from within the vessel. After encouraging results were obtained in peripheral vessels, coronary atherectomy has been selectively performed in 25 patients with lesions either not well suited for PTCA (n = 11), or as a bail‐out after resistant (n = 2) or failed PTCA (n = 12). Twenty‐one LAD lesions (4 ostial, 13 proximal, 2 mid, and 2 bifurcation) and four right coronary artery (RCA) lesions with a mean length of 9 ± 6 mm (19 eccentric, and 6 concentric) could be effectively reduced from 90%± 72% to 18%± 22%. Seventy‐five percent of rescue cases could be spared emergency bypass operation. At 6 months, angiographic restenosis has been documented in 3 out of 11 patients studied to date (27%). Histologically, rescue procedures resulted in the removal of obstructing plaque material and only minimal thrombus. The occurrence of two perforations during rescue procedures, although clinically insignificant, emphasizes the need for judicious excision. In summary, directional atherectomy appears to be useful to treat lesions not well suited for PTC A, and important as a bail‐out method after f

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1991.tb01003.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

The natural history of symptomatic young patients with coronary artery disease is often far from benign. Follow‐up studies of young patients who have undergone coronary bypass graft surgery show frequent recurrence of symptoms and need for reoperation. Prompted by these considerations, we reviewed the records of 23 consecutive patients aged ≤ 35 years with symptomatic coronary artery disease, who underwent coronary balloon angioplasty at our center between August, 1984 and November, 1989. Mean patient age was 32 (3) (mean [SD]) years. Acute myocardial infarction was the first symptom of coronary artery disease in 7 (30%) of the 23 patients. At the time of angioplasty, 17 (74%) patients, had functional Class 3 or 4 anginal symptoms. Eight (35%) had multivessel coronary artery disease (stenoses ≥ 70% in two or more major coronary arteries). Overall, a total of 36 critical coronary lesions were identified in 32 vessels of the 23 patients (mean of 1.6 lesions and 1.4 diseased vessels per patient). At angioplasty, dilatation of 31 lesions in 27 vessels was attempted. Multilesion angioplasty was attempted in 7 (30%) patients. Successful dilatation was achieved in 29 of the 31 (94%) lesions, and 25 of the 27 (93%) vessels. Primary clinical success (successful dilatation of all attempted lesions without any complications) was achieved in 21 of 23 (91%) patients. Three of the 21 patients with successful initial angioplasty had repeat angioplasty for restenosis. In all three, repeat angioplasty was performed 3 months after initial angioplasty and was successful. At a mean follow‐up of 25 (16) (range 5–71) months, 18 of the 21 patients with successful initial angioplasty have remained asymptomatic following one (15 patients) or two (three patients) angioplasty procedures; one patient underwent elective coronary bypass surgery and one patient had a fatal myocardial infarction. Taking into account the often accelerated atherosclerotic disease process in young adults with clinical coronary artery disease, these data suggest coronary balloon angioplasty should be considered favorably in selected young patients with symptomatic obstructive coronary arter

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1991.tb01004.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

To establish the method of coronary laser angioplasty using the argon laser, we investigated the optimal condition of laser ablation and the relationship between the size of laser probe and the diameter of the vessel. First, the relationship between laser energy and tissue reaction to the laser was examined using human cadaveric arteries. Subsequently, we recognized that repeated laser ablation is the optimal method with each shot being limited to 5–10 watts (W) in output and 2 seconds of ablation time when using a metal tip probe (MTP) of 1.5 mm in diameter. According to the experimental condition described above, we examined the response of normal coronary arteries to the laser in vivo. If the size of MTP was not suitable for the diameter of the vessel, thermal constriction of the coronary artery was observed; MTP/vessel diameter ratio should be 0.7 or less to avoid vessel constriction by thermal damage from the laser. Neither perforation nor spasm of the coronary artery was found in this experiment. In addition, the ablated area on the coronary artery was healed completely without thrombus formation and coronary stenosis, and it was covered with new endothelium 8 weeks after laser thermal ablatio

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1991.tb01005.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

To improve the result of peripheral laser recanalization (less perforation with wider tunnels of vaporization), we used the technique of sapphire laser angioplasty, A Nd: YAG laser with continuous emission was connected to a catheter with a 600 †m fiber and a sapphire probe to its extremity (1.8–3 mm in diameter). Treatment was performed on 127 patients with severe stenosis or occlusion of peripheral arteries (iliac, femoral, or popliteal arteries). Recanalization was obtained in 102 cases (80%) and was further embellished by balloon dilatation. The rate of success decreased proportionally with the length of occlusions (93% for 3 cm, 33% for 15 cm and more). Most failures were due to wall perforation or wall entry of the probe; passage of the sapphire tip was rarely blocked by the occlusion. At follow‐up, 26.4% of arteries were reoccluded after 2 months. In conclusion: laser angioplasty with a sapphire tip can totally recanalize occluded arteries with low rate of failure and complica

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1991.tb01006.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

Emergency stent implantation appears to be an effective method for restoring antegrade flow in case of an abrupt coronary occlusion during percutaneous transluminal coronary angioplasty (PTCA). In this case report, hemodynamic and metabolic changes throughout abrupt coronary closure and stent implantation were followed in order to study the efficacy of this bail out technique in restoring metabolic and hemodynamic disturbances due to acute coronary occlusion.

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1991.tb01007.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

An intravascular ultrasonic imaging device (40 MHz) was used to obtain in vitro ultrasonic images and matching histologic cross‐sections, derived from human vascular specimens. The feasibility of assessing vessel wall morphology as well as the ability to accurately document plaque thickness was determined. Based on the echogenicity of the arterial media, intravascular ultrasound could distinguish muscular arteries from elastic arteries, veins, and bypass grafts. The hypoechoic media only present in the muscular type of artery proved to be an essential landmark to document superimposed atherosclerosis. Plaque thickness calculated in these arteries showed close relationship with the corresponding histologic cross‐section. Using real‐time in vivo intravascular imaging (30 MHz), the morphology of the vessels interrogated was studied. The dynamic change of the arterial wall, as well as the outcome after intervention, is disc

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1991.tb01008.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

This study retrospectively examines 38 patients who presented with acute myocardial infarction requiring intraaortic balloon pump counterpulsation. Two groups of patients were identified. Group I consisted of patients with acute myocardial infarction treated with intraaortic balloon pump without thrombolytic therapy. Group II consisted of patients treated with intraaortic balloon pump after receiving intravenous thrombolytic therapy. These groups were compared and contrasted with regard to previously identified complications associated with intraaortic balloon pump counterpulsation including loss of limb and mortality. The need for surgery, embolectomy, and drainage of hematoma were also evaluated. The need for surgery in group II (11%) and in both groups combined (7%) is lower than is generally reported in literature (range 11.6% to 34%). In addition, no patients experienced a loss of limb and no patients in the study had severe life‐threatening iatrogenic morbidity or mortality. While mortality was not an end point in this study, it was noted that there was an increased survival rate in group II patients with 61% surviving until the time of hospital discharge. Also, eight out of 14 patients in group II who underwent intraaortic balloon pump counterpulsation for cardiogenic shock survived until the time of discharge. This represents a 57% survival rate for patients presenting with cardiogenic shock. We conclude that intraaortic balloon pumps can be inserted safely following thrombolytic therapy in a community hospita

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1991.tb01009.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

This study tests the hypothesis that careful control of the composition of the initial reperfusate and the conditions of the reperfusion during emergency CABG will restore immediate segmental contractility in the previously ischemia area despite ischemic intervals of>2 hours. Between January 1987, and October 1990, 41 consecutive patients with acute coronary occlusion (90% due to PTC A failures) were reperfused during emergency myocardial revascularization according to one of two different protocols: in 25 patients the reperfusate was normal blood given at systemic pressure (“uncontrolled reperfusion”); in 16 patients the ischemic segment was reperfused during the first 20 minutes with a regional blood cardioplegic solution (substrate‐enriched, hyperosmotic, hypocalcemic, alkalotic, diltiazem‐containing) at 37°C at a pressure of 50 mmHg. Thereafter, total bypass was prolonged for an additional 30 minutes before extracorporeal circulation was discontinued (“controlled reperfusion”). Assessment of regional contractility (echocardiography, radionuclide ventriculography), electrocar‐diographic evidence of myocardial infarction, release of CK and CK‐MB enzymes, and hospital mortality were performed. Quantification of regional contractility was done with a scoring system from 0 (normokinesis) to 4 (dyskinesis). Data are expressed as mean ± standard error of the mean. Both groups were well matched for age, sex, and the distribution of the occluded artery. In the controlled reperfusion group there was a higher incidence of previous infarctions (50% vs 30%), additional significant stenosis (1.1 ± 0.2 vs 0.8 ± 0.1), and cardiogenic shock (38% vs 20%) as compared to uncontrolled reperfusion. Furthermore, the interval between coronary occlusion and reperfusion was significantly longer in the controlled reperfusion group (3.9 ± 0.3 vs 2.2 ± 0.3 hr, P<0.05) with a range between 2 and 6 hours. Regional contractility (assessed on the 7thpostoperative day) returned to normal in all patients treated by controlled reperfusion (wall motion score = 0.6 ± 0.2, normokinesis = 0, slight hypokinesis = 1). In contrast, regional contractility remained severely depressed after uncontrolled reperfusion (score 2.5 ± 0.2, P<0.05) with only 4 out of 25 patients having a score<2(2 = severe hypokinesis). Postoperatively, enzymes and ECG changes showed fewer abnormalities in the controlled reperfusion group but these differences did not reach statistical significance. One patient died of mitral insufficiency in the controlled reperfusion group, despite complete recovery of wall motion in the PTCA related artery (1 out of 16). Conversely, the 4 out of 25 deaths after uncontrolled reperfusion occurred in patients that sustained infarct in the area of the coronary occlusion (mortality 6% vs 16%). In conclusion, these results indicate that wall‐motion abnormalities can be avoided after PTCA failure if the initial reperfusion is controlled during emergency CABG. Further clinical studies comparing controlled and uncontrolled reperfusion in patients after acute coronary occlusion caused by

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1991.tb01010.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

In two patients with massive pulmonary embolism and cardiogenic shock requiring mechanical ventilation and prolonged external cardiac massage, occluded pulmonary arteries were recanalized by primary mechanical fragmentation of thrombi using a percutaneously inserted catheter followed by fibrinolytic therapy. The hemodynamic and respiratory parameters rapidly and greatly improved. Pulmonary angiography before discharge revealed normal results in both patients. No central neurological abnormalities were detected. It is concluded that patients with cardiogenic shock due to massive pulmonary embolism may benefit from immediate mechanical thrombus fragmentation followed by fibrinolysis when thrombolysis or surgical embolectomy are strictly contraindicated or not available.

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1991.tb01011.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY