ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1988.tb00383.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

Three successive time periods were compared to study the impact of evolving techniques and new equipment on the immediate results of single‐vessel percutaneous transluminal coronary angioplasty (PTCA), the initial success rate and major complication rate (death, myocardial infarction, and urgent surgery). The three periods were selected on the basis of a significant advance in either PTCA technique or equipment. In period I from 1980 to 1983 a nonsteerable catheter system was used. In period II from 1983 to 1986 a steer‐able catheter was used. In period HI from 1986 to 1987 the long guidewire technique and/or monorail system was used. A total of 1,371 successive patients underwent single‐vessel dilatation for stable angina (848 patients) or for unstable angina (523 patients). Initial success was defined as a reduction of the stenosis to less than 50% with no major complications (myocardial infarction or death, or the necessity of proceeding to coronary artery bypass surgery). The initial success rate increased from 68% (period I) to 88% (period II) and to 91% (period III) for all attempts. When attempts of dilatation of totally occluded vessels were excluded these figures were 71%, 91%, and 95%, respectively. The overall major complication rate decreased from 16% (period I) to 8% (period II) to 3.5% (period III). Thus, increase in investigator experience, technical improvements of balloon catheter systems, and introduction of new PTCA techniques have resulted in an increase in success and safety of PTCA procedures. (J Inter‐ven Cardiol 1

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1988.tb00384.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

When a “culprit lesion” can be identified in a patient with unstable angina, it may be possible to achieve clinical improvement with incomplete revascularization. We analyzed actuarial survival free of an event (severe angina, myocardial infarction, coronary artery bypass graft, or death) at 6, 12, 18, and 24 months in 83 patients with multi‐vessel disease and unstable angina who had undergone successful percutaneous transluminal coronary angioplasty (PTCA); revascularization was complete in 31 patients and incomplete in 52. Event‐free survival in 85 patients with single‐vessel disease and unstable angina who had undergone successful PTCA also was analyzed. Event‐free survival at 24 months was worse in the multivessel disease patients than in the single‐vessel disease patients (62% vs 85%; P = 0.001). Multivessel disease patients with complete revascularization had the same event‐free survival as those with incomplete revascularization (63% vs 61%; P NS). Diagnostic angiograms revealed thrombus or an irregular ulcerated lesion in 42 of the multivessel disease patients. The event‐free survival of these 42 patients was not different from that of the multivessel disease patients as a whole (64% vs 60%; P NS). We conclude that in patients with multivessel disease and unstable angina the event‐free survival after PTCA is poorer than in patients with single‐vessel disease and unstable angina. In the former patients, event‐free survival does not necessarily depend on the completeness of revascularization. The outcome of patients who have intra‐coronary thrombus or an irregular ulcerated lesion resembles the outcome of patients who lack these findings. (J I

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1988.tb00385.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

Intracoronary blood flow velocity measurements with a Doppler probe and the radiographic assessment of myocardial perfusion with contrast media previously have been used to investigate regional coronary flow reserve. In the present study we applied both techniques in the same patients to measure the immediate improvement in coronary flow reserve as a result of angioplasty. In addition we compared papaverine induced hyperemia with reactive hyperemia following transient transluminal occlusion of a major coronary artery. In 13 consecutive patients with a single proximal stenosis, coronary flow reserve was measured pre‐ and postangioplasty by digital subtraction cineangiography, while pre‐ and postangioplasty Doppler measurements before and after papaverine were obtained in the proximal part of the stenotic vessel. After the last transluminal occlusion, reactive hyperemia recorded with the Doppler probe was also compared to the coronary flow reserve measurement obtained during papaverine induced hyperemia. As a result of the angioplasty, coronary flow reserve measured with the radiographic technique (mean ± SD) increased from 1.1 ± 0.4 to 2.2 ± 0.4 (P<0.001), while coronary flow reserve measured with the Doppler probe (mean ± SD) increased from 1.2 ± 0.3 to 2.4 ± 0.4 (P<0.001). Pharmacologically induced hyperemia measured with the radiographic technique and the Doppler probe were linearly related (r = 0.91 with a SEE 0.3) and confirmed the reliability of the intracoronary measurements. Using these two independent techniques, coronary flow reserve immediately after angioplasty was found to be substantially improved but still abnormal. In addition, the magnitude of hyperemia induced by papaverine was comparable to the reactive hyperemia following transluminal occlusion, although the latter measurement was recorded with the angioplasty catheter still across the dilated lesion. (J Interven Cardiol,

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1988.tb00386.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

Between July 1985 and July 1987, 18 consecutive adult patients with congenital pulmonary stenosis underwent pulmonary balloon valvuloplasty (PBV). There were 11 males and 7 females, aged 15–45 years (mean 25). A double balloon technique was used in 14 patients and a single balloon in four. The size of the balloon used was 0.9 to 1.4 times the size of the pulmonary annulus. Eleven patients were restudied by repeat cardiac catheterization 6 months later. Student's t‐test was used for comparison of data. Right ventricular (R V) systolic pressure before dilatation ranged from 84 to 180 (mean 123 ± 28.3) mmHg and the right ventricular to pulmonary artery (PA) peak systolic gradient ranged from 60 to 165 (mean 105 ± 30.2) mmHg. Immediately after dilatation, the RVsystolic pressure dropped to 30–80 (mean 53 ± 14.2) mmHg (P<0.001). RV to PA peak systolic gradient dropped to 10–57 (mean 32 ± 14.2) mmHg (P<0.001). A restudy of 11 patients 6 months later showed a further drop of RV systolic pressure to 35–65 (mean 49 ± 11.3) mmHg (P<0.05). RV to PA peak systolic gradient continued to drop to 10–48 (mean 26 ± 11.3) mmHg (P<0.01). Cardiac index improved from 2.68 ± 0.73 to 3.03 ± 0.40 L/min/m2, P<0.05. No complication was noted apart from either sinus bradycardia or extrasystole in a few patients. It was noted that balloon to annulus ratios of 1.1 to 1.4 produced sustained relief of the pulmonary valve stenosis. We concluded that PBV is the treatment of choice for congenital pulmonary stenosis. It reduced the hospital stay to 2 days and avoids the ri±k of open heart surgery. (J Inter

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1988.tb00387.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

The pressure drop over a coronary stenosis and the intracoronary Doppler blood flow velocity were measured at rest and during coronary vasodilation. We report the first observation that confirms the validity of fluid dynamic equations to describe the hemodynamics of a coronary stenosis based on quantitative arteriography in a human being. (J Interven Cardiol 1988:1:1)

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1988.tb00388.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

To examine the direct effects of nitroglycerin (NTG) on anterior regional coronary blòod flow, electrocardiographic and hemodynamic responses were measured immediately before, during, and after brief coronary occlusion in 17 patients undergoing left anterior descending coronary angioplasty (PTCA). Hemodynamic data and the time from the onset of coronary occlusion to 1.0 mm ST elevation or depression were compared for matched control and NTG occlusion periods. Ten seconds before the “NTG” occlusion, 200 μg of NTG was injected into the left coronary artery. Baseline and occlusion level great cardiac vein flow (thermodilution) was similar for both occlusion periods (93 ± 27 to 59 ± 23 mL/min for control; 95 ± 27 to 56 ± 22 mL/min for NTG occlusion). NTG reduced mean arterial pressure (91 ± 11 to 82 ± 15 mmHg, P<0.05) during increased basal great vein flow (95 ± 27 to 127 ± 54 mL/min p<0.01) immediately prior to occlusion. Great vein hyperemic flow after release of occlusion increased 21 ± 30% versus 36 ± 40% (P = ns) after control occlusion. There were no differences in heart rate or systolic‐heart rate pressure products, time to ischemic ST‐T wave changes or the maximal hyperemic responses from the control occlusion. These data suggest that during the initial minutes of coronary occlusion, the marked but transient coronary vasodilation induced by intracoronary NTG does not significantly modulate myocardial ischemia or regional coronary blood flow responses. The clinical benefits of NTG during PTCA most likely occur more through other mechanisms than direct myocardial flow augmentation. (J Interve

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1988.tb00389.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

Since it was first developed, the laser has had applications in medicine and surgery. Continued progress in fiber optics has allowed researchers to explore the potential use of the laser in cardiovascular diseases. Most of the effort has been devoted to building appropriate lasers and delivery systems to recanalize atherosclerotic obstructions of the coronary and peripheral arteries. Early clinical investigations have demonstrated the potential of lasers to remove atherosclerotic plaque during intraoperative bypass surgery and to assist percutaneous transluminal balloon angioplasty. Other investigations into the clinical use of lasers for vascular anastomosis, ablation of refractory ventricular arrhythmias after electrical recording, and palliative treatment of newborn infants with congenital problems hold promise. While early studies and recent technological advances appear encouraging, much more work and improvements are needed before lasers can gain acceptance as a potent clinical tool in the treatment of cardiovascular diseases. (J Interven Cardiol: 1988:1:1)

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1988.tb00390.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY

摘要:

We have developed a complete excimer laser and fiber‐optic angioplasty system and successfully opened completely occluded blood vessels in humans. We use the 308 nm XeCL excimer laser and fiber‐optic delivery system that can be passed through a catheter or over a guidewire. In this article, we describe the knowledge essential for the interventionalist using the device: the method for generating 308 nm laser light, laser‐tissue interaction, healing after laser injury, and how the rate of laser ablation is controlled. Our initial experience using the excimer laser in the superficial femoral artery has been excellent. (J of Interv Cardiology; 198

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1988.tb00391.x

出版商:Blackwell Publishing Ltd    

年代:1988

数据来源: WILEY