WorldWideScience

Sample records for coronary angioplasty balloon

  1. Absence of Bacteria on Coronary Angioplasty Balloons from Unselected Patients

    DEFF Research Database (Denmark)

    Hansen, Gorm Mørk; Nilsson, Martin; Nielsen, Claus Henrik

    2015-01-01

    if bacterial DNA from primarily oral bacteria could be detected on coronary angioplasty balloons by use of an optimized sampling process combined with an internally validated sensitive polymerase chain reaction (PCR) assay. Coronary angioplasty balloons and control samples from a total of 45 unselected...... angioplasty balloons are unlikely to be useful for detection of bacteria with current PCR techniques in unselected patients with coronary artery disease, more studies are warranted to determine the extent to which bacteria contribute to atherosclerosis and its clinical manifestations and whether the presence......, and translocation of bacteria from the oral cavity to the coronary arteries may play a role in the development of coronary artery disease. Very few studies have used angioplasty balloons for in vivo sampling from diseased coronary arteries, and with varying results. Therefore, the aim of this study was to assess...

  2. AUTOPERFUSION BALLOON CATHETER FOR COMPLICATED CORONARY ANGIOPLASTY - A PROSPECTIVE-STUDY WITH RETROSPECTIVE CONTROLS

    NARCIS (Netherlands)

    DEMUINCK, ED; VANDIJK, RB; DENHEIJER, P; MEEDER, JG; LIE, KI

    1992-01-01

    Prolonged angioplasty balloon inflation with an autoperfusion balloon for failed conventional coronary angioplasty, was compared with emergency surgery for this condition. Restenosis was assessed 6 weeks after successful intervention with the autoperfusion balloon. Forty consecutive patients with pe

  3. AUTOPERFUSION BALLOON CATHETER FOR COMPLICATED CORONARY ANGIOPLASTY - A PROSPECTIVE-STUDY WITH RETROSPECTIVE CONTROLS

    NARCIS (Netherlands)

    DEMUINCK, ED; VANDIJK, RB; DENHEIJER, P; MEEDER, JG; LIE, KI

    1992-01-01

    Prolonged angioplasty balloon inflation with an autoperfusion balloon for failed conventional coronary angioplasty, was compared with emergency surgery for this condition. Restenosis was assessed 6 weeks after successful intervention with the autoperfusion balloon. Forty consecutive patients with

  4. A randomized comparison of balloon angioplasty versus rotational atherectomy in complex coronary lesions (COBRA study)

    National Research Council Canada - National Science Library

    Dill, T; Dietz, U; Hamm, C W; Küchler, R; Rupprecht, H J; Haude, M; Cyran, J; Ozbek, C; Kuck, K H; Berger, J; Erbel, R

    2000-01-01

    .... The Comparison of Balloon-Angioplasty versus Rotational Atherectomy study (COBRA) is a multicentre, prospective, randomized trial to compare short- and long-term effects of percutaneous transluminal coronary angioplasty (PTCA...

  5. A comparison of balloon-expandable-stent implantation with balloon angioplasty in patients with coronary artery disease. Benestent Study Group.

    OpenAIRE

    Serruys, P.W.; de Jaegere, P; Kiemeneij, F.; Macaya, C; Rutsch, W; Heyndrickx, G.; Emanuelsson, H.; Marco, J.; Legrand, Victor; Materne, P.

    1994-01-01

    BACKGROUND: Balloon-expandable coronary-artery stents were developed to prevent coronary restenosis after coronary angioplasty. These devices hold coronary vessels open at sites that have been dilated. However, it is unknown whether stenting improves long-term angiographic and clinical outcomes as compared with standard balloon angioplasty. METHODS: A total of 520 patients with stable angina and a single coronary-artery lesion were randomly assigned to either stent implantation (262 patients)...

  6. Prevention of restenosis after coronary balloon angioplasty: rationale and design of the Fluvavastatin Angioplasty Restenosis (FLARE) Trial

    NARCIS (Netherlands)

    J.J.R.M. Bonnier (Hans); G. Jackson (Graham); C.M. Miguel (Carlos); J. Shepherd; M.C. Vrolix (Mathias); P.W.J.C. Serruys (Patrick); D.P. Foley (David)

    1994-01-01

    textabstractPrevention of restenosis after successful percutaneous transluminal coronary balloon angioplasty (PTCA) continues to present the greatest therapeutic challenge in interventional cardiology. Experimental and pathological studies describe restenosis as no more than the biologic healing res

  7. A comparison of balloon-expandable-stent implantation with balloon angioplasty in patients with coronary artery disease

    NARCIS (Netherlands)

    P.W.J.C. Serruys (Patrick); P.P.T. de Jaegere (Peter); F. Kiemeneij (Ferdinand); C.M. Miguel (Carlos); W.R. Rutsch (Wolfgang); G.R. Heyndrickx (Guy); H.U. Emanuelsson (Hakan); J. Marco (Jean); V.M.G. Legrand (Victor); P.H. Materne (Phillipe); J.A. Belardi (Jorge); U. Sigwart (Ulrich); A. Colombo (Antonio); J-J. Goy (Jean-Jacques); P.A. van den Heuvel (Paul); J. Delcan; M-A.M. Morel (Marie-Angèle)

    1994-01-01

    textabstractBalloon-expandable coronary-artery stents were developed to prevent coronary restenosis after coronary angioplasty. These devices hold coronary vessels open at sites that have been dilated. However, it is unknown whether stenting improves long-term angiographic and clinical outcomes as c

  8. A comparison of balloon-expandable-stent implantation with balloon angioplasty in patients with coronary artery disease.

    NARCIS (Netherlands)

    P.W.J.C. Serruys (Patrick); P.P.T. de Jaegere (Peter); F. Kiemeneij (Ferdinand); C.M. Miguel (Carlos); W.R. Rutsch (Wolfgang); G.R. Heyndrickx (Guy); H.U. Emanuelsson (Hakan); J. Marco (Jean); V.M.G. Legrand (Victor); P.H. Materne (Phillipe); J.A. Belardi (Jorge); U. Sigwart (Ulrich); A. Colombo (Antonio); J-J. Goy (Jean-Jacques); P. van den Heuvel; J. Delcan; M-A.M. Morel (Marie-Angèle)

    1994-01-01

    textabstractBACKGROUND. Balloon-expandable coronary-artery stents were developed to prevent coronary restenosis after coronary angioplasty. These devices hold coronary vessels open at sites that have been dilated. However, it is unknown whether stenting improves long-term angiographic and clinical o

  9. Usefulness of repeat coronary angiography 24 hours after balloon angioplasty to evaluate early lminal deterioration and facilitate quantitative analysis

    NARCIS (Netherlands)

    G.R. Heyndrickx (Guy); G-J. Laarman (GertJan); H. Suryapranata (Harry); F. Zijlstra (Felix); P.W.J.C. Serruys (Patrick); D.P. Foley (David); A.A. van den Bos (Arjan); J.W. Deckers (Jaap)

    1993-01-01

    textabstractBecause of the unavoidable occurrence of vessel disruption after successful coronary balloon angioplasty, the reliability of quantitative angiographic analysis in that setting has been questioned. For this reason and the suggested occurrence of delayed elastic recoil, repeat angiography

  10. Distal coronary hemoperfusion during percutaneous transluminal coronary angioplasty

    NARCIS (Netherlands)

    deMuinck, ED; denHeijer, P; vanDijk, RB; Crijns, HJGM; Hillige, HL; Lie, KI

    1996-01-01

    Distal coronary hemoperfusion during percutaneous transluminal coronary angioplasty (PTCA)-with an autoperfusion balloon or active system-facilitates prolonged balloon inflation. Prolonged inflations may tack up intimal dissections and improve the primary angioplasty result in complex lesions. Addit

  11. A randomized comparison of balloon angioplasty versus rotational atherectomy in complex coronary lesions (COBRA study).

    Science.gov (United States)

    Dill, T; Dietz, U; Hamm, C W; Küchler, R; Rupprecht, H J; Haude, M; Cyran, J; Ozbek, C; Kuck, K H; Berger, J; Erbel, R

    2000-11-01

    Rotablation is a widely used technique for the treatment of complex coronary artery lesions but is so far only poorly supported by controlled studies. The Comparison of Balloon-Angioplasty versus Rotational Atherectomy study (COBRA) is a multicentre, prospective, randomized trial to compare short- and long-term effects of percutaneous transluminal coronary angioplasty (PTCA) and rotablation in patients with angiographically pre-defined complex coronary artery lesions. At seven clinical sites 502 patients with pre-defined complex coronary artery lesions were assigned to either PTCA (n=250) or rotablation (n=252). Primary end-points were procedural success, 6-month restenosis rates in the treated segments, and major cardiac events during follow-up. Procedural success was achieved in 78% (PTCA), and 85% (rotablation) (P=0.038) of cases. Crossover from PTCA to rotablation was 4% and 10% vice versa (P=0.019). There was no difference between PTCA and rotablation with respect to procedure-related complications such as Q wave infarctions (2.4% each), emergency bypass surgery (1.2% versus 2.4%), and death (1.6% versus 0.4%). However, more stents were required after PTCA (14.9% versus 6.4%, P<0.002), predominantly for bailout or unsatisfactory results. Including bail-out stents as an end-point, the procedural success rates were 73% for angioplasty and 84% for rotablation (P=0.006). At 6 months, symptomatic outcome, target vessel reinterventions and restenosis rates (PTCA 51% versus rotablation 49%, P=0.33) were not different. Complex coronary artery lesions can be treated with a high level of success and low complication rates either by PTCA with adjunctive stenting or rotablation. The long-term clinical and angiographic outcome is comparable.

  12. Preliminary experience with drug-coated balloon angioplasty in primary percutaneous coronary intervention

    Institute of Scientific and Technical Information of China (English)

    Hee; Hwa; Ho; Julian; Tan; Yau; Wei; Ooi; Kwok; Kong; Loh; Than; Htike; Aung; Nwe; Tun; Yin; Dasdo; Antonius; Sinaga; Fahim; Haider; Jafary; Paul; Jau; Lueng; Ong

    2015-01-01

    We evaluated the clinical feasibility of using drugcoated balloon(DCB) angioplasty in patients undergoingprimary percutaneous coronary intervention(PPCI). Between January 2010 to September 2014,89 STelevation myocardial infarction patients(83% male,mean age 59 ± 14 years) with a total of 89 coronary lesions were treated with DCB during PPCI. Clinical outcomes are reported at 30 d follow-up. Left anterior descending artery was the most common target vessel for PCI(37%). Twenty-eight percent of the patients had underlying diabetes mellitus. Mean left ventricular ejection fraction was 44% ± 11%. DCB-only PCI was the predominant approach(96%) with the remaining 4% of patients receiving bail-out stenting. Thrombolysis in Myocardial Infarction(TIMI) 3 flow was successfully restored in 98% of patients. An average of 1.2 ± 0.5 DCB were used per patient,with mean DCB diameter of 2.6 ± 0.5 mm and average length of 23.2 ± 10.2 mm. At 30-d follow-up,there were 4 deaths(4.5%). No patients experienced abrupt closure of the infarctrelated artery and there was no reported target-lesion failure. Our preliminary experience showed that DCB angioplasty in PPCI was feasible and associated with a high rate of TIMI 3 flow and low 30-d ischaemic event.

  13. Transradial artery coronary angioplasty.

    Science.gov (United States)

    Kiemeneij, F; Laarman, G J; de Melker, E

    1995-01-01

    This study explored the feasibility and safety of percutaneous coronary balloon angioplasty (PTCA) with miniaturized PTCA equipment via the radial artery. Coronary angioplasty (PTCA) via the femoral or brachial arteries may be associated with rare vascular complications such as bleeding and damage to the artery and adjacent structures. It was postulated that PTCA via the radial artery with miniaturized angioplasty equipment is feasible and that no major puncture site-related complications occur because hemostasis is obtained easily and because no major structures are near the radial artery. With double blood supply to the hand, radial artery occlusion is well tolerated. In 100 patients with collateral blood supply to the right hand, PTCA was attempted with 6F guiding catheters and rapid-exchange balloon catheters for exertional angina (87 patients) or nonexertional angina (13 patients). Angioplasty was attempted in 122 lesions (type A n = 67 [55%], Type B n = 37 [30%], and type C n = 18 [15%]). Pre- and post-PTCA computerized quantitative coronary analysis was performed. Radial artery function and structure were assessed clinically and with Doppler and two-dimensional ultrasound on the day of discharge. Coronary catheterization via the radial artery was successful in 94 patients (94%). The 6 remaining patients had successful PTCA via the femoral artery (n = 5) or the brachial artery (n = 1). Procedural success (120 of 122 lesions) was achieved in 92 patients (98%) via the radial artery and in 98 patients of the total study population.(ABSTRACT TRUNCATED AT 250 WORDS)

  14. Absence of Bacteria on Coronary Angioplasty Balloons from Unselected Patients: Results with Use of a High Sensitivity Polymerase Chain Reaction Assay.

    Science.gov (United States)

    Hansen, Gorm Mørk; Nilsson, Martin; Nielsen, Claus Henrik; Holmstrup, Palle; Helqvist, Steffen; Tolker-Nielsen, Tim; Givskov, Michael; Hansen, Peter Riis

    2015-01-01

    Periodontitis is a chronic, bacterially-induced inflammatory disease of the tooth-supporting tissues, which may result in transient bacteremia and a systemic inflammatory response. Periodontitis is associated with coronary artery disease independently of established cardiovascular risk factors, and translocation of bacteria from the oral cavity to the coronary arteries may play a role in the development of coronary artery disease. Very few studies have used angioplasty balloons for in vivo sampling from diseased coronary arteries, and with varying results. Therefore, the aim of this study was to assess if bacterial DNA from primarily oral bacteria could be detected on coronary angioplasty balloons by use of an optimized sampling process combined with an internally validated sensitive polymerase chain reaction (PCR) assay. Coronary angioplasty balloons and control samples from a total of 45 unselected patients with stable angina, unstable angina/non-ST elevation myocardial infarction, and ST-elevation myocardial infarction (n = 15 in each group) were collected and analyzed using a PCR assay with high sensitivity and specificity for 16S rRNA genes of the oral microbiome. Despite elimination of extraction and purification steps, and demonstration of sensitivity levels of 25-125 colony forming units (CFU), we did not detect bacterial DNA from any of the coronary angioplasty balloons. A subsequent questionnaire indicated that the prevalence of periodontitis in the study cohort was at least 39.5%. Although coronary angioplasty balloons are unlikely to be useful for detection of bacteria with current PCR techniques in unselected patients with coronary artery disease, more studies are warranted to determine the extent to which bacteria contribute to atherosclerosis and its clinical manifestations and whether the presence of bacteria in the arteries is a transient phenomenon.

  15. Cutting balloon angioplasty for intrastent restenosis treatment

    Directory of Open Access Journals (Sweden)

    João Orávio de Freitas Jr

    1999-05-01

    Full Text Available We describe here two patients with angiographic diagnosis of intrastent restenosis and regional myocardial ischemia. One stent restenosis was located in a native coronary artery and the other in a vein graft. Both were treated with cutting balloon angioplasty (CBA, inflated at low pressures. Angiographic success was obtained and both patients were discharged in the day after the procedure. Cutting balloon angioplasty using low inflation pressures achieved important luminal gains, in these two cases of intrastent restenosis. Further studies are necessary before the effectiveness of this procedure can be precisely defined.

  16. Lumen narrowing after percutaneous transluminal coronary balloon angioplasty follows a near gaussian distribution: a quantitative angiographic study in 1,445 successfully dilated lesions

    NARCIS (Netherlands)

    B.J.W.M. Rensing (Benno); W.R.M. Hermans (Walter); P.J. de Feyter (Pim); J.G.P. Tijssen (Jan); P.W.J.C. Serruys (Patrick); J.W. Deckers (Jaap)

    1992-01-01

    textabstractTo determine whether significant angiographic narrowing and restenosis after successful coronary balloon angioplasty is a specific disease entity occurring in a subset of dilated lesions or whether it is the tail end of a gaussian distributed phenomenon, 1,445 successfully dilated lesion

  17. Angioplasty and stent - heart - discharge

    Science.gov (United States)

    Drug-eluting stents - discharge; PCI - discharge; Percutaneous coronary intervention - discharge; Balloon angioplasty - discharge; Coronary angioplasty - discharge; Coronary artery angioplasty - discharge; Cardiac ...

  18. Angiographic risk factors of luminal narrowing after coronary balloon angioplasty using balloon measurements to reflect stretch and elastic recoil at the dilation site. The CARPORT Study Group

    NARCIS (Netherlands)

    B.J.W.M. Rensing (Benno); W.R.M. Hermans (Walter); J. Vos (Jeroen); K.J. Beatt (Kevin); P.M.M. Bossuyt (Patrick); W.R. Rutsch (Wolfgang); P.W.J.C. Serruys (Patrick)

    1992-01-01

    textabstractBecause many ongoing clinical restenosis prevention trials are using quantitative angiography to assess whether a drug is capable of reducing the amount of intimal hyperplasia, quantitative angiographic risk factors for angiographic luminal narrowing after balloon angioplasty were determ

  19. Angiographic risk factors of luminal narrowing after coronary balloon angioplasty using balloon measurements to reflect stretch and elastic recoil at the dilatation site

    NARCIS (Netherlands)

    B.J.W.M. Rensing (Benno); W.R.M. Hermans (Walter); J. Vos (Jeroen); K.J. Beatt (Kevin); P.M.M. Bossuyt (Patrick); W.R. Rutsch (Wolfgang); P.W.J.C. Serruys (Patrick)

    1992-01-01

    textabstractAbstract Because many ongoing clinical restenosis prevention trials are using quantitative angiography to assess whether a drug is capable of reducing the amount of intimal hyperplasia, quantitative angiographic risk factors for angiographic luminal narrowing after balloon angioplasty

  20. Pseudoperforation during kissing balloon angioplasty.

    Science.gov (United States)

    Panetta, Carmelo J; Fasseas, Panayotis; Raveendran, Ganesh; Garratt, Kirk N

    2004-11-01

    We describe a case of apparent perforation during kissing balloon angioplasty of a bifurcation lesion. There was no evidence of perforation on follow-up angiography or via intravascular ultrasound. Possible etiologies include minimal perforation that immediately sealed postdeflation or forced contrast into the microvascular bed via a proximal side branch.

  1. Distal coronary hemoperfusion during percutaneous transluminal coronary angioplasty

    NARCIS (Netherlands)

    Muinck, Ebo Derk de

    1994-01-01

    In this thesis several aspects of passive and active coronary perfusion during coronary angioplasty are investigated. The autoperfusion balloon catheters that were evaluated are the Stack® and the RX-60® catheters (Advanced Cardiovascular Systems, inc., Santa Clara, California, U.S.A). The coronary

  2. Distal coronary hemoperfusion during percutaneous transluminal coronary angioplasty

    NARCIS (Netherlands)

    Muinck, Ebo Derk de

    1994-01-01

    In this thesis several aspects of passive and active coronary perfusion during coronary angioplasty are investigated. The autoperfusion balloon catheters that were evaluated are the Stack® and the RX-60® catheters (Advanced Cardiovascular Systems, inc., Santa Clara, California, U.S.A). The coronary

  3. Percutaneous transluminal angioplasty and stenting of the vertebral artery ostium with balloon-mounted bare coronary stents

    Directory of Open Access Journals (Sweden)

    Javad Kojuri

    2011-01-01

    Full Text Available Background : Vertebral artery ostial stenosis (VAOS is one of the most frequent causes of posterior circulation stroke. Percutaneous angioplasty and stenting (PTAS is one of the treatment modalities. Patients and Methods : This is a longitudinal observational study from September 2006 to February 2009, conducted at hospitals affiliated with the Shiraz University of Medical Sciences, Shiraz, southern Iran. The patient cohort included patients with posterior circulation stroke or transient ischemic attack (TIA and more than 70% VAOS, and patients with asymptomatic VAOS of more than 70% and aplasia or total occlusion of the contralateral VA or subclavian artery. All the patients underwent PTAS with balloon-mounted bare coronary stents. Technical success, procedural complications, composite outcomes of death, stroke or TIA in the vertebrobasilar territory during the first 30 days, stroke or TIA in the vertebrobasilar territory, and restenosis during follow-up, were assessed. Results : During the study period, 81 patients (mean age 68 + 8.9 years, 63 (78% males, 71 symptomatic and 18 asymptomatic underwent the procedure. Technical success was achieved in 88 (99% patients. Procedure-related complications, other than puncture site complications, were seen in two patients (2.2%. The composite outcome of death, stroke or TIA in the vertebrobasilar territory during the first 30 days was 1%. None of the patients had clinical recurrence or restenosis during the follow-up (mean follow-up 14 months. Conclusion : Percutaneous transluminal angioplasty and stenting of the proximal VA was feasible and safe. The risk of restenosis should be analyzed in long-term studies with angiographic follow-up.

  4. Management of failed angioplasty with laser balloon angioplasty

    Science.gov (United States)

    Jenkins, Ronald D.; Spears, J. Richard

    1990-07-01

    Laser balloon angioplasty (LBA) is a technique for improving the post angioplasty result by the radial diffusion of continuous wave Neodymium:YAG laser energy to the arterial wall during the final inflation of percutaneous transluminal coronary angioplasty (PTCA). Potential mechanisms of luminal improvement include sealing of dissections, reduction of arterial recoil, desiccation of thrombus, and reduction of thrombogenicity of tissues at the luminal surface. These effects are helpful in the management of failed PTCA as defined by the presence of a greater than 50% stenosis after conventional PTCA. Preliminary data suggest that LBA may be safe and effective for the treatment of abrupt closure, with a majority of patients successfully avoiding emergency coronary artery bypass surgery. Similarly, a cohort in which the residual post-PTCA luminal diameter was less than 50% of reference diameter (n=13) was subsequently treated with LBA and demonstrated uniform success in improving luminal diameter, with a mean increment of 0.9mm. Data on the long-term clinical outcome of this cohort is encouraging.

  5. A Rare and Serious Unforeseen Complication of Cutting Balloon Angioplasty

    Directory of Open Access Journals (Sweden)

    Praveen Vemula

    2014-01-01

    Full Text Available Cutting balloon angioplasty (CBA is one of the adept ways of treating “in-stent restenosis.” Various complications related to cutting balloon angioplasty have been reported including arterial rupture, delayed perforation and fracture of microsurgical blades. Here we report a very unusual and inadvertent extraction of a stent previously deployed in the ramus intermedius coronary branch by a cutting balloon catheter. This required repeat stenting of the same site for an underlying dissection. Even though stent extraction is a rare complication it can be serious due to dissection, perforation, and closure of the artery. Physicians performing coronary artery interventions would need to be aware of this rare and serious complication especially if any difficulty is encountered while withdrawing the cutting balloon. Therefore, after removal, cutting balloon should be examined thoroughly for possible stent dislodgment or extraction when used for “in-stent restenosis.”

  6. Cutting balloon angioplasty vs. conventional balloon angioplasty in patients receiving intracoronary brachytherapy for the treatment of in-stent restenosis.

    Science.gov (United States)

    Fasseas, Panayotis; Orford, James L; Lennon, Ryan; O'Neill, Jessica; Denktas, Ali E; Panetta, Carmelo J; Berger, Peter B; Holmes, David R

    2004-10-01

    The objective of this study was to evaluate the safety and efficacy of cutting balloon angioplasty (CBA) for the treatment of in-stent restenosis prior to intracoronary brachytherapy (ICB). Cutting balloon angioplasty may reduce the incidence of uncontrolled dissection requiring adjunctive stenting and may limit "melon seeding" and geographic miss in patients with in-stent restenosis who are subsequently treated with ICB. We performed a retrospective case-control analysis of 134 consecutive patients with in-stent restenosis who were treated with ICB preceded by either CBA or conventional balloon angioplasty. We identified 44 patients who underwent CBA and ICB, and 90 control patients who underwent conventional percutaneous transluminal coronary angioplasty (PTCA) and ICB for the treatment of in-stent restenosis. Adjunctive coronary stenting was performed in 13 patients (29.5%) in the CBA/ICB group and 41 patients (45.6%; P 0.05). Despite sound theoretical reasons why CBA may be better than conventional balloon angioplasty for treatment of in-stent restenosis with ICB, and despite a reduction in the need for adjunctive coronary stenting, we were unable to identify differences in clinical outcome.

  7. MYOCARDIAL PROTECTION DURING CORONARY ANGIOPLASTY WITH AUTOPERFUSION AND FORCED PERFUSION - AN IN-VITRO COMPARISON

    NARCIS (Netherlands)

    DEMUINCK, ED; VERKERKE, BJ; RAKHORST, G; LIE, KI

    1994-01-01

    During coronary angioplasty, perfusion distal to the inflated angioplasty balloon can be maintained with autoperfusion balloon catheters and coronary perfusion pumps. The blood flow rates through the autoperfusion balloon catheters and the flow rates achieved with a perfusion pump were compared in v

  8. Early and late effects of coumarin therapy started before percutaneous coronary intervention: Clinical, angiographic and cost-effective outcome of the Balloon Angioplasty and Anticoagulation Study (BAAS).

    Science.gov (United States)

    Ten Berg, J M; Kelder, J C; Suttorp, M J; Mast, E G; Bal, E T; Ernst, J M P G; Plokker, H W M

    2002-05-01

    Coronary angioplasty frequently creates a thrombogenic surface with subsequent mural thrombosis that may lead to acute complications and possibly stimulates the development of restenosis. Whether coumarins can prevent these complications is unclear. In the Balloon Angioplasty and Anticoagulation Study (BAAS), the effect of coumarins started before the procedure on early and late outcome was studied. Patients were randomised to aspirin only or to aspirin plus coumarins. Half of the patients were randomised to undergo six-month angiographic follow-up. Study medication was started one week before coronary angioplasty and the target international normalised ratio (INR) was 2.1-4.8 during angioplasty and six-month follow-up. 'Optimal' anticoagulation was defined as an INR in the target range for at least 70% of the follow-up time. In addition, cost-effectiveness of coumarin treatment was measured. At one year death, myocardial infarction, target-lesion revascularisation and stroke were observed in 14.3% of the 530 patients randomised to aspirin plus coumarin versus in 20.3% of the 528 patients randomised to aspirin alone (relative risk 0.71; 95% CI 0.54-0.93). The incidence of major bleedings and false aneurysms during hospitalisation was 3.2% and 1.0%, respectively, (relative risk 3.39; 95% CI 1.26-9.11). Optimal anticoagulation was an independent predictor of late thrombotic events (relative risk, 0.33; 95% CI, 0.19-0.57). Quantitative coronary analysis was performed of 301 lesions in the ASA group and of 297 lesions in the coumarin group. At six months, the minimal luminal diameter was similar in the ASA and coumarin group. However, optimal anticoagulation was an independent predictor of angiographic outcome at six months. Optimal anticoagulation led to a 0.21 mm (95% CI: 0.05-0.37) larger MLD as compared with suboptimal anticoagulation whereas aspirin use led to a 0.12 mm (95% CI -0.28-0.04) smaller MLD. When including all costs, the savings associated with coumarin

  9. Regional differences in elastic recoil after percutaneous transluminal coronary angioplasty: a quantitative angiographic study

    NARCIS (Netherlands)

    B.J.W.M. Rensing (Benno); B.H. Strauss (Bradley); P.W.J.C. Serruys (Patrick); W.R.M. Hermans (Walter)

    1991-01-01

    textabstractThe immediate result of percutaneous transluminal coronary angioplasty is influenced by both plastic and elastic changes of the vessel wall. To evaluate the amount of elastic recoil after coronary balloon angioplasty, the minimal luminal cross-sectional area of the largest balloon used a

  10. High prevalence of severe coronary artery disease in elderly patients with non-operable chronic thromboembolic pulmonary hypertension referred for balloon pulmonary angioplasty

    Directory of Open Access Journals (Sweden)

    Marek Roik

    2016-11-01

    Full Text Available Introduction : Balloon pulmonary angioplasty (BPA is a new emerging catheter-based alternative treatment option for patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH. Aim : To show that all elderly CTEPH patients referred for BPA are at higher risk of obstructive coronary artery disease and that, in daily practice, they should undergo invasive coronary angiography. Material and methods : Eleven patients at the age of at least 65 years (6 males, 5 females, 77.2 ±5.9 years with confirmed non-operable type II or type III CTEPH, considered for BPA, underwent elective coronary angiography. Severe obstructive coronary artery disease (CAD was diagnosed when stenosis of left main coronary artery ≥ 50% or stenosis of ≥ 70% of epicardial arteries was angiographically confirmed. We also screened for CAD consecutive age- and sex-matched 114 PE survivors (52 males, 62 females, 74.8 ±7.2 years with excluded CTEPH. Results : Severe CAD was more frequent in elderly patients with non-operable type II or type III CTEPH candidates for BPA than in elderly acute PE survivors with excluded CTEPH (54.5% vs. 16.7%, p < 0.01, and therefore elderly CTEPH patients referred for BPA were at higher risk of CAD (OR = 5.9, 95% CI: 1.64–21.46, p = 0.007 when compared to elderly survivors after acute PE with excluded CTEPH. Conclusions : All elderly CTEPH patients referred for BPA are at higher risk of severe CAD and should routinely undergo invasive coronary angiography before BPA.

  11. The use of primary stenting or balloon percutaneous transluminal coronary angioplasty for the treatment of acutely occluded saphenous vein grafts. Results from the Brazilian National Registry - CENIC

    Directory of Open Access Journals (Sweden)

    Luiz Alberto Mattos

    2001-06-01

    Full Text Available OBJECTIVE: We conducted a comparative analysis of the in-hospital outcomes of patients who underwent primary percutaneous transluminal angioplasty (PTCA or stent implantation because of an acute myocardial infarction (AMI related to an acute vein graft occlusion. METHODS: Since 1991 the Brazilian Society of Hemodynamic and Interventional Cardiology has maintained a large database (CENIC. From these, we selected all consecutive patients, who underwent primary PTCA or stenting in the first 24 hours of AMI, with the target vessel being an occluded vein graft. Immediate results and major coronary events occurring up until hospital discharge were analyzed. RESULTS: During this period, 5,932 patients underwent primary PTCA or stenting; 158 (3% of the procedures were performed because of an acute vein graft occlusion. Stenting was performed in 74 (47% patients. Patients treated with stents had a higher success rate and lower mean residual stenosis compared with those who underwent primary balloon PTCA. The incidence of reinfarction and death were similar for stenting and balloon PTCA. CONCLUSION: Primary percutaneous treatment of AMI related to acute vein graft occlusion is still an uncommon practice. Primary stenting improved luminal diameter and offered higher rates of success; however, this strategy did not reduce the in-hospital reinfarction and death rate, compared with that occurring with PTCA treatment.

  12. Cost-effectiveness of paclitaxel-coated balloon angioplasty and paclitaxel-eluting stent implantation for treatment of coronary in-stent restenosis in patients with stable coronary artery disease.

    Science.gov (United States)

    Bonaventura, Klaus; Leber, Alexander W; Sohns, Christian; Roser, Mattias; Boldt, Leif-Hendrik; Kleber, Franz X; Haverkamp, Wilhelm; Dorenkamp, Marc

    2012-07-01

    Recent studies have demonstrated the safety and efficacy of drug-coated balloon (DCB) angioplasty for the treatment of coronary in-stent restenosis (ISR). The cost-effectiveness of this practice is unknown. A Markov state-transition decision analytic model accounting for varying procedural efficacy rates, complication rates, and cost estimates was developed to compare DCB angioplasty with drug-eluting stent (DES) placement in patients with bare-metal stent (BMS)-ISR. Data on procedural outcomes associated with both treatment strategies were derived from the literature, and the cost analysis was conducted from a health care payer perspective. Effectiveness was expressed as life-years gained. In the base-case analysis, initial procedure costs amounted to €3,604.14 for DCB angioplasty and to €3,309.66 for DES implantation. Over a 12-month time horizon, the DCB strategy was found to be less costly (€4,130.38 vs. €5,305.30) and slightly more effective in terms of life expectancy (0.983 vs. 0.976 years) than the DES strategy. Extensive sensitivity analyses indicated that, in comparison with DES implantation, the cost advantage of the DCB strategy was robust to clinically plausible variations in the values of key model input parameters. The variables with the greatest impact on base-case results were the duration of dual antiplatelet therapy with acetylsalicylic acid and clopidogrel after DCB angioplasty, the use of generic clopidogrel, and variations in the costs associated with the DCB device. DCB angioplasty is a cost-effective treatment option for coronary BMS-ISR. The higher initial costs of DCB are more than offset by later cost-savings, predominantly as a result of reduced medication costs.

  13. Continued benefit of coronary stenting versus balloon angioplasty: one-year clinical follow-up of Benestent trial. Benestent Study Group.

    NARCIS (Netherlands)

    C.M. Miguel (Carlos); P.W.J.C. Serruys (Patrick); P.N. Ruygrok (Peter); H. Suryapranata (Harry); S. Klugmann (Silvio); P. Urban (Philip); P. den Heijer (Peter); K. Koch (Karel); R. Simon (Rudiger); M-C. Morice (Marie-Claude); P.A. Crean (Peter); J.J.R.M. Bonnier (Hans); W. Wijns (William); N. Danchin (Nicolas); C. Bourdonnec (Claude); M-A.M. Morel (Marie-Angèle); E.G. Mast (Gijs)

    1996-01-01

    textabstractObjectives. This study sought to determine the 1-year clinical follow-up of patients included in the Benestent trial. Background. The Benestent trial is a randomized study comparing elective Palmaz-Schatz stent implantation with balloon angioplasty in patients with stable angina and a de

  14. MRI temperature mapping during thermal balloon angioplasty.

    Science.gov (United States)

    Shmatukha, Andriy V; Bakker, Chris J G

    2006-04-21

    Knowledge on the thermal dose delivered during thermal balloon angioplasty (TBA) is desirable to understand why TBA's outcome varies widely among patients and why it is subject to high restenosis rates. In its conventional implementation, TBA involves injection of a heated medium into a balloon positioned within a stenotic blood vessel. The medium injection causes flow, motion and susceptibility-redistribution artefacts that are devastating to the proton resonance frequency shift (PRFS) technique of MRI temperature mapping. Here, we propose to separate in time medium injection and heating by first inflating a balloon with a medium at an initial temperature, and then by heating the medium up using laser light. The separation is shown to eliminate all the mentioned artefacts and to enable real-time MRI temperature mapping using the PRFS technique. Accurate and reliable temperature maps were acquired in a TBA balloon itself and in the surrounding phantom tissue during heat application.

  15. Emergency coronary angioplasty in refractory unstable angina

    NARCIS (Netherlands)

    P.J. de Feyter (Pim); P.W.J.C. Serruys (Patrick); M.J.B.M. van den Brand (Marcel); K. Balakumaran (Kulasekaram); A.L. Soward; P.G. Hugenholtz (Paul); A.E.R. Arnold (Alfred); B. Mochtar (Bas)

    1985-01-01

    textabstractWe performed percutaneous transluminal coronary angioplasty as an emergency procedure in 60 patients with unstable angina pectoris that was refractory to treatment with maximally tolerated doses of beta-blockers, calcium antagonists, and intravenous nitroglycerin. The initial success

  16. Local hemodynamic changes caused by main branch stent implantation and subsequent virtual side branch balloon angioplasty in a representative coronary bifurcation.

    Science.gov (United States)

    Williams, Andrew R; Koo, Bon-Kwon; Gundert, Timothy J; Fitzgerald, Peter J; LaDisa, John F

    2010-08-01

    Abnormal blood flow patterns promoting inflammation, cellular proliferation, and thrombosis may be established by local changes in vessel geometry after stent implantation in bifurcation lesions. Our objective was to quantify altered hemodynamics due to main vessel (MV) stenting and subsequent virtual side branch (SB) angioplasty in a coronary bifurcation by using computational fluid dynamics (CFD) analysis. CFD models were generated from representative vascular dimensions and intravascular ultrasound images. Time-averaged wall shear stress (TAWSS), oscillatory shear index (OSI), and fractional flow reserve (FFR) were quantified. None of the luminal surface was exposed to low TAWSS (stenting introduced eccentric areas of low TAWSS along the lateral wall of the MV. Virtual SB angioplasty resulted in a more concentric region of low TAWSS in the MV distal to the carina and along the lateral wall of the SB. The luminal surface exposed to low TAWSS was similar before and after virtual SB angioplasty (rest: 43% vs. 41%; hyperemia: 18% vs. 21%) and primarily due to stent-induced flow alterations. Sites of elevated OSI (>0.1) were minimal but more impacted by general vessel geometry established after MV stenting. FFR measured at a jailed SB was within the normal range despite angiographic stenosis of 54%. These findings indicate that the most commonly used percutaneous interventional strategy for a bifurcation lesion causes abnormal local hemodynamic conditions. These results may partially explain the high clinical event rates in bifurcation lesions.

  17. A randomized trial assessing the effect of coumarins started before coronary angioplasty on restenosis: results of the 6-month angiographic substudy of the Balloon Angioplasty and Anticoagulation Study (BAAS).

    Science.gov (United States)

    ten Berg, Jurriën M; Kelder, Johannes C; Suttorp, Maarten Jan; Verheugt, Freek W A; Plokker, H W Thijs

    2003-01-01

    Thrombus formation during coronary angioplasty may play a role in the restenosis process. The effect of pretreatment with coumarins on 6-month angiographic outcome was studied. In addition, the effect of "optimal" anticoagulation, defined as an international normalized ratio >70% of the follow-up time in the target range, was studied. A total of 261 patients were assigned to aspirin alone (ASA group) and 270 patients to aspirin plus coumarins started 1 week before the procedure (coumarin group). The mean international normalized ratio was 2.7 +/- 1.2 at the start of the procedure and 3.1 +/- 0.5 during follow up. Quantitative coronary analysis was performed on 301 lesions in the ASA group and of 297 lesions in the coumarin group. At 6 months, the minimal luminal diameter was similar in the ASA and coumarin groups. Optimal anticoagulation, however, was an independent predictor of a larger minimal luminal diameter at follow up (P =.01). Overall, coumarins do not improve angiographic outcome 6 months after coronary angioplasty.

  18. Quantitative angiographic assessment of elastic recoil after percutaneous transluminal coronary angioplasty

    NARCIS (Netherlands)

    B.J.W.M. Rensing (Benno); W.R.M. Hermans (Walter); K.J. Beatt (Kevin); G-J. Laarman (GertJan); H. Suryapranata (Harry); M.J.B.M. van den Brand (Marcel); P.J. de Feyter (Pim); P.W.J.C. Serruys (Patrick)

    1990-01-01

    textabstractLittle is known about the elastic behavior of the coronary vessel wall directly after percutaneous transluminal coronary angioplasty (PTCA). Minimal luminal cross-sectional areas of 151 successfully dilated lesions were studied in 136 patients during balloon inflation and directly after

  19. Quantitative angiographic assessment of elastic recoil after percutaneous transluminal coronary angioplasty

    NARCIS (Netherlands)

    B.J.W.M. Rensing (Benno); W.R.M. Hermans (Walter); K.J. Beatt (Kevin); G-J. Laarman (GertJan); H. Suryapranata (Harry); M.J.B.M. van den Brand (Marcel); P.J. de Feyter (Pim); P.W.J.C. Serruys (Patrick)

    1990-01-01

    markdownabstractAbstract Little is known about the elastic behavior of the coronary vessel wall directly after percutaneous transluminal coronary angioplasty (PTCA). Minimal luminal cross-sectional areas of 151 successfully dilated lesions were studied in 136 patients during balloon inflation and

  20. Restenosis of the coronary stenotic lesions treated by holmium:YAG laser coronary angioplasty

    Science.gov (United States)

    Miyazaki, Shunichi; Nonogi, Hiroshi; Goto, Yoichi; Itoh, Akira; Ozono, Keizaburo; Daikoku, Satoshi; Haze, Kazuo

    1994-07-01

    Clinical efficacy of newly developed Holmium YAG laser coronary angioplasty (HLCA) was assessed for 30 patients with angina. There were 12 near left main trunk (LMT) lesions and 4 aorto- ostial lesions. Adjunctive balloon angioplasty was performed for 25 of 30 lesions. Delivered energy ranged from 1.5 to 2.5 watts/pulse and the total exposure time ranged from 6 to 55 seconds. External diameter of laser catheter was 1.5 mm for 13 lesions, 1.4 mm for 17 lesions, and 1.7 mm for 5 lesions. Laser success, defined as 20% reduction of stenotic ratio, was obtained in 21 of 30 (70%) and overall procedural success rate was 93%. There were 3 cases with acute coronary occlusions relieved by adjunctive balloon angioplasty and one coronary perforation without manifestation of cardiac tamponade. There were no large coronary dissection which involved more than 5 mm of the coronary artery. Follow up coronary angiography after 3 months showed restenosis in 14 of 27 patients (52%). Percent stenosis after lasering (56%) was similar to that at 3 months after (62%). HLCA is acutely effective treatment for lesions near LMT, because of low incidence of large coronary dissection. However, angiographical restenosis rate is high at 3 months after HLCA. This may be attributed to the relatively large residual stenosis after the procedure and vessel injury caused by shock wave.

  1. Balloon Angioplasty - The Legacy of Andreas Grüntzig, M.D. (1939-1985

    Directory of Open Access Journals (Sweden)

    Matthias eBarton, MD, FAHA

    2014-12-01

    Full Text Available In 1974, at the Medical Policlinic of the University of Zürich, German-born physician-scientist Andreas Grüntzig (1939-1985 successfully applied a balloon-tipped catheter to re-open a severely stenosed femoral artery, a procedure which he initially called percutaneous transluminal dilatation. Transluminal angioplasty of atherosclerotic vascular disease, for which Grüntzig and Charles T. Dotter (1920-1985 received a nomination for the Nobel Prize in Physiology or Medicine in 1978, became one of the most successful examples of translational medicine in the 20th century. Known today as percutaneous transluminal angioplasty (PTA in peripheral arteries or percutaneous transluminal coronary angioplasty (PTCA or percutaneous coronary intervention (PCI in coronary arteries, balloon angioplasty has become the method of choice to treat patients with acute myocardial infarction or occluded leg arteries. On the occasion of the 40th anniversary of balloon angioplasty, we summarize Grüntzig’s life and career in Germany, Switzerland, and the United States and also review the developments in vascular medicine from the 1890s to the 1980s, including Dotter’s first accidental angioplasty in 1963. The work of pioneers of catheterization, including Pedro L. Fariñas in Cuba, André F. Cournand in France, Werner Forssmann, Werner Porstmann and Eberhard Zeitler in Germany, Sven-Ivar Seldinger in Sweden, and Thomas J. Fogarty, Melvin P. Judkins, Richard K. Myler, Dickinson W. Richards, and F. Mason Sones in the United States, is discussed. We also present quotes and excerpts from a unfinished book manuscript by Grüntzig, statements of his former colleagues and contemporary witnesses, and also include hitherto unpublished historic photographs and links to historic materials and archive recordings. This year, on June 25, 2014, Andreas Grüntzig would have celebrated his 75th birthday. This article is dedicated to his memory.

  2. Human percutaneous and intraoperative laser thermal angioplasty: initial clinical results as an adjunct to balloon angioplasty.

    Science.gov (United States)

    Sanborn, T A; Greenfield, A J; Guben, J K; Menzoian, J O; LoGerfo, F W

    1987-01-01

    In this study, the safety and efficacy of percutaneous laser thermal angioplasty as an adjunct to balloon angioplasty were investigated in 13 patients with severe peripheral vascular disease. By means of a novel fiberoptic laser delivery system (Laserprobe) in which argon laser energy is converted to heat in a metallic tip at the end of the fiberoptic fiber, improvement in the angiographic luminal diameter was noted in 14 of 15 femoropopliteal vessels (93%) by delivering 8 to 13 watts of continuous argon laser energy as the Laserprobe was advanced through the lesion. Initial clinical success (indicated by relief of symptoms and increase in Doppler index) for the combined laser and balloon angioplasty procedures was obtained in 12 of 15 vessels (80%), with inadequate balloon dilatation being the limiting factor in three patients. No significant complications of vessel perforation, dissection, pain, spasm, or embolization of debris occurred. Of the 12 patients who had procedures with initial angiographic and clinical success, 10 (83%) were asymptomatic in the initial follow-up period of 1 to 9 months (mean 6 months). Thus, laser thermal angioplasty with a Laserprobe is a safe and effective adjunct to peripheral balloon angioplasty. This technique has the potential to increase the initial success rate of angioplasty for lesions that are difficult or impossible to treat by conventional means. By removing most of the obstructing lesion, this technique may also reduce recurrent stenosis.

  3. Provisional stenting in the real world: results in 1058 consecutive patients undergoing percutaneous coronary angioplasty.

    Science.gov (United States)

    Ten Berg, Jurriën M; Kelder, Johannes C; Suttorp, Maarten Jan; Plokker, Thijs HW

    2001-09-01

    OBJECTIVE: To study a strategy of aggressive coronary balloon angioplasty with provisional stenting in allcomers. In randomized trials, stenting has improved the outcome of patients undergoing coronary intervention. However, whether these results hold up in clinical practice is largely unknown. Furthermore, the results of balloon angioplasty have also improved dramatically. It is therefore essential to evaluate the current results of balloon angioplasty and to assess whether stents are required in all patients. METHODS: The authors prospectively studied the occurrence of death, myocardial infarction (MI) and target lesion revascularization (TLR) of a large consecutive group of patients undergoing aggressive balloon angioplasty with provisional stenting. None of the patients received a platelet glycoprotein IIb/IIIa receptor blocker. The results were compared with the outcome of routine stenting in recent randomized trials. RESULTS: Angioplasty was performed in 1058 patients of whom 369 (34.9%) received a stent. The angiographic success rate was 98.9%. During hospital stay, 4.8% of the patients suffered any cardiac event. At one-year follow-up, death occurred in 1.1%, MI in 3.3%, TLR in 12.4% and any event in 16.7% of the patients. Event-free survival at one-year was 82.3%. These results compare favorably with routine stenting in recent trials. CONCLUSIONS: Aggressive balloon angioplasty with provisional stenting yields excellent results in a general patient population.

  4. Percutaneous transluminal coronary angioplasty. A review of the literature

    Energy Technology Data Exchange (ETDEWEB)

    Przybojewski, J.Z.; Weich, H.F.H. (Tygerberg Hospital, Stellenbosch (South Africa). Dept. of Internal Medicine)

    1984-01-25

    The purpose of this article is to review PTCA, percutaneous transluminal coronary angioplasty, which can be considered to be a truly revolutionary and fairly simple invasive form of intervention to atherosclerotic obstruction. The 'epidemic' of IHD, ischaemic heart disease, in the Republic of South Africa calls for the employment of this technique, which has already been carried out in a few teaching hospitals in this country. Very recently, modified balloon dilatation catheters have been used percutaneously in the non-operative transluminal correction of congenital coarctation of the aorta in infants and children, congenital pulmonary value stenosis, and hypoplasia and stenosis of the pulmonary arteries. It has also been employed for PTCA and for the simultaneous occlusion of coronary-bronchial artery anastomosis using a detachable balloon. The isotopes thallium 201 and technetium 99 were also used in scintiscanning.

  5. Safety and efficacy of recombinant Hirudin (CGP 39 393) versus Heparin in patients with stable angina undergoing coronary angioplasty

    NARCIS (Netherlands)

    A.A. van den Bos (Arjan); G.R. Heyndrickx (Guy); G-J. Laarman (GertJan); H. Suryapranata (Harry); F. Zijlstra (Felix); P. Close (Philip); J.J.M.M. Rijnierse (Joep); H.R. Büller (Harry); P.W.J.C. Serruys (Patrick); J.W. Deckers (Jaap)

    1993-01-01

    textabstractBACKGROUND. Enhanced thrombin activity has been associated with acute and long-term complications following balloon angioplasty (percutaneous transluminal coronary angioplasty (PTCA). We evaluated, in a 2-to-1 randomized, double-blind trial, the effects of recombinant hirudin, CGP 39 393

  6. Coronary angioplasty for early postinfarction unstable angina

    NARCIS (Netherlands)

    P.J. de Feyter (Pim); P.W.J.C. Serruys (Patrick); A. Soward; M.J.B.M. van den Brand (Marcel); E. Bos (Egbert); P.G. Hugenholtz (Paul)

    1986-01-01

    textabstractCoronary angioplasty was performed in 53 patients in whom unstable angina had reoccurred after 48 hr and within 30 days after sustained myocardial infarction. Single-vessel disease was present in 64% of the patients and multivessel disease in 36%. The preceding myocardial infarction had

  7. A technical strategy for carotid artery stenting: suboptimal prestent balloon angioplasty without poststenting balloon dilatation.

    Science.gov (United States)

    Jin, Sung-Chul; Kwon, O-Ki; Oh, Chang Wan; Jung, Cheolkyu; Han, Moon Gu; Bae, Hee-Joon; Lee, Sang Hyung; Jung, Young Sub; Han, Moon Hee; Kang, Hyun-Seung

    2010-11-01

    Traditional carotid artery stenting (CAS) consists of predilatation, optional deployment of embolic protection devices, stenting, and poststent angioplasty. Each step carries a risk of thromboembolism. To design a new and simplified procedural protocol, suboptimal balloon angioplasty without routine poststenting balloon dilatation, and to describe the efficacy this protocol in terms of procedural risks and angiographic and clinical outcomes. Over a period of 6 years, 161 carotid artery stenoses in 156 consecutive patients were treated by CAS with embolic protection devices. Among them, 110 lesions in 107 patients (68.3%) were treated by our simplified method (symptomatic, > 50% stenosis; asymptomatic, > 70% stenosis). Overall, 98 lesions (88.3%) had severe stenosis (> 70%). The mean stenosis was reduced from 77% to 10% after CAS. A persistent neurological deficit developed in 2 patients from thromboembolism. Hemodynamic insufficiency developed in 14 lesions during CAS (12.7%). The ipsilateral stroke and mortality rate was 4.5% within 1 month after CAS (asymptomatic, 3.6%; symptomatic, 4.8%). Over a mean of 19 months of follow-up, additive angioplasty was performed in 2 patients as a result of progressive restenosis (≥ 50%). A comparison of the balloon sizes of the prestent angioplasty for group 1 (balloon, ≤ 4 mm) and group 2 (balloon, ≥ 5 mm) showed no difference in restenosis between the groups at 15 months of follow-up after CAS. Our CAS technique with suboptimal prestenting angioplasty without routine use of poststenting dilatation is safe, simple, and efficient with acceptable risks.

  8. Balloon Angioplasty for Intracranial Atherosclerotic Disease: A Multicenter Study

    Science.gov (United States)

    Karanam, Lakshmi Sudha Prasanna; Sharma, Mukesh; Alurkar, Anand; Baddam, Sridhar Reddy; Pamidimukkala, Vijaya; Polavarapu, Raghavasarma

    2017-01-01

    Aim To evaluate the role and efficacy of the balloon angioplasty in intracranial atherosclerotic disease (ICAD) in patients who presented with acute stroke due to vessel occlusion and in patients with symptomatic disease despite optimum medical management. Methods From 2013 to 2016, a total of 39 patients (24 males and 15 females with a mean age of 64.5 years) underwent balloon angioplasty over a period of 2 years and 8 months in three different institutions in India. Maverick balloon catheter (Boston scientific) is used in all the patients. MRI brain with MR angiogram was done in all the patients prior to intervention. Twenty-three patients who had underlying severe ICAD presented with acute stroke due to vessel occlusion. Sixteen patients presented with symptomatic ICAD with recurrent ischemic attack due to the progressing underlying disease despite optimum medical management. Technical success, peri-procedural events, and clinical outcomes were documented for all the patients. Results Technical success (residual stenosis 90% of the patients. MR angiogram on follow-up of nine months was done in 26 patients, and none of them had restenosis. Conclusion Balloon angioplasty is a safe option and can be effectively used in patients of ICAD with acceptable risks and promising outcomes. PMID:28702117

  9. Primary coronary angioplasty in a nonagenarian

    Directory of Open Access Journals (Sweden)

    Baracioli Luciano M.

    2002-01-01

    Full Text Available A woman aged 98 years entered the tertiary hospital service with a picture of acute myocardial infarction of the extensive anterior wall, which began 4 hours earlier. Due to the large myocardial risk area suggested by the electrocardiogram, the patient was taken to the hemodynamics laboratory for the performance of emergency coronary arteriography, which revealed occlusion in the proximal third of the anterior descending artery. Primary angioplasty followed by stent grafting was successfully performed. The patient had a satisfactory evolution (Killip I and was discharged from the hospital on the seventh postinfarction day. We discuss here aspects of thrombolysis and coronary percutaneous interventions in the aged.

  10. A pilot study of coronary angioplasty in outpatients.

    OpenAIRE

    Laarman, G.J.; Kiemeneij, F.; van der Wieken, L R; Tijssen, J.G.; Suwarganda, J S; Slagboom, T.

    1994-01-01

    BACKGROUND--Is it safe to discharge patients from hospital on the same day as percutaneous transluminal coronary angioplasty (PTCA)? The hypothesis tested was that careful pre and post angioplasty selection of patients can identify a group that is at very low risk of postprocedural complications and that these patients may be discharged on the day of the procedure. METHODS--63 patients undergoing limited risk coronary angioplasty of 72 lesions were studied. So that patients would be able to w...

  11. Small coronary vessel angioplasty: outcomes and technical considerations

    Directory of Open Access Journals (Sweden)

    Sudhir Rathore

    2010-10-01

    Full Text Available Sudhir RathoreDepartment of Cardiology, Atkinson Morley wing, St George’s Healthcare NHS Trust, London, UKAbstract: Small vessel (<3 mm coronary artery disease is common and has been identified as independent predictor of restenosis after percutaneous coronary intervention. It remains controversial whether bare-metal stent (BMS implantation in small vessels has an advantage over balloon angioplasty in terms of angiographic and clinical outcomes. Introduction of drug-eluting stent (DES has resulted in significant reduction in restenosis and the need for repeat revascularization. Several DESs have been introduced resulting in varying reduction in outcomes as compared with BMS. However, their impact on outcomes in small vessels is not clearly known. It is expected that DES could substantially reduce restenosis in smaller vessels. Large, randomized studies are warranted to assess the impact of different DESs on outcomes in patients with small coronary arteries.Keywords: small coronary arteries, coronary artery disease, stent, drug-eluting stent, restenosis 

  12. Radiofrequency balloon angioplasty. Rationale and proof of principle

    Energy Technology Data Exchange (ETDEWEB)

    Becker, G.J.; Lee, B.I.; Waller, B.F.; Barry, K.J.; Kaplan, J.; Connolly, R.; Dreesen, R.G.; Nardella, P.

    1988-11-01

    Post-angioplasty restenosis (PARS) in atherosclerotic lesions of medium and small arteries occurs in about one-third of cases in the first year following percutaneous transluminal angioplasty (PTA) (early PARS). PARS includes acute spasm, dissection with reclosure, elastic recoil, fibrocellular proliferative response, and progressive atheromatous disease. Fibrocellular proliferation (possibly initiated by platelet derived growth factor) is felt to be culpable in many cases of early PARS (months). Pharmacologic regimens, stents, and thermal welding of the intimal-medial cracks of PTA are among the interventions being developed to deal with PARS. Radiofrequency (RF) current as a source of thermal energy may be useful in combination with balloon angioplasty to reduce PARS. Ideally, this combination would (1) weld intimal-medial cracks of PTA; (2) mold plaque and normal vessel to increase lumen diameters without creating intimal-medial cracks; and (3) destroy medial smooth muscle cells and multipotential cells (cellular substrate of PARS). Canine in vivo studies have established the feasibility of RF-mediated vascular tissue welding. Human aortic specimens (N = 28) were manually dissected into intima-media and media-adventitia layers. Bipolar RF energy (650 KHz, total 300 J) and mechanical pressure (1 atm) (experimental group, N = 24) or mechanical pressure alone (control group, N = 4) were applied to the reapposed specimen layers in a special chamber. The chamber was modified with a bipolar electrode designed to reproduce that planned for an RF balloon angioplasty catheter. Welding was demonstrated in normal and atherosclerotic treated specimens (23/24 or 96%) but not controls (0/4).

  13. Cost-effectiveness of paclitaxel-coated balloon angioplasty in patients with drug-eluting stent restenosis.

    Science.gov (United States)

    Dorenkamp, Marc; Boldt, Julia; Leber, Alexander W; Sohns, Christian; Roser, Mattias; Boldt, Leif-Hendrik; Haverkamp, Wilhelm; Bonaventura, Klaus

    2013-07-01

    The economic impact of drug-eluting stent (DES) in-stent restenosis (ISR) is substantial, highlighting the need for cost-effective treatment strategies. Compared to plain old balloon angioplasty (POBA) or repeat DES implantation, drug-coated balloon (DCB) angioplasty is a cost-effective therapy for DES-ISR. A Markov state-transition model was used to compare DCB angioplasty with POBA and repeat DES implantation. Model input parameters were obtained from the literature, and the cost analysis was conducted from a German healthcare payer's perspective. Extensive sensitivity analyses were performed. Initial procedure costs amounted to €3488 for DCB angioplasty and to €2782 for POBA. Over a 6-month time horizon, the DCB strategy was less costly (€4028 vs €4169) and more effective in terms of life-years (LYs) gained (0.497 versus 0.489) than POBA. The DES strategy incurred initial costs of €3167 and resulted in 0.494 LYs gained, at total costs of €4101 after a 6-month follow-up. Thus, DCB angioplasty was the least costly and most effective strategy. Base-case results were influenced mostly by initial procedure costs, target lesion revascularization rates, and the costs of dual antiplatelet therapy. DCB angioplasty is a cost-effective treatment option for coronary DES-ISR. The higher initial costs of the DCB strategy compared to POBA or repeat DES implantation are offset by later cost savings. © 2013 Wiley Periodicals, Inc.

  14. Modeling plaque fissuring and dissection during balloon angioplasty intervention.

    Science.gov (United States)

    Gasser, T Christian; Holzapfel, Gerhard A

    2007-05-01

    Balloon angioplasty intervention is traumatic to arterial tissue. Fracture mechanisms such as plaque fissuring and/or dissection occur and constitute major contributions to the lumen enlargement. However, these types of mechanically-based traumatization of arterial tissue are also contributing factors to both acute procedural complications and chronic restenosis of the treatment site. We propose physical and finite element models, which are generally useable to trace fissuring and/or dissection in atherosclerotic plaques during balloon angioplasty interventions. The arterial wall is described as an anisotropic, heterogeneous, highly deformable, nearly incompressible body, whereas tissue failure is captured by a strong discontinuity kinematics and a novel cohesive zone model. The numerical implementation is based on the partition of unity finite element method and the interface element method. The later is used to link together meshes of the different tissue components. The balloon angioplasty-based failure mechanisms are numerically studied in 3D by means of an atherosclerotic-prone human external iliac artery, with a type V lesion. Image-based 3D geometry is generated and tissue-specific material properties are considered. Numerical results show that in a primary phase the plaque fissures at both shoulders of the fibrous cap and stops at the lamina elastica interna. In a secondary phase, local dissections between the intima and the media develop at the fibrous cap location with the smallest thickness. The predicted results indicate that plaque fissuring and dissection cause localized mechanical trauma, but prevent the main portion of the stenosis from high stress, and hence from continuous tissue damage.

  15. Outpatient coronary angioplasty: feasible and safe.

    Science.gov (United States)

    Slagboom, Ton; Kiemeneij, Ferdinand; Laarman, Gert Jan; van der Wieken, Ron

    2005-04-01

    This study tested the safety and feasibility of coronary angioplasty on an outpatient basis. The purpose of this approach includes cost-effectiveness and patient comfort. Six hundred forty-four patients were randomized to either transradial or transfemoral PTCA using 6 Fr equipment. Patients were triaged to outpatient management based on a predefined set of predictors of an adverse outcome in the first 24 hr after initially successful coronary angioplasty. Three hundred seventy-five patients (58%) were discharged 4-6 hr after PTCA; 42% stayed in hospital overnight. In the outpatient group, one adverse event occurred (subacute stent thrombosis 7 hr postdischarge, nonfatal myocardial infarction). There were no major vascular complications. In the hospital group, 19 patients (7%) sustained an adverse cardiac even in the first 24 hr; 1 patient died. Patients treated via the femoral route had more (minor) bleeding complications (19 patients; 6%); in 17 of these, this was the sole reason that discharge was delayed. PTCA on an outpatient basis, performed via the radial or the femoral artery with low-profile equipment, is safe and feasible in a considerable part of a routine PTCA population. A larger proportion of transradial patients can be discharged due to a reduction in (minor) bleeding complications.

  16. Treatment of benign ureteral stricture by double J stents using high-pressure balloon angioplasty

    Institute of Scientific and Technical Information of China (English)

    YU Hua-liang; YE Lin-yang; LIN Mao-hu; YANG Yu; MIAO Rui; HU Xiao-juan

    2011-01-01

    Background Balloon dilatation angioplasty is a minimally invasive surgery for treating benign ureteral stricture. The aim of this study was to investigate the effect of placing double J (D-J) stents using high-pressure balloon angioplasty in treating benign ureteral stricture.Methods A total of 42 patients (48 cases) with benign ureteral stricture (42 had benign ureteral stricture) were investigated by inserting dual D-J stents using high-pressure balloon angioplasty. The control group contained 50 patients (57 cases) employing the conventional balloon angioplasty with a single D-J stent inserted for comparison.Results The overall effective rate of the treated and control groups was 87.8% (36/41) and 62.7% (32/51), respectively (P <0.05).Conclusion This new approach produces a better curative effect than the conventional balloon angioplasty with a single D-J stent insertion in treating benign ureteral stricture.

  17. Balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension

    Directory of Open Access Journals (Sweden)

    Irene Lang

    2017-03-01

    Full Text Available Chronic thromboembolic pulmonary hypertension (CTEPH is thought to result from incomplete resolution of pulmonary thromboemboli that undergo organisation into fibrous tissue within pulmonary arterial branches, filling pulmonary arterial lumina with collagenous obstructions. The treatment of choice is pulmonary endarterectomy (PEA in CTEPH centres, which has low post-operative mortality and good long-term survival. For patients ineligible for PEA or who have recurrent or persistent pulmonary hypertension after surgery, medical treatment with riociguat is beneficial. In addition, percutaneous balloon pulmonary angioplasty (BPA is an emerging option, and promises haemodynamic and functional benefits for inoperable patients. In contrast to conventional angioplasty, BPA with undersized balloons over guide wires exclusively breaks intraluminal webs and bands, without dissecting medial vessel layers, and repeat sessions are generally required. Observational studies report that BPA improves haemodynamics, symptoms and functional capacity in patients with CTEPH, but controlled trials with long-term follow-up are needed. Complications include haemoptysis, wire injury, vessel dissection, vessel rupture, reperfusion pulmonary oedema, pulmonary parenchymal bleeding and haemorrhagic pleural effusions. This review summarises the available evidence for BPA, patient selection, recent technical refinements and periprocedural imaging, and discusses the potential future role of BPA in the management of CTEPH.

  18. [The practical clinical guidelines of the Sociedad Española de Cardiología on interventional cardiology: coronary angioplasty and other technics].

    Science.gov (United States)

    Esplugas, E; Alfonso, F; Alonso, J J; Asín, E; Elizaga, J; Iñiguez, A; Revuelta, J M

    2000-02-01

    Interventional cardiology has had an extraordinary expansion in last years. This clinical guideline is a review of the scientific evidence of the techniques in relation to clinical and anatomic findings. The review includes: 1. Coronary arteriography. 2. Coronary balloon angioplasty. 3. Coronary stents. 4. Other techniques: directional atherectomy, rotational atherectomy, transluminal extraction atherectomy, cutting balloon, laser angioplasty and transmyocardial laser and endovascular radiotherapy. 5. Platelet glycoprotein IIb/IIIa inhibitors. 6. New diagnostic techniques: intravascular ultrasound, coronary angioscopy, Doppler and pressure wire. For the recommendations we have used the classification system: class I, IIa, IIb, III like in the guidelines of the American College of Cardiology and the American Heart Association.

  19. Stent-Apposition Salvage of an Anterior Tibial Artery After Inadvertent Angioplasty Balloon Retention During CTO Revascularization.

    Science.gov (United States)

    Choudry, R; Deutsch, E; Durinka, J; Dhir, T

    2016-01-01

    Progressive improvement in the ability to treat complete total occlusions in the tibial level arterial circulation have made it possible to revascularize patients with critical limb ischemia. A 59 year old male presented with a complete total occlusion of his anterior tibial artery with distal reconstitution through peroneal artery collaterals. During attempted angioplasty a balloon was retained within the patent portion of the target vessel. Two 3.0 mm drug eluting coronary stents were deployed across the length of the balloon with excellent luminal preservation. Successful CTO revascularization was completed and a strong dorsalis pedis artery pulse was restored following intervention.

  20. Emergency stenting for refractory acute coronary artery occlusion during coronary angioplasty

    NARCIS (Netherlands)

    P.J. de Feyter (Pim); I. DeScheerder (Ivan); M.J.B.M. van den Brand (Marcel); G-J. Laarman (GertJan); H. Suryapranata (Harry); P.W.J.C. Serruys (Patrick)

    1990-01-01

    markdownabstractAbstract Acute coronary artery occlusion occurs in 2 to 11% of the patients who undergo coronary angioplasty and is the major cause of in-hospital mortality and morbidity associated with coronary angioplasty. This procedural complication is usually caused by an occlusive

  1. Angioplasty with drug coated balloons for the treatment of infrainguinal peripheral artery disease.

    Science.gov (United States)

    Werner, Martin

    2016-09-01

    Restenosis or re-occlusion after femoropopliteal angioplasty or stent implantation is the main limitation of endovascular treatment strategies for peripheral artery disease. Within the last years, balloon catheters with anti-proliferative drug coating on the balloon surface have shown to be associated with higher patency rates compared to plain balloon angioplasty. Thus, drug-coated balloons were gradually adopted in many interventional centres for the treatment of femoropopliteal obstructions. The current review summarises the existing evidence for drug-coated balloons in the infrainguinal vessels and their indication in special lesion cohorts.

  2. Parallel wire balloon angioplasty for undilatable venous stenosis in hemodialysis fistula

    Energy Technology Data Exchange (ETDEWEB)

    Shin, Tae Beom; You, Jin Jong; Cho, Jae Min [Gyeongsang National University Hospital, Jinju (Korea, Republic of)] (and others)

    2007-05-15

    The purpose of this study was to assess the value of the parallel wire balloon angioplasty technique for treating dysfunctional hemdialysis fistula with rigid stenosis, and this type of lesion was resistant to conventional angioplasty. Between March 2002 and August 2003, we included 6 patients (mean age: 59, males: 2, females: 4) who were treated via parallel the wire balloon angioplasty technique and their hemodialysis fistula has stenoses that were resistant to conventional angioplasty. We performed conventional angioplasty in all patients, but we failed to achieve sufficient dilatation. In the cases of highly resistant stenosis, an additional 0.016 inch wire was inserted into the 7 F vascular sheath. During angioplasty, a 0.016 inch guide wire was inserted between the balloon and the stenosis and then it was pushed to and fro until the balloon indentation disappeared. After the procedure, we performed angiography to identify the residual stenosis and the procedure-related complications. The undilatable stenoses in 5 patients were successfully resolved without complications via the parallel wire angioplasty technique. In one patient, indentation of balloon was not resolved, but the residual stenosis was both minimal and hemodynamically insignificant. The parallel wire angioplasty technique seems to be a feasible and cost-effective method for treating a dysfunctional hemodialysis fistula with undilatable and rigid stenosis.

  3. Emergency coronary artery bypass surgery for failed percutaneous coronary angioplasty. A 10-year experience.

    Science.gov (United States)

    Craver, J M; Weintraub, W S; Jones, E L; Guyton, R A; Hatcher, C R

    1992-01-01

    Six hundred ninety-nine patients have required emergency coronary artery bypass after failed elective percutaneous coronary angioplasty during the decade September 1980 through December 1990. This represents 4% of 9860 patients having 12,146 elective percutaneous coronary angioplasty procedures during this interval. Emergency coronary artery bypass was required for acute refractory myocardial ischemia in 82%. Hospital mortality rate for all patients was 3.1%; 3.7% in patients with refractory myocardial ischemia but 0.8% in patients without refractory myocardial ischemia, p = 0.08. Postprocedural Q-wave myocardial infarctions were observed in 21% versus 2.4%, p less than 0.0001, and intra-aortic balloon pumping was required in 19% with versus 0.8% without refractory myocardial ischemia, p less than 0.0001. Multivessel disease, p = 0.004, age older than 65 years, p = 0.005, and refractory myocardial ischemia, p = 0.08, interacted to produce the highest risk of in-hospital death. Follow-up shows that there have been 28 additional late deaths, including 23 of cardiac causes for a 91% survival at 5 years. Freedom from both late death and Q-wave myocardial infarction at 5 years was 61%. In the group going to emergency coronary artery bypass with refractory myocardial ischemia, the late cardiac survival was 90%, and in those without ischemia, 92% at 5 years, p = not significant. The MI--free survival in the group with refractory ischemia, however, was 56% versus 83% in the group without ischemia, p less than 0.0001. Multivariate analysis showed the highest late event rates for patients with Q-wave myocardial infarction at the initial emergency coronary artery bypass, age older than 65 years, angina class III or IV, and prior coronary bypass surgery. In spite of a continuing high incidence of early acute myocardial infarction and an increasing operative mortality rate (7%) in the latest 3 years cohort of patients, excellent late survival and low subsequent cardiac event

  4. Prediction of Outcome after Femoropopliteal Balloon Angioplasty by Intervascular Ultrasound

    DEFF Research Database (Denmark)

    Schroeder, Torben Veith; Vogt, Katja; Just, S.;

    1997-01-01

    original, intravascular ultrasound, percutaneous transluminal angioplasty, peripheral arteries, plaquemorphology, prediction of outcome......original, intravascular ultrasound, percutaneous transluminal angioplasty, peripheral arteries, plaquemorphology, prediction of outcome...

  5. Primary balloon angioplasty plus balloon angioplasty maturation to upgrade small-caliber veins (<3 mm) for arteriovenous fistulas.

    Science.gov (United States)

    De Marco Garcia, Lorena P; Davila-Santini, Luis R; Feng, Qin; Calderin, Julio; Krishnasastry, Kambhampaty V; Panetta, Thomas F

    2010-07-01

    Small-diameter veins are often a limiting factor for the successful creation of arteriovenous fistulas (AVFs). This study evaluated the use of intraoperative primary balloon angioplasty (PBA) as a technique to upgrade small-diameter veins during AVF creation. Sequential balloon angioplasty maturation (BAM) was evaluated as a technique to salvage failed fistulas, expedite maturation, and improve the patency of AVFs after PBA. Sixty-two PBAs were performed in 55 patients with an intent-to-treat using an all-autologous policy. PBAs of veins were performed just before AVF creation using 2.5- to 4-mm angioplasty balloons (1- to 1.5-mm larger than the nominal vein diameter). PBAs were performed through the spatulated end of the vein for a length of up to 8 cm using hydrophilic guidewires and hand inflations without fluoroscopy. BAM was performed in 53 of the 62 PBAs at 2, 4, and 6 weeks after the PBA. Successful outcome was determined as the functional ability to use the fistula for hemodialysis without surgical revision. Of the 62 PBAs, 53 (85.4%), comprising 47 of the original AVFs and 6 new site AVFs created at other sites, remained patent and subsequently underwent BAM with a resulting functional AVF. Fifteen of the 47 original AVFs: 14 due to occlusion; one AVF with a steal was ligated. Seven of the 14 fistulas that occluded were salvaged using recanalization techniques during sequential BAMs. Two of the seven fistulas that were not salvaged required AVGs (3%), and five patients underwent redo AVFs using alternative veins. These five cases were also performed using PBAs and BAMs technique. One patient with a functioning fistula underwent intentional ligation for steal syndrome and also underwent an alternative site AVF, PBA, and BAM. At 3 months, 53 AVFs were functional and successfully used for dialysis. Overall, a working AVF was obtained at the initial site in 47 of 55 patients (85.4%), and 53 (96.3%) received working AVFs that were functioning for dialysis

  6. Balloon Angioplasty Versus Surgical Repair of Coarctation of Aorta in Infants

    Directory of Open Access Journals (Sweden)

    Fariba Alaei

    2011-09-01

    Full Text Available Background: Coarctation of the aorta is a discrete stenosis of the proximal thoracic aorta. The common clinical pattern is congestive heart failure in infancy. Treatment methods include balloon angioplasty and surgical repair in this age group. Percutaneous balloon angioplasty is a less invasive method for the repair of discrete coarctation but remains controversial as a primary treatment strategy for a native coarctation. This study aimed to compare the effectiveness and outcome of balloon angioplasty and surgical repair in coarctation infants younger than 1 year old.Methods: This retrospective study evaluated the results of the two methods in 167 patients younger than one year old admitted into a tertiary heart center pediatric ward with the diagnosis of coarctation of the aorta: Balloon angioplasty was done for 55 and surgical repair for 112 infants. Patients with previous interventions were not included in this study. Results: Primary results revealed no significant difference in the effectiveness of the two methods (p value = 0.0601. While the rate of recurrent coarctation was significantly lower in the surgery group [19 (17% vs. 11 (20%, p value = 0.0470], the mortality rate was lower in the balloon angioplasty method [5 (5.5% vs. 13 (11.6%, p value = 0.039]. Our multivariate logistic regression model, however, showed no statistically significant difference (p value = 0.120.Conclusion: Because of the incidence of re-coarctation, balloon angioplasty compared with surgical repair did not confer an improved outcome for our infants’ coarctation.

  7. Cephalic arch stenosis in autogenous brachiocephalic hemodialysis fistulas: results of cutting balloon angioplasty

    DEFF Research Database (Denmark)

    Heerwagen, Søren Thorup; Lönn, Lars; Schroeder, Torben V;

    2010-01-01

    Cephalic arch stenosis is a known cause of hemodialysis access failure in patients with brachiocephalic fistulas (BCFs). Outcomes of endovascular treatment are affected by resistance of the stenosis to balloon dilation, a high vein rupture rate and the development of early restenosis. The purpose...... of this retrospective study was to report outcomes after cutting balloon angioplasty (CBA) of cephalic arch stenosis....

  8. Primary coronary angioplasty for acute myocardial infarction (the Primary Angioplasty Registry).

    Science.gov (United States)

    O'Neill, W W; Brodie, B R; Ivanhoe, R; Knopf, W; Taylor, G; O'Keefe, J; Grines, C L; Weintraub, R; Sickinger, B G; Berdan, L G

    1994-04-01

    During a 14-month period, 6 experienced centers prospectively enrolled 271 patients into a registry in which percutaneous transluminal coronary angioplasty was the primary treatment for acute myocardial infarction. Patients age > 18 years who presented with ST-segment elevation on the 12-lead electrocardiogram were enrolled if symptom duration was or = 2 units of blood occurred in 46 patients (18%); 14 of these transfusions were related to coronary artery bypass surgery. Primary angioplasty is associated with a high reperfusion rate, low in-hospital mortality and few recurrent myocardial ischemic events. These results point to the need for a large-scale trial comparing angioplasty with thrombolytic therapy in the setting of acute myocardial infarction.

  9. Vessel wall temperature estimation for novel short term thermal balloon angioplasty: study of thermal environment.

    Science.gov (United States)

    Kaneko, Kenji; Nakatani, Eriko; Futami, Hikaru; Ogawa, Yoshifumi; Arai, Tsunenori; Fukui, Masaru; Shimamura, Satoshi; Kawabata, Takashi

    2005-01-01

    We have been proposing novel thermal balloon angioplasty, photo-thermo dynamic balloon angioplasty (PT-DBA). PTDBA realized thermal injury and low pressure dilatation that can prevent restenosis in chronic phase. We aim to determine the most efficient heating condition suit to individual symptom with pre-operation thermal simulation. We analyzed the flow dynamics and heat convection inside the balloon, and investigated heat conduction of balloon film to establish the temperature estimation method among vessel wall. Compared with ex vivo temperature measurement experiment, we concluded that the factors need to be considered for the establishment would be the heat conduction of the flow inside PTDB, heat conduction at the balloon film, and contact thermal resistance between the balloon film and vessel wall.

  10. Minimally invasive coronary artery bypass grafting versus coronary angioplasty for isolated type C stenosis of the left anterior descending artery

    NARCIS (Netherlands)

    Mariani, MA; Boonstra, PW; Grandjean, JG; Monnink, SHJ; denHeijer, P; Crijns, HJGM

    Background: Isolated stenosis of the left anterior descending coronary artery can be treated with medication, percutaneous transluminal coronary angioplasty, or coronary artery bypass grafting. Recently a new treatment has been developed, which is called minimally invasive direct coronary artery

  11. Percutaneous transluminal coronary angioplasty for culprit lesions in patients with post myocardial infarction angina based on dextrocardia and anomalous coronary arteries. Case reports and methods.

    Science.gov (United States)

    Yabe, Y; Tsukahara, R

    1995-05-01

    Four cases of successful coronary angioplasty for anomalous coronary arteries, including dextrocardia associated with three-vessel disease, single left coronary artery with proximal left anterior descending lesion, anomalous right coronary artery (RCA) from adjacent left coronary sinus of Valsalva associated with proximal RCA lesion, and anomalous left circumflex angulated lesion bifurcated from the RCA, were encountered. Four cases with 8 target lesions who had a mean age of 63.5 +/- 11.5 years old are presented. All the targets lesions were completely dilated through balloon angioplasty, including use of a newly developed support device for cases with large jeopardized myocardium. The factors for complete revascularization were appropriate selection of catheters and originality and ingenuity of procedural technique based on the anatomic characteristics.

  12. Residual stenosis after conventional balloon angioplasty for hemodialysis shunt failure: treatment with metallic stent placement and post-balloon dilatation.

    Science.gov (United States)

    Kariya, Shuji; Tanigawa, Noboru; Kojima, Hiroyuki; Komemushi, Atsushi; Shiraishi, Tomokuni; Kawanaka, Toshiaki; Sawada, Satoshi

    2005-02-01

    The usefulness of metallic stent placement and post-balloon dilatation was investigated for patients with residual stenosis after conventional percutaneous transluminal balloon angioplasty (balloon PTA) of dialysis shunt vessels. Among 92 patients who had received balloon PTA for dialysis shunt vessels, seven patients who showed a residual waist on the balloon even under maximum inflation were enrolled in this study. In these patients with residual stenosis after balloon PTA, we inserted a stent in the residual stenosis, and post-balloon dilatation was immediately applied using the same balloon catheter. After balloon PTA, the average percent diameter stenosis declined to 45.5 +/- 7.30%, and the stenosis was further improved to an average of 19.3 +/- 7.09% after the placement of a stent and the additional balloon PTA. The average percent diameter dilatation of the balloon before the placement of a stent was 65.8 +/- 12.7%, while the average dilatation increased to 84.1 +/- 8.96% after the placement of a stent. Dialysis became possible immediately after the procedure in all cases. Metallic stent placement and post-balloon dilatation was effective for patients with residual stenosis after conventional balloon PTA of dialysis shunt vessels.

  13. Healing after arterial dilatation with radiofrequency thermal and nonthermal balloon angioplasty systems.

    Science.gov (United States)

    Kaplan, J; Barry, K J; Connolly, R J; Nardella, P C; Hayes, L L; Lee, B I; Waller, B F; Becker, G J; Callow, A D

    1993-01-01

    Thermal balloon angioplasty has been proposed as a means of reducing acute and delayed reclosure of arteries after percutaneous transluminal balloon angioplasty. A radiofrequency (rf) balloon catheter was used to perform thermal balloon angioplasty on canine arteries in vivo. The histologic appearance of rf-treated sites was compared with that of control sites treated by conventional percutaneous transluminal angioplasty. Acutely, rf-treated sites showed a reduced medial cellularity with preservation of internal elastic lamina except at the transitional zone between thermal injury and normal artery, where localized internal elastic lamina disruption was found. Nonthermal sites showed generalized disruption of internal elastic lamina and normal medial cellularity. Both thermal and nonthermal sites displayed a return of intimal cover commencing at 1 to 2 weeks and completed by 4 weeks. Diffuse myointimal hyperplasia appeared by 2 weeks after injury at breaks in the internal elastic lamina along the nonthermal vessels but was localized to the transitional zone in thermal injury sites. In rf-treated vessels, repopulation of the acellular thermally modified media had commenced by 4 weeks, and by 8 weeks the media was diffusely repopulated by spindle-shaped cells resembling smooth muscle cells lying between and aligned with preserved connective tissue laminae. Overall, the distribution and extent of the proliferative response after rf thermal balloon angioplasty were less than those seen after nonthermal balloon angioplasty. Thermal sites, which underwent reintimalization before medial cells returned, were considerably less prone to the development of myointimal hyperplasia. These results suggest that this modality may have beneficial effects on arterial healing after angioplasty.

  14. Percutaneous laser-assisted thermal coronary angioplasty in native coronary arteries and saphenous vein grafts: initial results and angiographic follow-up.

    Science.gov (United States)

    Linnemeier, T J; Rothbaum, D A; Cumberland, D C; Landin, R J; Hodes, Z I; Ball, M W

    1990-01-01

    Percutaneous laser-assisted thermal coronary angioplasty was attempted in 29 vessels (27 patients): 10 left anterior descending, 2 left circumflex and 17 mid-shaft (non-anastomotic) saphenous vein grafts. Argon or YAG laser thermal energy was applied via a 1.3, 1.6 or 1.9 mm metal capped probe followed by conventional balloon angioplasty in 27 vessels and sole thermal laser therapy in two vessels. The laser probe successfully crossed 83% (24/29) of vessels and subsequent balloon dilatation increased the success rate to 93% (25/27). Perforation occurred in a vein graft resulting in one in-hospital death post repeat emergency coronary artery bypass graft surgery. Angiographic follow-up was obtained in 85% (24/28) of vessels. Angiographic restenosis ( greater than 50% reduction in lumen diameter) occurred in 27% (3/11) of native coronary arteries and 62% (8/13) of saphenous vein grafts. Therefore, despite high initial success rates, the application of laser thermal energy with small laser probes relative to vessel size, followed by conventional balloon angioplasty, does not appear to alter restenosis. Further evaluation of coronary laser systems should be continued only with catheters that are capable of creating channels closer to the size of the vessel treated.

  15. Outcome of patients undergoing balloon angioplasty in the two months prior to noncardiac surgery.

    Science.gov (United States)

    Brilakis, Emmanouil S; Orford, James L; Fasseas, Panayotis; Wilson, Stephanie H; Melby, Steven; Lennon, Ryan J; Berger, Peter B

    2005-08-15

    We report on the incidence of adverse cardiac events in 350 patients who underwent noncardiac surgery within 2 months of successful balloon angioplasty (BA) at our institution between 1988 and 2001. Three patients died perioperatively (n = 1) or had myocardial infarction (n = 2) (0.9%, 95% confidence interval [CI] 0.2% to 2.5%), which is a lower incidence than that reported for patients undergoing noncardiac surgery after stenting (3.9% to 32%). One patient died, and 2 had a nonfatal myocardial infarction. All 3 (1.6%, 95% CI 0.3% to 4.6%) were among the 188 patients who underwent surgery within 2 weeks of BA. Repeat target vessel revascularization was performed in 10 patients (2.9%, 95% CI 1.4% to 5.2%): in 3 (1.6%, 95% CI 0.3% to 4.6%) of 188 patients who underwent surgery within 2 weeks of BA and in 7 (5.1%, 95% CI 2.1% to 10.2%) of 138 patients who underwent surgery within 3 to 7 weeks of BA. Therefore, in patients in whom percutaneous coronary revascularization is required before noncardiac surgery, BA appears to be safe, especially in patients who need to undergo surgery early after percutaneous coronary intervention.

  16. Comparison of a nitinol stent versus balloon angioplasty for treatment of a dysfunctional arteriovenous graft

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, Yeo Chang; Shin, Byung Seok; Ahn, Moon Sang [Chungnam National University Hospital, Daejeon (Korea, Republic of); Park, Mi Hyun [Dankook Univ. Hospital, Cheonan (Korea, Republic of); Ohm, Joon Young [The Catholic Univ. of Korea College of Medicine/Bucheon St. Mary' s Hospital, Bucheon (Korea, Republic of); Kim, Ho Jun [Konyang Univ. Hospital, Daejeon (Korea, Republic of)

    2012-06-15

    This study aimed to 1) evaluate the outcome of placing a nitinol stent for treating dysfunctional arteriovenous grafts (AVG), and 2) compare the results with those of successful balloon angioplasty. Between February 2008 and October 2011, we retrospectively reviewed the interventional data and medical records of 29 patients (21 men, 8 women; mean age, 67.4 years) who underwent interventional procedures for dysfunctional AVG. Stents were placed only in cases with inadequate angioplasty results. Stent patency was evaluated and compared to cases of successful balloon angioplasty using the Kaplan Meier analysis. Eleven stents and 18 angioplasties were performed successfully at the venous anastomotic site of AVG. The primary patency at 3, 6, 12, and 18 months did not differ significantly for stent placement and angioplasty (52%, 29%, 15%, 15% vs. 71%, 50%, 34%, 34%; mean survival, 164 vs. 253 days, p = 0.283). Secondary patency of the stent also did not differ significantly from angioplasty (80%, 80%, 49%, 49% vs. 76%, 57%, 57%, 36%; mean survival, 405 vs. 385 days, p = 0.553). Nitinol stent placement was effective for treating dysfunctional AVG, but did not improve the primary and secondary patency compared to successful angioplasty.

  17. Cutting balloon angioplasty for undilatable venous stenoses causing dialysis graft failure.

    Science.gov (United States)

    Bittl, John A; Feldman, Robert L

    2003-04-01

    Dialysis fistulas and bridge grafts frequently develop outflow stenoses in the venous limb, leading to graft failure. The venous stenoses are fibrotic and require percutaneous transluminal angioplasty with high-pressure balloons. We have encountered venous stenoses in 3 out of 219 hemodialysis patients with graft failure that were undilatable with 6-8 mm high-pressure balloons inflated to more than 24 atm. In each of these cases, treatment with a 4 mm cutting balloon successfully facilitated subsequent balloon dilation at lower pressures. Copyright 2003 Wiley-Liss, Inc.

  18. Which angiographic variable best describes functional status 6 months after successful single-vessel coronary balloon angiopasty?

    NARCIS (Netherlands)

    B.J.W.M. Rensing (Benno); W.R.M. Hermans (Walter); P.J. de Feyter (Pim); P.W.J.C. Serruys (Patrick); J.W. Deckers (Jaap)

    1993-01-01

    textabstractOBJECTIVES. The aim of this study was to determine which quantitative angiographic variable best describes functional status 6 months after coronary balloon angioplasty. BACKGROUND. Several angiographic restenosis criteria have been developed. These can be divided into those that describ

  19. Effect of low-grade conductive heating on vascular compliance during in vitro balloon angioplasty.

    Science.gov (United States)

    Mitchel, J F; Fram, D B; Aretz, T A; Gillam, L D; Woronick, C; Waters, D D; McKay, R G

    1994-07-01

    Radiofrequency-powered, thermal balloon angioplasty is a new technique that enhances luminal dilatation with less dissection than conventional angioplasty. The purpose of this study was to assess the effect of radiofrequency heating of balloon fluid on the pressure-volume mechanics of in vitro balloon angioplasty and to determine the histologic basis for thermal-induced compliance changes. In vitro, radiofrequency-powered, thermal balloon angioplasty was performed on 46 paired iliac segments freshly harvested from 23 nonatherosclerotic pigs. Balloon inflations at 60 degrees C were compared to room temperature inflations in paired arterial segments. Intraballoon pressure and volume were recorded during each inflation as volume infusion increased pressure over a 0 to 10 atm range. Pressure-volume compliance curves were plotted for all dilatations. Six segments were stained to assess the histologic abnormalities associated with thermal compliance changes. Radiofrequency heating acutely shifted the pressure-volume curves rightward in 20 of 23 iliac segments compared to nonheated controls. This increase in compliance persisted after heating and exceeded the maximum compliance shift caused by multiple nonheated inflations in a subset of arterial segments. Histologically, heated segments showed increased thinning and compression of the arterial wall, increased medial cell necrosis and altered elastic tissue fibers compared to nonheated specimens. In conclusion, radiofrequency heating of intraballoon fluid to 60 degrees C acutely increases vascular compliance during in vitro balloon angioplasty of nonatherosclerotic iliac arteries. The increased compliance persists after heating and can be greater than the compliance shifts induced by multiple conventional dilatations. Arterial wall thinning and irreversible alteration of elastic tissue fibers probably account for thermal compliance changes.

  20. The Application of Dual-wire Balloon in The Treatment of Coronary Bifurcation Lesions

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Objectives To assess the efficiency and safety of dual-wire balloon angioplasty side branch combined stenting the main branch in the treatment of coronary bifurcation lesions. Methods This study included thirty-six patients with 41 coronary bifurcation lesions. Selective dual-wire balloon angioplasty was performed in side branch and/or in main branch, and implantation of stents was performed in main branch only. Clinical outcome and major adverse cardiac events were observed inhospital and follow-up. Results Success rate of side branch dilatation before main branch stenting was 100%; main branch direct stenting performed in 4 cases; success main branch dilatation performed in the other 37 cases; kissing technique was performed successfully in 5 cases, which side branch was jailed after main branch stenting with TIMI grade 0-2 flow. No Q-wave myocardial infarction, acute revascularization and death occurred during in-hospital.Clinical follow-up was available in all patients. No Q-wave myocardial infarction, revascularization and death occurred, angina pectoris recurred in three patients,released by strengthen drug treatment. Conclusions Dual-wire balloon angioplasty side branch combined stenting the main branch is simple, safe and effective for the treatment of coronary bifurcation lesions.

  1. Cost-effectiveness analysis of orbital atherectomy plus balloon angioplasty vs balloon angioplasty alone in subjects with calcified femoropopliteal lesions

    Directory of Open Access Journals (Sweden)

    Weinstock B

    2014-03-01

    Full Text Available Barry Weinstock,1 Raymond Dattilo,2 Tiffini Diage3 1Orlando Health Heart Institute, Mid-Florida Cardiology Specialists, Orlando, FL, USA; 2Department of Cardiology, St Francis Health Center, Topeka, KS, USA; 3North American Science Association (NAMSA, Sunnyvale, CA, USA Introduction: As cost considerations become increasingly critical when selecting optimal endovascular treatment strategies, a cost-benefit analysis was conducted comparing the Diamondback 360°® Orbital Atherectomy System (OAS (Cardiovascular Systems, Inc., St Paul, MN, USA and balloon angioplasty (BA vs BA alone for treatment of calcified femoropopliteal lesions. Patients and methods: The clinical outcomes from COMPLIANCE 360°, a prospective, multicenter, randomized study comparing OAS+BA vs BA alone for treatment of calcified femoropopliteal lesions, were correlated with cost data and previously published quality of life data. Site of service, hospital charges, and associated medical resource utilization were obtained from Uniform Billing statements for index treatments and associated revascularizations out to 1 year. Hospital costs were estimated using hospital-specific, procedure-specific cost-to-charge ratios. Length of stay and procedural data were collected from participating study sites. Results: Twenty-five subjects with 38 lesions and 25 subjects with 27 lesions were randomized to the OAS+BA and BA-alone groups, respectively. Mean hospital charges (US$51,755 vs US$39,922 and estimated hospital costs (US$15,100 vs US$11,016 were higher for OAS+BA compared with BA alone (not statistically significant. Stent utilization was statistically significantly higher with BA-alone treatment for all subjects (1.1 vs 0.1, P=0.001 and in the subset of subjects with one lesion (1.0 vs 0.1, P<0.00001. There was a significant difference in cost for single-lesion versus multiple-lesion treatment. Using costs and quality-adjusted life years (QALYs for the single-lesion cohort, the 1-year

  2. Drug therapy or coronary angioplasty for the treatment of coronary artery disease : New insights

    NARCIS (Netherlands)

    Amoroso, G; Van Boven, AJ; Crijns, HJGM

    2001-01-01

    Background In the last decade percutaneous transluminal coronary angioplasty has become a very popular strategy For the treatment of coronary artery disease, although its efficacy in reducing ischemic events and the subsequent need for revascularization has yet to be proved. Methods We reviewed the

  3. Incidence, predictors, and management of acute coronary occlusion after coronary angioplasty

    NARCIS (Netherlands)

    P.J. de Feyter (Pim); P.W.J.C. Serruys (Patrick); P.P.T. de Jaegere (Peter)

    1994-01-01

    textabstractAcute coronary occlusion occurs in 4.3% to 8.3% of patients during coronary angioplasty. Its occurrence is difficult to predict in an individual patient. At high risk are patients with unstable angina, intracoronary thrombus, extreme age, long complex lesions, and diffuse disease.

  4. Ten-year follow-up of percutaneous transluminal coronary angioplasty for proximal left anterior descending coronary artery stenosis in 351 patients.

    Science.gov (United States)

    Ten Berg, J M; Gin, M T; Ernst, S M; Kelder, J C; Suttorp, M J; Mast, E G; Bal, E; Plokker, H W

    1996-07-01

    We sought to evaluate the short- and long-term results of balloon angioplasty for stenoses in the proximal left anterior descending coronary artery. Both the supposedly high rate of acute complications and relatively poor long-term results of balloon angioplasty for stenoses in the proximal left anterior descending coronary artery have led to a search for alternative interventional techniques. We analyzed the success rates and long-term follow-up results in 351 consecutive patients who underwent balloon angioplasty for stenosis of the left anterior descending coronary artery proximal to its first side branch. The power of the study was >80% in detecting a difference of 9% in the proportion of patients who survived at 10 years, assuming an 80% survival rate in the control group. There were 60 ostial and 291 nonostial stenoses. Follow-up lasted a median of 85 months (range 0 to 137) and was 100% complete. The angiographic success rate was 90.9%. The clinical success rate was 86.3%. Nine patients (2.6%) died, 17 (4.8%) needed emergency coronary artery bypass graft surgery, and 10 (2.8%) developed a myocardial infarction. Several patients had subsequent complications. The success and complication rates were not significantly different for patients with ostial and nonostial stenoses. Ten years after balloon angioplasty, freedom from mortality was 80%, freedom from cardiac death was 87%, freedom from myocardial infarction was 84%, freedom from vessel-related reinterventions was 66%, and freedom from angina pectoris was 33%. There were more reinterventions for ostial stenoses, with a 1-year relative risk of ostial versus nonostial stenoses for related reinterventions of 1.7 (95% confidence interval 1 to 2.8, p = 0.049). More than 10 years ago, balloon angioplasty for stenoses in the proximal left anterior descending coronary artery, either ostial or nonostial, had a high success rate. Although the long-term results are satisfactory, ostial stenoses are associated with a

  5. Low-pressure balloon angioplasty with adjuvant pharmacological therapy in patients with acute ischemic stroke caused by intracranial arterial occlusions

    Energy Technology Data Exchange (ETDEWEB)

    Nogueira, Raul G. [Massachusetts General Hospital, Harvard Medical School, Department of Radiology, Endovascular Neurosurgery/Interventional Neuroradiology Section, Boston, MA (United States); Massachusetts General Hospital, Harvard Medical School, Department of Neurosurgery, Endovascular Neurosurgery/Interventional Neuroradiology Section, Boston, MA (United States); Massachusetts General Hospital, Harvard Medical School, Department of Neurology, Neurocritical Care and Vascular Neurology Section, Boston, MA (United States); Massachusetts General Hospital, Boston, MA (United States); Schwamm, Lee H.; Buonanno, Ferdinando S.; Koroshetz, Walter J. [Massachusetts General Hospital, Harvard Medical School, Department of Neurology, Neurocritical Care and Vascular Neurology Section, Boston, MA (United States); Yoo, Albert J.; Rabinov, James D.; Pryor, Johnny C.; Hirsch, Joshua A. [Massachusetts General Hospital, Harvard Medical School, Department of Radiology, Endovascular Neurosurgery/Interventional Neuroradiology Section, Boston, MA (United States); Massachusetts General Hospital, Harvard Medical School, Department of Neurosurgery, Endovascular Neurosurgery/Interventional Neuroradiology Section, Boston, MA (United States)

    2008-04-15

    The use of coronary balloons in the cerebral vasculature is limited due to their poor trackability and increased risk of vessel injury. We report our experience using more compliant elastomer balloons for thrombus resistant to intraarterial (IA) pharmacological and mechanical thrombolysis in acute stroke. We retrospectively analyzed 12 consecutive patients with an occluded intracranial artery treated with angioplasty using a low-pressure elastomer balloon. Angiograms were graded according to the Thrombolysis in Cerebral Infarction (TICI) and Qureshi grading systems. Outcomes were categorized as independent (modified Rankin scale, mRS, score {<=}2), dependent (mRS score 3-5), or dead (mRS score 6). Included in the study were 12 patients (mean age 66{+-}17 years, range 31-88 years; mean baseline National Institutes of Health stroke scale score 17{+-}3, range 12-23). The occlusion sites were: internal carotid artery (ICA) terminus (five patients, including two concomitant cervical ICA occlusions), M1 segment (two patients), and basilar artery (two patients). Pharmacological treatment included intravenous (IV) t-PA only (two patients), IA urokinase only (nine patients), both IV t-PA and IA urokinase (one patient), and IV and/or IA eptifibatide (eight patients). Mean time to treatment was 5.9{+-}3.9 h (anterior circulation) and 11.0{+-}7.2 h (posterior circulation). Overall recanalization rate (TICI grade 2/3) was 91.6%. Procedure-related morbidity occurred in one patient (distal posterior inferior cerebellar artery embolus). There were no symptomatic hemorrhages. Outcomes at 90 days were independent (five patients), dependent (three patients) and dead (four patients, all due to progression of stroke with withdrawal of care). Angioplasty of acutely occluded intracranial arteries with low-pressure elastomer balloons results in high recanalization rates with an acceptable degree of safety. Prior use of thrombolytics may increase the chances of recanalization, and

  6. Cutting-Balloon Angioplasty Versus Balloon Angioplasty as Treatment for Short Atherosclerotic Lesions in the Superficial Femoral Artery: Randomized Controlled Trial

    Energy Technology Data Exchange (ETDEWEB)

    Poncyljusz, Wojciech, E-mail: wponcyl@poczta.onet.pl; Falkowski, Aleksander, E-mail: bakhis@hot.pl [Pomeranian Medical University, Department of Interventional Radiology (Poland); Safranow, Krzysztof, E-mail: chrissaf@mp.pl; Rac, Monika, E-mail: carmon@pum.edu.pl [Pomeranian Medical University, Department of Biochemistry and Medical Chemistry (Poland); Zawierucha, Dariusz, E-mail: dariusz13@yahoo.com [Interventional Radiology, Sacred Heart Medical Center, River Bend (United States)

    2013-12-15

    Purpose: To evaluate the treatments of a short-segment atherosclerotic stenosis in the superficial femoral arteries with the cutting balloon angioplasty (CBA) versus conventional balloon angioplasty [percutaneous transluminal angioplasty (PTA)] in a randomized controlled trial. Material and Methods: The study group comprised 60 patients (33 men, 27 women; average age 64 years) with a short ({<=}5 cm) focal SFA de novo atherosclerotic stenosis associated with a history of intermittent claudication or rest pain. The primary end point of this study was the rate of binary restenosis in the treated segment 12 months after the intervention. All patients were evenly randomized to either the PTA or CBA treatment arms. Follow-up angiograms and ankle-brachial index (ABI) measurements were performed after 12 months. The evaluation of the restenosis rates and factors influencing its occurrence were calculated by logistic regression analysis. Results: In the intention-to-treat analysis, restenosis rates after 2-month follow-up were 9 of 30 (30 %) in the PTA group and 4 of 30 (13 %) in the CBA group (p = 0.117). In the actual treatment analysis, after exclusion of patients who required nitinol stent placement for a suboptimal result after angioplasty alone (5 patients in the PTA group and none in the CBA group), restenosis rates were 9 of 25 (36 %) and 4 of 30 (13 %), respectively (p = 0.049). In the intention-to-treat analysis there were also significant differences in ABI values between the PTA and CBA groups at 0.77 {+-} 0.11 versus 0.82 {+-} 0.12, respectively (p = 0.039), at 12 months. Conclusion: Based on the presented results of the trial, CBA seems to be a safer and more effective than PTA for treatment of short atherosclerotic lesions in the superior femoral artery.

  7. Transradial approach for coronary angioplasty in Chinese elderly patients

    Institute of Scientific and Technical Information of China (English)

    CAO Zheng; ZHOU Yu-jie; ZHAO Ying-xin; LIU Yu-yang; SHI Dong-mei; GUO Yong-he; CHENG Wan-jun; NIE Bin; WANG Jian-long

    2008-01-01

    Background The radiaI artery is currently regarded as a useful vascular access site for coronary procedures.This study was conducted to investigate the feasibility and safety of the percutaneous radial artery approach for angioplasty in the elderly.Methods Two thousand and fifty-eight consecutive patients (762 elderly,age≥65 years;and 1296 non-elderly,age <65 years,respectively) who underwent transradial coronary angioplasty were recruited in this study.Study endpoints included procedure success rate,procedure time,vascular complications at access site,and major adverse cardiac and cerebrovascular events during hospitalization.Results Elderly patients were more likely to present with unstable angina and renal dysfunction.The incidence of radial and brachiocephalic trunk anatomical tortuosity was higher in elderly patients than that in non-elderly patients (11.5% vs 3.7%;8.9% vs 2.6%,P<0.01,respectively).However,procedural success rate(94.7% vs 95.6%)and total mean procedure time ((67.9±27.3)minutes vs (58.6±38.5) minutes) for transradial coronary angioplasty were not significantly different between the two groups.Clinical course during the hospitalization was slightly worse in the elderly patients because of more adverse cardiac and cerebrovascular events after the procedure.However,the incidence of vascular complications was not significantly different between the elderly and non-elderly patients.Conclusion Although the incidence of radial and brachiocephalic trunk anatomical tortuosity is higher in elderly patients,transradial coronary intervention can be performed with similar safety and procedural success in these patients as compared with non-elderly patients.

  8. Cutting balloon angioplasty for resistant venous stenoses of dialysis access: immediate and patency results.

    Science.gov (United States)

    Wu, Chih-Cheng; Wen, Szu-Chi

    2008-02-01

    To evaluate the technical success, safety and patency of cutting balloon angioplasty for the treatment of resistant dialysis access stenoses. Cutting balloon angioplasty has been proposed to be useful in treating resistant dialysis access stenoses. However, they are based on experience with very limited cases and formal patency data is insufficient. The author retrospectively reviewed 896 percutaneous transluminal angioplasty (PTA) procedures for the treatment of dysfunctional or thrombotic dialysis access. Thirty-seven of 623 patients with native fistulas and 23 of 273 patients with synthetic grafts had residual stenoses of more than 30% after conventional PTA at an inflation pressure of 24 atm for 60 sec. In these 60 patients, additional cutting balloon PTA was performed. The overall technical success rate was 96.7% and clinical success rate was 98.3%. Only one patient experienced mild local extravasation. The postintervention primary patency rates for native fistula group (N = 37) were 100%, 86.4%, and 67.5% at 1-month, 3-month, and 6-month; the postintervention primary patency rates for synthetic graft group (N = 23) were 87.0%, 60.9%, and 34.2% at 1-month, 3-month, and 6-month respectively. For resistant venous stenoses of dialysis access, cutting balloon PTA is effective, safe, and seems to provide comparative primary patency as suggested by guidelines. Copyright 2008 Wiley-Liss, Inc.

  9. Acute coronary artery occlusion during and after percutaneous transluminal coronary angioplasty. Frequency, prediction, clinical course, management, and follow-up

    NARCIS (Netherlands)

    M.J.B.M. van den Brand (Marcel); G-J. Laarman (GertJan); P.W.J.C. Serruys (Patrick); H. Suryapranata (Harry); G. Jaarman; P.J. de Feyter (Pim); R.T. van Domburg (Ron)

    1991-01-01

    textabstractBACKGROUND. Acute coronary artery occlusion after percutaneous transluminal coronary angioplasty (PTCA) continues to remain a serious complication despite significant improvement in operator performance and technological advancements. This retrospective study was performed to ascertain

  10. Optical coherence tomography layer thickness characterization of a mock artery during angioplasty balloon deployment

    Science.gov (United States)

    Azarnoush, Hamed; Vergnole, Sébastien; Boulet, Benoît; Lamouche, Guy

    2011-03-01

    Optical coherence tomography (OCT) is used to study the deformation of a mock artery in an angioplasty simulation setup. An OCT probe integrated in a balloon catheter provides intraluminal real-time images during balloon inflation. Swept-source OCT is used for imaging. A 4 mm semi-compliant polyurethane balloon is used for experiments. The balloon is inflated inside a custom-built multi-layer artery phantom. The phantom has three layers to mock artery layers, namely, intima, media and adventitia. Semi-automatic segmentation of phantom layers is performed to provide a detailed assessment of the phantom deformation at various inflation pressures. Characterization of luminal diameter and thickness of different layers of the mock artery is provided for various inflation pressures.

  11. Ureteric angioplasty balloon placement to increase localised dosage of BCG for renal pelvis TCC.

    LENUS (Irish Health Repository)

    Forde, J C

    2012-03-01

    Endoscopic percutaneous resection of a renal pelvis transitional cell carcinoma (TCC) is a viable treatment option in those who would be rendered dialysis dependent following a nephroureterectomy. We report endoscopic percutaneous resection of an upper tract TCC recurrence in a single functioning kidney followed by antegrade renal pelvis BCG instillation with novel placement of inflated angioplasty balloon in the ureter to help localise its effect.

  12. Balloon angioplasty for disruption of tunneled dialysis catheter fibrin sheath.

    Science.gov (United States)

    Watorek, Ewa; Golebiowski, Tomasz; Letachowicz, Krzysztof; Garcarek, Jerzy; Kurcz, Jacek; Bartosik, Hanna Augustyniak; Letachowicz, Waldemar; Weyde, Waclaw; Klinger, Marian

    2012-01-01

    Management of failing tunneled hemodialysis catheters, sometimes the only vascular access for hemodialysis, presents a difficult problem. In spite of various techniques having been developed, no consensus has been reached about the preferred technique, associated with the longest catheter patency. We report disruption of the fibrin sheath covering dysfunctional tunneled hemodialysis catheter by means of angioplasty, followed by over guidewire catheter exchange. Following the procedure, the catheter placed in the recovered lumen of the vessel presented correct function. The described procedure allowed maintenance of vascular access in our patient. Additionally, dilatation of the concomitant central vein stenosis opens an option for another attempt for arteriovenous fistula creation.

  13. Exercise training intervention after coronary angioplasty: the ETICA trial.

    Science.gov (United States)

    Belardinelli, R; Paolini, I; Cianci, G; Piva, R; Georgiou, D; Purcaro, A

    2001-06-01

    The goal of this study was to determine the effects of exercise training (ET) on functional capacity and quality of life (QOL) in patients who received percutaneous transluminal coronary angioplasty (PTCA) or coronary stenting (CS), the effects on the restenosis rate and the outcome. It is unknown whether ET induces beneficial effects after coronary angioplasty. We studied 118 consecutive patients with coronary artery disease (mean age 57+/-10 years) who underwent PTCA or CS on one (69%) or two (31%) native epicardial coronary arteries. Patients were randomized into two matched groups. Group T (n = 59) was exercised three times a week for six months at 60% of peak VO2. Group C (n = 59) was the control group. Only trained patients had significant improvements in peak VO2 (26%, p < 0.001) and quality of life (26.8%, p = 0.001 vs. C). The angiographic restenosis rate was unaffected by ET (T: 29%; C: 33%, P = NS) and was not significantly different after PTCA or CS. However, residual diameter stenosis was lower in trained patients (-29.7%, p = 0.045). In patients with angiographic restenosis, thallium uptake improved only in group T (19%; p < 0.001). During the follow-up (33+/-7 months) trained patients had a significantly lower event rate than controls (11.9 vs. 32.2%, RR: 0.71, 95% confidence interval [CI]: 0.60 to 0.91, p = 0.008) and a lower rate of hospital readmission (18.6 vs. 46%, RR: 0.69, 95% CI: 0.55 to 0.93, p < 0.001). Moderate ET improves functional capacity and QOL after PTCA or CS. During the follow-up, trained patients had fewer events and a lower hospital readmission rate than controls, despite an unchanged restenosis rate.

  14. [Results of emergency coronary artery bypass surgery after failed coronary angioplasty].

    Science.gov (United States)

    Imazeki, T; Yokoyama, M; Murai, N; Kurimoto, Y; Sakurada, M; Simizu, Y

    1995-06-01

    In the past 7 years, 9 emergent or urgent coronary artery bypass operations after failed percutaneous transluminal angioplasty (PTCA) were performed among 947 (PTCA). Since the introduction of coronary perfusion catheter system for the support of coronary perfusion during PTCA we could reduce the number of emergent cases and these patients could be operated on semi-emergently and securely without endangering co-medical staffs in a hurry. It is also unnecessary to be on standby all the time when the PTCA is being undertaken. Two acute myocardial infarction cases died in the early phase of this study (operative mortality 22%) and none after the introduction of coronary perfusion system during PTCA.

  15. Costs and effectiveness of using coumarins before, during and after coronary angioplasty.

    Science.gov (United States)

    ten Berg, Jurrien M; Kelder, Johannas C; Plokker, Thys H W; van Hout, Ben A

    2002-01-01

    In the Balloon Angioplasty and Anticoagulation Study (BAAS), coumarins added to routine aspirin therapy before coronary angioplasty reduced cardiac events at the cost of a slightly higher risk of bleeding complications. To determine the cost effectiveness of coumarin treatment, based on the occurrence of both cardiac and bleeding events. Effectiveness was measured, applying two definitions, in terms of the number of events occurring at one year. In the first definition, the occurrence of death, myocardial infarction (MI), or stroke was assessed. The second definition also included revascularisations and major bleeding episodes as an event. Costs were limited to direct medical costs. Cost effectiveness was addressed by probability ellipses representing the point estimates and uncertainties surrounding both costs and effectiveness. At 1 year, death, MI or stroke occurred 1.1% less often when treating with aspirin plus coumarins rather than aspirin therapy alone. When revascularisations and major bleeding events were also included, the difference was 5.0%. Overall, the additional costs in relation to coumarin treatment were compensated by a reduction in repeat interventions. When including all costs, the savings associated with coumarin treatment were estimated at Euros 235 per patient after 1 year. The probability that coumarins are cost saving was estimated at 0.85. The probability that coumarins combine additional effectiveness with cost savings was estimated at 0.70 when survival free of MI or stroke as an effectiveness measure was considered, and at 0.83 when survival free of MI, stroke, revascularisation or major bleeding was considered. Coumarin therapy added to routine aspirin therapy before coronary angioplasty, and continued during follow-up, may not only be considered more effective but also cost saving relative to aspirin therapy alone.

  16. Immediate versus deferred coronary angioplasty in non-ST-segment elevation acute coronary syndromes

    NARCIS (Netherlands)

    Riezebos, R.K.; Ronner, E.; ter Bals, E.; Slagboom, T.; Smits, P.C.; ten Berg, J.M.; Kiemeneij, F.; Amoroso, G.; Patterson, M.S.; Suttorp, M.J.; Tijssen, J.G.P.; Laarman, G.J.

    2009-01-01

    BACKGROUND: The field of acute coronary syndromes is characterised by an increasing tendency towards early invasive catheter-based diagnostics and therapeutics-a practice based on observational and retrospective data. OBJECTIVE: To compare immediate versus deferred angioplasty in patients with non-S

  17. Angioplasty and stent placement - heart

    Science.gov (United States)

    ... angioplasty; Coronary artery angioplasty; Percutaneous transluminal coronary angioplasty; Heart artery dilatation ... to carefully guide the catheter up into your heart and arteries. Dye will be injected into your ...

  18. Intraoperative balloon angioplasty using fogarty artertial embolectomy balloon catheter for creation of arteriovenous fistula for hemodialysis: single center experience.

    Science.gov (United States)

    Jin, Moran; Yoon, Young Chul; Wi, Jin Hong; Lee, Yang-Haeng; Han, Il-Yong; Park, Kyung-Taek

    2015-04-01

    The purpose of this study was to evaluate the use of a Fogarty arterial embolectomy catheter (Fogarty catheter) in intraoperative balloon angioplasty of the cephalic vein, in order to determine its effect on the patency of arteriovenous fistulas (AVFs) created for hemodialysis access. A total of 156 patients who underwent creation of an AVF were divided into two groups, based whether a Fogarty catheter was used during AVF creation. Group A (89 patients) comprised the patients who underwent balloon angioplasty with a Fogarty catheter during the operation. Group B (67 patients) included the patients in whom a Fogarty catheter was not used during the operation. Patient records were reviewed retrospectively and documented. The patency rate was determined by the Kaplan-Meier method. The records of 156 patients who underwent the creation of an AVF from January 2007 to October 2011 were included. The mean follow-up duration was 40.2±19.4 months (range, 1 to 97 months). The patency rates in group A at 12, 36, and 72 months were 83.9%±3.9%, 78.3%±4.6%, and 76.3%±4.9%, respectively, while the corresponding patency rates in group B were 92.5%±3.2%, 82.8%±0.5%, and 79.9%±5.7%, respectively. The patency rates in group B were found to be slightly higher than those in group A, but the difference was not statistically significant (p=0.356). Intraoperative balloon angioplasty of the cephalic vein using the Fogarty catheter is a simple and easily reproducible procedure, and it can be helpful in increasing AVF patency in cases of insufficient runoff or a suboptimal cephalic vein.

  19. Inability of coronary blood flow reserve measurements to assess the efficacy of coronary angioplasty in the first 24 hours in unselected patients

    NARCIS (Netherlands)

    G-J. Laarman (GertJan); P.W.J.C. Serruys (Patrick); H. Suryapranata (Harry); M.J.B.M. van den Brand (Marcel); P.R. Jonkers; P.J. de Feyter (Pim)

    1991-01-01

    textabstractTo determine functional and anatomic changes in the first 24 hours after coronary angioplasty, we studied at random 15 patients (9 men, mean age 60 years) who underwent coronary angioplasty of 16 coronary arteries. Quantitative coronary angiography and coronary flow reserve measurements

  20. Inability of coronary blood flow reserve measurements to assess the efficacy of coronary angioplasty in the first 24 hours in unselected patients

    NARCIS (Netherlands)

    G-J. Laarman (GertJan); P.W.J.C. Serruys (Patrick); H. Suryapranata (Harry); M.J.B.M. van den Brand (Marcel); P.R. Jonkers; P.J. de Feyter (Pim)

    1991-01-01

    textabstractTo determine functional and anatomic changes in the first 24 hours after coronary angioplasty, we studied at random 15 patients (9 men, mean age 60 years) who underwent coronary angioplasty of 16 coronary arteries. Quantitative coronary angiography and coronary flow reserve measurements

  1. The TRAPIST Study. A multicentre randomized placebo controlled clinical trial of trapidil for prevention of restenosis after coronary stenting, measured by 3-D intravascular ultrasound.

    NARCIS (Netherlands)

    P.W.J.C. Serruys (Patrick); D.P. Foley (David); M. Pieper (Michael); J.A. Kleijne; P.J. de Feyter (Pim)

    2001-01-01

    textabstractBACKGROUND: Studies have reported benefit of oral therapy with the phosphodiesterase inhibitor, trapidil, in reducing restenosis after coronary angioplasty. Coronary stenting is associated with improved late outcome compared with balloon angioplasty, but significant neointimal hyperplasi

  2. Cineangiographic findings and balloon catheter angioplasty of pulmonic valvular stenosis

    Energy Technology Data Exchange (ETDEWEB)

    Yeon, Kyung Mo; Yoon, Yong Soo; Kim, In One; Han, Man Chung [College of Medicine, Seoul National University, Seoul (Korea, Republic of)

    1987-08-15

    Transluminal balloon valvuloplasty was performed in the treatment of congenital pulmonic valvular stenosis in 55 children, aged 4 months to 15 years. The right ventricular outflow tract pressure gradient decreased significantly immediately after the procedure from 87.18 {+-} 56mmHg to 29.62 {+-} 26.48mmHg ({rho} < 0.001). Technical success rate was 98% (54/55 patients) and failed case (1 patient) was due to severe fibrous thickening of valve. Complication occurred in one case, that is tricuspid regurgitation (Grade II) due to suspected rupture of chordae tendinae. The degree of pulmonary conus dilatation was closely related with age than the pressure gradient.

  3. Percutaneous transluminal coronary angioplasty in refractory unstable angina pectoris: are new devices useful?

    Science.gov (United States)

    Bertaglia, E; Ramondo, A; Cacciavillani, L; Isabella, G; Reimers, B; Marzari, A; Maddalena, F; Chioin, R

    1996-11-15

    This study was undertaken to assess if the introduction of new angioplasty devices (autoperfusion balloon catheters, stent and atherectomy) could ameliorate early and late results of prompt percutaneous transluminal coronary angioplasty (PTCA) in patients with refractory unstable angina. From January 1993 to June 1995, 59 of 278 patients (14 female, 45 male; mean age: 61 +/- 10 years; range: 38-78) admitted to our Coronary Care Unit with the diagnosis of unstable angina had more than one episode of chest pain at rest with dynamic electrocardiographic ST-T changes and without signs of cardiac necrosis while on medical therapy including oxygen, aspirin, heparin, nitroglycerin and either a beta-blocker or a calcium-antagonist. Coronary angiography was performed within 48 h from the last ischemic attack and a culprilesion technically suitable for PTCA was identified. PTCA was performed in 73 lesions. Elective stent implantation was considered for 16 type B or C lesions in 14 patients. The procedure was initially successful in 52/59 patients (88%), uncomplicated unsuccessful in 4/59 (7%) and complicated in 3/59 (5%). Elective stent insertions were all successful (16/16, 100%). All successfully treated patients were followed up for a mean of 12 +/- 7 months (range: 6-27): 2/52 patients (3.8%) suffered from non-transmural myocardial infarction, 14/52 (26.9%) had a recurrence of angina and 2/52 (3.8%), asymptomatic, had a positive stress test. We conclude that prompt PTCA in refractory unstable angina using 1990s 'state of the art' equipment compares favorably to previous study and that stent delivery might become the elective treatment of complex lesions in this subset of patients.

  4. Infrapopliteal Percutaneous Transluminal Balloon Angioplasty: Clinical Results and Influence Factors

    Energy Technology Data Exchange (ETDEWEB)

    Song, Jang Hyeon; Lee, Seung Jin; Jung, Hye Doo; Lim, Jae Hoon; Chang, Nam Kyu; Yim, Nam Yeol; Kim, Jae Kyu [Dept. of Radiology, Chonnam National University Hospital, Gwangju (Korea, Republic of); Lee, Keun Bae [Dept. of Radiology, Chonnam National University Hospital, Gwangju (Korea, Republic of)

    2011-09-15

    To assess the efficacy of percutaneous transluminal angioplasty (PTA) in patients with infrapopliteal arterial disease, and to determine the influencing factor for prognosis. A total of 55 patients (60 limbs) with infrapopliteal arterial stenosis or occlusion underwent PTA. Atherosclerotic risk factors, clinical symptoms, TransAtlantic Inter-Society Consensus (TASC) classification, and vascular wall calcification were evaluated before PTA. The number of patent infrapopliteal arteries was estimated, and the outcome was evaluated by symptom relief and limb salvage. Technical success was achieved in 53/60 limbs (88.3%) and 81/93 arteries (87.1%), TASC classification (p = 0.038) and vascular calcification (p = 0.002) influenced on technical failure. During follow-up, 26 of 55 limbs (47%) achieved symptom relief and 42/55 limbs (76%) underwent limb salvage. Non-diabetic patients (9/12, 75%) were superior to diabetic patients (17/43, 40%) in terms of symptom relief (p = 0.024). TASC classification and vascular wall calcification influenced on symptom relief and limb salvage. The number of patent infrapopliteal arteries after PTA influenced symptom relief (p < 0.001) and limb amputation (p = 0.003). PTA in patients with chronic critical limb ischemia is worthwhile as a primary treatment. The influence factors should be considered before PTA, and PTA should be performed in as many involved arteries as possible.

  5. Detection of platelet deposition at the site of peripheral balloon angioplasty using indium-111 platelet scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Pope, C.F.; Ezekowitz, M.D.; Smith, E.O.; Rapoport, S.; Glickman, M.; Sostman, H.D.; Zaret, B.L.

    1985-02-01

    Restenosis after balloon angioplasty may be mediated through platelet deposition at the site of arterial dilatation. The purpose of this study was to determine whether platelet deposition at the site of dilatation could be detected using indium-111 platelet scintigraphy. Fifteen patients, aged 60 +/- 9 years, with iliac or femoral (n . 12), renal artery (n . 2) or distal aortic (n . 1) stenoses were studied. All patients received intravenous heparin at the time of dilatation. Labeled platelets containing 471 +/- 65 muCi indium-111 were injected 0.25 to 4 hours after dilatation and 1 to 24 hours after imaging. In 11 of 12 patients with iliac and femoral dilatations, focal uptake was demonstrated at the angioplasty site. In 4 patients (2 patients with renal, 1 patient with iliofemoral, and 1 with distal aortic stenoses), uptake at the dilatation sites was not detected. This preliminary study indicates that despite intravenous heparin, platelets accumulate at sites of balloon dilatation. Platelet scintigraphy may be useful in predicting sites of future narrowing after angioplasty and may be used to test the efficacy of antiplatelet therapy in retarding restenosis.

  6. The patients' perception of recovery after coronary angioplasty.

    Science.gov (United States)

    Higgins, M; Dunn, S; Theobald, K

    2000-08-01

    Coronary angioplasty and stent placement is associated with short hospital stays. Patients are expected to recover at home, alone, following limited care time with nurses. The purpose of the study was to describe participants' perceptions of recovery after angioplasty. Eight men and three women were interviewed 1 month after discharge from hospital. Verbatim transcripts were analysed for major themes using the qualitative techniques of grounded theory. Data analysis revealed three major categories: awareness of the problem, coping response and appraisal of the situation. These were linked via a problem solving process. In step one, the problem was identified. In step two, coping responses were taken to try and solve the problem. In step three, the results of the coping responses were appraised or evaluated. These categories were further defined by four phases identified as: pre-admission, admission, during the angioplasty and recovery. This paper describes the recovery phase. Awareness of the problem in the recovery phase was associated with 'relief from chest pain' for most participants. In contrast, anxiety continued and was associated with 'uncertainty over future health'. Participants described coping responses of "taking control of their life again" by undertaking both physical and psychological strategies. Finally, the situation was appraised to be either a 'good' or a 'bad' recovery. This appraisal was based on such considerations as the absence of chest pain, improvement in well-being and energy levels. The results of this study highlight patients' concerns and support the need for greater emphasis on their psychosocial needs. This care must be provided within the time constraints of short hospital stays. Nurses must also consider providing support to patients in the pre-admission and recovery phases.

  7. Early outcome of high energy Laser (Excimer) facilitated coronary angioplasty ON hARD and complex calcified and balloOn-resistant coronary lesions: LEONARDO Study

    Energy Technology Data Exchange (ETDEWEB)

    Ambrosini, Vittorio; Sorropago, Giovanni; Laurenzano, Eugenio [Montevergine Clinic, Mercogliano (Italy); Golino, Luca, E-mail: lucagolino.jazz@alice.it [Montevergine Clinic, Mercogliano (Italy); Moriggia-Pelascini Hospital, Gravedona, Como (Italy); Casafina, Alfredo; Schiano, Vittorio [Montevergine Clinic, Mercogliano (Italy); Gabrielli, Gabriele [University Hospital Ospedali Riuniti, Ancona (Italy); Ettori, Federica; Chizzola, Giuliano [Spedali Civili University Hospital, Brescia (Italy); Bernardi, Guglielmo; Spedicato, Leonardo [University Hospital S. Maria Misericordia, Udine (Italy); Armigliato, Pietro [Istituto Italiano Ricerche Mediche, Verona (Italy); Spampanato, Carmine [Telethon Institute of Genetics and Medicine (TIGEM), Naples (Italy); Furegato, Martina [Istituto Italiano Ricerche Mediche, Verona (Italy)

    2015-04-15

    Aim: An innovative xenon–chlorine (excimer) pulsed laser catheter (ELCA X80) has been recently used for the treatment of complex coronary lesions, as calcified stenosis, chronic total occlusions and non-compliant plaques. Such complex lesions are difficult to adequately treat with balloon angioplasty and/or intracoronary stenting. The aim of this study was to examine the acute outcome of this approach on a cohort of patients with coronary lesions. Methods and Results: Eighty patients with 100 lesions were enrolled through four centers, and excimer laser coronary angioplasty was performed on 96 lesions (96%). Safety and effectiveness data were compared between patients treated with standard laser therapy and those treated with increased laser therapy. Laser success was obtained in 90 lesions (93.7%), procedural success was reached in 88 lesions (91.7%), and clinical success in was obtained in 87 lesions (90.6%). There was no perforation, major side branch occlusion, spasm, no-reflow phenomenon, dissection nor acute vessel closure. Increased laser parameters were used successfully for 49 resistant lesions without complications. Conclusions: This study suggests that laser-facilitated coronary angioplasty is a simple, safe and effective device for the management of complex coronary lesions. Furthermore, higher laser energy levels delivered by this catheter improved the device performance without increasing complications. - Highlights: • We planned this multicenter study to examine the acute outcome of an innovative xenon–chlorine (excimer) pulsed laser catheter (ELCA X80) for treatment of complex coronary lesions. • We enrolled 80 patients with 100 lesions and performed excimer laser coronary angioplasty in 96 lesions (96%). • Laser success was obtained in 90 lesions (93.7%), procedural success was reached in 88 lesions (91.7%), and clinical success was obtained in 87 lesions (90.6%). • Increased laser parameters were used successfully for 49 resistant

  8. [Complications of transluminal coronary angioplasty. A multicenter French study (1983)].

    Science.gov (United States)

    Valeix, B; Labrunie, P; Marco, J; Cherrier, F; Cuillière, M; Bertrand, M; Schmitt, R; Sabatier, M; Gaspard, P; Guermonprez, J L

    1985-03-01

    The authors report the complications observed during 1 247 transluminal coronary angioplasties (TCA) performed in 1 187 patients in 17 french centers between 1979 and October 1983. There were 855 primary successes (68.9 p. 100). There were 41 cases of symptomatic dissection (3.3 p. 100) of which 32 underwent aortocoronary bypass surgery with a residual myocardial infarction (MI) in 13 cases (40.6 p. 100). Medical treatment of symptomatic dissection gave very poor results (7 out of 9 MI) and is formally contra-indicated. 67 per- or postoperative occlusions were observed (5.3 p. 100). This is the most serious complication which necessitates an emergency revascularisation procedure (TCA or coronary bypass surgery--CBS--) because MI rapidly follows in patients without a well-developed collateral circulation. In this series MI occurred in 28 out of 45 patients--62 p. 100--despite CBS. This underlines the value of an immediate repeat TCA which, when successful, results in a much faster revascularisation. Seventy-three MI (5.8 p. 100) were observed in the first 24 hours: 50 p. 100 were secondary to an angiographically documented coronary occlusion. The other two causes were coronary dissection and spasm. Emergency CBS was carried out in 107 cases (8.9 p. 100) mainly for coronary occlusion or symptomatic dissection. The mortality was 11 out of 1 187 patients (0.93 p. 100). Death occurred in the catheter laboratory in 3 cases, during the first 24 hours in the operating theatre in 1 case, and after the first 24 hours but before hospital discharge in 7 patients.(ABSTRACT TRUNCATED AT 250 WORDS)

  9. Balloon pulmonary angioplasty: a treatment option for inoperable patients with chronic thromboembolic pulmonary hypertension

    Directory of Open Access Journals (Sweden)

    Aiko eOgawa

    2015-02-01

    Full Text Available In chronic thromboembolic pulmonary hypertension, stenoses or obstructions of the pulmonary arteries due to organized thrombi can cause an elevation in pulmonary artery resistance, which in turn can result in pulmonary hypertension. Chronic thromboembolic pulmonary hypertension can be cured surgically by pulmonary endarterectomy; however, patients deemed unsuitable for pulmonary endarterectomy due to lesion, advanced age, or comorbidities have a poor prognosis and limited treatment options. Recently, advances have been made in balloon pulmonary angioplasty for these patients, and this review highlights this recent progress.

  10. Kissing balloon inflation in percutaneous coronary interventions.

    Science.gov (United States)

    Sgueglia, Gregory A; Chevalier, Bernard

    2012-08-01

    Bifurcation lesions are the most frequently approached complex coronary lesions in everyday interventional practice. Bifurcations complexity relies essentially on their very specific anatomy that is imperfectly handled by current coronary devices and, despite dedicated techniques and drug-eluting stents, percutaneous coronary interventions directed toward the treatment of bifurcations are technically demanding and require proper execution. Kissing balloon (KB) inflation was the first specific bifurcation technique to have been developed for percutaneous bifurcation interventions and continues to currently play an important role. Indeed, KB has been proposed to optimize stent apposition, improve side branch access while correcting stent deformation or distortion. Over the years, the KB technique has been deeply investigated by many different methods, from bench testing and computer simulations to in vivo intravascular imaging and clinical studies, producing a large amount of data pointing out the benefits and limitations of the technique. We sought to provide here a comprehensive overview of all those aspects. Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  11. Self-expanding nitinol stents for treatment of infragenicular arteries following unsuccessful balloon angioplasty

    Energy Technology Data Exchange (ETDEWEB)

    Tepe, Gunnar; Heller, Stephan; Wiskirchen, Jakub; Fischmann, Arne; Claussen, Claus D. [University of Tuebingen, Department of Diagnostic Radiology, Tuebingen (Germany); Zeller, Thomas [Heart Center, Bad Krotzingen (Germany); Coerper, Stephan; Beckert, Stefan [University of Tuebingen, Department of Surgery, Tuebingen (Germany); Balletshofer, Bernd [University of Tuebingen, Department of Angiology, Tuebingen (Germany)

    2007-08-15

    The feasibility of self-expanding nitinol stents for treatment of infragenicular arteries following unsuccessful balloon angioplasty was assessed. Options for lower limb percutaneous revascularization are limited, especially for complex vessel obstruction. Depending on the lesion and the experience of the interventionalist, the failure rate of balloon angioplasty (PTA) ranges between 10 and 40%. Until recently, no self-expanding stent for the use in the infragenicular arteries was available. This is the first report of the results for 18 consecutive patients who received 4F sheath compatible self-expanding nitinol stents following unsuccessful PTA or early restenosis. Twenty-four stents were implanted in 21 lesions for various indications residual stenosis >50% due to heavy calcification, flow-limiting dissection, occluding thrombus resistant to thrombolyis, thrombaspiration, and PTA, and early restenosis after previous PTA. Stent implantation was feasible in all cases. No complications occurred. After the stent implantation, all primarily unsuccessful interventions could be transformed into successful procedures with no residual stenosis >30% in any case. After 6 {+-} 2 months, two of the 18 patients died, and 14 of the 16 remaining patients improved clinically. At follow-up, the patency could be assessed in 14 stented arteries. Three stents were occluded, one stent showed some neointimal hyperplasia (50-70% restenosis), the remaining ten stents showed no restenosis (0-30%). The use of self-expanding nitinol stents in tibioperoneal and popliteal arteries is a safe and feasible option for the treatment of unsuccessful PTA. The 6-months patency is high. (orig.)

  12. [Recanalization of the peripheral arteries by laser thermal balloon angioplasty. 2 years of clinical experience].

    Science.gov (United States)

    Riambau Alonso, V; Masotti Centol, M; Latorre Vilallonga, J; Viver Manresa, E; Crexells Figueres, C; Oriol Palou, A

    1991-01-01

    Laser angioplasty represents an attractive alternative to overcome the limitations of balloon angioplasty. We describe our results with laser thermal balloon angioplasty (LTBA) in the treatment of atherosclerosis obliterans in the lower limbs after two years clinical follow up. We also analyse the influence of lesion characteristics on immediate results. Thirty seven patients (34 men), whose mean age was 58 +/- 9 years, were included in this study. Occlusive arterial disease (Fontaine stage II-IV), with 39 significant haemodynamic arterial lesions were present in all of them. Ankle/brachial Doppler index was O,51 +/- 0,17. Eighteen lesions were located in the iliac area (13 stenoses 2,3 +/- 1 cm of length and 5 occlusions 4,2 +/- 3 cm) and 21 lesions in femoro-popliteal area (5 stenoses 2,6 +/- 2 cm and 16 occlusions 5,7 +/- 3 cm). A percutaneous procedure was used in 38 cases and only in one case a femoral dissection was necessary. The laser source was argon in 26 cases and Nd-YAG in 13. The overall immediate angiographic and clinical success was 85% (89% in iliac lesions and 81% in femoropopliteal lesions; 100% in stenoses and 70% in occlusions). The presence of occlusion (p less than 0,01) and/or calcium (p less than O,05) influenced negatively the immediate results. No major complications were observed. Seven (17%) minor complications occurred, but no emergency surgery was necessary. The ankle/brachial Doppler index after treatment was 0,82 +/- 0,21. Cumulative clinical patency was 91% for successfully treated patients after two years follow up. We conclude that LTBA represents an effective and less aggressive way to treat atherosclerosis obliterans.(ABSTRACT TRUNCATED AT 250 WORDS)

  13. Oral anticoagulant therapy during and after coronary angioplasty the intensity and duration of anticoagulation are essential to reduce thrombotic complications.

    Science.gov (United States)

    ten Berg, J M; Hutten, B A; Kelder, J C; Verheugt, F W; Plokker, H W

    2001-04-24

    In the randomized Balloon Angioplasty and Anticoagulation Study (BAAS), the addition of oral anticoagulants to aspirin significantly reduced early and late events after coronary angioplasty. However, bleeding episodes were increased. The present report studied the intensity and the duration of anticoagulation as predictors of thrombotic and bleeding events. A total of 530 patients, 34% of whom received a stent, were treated with aspirin plus coumarins. Half of the patients were randomized to angiographic follow-up. The target international normalized ratio (INR) was 2.1 to 4.8 during angioplasty and 6-month follow-up. Thrombotic events were death, myocardial infarction, target lesion revascularization, and thrombotic stroke. Bleeding complications were hemorrhagic stroke, major extracranial bleeding, and false aneurysm. "Optimal" anticoagulation was defined as an INR in the target range for at least 70% of the follow-up time. There were 17 early thrombotic events (3.2%), 7 early bleeding episodes (1.3%), and 10 false aneurysms (1.9%). The incidence rate for both early thrombotic and bleeding events was lowest in patients in the target range. A total of 61 late thrombotic events occurred (11.6%). Optimal anticoagulation was an independent predictor of late thrombotic events (relative risk, 0.33; 95% CI, 0.19 to 0.57) and was associated with a 0.21 mm (95% CI, 0.17 to 0.42) larger vessel lumen at 6 months. Late bleeding episodes (1.4%) were lowest in patients in the target range. Coumarins started before coronary angioplasty with a target INR of 2.1 to 4.8 led to the lowest procedural event rate, without an increase in bleeding episodes. During follow-up, optimal anticoagulation was associated with a decrease in the incidence of late events by 67% and a significant improvement in 6-month angiographic outcome.

  14. Reversible transient apical ballooning syndrome with coronary lesions

    Institute of Scientific and Technical Information of China (English)

    Yunshan Cao; Min Zhang; Xiang Li; Ping Xie; Lynn Cronin

    2009-01-01

    Transient apical ballooning syndrome(Tako-Tsubo syndrome or ampulla cardiomyopathy) occurs predominantly in women over 60 years of age with a history of recent physical or psychological stress. We present a case of a male patient with reversible transient apical ballooning syndrome with significant coronary lesions and other ECG changes that did not explain the clinical symptoms.

  15. Differences in optical coherence tomographic findings and clinical outcomes between excimer laser and cutting balloon angioplasty for focal in-stent restenosis lesions.

    Science.gov (United States)

    Nishino, Masami; Lee, Yasuharu; Nakamura, Daisuke; Yoshimura, Takahiro; Taniike, Masayuki; Makino, Nobuhiko; Kato, Hiroyasu; Egami, Yasuyuki; Shutta, Ryu; Tanouchi, Jun; Yamada, Yoshio

    2012-10-01

    In-stent restenosis (ISR), especially focal ISR, after percutaneous coronary intervention (PCI) remains one of the major clinical problems in the drug-eluting stent (DES) era. Several reports have revealed that excimer laser coronary angioplasty (ELCA) is useful for ISR; however, detailed findings after ELCA are unknown. Therefore, we investigated the condition of the neointima after ELCA for ISR with optical coherence tomography (OCT) and compared the OCT findings and clinical outcome between ELCA and cutting-balloon angioplasty (CBA). Twenty-one consecutive patients with focal ISR who underwent ELCA or CBA were enrolled. All patients underwent 12- to 15-month follow-up coronary angiography. OCT was performed immediately after successful PCI to evaluate the neointimal condition in the ISR lesion. We compared the following OCT parameters between ELCA and CBA groups: maximal thickness of remaining in-stent neointima (MTN), number of tears, minimum lumen dimension (MLD), and minimum lumen area (MLA). We also evaluated clinical outcomes, including target vessel revascularization, acute myocardial infarction, death, and stent thrombosis. MLA in the ELCA group (n = 10) was significantly larger than in the CBA group, and number of tears in the ELCA group was significantly lower than in the CBA group. A trend was shown toward lower TLR with ELCA versus CBA (10.0% vs 45.5%). OCT immediately after ELCA for ISR lesions revealed larger lumen area and smaller number of tears compared with CBA, which may support favorable effects of ELCA for focal ISR.

  16. Laser angioplasty for cardiovascular disease

    Science.gov (United States)

    Okada, Masayoshi

    2005-07-01

    Recently, endovascular interventions such as balloon angioplasty, atherectomy and the stenting method, except for conventional surgery have been clinically employed for the patients with atheromatous plaques of the peripheral- and the coronary arteries, because the number of patients with arteriosclerosis is now increasing in the worldwide. Among these procedures, restenoses after endovascular interventions have been remarkably disclosed in 20-40 % of the patients who underwent percutaneous coronary interventions. Thus, there are still some problems in keeping long-term patency by means of endovascular techniques such as balloon angioplasty and atherectomy (1, 2). For reduction of these problems , laser angioplasty using Argon laser was applied experimentally and clinically. Based on excellent experimental studies, laser was employed for 115 patients with stenotic ,or obstructive lesions occluding more thasn 75 % of the peripheral and the coronary arteries angiographycally.

  17. Resource utilization, cost, and health status impacts of coronary stent versus "optimal" percutaneous coronary angioplasty: results from the OPUS-I trial.

    Science.gov (United States)

    Neil, Nancy; Ramsey, Scott D; Cohen, David J; Every, Nathan R; Spertus, John A; Weaver, W Douglas

    2002-08-01

    In the OPUS-I trial, primary coronary stent implantation reduced 6-month composite incidence of death, myocardial infarction, cardiac surgery, or target vessel revascularization relative to a strategy of initial PTCA with provisional stenting in patients undergoing single vessel coronary angioplasty. The purpose of this research was to compare the economic and health status impacts of each treatment strategy. Resource utilization data were collected for the 479 patients randomized in OPUS-I. Itemized cost estimates were derived from primary hospital charge data gathered in previous multicenter trials evaluating coronary stents, and adjusted to approximate 1997 Medicare-based costs for a cardiac population. Health status at 6 months was assessed using the Seattle Angina Questionnaire (SAQ). Initial procedure related costs for patients treated with a primary stent strategy were higher than those treated with optimal PTCA/provisional stent ($5,389 vs $4,339, P < 0.001). Costs of initial hospitalization were also higher for patients in the primary stent group ($9,234 vs $8,434, P < 0.01) chiefly because of the cost differences in the index revascularization. Mean 6-month costs were similar in the two groups; however, there was a slight cost advantage associated with primary stenting. Bootstrap replication of 6-month cost data sustained the economic attractiveness of the primary stent strategy. There were no differences in SAQ scores between treatment groups. In patients undergoing single vessel coronary angioplasty, routine stent implantation improves important clinical outcomes at comparable, or even reduced cost, compared to a strategy of initial balloon angioplasty with provisional stenting.

  18. Safety and efficacy of angioplasty with intracoronary stenting in patients with unstable coronary syndromes. Comparison with stable coronary syndromes

    Directory of Open Access Journals (Sweden)

    Luís C. L. Correia

    2000-06-01

    Full Text Available OBJECTIVE: To assess safety and efficacy of coronary angioplasty with stent implantation in unstable coronary syndromes. METHODS: Retrospective analysis of in-hospital and late evolution of 74 patients with unstable coronary syndromes (unstable angina or infarction without elevation of the ST segment undergoing coronary angioplasty with stent placement. These 74 patients were compared with 31 patients with stable coronary syndromes (stable angina or stable silent ischemia undergoing the same procedure. RESULTS: No death and no need for revascularization of the culprit artery occurred in the in-hospital phase. The incidences of acute non-Q-wave myocardial infarction were 1.4% and 3.2% (p=0.6 in the unstable and stable coronary syndrome groups, respectively. In the late follow-up (11.2±7.5 months, the incidences of these events combined were 5.7% in the unstable coronary syndrome group and 6.9% (p=0.8 in the stable coronary syndrome group. In the multivariate analysis, the only variable with a tendency to significance as an event predictor was diabetes mellitus (p=0.07; OR=5.2; 95% CI=0.9-29.9. CONCLUSION: The in-hospital and late evolutions of patients with unstable coronary syndrome undergoing angioplasty with intracoronary stent implantation are similar to those of the stable coronary syndrome group, suggesting that this procedure is safe and efficacious when performed in unstable coronary syndrome patients.

  19. Usefulness of percutaneous transluminal coronary angioplasty in silent myocardial ischemia

    Energy Technology Data Exchange (ETDEWEB)

    Hou, Mami [Toho Univ., Tokyo (Japan). School of Medicine

    1996-04-01

    The usefulness of percutaneous transluminal coronary angioplasty (PTCA) was assessed in patients with exercise-induced asymptomatic myocardial ischemia (silent ischemia) and compared with exercise-induced symptomatic myocardial ischemia (symptomatic ischemia). Patients with single vessel coronary artery disease (51 with angina pectoris, 40 with old myocardial infarction) and evidence of stress-induced ischemia on thallium-201 single photon emission computed tomography (SPECT) underwent successful PTCA. Thirty-seven percent of angina patients and 60% of infarction patients showed asymptomatic exercise-induced ischemia. There was no significant difference in population characteristics between silent and symptomatic patients. Patients with silent angina had significantly higher percentage thallium uptake and washout rate than symptomatic patients. After PTCA, both percentage diameter stenosis and percentage thallium uptake were improved in all patients with angina irrespective of the presence or absence of symptoms. There were no significant differences in percentage thallium uptake and washout rate between patients with silent and symptomatic infarction. After PTCA, percentage diameter stenosis, percentage thallium uptake, and washout rate improved in all infarction patients irrespective of the symptoms. Zero percent of silent angina patients, 12% of symptomatic angina patients, 12% of silent infarction patients, 19% of symptomatic infarction patients had cardiac events during about 4.5 years after PTCA. The incidence of cardiac events did not significantly differ in any patient group. PTCA improved myocardial perfusion in all patients, and the incidence of cardiac events did not differ between the silent and symptomatic groups. Revascularization with PTCA is suitable for patients with silent as well as symptomatic ischemia. (author).

  20. Association between disruption of fibrin sheaths using percutaneous transluminal angioplasty balloons and late onset of central venous stenosis.

    Science.gov (United States)

    Ni, Nina; Mojibian, Hamid; Pollak, Jeffrey; Tal, Michael

    2011-02-01

    To compare the rates of central venous stenosis in patients undergoing hemodialysis who underwent disruption of fibrin sheath with percutaneous transluminal angioplasty balloons and those who underwent over-the-wire catheter exchange. This study is a retrospective review of 209 percutaneous transluminal angioplasty balloon disruption and 1304 over-the-wire catheter exchange procedures performed in 753 patients. Approval from the Human Investigations Committee was obtained for this study. Up to 10-year follow-up was performed. A χ(2) test was used to compare the rates of central venous stenosis after balloon disruption versus catheter exchange. A t-test was used to compare time to central venous stenosis development. Of the 753 patients in the study, 127 patients underwent balloon disruption of fibrin sheath and 626 had catheter exchange. Within the balloon disruption group, 18 (14.2%) of 127 patients subsequently developed central venous stenosis, compared with 44 (7.0%) of 626 in the catheter exchange group (P balloon disruption group had four or more subsequent catheter exchanges, versus 12.6% in the catheter exchange group (P balloon disruption of fibrin sheath and late-onset central venous stenosis. Because venography was not routinely performed in catheter exchange patients, future randomized studies are necessary to confirm these findings.

  1. Critical appraisal of paclitaxel balloon angioplasty for femoral–popliteal arterial disease

    Directory of Open Access Journals (Sweden)

    Herten M

    2016-08-01

    Full Text Available Monika Herten,1 Giovanni B Torsello,1,2 Eva Schönefeld,3 Stefan Stahlhoff2 1Department of Vascular and Endovascular Surgery, University Hospital Münster, 2Department of Vascular Surgery, St Franziskus Hospital, Münster, 3Institute for Education and Student Affairs, University Hospital Münster, Münster, Germany Abstract: Peripheral arterial disease, particularly critical limb ischemia, is an area with urgent need for optimized therapies because, to date, vascular interventions often have limited life spans. In spite of initial encouraging technical success after femoropopliteal percutaneous transluminal angioplasty or stenting, postprocedural restenosis remains the major problem. The challenging idea behind the drug-coated balloon (DCB concept is the biological modification of the injury response after balloon dilatation. Antiproliferative drugs administered via DCBs or drug-eluting stents are able to suppress neointimal hyperplasia, the main cause of restenosis. This article reviews the results of DCB treatments of femoropopliteal and infrapopliteal lesions in comparison to standard angioplasty with uncoated balloons. A systematic literature search was performed in 1 medical journals (ie, MEDLINE, 2 international registers for clinical studies (ie, www.clinicaltrials.gov, and 3 abstracts of scientific sessions. Several controlled randomized trials with follow-up periods of up to 5 years demonstrated the efficacy of paclitaxel –DCB technology. However, calcified lesions seem to affect the efficacy of DCB. Combinations of preconditioning methods with DCBs showed promising results. Although the mechanical abrasion of calcium via atherectomy or laser ablation showed favorable periprocedural results, the long-term impact on restenosis and clinical outcome has to be demonstrated. Major advantages of the DCBs are the rapid delivery of drug at uniform concentrations with a single dose, their efficacy in areas wherein stents have been

  2. Effect of Carvedilol on the Coronary Vascular Endothelial Function after Percutaneous Transluminal Coronary Angioplasty

    Institute of Scientific and Technical Information of China (English)

    苏显明; 马奕; 崔长琮

    2003-01-01

    Objectives To understand the effect of carvedilol on the coronary vascular endothelial function of the patients with coronary heart disease after percutaneous transluminal coronary angioplasty (PTCA). Methods 51cases, having one or more than two branches narrow ( ≥ 70% ) , were diagnosed by coronary angiography. These patients were divided randomly into carvedilol group (n = 28 ) and control group (n = 23) who did not take carvedilol.Endothelin (ET) and nitro dioxide (NO) levels of peripheral blood were measured before and after PTCA,before and after two weeks by taking carvedilol. Results Compared with the ET and NO levels before PTCA, ET were markedly increased and NO were decreased after PTCA (p < 0.05); compared with the ET and NO levels before taking carvedilol, ET were decreased and NO were increased after two week (p <0.05) , but the ET and NO levels of the control group did not change in the period of two weeks observation (p > 0.05). Conclusions Carvedilol may improve the coronary vascular endothelial function after PTCA.

  3. Is routine stenting for acute myocardial infarction superior to balloon angioplasty? A randomised comparison in a large cohort of unselected patients

    NARCIS (Netherlands)

    Suryapranata, H; De Luca, G; van't Hof, AWJ; Ottervanger, JP; Hoorntje, JCA; Gosselink, ATM; Zijlstra, F; de Boer, MJ; Dambrink, Jan Hendrik Everwijn

    2005-01-01

    Objective: To evaluate the impact of routine stenting, compared with balloon angioplasty, in unselected patients presenting with ST segment elevation myocardial infarction (STEMI). Design: Randomised trial. Setting: Tertiary referral centre. Participants: All patients presenting with STEMI randomly

  4. Spontaneous Coronary Dissection: “Live Flash” Optical Coherence Tomography Guided Angioplasty

    Science.gov (United States)

    Bento, Angela Pimenta; Fernandes, Renato Gil dos Santos Pinto; Neves, David Cintra Henriques Silva; Patrício, Lino Manuel Ribeiro; de Aguiar, José Eduardo Chambel

    2016-01-01

    Optical Coherence tomography (OCT) is a light-based imaging modality which shows tremendous potential in the setting of coronary imaging. Spontaneous coronary artery dissection (SCAD) is an infrequent cause of acute coronary syndrome (ACS). The diagnosis of SCAD is made mainly with invasive coronary angiography, although adjunctive imaging modalities such as computed tomography angiography, IVUS, and OCT may increase the diagnostic yield. The authors describe a clinical case of a young woman admitted with the diagnosis of ACS. The ACS was caused by SCAD detected in the coronary angiography and the angioplasty was guided by OCT. OCT use in the setting of SCAD has been already described and the true innovation in this case was this unique use of OCT. The guidance of angioplasty with live and short images was very useful as it allowed clearly identifying the position of the guidewires at any given moment without the use of prohibitive amounts of contrast. PMID:26989520

  5. Balloon Occlusion Types in the Treatment of Coronary Perforation during Percutaneous Coronary Intervention

    Directory of Open Access Journals (Sweden)

    Xiangfei Wang

    2014-01-01

    Full Text Available Coronary artery perforation is an uncommon complication in patients with coronary heart disease undergoing percutaneous coronary intervention. However, pericardial tamponade following coronary artery perforation may be lethal, and prompt treatment is crucial in managing such patients. Balloon occlusion and the reversal of anticoagulant activity are the common methods used to prevent cardiac tamponade by reducing the amount of bleeding. Herein, we discuss the pros and cons of currently used occlusion types for coronary perforation. Optimal balloon occlusion methods should reduce the amount of bleeding and ameliorate subsequent myocardial ischemia injury, even during cardiac surgery.

  6. Influence of inflation pressure and balloon size on the development of intimal hyperplasia after balloon angioplasty. A study in the atherosclerotic rabbit.

    Science.gov (United States)

    Sarembock, I J; LaVeau, P J; Sigal, S L; Timms, I; Sussman, J; Haudenschild, C; Ezekowitz, M D

    1989-10-01

    To evaluate the effect of balloon size and inflation pressure on acute and subsequent outcome following balloon angioplasty (BA), 70 New Zealand White rabbits with bilateral femoral atherosclerosis were assigned to four groups: group 1, oversized balloon, low inflation pressure (n = 35 vessels; balloon size, 3.0 mm/inflation pressure, 5 atm); group 2, oversized balloon, high inflation pressure (n = 36; 3.0 mm/10 atm); group 3, appropriate size, low inflation pressure (n = 17; 2.5 mm/5 atm); and group 4, appropriate size balloon, high inflation pressure (n = 19; 2.5 mm/10 atm). Angiograms were obtained before, 10 minutes after, and 28 days after BA and read by two blinded observers using electronic calipers. The in vivo balloon-to-vessel ratio was measured for each group. There were eight non-BA controls. Rabbits were sacrificed either immediately (n = 34) or at 28 days after BA (n = 36), with the femoral vessels pressure perfused for histologic and morphometric analysis. The latter was performed at 28 days only. Absolute angiographic diameters increased in all groups immediately after BA (p less than 0.01). Acute angiographic success, defined as greater than 20% increase in luminal diameter, was higher using high inflation pressure (group 2, 32/36 [89%] and group 4, 16/19 [84%] vs. group 1, 23/35 [66%] and group 3, 9/17 [53%]; p less than 0.05). A 3.0-mm balloon resulted in significant oversizing irrespective of inflation pressure (balloon-to-vessel ratio, 1.5 +/- 0.1 vs. 1.1 +/- 0.1 to 1, for the 2.5-mm balloon). Vessels exposed to high inflation pressure had a significantly higher incidence of mural thrombus, dissection (p less than 0.01), and medial necrosis versus low pressure (p less than 0.05). At 28 days, the rates of restenosis (defined as greater than 50% loss of initial gain) were 14/20 (70%), 11/16 (69%), 5/10 (50%), and 5/10 (50%) for groups 1 through 4 (p = NS; a trend in favor of the groups using an oversized balloon). There was an increase in the

  7. One hundred and thirteen attempts at directional coronary atherectomy: the early and combined experience of two European centres using quantitative angiography to assess their results

    NARCIS (Netherlands)

    V.A.W.M. Umans (Victor); E. Haine; J. Renkin; P.J. de Feyter (Pim); W. Wijns (William); P.W.J.C. Serruys (Patrick)

    1992-01-01

    textabstractDirectional coronary atherectomy has been introduced as an alternative to conventional balloon angioplasty when treating coronary artery stenoses with complex lesion morphology. To determine the immediate efficacy of coronary atherectomy in patients with such lesions, the first 113

  8. Deep sea water prevents balloon angioplasty-induced hyperplasia through MMP-2: an in vitro and in vivo study.

    Science.gov (United States)

    Li, Pei-Chuan; Pan, Chun-Hsu; Sheu, Ming-Jyh; Wu, Chin-Ching; Ma, Wei-Fen; Wu, Chieh-Hsi

    2014-01-01

    Major facts about the development of restenosis include vascular smooth muscle cells (VSMCs) proliferation and migration. A previous study showed that in vitro treatment with magnesium chloride has the potential to affect the proliferation and migration of VSMCs. Magnesium is the major element in deep sea water (DSW) and is a biologically active mineral. It is unclear whether DSW intake can prevent abnormal proliferation and migration of VSMCs as well as balloon angioplasty-induced neointimal hyperplasia. Thus, we attempted to evaluate the anti-restenotic effects of DSW and its possible molecular mechanisms. Several concentrations of DSW, based on the dietary recommendations (RDA) for magnesium, were applied to a model of balloon angioplasty in SD rats. The results showed that DSW intake markedly increased magnesium content within the vascular wall and reduced the development of neointimal hyperplasia. The immunohistochemical analysis also showed that the expression of proteins associated with cell proliferation and migration were decreased in the balloon angioplasty groups with DSW supplement. Furthermore, in vitro treatment with DSW has a dose-dependent inhibitory effect on serum-stimulated proliferation and migration of VSMCs, whose effects might be mediated by modulation of mitogen-activated protein kinase (MAPK) signaling and of the activity of matrix metalloproteinase-2 (MMP-2). Our study suggested that DSW intake can help prevent neointimal hyperplasia (or restenosis), whose effects may be partially regulated by magnesium and other minerals.

  9. Deep sea water prevents balloon angioplasty-induced hyperplasia through MMP-2: an in vitro and in vivo study.

    Directory of Open Access Journals (Sweden)

    Pei-Chuan Li

    Full Text Available Major facts about the development of restenosis include vascular smooth muscle cells (VSMCs proliferation and migration. A previous study showed that in vitro treatment with magnesium chloride has the potential to affect the proliferation and migration of VSMCs. Magnesium is the major element in deep sea water (DSW and is a biologically active mineral. It is unclear whether DSW intake can prevent abnormal proliferation and migration of VSMCs as well as balloon angioplasty-induced neointimal hyperplasia. Thus, we attempted to evaluate the anti-restenotic effects of DSW and its possible molecular mechanisms. Several concentrations of DSW, based on the dietary recommendations (RDA for magnesium, were applied to a model of balloon angioplasty in SD rats. The results showed that DSW intake markedly increased magnesium content within the vascular wall and reduced the development of neointimal hyperplasia. The immunohistochemical analysis also showed that the expression of proteins associated with cell proliferation and migration were decreased in the balloon angioplasty groups with DSW supplement. Furthermore, in vitro treatment with DSW has a dose-dependent inhibitory effect on serum-stimulated proliferation and migration of VSMCs, whose effects might be mediated by modulation of mitogen-activated protein kinase (MAPK signaling and of the activity of matrix metalloproteinase-2 (MMP-2. Our study suggested that DSW intake can help prevent neointimal hyperplasia (or restenosis, whose effects may be partially regulated by magnesium and other minerals.

  10. [Dextrocardia in situs inversus totalis with obstructive coronary disease. Its treatment by coronary angioplasty by the brachial approach].

    Science.gov (United States)

    da Silva, M J; Arie, S; Garcia, D P; Bellotti, G; Pileggi, F

    1992-10-01

    Dextrocardia in "situs inversus totalis" with obstructive coronary disease is a rare clinical situation, with few cases treated by coronary angioplasty using the femoral approach being reported. In this report we describe the case of a 61-year-old male patient who underwent successful dilatation of two arteries by the brachial approach. We discuss technical aspects related to the procedure, which may be easily performed when proper equipment is available.

  11. A clinical trial comparing primary coronary angioplasty with tissue plasminogen activator for acute myocardial infarction

    NARCIS (Netherlands)

    M.L. Simoons (Maarten); S.G. Ellis (Stephen)

    1997-01-01

    textabstractBACKGROUND: Among physicians who treat patients with acute myocardial infarction, there is controversy about the magnitude of the clinical benefit of primary (i.e., immediate) coronary angioplasty as compared with thrombolytic therapy. METHODS: As part of the Global Use of Strategies to

  12. Restenosis after coronary angioplasty: the paradox of increased lumen diameter and restenosis

    NARCIS (Netherlands)

    K.J. Beatt (Kevin); P.W.J.C. Serruys (Patrick); H.E. Luijten; B.J.W.M. Rensing (Benno); H. Suryapranata (Harry); P.J. de Feyter (Pim); M.J.B.M. van den Brand (Marcel); G-J. Laarman (GertJan); G.A. van Es (Gerrit Anne); J.R.T.C. Roelandt (Jos)

    1992-01-01

    textabstractRestenosis after coronary angioplasty is the single complication that most limits this revascularization procedure in clinical practice. The process is largely unpredictable and the lesion-related factors predisposing to restenosis are poorly understood, with little consensus in publishe

  13. Rare occurrence of simultaneous coronary artery perforation and intracoronary thrombus formation following angioplasty

    Institute of Scientific and Technical Information of China (English)

    Su-Yan Bian; Liu-Fa Duan

    2013-01-01

    Both coronary artery perforation and intracoronary thrombus formation are life-threatening complications of percutaneous coronary interventions, which rarely occur simultaneously during angioplasty. We herein report a case of stent-related, left circumflex artery perforation, and subsequently acute left main artery thrombosis after the leakage was embolized with 7 microcoils. Intracoronary thromboectomy and systemic anticoagulant therapy were carefully used with good results. This case also represents some of our uncertainties regarding the best management of the patient.

  14. Safety and efficacy of limus-eluting stents and balloon angioplasty for sirolimus-eluting in-stent restenosis

    Energy Technology Data Exchange (ETDEWEB)

    Ota, Hideaki [Division of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC 20010 (United States); Mahmoudi, Michael [University of Surrey, Guildford Road, Surrey, GU2-7XH (United Kingdom); Kitabata, Hironori; Torguson, Rebecca; Chen, Fang; Satler, Lowell F.; Suddath, William O.; Pichard, Augusto D. [Division of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC 20010 (United States); Waksman, Ron, E-mail: ron.waksman@medstar.net [Division of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC 20010 (United States)

    2015-03-15

    Objectives: The aim of this study was to compare the safety and efficacy of everolimus-eluting stent (EES), sirolimus-eluting stent (SES), and plain old balloon angioplasty (POBA) for the treatment of SES in-stent restenosis (S-ISR). Background: The optimal treatment for drug-eluting in-stent restenosis remains controversial. Methods: The study cohort comprised 310 consecutive patients (444 lesions) who presented with S-ISR to our institution and underwent treatment with EES (43 patients), SES (102), or POBA (165). The analyzed clinical parameters were the 1-year rates of death, Q-wave myocardial infarction (MI), target lesion revascularization (TLR), target vessel revascularization (TVR), definite stent thrombosis (ST) and major adverse cardiac event (MACE) defined as the composite of death, MI, or TLR at 1-year. Results: The three groups were well matched for the conventional risk factors for coronary artery disease except for smoking. The 1-year analyzed clinical parameters were similar in the three groups: MACE (EES = 14%, SES = 18%, POBA = 20%; p = 0.65), death (EES = 2.3%, SES = 6.2%, POBA = 6.1%; p = 0.61), MI (EES = 4.8%, SES = 2.1%, POBA = 2.5%; p = 0.69), TLR (EES = 11.9%, SES = 12.1%, POBA = 24%; p = 0.78), and TVR (EES = 11.9%, SES = 24.8%, POBA = 22.2%; p = 0.23). There were no cases of definite ST. MACE-free rate was significantly lower in patients with recurrent in-stent restenosis (log-rank p = 0.006). Presentation with acute MI, number of treated lesions and a previous history of MI were found to be independent predictors of MACE. Conclusions: In patients presenting with S-ISR, treatment with implantation of an EES, SES, or POBA is associated with similar clinical outcomes. Patients presenting with recurrent ISR may have a poorer clinical outcome.

  15. Off-pump coronary artery bypass grafting or percutaneous transluminal coronary angioplasty with stenting for proximal left anterior descending coronary artery disease?

    NARCIS (Netherlands)

    Drenth, Derk Jan

    2005-01-01

    This thesis describes and discusses the results of a prospective randomized controlled clinical trial comparing percutaneous coronary angioplasty with stenting (stenting) and off-pump coronary artery bypass grafting with a left internal mammary artery (surgery) in patients with a high-grade stenosis

  16. Off-pump coronary artery bypass grafting or percutaneous transluminal coronary angioplasty with stenting for proximal left anterior descending coronary artery disease?

    NARCIS (Netherlands)

    Drenth, Derk Jan

    2005-01-01

    This thesis describes and discusses the results of a prospective randomized controlled clinical trial comparing percutaneous coronary angioplasty with stenting (stenting) and off-pump coronary artery bypass grafting with a left internal mammary artery (surgery) in patients with a high-grade stenosis

  17. The Effect of Charcot Neuroarthropathy on Limb Preservation in Diabetic Patients with Foot Wound and Critical Limb Ischemia after Balloon Angioplasty

    Directory of Open Access Journals (Sweden)

    Mehmet Burak Çildağ

    2017-01-01

    Full Text Available Objective. The aim of this article is to investigate one-year limb preservation rates after below-the-knee angioplasty in patients with diabetic foot wound who only have critical limb ischemia (CLI and those who have Charchot neuroarthropathy (CN accompanied by CLI. Methods. This single-center, retrospective study consists of 63 patients with diabetic foot wound who had undergone lower extremity balloon angioplasty of at least 1 below-the-knee (BTK vessel. Only those patients with postprocedural technical success of 100% were selected from the database. All patients were classified into two groups as patients with CLI and CN and patients with CLI only without CN. The Kaplan-Meier method was used to compare the limb preservation rates for the two groups. Results. There was no statistically significant difference between patient age, gender, diabetic disease duration, and comorbid disease such as chronic renal insufficiency, hypertension, and coronary artery disease of the two groups (p>0.05. Limb preservation in the 12 months was 59.1% in the CN group and 92.7% in the group without CN. Also, limb preservation rates between the two groups displayed statistically significant differences (p<0.005. Conclusion. This study showed that CLI can accompany CN in patients with diabetes. Limb preservation rates with endovascular treatment in diabetic patients with CLI only are better than in diabetic patients with CLI and CN.

  18. Balloon pulmonary angioplasty: applicability of C-Arm CT for procedure guidance

    Energy Technology Data Exchange (ETDEWEB)

    Hinrichs, Jan B. [Department for Diagnostic and Interventional Radiology, Member of the German Center for Lung Research (DZL), Hannover Medical School, Hannover (Germany); Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover (Germany); Renne, Julius; Wacker, Frank K.; Meyer, Bernhard C. [Department for Diagnostic and Interventional Radiology, Member of the German Center for Lung Research (DZL), Hannover Medical School, Hannover (Germany); Hoeper, Marius M.; Olsson, Karen M. [Clinic for Pneumology, Member of the German Center for Lung Research (DZL), Hannover Medical School, Hannover (Germany)

    2016-11-15

    To investigate the feasibility of and compare two C-Arm CT (CACT) guidance methods during balloon pulmonary angioplasty (BPA). Forty-two BPAs [27 CTEPH patients (nine males, 70 ± 14y)] targeting 143 pulmonary arteries were included. Twenty-two BPAs were guided by contrast-enhanced CACT acquired immediately before BPA (G3D). In another 20 BPAs (G2D), two orthogonal fluoroscopy images of the chest where acquired to compute a registration of a previously acquired CACT. Volume rendering-based graphic representations (VRT guidance) were generated indicating the origin and course of the vessels. Based on VRT guidance, the intervention was planned. Procedure durations and radiation exposure data were compared between the two groups (Wilcoxon test). The overall intervention time was approximately 2 h in both groups (p = 0.31). BPA was successfully performed in G3D 91 % and G2D 94 %. No significant difference was found concerning the mean dose area product (DAP) related to fluoroscopy (p = 0.38), while DAP related to DSA was slightly higher in G3D (p = 0.048). Overall, DAP was significantly higher in G3D (p = 0.002). The use of CACT for procedure guidance in patients undergoing BPA is feasible and accurate. Image fusion of a pre-acquired CACT can be used to decrease radiation exposure due to multiple BPA sessions. (orig.)

  19. Percutaneous recanalization and balloon angioplasty of congenital isolated local atresia of the aortic isthmus in adults.

    Science.gov (United States)

    Joseph, G; Mandalay, A; Rajendiran, G

    2001-08-01

    Congenital isolated local atresia of the aortic isthmus is anatomically similar and morphogenetically related to congenital coarctation of the aorta and was encountered in 4 out of 26 consecutive adult patients selected for coarctation angioplasty at our center. Anterograde recanalization of the atresia was safely and successfully accomplished in all four patients, using a brachial approach. Balloon dilation in the four patients, with ancillary stent implantation in one patient, resulted in reduction of translesion gradient from 84 +/- 11 mm Hg to 9 +/- 7 mm Hg without complications. Angiography in the three non-stented patients after a mean follow-up of 13 months showed no evidence of restenosis, dissection or aneurysm formation, though one patient had mild dilatation of the posterior aspect of the aortic isthmus. The clinical presentation of patients with isolated local aortic atresia, and their short- to mid-term response to percutaneous treatment, is similar to that of patients with isolated severe coarctation of aorta. Copyright 2001 Wiley-Liss, Inc.

  20. Randomized Trial of the SMART Stent versus Balloon Angioplasty in Long Superficial Femoral Artery Lesions: The SUPER Study

    Energy Technology Data Exchange (ETDEWEB)

    Chalmers, Nicholas, E-mail: nicholas.chalmers@cmft.nhs.uk [Manchester Royal Infirmary, Department of Radiology (United Kingdom); Walker, Paul T. [James Cook University Hospital, Department of Radiology (United Kingdom); Belli, Anna-Maria [St. George' s Healthcare NHS Trust, Department of Radiology (United Kingdom); Thorpe, Anthony P. [Aberdeen Royal Infirmary, Department of Radiology (United Kingdom); Sidhu, Paul S. [King' s College Hospital, Department of Radiology (United Kingdom); Robinson, Graham [Hull Royal Infirmary, Department of Radiology (United Kingdom); Ransbeeck, Mariella van [Johnson and Johnson Medical NV/SA, Cordis (Belgium); Fearn, Steven A. [Johnson and Johnson Medical Ltd., Cordis (United Kingdom)

    2013-04-15

    To determine whether primary stenting reduces the rate of restenosis compared with balloon angioplasty alone in the endovascular treatment of long superficial femoral artery lesions; and to assess the effect of treatment on quality of life. A total of 150 patients with superior femoral artery occlusion or severe stenosis of 5-22 cm length from 17 UK centers were randomized to either primary stenting with the SMART stent or balloon angioplasty (i.e., percutaneous transluminal angioplasty, PTA). Bailout stent placement was permitted in case of inadequate result from PTA. The primary end point was restenosis measured by duplex ultrasound at 1 year. Quality-of-life assessments were performed by the EuroQol (EQ)-5D questionnaire. Mean lesion length was 123.0 mm in the stent group and 116.8 mm in the PTA group. A total of 140 (93.3 %) of 150 had total occlusions. At 12 months' follow-up, restenosis measured by Duplex ultrasound was not significantly different between the stent and PTA groups by intention-to-treat or as-treated analyses: 47.2 versus 43.5 % (p = 0.84) and 40.8 versus 46.7 % (p = 0.68), respectively. There were fewer target lesion revascularizations in patients randomized to stenting, but this did not reach statistical significance (12.5 vs. 20.8 %, p = 0.26). There was no difference in the rate of amputation. Patients in both groups reported improved quality of life. Primary stenting of long lesions in predominantly occluded superficial femoral arteries does not reduce the rate of binary restenosis compared with balloon angioplasty and bailout stenting. Both treatment strategies conferred a meaningful and sustained improvement to the quality of life of patients with severe superficial femoral artery disease.

  1. Incidence and outcome of radial artery occlusion following transradial artery coronary angioplasty.

    Science.gov (United States)

    Stella, P R; Kiemeneij, F; Laarman, G J; Odekerken, D; Slagboom, T; van der Wieken, R

    1997-02-01

    Coronary angioplasty with 6F guiding catheters via the radial artery is associated with a minimal risk for major entry site-related complications. Although the incidence of radial artery occlusion (RAO) in the literature is approximately 30% after prolonged cannulations, little is known about the incidence and its clinical consequences of RAO following transradial percutaneous coronary angioplasty. In a prospective study, 563 patients with a normal Allen test were evaluated on patency and function of the radial artery after transradial angioplasty, by physical and ultrasound examination at discharge, and at 1 month follow-up. At discharge, 30 patients (5.3%) had clinical evidence of RAO. At follow-up, persistent RAO was found in 16 patients (2.8%). In this study we found a low incidence of RAO after transradial percutaneous coronary angioplasty. None of the patients with temporary or persistent RAO had any major clinical symptoms. Therefore, the occurrence of RAO can be considered a minor complication in patients with a previously good double blood supply to the hand.

  2. Coronary angioplasty in patients 75 years and older; comparison with coronary bypass surgery.

    Science.gov (United States)

    Metzger, J P; Tabone, X; Georges, J L; Gueniche, C; Detienne, J P; Le Feuvre, C; Vacheron, A

    1994-02-01

    From November 1988 to May 1992, 108 patients (79 men, 29 women) 75 years or older (mean 78 +/- 3, range 75-90 years) underwent coronary angioplasty (group I: n = 62) or coronary bypass surgery (group II: n = 46). Group II patients were younger (76 +/- 2 vs 79 +/- 4, P = 0.002) and had a higher proportion of multivessel disease. The two groups were comparable with regard to the presence of unstable angina, left ventricular ejection fraction and Q wave infarction. In-hospital mortality was similar in the two groups (6.4% vs 4.3%). Complete revascularization (72% vs 47%, P < 0.05) and left anterior descending artery revascularization (100% vs 45%, P < 0.01) were more frequent in group II. Two-year infarction-free survival was similar (group I: 76 +/- 6%; group II: 79 +/- 6%) but recurrent class III or IV angina (36% vs 9%, P < 0.05) and repeat procedures (26% vs 0%, P < 0.05) were more frequent in group I.

  3. Influence of a history of smoking on short term (six month) clinical and angiographic outcome after successful coronary angioplasty

    NARCIS (Netherlands)

    A.G. Violaris (Andonis); A. Thury (Attila); R. Melkert (Rein); P.W.J.C. Serruys (Patrick); E.S. Regar (Eveline)

    2000-01-01

    textabstractOBJECTIVES: To assess the influence of smoking on restenosis after coronary angioplasty. DESIGN AND PATIENTS: The incidence of smoking on restenosis was investigated in 2948 patients. They were prospectively enrolled in four major restenosis trials in which quantitative

  4. Finite Element Modeling of Balloon Angioplasty by Considering Overstretch of Remnant Non-diseased Tissues in Lesions

    Science.gov (United States)

    Gasser, T. Christian; Holzapfel, Gerhard A.

    2007-06-01

    The paper deals with the modeling of balloon angioplasty by considering the balloon-induced overstretch of remnant non-diseased tissues in atherosclerotic arteries. A stenotic artery is modeled as a heterogenous structure composed of adventitia, media and a model plaque, and residual stresses are considered. The constitutive models are able to capture the anisotropic elastic tissue response in addition to the inelastic phenomena associated with tissue stretches beyond the physiological domain. The inelastic model describes the experimentally-observed changes of the wall during balloon inflation, i.e. non-recoverable deformation, and tissue weakening. The contact of the artery with a balloon catheter is simulated by a point-to-surface strategy. The states of deformations and stresses within the artery before, during and after balloon inflation are computed, compared and discussed. The 3D stress states at physiological loading conditions before and after balloon inflation differ significantly, and even compressive normal stresses may occur in the media after dilation.

  5. Refractory angina pectoris in end-stage coronary artery disease : Evolving therapeutic concepts

    NARCIS (Netherlands)

    Schoebel, FC; Frazier, OH; Jessurun, GAJ; DeJongste, MJL; Kadipasaoglu, KA; Jax, TW; Heintzen, MP; Cooley, DA; Strauer, BE; Leschke, M

    1997-01-01

    Refractory angina pectoris in coronary artery disease is defined as the persistence of severe anginal symptoms despite maximal conventional antianginal combination therapy. Further, the option to use an invasive revascularization procedure such as percutaneous coronary balloon angioplasty or aortoco

  6. Minimally invasive coronary artery bypass grafting versus percutaneous transluminal coronary angioplasty with stenting in isolated high-grade stenosis of the proximal left anterior descending coronary artery : Six months' angiographic and clinical follow-up of a prospective randomized study

    NARCIS (Netherlands)

    Drenth, DJ; Winter, JB; Veeger, NJGM; Monnink, SHJ; van Boven, AJ; Grandjean, JG; Mariani, MA; Boonstra, PW

    Objective: We sought to compare minimally invasive coronary artery bypass grafting (surgical intervention) with percutaneous transluminal coronary angioplasty with primary stenting (stenting) in patients having an isolated high-grade stenosis (American College of Cardiology/American Heart

  7. Endovascular brachytherapy from Re-188-filled balloon catheter to prevent restenosis following angioplasty; Endovaskulaere Brachytherapie mit einem Re-188-gefuellten Ballonkatheter zur Praevention der Restenose nach Angioplastie

    Energy Technology Data Exchange (ETDEWEB)

    Kotzerke, J. [Ulm Univ. (Germany). Abt. Nuklearmedizin; Kropp, J. [Technische Univ. Dresden (Germany). Klinik und Poliklinik fuer Nuklearmedizin

    2001-12-01

    Stent implantation and endovascular brachytherapy are the single effective methods to reduce restenosis after angioplasty. Gamma- and beta-emitter can be applied. The use of a liquid beta-emitter filled balloon catheter allows nuclear medicine to participate in this new concept of therapy due to the unsealed source. From various beta-emitters Re-188-perrhenate seems to be the most attractive one regarding logistic, radiation protection and costs. Feasibility of the method was demonstrated by several groups. Interim analysis of ECRIS-2 demonstrate an effectiveness comparable to the best of other irradiation data. (orig.) [German] Die endovaskulaere Brachytherapie ist neben der Stentimplantation bisher die einzige Methode, mit der die Restenoserate nach Angioplastie (PTCA) deutlich reduziert werden kann. Sowohl Gamma- wie auch Betastrahler sind einsetzbar. Die Anwendung eines fluessigen Betastrahlers in einem Ballonkatheter erlaubt dem Nuklearmediziner, an diesem Therapiekonzept zu partizipieren, da es sich um die Anwendung eines offenen radioaktiven Isotops handelt. Von den diversen moeglichen Betastrahlern erscheint Re-188-Perrhenat am geeignetsten zu sein im Hinblick auf die Logistik, den Strahlenschutz und die Kosten. Die Praktikabilitaet dieser Methode wurde von mehreren Zentren bestaetigt. Eine Zwischenauswertung der ECRIS-2-Studie aus Ulm ergibt Daten, die grossen amerikanischen Studien keineswegs nachstehen. (orig.)

  8. Balloon angioplasty of coarctation of the aorta: a safe alternative for surgery in adults: immediate and mid-term results.

    Science.gov (United States)

    Koerselman, J; de Vries, H; Jaarsma, W; Muyldermans, L; Ernst, J M; Plokker, H W

    2000-05-01

    Patients with coarctation of the aorta can be treated either with surgery or with balloon angioplasty. So far, the last method has proved to be successful in children, but results of this treatment in (young) adults are virtually unknown. The aim of this study was to evaluate the immediate and mid-term follow-up results of balloon angioplasty of native coarctation in (mainly young) adults. Coarctation of the aorta was diagnosed by means of ultrasound or angiography, and defined as a stenosis with a pressure gradient greater than 20 mm Hg. The balloon angioplasty-procedure was carried out under complete anesthesia, and was considered to be successful, if the pressure gradient was reduced to less than 20 mm Hg. Nineteen consecutive adults (12 males, 7 females; aged 14-67 years, median 29) with native coarctation were treated from 1995-99. Mean pressure gradient decreased from 49.3+/- 20.8 to 4.8+/-8.2 mm Hg (P<0.0001). One patient showed a suboptimal result with a residual pressure gradient of 28 mm Hg. In one other patient a stent was placed on request of the referring physician. Follow-up was 100% complete and ranged from 3-47 months (mean 20.2+/- 12.9). At 1-year follow-up mean systolic blood pressure was reduced from 159.4+/-19.5 to 132.5+/-17.6 mm Hg (n = 18; P<0.0001), and mean ankle-arm pressure index improved from 0.73+/-0.09 to 0.96+/-0.05 (n = 18; P<0.0001). Anti-hypertensive medication could either be reduced or stopped in 7 patients (53.8%). With ultrasound or angiography or MRI, no patients had signs of aneurysm formation or worsening restenosis during follow-up. In adult patients with uncomplicated native coarctation of the aorta, balloon angioplasty (without stenting) would seem to be an excellent and safe alternative for surgery. In our hospital it has completely replaced surgical correction in such patients.

  9. Long-term angiographic follow up, cardiac events, and survival in patients undergoing percutaneous transluminal coronary angioplasty.

    Science.gov (United States)

    Ernst, S M; van der Feltz, T A; Bal, E T; van Bogerijen, L; van den Berg, E; Ascoop, C A; Plokker, H W

    1987-01-01

    The results of percutaneous transluminal coronary angioplasty were studied in 1352 consecutive patients. The angioplasty procedure was angiographically successful in 1163 (86%) patients and the success rate increased gradually with time. There were no significant differences in success rates in different vessels or indications. The success rate for repeat coronary angioplasty was 92%. In 85% of the patients the clinical course was uncomplicated. Myocardial infarction occurred in 3.6%, emergency coronary bypass grafting in 2.6%, elective bypass surgery in 4.6%, and there were 10 deaths (0.7%). There were 16 deaths (10 non-cardiac) during follow up in the 1163 patients in whom the first procedure was successful. Actuarial analysis showed that after a first angioplasty 77.9% remained free of symptoms and cardiac events for five years and that after a second angioplasty 76% did so. Angiographic follow up showed restenosis in 24% of patients but the overall clinical success rate was 86.2%. On the basis of the intention to treat the procedure was successful in 74.3% of all 1352 patients. Coronary artery bypass surgery was eventually performed in 11.6% of all patients. The long term angiographic success rate of coronary angioplasty is higher than previously suggested. PMID:2952153

  10. Effect and outcome of balloon angioplasty and stenting of the iliac arteries evaluated by intravascular ultrasound

    DEFF Research Database (Denmark)

    Vogt, K J; Rasmussen, John Bøje Grønvall; Just, S;

    1999-01-01

    To document the mechanism of percutaneous transluminal angioplasty (PTA) and stenting of the iliac arteries, and to relate the effect to patency.......To document the mechanism of percutaneous transluminal angioplasty (PTA) and stenting of the iliac arteries, and to relate the effect to patency....

  11. Prolonged high-pressure balloon angioplasty of femoropopliteal lesions:Impact on stent implantation rate and mid-term outcome

    Institute of Scientific and Technical Information of China (English)

    Gianluca Rigatelli; Mariano Palena; Paolo Cardaioli; Fabio dellAvvocata; Massimo Giordan; Dobrin Vassilev; Marco Manzi

    2014-01-01

    Objectives To assess the impact on stent implantation rate and mid-term outcomes of prolonged high pressure angioplasty of femoropopliteal lesions. Methods We retrospectively enrolled 620 consecutive patients from January 2011 to December 2011 (75.6 ±12.3 years, 355 males, 76.5%in Rutherford class 5-6), referred for critical limb ischemia and submitted to prolonged high-pressure angioplasty of femoropopliteal lesions. The definition of prolonged high-pressure angioplasty includes dilation to at least 18 atm for at least 120 s. Proce-dural data, and clinical and instrumental follow-up were analyzed to assess stent implantation rate and mid-term outcomes. Results The preferred approach was ipsilateral femoral antegrade in 433/620 patients (69.7%) and contralateral cross-over in 164/620 (26.4%) and pop-liteal retrograde+femoral antegrade in 23/620 (3.7%). Techniques included subintimal angioplasty in 427/620 patients (68.8%) and endolu-minal angioplasty in 193/620 patients (31.2%). The prolonged high pressure balloon angioplasty procedure was successful in 86.2%(minor intra-procedural complications rate 15.7%), stent implantation was performed in 74 patients (11.9%), with a significant improvement of ankle-brachial index (0.29 ±0.6 vs. 0.88 ±0.3, P<00.1) and Rutherford class (5.3 ±0.8 vs. 0.7 ±1.9, P<0.01), a primary patency rate of 86.7%, restenosis of 18.6%on Doppler ultrasound and a target lesion revascularization of 14.8%at a mean follow-up of 18.1 ±6.4 months (range 1-24 months). Secondary patency rate was 87.7%. Conclusions Prolonged high pressure angioplasty of femoropopliteal lesions appears to be safe and effective allowing for an acceptable patency and restenosis rates on mid-term.

  12. Study of Traditional Chinese Medicine in Intervening Vascular Remodeling after Percutaneous Transluminal Coronary Angioplasty

    Institute of Scientific and Technical Information of China (English)

    鹿小燕; 徐浩; 史大卓; 陈可冀

    2004-01-01

    Interventional therapy of coronary heart disease (CHD) includes percutaneous transluminal coronary angioplasty (PTCA), stent implantation etc. Owing to its revascularization without cardiac surgery, it has been the main effective method in treating CHD. But at the same time, there exists the problem of restenosis (RS). After PTCA, RS rate can reach 30% to 50%, even with direct stenting into the vessels, it still reaches 20% to 35%. So this affects long-term effect of interventional therapy, which directly relates to prognosis of patients with CHD and has been a hot spot of study in the field of preventing and treating CHD.

  13. Study of Traditional Chinese Medicine in Intervening Vascular Remodeling after Percutaneous Transluminal Coronary Angioplasty

    Institute of Scientific and Technical Information of China (English)

    鹿小燕; 徐浩; 史大卓; 陈可冀

    2004-01-01

    Interventional therapy of coronary heart disease (CHD) includes percutaneous transluminal coronary angioplasty (PTCA), stent implantation etc. Owing to its revascularization without cardiac surgery, it has been the main effective method in treating CHD. But at the same time, there exists the problem of restenosis (RS). After PTCA, RS rate can reach 30% to 50%, even with directstenting into the vessels, it still reaches 20% to 35%. So this affects long-term effect of interventional therapy, which directly relates to prognosis of patients with CHD and has been a hot spot of study in the field of preventing and treating CHD.

  14. Percutaneous transradial artery approach for coronary stent implantation.

    Science.gov (United States)

    Kiemeneij, F; Laarman, G J

    1993-10-01

    A new approach for implantation of Palmaz Schatz coronary stents is reported. We describe the technique and rationale of coronary stenting with miniaturized angioplasty equipment via the radial artery. This technique is illustrated in three patients. One patient underwent Palmaz Schatz stent implantation for a saphenous vene coronary bypass graft stenosis, the second patient for a restenosis in the anterior descending coronary artery after atherectomy, and the third patient for a second restenosis after balloon angioplasty in the circumflex coronary artery.

  15. Optical coherence tomography monitoring of angioplasty balloon inflation in a deployment tester

    Science.gov (United States)

    Azarnoush, Hamed; Vergnole, Sébastien; Bourezak, Rafik; Boulet, Benoit; Lamouche, Guy

    2010-08-01

    We present an innovative integration of an intravascular optical coherence tomography probe into a computerized balloon deployment system to monitor the balloon inflation process. The high-resolution intraluminal imaging of the balloon provides a detailed assessment of the balloon quality and, consequently, a technique to improve the balloon manufacturing process. A custom-built swept-source optical coherence tomography system is used for real-time imaging. A semicompliant balloon with a nominal diameter of 4 mm is fabricated for the experiments. Imaging results correspond to balloon deployment in air and inside an artery phantom. A characterization of the balloon diameter, wall thickness, compliance, and elastic modulus is provided, based on image segmentation. Using the images obtained from the probe pullback, a three-dimensional visualization of the inflated balloon is presented.

  16. Effect of intra-aortic balloon pump on coronary blood flow during different balloon cycles support: A computer study.

    Science.gov (United States)

    Aye, Thin Pa Pa; Htet, Zwe Lin; Singhavilai, Thamvarit; Naiyanetr, Phornphop

    2015-01-01

    Intra-aortic balloon pump (IABP) has been used in clinical treatment as a mechanical circulatory support device for patients with heart failure. A computer model is used to study the effect on coronary blood flow (CBF) with different balloon cycles under both normal and pathological conditions. The model of cardiovascular and IABP is developed by using MATLAB SIMULINK. The effect on coronary blood flow has been studied under both normal and pathological conditions using different balloon cycles (balloon off; 1:4; 1:2; 1:1). A pathological heart is implemented by reducing the left ventricular contractility. The result of this study shows that the rate of balloon cycles is related to the level of coronary blood flow.

  17. The qualitative assessment of biodegradable coronary stents with the use of intravascular ultrasound, optical coherence tomography and histology

    OpenAIRE

    Burcu GÜL

    2014-01-01

    Percutaneous coronary intervention (PCI) is the most common treatment for coronary artery disease (CAD). The first form of PCI introduced was balloon angioplasty. After that, the advent of coronary stents (tubular wire mesh for intravascular mechanical support) led to a new era in interventional cardiology. Through the implantation of bare metal stents (BMS), all three limitations of balloon angioplastycoronary artery dissection, elastic recoil and negative remodelling – are prevented. Unf...

  18. Emergent intracranial balloon angioplasty and bailout self-expandable stent placement in acute large vessel occlusion of the anterior circulation: Experience of a single institution

    Energy Technology Data Exchange (ETDEWEB)

    Heo, Young Jin; Seo, Jung Hwa; Jeong, Hae Woong [Busan Paik Hospital, Inje University, Busan (Korea, Republic of)

    2017-06-15

    To evaluate the outcomes of angioplasty for recanalization after acute ischemic stroke (AIS). The study population was selected from 134 patients who underwent endovascular revascularization therapy (ERT) for AIS between October 2011 and May 2014. Of those 134 patients, 39 who underwent balloon angioplasty with or without stent insertion were included in this study. Balloon angioplasty was the primary treatment for nine patients and a rescue method for 30 patients. The revascularization rate at 7 days, procedure-related complications, and clinical outcomes at 3 months were analyzed. The occlusion sites were the middle cerebral artery (n = 26), intracranial internal carotid artery (n = 10), and middle cerebral artery branch (n = 3). Angioplasty achieved successful revascularization (Thrombolysis in Cerebral Ischemia grade 2b–3) in 76.9% of patients. Computed tomography angiography performed 7 days post-procedure revealed a maintained reperfusion in 82.8% of successful cases. Only two patients had symptomatic intracerebral hemorrhage. At the 3-month follow-up, 18 (48.6%) and 10 (27.0%) patients showed good and poor functional outcomes, respectively (modified Rankin Scale scores, 0–2 and 5–6). Emergent balloon angioplasty and bailout self-expandable stent placement may be safe and effective for achieving successful revascularization in acute large vessel occlusion of the anterior circulation. It could be a feasible rescue method as well as a primary method for ERT.

  19. [Comparison of the results of coronary angioplasty and stenting during one year following surgery].

    Science.gov (United States)

    Simonenko, V B; Seĭdov, V G; Zakharov, S V; Evsiukov, V V; Liubchuk, I V

    2007-01-01

    The purpose of the study was to compare long-term results of angioplasty and coronary arterial stenting (CAS) depending on the initial degree of coronary arterial (CA) lesion according to morphological stenosis classification, as well as to evaluate the influence of re-stenosis on myocardial contractility dynamics, anginal recurrence rate, and exercise tolerance. The subjects, 228 men after angioplasty and 184 men after CAS with wire stents without drug coating, were included in the study between 1989 and 2005. Coronarography was repeated in 358 patients one year after surgery. The patients were divided into two groups. The first group consisted of 161 patients, to who 180 stents were implanted. The second group consisted of 197patients, in who 226 angioplasty procedures were performed. Data were processed using standard variational statistical methods, i.e. the calculation of mean values and standard deviation. Statistical calculations were carried out using Analysis ToolPak- VBA software of Microsoft Excel 2000. The study found that one year after either intervention the number of patients without anginal symptoms fell significantly compared with this number during the in-hospital period. In group 2 the frequency of restenosis was higher and the number of patients with anginal symptoms was significantly bigger than in group 1; the number of asymptomatic patients was significantly bigger in group 1. Initial morphological characteristics of CA lesion had a significant effect on the long-term frequency of restenosis following endovascular treatment. Restenosis was 2 to 2.5 times more frequent in patients with C type CA lesion vs. patients with A type regardless the method of endovascular intervention. The results of the study demonstrate the importance of taking into account initial morphological characteristics of CA lesion; CAS is more preferable than angioplasty, especially in patients with C type CA lesion.

  20. Cutting balloon angioplasty for in-stent restenosis of the aortic coarctation in a young boy presenting with systemic hypertension of the upper extremities.

    Science.gov (United States)

    Lee, Meng-Luen

    2013-12-01

    An 8.25-year-old boy was incidentally found to have systemic hypertension of the upper extremities. Blood pressures of the upper extremities were 142-150/86-98 mmHg, and those of the lower extremities 110-116/60-66 mmHg. Doppler echocardiography showed in-stent restenosis of the aortic coarctation. Traditional high-pressure balloon angioplasty failed to dilate this inveterate in-stent restenosis. Instead, a cutting balloon angioplasty was performed. The lumen was dilated from 4.80 mm to 7.89 mm. The pressure gradient dropped from 32 mmHg to 9 mmHg. Blood pressures of the upper extremities were 112-116/76-78 mmHg, and those of the lower extremities 100-104/70-72 mmHg. This paper highlights that a cutting balloon angioplasty can serve as a juste milieu to relieve in-stent restenosis of the aortic coarctation when traditional high-pressure balloon angioplasty is debatable.

  1. Clinical impact and risk stratification of balloon angioplasty for femoropopliteal disease in nitinol stenting era: Retrospective multicenter study using propensity score matching analysis

    Directory of Open Access Journals (Sweden)

    Taketsugu Tsuchiya

    2016-07-01

    Full Text Available Objective: Nitinol stenting could bring the better outcome in endovascular therapy for femoropopliteal disease. However, it might be expected that recent marked advances in both device technology and operator technique had led to improved efficacy of balloon angioplasty even in this segment. The aims of this study were to evaluate the clinical impact of balloon angioplasty for femoropopliteal disease and make risk stratification clear by propensity score matching analysis. Methods: Based on the multicenter retrospective data, 2758 patients (balloon angioplasty: 729 patients and nitinol stenting: 2029 patients, those who underwent endovascular therapy for femoropopliteal disease, were analyzed. Results: The propensity score matching procedure extracted a total of 572 cases per group, and the primary patency rate of balloon angioplasty and nitinol stenting groups after matching was significantly the same (77.2% vs 82.7% at 1 year; 62.2% vs 64.3% at 3 years; 47.8% vs 54.3% at 5 years. In multivariate Cox hazard regression analysis, significant predictors for primary patency were diabetes mellitus, regular dialysis, cilostazol use, chronic total occlusion, and intra-vascular ultra-sonography use. The strategy of balloon angioplasty was not evaluated as a significant predictor for the primary patency. After risk stratification using five items (diabetes mellitus, regular dialysis, no use of intra-vascular ultra-sonography, chronic total occlusion, and no use of cilostazol: the DDICC score, the estimated primary patency rates of each group (low, DDICC score 0–2; moderate, DDICC score 3; high risk, DDICC score 4–5 were 88.6%, 78.3%, and 63.5% at 1 year; 75.2%, 60.7%, and 39.8% at 3 years; and 66.0%, 47.1%, and 26.3% at 5 years (p < 0.0001. The primary patency rate of balloon angioplasty and nitinol stenting groups was significantly the same in each risk stratification. Conclusion: This study suggests that balloon angioplasty does

  2. Long-term outcome after balloon angioplasty of coarctation of the aorta in adolescents and adults: Is aneurysm formation an issue?

    Science.gov (United States)

    Walhout, R J; Suttorp, M J; Mackaij, G J; Ernst, J M P G; Plokker, H W M

    2009-03-01

    The purpose was to evaluate long-term outcome following balloon angioplasty for coarctation in adults. Long-term results of balloon angioplasty for native coarctation in adults remain incomplete, especially concerning the occurrence of aneurysm formation. Long-term follow-up data were collected in consecutive patients retrospectively. Results of balloon angioplasty (29 patients, age 15-71 years, during 1995-2005) for discrete, native coarctation were evaluated, including MRI or CT. Mean follow-up ranged from 2.2 to 13 years (mean 8.5 +/- 3.2). Immediate success was obtained in all patients. Early mortality or complications were not encountered. Peak systolic pressure gradient decreased from 52 +/- 21 to 7.2 +/- 7.6 mm Hg (P < 0.001). Intima tear was detected in eight procedures angiographically, without signs of dissection. Three-month follow-up angiography in these patients showed unchanged (4/8 patients) or diminished abnormalities (4/8 patients). One asymptomatic patient, known with left ventricular dysfunction due to significant aortic valve insufficiency, died suddenly 5 years after balloon angioplasty. Recoarctation occurred in one patient (3%). Late aneurysm formation was excluded by MR in 24/29 and CT in remaining 5/29 patients during follow-up, including those patients in whom intima tear was encountered immediately postangioplasty. In three of seven patients an irregular aortic contour persisted, without indication of progression or aneurysm formation. Hypertension was completely relieved in 67% (14/21 patients) and improved in 33% (7/21 patients). Balloon angioplasty for native coarctation yields low reintervention probability in adult patients. Despite occurrence of angiographically established intimal tearing, aortic dissection and aneurysm formation were not encountered. (c) 2009 Wiley-Liss, Inc.

  3. Transthoracic coronary flow reserve and dobutamine derived myocardial function: a 6-month evaluation after successful coronary angioplasty

    Directory of Open Access Journals (Sweden)

    Pardo Moira

    2004-12-01

    Full Text Available Abstract After percutaneous transluminal coronary angioplasty (PTCA, stress-echocardiography and gated single photon emission computerized tomography (g-SPECT are usually performed but both tools have technical limitations. The present study evaluated results of PTCA of left anterior descending artery (LAD six months after PTCA, by combining transthoracic Doppler coronary flow reserve (CFR and color Tissue Doppler (C-TD dobutamine stress. Six months after PTCA of LAD, 24 men, free of angiographic evidence of restenosis, underwent standard Doppler-echocardiography, transthoracic CFR of distal LAD (hyperemic to basal diastolic coronary flow ratio and C-TD at rest and during dobutamine stress to quantify myocardial systolic (Sm and diastolic (Em and Am, Em/Am ratio peak velocities in middle posterior septum. Patients with myocardial infarction, coronary stenosis of non-LAD territory and heart failure were excluded. According to dipyridamole g-SPECT, 13 patients had normal perfusion and 11 with perfusion defects. The 2 groups were comparable for age, wall motion score index (WMSI and C-TD at rest. However, patients with perfusion defects had lower CFR (2.11 ± 0.4 versus 2.87 ± 0.6, p m at high-dose dobutamine (p m of middle septum (r = 0.55, p In conclusion, even in absence of epicardial coronary restenosis, stress perfusion imaging reflects a physiologic impairment in coronary microcirculation function whose magnitude is associated with the degree of regional functional impairment detectable by C-TD.

  4. THE KISSING BALLOON TECHNIQUE WITH 2 OVER-THE-WIRE BALLOON CATHETERS THROUGH A SINGLE 8-FRENCH GUIDING CATHETER

    NARCIS (Netherlands)

    DENHEIJER, P; BERNINK, PJLM; VANDIJK, RB; TWISK, SPM; LIE, KI

    1991-01-01

    Some of the newer over-the-wire coronary angioplasty catheters have shaft sizes of 3.0 French (F) or less. The inner diameter of modern 8-F guiding catheters is large enough to accommodate two of such balloon catheters. We report a kissing balloon procedure with two over-the-wire catheters through a

  5. THE KISSING BALLOON TECHNIQUE WITH 2 OVER-THE-WIRE BALLOON CATHETERS THROUGH A SINGLE 8-FRENCH GUIDING CATHETER

    NARCIS (Netherlands)

    DENHEIJER, P; BERNINK, PJLM; VANDIJK, RB; TWISK, SPM; LIE, KI

    Some of the newer over-the-wire coronary angioplasty catheters have shaft sizes of 3.0 French (F) or less. The inner diameter of modern 8-F guiding catheters is large enough to accommodate two of such balloon catheters. We report a kissing balloon procedure with two over-the-wire catheters through a

  6. Genetic polymorphism of angiotensin converting enzyme and risk of coronary restenosis after percutaneous transluminal coronary angioplasties: evidence from 33 cohort studies.

    Directory of Open Access Journals (Sweden)

    Shen Wang

    Full Text Available BACKGROUND: In the past decade, a number of cohort studies studies have been carried out to investigate the relationship between the insertion/deletion polymorphism of the gene encoding angiotensin-converting enzyme and risk of restenosis after percutaneous transluminal coronary angioplasties in patients. However, these studies have yielded contradictory results. Genetic association studies addressing this issue are frequently hampered by insufficient power. We therefore performed a meta-analysis of the published studies to clarify this inconsistency and to establish a comprehensive picture of the relationship between ACE I/D polymorphism and post-PTCA restenosis risk. METHODS: Databases including Pubmed, EMBASE, ISI Web of Science, EBSCO, Cochrane Library databases and CNKI were searched to find relevant studies. Odds ratios (ORs with 95% confidence intervals (CIs were used to assess the strength of association. The random-effects model was applied, addressing heterogeneity and publication bias. RESULTS: A total of 33 cohort studies involving 11,099 subjects were included. In a combined analysis, the OR for post-PTCA restenosis of the ACE DD genotype was 1.61 (95% CI: 1.27-2.04; P<10(-5. In the subgroup analysis by intervention, significantly increased risks were also found in PTCA-stent and PTCA-balloon for the DD genotype of the polymorphism. CONCLUSIONS: Our meta-analysis showed that the DD genotype of ACE I/D polymorphism was significantly associated with increased risk of restenosis, particularly for PTCA-stent.

  7. Safety and effectiveness of combined percutaneous coronary angioplasty and aortic valvuloplasty in an elderly patient with cardiogenic shock: effect on concomitant severe mitral regurgitation.

    Directory of Open Access Journals (Sweden)

    Emanuele Cecchi

    2013-08-01

    Full Text Available An 80-year-old diabetic man with severe aortic stenosis was admitted to our hospital for cardiogenic shock complicating non-ST-elevation myocardial infarction. Echocardiographic evaluation showed also a severe degree of both left ventricular dysfunction and mitral regurgitation. The patient was initially stabilized with inotropes and mechanical ventilation was necessary because of concurrent pulmonary edema. The day after, he was submitted to coronary angiography showing bivessel coronary disease. Given the high estimated operative risk, the patient was treated with angioplasty and bare metal stent implantation on both right coronary and circumflex artery; contemporarily, balloon aortic valvuloplasty (BAV was performed with anterograde technique, obtaining a significant increase in planimetric valve area and reduction in transvalvular peak gradient. Few days after the procedure echocardiogram showed an increase in left ventricular ejection fraction, moderate aortic stenosis with mild regurgitation and moderate mitral regurgitation. Hemodynamic and clinical stabilization were also obtained, allowing amine support discontinuation and weaning from mechanical ventilation. At three months follow-up, the patient reported a further clinical improvement from discharge, and echocardiographic evaluation showed moderate aortic stenosis and an additional increase in left ventricular function and decrease in mitral regurgitation degree. In conclusion, combined BAV and coronary angioplasty were associated in our patient with hemodynamic and clinical stabilization as well as with a significant reduction in transvalvular aortic gradient and mitral regurgitation and an increase in left ventricular ejection fraction both in-hospital and at three month follow-up; this case suggests that these procedures are feasible even in hemodynamically unstable patients and are associated with a significant improvement in quality of life.

  8. Simulation of balloon angioplasty in residually stressed blood vessels-Application of a gradient-enhanced fibre damage model.

    Science.gov (United States)

    Polindara, César; Waffenschmidt, Tobias; Menzel, Andreas

    2016-08-16

    In this contribution we study the balloon angioplasty in a residually stressed artery by means of a non-local gradient-enhanced fibre damage model. The balloon angioplasty is a common surgical intervention used to extend or reopen narrowed blood vessels in order to restore the continuous blood flow in, for instance, atherosclerotic arteries. Inelastic, i.e. predominantly damage-related and elastoplastic processes are induced in the artery during its inflation resulting in an irreversible deformation. As a beneficial consequence, provided that the inelastic deformations do not exceed a specific limit, higher deformations can be obtained within the same pressure level and a continuous blood flow can be guaranteed. In order to study the mechanical response of the artery in this scenario, we make use of the non-local gradient-enhanced model proposed in Waffenschmidt et al. (2014). In this contribution, we extend this model to make use of an incompressible format in connection with a Q1Q1P0 finite element implementation. The residual stresses in the artery are also taken into account following the framework presented in Waffenschmidt (2015). From the results it becomes apparent that, when the artery is subjected to radial stresses beyond the physiological range, damage evolution is triggered in the collagen fibres. The impact of the residual stresses on the structural response and on the circumferential stress distribution along the thickness of the arterial wall is also studied. It is observed that the residual stresses have a beneficial effect on the mechanical response of the arterial wall.

  9. Ultrasonography-guided Balloon Angioplasty in an Autogenous Arteriovenous Fistula: Preliminary Results

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Ji Chang [Daejeon St Mary' s Hospital, Daejeon (Korea, Republic of); Cho, June Sik [Chungnam National University College of Medicine, Daejeon (Korea, Republic of)

    2007-09-15

    Percutaneous trasnluminal angioplasty (PTA) of a malfunctioning arteriovenous fistula (AVF) in hemodialysis patients requires the use of contrast angiography and fluoroscopy guidance. We attempted to perform this procedure under duplex ultrasound guidance to reduce the amount of contrast agent administered and to reduce the radiation dose during the interventional procedures. From September 2006 to February 2007, 45 patients received interventional treatment due to malfunctioning hemodialysis access in our hospital. Among the patients, we selected 10 patients diagnosed with stenosis of an autogenous arteriovenous fistula based on a physical examination. There were six males and four females aged 51-78 years (mean age, 59 years). Seven of these patients had a Brescia-Cinimo type fistula and three patients had a basilic vein transposition. All procedures were performed in the angiography suite. All procedures that required angioplasty were performed under duplex ultrasound guidance and then contrast angiography was performed to confirm the final patency of the vessels. Conventional angioplasty was also performed under fluoroscopy guidance for any lesions that required an additional angioplasty. The volume flow before and after the PTA and procedure time were recorded. Clinical success was defined as the performance of one or more successful hemodialysis sessions after treatment. Eight of ten patients did not require an additional angioplasty by conventional angiography after the duplex- guided angioplasty. One case showed recoiling of stenosis after the duplex-guided PTA and another case was missed at duplex scanning due to the extremely short nature of the recoiling of stenosis. The mean volume flow before and after PTA was 167 ml/min (range, 80-259 ml/min) and 394.2 ml/min (range, 120-586 ml/min), respectively. No complications associated with the duplex-guide procedure occurred. In nine cases, PTA enabled hemodialysis to be conducted more than one time. In one

  10. Myxomavirus anti-inflammatory chemokine binding protein reduces the increased plaque growth induced by chronic Porphyromonas gingivalis oral infection after balloon angioplasty aortic injury in mice.

    Directory of Open Access Journals (Sweden)

    Alexandra R Lucas

    Full Text Available Thrombotic occlusion of inflammatory plaque in coronary arteries causes myocardial infarction. Treatment with emergent balloon angioplasty (BA and stent implant improves survival, but restenosis (regrowth can occur. Periodontal bacteremia is closely associated with inflammation and native arterial atherosclerosis, with potential to increase restenosis. Two virus-derived anti-inflammatory proteins, M-T7 and Serp-1, reduce inflammation and plaque growth after BA and transplant in animal models through separate pathways. M-T7 is a broad spectrum C, CC and CXC chemokine-binding protein. Serp-1 is a serine protease inhibitor (serpin inhibiting thrombotic and thrombolytic pathways. Serp-1 also reduces arterial inflammation and improves survival in a mouse herpes virus (MHV68 model of lethal vasculitis. In addition, Serp-1 demonstrated safety and efficacy in patients with unstable coronary disease and stent implant, reducing markers of myocardial damage. We investigate here the effects of Porphyromonas gingivalis, a periodontal pathogen, on restenosis after BA and the effects of blocking chemokine and protease pathways with M-T7 and Serp-1. ApoE-/- mice had aortic BA and oral P. gingivalis infection. Arterial plaque growth was examined at 24 weeks with and without anti-inflammatory protein treatment. Dental plaques from mice infected with P. gingivalis tested positive for infection. Neither Serp-1 nor M-T7 treatment reduced infection, but IgG antibody levels in mice treated with Serp-1 and M-T7 were reduced. P. gingivalis significantly increased monocyte invasion and arterial plaque growth after BA (P<0.025. Monocyte invasion and plaque growth were blocked by M-T7 treatment (P<0.023, whereas Serp-1 produced only a trend toward reductions. Both proteins modified expression of TLR4 and MyD88. In conclusion, aortic plaque growth in ApoE-/- mice increased after angioplasty in mice with chronic oral P. gingivalis infection. Blockade of chemokines, but not

  11. Probe exchange catheter used for angioplasty of total coronary artery occlusions.

    Science.gov (United States)

    Kiemeneij, F; Suwarganda, J S; van der Wieken, L R

    1990-04-01

    Percutaneous transluminal coronary angioplasty (PTCA) for total occlusions frequently fails, because the guidewire fails to pass the occlusion. With the use of the Probe exchange catheter (PEC), however, stiffness of the guidewire is increased and a higher pushability is obtained in order to manipulate the guidewire beyond the lesion. Once the guidewire has passed, the PEC is advanced and a non-over-the-wire dilatation catheter can be introduced through the PEC. This paper describes the technique in a representative case. The results of this technique in 19 consecutive patients with class III-IV/IV(NYHA) angina due to an occluded coronary artery are presented. In 16 patients the PEC reached the lesion (84%) and in all these patients the guidewire could pass the occlusion. A successful PTCA was performed in 14 patients (74%).

  12. Impact of the Intracoronary Rendezvous technique on coronary angioplasty for chronic total occlusion.

    Science.gov (United States)

    Nihei, Taro; Yamamoto, Yoshito; Kudo, Shun; Hanawa, Kenichiro; Hasebe, Yuhi; Takagi, Yusuke; Minatoya, Yutaka; Sugi, Masafumi; Shimokawa, Hiroaki

    2016-08-30

    The Rendezvous technique, which requires bidirectional wiring, is one of the useful methods for improving the success rate of recanalization for chronic total occlusion (CTO) in the field of peripheral intervention. Recently, advanced new devices for percutaneous coronary intervention have enabled us to perform the Rendezvous technique for peripheral as well as for coronary CTO lesions. We used the Intracoronary Rendezvous technique to perform angioplasty for coronary CTO. "Intracoronary Rendezvous" means that Rendezvous was achieved within the CTO lesion. From March 2009 to November 2015, 189 patients underwent CTO angioplasty at our institute, and we treated 10 patients with the Intracoronary Rendezvous technique. This technique involves crossing the Gaia series guidewire to the contralateral Corsair microcatheter located inside the plaque of CTO lesions. The majority of the CTO sites examined were in the proximal RCA (60 %). Lesion length of the occlusion was relatively long (64.4 ± 12.2 mm). Using the biplane imaging system, we were able to control the Gaia guidewires in a specific direction. Furthermore, if the antegrade and retrograde wires can be advanced into contiguous space inside the CTO lesion, we intentionally entered either wire into the contralateral Corsair microcatheter, followed by successful CTO crossing. CTO recanalization was completed for all patients without controlled antegrade retrograde subintimal tracking (CART) or reverse CART. No major complications occurred during hospitalization. These results indicate that the Rendezvous technique, assisted by new devices and a biplane imaging system, represents one of the primary options to achieve successful coronary CTO recanalization. (249/250 words).

  13. Cardiac troponin T and CK-MB mass release after visually successful percutaneous transluminal coronary angioplasty in stable angina pectoris

    DEFF Research Database (Denmark)

    Ravkilde, J; Nissen, H; Mickley, H

    1994-01-01

    The incidence of cardiac troponin T (Tn-T) and creatine kinase (CK) isoenzyme MB mass release was studied in 23 patients with stable angina pectoris undergoing visually successful percutaneous transluminal coronary angioplasty (PTCA). Serial blood samples were drawn for measurement of serum Tn...

  14. Device closure of post-myocardial infarction ventricular septal defect three weeks after coronary angioplasty

    Science.gov (United States)

    Patnaik, A. N.; Barik, Ramachandra; Kumari, N. Rama; Gulati, A. S.

    2012-01-01

    Percutaneus device closure appears to be safe and effective in patients treated for a residual shunt after initial surgical closure, as well as after two to three weeks of index myocardial infarction. The index case presented with a ventricular septal defect on second of acute myocardial infarction thrombolysed with streptokinase. The general condition of the patient was fairly stable. Cardiac catheterization and coronary angiography showed significant left to right shunt and there was 90 % proximal stenosis of left anterior descending coronary artery. Other coronary arteries were normal. Angioplasty and stenting to the coronary artery lesion was done using drug eluting stent (DES) with very good angiographic result. Patient was discharged after four days in stable condtion. After 3 weeks his ventricular septal defect was closed percutaneusly using cardio -O-fix device with tiny residual shunt. The procedure was uneventful and of brief duration. He was discharged after 5 days of the post procedure in very stable condition with minimal residual shunt. A staged procedure is a better option if the condition of the patient allows strengthening ventricular septal defect border. PMID:22629038

  15. A successful patch angioplasty with auto-pulmonary wall for congenital coronary left main trunk occlusion in a young child.

    Science.gov (United States)

    Terada, Takafumi; Sakurai, Hajime; Nonaka, Toshimichi; Sakurai, Takahisa; Sugiura, Junya; Taneichi, Tetsuyoshi; Ohtsuka, Ryohei

    2015-12-01

    Congenital occlusion of the left main coronary trunk is a life-threatening abnormality, and its optimal management remains controversial. This report describes a case of successful patch angioplasty with auto-pulmonary artery for a 12-year-old boy with congenital left main trunk occlusion. We divided the main pulmonary artery, harvested a pulmonary artery wall strip, and performed patch angioplasty of the occluded left main trunk ostium. We were able to clearly expose the left main trunk behind the pulmonary artery because the obstruction was divided for the patch material. The postoperative course was uneventful, and coronary angiography at 4 months after surgery showed excellent patency of the left main trunk. The auto-pulmonary arterial wall was easy to handle during angioplasty, and its favorable durability has been established both in the Ross procedures and in an arterial switch procedure. Therefore, we conclude that patch angioplasty using a piece of the pulmonary arterial wall represents a good alternative to conventional coronary artery bypass grafting.

  16. Effects of Nicorandil on the Clinical and Laboratory Outcomes of Unstable Angina Patients after Coronary Angioplasty

    Directory of Open Access Journals (Sweden)

    Homa Falsoleiman

    2016-09-01

    Full Text Available Introduction: Ischemic preconditioning mediated by potassium channels is a physiological protective mechanism, . It is hypothesized that Nicorandil, which is a potassium channel activator, could protect the heart via preconditioning. Materials and Methods:This clinical trial was conducted on 162 patients undergoing percutaneous coronary intervention (PCI in Quem hospital, from Jan2013 to Jan 2014,patients  divided into two groups. The first group received standard treatment plus Nicorandil (10 mg, twice daily for three days before and after angioplasty. The second group received standard treatment after PCI. Results: Cardiac enzyme levels were significantly lower in the Nicorandil group at 6 and 12 hours after angioplasty,(p value=0.001 while no significant differences were observed in the symptoms and four-month prognosis of the study groups(p value=0.8. Conclusion:It is recommended that a randomized clinical trial be conducted for the close evaluation of the effects of Nicorandil on unstable angina patients.

  17. Long-term Luminal Renarrowing After Successful Elective Coronary Angioplasty of Total Occlusions : A Quantitative Angiographic Analysis

    NARCIS (Netherlands)

    A.G. Violaris (Andonis); R. Melkert (Rein); P.W.J.C. Serruys (Patrick)

    1995-01-01

    textabstractBackground The long-term angiographic outcome after successful dilatation of coronary occlusions remains unclear. The objective of this study was to examine long-term restenosis after successful balloon dilatation of coronary occlusions at a predetermined time interval with quantitative

  18. Cephalic arch stenosis in autogenous brachiocephalic hemodialysis fistulas: results of cutting balloon angioplasty

    DEFF Research Database (Denmark)

    Heerwagen, Søren Thorup; Lönn, Lars; Schroeder, Torben V;

    2010-01-01

    Cephalic arch stenosis is a known cause of hemodialysis access failure in patients with brachiocephalic fistulas (BCFs). Outcomes of endovascular treatment are affected by resistance of the stenosis to balloon dilation, a high vein rupture rate and the development of early restenosis. The purpose...

  19. Outcome from balloon induced coronary artery dissection after intracoronary beta radiation

    NARCIS (Netherlands)

    I.P. Kay (Ian Patrick); S.G. Carlier (Stephan); V.L.M.A. Coen (Veronique); P.J. de Feyter (Pim); M. Sabaté (Manel); G.J.J. van Langenhove (Glenn); M.A. Costa (Marco); A.J. Wardeh (Alexander); A.L. Gijzel (Anthonie); N.V. Deshpande (Niteen Vijay); P.W.J.C. Serruys (Patrick); P.C. Levendag (Peter); W.J. van der Giessen (Wim)

    2000-01-01

    textabstractOBJECTIVE: To evaluate the healing of balloon induced coronary artery dissection in individuals who have received beta radiation treatment and to propose a new intravascular ultrasound (IVUS) dissection score to facilitate the comparison of dissection through time.

  20. Percutaneous coronary angioplasty versus coronary artery bypass grafting in treatment of unprotected left main stenosis (NOBLE)

    DEFF Research Database (Denmark)

    Mäkikallio, Timo; Holm, Niels R; Lindsay, Mitchell

    2016-01-01

    Background Coronary artery bypass grafting (CABG) is the standard treatment for revascularisation in patients with left main coronary artery disease, but use of percutaneous coronary intervention (PCI) for this indication is increasing. We aimed to compare PCI and CABG for treatment of left main...... coronary artery disease. Methods In this prospective, randomised, open-label, non-inferiority trial, patients with left main coronary artery disease were enrolled in 36 centres in northern Europe and randomised 1: 1 to treatment with PCI or CABG. Eligible patients had stable angina pectoris, unstable......), a composite of all-cause mortality, non-procedural myocardial infarction, any repeat coronary revascularisation, and stroke. Non-inferiority of PCI to CABG required the lower end of the 95% CI not to exceed a hazard ratio (HR) of 1 . 35 after up to 5 years of follow-up. The intention-to-treat principle...

  1. Effect of coumarins started before coronary angioplasty on acute complications and long-term follow-up: a randomized trial.

    Science.gov (United States)

    ten Berg, J M; Kelder, J C; Suttorp, M J; Mast, E G; Bal, E; Ernst, S M; Verheugt, F W; Plokker, H W

    2000-07-25

    Coronary angioplasty frequently creates a thrombogenic surface, with subsequent mural thrombosis that may lead to acute complications and possibly stimulates the development of restenosis. Whether coumarins can prevent these complications is unclear. The objective of this open, randomized trial was to assess the clinical effect of coumarins started before coronary angioplasty and continued for 6 months. Before coronary angioplasty, 530 patients were randomly assigned to aspirin plus coumarins and 528 patients to aspirin alone. At the start of the angioplasty, the mean international normalized ratio was 2.7+/-1.1; during follow-up, it was 3.0+/-1.1. At 30 days, the composite end point of death, myocardial infarction, target-lesion revascularization, and stroke was observed in 18 patients (3.4%) treated with aspirin plus coumarin compared with 34 patients (6.4%) treated with aspirin alone (relative risk, 0.53; 95% CI, 0.30 to 0.92). At 1 year, these figures were 14.3% and 20.3%, respectively (relative risk, 0.71; 95% CI, 0.54 to 0.93). The incidence of major bleeding and false aneurysm during hospitalization was 3.2% and 1.0%, respectively (relative risk, 3.39; 95% CI, 1.26 to 9.11). The benefit of coumarins was observed in both stented and nonstented patients. Coumarins in addition to aspirin started before PTCA and continued for 6 months was more effective than aspirin alone in the prevention of acute and late complications after coronary angioplasty. This benefit was accompanied by a small but significant increase in bleeding complications.

  2. Emergency coronary stenting with the Palmaz-Schatz stent for failed transluminal coronary angioplasty: results of a learning phase.

    Science.gov (United States)

    Kiemeneij, F; Laarman, G J; van der Wieken, R; Suwarganda, J

    1993-07-01

    This study describes initial results of Palmaz-Schatz stent implantation in our department to restore and maintain vessel patency in 52 patients with obstructive dissection, defined as an intraluminal filling defect with coronary flow impairment after percutaneous transluminal coronary angioplasty (PTCA). The majority of patients (62%) underwent PTCA for unstable angina (n = 28), defined as angina at rest with documented ST segment changes resistant to nitrates, or acute myocardial infarction (n = 4). In six patients (11%) the stent could not be delivered. Seven of the remaining 46 patients (15%) had coronary artery bypass surgery performed because of increased risk for subacute stent occlusion, residual thrombosis, residual obstruction near the stent, coronary artery diameter less than 3.0 mm, or multiple and overlapping stents. One patient (3%) died in hospital from intracranial bleeding. Nine patients (23%) had subacute stent occlusion, retrospectively unpredictable in four patients. Nine of 29 patients (29%) with an uncomplicated clinical course after stenting had angiographic restenosis at a mean follow-up of 6.0 +/- 1.4 months (range 12 days to 8.3 months). Two patients (7%) died 3 months after successful stenting: one patient because of stent thrombosis after stopping warfarin before an abdominal operation and one patient after acute vascular surgery for late traumatic groin bleeding. Of the 39 medically treated patients with a stent, three (8%) had major bleeding complications. It is concluded that stent implantation is feasible in most patients with obstructive dissection after PTCA. After successful stent delivery, coronary flow is temporarily restored.(ABSTRACT TRUNCATED AT 250 WORDS)

  3. Percutaneous transluminal angioplasty of the left subclavian artery to prevent or treat the coronary-subclavian steal syndrome.

    Science.gov (United States)

    Marques, K M; Ernst, S M; Mast, E G; Bal, E T; Suttorp, M J; Plokker, H W

    1996-09-15

    A hemodynamic significant left subclavian artery stenosis or occlusion proximal to the origin of the left internal mammary artery (LIMA) can result in an impaired or reversed flow through the LIMA and the coronary artery to which it has been anastomosed. In this study, we report on our immediate and long-term follow-up results in 31 consecutive patients who underwent percutaneous transluminal coronary angioplasty of the left subclavian artery shortly before or after coronary artery bypass grafting with use of the LIMA.

  4. Primary coronary angioplasty in 9,434 patients during acute myocardial infarction: predictors of major in- hospital adverse events from 1996 to 2000 in Brazil

    Directory of Open Access Journals (Sweden)

    Mattos Luiz Alberto

    2002-01-01

    Full Text Available OBJECTIVE: To verify the results after the performance of primary coronary angioplasty in Brazil in the last 4 years. METHODS: During the first 24 hours of acute myocardial infarction onset, 9,434 (12.2% patients underwent primary PTCA. We analyzed the success and occurrence of major in-hospital events, comparing them over the 4-year period. RESULTS: Primary PTCA use increased compared with that of all percutaneous interventions (1996=10.6% vs. 2000=13.1%; p<0.001. Coronary stent implantation increased (1996=20% vs. 2000=71.9%; p<0.001. Success was greater (1998=89.5% vs. 1999=92.5%; p<0.001. Reinfarction decreased (1998=3.9% vs. 99=2.4% vs. 2000=1.5%; p<0.001 as did emergency bypass surgery (1996=0.5% vs. 2000=0.2%; p=0.01. In-hospital deaths remained unchanged (1996=5.7% vs. 2000=5.1%, p=0.53. Balloon PTCA was one of the independent predictors of a higher rate of unsuccessful procedures (odds ratio 12.01 [CI=95%] 1.58-22.94, and stent implantation of lower mortality rates (odds ratio 4.62 [CI=95%] 3.19-6.08. CONCLUSION: The success rate has become progressively higher with a significant reduction in reinfarction and urgent bypass surgery, but in-hospital death remains nearly unchanged. Coronary stenting was a predictor of a lower death rate, and balloon PTCA was associated with greater procedural failure.

  5. Impact of previous percutaneous transluminal coronary angioplasty and/or stenting revascularization on outcomes after surgical revascularization : insights from the imagine study

    NARCIS (Netherlands)

    Chocron, Sidney; Baillot, Richard; Rouleau, Jean Lucien; Warnica, Wayne J.; Block, Pierre; Johnstone, David; Myers, Martin G.; Calciu, Cristina Dana; Nozza, Anna; Martineau, Pierre; van Gilst, Wiek H.

    2008-01-01

    Aim To determine the impact of previous coronary artery revascularization by percutaneous transluminal coronary angioplasty and/or stenting (PCI) on outcome after subsequent coronary artery bypass grafting (CABG). Methods and results The ischaemia management with Accupril post-bypass Graft via Inhib

  6. A comparison of directional atherectomy with coronary angioplasty in patients with coronary artery disease

    NARCIS (Netherlands)

    E.J. Topol (Eric); F. Leya; C.A. Pinkerton; P.L. Whitlow (Patrick); B. Hofling; C.A. Simonton; R.R. Masden; P.W.J.C. Serruys (Patrick); M.B. Leon (Martin); D.O. Williams (David); S.B. King 3rd (Spencer); B. Daniel; D.B. Mark (Daniel); J.M. Isner; D.R. Holmes Jr (David); S.G. Ellis (Stephen); K.L. Lee (Kerry); G.P. Keeler; L.G. Berdan (Lisa); T. Hinohara; R.M. Califf (Robert)

    1993-01-01

    textabstractBACKGROUND. Directional coronary atherectomy is a new technique of coronary revascularization by which atherosclerotic plaque is excised and retrieved from target lesions. With respect to the rate of restenosis and clinical outcomes, it is not known how this procedure compares with ballo

  7. A comparison of directional atherectomy with coronary angioplasty in patients with coronary artery disease

    NARCIS (Netherlands)

    E.J. Topol (Eric); F. Leya; C.A. Pinkerton; P.L. Whitlow (Patrick); B. Hofling; C.A. Simonton; R.R. Masden; P.W.J.C. Serruys (Patrick); M.B. Leon (Martin); D.O. Williams (David); S.B. King 3rd (Spencer); B. Daniel; D.B. Mark (Daniel); J.M. Isner; D.R. Holmes Jr (David); S.G. Ellis (Stephen); K.L. Lee (Kerry); G.P. Keeler; L.G. Berdan (Lisa); T. Hinohara; R.M. Califf (Robert)

    1993-01-01

    textabstractBACKGROUND. Directional coronary atherectomy is a new technique of coronary revascularization by which atherosclerotic plaque is excised and retrieved from target lesions. With respect to the rate of restenosis and clinical outcomes, it is not known how this procedure compares with

  8. Comparative quantitative angiographic analysis of directional coronary atherectomy and balloon coronary angioplasty

    NARCIS (Netherlands)

    A.W.M. Umans (A. W M); K.J. Beatt (Kevin); B.J.W.M. Rensing (Benno); W.R.M. Hermans (Walter); P.J. de Feyter (Pim); P.W.J.C. Serruys (Patrick)

    1991-01-01

    markdownabstract__Abstract__ An attempt to assess the “utility” of directional atherectomy was made using a new quantitative angiographic index. This index can be subdivided into an initial gain component and a restenosis component. The initial gain index is the ratio between the gain in diameter d

  9. Complex Coronary Interventions with the Novel Mozec™ CTO Balloon: The MOZART Registry.

    Science.gov (United States)

    Lupi, Alessandro; Rognoni, Andrea; Schaffer, Alon; Secco, Gioel G; Bongo, Angelo S

    2015-01-01

    Mozec™ CTO is a novel semicompliant rapid-exchange PTCA balloon catheter with specific features dedicated to treat complex coronary lesions like chronic total occlusions (CTOs). However, no data have been reported about the performance of this device in an all-comers population with complex coronary lesions. We evaluated the safety and success rate of Mozec™ CTO balloon in 41 consecutive patients with chronic stable angina and complex coronary lesions (15 severe calcified coronary stenoses, 15 bifurcation lesions with planned two-stent intervention, and 11 CTOs). Safety was assessed reporting the balloon burst rate after inflation exceeding the rated burst pressure (RBP) according to the manufacturer's reference table. Success was defined as the possibility to advance the device further the target lesion. The Mozec™ CTO balloon showed an excellent performance with a 93.3% success in crossing tight and severely calcified lesions (14/15 pts), a 93.3% success in engaging jailed side branches after stent deployment across bifurcations (14/15 pts), and a 90.9% success in crossing CTO lesions (10/11 pts). The burst rate at RBP of the Mozec™ CTO balloon was 6.7% (1/15 balloons) in the tight and severely calcified lesions, 6.7% (1/15 balloons) when dilating jailed vessels, and 9.1% (1/11 balloons) in CTOs. The novel Mozec™ CTO balloon dilatation catheter showed promising results when employed to treat complex lesions in an all-comers population. Further studies should clarify if this kind of balloon might reduce the need of more costly devices like over-the-wire balloons and microcatheters for complex lesions treatment.

  10. Multivessel versus Single Vessel Angioplasty in Non-ST Elevation Acute Coronary Syndromes: A Systematic Review and Metaanalysis.

    Directory of Open Access Journals (Sweden)

    Javier Mariani

    Full Text Available Multivessel disease is common in acute coronary syndrome patients. However, if multivessel percutaneous coronary intervention is superior to culprit-vessel angioplasty has not been systematically addressed.A metaanalysis was conducted including studies that compared multivessel angioplasty with culprit-vessel angioplasty among non-ST elevation ACS patients. Since all studies were observational adjusted estimates of effects were used. Pooled estimates of effects were computed using the generic inverse of variance with a random effects model.Twelve studies were included (n = 117,685. Median age was 64.1 years, most patients were male, 29.3% were diabetic and 36,9% had previous myocardial infarction. Median follow-up was 12 months. There were no significant differences in mortality risk (HR 0.79; 95% CI 0.58 to 1.09; I2 67.9%, with moderate inconsistency. Also, there were no significant differences in the risk of death or MI (HR 0.90; 95% CI 0.69 to 1.17; I2 62.3%, revascularization (HR 0.76; 95% CI 0.55 to 1.05; I2 49.9% or in the combined incidence of death, myocardial infarction or revascularization (HR 0.83; 95% CI 0.66 to 1.03; I2 70.8%. All analyses exhibited a moderate degree of inconsistency. Subgroup analyses by design reduced the inconsistency of the analyses on death or myocardial infarction, revascularization and death, myocardial infarction or revascularization. There was evidence of publication bias (Egger's test p = 0.097.Routine multivessel angioplasty in non-ST elevation acute coronary syndrome patients with multivessel disease was not superior to culprit-vessel angioplasty. Randomized controlled trials comparing safety and effectiveness of both strategies in this setting are needed.

  11. Primary percutaneous transluminal coronary angioplasty in the acute infarction of the right ventricle

    Directory of Open Access Journals (Sweden)

    Gligić Branko

    2003-01-01

    Full Text Available Background. Predilection site for the acute myocardial infarction of the right ventricle, (AMI-RV is the upper third of the right coronary artery and for this reason such an infarction is followed by numerous complications, primarily by conduction disorders and very often by sudden and rapid cardiogenic shock development. Methods. Primary percutaneous transluminal coronary angioplasty (PPTCA was performed on three patients in whom the acute infarction of the right ventricular was diagnosed and who had been hospitalized six hours after the beginning of chest pain. In all three patients intracoronary stent was implanted. On the admission patients had been in the threatening cardiogenic shock, with the prominent chest pain and with the elevation of ST-segment in V4R>2 mV. In the course of intervention patients were administered low-molecular intracoronary heparin with direct platelet glycoprotein IIb/IIIa inhibitors (abciximab, according to the established procedure applied in such cases. Results. The complete dilatation of the infarcted artery was established with the signs of reperfusion and the further clinical course was completely normal, there was no heart failure and patients had no subjective difficulties. Conclusion. Invasive approach in the treatment of AMI-RV is justifiable, and possibly the therapy of choice of these patients, providing well trained and equipped team is available.

  12. Percutaneous Balloon Angioplasty for Severe Native Aortic Coarctation in Young Infants Less Than 6 Months: Medium-to Long-term Follow-up

    Institute of Scientific and Technical Information of China (English)

    Lan He; Fang Liu; Lin Wu; Chun-Hua Qi; Li-Feng Zhang; Guo-Ying Huang

    2015-01-01

    Background:Although balloon angioplasty (BA) has been performed for more than 20 years,its use as a treatment for native coarctation of the aorta (CoA) during childhood,especially in young infants,remains controversial.This study aimed to assess the effects and potential role of percutaneous transcatheter BA for native CoA as an alternative therapy to surgical repair in young infants.Methods:The 37 patients aged from 6 days to 6 months with severe CoA in congestive heart failure or circulatory shock were admitted for BA.Patient's weight ranged from 2.4 to 6.1 kg.All 37 patients were experiencing cardiac dysfunction,and eight patients were in cardiac shock with severe metabolic acidosis.Eleven patients had an isolated CoA,whereas the others had a CoA associated with other cardiac malformations.Cardiac catheterization and aortic angiography were performed under general anesthesia with intubation.Transfemoral arterial approaches were used for the BA.The size of the balloon ranged from 3 mm × 20 mm to 8 mm × 20 mm,and a coronary artery balloon catheter was preferred over a regular peripheral vascular balloon catheter.Results:The femoral artery was successfully punctured in all but one patient,with that patient undergoing a carotid artery puncture.The systolic peak pressure gradient (PG) across the coarctation was 41.0 ± 16.0 mmHg (range 13-76 mmHg).The mean diameter of the narrowest coarctation site was 1.7 ± 0.6 mm (range 0.5-2.8 mm).All patients had successful dilation;the PG significantly decreased to 13.0 ± 1 1.0 mmHg (range 0-40 mmHg),and the diameter of coarctation significantly improved to 3.8 ± 0.9 mm (range 2.5-5.3 mm).No intraoperative complications occurred for any patients.However,in one case that underwent a carotid artery puncture,a giant aneurysm formed at the puncture site and required surgical repair.The following observations were made during the follow-up period from 6-month to 7-year:(1) The PG across the coarctation measured by

  13. Use of Reactor-Produced Radioisotopes for Prevention Restenosis After Angioplasty

    Energy Technology Data Exchange (ETDEWEB)

    Knapp, F.F.; Pipes, D.W.

    1999-12-21

    Coronary heart disease leads to myocardial infarction and is a major cause of death in the US. Myocardial infarctions result from atherosclerotic plaque deposits in the coronary arteries, reducing blood flow through these arteries which supply oxygen and nutrients to the heart muscle. The two major approaches for restoring adequate blood flow are coronary bypass graft surgery and coronary angioplasty. Angioplasty is a routinely used clinical procedure, where a deflated balloon attached to the end of a long catheter is inserted into an artery in the leg and then advanced through the aorta into the blocked regions of the coronary arteries. After positioning in the occluded region of the artery, the balloon is inflated with a pressurized saline solution which opens the artery restoring blood flow by pressing the atherosclerotic plaque into the vessel wall. Angioplasty is a widely performed procedure with the coronary arteries and is a much less expensive alternative to coronary bypass surgery. The best patients for angioplasty are those with single occlusions and this method is preferred over bypass grafting because of the significantly reduced expense. The reformation of plaque deposits in arteries (restenosis) following angioplasty, however, is a major clinical problem encountered in as high as 40 percent of patients. Because reduction of health care costs is a major national priority, development of effective new preventative methods for restenoses is an important national priority.

  14. Preparation and characterisation of polyamide 11/montmorillonite (MMT) nanocomposites for use in angioplasty balloon applications

    Energy Technology Data Exchange (ETDEWEB)

    Halim, Khairul Anwar A. [Department of Polymer Engineering, Athlone Institute of Technology, Athlone (Ireland); School of Materials Engineering, Universiti Malaysia Perlis, Perlis (Malaysia); Farrell, Joseph B. [Department of Polymer Engineering, Athlone Institute of Technology, Athlone (Ireland); Kennedy, James E., E-mail: jkennedy@ait.ie [Department of Polymer Engineering, Athlone Institute of Technology, Athlone (Ireland)

    2013-12-16

    With increased demands on catheter balloon functionality, there is an emphasis to blend new materials which can improve mechanical performance. Polymer nanocomposites were prepared by melt blending polyamide 11 (PA 11) with organically modified montmorillonite nanoclay. The effects of incorporating the nanoclay on the short-term mechanical properties of PA 11 were assessed using a design of experiments (DoEs) approach. X-ray diffraction (XRD), transmission electron microscopy (TEM), differential scanning calorimetry (DSC) and dynamic mechanical thermal analysis techniques (DMA) were used to characterise the morphology of the nanocomposites. Design of experiments studies revealed that the optimum nanocomposites properties can be achieved by carefully controlling the melt compounding parameters. XRD and TEM data proved that exfoliated clay morphologies existed within the matrix at low clay loading (2%). Whereas the interaction between the polymer matrix and nanoclay was quantified in the DMA spectra, showed a significant increase in storage modulus (up to 80%). The reinforcing effect of nanoclay within the PA 11 was further investigated using mechanical testing, where significant increases in the ultimate tensile strength and strain at break of reinforced tri-layer balloon tubing were observed. - Highlights: • TEM reveals the coexistence of exfoliated and intercalated nanostructures. • Isothermal crystallisation studies found that the nano-clays reduced the crystallisation time. • Significant increase in the storage modulus was due to the reinforcing effect of the nano-clay platelets. • It was observed that the activation energy values decreased due to the presence of nanoclay.

  15. Bailout techniques for failed coronary angioplasty using 6 French guiding catheters.

    Science.gov (United States)

    Kiemeneij, F; Laarman, G J

    1994-08-01

    Coronary angioplasty (PTCA) through 6 French (F) guiding catheters is feasible, although acute or threatened closure following coronary artery dissections may occur. This report describes our experience with the treatment of suboptimal results in 13 patients from a population of 144 patients who had PTCA through 6F guiding catheters. Patients were treated with a new low profile autoperfusion catheter (ACS, Flowtrack40) or with Palmaz Schatz stents, advanced through 6F guiding catheters. PTCA was performed via the radial artery in 11 pts (85%) or via the femoral artery in two patients (15%). In two patients, (15%) PTCA was complicated by an dissection associated with complete loss of flow (TIMI 0) and a dissection was considered to lead to abrupt closure in the remaining 11 patients (85%), despite the presence of normal flow. A Flow-track40 perfusion catheter was successfully applied in three of four patients. In one patient a persisting dissection after restoration of flow by a perfusion catheter was treated with three Palmaz Schatz stents. Implantation of Palmaz Schatz stents was attempted as primary technique in nine patients. In one patient the stent could not cross a dissection in the proximal LAD via the radial artery. With an 8F system via the femoral artery, two stents could successfully be deployed with the stent delivery system. In another patient the stent could not be advanced across a subtotal residual stenosis in a tortuous left anterior descending coronary artery. Despite normal antegrade flow and emergency bypass surgery, this patient developed a non-Q-myocardial infarction. In the remaining patients, the clinical course was uncomplicated.(ABSTRACT TRUNCATED AT 250 WORDS)

  16. Utility of birefringence changes due to collagen thermal denaturation rate process analysis: vessel wall temperature estimation for new short term heating balloon angioplasty

    Science.gov (United States)

    Kaneko, Kenji; Shimazaki, Natsumi; Gotoh, Maya; Nakatani, Eriko; Arai, Tsunenori

    2007-02-01

    Our photo thermal reaction heating architecture balloon realizes less than 10 s short term heating that can soften vessel wall collagen without damaging surrounding tissue thermally. New thermal balloon angioplasty, photo-thermo dynamic balloon angioplasty (PTDBA) has experimentally shown sufficient opening with 2 atm low pressure dilation and prevention of chronic phase restenosis and acute phase thrombus in vivo. Even though PTDBA has high therapeutic potential, the most efficient heating condition is still under study, because relationship of treatment and thermal dose to vessel wall is not clarified yet. To study and set the most efficient heating condition, we have been working on establishment of temperature history estimation method from our previous experimental results. Heating target of PTDBA, collagen, thermally denatures following rate process. Denaturation is able to be quantified with measured collagen birefringence value. To express the denaturation with equation of rate process, the following ex vivo experiments were performed. Porcine extracted carotid artery was soaked in two different temperature saline baths to enforce constant temperature heating. Higher temperature bath was set to 40 to 80 degree Celsius and soaking duration was 5 to 40 s. Samples were observed by a polarizing microscope and a scanning electron microscope. The birefringence was measured by polarizing microscopic system using Brace-Koehler compensator 1/30 wavelength. The measured birefringence showed temperature dependency and quite fit with the rate process equation. We think vessel wall temperature is able to be estimated using the birefringence changes due to thermal denaturation.

  17. Anxiety, Self Efficacy Expectation and Social Support in Patients after Coronary Angioplasty and Coronary Bypass

    Directory of Open Access Journals (Sweden)

    T Dehdari

    2008-12-01

    Full Text Available "nBackground: Coronary artery bypass grafting surgery (CABG and precutaneous transluminal coronary intervention (PCI are safe and effective in the treatment of coronary artery disease. The aim of this study was to determine and compare anxi­ety, self efficacy expectation and perceived social support between CABG patients and PCI patients referral to receiving car­diac rehabilitation programs."nMethods: In this descriptive- analytical study 150 patients with CABG and PCI were selected. The Spilberger state trait anxi­ety inventory, general self efficacy scale and perceived social support scale three instruments for collecting data in the pre­sent study."nResults: PCI patients as compared to CABG patients experience higher anxiety (P= 0.02 and lower perceived social sup­port (P= 0.02. Self efficacy score in the PCI patients was higher than CABG patients (P= 0.01."nConclusion: It is necessary to be more considerate to psychological problems in the PCI patients.

  18. Effect of coronary occlusion during percutaneous transluminal angioplasty in humans on left ventricular chamber stiffness and regional diastolic pressure-radius relations

    NARCIS (Netherlands)

    W. Wijns (William); P.W.J.C. Serruys (Patrick); C.J. Slager (Cornelis); J. Grimm; H.P. Krayenbuehl; P.G. Hugenholtz (Paul); O.M. Hess (Otto)

    1986-01-01

    textabstractThe effect of repeated (3 to 10 second) and transient (15 to 75 second) abrupt coronary occlusion on the global and regional chamber stiffness was studied in nine patients undergoing angioplasty of a single proximal left anterior descending coronary artery stenosis. The left ventricular

  19. INtimal hyPerplasia evAluated by oCT in de novo COROnary lesions treated by drug-eluting balloon and bare-metal stent (IN-PACT CORO: study protocol for a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Burzotta Francesco

    2012-05-01

    Full Text Available Abstract Background Neointimal hyperplasia plays a pivotal role in the pathogenesis of in-stent restenosis in patients undergoing percutaneous coronary interventions. Drug-eluting balloons are a promising tool to prevent restenosis after coronary angioplasty. Moreover, an increased knowledge of the pathophysiology of restenosis my help improve therapeutic strategies. Methods/Design We present the design of an open-label, randomized three-arm clinical trial aimed to assess whether a strategy of bare-metal stent implantation with additional use of drug-eluting balloons, either before (pre-dilation or after stenting (post-dilation, reduces the primary endpoint of in-stent neointimal hyperplasia area as compared with a strategy of bare-metal stent implantation alone. This primary endpoint will be assessed by optical coherence tomography at follow-up. Secondary endpoints will be the percentage of uncovered struts, and the percentage of struts with incomplete apposition. An ancillary study investigating the relation between systemic levels of endothelial progenitors cells and neointimal hyperplasia, and the interaction between endothelial progenitors cell levels and drug-eluting balloons has been planned. Thirty consecutive patients undergoing percutaneous coronary intervention will be randomized with a 1:1:1 design to bare-metal stent implantation alone (n = 10; bare-metal stent implantation after pre-dilation with a drug-eluting balloon (n = 10; or bare-metal stent implantation followed by post-dilation with a drug-eluting balloon (n = 10. Six-month follow-up coronary angiography with optical coherence tomography imaging of the stented segment will be performed in all patients. Blood samples for the assessment of endothelial progenitors cell levels will be collected on admission and at 6 months. Discussion Experimental and early clinical data showed that inhibition of neointimal hyperplasia may be obtained by local administration of

  20. Comparison of Results of Coronary Angioplasty in Patients with Unstable vs. Stable Angina

    Institute of Scientific and Technical Information of China (English)

    梅卫义; 杜志民; 罗初凡; 胡承恒; 李怡; 马虹

    2002-01-01

    Objectives To comparethe short and mid - term outcomes in cases of percuta-neous transluminal coronary angioplasty (PTCA) inpatients with unstable v stable angina. MethodsPatients selected for PTCA/stenting were divided into two groups, one with stable angina pectoris (SAgroup, n--92) and one with unstable angina pectoris(UA group, n = 112). The outcomes of coronary angiographies (CAG), initial (30-d) success of theprocedure, and follow- up status in the two groupswere compared. Results Baseline characteristicswere similar, although the patients with unstablesymptoms more females ( P< 0.05), and had a higheraverage CCS class ( P< 0.05) and a higher incidenceof postinfarction angina ( P< 0. 01 ). The frequency of"complex" stenosis in patients with unstable anginawas higher than that of patients with stable angina,33% v 20% (P<0.01). A total of 309 vessels accepted the procedure; including 210 stents were successfully delivered to 156 patients. 143 and 67 stentswere implanted in the UA and SA group, respectively(P< 0.01 ). No major complication occurred in thetwo groups, except 12 patients experienced reoccurring chest pain initially, 9 in UA group v 3 in SAgroup ( P< 0.05). The averaged six - month follow -up status was compared too. Only 3 cases developedmyocardial infarction, including 2 patients with unstable angina. 12 and 16 reoccurring chest pains werefound in the two groups, respectively (13% in SAgroup vs 14% in UA group). There were no significant differences between groups in rates of clinicalrestenosis, follow- up angina class, or overall clinicalsuccess. Conclusions Patients with unstable anginareceiving PTCA/stenting have similar complication,restenosis, and initial and midterm success rate ascompared to patients with stable symptoms with strictcases select and careful preparation.

  1. Monitoring of gadolinium-BOPTA uptake into the vessel wall during magnetic resonance (MR)-guided angioplasty of the peripheral arteries with a paclitaxel/gadolinium-BOPTA-coated balloon. An experimental study at 3 Tesla

    Energy Technology Data Exchange (ETDEWEB)

    Neizel, M.; Kelm, M. [University Hospital Duesseldorf (Germany). Dept. of Cardiology, Pneumology and Angiology; Ruebben, A.; Weiss, N. [Aachen Resonance, Aachen (Germany); Guenther, R.W. [University Hospital Aachen (Germany). Dept. of Radiology; Krombach, G.A. [University Hospital Giessen (Germany). Dept. of Radiology

    2014-04-15

    Purpose: The success of paclitaxel distribution within the vessel wall during paclitaxel-coated balloon angioplasty to prevent restenosis cannot be monitored under X-ray guidance. The aim of this pilot study was to demonstrate the feasibility of monitoring Gadolinium-BOPTA delivery within the vessel wall during magnetic resonance (MR)-guided paclitaxel/Gadolinium-BOPTA-coated balloon angioplasty of the peripheral arteries. Materials and methods: 6 pigs (47 ± 2 kg) were investigated. All experiments were performed using a 3 Tesla MR scanner. MR-guided bilaterial angioplasty of the iliac arteries was performed using a paclitaxel/MR contrast agent-coated balloon catheter. The feasibility of monitoring the delivery of Gadolinium-BOPTA to the vessel was assessed in 4 animals. In two additional animals, bilateral stenosis was surgically induced in the iliac arteries. Delivery of paclitaxel to the vessel wall was monitored using a 3 D T1-weighted gradient echo (GE) sequence for delineation of the vessel wall. Normalized signal intensity (SI) of the vessel wall was measured before and repeatedly after the intervention for 45 min. in all animals. Results: Paclitaxel/gadolinium-BOPTA-coated balloon angioplasty was successfully accomplished in all iliac arteries (n = 12). In animals with stenosis MR-angiography demonstrated successful dilatation (n = 4). The normalized SI of the vessel wall on T1-weighted GE images significantly increased after the intervention in all animals with and without stenosis for more than 45 min. (p < 0.001). Conclusion: Monitoring of Gadolinium-BOPTA into the vessel wall during MR-guided coated balloon angioplasty is feasible. This is a first step towards providing a tool for the online control of homogenous drug delivery after paclitaxel-coated balloon angioplasty. (orig.)

  2. Has multivessel angioplasty displaced surgical revascularization?

    Science.gov (United States)

    King, S B; Ivanhoe, R J

    1990-01-01

    Over the years, PTCA has been proved a safe and effective therapy for single-vessel CAD. Given the record of favorable results for single-vessel angioplasty, the extension of angioplasty to multivessel CAD soon followed. The successful application of PTCA to multivessel disease has been facilitated by developments in balloon, guidewire, and guide catheter technology. Success rates have been satisfactory, and complications have remained acceptable. Furthermore, as an outgrowth of an understanding of the mechanism and effect of PTCA, guidelines have been developed to aid case selection. As emphasized earlier, these guidelines should weigh heavily in deciding whether to select PTCA as a treatment modality. Presently, in our opinion, PTCA has not yet completely displaced surgery for multivessel CAD. Surgical standby is required for safe PTCA, because emergency surgery can be lifesaving and limit myocardial infarction after failed angioplasty. It is doubtful that surgery will ever relinquish its position as the treatment of choice for left main coronary artery disease. Nor will elective surgery find wide application in single-vessel disease. Whether one mode of revascularization will emerge as the most efficacious for multivessel disease related to long-term survival, limitation of cardiac events, and cost will be addressed in the analysis of the ongoing randomized trials of surgery versus angioplasty. Andreas Gruentzig established that it was possible to work within the coronary artery in an alert and comfortable patient. Interventional cardiology has experienced rapid technologic growth. Many patients formerly treated with bypass surgery can be managed effectively with angioplasty. If effective bail-out methods for acute closure are proven effective and restenosis is limited to a small percentage of patients, angioplasty in some form will further displace CABG. Until those ultimate goals are achieved, the value of angioplasty compared with bypass surgery must rest

  3. [Glycoprotein IIb-IIIa antagonist Monafram in primary angioplasty of patients with acute coronary syndrome without st segment elevation].

    Science.gov (United States)

    Pevzner, D V; Staroverov, I I; Samko, A N; Frolova, N S; Mazurov, A V; Ruda, M Ya

    2010-01-01

    Glycoprotein (GP) llb-llla anagonist monafram is the F(ab)2 fragments of anti GP llb llla monoclonal antibody FraMon (CRC64). Efficacy and safety of monafram in primary coronary angioplasty of patients with acute coronary syndrome without ST segment elevation (non ST ACS) was evaluated in this study. Monafram was introduced intravenously to 284 patients just before angioplasty at standard dosage - 0.25 mg/kg as single i.v. bolus. Control group included 203 patients. All patients received aspirin (loading dose 300 mg and then 75 mg daily) and more than 90% - clopidogrel (loading dose 300-600 mg and then 75 mg daily). Within 30 days of follow up period monafram decreased by more than 2.5 fold the total amount of unfavorable outcomes (cardiovascular death, myocardial infarction and indications for repeat revascularization due to angina recurrence) - from 19.2% to 7.4% (p<0.001). The rate of indications for revascularization was most strongly decreased - by more than 7 times - from 7.9% to 1.1% (p<0.001). The number of myocardial infarctions was reduced by more than 2 times - from 8.4% to 3.9% (p=0.057). The amount of lethal outcomes did not differ between two groups (2.9% and 2.4% in the control and monafram groups, respectively). In the control group 8.9% patients received monafram during primary angioplasty due to urgent indications. Monafram did not cause any allergic reaction in all tested patients. Major bleeding was registered in one (less than 0.5%) and deep thrombocytopenia (<20000 platelets per 1 ul) - in 3 (1.1%) out of 284 patients. The data obtained indicated that monafram decreased the number of thrombotic complications in non ST ACS patients undergoing angioplasty upon the dual antiplatelet therapy (aspirin+clopidogrel) and without significant increase of dangerous side effects.

  4. 球囊血管成形术对血浆TNF-α、ET水平及局部血管组织ET-IR的影响%Effect of balloon angioplasty on plasma ET and TNF-α levels and tissue endothe lin immunoreactivity in experimental atherosclerotic rabbits

    Institute of Scientific and Technical Information of China (English)

    杜荣增; 吴宗贵; 黄佐; 黄高忠; 张国元

    2001-01-01

    ET, TNF-α levels and tissue ET-IR in iliac artery wall after balloon angioplasty may be associated with the injury of l ocal vascular intima, suggesting that ET and TNF-α may take part in the corona ry constriction and the development of coronary restenosis after percutaneous tr ansluminal coronary angioplasty.

  5. Acute embolic occlusion of the right common iliac artery after revision total hip arthroplasty treated with catheter-directed thrombolysis and balloon angioplasty: A case report

    Directory of Open Access Journals (Sweden)

    Hongqi Yang

    2015-07-01

    Full Text Available Methods: A 63-year-old woman with atrial fibrillation presented clinical symptoms and signs of acute ischemia in the right lower extremity on the 17th postoperative day after revision total hip arthroplasty of the left hip for aseptic loosening of femoral component. Aspirin was discontinued 7 days before surgery. Both computed tomography angiography and digital subtraction angiography demonstrated complete occlusion of the right common iliac artery. An emergency catheter-directed thrombolysis with urokinase combined with balloon angioplasty was performed to obtain complete patency of the right common iliac artery. Results: The patient received anticoagulation and antiplatelet therapy postoperatively and was fine at the 2-year follow-up. Conclusions: This case demonstrated that catheter-directed thrombolysis combined with balloon angioplasty could be an efficacious, minimally invasive approach for the treatment of acute embolic occlusion of the common iliac artery. Preoperative anticoagulation for patients undergoing total hip arthroplasty with long-term use of aspirin for atrial fibrillation needs further investigation.

  6. [The performance of coronary angioplasties at centers without cardiac surgery. The recommendations of the Sociedad Española de Cardiología].

    Science.gov (United States)

    Esplugas Oliveras, E; Hernández Antolín, R A; López Bescós, L; Moreu Burgos, J; Pomar Moya-Prats, J L

    1999-01-01

    During the early years of coronary interventions a rigorous on-site surgical stand-by was mandatory. The increased experience in coronary angioplasty both on total number of procedures and the experience gained by each operator, together with the technical improvements, namely since the introduction of stents has induced an evolution in the stand-by strategy, with new concepts such as "next available operating room" or coronary interventions "without on site" surgical facilities, are gaining widespread acceptance. With the aim of defining the requirements to perform coronary interventions at hospitals without coronary surgery, the following aspects are reviewed: a) complications following coronary angioplasty that require coronary surgery; b) the current status of coronary angioplasty without surgical stand-by in different countries. All this information allows us to advance some recommendations concerning the performance of coronary interventions at hospitals without on-site cardiac surgery. Different issues including hospital characteristics, operator and cardiac catheterization laboratory requirements, as well as lesion characteristics and the type of informed consent, should be taken into account.

  7. Antiplatelet and anticoagulant therapy in elective percutaneous coronary intervention.

    Science.gov (United States)

    ten Berg, Jurriën M; Plokker, HW Thijs; Verheugt, Freek WA

    2001-01-01

    Thrombosis plays a major role in acute vessel closure both after coronary balloon angioplasty and after stenting. This review will address the role of antiplatelet and anticoagulant therapy in preventing early thrombotic complications after percutaneous coronary intervention. The focus will be on agents that are routinely available and commonly used.

  8. Antiplatelet and anticoagulant therapy in elective percutaneous coronary intervention

    Directory of Open Access Journals (Sweden)

    Verheugt Freek WA

    2001-05-01

    Full Text Available Abstract Thrombosis plays a major role in acute vessel closure both after coronary balloon angioplasty and after stenting. This review will address the role of antiplatelet and anticoagulant therapy in preventing early thrombotic complications after percutaneous coronary intervention. The focus will be on agents that are routinely available and commonly used.

  9. Randomized trial of Legflow® paclitaxel eluting balloon and stenting versus standard percutaneous transluminal angioplasty and stenting for the treatment of intermediate and long lesions of the superficial femoral artery (RAPID trial): Study protocol for a randomized controlled trial

    NARCIS (Netherlands)

    A. Karimi; S.W. de Boer (Sanne W.); D.A.F. Van Den Heuvel; B. Fioole (Bram); D. Vroegindeweij (Dammis); J.M.M. Heyligers (Jan); P.N.M. Lohle (Paul N.M.); O.E. Elgersma (Otto E.); R.P.T. Nolthenius (Rudolf ); J.A. Vos (Jan Albert); J.-P.P.M. de Vries (Jean-Paul)

    2013-01-01

    textabstractBackground: Restenosis after percutaneous transluminal angioplasty (PTA) of the superficial femoral artery (SFA) may occur in 45% of patients at 2 years follow-up. Paclitaxel-coated balloons have been found to reduce neointimal hyperplasia, and thus reduce restenosis. Recently, the Legfl

  10. Antiplatelet therapy in the era of percutaneous coronary intervention with drug-eluting balloons.

    Science.gov (United States)

    Bonaventura, Klaus; Sonntag, Steffen; Kleber, Franz X

    2011-05-01

    The high rate of restenosis associated with percutaneous coronary intervention (PCI) procedures can be reduced with the implantation of metallic stents into the stenotic vessels. The knowledge that neointimal formation can result in restenosis after stent implantation led to the development of drug-eluting stents (DES) which require long lasting antiplatelet therapy to avoid thrombotic complications. In the last years, the drug-eluting balloon (DEB) technology has emerged as an alternative option for the treatment of coronary and peripheral arteries. Clinical studies demonstrated the safety and effectiveness of DEB in various clinical scenarios and support the use of paclitaxel-eluting balloons for the treatment of in-stent restenosis, of small coronary arteries and bifurcations lesions. The protocols of DEB studies suggest that the dual antiplatelet therapy with aspirin and clopidogrel of four weeks after DEB is safe and effective.

  11. Letter regarding article "Primary coronary angioplasty for ST-°©‐Elevation Myocardial Infarction in Qatar: First nationwide program"

    Directory of Open Access Journals (Sweden)

    Mohamed Badreldin Elshazly

    2012-03-01

    Full Text Available Dear Editor: In their article “Primary Coronary Angioplasty for ST-Elevation Myocardial Infarction (STEMI in Qatar: First Nationwide Program”, Gehani et al. developed an impressive plan to implement primary percutaneous coronary intervention (PCI for the first time in Qatar [1]. As a graduate of Weill Cornell Medical College in Qatar, I have witnessed immense improvement in the Qatari healthcare system over the past few years. From building the new state of the art Heart Hospital to developing the first unified nationwide primary PCI program in the world, there is no doubt that Qatar has made an immense leap towards implementing world-class cardiovascular healthcare in the Middle East.

  12. Design and modeling balloon-expandable coronary stent for manufacturability

    Science.gov (United States)

    Suryawan, D.; Suyitno

    2017-02-01

    Coronary artery disease (CAD) is a disease that caused by narrowing of the coronary artery. The narrowing coronary artery is usually caused by cholesterol-containing deposit (plaque) which can cause a heart attack. CAD is the most common cause mortality in Indonesia. The commonly CAD treatment use the stent to opens or alleviate the narrowing coronary artery. In this study, the stent design is optimized for the manufacturability. Modeling is used to determine the free stent expansion due to applied pressure in the inner surface of the stent. The stress distribution, outer diameter change, and dogboning phenomena are investigated in the simulation. The result of modeling and simulating was analyzed and used to optimize the stent design before it is manufactured using EDM (Electric Discharge Machine) in the next research.

  13. Coronary angioplasty for unstable angina: immediate and late results in 200 consecutive patients with identification of risk factors for unfavorable early and late outcome

    NARCIS (Netherlands)

    P.J. de Feyter (Pim); H. Suryapranata (Harry); P.W.J.C. Serruys (Patrick); K.J. Beatt (Kevin); M.J.B.M. van den Brand (Marcel); J.J. Tijssen; A.J. Azar (Aida); P.G. Hugenholtz (Paul); R.T. van Domburg (Ron)

    1988-01-01

    textabstractTwo hundred patients (mean age 56 years, range 36 to 74) with unstable angina (chest pain at rest, associated with ST-T changes) underwent coronary angioplasty. In 65 patients with multivessel disease, only the "culprit" lesion was dilated. The initial success rate was 89.5% (179 of 200

  14. Primary coronary angioplasty compared with intravenous thrombolytic therapy for acute myocardial infarction : Six-month follow up and analysis of individual patient data from randomized trials

    NARCIS (Netherlands)

    Grines, C; Patel, A; Zijlstra, F; Weaver, WD; Granger, C; Simes, RJ; Ellis, S; Betriu, A; Grines, C; Garcia, E; Grinfeld, L; Gibbons, R; Ribeiro, E; Ribichini, F; Akhras, F; Jones, M; Topol, E; Califf, R; Van der Werf, F; Ardissino, D; Armstrong, PW; Aylward, P; Bates, E; Beatt, K; Cheseboro, J; Col, J; Emanuelsson, H; Fuster, [No Value; Gibler, WB; Gore, J; Guerci, A; Hochman, J; Holmes, D; Kleiman, N; Morris, D; Neuhaus, K; Ohman, M; Pfisterer, M; Phillips, H; Rutsch, W; Vahanian, A; White, H; Stone, G; Browne, K; Marco, J; Rothbaum, D; O'Keefe, DRJ; Overlie, P; Donohue, B; O'Neill, W; de Boer, MJ; van 'T Hof, AWJ; Hoorntje, JCA; Ottervanger, JP; Suryapranata, H; Moreno, R; Abeytua, M; de Sa, EL; Lopez-Sendon, JL; Delcan, JL; Berrocal, D; Bellardi, J; Steffenino, G; Dellavalle, A; Holmes, DR; Gersh, BJ; Hopfenspirger, MR; Silva, LA; Carneiro, R; Akhras, F; Abu Ousa, A

    2003-01-01

    Background Overviews of trials suggest that percutaneous transluminal coronary angioplasty (PTCA) may be more effective than thrombolysis. However, whether these effects are sustained beyond hospital discharge, and the extent to which the results are applicable to a broad cross section of patients a

  15. 切割球囊扩张在股浅动脉长段闭塞治疗中的作用%Angioplasty with cutting balloon in patient with long segmental obstruction of superficial femoral artery

    Institute of Scientific and Technical Information of China (English)

    王爱林; 徐恒; 刘军; 韩圣辉

    2012-01-01

    Objective To compare the technical success rate and midterm results of cutting balloon angioplasty (CBA) to conventional balloon angioplasty (BA) for treatment of long segmental obstruction of the superficial femoral artery. Methods Between March 2009 and May 2010, 33 patients with long segmental obstruction of the superficial femoral artery treated with conventional angioplasty underwent cutting angioplasty. Follow-up consisted clinical examination and computed tomographic angiography at interval of one year. Results After conventional angioplasty there were still severe stenoses in the treated segments of the superficial femoral artery among the 33 selected patients. The stenosis rate decreased from 60% -95% (average 78%) post-conventional angioplasty to 15% -45% (average 36%) after cutting balloon angioplasty. Three patients complicated minor vessel dissection without other major complication. The one year patency of the cutting balloon angioplasty was 66% , which is better than the patency of the conventional balloon angioplasty ( 37% ) . Conclusion Cutting balloon angioplasty provides better vessel patency additional to balloon angioplasty in the treatment of the long segmental obstruction of the superficial femoral artery.%目的 分析评价在常规球囊扩张基础上加用切割球囊治疗股浅动脉长段闭塞的治疗效果和中期通畅率.方法 应用了切割球囊扩张治疗33例股浅动脉长段闭塞患者,导丝通过闭塞段后,首先应用常规球囊进行扩张后,进行动脉造影,对常规球囊扩张后仍有明显狭窄部位进行切割球囊扩张,再次动脉造影评价切割球囊扩张效果.术后对经过治疗的24例患者进行1年的中期随访,并与前期完成的24例单纯常规球囊扩张的1年通畅率进行比较,总结分析两者的中期通畅率、再狭窄的病变特点.结果 在股浅动脉长段闭塞部位进行常规球囊扩张后,均存在不同部位的短段重度狭窄,狭窄部位位于

  16. Sequential Structural and Fluid Dynamics Analysis of Balloon-Expandable Coronary Stents: A Multivariable Statistical Analysis.

    Science.gov (United States)

    Martin, David; Boyle, Fergal

    2015-09-01

    Several clinical studies have identified a strong correlation between neointimal hyperplasia following coronary stent deployment and both stent-induced arterial injury and altered vessel hemodynamics. As such, the sequential structural and fluid dynamics analysis of balloon-expandable stent deployment should provide a comprehensive indication of stent performance. Despite this observation, very few numerical studies of balloon-expandable coronary stents have considered both the mechanical and hemodynamic impact of stent deployment. Furthermore, in the few studies that have considered both phenomena, only a small number of stents have been considered. In this study, a sequential structural and fluid dynamics analysis methodology was employed to compare both the mechanical and hemodynamic impact of six balloon-expandable coronary stents. To investigate the relationship between stent design and performance, several common stent design properties were then identified and the dependence between these properties and both the mechanical and hemodynamic variables of interest was evaluated using statistical measures of correlation. Following the completion of the numerical analyses, stent strut thickness was identified as the only common design property that demonstrated a strong dependence with either the mean equivalent stress predicted in the artery wall or the mean relative residence time predicted on the luminal surface of the artery. These results corroborate the findings of the large-scale ISAR-STEREO clinical studies and highlight the crucial role of strut thickness in coronary stent design. The sequential structural and fluid dynamics analysis methodology and the multivariable statistical treatment of the results described in this study should prove useful in the design of future balloon-expandable coronary stents.

  17. Comparison of costs of percutaneous transluminal coronary angioplasty and coronary bypass surgery for patients with angina pectoris

    NARCIS (Netherlands)

    C. van Halem; F. van den Brink; P.J. de Feyter (Pim); P.W.J.C. Serruys (Patrick); H. Suryapranata (Harry); K.J. Meeter; E. Bos (Egbert); F.J. van Dalen (Frederik); M.J.B.M. van den Brand (Marcel)

    1990-01-01

    textabstractTo determine the costs of a procedure, the total costs of the department that provides the service must be considered and, in addition, the direct cost of the specific procedure. Applying this principle to the cost accounting of angioplasty and bypass surgery results in a direct, i.e. pr

  18. Quality of life after PCI with drug-eluting stents or coronary-artery bypass surgery

    NARCIS (Netherlands)

    D.J. Cohen (David J.); B.A. van Hout (Ben); P.W.J.C. Serruys (Patrick); F.W. Mohr (Friedrich); C.M. Miguel (Carlos); P. den Heijer (Peter); M.M. Vrakking (M. M.); K.K. Wang (Kenneth); E.M. Mahoney (Elizabeth M.); S. Audi (Salma); K. Leadly (Katrin); K.D. Dawkins (Keith); A.P. Kappetein (Arie Pieter)

    2011-01-01

    textabstractBACKGROUND: Previous studies have shown that among patients undergoing multivessel revascularization, coronary-artery bypass grafting (CABG), as compared with percutaneous coronary intervention (PCI) either by means of balloon angioplasty or with the use of bare-metal stents, results in

  19. Quality of life after PCI with drug-eluting stents or coronary-artery bypass surgery

    NARCIS (Netherlands)

    D.J. Cohen (David J.); B.A. van Hout (Ben); P.W.J.C. Serruys (Patrick); F.W. Mohr (Friedrich); C.M. Miguel (Carlos); P. den Heijer (Peter); M.M. Vrakking (M. M.); K.K. Wang (Kenneth); E.M. Mahoney (Elizabeth M.); S. Audi (Salma); K. Leadly (Katrin); K.D. Dawkins (Keith); A.P. Kappetein (Arie Pieter)

    2011-01-01

    textabstractBACKGROUND: Previous studies have shown that among patients undergoing multivessel revascularization, coronary-artery bypass grafting (CABG), as compared with percutaneous coronary intervention (PCI) either by means of balloon angioplasty or with the use of bare-metal stents, results in

  20. [Role of angioplasty in the treatment of renal artery stenosis].

    Science.gov (United States)

    Armero, S; Bonello, L; Paganelli, F; Barragan, P; Roquebert, P-O; Commeau, P

    2011-12-01

    Atherosclerotic renal artery stenosis is frequent and is associated with a high incidence of morbidity and mortality, with a strong correlation with coronary artery disease, (Kalra et al., 2005; Cheung et al., 2002; Guo et al., 2007 [1-3]). The atherosclerotic renal artery stenosis is an independent predictive factor of death (Conlon et al., 1998 [4]). The treatment of this lesion does not have strong evidence. A lot of studies in this area suggest the angioplasty is superior in a big majority between surgery, and angioplasty with stent is superior between balloon angioplasty, but some studies fail to prove the superiority of angioplasty versus medical treatment. These studies have sadly a lot of mistakes and nowadays we don't know what is the treatment for our patients in a lot of cases. The angioplasty is indicated when there is a failure of antihypertensive medications for control of blood pressure, when it is associated with a renal insufficiency quickly progressive or when there is a lesion on each renal artery. Other studies must be organized for prove the superiority of angioplasty when there is a real stenosis, maybe with the use of fractional flow reserve.

  1. Unintended Thermal Injuries from Radiofrequency Ablation: Organ Protection with an Angioplasty Balloon Catheter in an Animal Model

    Directory of Open Access Journals (Sweden)

    Martha-Grace Knuttinen

    2014-01-01

    Full Text Available Objectives: The aim of this study was to investigate a novel approach of using a balloon catheter as a protective device to separate liver from the diaphragm or nearby bowel during radiofrequency ablation (RFA of hepatic dome tumors in an animal model. Materials and Methods: All experimental procedures were approved by animal Institutional Review Board. Using a 3 cm RF needle electrode, 70 hepatic ablation zones were created using ultrasound in 7 pigs. 50 lesions were created using balloon interposition between liver and diaphragm; 20 lesions were created using the balloon device interposed posteriorly between liver and bowel. Additional 21 control lesions were performed. Animals were sacrificed immediately; diaphragm and bowel were then visually inspected and sectioned. Diaphragmatic and bowel injury was then classified according to the depth of thickness. Results: Control lesions caused full thickness injury, either to diaphragm or bowel. During ablation of lesions with balloon interposition, there was significantly less diaphragmatic injury, P < 0.001 and less bowel injury, P < 0.01. Conclusion: Using balloon interposition as a protective device has advantages over previous saline infusion or CO 2 insufflation, providing a safe way to expand percutaneous RFA of liver tumors located on the undersurface of the diaphragm. In addition, this method may be used in protection of other organs adjacent to areas being ablated.

  2. The management of impending myocardial infarction using coronary artery by-pass grafting and an intra-aortic balloon pump.

    Science.gov (United States)

    Harris, P L; Woollard, K; Bartoli, A; Makey, A R

    1980-01-01

    Of 33 patients with impending myocardial infarction 25 were treated using a combination of coronary artery by-pass grafting and intra-aortic balloon pumping. Eight patients were treated with coronary artery by-pass grafting alone. Twenty-two of the 25 patients who were treated with the combined technique made a full recovery. Three patients sustained definite myocardial infarctions and one of these died. Five of the 8 patients treated by grafting alone suffered infarction and of these 3 died. The value of intra-aortic balloon pumping in combination with coronary artery by-pass grafting in the management of impending myocardial infarction is discussed.

  3. Intimal Hyperplasia in Balloon Dilated Coronary Arteries is Reduced by Local Delivery of the NO Donor, SIN-1 Via a cGMP-Dependent Pathway

    Directory of Open Access Journals (Sweden)

    Arner Anders

    2011-06-01

    Full Text Available Abstract Background To elucidate the mechanism by which local delivery of 3-morpholino-sydnonimine (SIN-1 affects intimal hyperplasia after percutaneous transluminal coronary angioplasty (PTCA. Methods Porcine coronary arteries were treated with PTCA and immediately afterwards locally treated for 5 minutes, with a selective cytosolic guanylate cyclase inhibitor, 1 H-(1,2,4oxadiazole(4,3-alphaquinoxaline-1-one (ODQ + SIN-1 or only SIN-1 using a drug delivery-balloon. Arteries were angiographically depicted, morphologically evaluated and analyzed after one and eight weeks for actin, myosin and intermediate filaments (IF and nitric oxide synthase (NOS contents. Results Luminal diameter after PCI in arteries treated with SIN-1 alone and corrected for age-growth was significantly larger as compared to ODQ + SIN-1 or to controls (p Conclusions After PTCA local delivery of high concentrations of the NO donor SIN-1 for 5 minutes inhibited injury induced neointimal hyperplasia. This favorable effect was abolished by inhibition of guanylyl cyclase indicating mediation of a cyclic guanosine 3',5'-monophosphate (cGMP-dependent pathway. The momentary events at the time of injury play crucial role in the ensuring development of intimal hyperplasia.

  4. Luminal narrowing after percutaneous transluminal coronary angioplasty. A study of clinical, procedural, and lesional factors related to longterm angiographic outcome : Coronary Artery Restenosis Prevention on Repeated Thromboxane Antogonism (CARPORT) Study Group

    NARCIS (Netherlands)

    B.J.W.M. Rensing (Benno); W.R.M. Hermans (Walter); J. Vos (Jeroen); J.G.P. Tijssen (Jan); W.R. Rutsch (Wolfgang); N. Danchin (Nicolas); G.R. Heyndrickx (Guy); E.G. Mast (Gijs); W. Wijns (William); P.W.J.C. Serruys (Patrick)

    1993-01-01

    textabstractBackground. The renarrowing process after successful percutaneous transluminal coronary angioplasty (PTCA) is now believed to be caused by a response-to-injury vessel wall reaction. The magnitude of this process can be assessed by the change in minimal lumen diameter (MLD) at follow-up

  5. Provisional T-stenting and kissing balloon in the treatment of coronary bifurcation lesions: results of the French multicenter "TULIPE" study.

    Science.gov (United States)

    Brunel, Philippe; Lefevre, Thierry; Darremont, Olivier; Louvard, Yves

    2006-07-01

    In previous prospective studies, a strategy of (a) stenting of the main branch, (b) provisional T-stenting of the side branch, and (c) final kissing balloon inflation, was associated with high success and low target lesion revascularization (TLR) rates on the long-term. To examine the performance of this strategy in a multicenter study. Consecutive patients were treated at 14 French medical centers for de novo coronary bifurcation lesions with the same technique used. Immediate results and clinically-driven TLR at 7 months were examined. The mean reference diameters of the main and side branches were 3.2 +/- 0.6 mm and 2.4 +/- 0.5 mm, respectively. The side branch was stented in 34% of patients. A <30% residual stenosis in the main branch was achieved in 99%, <50% in the side branch in 90%, and both in 89% of procedures. The in-hospital major adverse cardiovascular event were a Q-wave and 5 non-Qwaves MI (0.54% and 2.7%). At 7 months of follow-up, 3 patients (1.76%) had died, 1 suffered a non-Q-wave MI (0.59%), and 28 (15.88%) underwent TLR. By multivariate analysis, a lower left ventricular ejection fraction (OR: 0.934), moderate calcifications (OR: 7.86), and non-use of the "jailed" wire technique (OR: 4.26) were associated with reinterventions during follow-up. A strategy of provisional T-stenting with a tubular stent and final kissing balloon angioplasty for the treatment of coronary bifurcation lesions was safe and associated with a low TLR rate at 7 months. This strategy should be applicable to the new era of drug eluting stents. Copyright 2006 Wiley-Liss, Inc.

  6. Cutting balloons for the treatment of vascular stenoses

    Energy Technology Data Exchange (ETDEWEB)

    Tsetis, Dimitrios [University Hospital of Heraklion, Department of Radiology, Medical School of Crete, Heraklion (Greece); Morgan, Robert; Belli, Anna-Maria [St George' s Hospital, Department of Radiology, London (United Kingdom)

    2006-08-15

    The aim of this article is to review the mechanism, technical characteristics, biological response and clinical applications of cutting balloon angioplasty in peripheral vessels. The cutting balloon is a non-compliant, balloon catheter equipped with three-to-four microtome-sharp atherotomes. When used appropriately, it is safe and easy to use, with a high immediate success rate and few complications, provided oversizing is avoided. There is some evidence that pre-dilation with a standard or high-pressure balloon may also predispose to vascular rupture. The cutting balloon has proved to be beneficial in treating difficult complex lesions in the coronary arteries. Early experience in non-coronary vessels shows that cutting balloon angioplasty can be used to treat peripheral bypass anastomotic and haemodialysis fistula stenoses that are resistant to conventional high-inflation pressures. Its application in de novo peripheral arterial lesions and non-coronary in-stent restenosis is still under discussion. Theoretically, this device induces a smaller degree of vessel wall injury localised to the area of incisions and sparing the interincisional segments; however, this postulated reduction in restenosis rates has not been confirmed in clinical practice. (orig.)

  7. Lack of Serum Creatinine Decrease After Coronary Angiography Despite Prophylactic Hydration After Routine Coronary Angiography/Angioplasty in Stable Angina Patients - Pilot Study

    Directory of Open Access Journals (Sweden)

    Pawel Burchardt

    2016-03-01

    Full Text Available Background/Aims: To prevent contrast induced renal dysfunction a periprocedural prophylactic hydration is applied. Due to dilution it should cause a drop in serum creatinine concentration (SCR. Surprisingly, no reduction in SCR after contrast admission is found in up to 25% of patients as early as 12-18 hours after coronary angiography/angioplasty. This study aims to find a clinical explanation as well as predict circumstances for this phenomenon. Methods: Retrospective clinical and laboratory data was used from 341 patients who underwent elective coronary angiography/angioplasty, received a prophylactic hydration, and had serum creatinine concentration measured prior to, and 12-18 hours after invasive procedure with iodine contrast administration. To exclude an improper hydration due to no creatinine decrease, the number of red blood cells was analysed as well as hemoglobin and hematocrit in blood donations collected during the study time points. Results: The resulting lack of serum creatinine reduction could be explained by dehydration (measured by increase in number of RBC, HGB and HCT only in 13.5% , 10.8 %, and 20% of cases, respectively. Any form of abnormal glucose metabolism combined with either baseline serum creatinine concentration 86.77 mL/min, or GFR by CKD EPI >80.08 mL/min/1.73 m2, or GFR by MDRD >74.48 mL/min/1.73 m2 were the predictors for no creatinine decrease at outcome. Additionally, it was demonstrated that the lack of creatinine decrease was more often observed among those patients whose initial renal function was better than in the subjects with reduction of SCR. Conclusions: This observation requires further prospective investigation on extended group of patients.

  8. Drug-eluting versus plain balloon angioplasty for the treatment of failing dialysis access: Final results and cost-effectiveness analysis from a prospective randomized controlled trial (NCT01174472)

    Energy Technology Data Exchange (ETDEWEB)

    Kitrou, Panagiotis M., E-mail: panoskitrou@gmail.com [Department of Interventional Radiology, Patras University Hospital, School of Medicine, Rion 26504 (Greece); Katsanos, Konstantinos [Department of Interventional Radiology, Guy' s and St. Thomas’ Hospitals, NHS Foundation Trust, King' s Health Partners, London SE1 7EH (United Kingdom); Spiliopoulos, Stavros; Karnabatidis, Dimitris; Siablis, Dimitris [Department of Interventional Radiology, Patras University Hospital, School of Medicine, Rion 26504 (Greece)

    2015-03-15

    Highlights: •1-Year target lesion primary patency significantly higher after PCB application compared to plain balloon angioplasty in the failing dialysis access. •Significant difference in favor of PCB in cumulative primary patency of AVGs at 1 year. •No significant difference in cumulative primary patency of AVFs treated with PCB at 1 year. •Cost effectiveness analysis performed. •Paclitaxel-coated balloon angioplasty proves to be a cost-effective option for treating dialysis access. -- Abstract: Objective: To report the final results and cost-effectiveness analysis of a prospective randomized controlled trial investigating drug-eluting balloon (DEB) versus plain balloon angioplasty (BA) for the treatment of failing dialysis access ( (NCT01174472)). Methods: 40 patients were randomized to angioplasty with either DEB (n = 20) or BA (n = 20) for treatment of significant venous stenosis causing a failing dialysis access. Both arteriovenous fistulas (AVF) and synthetic arteriovenous grafts (AVG) were included. Angiographic follow up was scheduled every two months. Primary endpoints were technical success and target lesion primary patency at 1 year. Cumulative and survival analysis was performed. Incremental net benefit (INB) and incremental cost effectiveness ratio (ICER) were calculated and the cost-effectiveness acceptability curve (CEAC) was drawn. Results: Baseline variables were equally distributed between the two groups. At 1 year, cumulative target lesion primary patency was significantly higher after DEB application (35% vs. 5% after BA, p < 0.001). Overall, median primary patency was 0.64 years in case of DEB vs. 0.36 years in case of BA (p = 0.0007; unadjusted HR = 0.27 [95%CI: 0.13–0.58]; Cox adjusted HR = 0.23 [95%CI: 0.10–0.50]). ICER was 2198 Euros (€) per primary patency year of dialysis access gained. INB was 1068€ (95%CI: 31–2105€) for a willingness-to-pay (WTP) threshold of 5000€ (corresponding acceptability probability >97

  9. Stingray balloon used in slender percutaneous coronary intervention for chronic total occlusion.

    Science.gov (United States)

    Wu, Eugene B; Ikari, Yuji

    2013-07-01

    Slender chronic total occlusion (CTO) percutaneous coronary intervention (PCI) using 5 Fr radial Ikari catheter is possible in simple CTO cases. We report a case where we initially thought the LAD CTO was short and easy, but we found that the CTO had a considerable amount of calcium and also some tortuosity, making simple wire crossing impossible. We used a Stingray balloon to perform re-entry by tracking the balloon over an Ultimate Bros 3 gram wire using an extension wire. We successfully punctured into true lumen and completed stenting through a slender 5 Fr system. This case demonstrates the beauty of combining the advances in CTO PCI from the East and the West together and also demonstrates the possibility of using the Stingray system in a 5 Fr guiding catheter.

  10. Aggressive lipid-lowering therapy compared with angioplasty in stable coronary artery disease

    NARCIS (Netherlands)

    Pitt, B; Waters, D; Brown, WV; van Boven, AJ; Schwartz, L; Title, LM; Eisenberg, D; Shurzinske, L; McCormick, LS

    1999-01-01

    Background Percutaneous coronary revascularization is widely used in improving symptoms and exercise performance in patients with ischemic heart disease and stable angina pectoris. In this study, we compared percutaneous coronary revascularization with lipid-lowerin Methods We studied 341 patients w

  11. Angina self-management plan and quality of life, anxiety and depression in post coronary angioplasty patients.

    Science.gov (United States)

    Moattari, Marzieh; Adib, Fakhteh; Kojuri, Javad; Tabatabaee, Seyed Hamid Reza

    2014-11-01

    Coronary artery diseases are the most frequent cause of mortality in industrialized countries as well as Iran. Coronary artery disease affects patient's quality of life (QoL) and produces some degrees of anxiety and depression. Although self-management programs have shown significant impact on chronic diseases, there is limited evidence in Iran regarding the effectiveness of these interventions, particularly in patients with coronary artery disease. This study aimed to evaluate the effects of angina plan on QoL, anxiety, and depression in post coronary angioplasty patients referred to selected hospitals in Shiraz. This parallel randomized, controlled trial was conducted in selected hospitals in Shiraz, Iran. We enrolled 80 post coronary angioplasty eligible patients in the study. After acquisition of the informed consent, eligible patients were randomly divided into two groups: control and experimental. Pretest data were obtained by using a demographic data form and two valid and reliable questionnaires for QoL, anxiety, and depression. Blood pressure, weight, and height (to calculate body mass index) were measured too. Patient's history of smoking, diabetes, hypercholesterolemia, hypertension, and coronary vascular involvement (with grade and severity) were obtained from their medical records. A 12-week angina plan intervention consisted of a 30 to 40 minutes of counseling interview and telephone follow up at the end of 1, 4, 8, and 12 weeks were performed for experimental group. Post-test data were obtained three months after the pretest using the same questionnaires as pretest. QoL data were analyzed by analysis of co-variance (ANCOVA). The results (before and after intervention) regarding anxiety and depression were analyzed by independent t-tests or their equivalent nonparametric Mann-Whitney test using SPSS v. 11.5. There was no statistically significant difference in demographic variables between two groups. Baseline mean scores for QoL, anxiety, and

  12. Surface modification of poly(ethylene terephthalate) angioplasty balloons with a hydrophilic poly(acrylamide-co-ethylene glycol) interpenetrating polymer network coating.

    Science.gov (United States)

    Park, S; Bearinger, J P; Lautenschlager, E P; Castner, D G; Healy, K E

    2000-09-01

    An interpenetrating polymer network (IPN) of poly(acrylamide-co-ethylene glycol) (p(AAm-co-EG)) hydrogel was covalently grafted to polyethylene terephthalate (PET) angioplasty balloons to increase surface hydrophilicity and improve lubricity. A 2-step graft polymerization protocol was followed to first polymerize and cross-link acrylamide onto the substrate with a photosensitizer and/or oxygen plasma pretreatment. The effects of varying photo-initiation and plasma exposure times were investigated separately and conjunctively using water contact angles to obtain optimal coating deposition parameters. A poly(ethylene glycol) network was then grafted by swelling the preexisting polyacrylamide network to allow inter-diffusion of the monomer and cross-linker, which were then polymerized by photo-initiation. When the photo-initiation time was long enough to reach near gelation, pretreatment of PET with oxygen plasma did not offer significant benefit. X-ray photoelectron spectroscopy confirmed the presence of both polymer layers, and composition depth profiles supported the assessment that an interpenetrating network was formed. Tensile testing and application of Weibull statistics on unmodified and modified films indicated that the surface modification approach did not significantly alter the mechanical integrity of the material. These findings indicate that a p(AAm-co-EG) coating can be effectively deposited on PET surfaces without compromising the structural integrity of the substrate.

  13. Maximizing benefit of drug-eluting stent by direct coronary stenting because of further reduction of inflammatory response

    Institute of Scientific and Technical Information of China (English)

    LI Jian-jun; GAO Run-lin

    2009-01-01

    @@ Coronary stents have been used as standard mechanical devices for percutaneous coronary intervention (PCI) in patients with coronary artery disease (CAD).1-3 They provide vessel wall scaffolding and prevent early elastic recoil and restenosis, which are major limitations of balloon angioplasty.4,5 Consequently, coronary stenting has a higher successful rate of PCI and improves the clinical outcome of the patients with CAD.6

  14. Noradrenaline depletion in patients with coronary artery disease before and after percutaneous transluminal coronary angioplasty with iodine-123 metaiodobenzylguanidine and single-photon emission tomography

    Energy Technology Data Exchange (ETDEWEB)

    Guertner, C. (Dept. of Nuclear Medicine, Univ. Hospital, Frankfurt am Main (Germany)); Klepzig, H. Jr. (Dept. of Internal Medicine, Div. of Cardiology, Univ. Hospital, Frankfurt am Main (Germany)); Maul, F.D. (Dept. of Nuclear Medicine, Univ. Hospital, Frankfurt am Main (Germany)); Hartmann, A. (Dept. of Internal Medicine, Div. of Cardiology, Univ. Hospital, Frankfurt am Main (Germany)); Leibach, S. (Dept. of Nuclear Medicine, Univ. Hospital, Frankfurt am Main (Germany)); Hellmann, A. (Dept. of Nuclear Medicine, Univ. Hospital, Frankfurt am Main (Germany)); Hoer, G. (Dept. of Nuclear Medicine, Univ. Hospital, Frankfurt am Main (Germany))

    1993-09-01

    Iodine-123 metaiodobenzylguanidine (MIBG) is a noradrenaline analogue which can be used as a tracer to investigate the cardiac sympathetic nervous system. Regional ischaemia leads to noradrenaline depletion with functional denervation which can be demonstrated by reduced MIGB uptake. In order to evaluate the reversibility of ischaemia-associated damage to the sympathetic nervous system, neuronal scintigraphy with [sup 123]I-MIBG and myocardial rest and stress perfusion scintigraphy with technetium-99m sestamibi was performed in 16 patients with coronary artery disease before and 3-4 months after percutaneous transluminal coronary angioplasty (PTCA). Partial re-innervation ocurred in five patients, the degree of stenosis of reamining lesions being estimated by repeat angiography to be below 40%. Unchanged MIBG defects cold be confirmed in four patients with residual lesions of between 40% and 50%. Increased MIBG defects were shown in three patients with significant restenoses of more than 70%. In all patients the neuronal defects exceeded the ischaemia-induced or scar-associated perfursion defects. Three patients dropped out of this study: One for technical reasons, one due to emergency aortocoronary bypass surgery and one due to diabetic polyneuropathy. This investigation shows that the sympathetic nevous system is highly sensitive to ischaemia. Further studies need to be done to assess the conditions allowing re-innervation after PTCA. (orig.)

  15. Emergency Off-Pump Coronary Artery Bypass Graft Surgery for Patients on Preoperative Intraaortic Balloon Pump.

    Science.gov (United States)

    Ito, Hisato; Mizumoto, Toru; Tempaku, Hironori; Fujinaga, Kazuya; Sawada, Yasuhiro; Teranishi, Satoshi; Shimpo, Hideto

    2016-09-01

    The aim of this study was to investigate early and long-term outcomes of patients with acute coronary syndrome preoperatively requiring intraaortic balloon pump support who underwent emergency off-pump coronary artery bypass graft surgery. One hundred and fifteen patients on preoperative intraaortic balloon pump receiving emergency off-pump coronary artery bypass graft surgery over an 11-year period were evaluated. The median age was 71 years (range, 33 to 87). Acute myocardial infarction and unstable angina were present in 54 patients (47.0%) and 61 patients (53.0%), respectively. Left main disease and triple-vessel disease without left main involvement were present in 74 patients (64.3%) and 33 patients (28.7%), respectively. There were 3 perioperative deaths. Complete surgical revascularization was accomplished in 82 patients (71.3%), and in situ internal thoracic artery graft was used in 96 (83.5%). Late survival, freedom from major adverse cardiac and cerebrovascular events, and freedom from repeat revascularization rates at 5 years were 83.3%, 73.5%, and 84.2%, respectively. The Cox multivariate prognostic predictors of total mortality were preoperative renal impairment (hazard ratio [HR] 7.90; 95% confidence interval [CI]: 3.06 to 20.4) and low ejection fraction (HR 0.94, 95% CI: 0.88 to 0.99). The multivariate risk predictors of major adverse cardiac and cerebrovascular events were preoperative renal impairment (HR 2.68, 95% CI: 1.00 to 7.19) and peripheral vascular disease (HR 2.81, 95% CI: 1.05 to 7.51), and complete revascularization was protective (HR 0.39, 95% CI: 0.19 to 0.81). The multivariate risk factor of repeat revascularization was previous percutaneous coronary intervention (HR 3.26, 95% CI: 1.14 to 9.33), and complete surgical revascularization was also protective (HR 0.30, 95% CI: 0.11 to 0.85). Off-pump coronary artery bypass graft surgery is a feasible option for patients requiring preoperative intraaortic balloon pump support. Copyright

  16. Factors influencing technical success and outcome of percutaneous balloon angioplasty in de novo native hemodialysis arteriovenous fistulas

    Energy Technology Data Exchange (ETDEWEB)

    Heye, Sam, E-mail: sam.heye@uzleuven.be [University Hospitals Leuven, Department of Radiology, Herestraat 49, 3000 Leuven (Belgium); Maleux, Geert, E-mail: geert.maleux@uzleuven.be [University Hospitals Leuven, Department of Radiology, Herestraat 49, 3000 Leuven (Belgium); Vaninbroukx, Johan, E-mail: johan.vaninbroukx@uzleuven.be [University Hospitals Leuven, Department of Radiology, Herestraat 49, 3000 Leuven (Belgium); Claes, Kathleen, E-mail: Kathleen.claes@uzleuven.be [University Hospitals Leuven, Department of Nephrology, Herestraat 49, 3000 Leuven (Belgium); Kuypers, Dirk, E-mail: dirk.kuypers@uzleuven.be [University Hospitals Leuven, Department of Nephrology, Herestraat 49, 3000 Leuven (Belgium); Oyen, Raymond, E-mail: raymond.oyen@uzleuven.be [University Hospitals Leuven, Department of Radiology, Herestraat 49, 3000 Leuven (Belgium)

    2012-09-15

    Objective: To determine predictors of technical success, dysfunction recurrence and patency after percutaneous transluminal angioplasty (PTA) of de novo dysfunctional hemodialysis arteriovenous fistulas (AVFs). Methods: Retrospective analysis of first time PTA of 167 AVF in 162 patients (100 men, 66 ± 13 years). Anatomical (location, length, grade and number of stenoses) and clinical variables (sex, age, prior AVF, diabetes mellitus and AVF age, side and location) were reviewed. Results: 217 stenoses or segmental occlusions were treated. Technical success rate (84.4%) was higher in radiocephalic AVF compared to brachial artery–median vein AVF (p = 0.030) and was negatively correlated with initial stenosis (p = 0.049). Dysfunction recurrence was seen in 52.7% and correlated negatively with technical success (p = 0.013) and AVF age (p = 0.008). Early dysfunction (within 6 months) was negatively correlated with AVF age (p = 0.016) and positively with diabetes (p = 0.003). Higher AVF age resulted in higher primary (p = 0.005) and secondary patency rates (p = 0.037–0.005). Conclusions: Technical success of PTA in hemodialysis AVF is affected by AVF type and initial stenosis and has significant effect on dysfunction recurrence, but not on AVF longevity. Younger AVF has increased risk for (early) recurrent dysfunction and lower patency rates. Patients with diabetes mellitus have higher risk for early dysfunction.

  17. Target vessel revascularization following percutaneous coronary intervention. A 10-year report from the Danish Percutaneous Transluminal Coronary Angioplasty Registry

    DEFF Research Database (Denmark)

    Jensen, Lisette Okkels; Thayssen, Per; Kassis, Eli

    2005-01-01

    .4%). Independent predictors for TVR were: coronary stenting (OR 0.60; 95% CI 0.52-0.69, p stenosis severity (OR 1.01; 95% CI 1.00-1.01, p = 0.03), left anterior descending coronary artery (OR 2.35; 95% CI 1.73-3.19, p ... coronary artery (OR 1.61; 95% CI 1.17-2.20, p = 0.003), sapheneous vein graft (OR 2.03; 95% CI 1.13-3.63, p = 0.017) and age (OR 0.99; 95% CI 0.98-1.00, p = 0.002). CONCLUSION: Coronary stenting, primary success rate, pre-PCI stenosis severity, age and treated vessel were independent predictors for TVR.......OBJECTIVE: To present the rate of target vessel revascularization (TVR) in a consecutive and unselected national population over 10 years. DESIGN: From 1989 to 1998 all percutaneous coronary interventions (PCIs) performed in Denmark were recorded in the Danish PTCA Registry. RESULTS: From 1989...

  18. When is rotational angiography superior to conventional single‐plane angiography for planning coronary angioplasty?

    Science.gov (United States)

    Taylor, Jane; Boutong, Sara; Brett, Sarah; Louis, Amal; Heppenstall, James; Morton, Allison C.; Gunn, Julian P.

    2015-01-01

    Objectives To investigate the value of rotational coronary angiography (RoCA) in the context of percutaneous coronary intervention (PCI) planning. Background As a diagnostic tool, RoCA is associated with decreased patient irradiation and contrast use compared with conventional coronary angiography (CA) and provides superior appreciation of three‐dimensional anatomy. However, its value in PCI remains unknown. Methods We studied stable coronary artery disease assessment and PCI planning by interventional cardiologists. Patients underwent either RoCA or conventional CA pre‐PCI for planning. These were compared with the referral CA (all conventional) in terms of quantitative lesion assessment and operator confidence. An independent panel reanalyzed all parameters. Results Six operators performed 127 procedures (60 RoCA, 60 conventional CA, and 7 crossed‐over) and assessed 212 lesions. RoCA was associated with a reduction in the number of lesions judged to involve a bifurcation (23 vs. 30 lesions, P RoCA improved confidence assessing lesion length (P = 0.01), percentage stenosis (P = 0.02), tortuosity (P RoCA augments quantitative lesion assessment, enhances confidence in the assessment of coronary artery disease and the precise details of the proposed procedure, but does not affect X‐ray dose, contrast agent volume, or procedure duration. © 2015 Wiley Periodicals, Inc. PMID:26012725

  19. Population Trends in Percutaneous Coronary Intervention 20-Year Results From the SCAAR (Swedish Coronary Angiography and Angioplasty Registry)

    NARCIS (Netherlands)

    Fokkema, Marieke L.; James, Stefan K.; Albertsson, Per; Akerblom, Axel; Calais, Fredrik; Eriksson, Peter; Jensen, Jens; Nilsson, Tage; de Smet, Bart J.; Sjogren, Iwar; Thorvinger, Bjorn; Lagerqvist, Bo

    2013-01-01

    Objectives The aim of this study was to describe the characteristics and outcome of all consecutive patients treated with percutaneous coronary intervention (PCI) in an unselected nationwide cohort over the past 2 decades. Background Over the last 20 years, treatment with PCI has evolved dramaticall

  20. Exercise stress testing before and after successful multivessel percutaneous transluminal coronary angioplasty

    Directory of Open Access Journals (Sweden)

    W.A. Chalela

    2006-04-01

    Full Text Available Controversy exists regarding the diagnostic accuracy, optimal technique, and timing of exercise testing after percutaneous coronary intervention. The objectives of the present study were to analyze variables and the power of exercise testing to predict restenosis or a new lesion, 6 months after the procedure. Eight-four coronary multi-artery diseased patients with preserved ventricular function were studied (66 males, mean age of all patients: 59 ± 10 years. All underwent coronary angiography and exercise testing with the Bruce protocol, before and 6 months after percutaneous coronary intervention. The following parameters were measured: heart rate, blood pressure, rate-pressure product (heart rate x systolic blood pressure, presence of angina, maximal ST-segment depression, and exercise duration. On average, 2.33 lesions/patient were treated and restenosis or progression of disease occurred in 46 (55% patients. Significant increases in systolic blood pressure (P = 0.022, rate-pressure product (P = 0.045 and exercise duration (P = 0.003 were detected after the procedure. Twenty-seven (32% patients presented angina during the exercise test before the procedure and 16 (19% after the procedure. The exercise test for the detection of restenosis or new lesion presented 61% sensitivity, 63% specificity, 62% accuracy, and 67 and 57% positive and negative predictive values, respectively. In patients without restenosis, the exercise duration after percutaneous coronary intervention was significantly longer (460 ± 154 vs 381 ± 145 s, P = 0.008. Only the exercise duration permitted us to identify patients with and without restenosis or a new lesion.

  1. How good are experienced interventional cardiologists in predicting the risk and difficulty of a coronary angioplasty procedure? A prospective study to optimize surgical standby.

    Science.gov (United States)

    Brueren, B R; Mast, E G; Suttorp, M J; Ernst, J M; Bal, E T; Plokker, H W

    1999-03-01

    The prediction of the risk of a percutaneous transluminal coronary angioplasty has either been based on coronary lesion morphology or on clinical parameters, but a combined angiographic and clinical risk assessment system has not yet been evaluated prospectively. Five experienced interventionalists categorized 7,144 patients with 10,081 stenoses (1.4 lesion/patient) for both the risk and the difficulty of the procedure. Risk categories are as follows: 1 = low risk; 2 = intermediate risk; 3 = high risk. This division was made for percutaneous transluminal coronary angioplasty planning purposes. Category 1 patients denotes those in whom surgical standby is not required; category 2 patients, surgical standby not required but available within 1 hr; category 3 patients, surgical standby required. Difficulty categories are as follows: 1 = easy lesion; 2 = moderately difficult lesion; 3 = difficult lesion. Success was defined as a reduction of the degree of stenosis to less than 50%, without acute myocardial infarction, emergency redilatation, emergency bypass grafting, or death within 1 week. The procedure was not successful in difficulty category 1 in 1.6%, in category 2 in 3.5%, and in category 3 in 9.9%. Complications occurred in risk category 1 in 3.5%, in category 2 in 5.2%, and in category 3 in 12.4%. All differences were statistically significant (P < 0.05). Experienced cardiologists can well predict the risk and success of a coronary angioplasty procedure. This helps to optimize surgical standby, although even in the lowest-risk category complications can occur.

  2. 冠状动脉球囊成形术及支架术后再狭窄%Restenosis after percutaneous transluminal coronary angioplasty and stent implantation

    Institute of Scientific and Technical Information of China (English)

    沈珠军

    2001-01-01

    Percutaneous transluminal coronary angioplasty (PTCA) has become one of the most important treatment method in coronary artery disease along with coronary bypass operation and medicine in recent years.Restenosis after intervention becomes the Achili's heel in our daily treatment.In some degree stenting can reduce restenosis,but the restenosis after stenting is still over 20%.The focus of the treatment of restenosis over the last 2 decades has been through the application of pharmacologically active agents and mechanical approaches using a host of different devices.But this frequent and costly complication of percutaneous revascularization techniques has proved refractory to all such therapies.This review will focus on the studies that have been done during recent years,it will cover the mechanism of restenosis after PTCA and stenting,the risk factors involved in the restenosis,and the prevention and treatment of restenosis.

  3. Too much coronary angioplasty in the USA?: less may be better - the conflicting roles of inexactness of medicine as a science, asymmetric information, technologic imperative, unnecessary care and ethicomedicinomics in US healthcare.

    Science.gov (United States)

    Onuigbo, M A C; Agbasi, N

    2014-09-01

    US healthcare expenditure per capita far exceeds that of any other nation in the world. Indeed, over the last 15 years, the USA has distantly surpassed most countries in the developed world in total healthcare expenditures per capita with the USA now spending 17.4% of its gross domestic product (GDP) on healthcare ($7960 per capita), compared with only 8.5% of GDP in Japan ($2878 per capita), a distant second. Consequently, by current projections, the US healthcare bill will have ballooned from $2.5 trillion in 2009 to over $4.6 trillion by 2020. Such spending growth rates are unsustainable and the system would soon go broke if not corrected. The drivers of these spending growth rates in US healthcare are several and varied. Indeed, in September 2012, the Institute of Medicine reported that US healthcare squandered $750 billion in 2009 through unneeded care, Byzantine paperwork, fraud and other wasteful activities. Recently, the question was raised as to whether we have too much coronary angioplasty in the USA. In this analysis, we examine these and other various related aspects of US healthcare, make comparisons with other national healthcare delivery systems, and suggest several reengineering modalities to help fix these compellingly glaring glitches and maladies of US healthcare.

  4. Long-term follow-up of coronary angioplasty in patients with diabetes compared with nondiabetics.

    Science.gov (United States)

    Brueren, B R G; Ten Berg, J M; Kelder, J C; Suttorp, M J; Mast, E G; Bal, E; Ernst, S M P G; Plokker, H W T

    2004-04-01

    Some reports have indicated that in patients with diabetes mellitus and multivessel disease, coronary artery bypass surgery is preferred over percutaneous coronary intervention (PCI). We retrospectively compared outcome PCI in diabetic and nondiabetic patients. Ninety-seven diabetics and 971 nondiabetics were included and randomised before PCI to aspirin alone or aspirin plus coumadin. Fifty diabetics and 481 nondiabetics underwent follow-up angiography. The primary endpoint comprised all-cause mortality, myocardial infarction or targetvessel revascularisation. Baseline characteristics were similar between the groups except for significantly more males and smokers among the nondiabetics. The diabetics had significantly more previous strokes, more left anterior descending coronary artery disease as well as more restenotic lesions and multivessel disease. At 30 days, the primary endpoint had occurred in five diabetics (5.2%) and 47 nondiabetics (4.9%), (p=0.8) and at one year in 17 (17.5%) and in 165 (17.1%), respectively (p=0.9). Event-free survival remained comparable during long-term follow-up (four years). Multivariate analysis showed no differences for the occurrence of any event (p=0.9, 95% CI 0.6-1.7). At six months, the minimal luminal diameter was significantly smaller in the diabetics (1.55±0.76 mm vs. 1.78±0.66 mm, p=0.01). Diabetics also had more restenosis (41% vs. 23%, p=0.003). Despite angiographical differences at six months between the diabetics and nondiabetics, both short-term and long-term clinical follow-up appeared to be similar.

  5. Radiation risk and exposure of radiologists and patients during coronary angiography and percutaneous transluminal coronary angioplasty (PTCA)

    Energy Technology Data Exchange (ETDEWEB)

    Karppinen, J.; Parviainen, T.; Servomaa, A.; Komppa, T. [Finnish Centre for Radiation and Nuclear Safety (STUK), Helsinki (Finland)

    1995-12-31

    The exposure of radiologists and patient to radiation during coronary angiography and PTCA in Finland was studied using phantom measurements. The effective dose was calculated according to the ICRP 60 recommendations and patients` radiation risk according to the BEIR V report. An adult patient`s mean surface dose was 660 mGy, corresponding to an effective dose of about 11 mSv. The average effective dose to the radiologist performing coronary angiography is about 0.05 mSv per examination. The eye dose to the radiologist who injects contrast medium manually is about 0.5 mSv per procedure, which would suggest a limit of seven procedures per week on the basis of occupational dose limits. The average risk of exposure-induced death (REID) for male patients is about 0.24% and for female patients 0.1%. The average loss of life expectancy (LLE/REID) among patients with an exposure-induced fatal cancer is about ten years. The radiation risk for male patients is underestimated by about 66% if the risk is assessed on the basis of the effective dose instead of organ doses. (Author).

  6. Cell adhesion molecules and the coronary restenosis after percutaneous transluminal corcnary angioplasty%粘附分子与冠脉成形术后再狭窄

    Institute of Scientific and Technical Information of China (English)

    刘云海; 徐标; 张丽容

    2003-01-01

    @@ 冠心病的介入治疗,尤其是经皮腔内冠脉成形术(percutaneous transluminal coronary angioplasty, PTCA)及冠脉内支架术(intracoronary stenting, ICS)已成为冠心病治疗的主要手段之一,但30%~50%的PTCA术后及10%~15%的ICS术后的再狭窄(restenosis, RS)率已成为影响冠脉成形术远期疗效的重要因素.

  7. Preventive effects of anisodamine against contrast-induced nephropathy in type 2 diabetics with renal insufficiency undergoing coronary angiography or angioplasty

    Institute of Scientific and Technical Information of China (English)

    GENG Wei; XUE Ling; FU Xiang-hua; GU Xin-shun; WANG Yan-bo; WANG Xue-chao; LI Wei; JIANG Yun-fa; HAO Guo-zhen; FAN Wei-ze

    2012-01-01

    Background Anisodamine is widely used in therapy for treating acute glomerulonephritis and diabetic nephropathy because it can improve renal microcirculation.We performed a study to evaluate the preventive effects of anisodamine against contrast-induced nephropathy (CIN) in type 2 diabetics with renal insufficiency undergoing coronary angiography or angioplasty.Methods A total of 260 patients with type 2 diabetes and an estimated glomerular filtration rate (eGFR) of 60 ml-1 ·min-1.1.73 m-2 or less,who were undergoing coronary angiography or angioplasty,were randomly assigned to receive an infusion of either sodium chloride (control group,n=128) or anisodamine (treatment group,n=132).Patients in the treatment group received an infusion of anisodamine at a rate of 0.2 μg · kg-1.min-1 from 12 hours before to 12 hours after coronary angiography or angioplasty,while patients in the control group received an infusion of sodium chloride with the same volume as the treatment group.All patients received intravenous sodium chloride hydration.CIN was defined as a 25% increase in serum creatinine from baseline or an absolute increase of >0.5 mg/dl within three days after contrast exposure.The primary end point was the incidence of CIN.The secondary end point was a 25% or greater reduction in eGFR.Results There were no significant differences between the two groups with regard to age,gender,risk factors,laboratory results,medications and interventions.The incidence of CIN was 9.8% (13/132) in the treatment group and 20.3% (26/128) in the control group (P <0.05).The secondary end point was 6.0% (8/132) in the treatment group and 16.4% (21/128) in the control group (P<0.05).Conclusion These results indicate the preventive effects of anisodamine against CIN in type 2 diabetics with renal insufficiency who are undergoing coronary angiography or angioplasty.

  8. Immediate and Long-Term Results of Coronary Angioplasty in Patients Aged 80 Years and Older

    Directory of Open Access Journals (Sweden)

    Bo Chen

    2010-01-01

    Full Text Available Objectives. To observe the short- and long-term outcomes after percutaneous coronary intervention (PCI in octogenarians (>80 y.o. at our institution. Method. All octogenarians who underwent PCI during the study period were retrospectively retrieved from our database and clinically followed. Major adverse cardiac (and cerebral events (MAC(CE was considered as primary outcome. Results. From January 2003 to December 2007, 140 octogenarians (mean age: 85±3 y.o., 79% of male underwent PCI and were clinically followed 14±11 months. Procedural success was obtained in 100 percent of patients with single vessel disease, in 96 percent of patients with double vessel disease, and in 75 percent of patients with triple vessel disease. In-hospital, 30 days, and one year MACE rates were 5%, 5%, and 10.7%, respectively. Impaired left ventricular (LV ejection fraction (hazard ratio (HR=0.909, 95% confidence interval (CI=0.856 to 0.964, =.002, diabetes mellitus (HR=5.792, 95%  CI=1.785 to 18.796, =.003, and low GFR (HR=2.943, 95%  CI=1.161, to 7.464, =.023 were independently associated with an increase risk of MACE at long-term followup. Conclusion. Coronary angiography can be successfully performed in elderly patients with single and double vessel disease. The results in triple vessel disease are encouraging. Low LV function, diabetes, and impaired renal function increase the risk of long-term major adverse cardiac events.

  9. Cardiac tamponade complicating coronary perforation during angioplasty: short-term outcomes and long-term survival.

    Science.gov (United States)

    Stathopoulos, Ioannis; Kossidas, Konstantinos; Panagopoulos, Georgia; Garratt, Kirk

    2013-10-01

    Cardiac tamponade constitutes the most severe clinical consequence of a coronary perforation (CP) during percutaneous coronary intervention (PCI). We analyzed 23,399 PCIs and identified 73 patients complicated by CP (0.31%), of which 26 developed tamponade (0.11%). Patients were divided into two groups: CP with tamponade (group A) and CP without tamponade (group B). Characteristics and outcomes were compared and a multivariate model was developed to evaluate the independent contribution of tamponade on mortality. All patients with tamponade were treated with pericardiocentesis. Tamponade increased the risk of death by more than 3-fold (odds ratio [OR] = 3.3; 95% confidence interval [CI],1.01-10.6; P=.047) relative to patients with CP but no tamponade. CP with tamponade during non-elective PCI carried a significantly worse long-term prognosis (P=.001) than the same complications during elective PCI. The use of glycoprotein IIb/IIIa inhibitors and bivalirudin did not differ between groups. Polytetrafluoroethylene-covered stents were used similarly between the two groups, while coil embolization was used more often in group A (P=.003). Emergent cardiac surgery was needed in 3 patients (11.5%) in group A versus 1 patient (2.1%) in group B. Tamponade complicating CP during PCI has short- and long-term major adverse effects. In-hospital mortality after tamponade and referral for emergent surgical treatment have decreased. Nonetheless, tamponade in this setting increases risk of death by >3-fold. PCI of complex lesions with an expected increased risk of perforation should be undertaken cautiously among patients with non-elective PCI because of increased early and late risk of death.

  10. Acute clinical and angiographic results with the new AVE Micro coronary stent in bailout management.

    NARCIS (Netherlands)

    Y. Ozaki (Yukio); D.T.J. Keane (David); P.N. Ruygrok (Peter); S. Stertzer (Simon); P.W.J.C. Serruys (Patrick); P.J. de Feyter (Pim)

    1995-01-01

    textabstractTo determine the feasibility and safety of development of this new stent, we deployed 28 AVE Micro stents in 23 native coronary artery lesions in 20 patients who developed acute or threatened closure after balloon angioplasty (BA). Ten stents were deployed in the left anterior descending

  11. Eventos adversos e motivos de descarte relacionados ao reuso de produtos médicos hospitalares em angioplastia coronária Adverse events and reasons for discard related to the reuse of cardiac catheters in percutaneous transluminal coronary angioplasty

    Directory of Open Access Journals (Sweden)

    Margarete Ártico Batista

    2006-09-01

    the brand-new and reuse of medical equipment. METHOD: Sixty patients were studied (48.3% with unstable angina, 45% with acute myocardial infarction and 6.7% with other diagnoses. During the procedure and stay in the Intensive Coronary Unit, the occurrence of fever, hypotension or hypertension, chills, sudoresis, bleeding, nausea and vomits were observed. Seven products were evaluated: catheter introducer, catheter guides (0.35 and 0.014, catheter balloons for angioplasty, indeflators and manifolds. In total, 76 brand-new and 410 reused apparatuses were studied to verify the occurrence of discard, whether this happened before or during the procedure and for what reasons. P-values < 0.05 were considered signicant. RESULTS: Twenty-six patients presented adverse effects. Hypotension was the most common seen in 11(18.3% cases. There was no significant association between this adverse effect and reuse or not of the equipment. Three brand-new products and 55 of the reused products were discarded as they were incomplete. CONCLUSION: The adverse effects presented by patients submitted to coronary vessel angioplasty were not associated to the reuse of the medical equipment. The integrity and functionality were the main reasons of discard.

  12. Design of a randomized controlled trial of comprehensive rehabilitation in patients with myocardial infarction, stabilized acute coronary syndrome, percutaneous transluminal coronary angioplasty or coronary artery bypass grafting: Akershus Comprehensive Cardiac Rehabilitation Trial (the CORE Study

    Directory of Open Access Journals (Sweden)

    Karin Kogstad Else

    2000-11-01

    Full Text Available Abstract Objectives 1. To assess the long-term effectiveness of a comprehensive cardiac rehabilitation programme on quality of life and survival in patients with a large spectrum of cardiovascular diseases (myocardial infarction, acute coronary syndrome, percutaneous transluminal coronary angioplasty and coronary artery bypass grafting. 2. To establish the degree of correlation between expected improvement of health-related quality of life and improvement in physical function attributable to rehabilitation in the intervention group, in comparison with similar changes in the conventional care group. Design Randomized, controlled, parallel-group design (intervention/conventional care. Setting Akershus County, southeast of Oslo City, Norway. Participants 500 patients, men and women, aged 40-85 years, who have sustained at least one of the above-mentioned cardiovascular diseases. Interventions 8 weeks of supervised, structured physical training of three periods of 20 min per week, targeting a heart rate of 60-70% of the individual's maximum; home-based physical exercise training with the same basic schedule as in the supervised period; quantification of patients' compliance with the exercise programme by the use of wristwatches, information stored in the watch memory being retrieved once a month during the 3-year follow-up period; and life-style modification with an emphasis on the cessation of smoking and on healthy nutrition and weight control.

  13. Paclitaxel-coated balloons - Survey of preclinical data.

    Science.gov (United States)

    Schnorr, B; Kelsch, B; Cremers, B; Clever, Y P; Speck, U; Scheller, B

    2010-10-01

    Restenosis following interventions in the coronary or peripheral arteries develops over weeks to months. In coronary arteries the restenosis rate has been markedly reduced since the advent of drug-eluting stents. Non-stent-based methods for local drug delivery enable restenosis inhibition without the need for stent implantation, does not permanently change the structure of the vessel, are repeatable, and seems to be applicable where drug-eluting stents provide insufficient protection. Preclinical data indicate that short exposure of the vessel wall to a lipophilic inhibitor of cell proliferation is sufficient for preventing restenosis. Initial evidence to this effect emerged from an investigation of paclitaxel embedded in a matrix that enhances the solubility and release of the agent from the balloon coating as well as its transfer to the vessel wall. Further corroborating data from preclinical and clinical studies demonstrating a reduction in late lumen loss and lower restenosis rates led to the market introduction of a variety of paclitaxel-coated angioplasty balloons. The effectiveness of restenosis inhibition is not determined by the active agent alone. Other factors that are crucial for the effectiveness and safety of drug-coated angioplasty balloons are the formulation containing the agent and the coating technique. In this review we first outline the development of paclitaxel-coated balloons to then provide an overview of the preclinical results obtained with different paclitaxel-coated balloons and finally compare these with the outcome in patients. The article concludes with a short outlook on initial results with a zotarolimus-coated angioplasty balloon.

  14. Angioplastia cirúrgica de óstio e tronco coronariano: experiência de oito casos Ostium and left coronary angioplasty: experience with eight cases

    Directory of Open Access Journals (Sweden)

    Danton R. R Loures

    1990-12-01

    Full Text Available No período de abril de 1980 a março de 1990, foram realizadas oito cirurgias de angioplastia de óstio e/ou tronco de coronária esquerda ou direita. Não houve mortalidade imediata e esses pacientes foram acompanhados por um período de 1-109 meses (43,2 meses. Houve melhora clínica e de classe funcional. Seis pacientes fizeram estudo cineangiográfico das coronárias e do ventrículo esquerdo, revelando uma anatomia de óstio e tronco adequada na área operada, e melhora da contratilidade do ventrículo esquerdo. Na evolução tardia houve dois óbitos. Um paciente morreu a 39 meses do pósoperatório, com insuficiência cardíaca congestiva e dor anginosa; o outro faleceu em acidente rodoviário, após 109 meses da cirurgia. Estes resultados permitem concluir que a angioplastia por lesões obstrutivas em óstio ou tronco coronário direito ou esquerdo, isoladas ou associadas a outros defeitos, é um procedimento cirúrgico com baixo risco imediato, com evolução favorável a longo prazo e que pode ser considerado como tratamento opcional para revascularizaçáo coronária.Between April 1980 and March 1990 we performed eight surgical angioplasties of the left main coronary artery and/or its ostium and of the right coronary artery's ostium. There was no early mortality, and these patients were followed by a period of one to 109 months (medium of 43.2 months. We have observed improvement in the clinical symptoms and functional class. A new angiocardiography was performed in six patients, for angioplasty control and left ventricular (L V function evaluation if there was an adequate anatomy on the surgical corrected site and an improvement on the L V contractility and ejection fraction. There were two late deaths. One patient died 39 of postoperative months in congestive heart failure and with angor pectoris, the other one in a car accident 109 months after the surgical correction. These results lead us to conclude that surgical angioplasty

  15. Primary angioplasty for infarction due to isolated right ventricular artery occlusion

    Institute of Scientific and Technical Information of China (English)

    Anwar; A; Chahal; Min-Young; Kim; Alexander; N; Borg; Yahya; Al-Najjar

    2014-01-01

    We report an unusual case of an isolated right ventricular infarction with haemodynamic compromise caused by spontaneous isolated proximal occlusion of the right ventricular branch of the right coronary artery(RCA), successfully treated by balloon angioplasty. A 58-yearold gentleman presented with epigastric pain radiating into both arms. Electrocardiograph with right ventricular leads confirmed ST elevation in V4 R and a diagnosis of isolated right ventricular infarction was made. Urgent primary percutaneous intervention was performed which revealed occlusion of the right ventricular branch of the RCA. During the procedure, the patient’s blood pressure dropped to 80/40 mm Hg, and echocardiography showed impaired right ventricular systolic function. Despite aggressive fluid resuscitation, the patient remained hypotensive, continued to have chest pain and persistent electrocardiograph changes, and hence balloon angioplasty was performed on the proximal right ventricular branch which restored flow to the vessel and revealed a severe ostial stenosis. This was treated with further balloon angioplasty which restored TIMI 3 flow with resolution of patient’s symptoms. Repeat echocardiography showed complete resolution of theST-elevation in leads V4 R and V5 R and partial resolution in V1. Subsequent dobutamine-stress echocardiography at 4 wk showed good left and right ventricular contractions. The patient was discharged after a 3-d inpatient stay without any complications.

  16. Captopril for prevention of Contrast Induced Nephropathy in patients undergoing Coronary Angioplasty: A double blind placebo controlled clinical trial

    Directory of Open Access Journals (Sweden)

    M Hashemi

    2005-09-01

    Full Text Available Background: Contrast induced nephropathy is a potential cause of mortality and morbidity in patients undergoing angiography–angioplasty. Except for hydrating and probably low – isoosmolar contrast agents in high risk groups, other modalities have not provided benefit. We investigated preventive effects of captopril for contrast induced nephropathy during angiography–angioplasty. Methods: In a double blind placebo controlled clinical trial, 88 patients were randomized to two groups: 42 patients received captopril (12.5 mg every 8 hours from 2 hours before the procedure until 48 hours thereafter, and 46 patients received placebo in the same manner. Serum creatinine was measured before and 48 hours after angioplasty. The data were analyzed by SPSS software, using unpaired student t-test for comparing mean creatinine rise in both groups and paired student t-test for the changes in serum creatinine in each group. Results: The mean creatinine rise in captopril group (0.214 mg/dl and placebo group (0.226 mg/dl were not significantly different. The incidence of acute renal failure (creatinine rise more than 0.5 mg/dl in the captopril (11.9 % and placebo group (10.8 % were not significantly different. Conclusion: Captopril does not effectively prevent contrast nephropathy, but it is not harmful for renal function and can be administered safely during angiography – angioplasty in patients with normal renal function. However, the effect of captopril in patients with high- risk characteristics remains to be clarified. Of note, we found a trend for less creatinine rise in diabetics who received captopril during the procedure in comparison to diabetics who received placebo. Keywords: Angiography, Angioplasty, Contrast induced Nephropathy, Captopril, Angiotension Converting Enzyme Inhibitor, Creatinine

  17. Angioplastia del seno coronario en el implante de electrodo del ventrículo izquierdo Angioplasty of coronary sinus in left ventricle electrode implant

    Directory of Open Access Journals (Sweden)

    Alejandro Orjuela

    2011-07-01

    need to submit the patient to thoracotomy for positioning the electrode in the left ventricle posterior-lateral epicardium. Thus, in order to shorten the times and morbidity and increment the implant success, we designed a strategy based on the hemodynamic technique to overcome coronary arteries obstruction and achieve through the angioplasty of the coronary sinus narrowness a more precise approach to a preselected determined epicardial vessel. We describe the technique used in the angioplasty of the coronary sinus for this purpose.

  18. What Is Coronary Angioplasty?

    Science.gov (United States)

    ... What Are Heart Disease and Stroke? What is Metabolic Syndrome? What is Peripheral Vascular Disease? Stroke, Recovery and ... Blood Pressure Readings 4 Heart Attack Symptoms in Women 5 How to Eat Healthy 6 All About ...

  19. Computational Modelling of Multi-folded Balloon Delivery Systems for Coronary Artery Stenting: Insights into Patient-Specific Stent Malapposition.

    Science.gov (United States)

    Ragkousis, Georgios E; Curzen, Nick; Bressloff, Neil W

    2015-08-01

    Despite the clinical effectiveness of coronary artery stenting, percutaneous coronary intervention or "stenting" is not free of complications. Stent malapposition (SM) is a common feature of "stenting" particularly in challenging anatomy, such as that characterized by long, tortuous and bifurcated segments. SM is an important risk factor for stent thrombosis and recently it has been associated with longitudinal stent deformation. SM is the result of many factors including reference diameter, vessel tapering, the deployment pressure and the eccentric anatomy of the vessel. For the purpose of the present paper, virtual multi-folded balloon models have been developed for simulated deployment in both constant and varying diameter vessels under uniform pressure. The virtual balloons have been compared to available compliance charts to ensure realistic inflation response at nominal pressures. Thereafter, patient-specific simulations of stenting have been conducted aiming to reduce SM. Different scalar indicators, which allow a more global quantitative judgement of the mechanical performance of each delivery system, have been implemented. The results indicate that at constant pressure, the proposed balloon models can increase the minimum stent lumen area and thereby significantly decrease SM.

  20. Drug-eluting stents:is it the beginning of the end for coronary artery bypass surgery?

    Institute of Scientific and Technical Information of China (English)

    Shahzad G Raja

    2004-01-01

    @@ Myocardial revascularization therapy of coronary artery disease is one of the most important medical advances of the past 50 years.1 Coronary revascularization by either bypass surgery or coronary angioplasty relieves angina and may improve the prognosis in patients with coronary artery disease.2,3 Randomized comparisons reveal no difference in survival free from myocardial infarction (MI) between surgery and balloon angioplasty.4,5 Stenting significantly improved the long-term outcome, while surgery is still associated with fewer reinterventions during follow-up.6-10 However, subsequent improvements in both percutaneous and surgical techniques may now limit the validity of any conclusions that have been drawn from the earlier studies. In fact, the lines of demarcation for patients suited for bypass or angioplasty are becoming blurry with each passing day.

  1. ANALYSIS OF OUTPATIENT PHYSICIANS, PRESCRIPTION OF DISAGGREGANT THERAPY FOR PATIENTS AFTER ACUTE MYOCARDIAL INFARCTION AND/OR CORONARY ANGIOPLASTY WITH STENT IMPLANTATION WITHIN THE RECVAD REGISTRY

    Directory of Open Access Journals (Sweden)

    A. V. Zagrebelnyi

    2015-01-01

    Full Text Available Objective: to estimate the quality of antiaggregants therapy in patients with coronary heart disease in outpatient settings. Materials and methods. The data of the retrospective outpatient RECVAD registry (3690 patients who lived in Ryazan and its Region and had evidence in their outpatient medical records for one of the diagnoses, such as coronary heart disease, hypertension, chronic heart failure, atrial fibrillation, or their concurrence, were used. Forty­nine patients after acute myocardial infarction (AMI and/or percutaneous coro­ nary interventions (PCI with stenting ≤ 1 year before their inclusion in the registry, who were to undergo dual antiaggregant therapy (DAT according to current clinical guidelines (CG, were identified among 427 patients after AMI and/or PCI with coronary angioplasty. Contra­ indications to DAT were simultaneously revealed and a relationship of the use of therapy to their presence was compared. Results. Among the 49 patients who had indications for DAT that was used in 15 (30.6 % cases and that was not in 3 (6.1 % patients in the presence of contraindications, 25 (51.0 % did not receive DAT in the absence of contraindications and 6 (12.3 % patients received the therapy in the presence of contraindications. Conclusion. DAT prescribed by outpatient physicians does not always meet the current CG. There are cases of not using DAT in the presence of obvious indications for DAT and, on the contrary, those of its use in the presence of contraindications. 

  2. 经皮冠状动脉成形术并发症及其护理%Complications and nursing after percutaneous transluminal coronary angioplasty

    Institute of Scientific and Technical Information of China (English)

    钟莉萍

    2006-01-01

    经皮冠状动脉成形术(percutaneous transluminal coronary angioplasty,PTCA)具有创伤小、安全、成功率高、患者易接受等优点,在临床上得到越来越广泛的应用,成为治疗冠心病的主要方法之一.随着技术水平的提高和设备条件的改善,PTCA的手术安全性已大为提高,但术后的并发症却显得愈加突出.因此,术前预防与术后护理对减少PTCA术后并发症显得愈加重要.

  3. ANGIOPLASTIA PERCUTÁNEA CON STENT EN EL TRONCO PRINCIPAL DE LA ARTERIA CORONARIA IZQUIERDA / Percutaneous angioplasty with stent in the left main coronary artery

    Directory of Open Access Journals (Sweden)

    Javier Almeida Gómez

    2012-10-01

    is coronary artery bypass surgery. In several multicenter studies, the possibility of treating coronary artery disease by percutaneous coronary intervention with implantation of endoluminal prosthesis or stent is suggested. The objective of this research was to characterize percutaneous angioplasty with stent in the left main coronary artery. Method: An observational, descriptive and transversal study was carried out in 21 patients with percutaneous angioplasty with stent in the left main coronary artery, performed in the laboratory of Hemodynamics and Interventional Cardiology of Hermanos Ameijeiras Hospital, between January 2010 and July 2011. Results: There was no significant difference in sex. The age group 50-64 years (47.6% and white skin color (76.19% were predominant. The most commonly found cardiovascular risk factor was hypertension (85.71%, followed by dyslipidemia (47.61%. Effort angina was the most observed diagnosis with 14 cases (66.66%. The lesion in the body of the trunk (12 patients, 57.1% was the most prevalent, followed by ostial lesion (8 cases. Drug-eluting (61.9% was the most used type of stent and only 4 patients had surgically protected trunks. Conclusions: Most cases were elective, with a predominance of unprotected trunks. Hypertension was the coronary risk factor most commonly found. A significant association between diabetes mellitus and ostial location of the lesion was found.

  4. Choice PTTM guidewire for recanalization of total occlusive coronary arteries

    Institute of Scientific and Technical Information of China (English)

    OUYANG Ping; HE Shi-hua; CHEN Wei-Kang; WOO Carrie

    2002-01-01

    Objective: To evaluate the therapeutic effects of 0. 014″Choice PTTM wire in chronic total occlusion angioplasty. Methods: Balloon angioplasty was attempted in 25 arteries with chronic total occlusion,with the mean time of occlusion of 17±13 months (ranging from 2 to 84 months) and mean length of 14±6mm (ranging from 5 to 25 mm). The morphology of the lesions included bridging collaterals (4 cases), calcification (3 cases) and major side branch at the lesion (4 cases) . Choice PTTM wire was used electively in all the cases. Results: Lesion was crossed successfully in 92% (23/25) cases, without incidences of dissection of the coronary artery with subintimal entry. Balloon angioplasy and stenting (n=21) were performed with good immediate angiograghic results. Acute myocardial infarction or death occurred in none of the patients.Conclusion Successful recanalization of chronic coronary total occlusions using Choice PTTM wire can be achieved with good safety.

  5. Distal protection devices during percutaneous coronary and carotid interventions

    OpenAIRE

    2001-01-01

    Abstract Distal embolization of particulate matter complicates percutaneous coronary and peripheral interventions more often than had been recognized until recently. A number of distal protection devices are under development. The PercuSurge GuardWire™ is a balloon occlusion thrombectomy device approved by the United States Food and Drug Administration for saphenous vein graft intervention. A number of filter devices utilize an expandable filter mounted on the angioplasty guidewire to facilit...

  6. Balloon angioplasty for native coarctation in children: one year follow-up results%球囊扩张成形术治疗儿童主动脉缩窄一年随访

    Institute of Scientific and Technical Information of China (English)

    何岚; 吴琳; 刘芳; 齐春华; 陆颖; 张丹艳; 黄国英

    2014-01-01

    Objective Balloon angioplasty is an alternative to surgical repair for coarctation of the aorta in children.However,its role in the treatment of neonates and infants younger than 3 months old remains controversial.The purpose of this study was to evaluate the efficacy and safety of balloon angioplasty for native coarctation by comparing children in different age groups.Method This is a retrospective clinical study including 37 children treated with balloon angioplasty for native coarctation from January 2006 to December 2012.A total of 37 patients consisting of 26 boys and 11 girls underwent the procedure,with median age 10 months (range from 7 days to 6 years) and the mean body weight was 6.3 (2.5-17.0) kg.The indication of the procedure includes discrete native coarctation without aortic arch hypoplasia and a peak-to-peak systolic pressure gradient > 20 mmHg (1 mmHg =0.133 kPa) across aortic coarctation.During one year follow-up,the approach artery injury,recoarctation and aneurysm formation were particularly assessed.Result We classified these patients into two groups according to their age.Group A consisted of 25 patients younger than 3 months and Group B of 12 patients older than 3 months.There was no significant difference between the two groups in systolic pressure gradient before balloon angioplasty (P > 0.05).The mean peak systolic gradient decreased from (38 ± 18) mmHg to (12 ± 11) mmHg immediately after angioplasty in group A and from (47 ±18) to (17 ± 12) mmHg in group B (P =0.000 for both).Meanwhile,the mean diameter of the coarctation segment increased from (1.8 ± 0.7) to (3.7 ± 1.1) mm after angioplasty in group A and from (2.6 ± 1.5) to (5.5 ± 1.8) mm in group B (both P =0).The initial successful balloon angioplasty (immediate postangioplasty peak pressure gradient < 20 mmHg) was achieved in all the 37 patients; 32 patients (86.5%) have been followed up for one year.Approach arterial complications occurred in 3 patients (9.4

  7. Relative risk of aortic and femoral insertion of intraaortic balloon pump after coronary artery bypass grafting procedures.

    Science.gov (United States)

    Pinkard, J; Utley, J R; Leyland, S A; Morgan, M; Johnson, H

    1993-04-01

    We compared the preoperative, operative, and postoperative characteristics of patients who required balloon pumps after coronary artery bypass graft procedures to determine the relative risks of femoral and aortic insertion. The balloon pump was inserted into the ascending aorta when femoral insertion was not possible because of occlusive disease or small femoral arteries. Femoral insertion was performed in 81 patients and aortic insertion in 42 patients. Patients with aortic insertion were more likely to be small and female (p < 0.05) and were more likely to have carotid bruits and a history of strokes or transient ischemic attacks (p < 0.05). Death was more common in the patients with aortic insertion (18/42, 42.9%) than in those with femoral insertion (19/81, 23.4%) (p < 0.05), as calculated with single regression analysis. Route of insertion was not a predictor of operative death, according to multiple regression analysis. Leg complications were more common in patients with femoral artery insertion (23/81, 28.4%) than in those with aortic insertion (0/42, 0.0%) (p < 0.05). No sternal complications occurred in either group. New neurologic abnormalities were not significantly different between the patients with aortic and femoral insertion. Aortic insertion is a safe alternative to femoral insertion of intraaortic balloon pumps and is associated with fewer leg complications in small or diseased iliac and femoral arteries. The greater mortality rate with aortic insertion is related to greater comorbidity rate in these patients.

  8. Stent graft versus balloon angioplasty for failing dialysis access grafts: a long-awaited advance in the treatment of permanent hemodialysis access.

    Science.gov (United States)

    Dolmatch, Bart L

    2010-01-01

    Arteriovenous grafts (AVGs) for hemodialysis have a high failure rate, often due to the development of stenosis at the graft-to-vein anastomosis. Angioplasty (PTA) has been used for over two decades to treat AVG stenosis, with good technical success but limited AVG patency. Results of a prospective multi-center randomized trial, comparing stent graft to PTA in AVGs, has demonstrated superior access circuit patency for the stent graft group. Recent publication of this clinical study brings us into an exciting new era of dialysis access management using covered stents to improve durability of catheter-based therapy.

  9. Eating behavior and nutritional status in patients who underwent coronary angioplasty La conducta alimentaria y estado nutricional en pacientes sometidos a angioplastia coronaria

    Directory of Open Access Journals (Sweden)

    L. Proença Vieira

    2012-02-01

    Full Text Available Introduction: The identification of stages of dietary change and the factors affecting food choices can direct more effective nutritional intervention against coronary heart disease progression. Objective: Identify the stages of change of eating behavior and its relation with nutritional status, food consumption and previous cardiovascular events in patients who underwent coronary angioplasty. Methods: A cross-sectional study with 200 hospitalized patients from a specialized cardiology hospital, after elective coronary angioplasty. They were applied an algorithm that identifies the provision of change of eating habits for a healthier pattern. Variables measured were stages of change of eating behavior, nutritional status, food consumption and cardiovascular events (previous myocardial infarction or angioplasty. It was realized comparison of averages by analysis of variance or Student´s test and Chi-square test for qualitative variables. Value of significance was taken at 5%. Results: The patients were classified in the following stages: 36% maintenance, 26% preparation, 17% precontemplation, 12% action and 9% contemplation. It was observed higher cardiovascular events in maintenance/action group (p = 0.04, higher consumption of calories (p = 0.04, meat/eggs (p = 0.01 and sweets (p = 0.03 in preparation stage, comparing to maintenance group, and no association between nutritional status and stages of change (p = 0.13, although 62% of the individuals in maintenance stage were overweight. Conclusions: This work contributed to identifying the stages of change and conditions that favor changes in eating pattern. Even patients that classified themselves into the maintenance stage need to adjust their eating habits in order to reach a healthy weight.Introducción: La identificación de las etapas de cambio en la dieta y los factores que afectan la elección de alimentos puede dirigir una intervención nutricional más eficaz contra la progresión de

  10. Cardiac tamponade arising from a venous source following anterograde dissection re-entry coronary angioplasty to a chronic total occlusion.

    Science.gov (United States)

    Danson, E; Arena, F; Sapontis, J; Ward, M; Bhindi, R

    2016-10-01

    Cardiac tamponade is a rare complication of coronary intervention to chronic total occlusions (CTO PCI). We report a case of persistent bleeding from a venous source following successful anterograde dissection-reentry (ADR) CTO PCI. Pericardiocentesis was performed 1 h post-procedure for tamponade. Persistent bleeding was investigated with contrast transesophageal echocardiography, pericardial manometry and blood analysis. Coronary venography revealed subtle extravasation from a cardiac vein adjacent to the site of luminal re-entry. Coronary venous perforation using ADR CTO PCI has not previously been described; however, the volume of blood loss may be significant and surgical exploration may be appropriate.

  11. PTCA后再狭窄的中医药防治研究进展%Progression on prevention & treatment of coronary artery restenosis following percutaneous transluminal coronary angioplasty by using traditional Chinese medicine

    Institute of Scientific and Technical Information of China (English)

    方平; 王发渭

    2004-01-01

    经皮腔内冠状动脉成形术(Percutaneous transluminal coronary angioplasty,PTCA)由Gmentzing等人于1977年发明至今,已作为有效治疗冠心病的一种方法广泛应用于临床。随着临床经验的不断积累及手术装置的不断改善,成为心血管疾病介入治疗的主要手段之一。但此后20余年间,术后再狭窄的高发病率(据报道达30%-50%)一直是困扰西

  12. Coronary embolism causing acute myocardial infarction in a patient with mitral valve prosthesis: successful management with angioplasty.

    Science.gov (United States)

    Sial, Jawaid Akbar; Ferman, Mohammad Tariq; Saghir, Tahir; Rasool, Syed Ishtiaq

    2009-06-01

    A 24-year-old male patient with anterior myocardial infarction, caused by embolization from mitral valve prosthesis due to inadequate anticoagulation is presented. The patient underwent cardiac catheterization within 90 minutes of arrival. Angiography showed total occlusion of the left anterior descending coronary artery (LAD) after the second diagonal branch. Thrombus was extracted with export catheter from LAD, and coronary artery perfusion was restored. The pain disappeared completely immediately after this intervention. Transoesophageal echocardiography performed 2 days later revealed no thrombus at the prosthetic valve. In conclusion, this case demonstrated that coronary embolism may occur even without prosthetic valve thrombus or dysfunction with suboptimal International Normalized Ratio levels, and can be successfully treated with coronary angiography with clot extraction with aspiration catheter (Export XT 6F Medtronic) only, without stenting.

  13. Long-term outcome of primary angioplasty compared with fibrinolysis across age groups: a Danish Multicenter Randomized Study on Fibrinolytic Therapy Versus Acute Coronary Angioplasty in Acute Myocardial Infarction (DANAMI-2) substudy

    DEFF Research Database (Denmark)

    Fosbøl, Emil Loldrup; Thune, Jens Jakob; Kelbaek, Henning;

    2008-01-01

    BACKGROUND: Primary angioplasty in patients with acute ST-elevation myocardial infarction has been shown to be superior to fibrinolysis. Whether elderly patients have the same long-term benefit from angioplasty, compared with fibrinolysis, as younger patients is unknown. METHODS: The effect...... of angioplasty versus fibrinolysis was investigated in 1,572 patients from the DANAMI-2 study across age groups. End points were total mortality and a composite end point of death, reinfarction, or disabling stroke. Follow-up was 3 years. RESULTS: Increasing age was associated with mortality (adjusted hazard...... ratio [HR] 2.45 per 10 year increment, 95% confidence interval [CI] 1.78-3.37, P angioplasty over fibrinolysis on the combined outcome was independent of age: patients aged

  14. Clinical efficacy of intra-aortic balloon pumping in treating patients with acute myocardial infarction with left main coronary artery disease

    Institute of Scientific and Technical Information of China (English)

    赵昕

    2012-01-01

    Objective To evaluate the efficacy and safety of intra-aortic balloon pump(IABP) counter pulsation in the treatment of ST-segment elevation myocardial infarction(STEMI) with concurrent left main coronary artery(LM-CA) disease. Methods A retrospective analysis was performed

  15. Intravascular ultrasound-guided angioplasty of hemodialysis loop graft in a patient with contrast allergy.

    Science.gov (United States)

    Casey, Patrick E; Miranda, Charles J; Al-Khaffaf, Haytham; Woodhead, Peter M

    2014-01-01

    A surveillance duplex scan detected a stenosis within a left groin hemodialysis loop graft in a 57-year-old woman who was allergic to both iohexol and gadolinium contrast agents. This precluded the use of standard angioplasty treatment techniques. Intravascular ultrasound (IVUS) uses a catheter mounted with a miniaturized ultrasound probe to produce detailed cross-sectional vessel images. Clinically, it has been used in the assessment of coronary artery disease but has also supplemented standard angiography techniques in the assessment of peripheral vascular and hemodialysis access lesions. IVUS was utilized as the solitary imaging modality to identify the graft stenosis and guide the placement of a 6 mm diameter angioplasty balloon. Two areas of stenosis were successfully dilated and subsequent IVUS re-examination showed abolition of the stenosis. Twelve-month follow-up surveillance scan showed that the graft remained functional with good flow rates. In the setting of contrast allergy, IVUS may provide a valid and safe tool in the localization and treatment of peripheral vessel stenosis, including arteriovenous fistula angioplasty. To our knowledge this is the first reported use of IVUS for hemodialysis graft salvage adopting a completely 'contrast-free' technique. More studies are required to establish the true role of IVUS in the management of hemodialysis access angioplasty, but this successful case contributes valuable information to the literature on its clinical application.

  16. T-shaped angioplasty with apex puncture of thrombosed looped hemodialysis grafts.

    Science.gov (United States)

    Oh, Jung Suk; Choi, Byung Gil; Chun, Ho Jong; Lee, Hae Giu

    2013-03-01

    This study is a retrospective evaluation of an alternative technique for angioplasty of thrombosed loop hemodialysis grafts through a single vascular access. This technique can provide balloon angioplasty to the puncture site without any additional vascular accesses by using a T-shaped balloon catheter and can simplify thrombectomy procedures. Copyright © 2013 SIR. Published by Elsevier Inc. All rights reserved.

  17. Delayed metabolic recovery of hibernating myocardium after percutaneous transluminal coronary angioplasty. Assessment with iodine-123-betamethyl-p-iodophenyl-pentadecanoic acid imaging

    Energy Technology Data Exchange (ETDEWEB)

    Takeishi, Yasuchika; Atsumi, Hiroyuki; Fujiwara, Satomi; Tomoike, Hitonobu [Yamagata Univ. (Japan). School of Medicine

    1996-07-01

    The time course of improvement in fatty acid metabolism after percutaneous transluminal coronary angioplasty (PTCA) was investigated using echocardiography and fatty acid metabolic imaging with iodine-123-betamethyl-p-iodophenyl-pentadecanoic acid ({sup 123}I-BMIPP) before, 1 week and 3 months after PTCA in 31 patients with angina pectoris. Decreased left ventricular wall motion before PTCA improved 1 week after PTCA in 13 of 31 patients. {sup 123}I-BMIPP uptake was reduced in these 13 patients before PTCA, and did not improve 1 week after PTCA. Decreased myocardial uptake of {sup 123}I-BMIPP improved 1 week after PTCA in eight of 23 patients (group A). Thirteen patients in whom {sup 123}I-BMIPP uptake had not improved 1 week after PTCA showed a delayed recovery of 3 months after PTCA (group B). All patients in groups A and B showed improvement in wall motion 1 week after PTCA. Patients in group B had a higher incidence of unstable angina (77% vs 25%, p<0.01), 99% or 100% stenosis (62% vs 13%, p<0.01) and collateral vessels (46% vs 13%, p<0.05) than those in group A. Serial fatty acid metabolic imaging with {sup 123}I-BMIPP after PTCA showed delayed metabolic recovery after improvement in wall motion in 13 of 23 patients. The presence of severe myocardial ischemia before PTCA enhanced the chronological discrepancies between the recovery of wall motion and fatty acid metabolism. (author)

  18. Traços psicológicos dos pacientes submetidos a angioplastia transluminal coronária Psychological profile of patients that underwent coronary angioplasty

    Directory of Open Access Journals (Sweden)

    Lourdes Helena de Campos

    1990-12-01

    Full Text Available Este trabalho teve por objetivo a identificação de traços psicológicos e características emocionais comuns aos pacientes que foram, pela primeira vez, submetidos a angioplastia transluminal coronária (ATC, no Instituto Dante Pazzanese de Cardiologia. Foram analisados 84 pacientes, de ambros os sexos, com idade média de 55 anos. Foram realizadas, pela equipe de psicólogos, duas entrevistas semidirigidas, durante cada uma das quais foram aplicados o Inventário de Ansiedade Traço - Estado (IDATE e a Escala de Hamilton. Essas entrevistas foram realizadas imediatamente anterior à ATC e um dia após o procedimento, na alta dos pacientes. Os resultados permitiram-nos concluir que a grande maioria apresentou padrão comportamental tipo A, próprio do coronariano, alto estresse constitucional e ambiental e ansiedade - traço acima da média. Obtiveram alta porcentagem, também, as variáveis tensão, depressão, grau de competitividade e labilidade de humor.This paper presents psychological and emotional characteristics that were found common to patients that underwent a first coronary angioplasty at Instituto Dante Pazzanese de Cardiologia. We studied 84 patients of both sexes, with mean age of 55 years. Two semi-directed interviews were conducted by the psychology team, and during each of them the State-Trait - Anxiety Inventory STAI and the Hamilton Scale were applied. Such interviews were conducted immediately before PTCA and repeated one day after it, at patient's discharge. We concluded that most patients had a type A personality, typical of patients with coronary artey disease, high constitutional stress and anxiety-trace higher than the average population. There was also a high incidence of tension, depression, competitivity and humor lability.

  19. Correlation between balloon release pressure and no-reflow in patients with acute myocardial infarction undergoing direct percutaneous coronary intervention

    Institute of Scientific and Technical Information of China (English)

    Wang Yanfei; Yao Min; Liu Haibo; Yang Yuejin; Xie Junmin; Jia Xinwei; Pan Huanjun

    2014-01-01

    Background Balloon release pressure may increase the incidence of no reflow after direct percutaneous coronary intervention (PCI).This randomized controlled study was designed to analyze the correlation between balloon release pressure and no-reflow in patients with acute myocardial infarction (AMI) undergoing direct PCI.Methods There were 156 AMI patients who underwent PCI from January 1,2010 to December 31,2012,and were divided into two groups according to the stent inflation pressure:a conventional pressure group and a high pressure group.After PCI,angiography was conducted to assess the thrombolysis in myocardial infarction (TIMI) grade with related artery.Examinations were undertaken on all patients before and after the operation including cardiac enzymes,total cholesterol,low-density lipoprotein,blood glucose,homocysteine,β-thromboglobulin (β-TG),Hamilton depression scale (HAMD) and self-rating anxiety scale (SAS).After interventional therapy,the afore-mentioned parameters in both the conventional pressure group and high pressure group were again analyzed.Results The results showed that CK-MB,HAMD,SAS were significantly different (P <0.05) in all patients after PCI,especially the CK-MB in the high pressure group ((25.7±7.6) U/L vs.(76.7±11.8) U/L).CK-MB,HAMD,SAS,and β-TG were comparative before PCI but they were significantly changed (P <0.05) after intervention.No-reflow phenomenon occurred in 13 patients in the high pressure group,which was significantly higher than in the conventional pressure group (17.11% vs.6.25%,P<0.05).Conclusion In stent implantation,using a pressure less than 1823.4 kPa balloon to release pressure may be the better choice to reduce the occurrence of no-reflow following direct PCI.

  20. Novel paclitaxel-coated angioplasty balloon catheter based on cetylpyridinium salicylate: Preparation, characterization and simulated use in an in vitro vessel model

    Energy Technology Data Exchange (ETDEWEB)

    Petersen, Svea, E-mail: svea.petersen@uni-rostock.de [Institute for Biomedical Engineering, University of Rostock, Friedrich-Barnewitz-Straße 4, 18119 Rostock (Germany); Kaule, Sebastian [Institute for Biomedical Engineering, University of Rostock, Friedrich-Barnewitz-Straße 4, 18119 Rostock (Germany); Stein, Florian [Institute for Chemistry, Analytical and Technical Chemistry University of Rostock, Albert-Einstein-Straße 3a, 18059 Rostock (Germany); Minrath, Ingo; Schmitz, Klaus-Peter [Institute for Biomedical Engineering, University of Rostock, Friedrich-Barnewitz-Straße 4, 18119 Rostock (Germany); Kragl, Udo [Institute for Chemistry, Analytical and Technical Chemistry University of Rostock, Albert-Einstein-Straße 3a, 18059 Rostock (Germany); Sternberg, Katrin [Institute for Biomedical Engineering, University of Rostock, Friedrich-Barnewitz-Straße 4, 18119 Rostock (Germany)

    2013-10-15

    Drug-coated balloons (DCB), which have emerged as therapeutic alternative to drug-eluting stents in percutaneous cardiovascular intervention, are well described with regard to clinical efficiency and safety within a number of clinical studies. In vitro studies elucidating the correlation of coating method and composition with DCB performance are however rare but considered important for the understanding of DCB requirements and the improvement of established DCB. In this context, we evaluated the applicability of a pipetting, dip-coating, and spray-coating process for the establishment of DCB based on paclitaxel (PTX) and the ionic liquid cetylpyridinium salicylate (Cetpyrsal) as novel innovative additive in three different compositions. Among tested methods and compositions, the pipetting process with 50 wt.% PTX resulted in most promising coatings as drug load was less controllable by the other processes and higher PTX contents led to considerable drug crystallization, as visualized by electron microscopy, accelerating PTX loss during short-term elution. Applying these conditions, homogeneous coatings could be applied on balloon catheter, whose simulated use in an in vitro vessel model revealed percental drug losses of 36 and 28% during transit and percental drug transfers of 12 and 40% under expansion for coatings applied in expanded and folded balloon condition, respectively. In comparison to literature values, these results support the high potential of Cetpyrsal as novel DCB matrix regarding low drug loss and efficient drug transfer. - Highlights: • We provide detailed in vitro data for definition of DCB coating requirements. • An in vitro vessel model for evaluating drug delivery from DCB is presented. • Innovative ionic liquid-based coatings for DCB are developed. • The coating shows low drug loss and efficient drug transfer.

  1. [Appropriateness of indicating aortocoronary bypass and coronary angioplasty: results of an observational prospective study in the Lombardy region. Gruppo Interdisciplinare Valutazione Appropriatezza Rivascolarizzazione Coronarica].

    Science.gov (United States)

    Valagussa, F; Maggioni, A P; Valagussa, L; Filardo, G; Mura, G; Liberati, A

    1997-12-01

    Most studies on the appropriateness of cardiac revascularization procedures have been aimed at detecting "overuse" (ie when patients get a procedure without a clear indication), while little attention has been paid yet to "underuse" (when patients who could benefit from a procedure do not get it). This study was planned to assess the extent of over- and underuse of revascularization procedures in northern Italy. A multidisciplinary panel of experts convened by the Italian Association of Hospital Cardiologists (ANMCO) rated the appropriateness of 898 "theoretical indications" for coronary artery by-pass grafting (CABG) and percutaneous transluminal angioplasty (PTCA) using the RAND Corporation methodology. Standardized information has been collected on a consecutive sample of patients in the Lombardy region and identified during performance of a coronary angiogram at one of the services belonging to the GISE (Gruppo Italiano Studi Emodinamica) network. Out of the 2718 consecutive patients undergoing a coronary angiogram during the recruitment period (February-May 1995), a total of 1821 (70%) were eligible for the appropriateness study. Indication for CABG were appropriate in 565 (80%) patients, uncertain in 111 (16%) and inappropriate in 25 (4%). Corresponding values for PTCA were: 40% (n = 262), 46% (n = 300) and 14% (n = 90). Among the 394 to whom a medical therapy was recommended after angiography, the indication was considered appropriated in only 14% (n = 57) and uncertain for 30% (n = 117). For the remaining 220, the indication was considered inappropriate, suggesting that according to the panel criteria, 56% of the patients should have received a revascularization procedure (either a CABG or PTCA) instead. These results suggest that underuse of revascularization procedures represents a substantial health care problem in Lombardy region, at least with reference to the period covered by this study. The study in itself does not make it possible to understand

  2. Balloon-Assisted Tracking to Overcome Radial Spasm during Transradial Coronary Angiography: A Case Report

    OpenAIRE

    Verouden, N. J. W.; Kiemeneij, F.

    2014-01-01

    Spasm of the radial artery is the most important cause of failure to perform coronary angiography via the transradial approach. Spasmolytic cocktail may prevent radial artery spasm but is relatively contraindicated in patients with aortic stenosis or diminished left ventricular function. In this case report we describe a recently published technique to overcome severe radial spasm during transradial coronary angiography in a patient with moderate aortic valve stenosis.

  3. Balloon-Assisted Tracking to Overcome Radial Spasm during Transradial Coronary Angiography: A Case Report.

    Science.gov (United States)

    Verouden, N J W; Kiemeneij, F

    2014-01-01

    Spasm of the radial artery is the most important cause of failure to perform coronary angiography via the transradial approach. Spasmolytic cocktail may prevent radial artery spasm but is relatively contraindicated in patients with aortic stenosis or diminished left ventricular function. In this case report we describe a recently published technique to overcome severe radial spasm during transradial coronary angiography in a patient with moderate aortic valve stenosis.

  4. Balloon-Assisted Tracking to Overcome Radial Spasm during Transradial Coronary Angiography: A Case Report

    Directory of Open Access Journals (Sweden)

    N. J. W. Verouden

    2014-01-01

    Full Text Available Spasm of the radial artery is the most important cause of failure to perform coronary angiography via the transradial approach. Spasmolytic cocktail may prevent radial artery spasm but is relatively contraindicated in patients with aortic stenosis or diminished left ventricular function. In this case report we describe a recently published technique to overcome severe radial spasm during transradial coronary angiography in a patient with moderate aortic valve stenosis.

  5. Shortening of median door-to-balloon time in primary percutaneous coronary intervention in Singapore by simple and inexpensive operational measures: clinical practice improvement program.

    Science.gov (United States)

    Lee, Chi-Hang; Ooi, Shirley B S; Tay, Edgar L; Low, Adrian F; Teo, Swee-Guan; Lau, Cindy; Tai, Bee-Choo; Lim, Irene; Lam, Susan; Lim, Ing-Haan; Chai, Ping; Tan, Huay-Cheem

    2008-10-01

    Primary percutaneous coronary intervention is the standard reperfusion strategy for ST-segment elevation myocardial infarction in our center. We aimed to shorten the median door-to-balloon time from over 100 minutes to 90 minutes or less. We have been using three strategies since March 2007 to shorten the door-to-balloon time: (1) the intervention team is now activated by emergency department physicians (where previously it had been activated by coronary care unit); (2) all members of the intervention team have converted from using pagers to using cell phones; and (3) as soon as the intervention team is activated, patients are transferred immediately to the cardiac catheterization laboratory (where previously they had waited in the emergency department for the intervention team to arrive). An in-house physician and a nurse would stay with the patients before arrival of the intervention team. During 12 months, 285 nontransfer patients (analyzed, n = 270) underwent primary PCI. The shortest monthly median door-to-balloon time was 59 minutes; the longest monthly median door-to-balloon time was 111 minutes. The overall median door-to-balloon time for the entire 12 months was 72 minutes. On a per-month basis, the median door-to-balloon time was 90 minutes or less in 10 of 12 months. On a per-patient basis, the median door-to-balloon time was 90 minutes or less in 182 patients (67.4%). There was 1 case (0.4%) of inappropriate activation by the emergency department. While waiting for the intervention team to convene, 1 patient (0.4%) deteriorated and had to be resuscitated in the cardiac catheterization laboratory. Improved health care delivery can be achieved by changing simple and inexpensive operational processes.

  6. Primary stenting of occluded native coronary arteries: final results of the Primary Stenting of Occluded Native Coronary Arteries (PRISON) study.

    Science.gov (United States)

    Rahel, Braim M; Suttorp, Maarten J; Laarman, Gert J; Kiemeneij, Ferdinand; Bal, Egbert T; Rensing, Benno J; Ernst, Sjef M P G; ten Berg, Jurriën M; Kelder, Johannes C; Plokker, H W Thijs

    2004-05-01

    Primary intracoronary stent placement after successfully crossing chronic total coronary occlusions may decrease the high restenosis rate at long-term follow-up compared with conventional balloon angioplasty. In a prospective, randomized trial, balloon angioplasty was compared with stent implantation for the treatment of chronic total occlusions. Patients were followed for 12 months with angiographic follow-up at 6 months. Quantitative coronary analysis was performed by an independent core lab. A total of 200 patients were enrolled. Baseline characteristics were evenly distributed. After the procedure the mean minimal luminal diameter in the conventional group was 2.34 +/- 0.46 mm versus 2.90 +/- 0.41 mm in the stented group (P 50% diameter stenosis) was seen in 33% in the conventional group versus 22% in the stented group (P =.137). The reocclusion rates were 7.3% and 8.2%, respectively (P = 1.00). At 12 month follow-up, the rate of target lesion revascularization was significantly higher in the conventional group (29% versus 13%, P <.0001). These data demonstrate that stenting of chronic total occlusions is superior to balloon angioplasty alone with a statistically significant reduction in the need for target lesion revascularization and a lower, but not significant, restenosis rate.

  7. Biocompatibility of Coronary Stents

    Directory of Open Access Journals (Sweden)

    Thamarasee M. Jeewandara

    2014-01-01

    Full Text Available Cardiovascular disease is the dominant cause of mortality in developed countries, with coronary artery disease (CAD a predominant contributor. The development of stents to treat CAD was a significant innovation, facilitating effective percutaneous coronary revascularization. Coronary stents have evolved from bare metal compositions, to incorporate advances in pharmacological therapy in what are now known as drug eluting stents (DES. Deployment of a stent overcomes some limitations of balloon angioplasty alone, but provides an acute stimulus for thrombus formation and promotes neointimal hyperplasia. First generation DES effectively reduced in-stent restenosis, but profoundly delay healing and are susceptible to late stent thrombosis, leading to significant clinical complications in the long term. This review characterizes the development of coronary stents, detailing the incremental improvements, which aim to attenuate the major clinical complications of thrombosis and restenosis. Despite these enhancements, coronary stents remain fundamentally incompatible with the vasculature, an issue which has largely gone unaddressed. We highlight the latest modifications and research directions that promise to more holistically design coronary implants that are truly biocompatible.

  8. Cutting balloon for in-stent restenosis: acute and long-term results.

    Science.gov (United States)

    Rahel, Braim M; Suttorp, Maarten Jan; ten Berg, Jurrien M; Bal, Egbert T; Ernst, Sjef M P G; Rensing, Benno J; Kelder, Johannes C; Plokker, H W Thijs

    2004-08-01

    Conventional percutaneous coronary intervention for the treatment of in-stent restenosis (ISR) has shown a high rate of ISR (30-55%). Considering the need for both extrusion of hyperplastic intima and additional stent expansion, a cutting balloon might be more effective for the treatment of ISR. We prospectively assessed the immediate and 8-month outcome of balloon angioplasty using the Barath Cutting Balloon in 100 consecutive patients (mean age: 60.5 +/- 10.8 years, 71% male). In 73 lesions (73%), a good result was reached with the cutting balloon only. In 21 lesions (21%) postdilatation and in 6 lesions (6%) predilatation with a conventional balloon was necessary. The mean inflation pressure was 8.7 +/- 2.0 (range: 6.0-18.0) atm. Before the procedure the mean minimal luminal diameter (MLD) was 0.95 +/- 0.45 mm. Quantitative coronary analysis showed a mean diameter stenosis of 65%+/- 16%. Immediately after the procedure the mean MLD was 2.42 +/- 0.54 mm with a mean diameter stenosis of 19%+/- 13%. Two patients died during the follow-up period (1 stroke, 1 nonvascular). At 8-month follow-up 26 patients (26%) reported to have anginal complaints CCS class II-IV of whom 16 (16%) needed target lesion revascularization. Treatment of ISR using the Barath Cutting Balloon can be performed safely with good immediate results and a relatively low need for repeated target lesion revascularization at 8-month follow-up.

  9. Primary percutaneous coronary intervention compared with fibrinolysis for myocardial infarction in diabetes mellitus - Results from the primary coronary angioplasty vs thrombolysis-2 trial

    NARCIS (Netherlands)

    Timmer, Jorik R.; Ottervanger, Jan Paul; de Boer, Menko-Jan; Boersma, Eric; Grines, Cindy L.; Westerhout, Cynthia M.; Simes, John; Granger, Christopher B.; Zijlstra, Felix

    2007-01-01

    Background: There is growing evidence for a clinical benefit of primary percutaneous coronary intervention (PCI) compared with fibrinolysis; however, whether the treatment effect is consistent among patients with diabetes mellitus is unclear. We compared PCI with fibrinolysis for treatment of ST-seg

  10. QUALITY OF LIFE AND COMPLIANCE TO THERAPY IN PATIENTS FOLLOWING SUCCESSFUL TRANSLUMINAL CORONARY ANGIOPLASTY, WHO WERE PRESCRIBED LESCOL XL (FLUVASTATIN ADDED TO STANDARD THERAPY. RESULTS OF THE LESQOL OPEN-LABEL OBSERVATIONAL STUDY

    Directory of Open Access Journals (Sweden)

    A. V. Susekov

    2010-01-01

    Full Text Available Aim. The main aim of the present study was to evaluate quality of life changes and compliance to therapy in patients following successful transluminal angioplasty, who were prescribed fluvastatin extended release in addition to standard treatment.Material and methods. This was a national prospective multicenter observational study. Patients with coronary heart disease following successful transluminal coronary angioplasty, who were prescribed fluvastatin extended release (Lescol Forte, Novartis 80 mg QD were included in the present observation. The following efficacy and safety parameters were evaluated: quality of life evaluated with SF-36 scale before and during treatment; hypolipidemic efficacy, compliance to therapy; adverse events and serious adverse events. Observation period was 6 months in all patients and 12 months in some patients at the discretion of the investigator.Results. 524 patients (79% men and 21% women completed the 6 months observation period and 116 patients were followed up for 12 months. Significant increase of all measures of SF-36 scales, physical and mental health was observed in 6 and 12 months of fluvastatin extended release treatment. Total and low density lipoprotein cholesterol reduction was 30.5% and 54.9% respectively, p<0.01, in 6 months and 34.2% and 34.3% respectively in 12 months of treatment, p<0.01. High density lipoprotein cholesterol was significantly increased by 22.5% in 12 months of treatment, p<0.01. There were very few adverse events and laboratory changes during the course of treatment.Conclusion. LESQOL study showed significant increase in quality of life and good hypolipidemic efficacy as well as good tolerability of fluvastatin extended release in patients after coronary angioplasty.

  11. Angioplasty for coarctation in different aged patients.

    Science.gov (United States)

    Walhout, Ronald J; Lekkerkerker, Jaco C; Ernst, Sjef M P G; Hutter, Paul A; Plokker, Thijs H W M; Meijboom, Erik J

    2002-07-01

    Differences in the indication and outcome of balloon angioplasty for coarctation in children and adults have not been elucidated sufficiently. The results of balloon angioplasty for coarctation are compared between pediatric and adult age groups. Balloon angioplasty for coarctation of the aorta was performed in 85 patients who were classified according to age and native coarctation/recoarctation. Groups A (patients aged or =16 years, n = 17) included patients with native coarctations. Groups rCoA A (patients aged or =16 years, n = 3) included patients with recoarctations. Follow-up included 2-dimensional Doppler scanning echocardiography and additional angiography or magnetic resonance imaging. Gradient reductions in groups were compared by use of the independent-samples t test. Kaplan-Meier and log-rank analyses were performed as a means of comparing long-term outcome. No mortality occurred. Immediate success was equal in groups A, B, and rCoA A (94%). Dilatation was unsuccessful in 2 patients in group rCoA B. Pressure gradients decreased 23 mm Hg in group A, 31 mm Hg in group B, 18 mm Hg in group rCoA A, and 11 mm Hg in group rCoA B. Pressure gradient drops, compared between groups A and B, showed a significant difference (P <.001). The length of hospital stay ranged from 12 to 48 hours. The period of follow-up ranged from 6 months to 12 years (mean, 4.9 years). Kaplan-Meier curves of groups A and B are not different, as determined by means of log-rank analysis. No aneurysm formation was encountered. The results of balloon angioplasty for native coarctation in both selected children and adults are excellent. In recoarctation, we recommend balloon angioplasty in the pediatric patients.

  12. Microvascular Coronary Flow Comparison in Acute Myocardial Infarction Angioplasty treated with a mesh covered stent (MGUARD Stent) versus Bare Metal Stent

    Energy Technology Data Exchange (ETDEWEB)

    Lindefjeld, Dante S., E-mail: dslindef@puc.cl [Hospital Clínico, Pontificia Universidad Católica de Chile (Chile); Hospital Dr. Sótero del Río, Santiago-Chile (Chile); Guarda, Eduardo [Hospital Clínico, Pontificia Universidad Católica de Chile (Chile); Méndez, Manuel [Hospital Clínico, Pontificia Universidad Católica de Chile (Chile); Hospital Dr. Sótero del Río, Santiago-Chile (Chile); Martínez, Alejandro [Hospital Clínico, Pontificia Universidad Católica de Chile (Chile); Pérez, Osvaldo [Hospital Clínico, Pontificia Universidad Católica de Chile (Chile); Hospital Dr. Sótero del Río, Santiago-Chile (Chile); Fajuri, Alejandro; Marchant, Eugenio [Hospital Clínico, Pontificia Universidad Católica de Chile (Chile); Aninat, Mauricio; Torres, Humberto [Hospital Dr. Gustavo Fricke, Viña del Mar-Chile (Chile); Dussaillant, Gastón [Hospital Clínico Universidad de Chile, Santiago-Chile (Chile)

    2013-01-15

    Background: Distal embolization of thrombus/platelet aggregates decreases myocardial reperfusion during primary percutaneous coronary intervention (PCI), and is associated with worse immediate and long-term prognosis of patients with ST-elevation myocardial infarction (STEMI). Objective: Assess the efficacy of a mesh covered stent (MGuard™ stent, MGS) in preventing distal embolization and microvascular reperfusion impairment during primary PCI, compared with a bare metal stent (BMS). Methods: Forty patients with STEMI referred for primary PCI were randomized for stenting the culprit lesion with the MGS (n = 20) or a BMS (n = 20). Blinded experts performed off-line measurements of angiographic epicardial and microvascular reperfusion criteria: TIMI flow grade, myocardial blush, corrected TIMI frame count (cTFC). Results: At baseline clinical, angiographic and procedural variables were not different between groups. Post PCI TIMI flow grade was similar in both groups. We observed better myocardial Blush grade in group MGS compared to BMS (median value 3.0 vs 2.5, 2p = 0.006) and cTFC (mean cTFC: MGS 19.65 ± 4.07 vs BMS 27.35 ± 7.15, 2p < 0.001, cTFC mean difference MGS-BMS: 7.7, CI 95%: 3.94 to 11.46). MGS stent group had a higher percentage of successful angioplasty (cTFC ≤ 23: MGS 85% vs BMS 30%, 2p < 0.001). We had two cases of acute stent thrombosis (one for each group) at 30 days follow up, but no clinical events at 6 months follow up. Conclusions: In this exploratory study, MGS significantly improved microvascular reperfusion criteria compared with a BMS in primary PCI. However its safety and impact on clinical outcomes should be verified in larger randomized clinical trials.

  13. Endothelin Receptor Antagonist and the Prevention of Percutaneous Transluminal Coronary Angioplasty Restenosis%内皮素受体抗体与PTCA术后再狭窄的防治

    Institute of Scientific and Technical Information of China (English)

    陆平; 盛净

    2004-01-01

    经皮腔内冠状动脉成形术(percutaneous transluminal coronary angioplasty,PTCA)已广泛应用于冠心病的治疗.但是术后再狭窄限制其发展.再狭窄的发生常伴随内皮素(endothelin,ET)和其受体表达增多,抑制ET受体可以减轻再狭窄的发生.本文阐述内皮素受体抗体与PTCA术后再狭窄的关系.

  14. Using a Cloud Computing System to Reduce Door-to-Balloon Time in Acute ST-Elevation Myocardial Infarction Patients Transferred for Percutaneous Coronary Intervention.

    Science.gov (United States)

    Ho, Chi-Kung; Chen, Fu-Cheng; Chen, Yung-Lung; Wang, Hui-Ting; Lee, Chien-Ho; Chung, Wen-Jung; Lin, Cheng-Jui; Hsueh, Shu-Kai; Hung, Shin-Chiang; Wu, Kuan-Han; Liu, Chu-Feng; Kung, Chia-Te; Cheng, Cheng-I

    2017-01-01

    This study evaluated the impact on clinical outcomes using a cloud computing system to reduce percutaneous coronary intervention hospital door-to-balloon (DTB) time for ST segment elevation myocardial infarction (STEMI). A total of 369 patients before and after implementation of the transfer protocol were enrolled. Of these patients, 262 were transferred through protocol while the other 107 patients were transferred through the traditional referral process. There were no significant differences in DTB time, pain to door of STEMI receiving center arrival time, and pain to balloon time between the two groups. Pain to electrocardiography time in patients with Killip I/II and catheterization laboratory to balloon time in patients with Killip III/IV were significantly reduced in transferred through protocol group compared to in traditional referral process group (both p cloud computing system in our present protocol did not reduce DTB time.

  15. Restenosis following balloon dilation of benign esophageal stenosis

    Institute of Scientific and Technical Information of China (English)

    Ying-Sheng Cheng; Ming-Hua Li; Ren-Jie Yang; Hui-Zhen Zhang; Zai-Xian Ding; Qi-Xin Zhuang; Zhi-Ming Jiang; Ke-Zhong Shang

    2003-01-01

    AIM: To elucidate the mechanism of restenosis following balloon dilation of benign esophageal stenosis.METHODS: A total of 49 rats with esophageal stenosis were induced in 70 rats using 5 ml of 50 % sodium hydroxide solution and the double-balloon method, and an esophageal restenosis (RS) model was developed by esophageal stenosis using dilation of a percutaneous transluminal coronary angioplasty (PTCA) balloon catheter. These 49 rats were divided into two groups: rats with benign esophageal stricture caused by chemical burn only (control group, n=21) and rats with their esophageal stricture treated with balloon catheter dilation (experimental group, n=28). Imaging analysis and immunohistochemistry were used for both quantitative and qualitative analyses of esophageal stenosis and RS formation in the rats, respectively.RESULTS: Cross-sectional areas and perimeters of the esophageal mucosa layer, muscle layer, and the entire esophageal layers increased significantly in the experimental group compared with the control group. Proliferating cell nuclear antigen (PCNA) was expressed on the 5th day after dilation, and was still present at 1 month. Fibronectin (FN)was expressed on the 1st day after dilation, and was still present at 1 month.CONCLUSION: Expression of PCNA and FN plays an important role in RS after balloon dilation of benign esophageal stenosis.

  16. Drug-Eluting Balloons in the Treatment of Coronary De Novo Lesions

    DEFF Research Database (Denmark)

    Richelsen, Rasmus Kapalu Broge; Overvad, Thure Filskov; Jensen, Svend Eggert

    2016-01-01

    in coronary de novo lesions, either as part of a DEB-only strategy or in combination with another device, mainly a bare metal stent (BMS). By searching Pubmed and Embase we were able to identify 52 relevant studies, differing in design, intervention, and clinical setting, including patients with small vessel...

  17. [Percutaneous transluminal coronary angioplasty. The experience of the Hospital de Especialidades of the La Raza Medical Center, IMSS].

    Science.gov (United States)

    Murillo, H; Ayala, F; Almazán, A; Madrid, R; Rangel, A; Valdespino, A; Solorio, S; Lepe, L; Badui, E

    1993-01-01

    We analyzed the initial results of the PTCA program at the Hospital de Especialidades CMR, IMSS. During the last year we studied 33 patients in whom we performed 35 PTCA procedures with total of 45 lesions. The age of the patients varied from 27 to 75 years of age (average 57 year +/- 10.9). Among them, 84.8% were males and 15.2% females. In 54.5% of the patients, stable angina was present, whereas in 45.5% unstable angina was observed. Multivessel disease was detected in 39.4% of the cases. In 17.8% the coronary lesions were type "A", in 77.8% type "B" and in 4.4% type C. The most frequent lesions were present at the left anterior descending artery in 46.6%, right coronary artery in 40% and circumflex in 13.4%. The global procedural success was 88.5% (32/35 procedure) whereas the procedural success by isolated lesion was 88.8% (40/45 lesions). The average artery stenosis was decreased from 85 +/- 10.4% to 23 +/- 16%. A procedural failure occurred in 4 instances (11.4%), among them, 2 (5.71%) without complications and 2 more, associated to acute myocardial infarction. In the present study there were no emergency operation neither deaths. Although the number of PTCA performed in our hospital is limited, we consider that the initial results are good, with a success rate of 88.5% with a minimal complications.

  18. Association of Door-to-Balloon Time and Mortality in Patients ≥65 Years With ST-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

    OpenAIRE

    Rathore, Saif S.; Curtis, Jeptha P.; Nallamothu, Brahmajee K.; Wang, Yongfei; Foody, JoAnne Micale; Kosiborod, Mikhail; Masoudi, Frederick A; Havranek, Edward P.; Krumholz, Harlan M.

    2009-01-01

    Current guidelines recommend ST-elevation myocardial infarction (STEMI) patients receive primary percutaneous coronary intervention (PCI) within 90 minutes of admission, although there is conflicting data regarding the relationship between time to treatment and mortality in these patients. We used logistic regression analyses employing fractional polynomial model to evaluate the association between door-to-balloon time and one-year mortality in STEMI patients age ≥65 years undergoing primary ...

  19. Coronary Stents: The Impact of Technological Advances on Clinical Outcomes.

    Science.gov (United States)

    Mennuni, Marco G; Pagnotta, Paolo A; Stefanini, Giulio G

    2016-02-01

    Percutaneous coronary interventions (PCI) were proposed in the late 1970s as an alternative to surgical coronary artery bypass grafting for the treatment of coronary artery disease. Important technological progress has been made since. Balloon angioplasty was replaced by bare metal stents, which allowed to permanently scaffold the coronary vessel avoiding acute recoil and abrupt occlusion. Thereafter, the introduction of early generation drug-eluting stents (DES) has significantly improved clinical outcomes, primarily by markedly reducing the risk of restenosis. New generation DES with thinner stent struts, novel durable or biodegradable polymer coatings, and new limus antiproliferative agents, have further improved upon the safety and efficacy profile of early generation DES. The present article aims to review the impact of technological advances on clinical outcomes in the field of PCI with coronary stents, and to provide a brief overview on clinical margins of improvement and unmet needs of available DES.

  20. 依达拉奉防治大鼠颈动脉球囊成形术后血管再狭窄%Experimental study on edaravone in prevention of restenosis in rat common carotid balloon angioplasty

    Institute of Scientific and Technical Information of China (English)

    周海武; 徐平

    2008-01-01

    Objective To investigate edaravane in prevention of restenosis in rat common catery arteries balloon angioplasty and the possible mechanism of this process. Methods Forty male SD rats were randomly divided into 2 groups: treatment group (whose intima was injured by balloon and was given edaravone 3 mg/kg by peritoneal injection, bid) and control group (whose intima was injured by ballon and was given the same volume NS as edaravone). 1, 3, 7, 14 and 28 days after angioplasty, rats were killed and the local arteries were sectioned for analysis of pathological morphology and the expression of matrix metalloproteinase-2 (MMP-2) analyzed by immunohistochemistry. Results Small amounts of smooth muscle cell appeared at the intima of blood vessel 3 days after the artery injured by balloon. Consecutive intima was formed 7 days after artery injury. The intima was even or uneven thickened and the lumen of artery was significant stenosed 14 and 28 days afterwards. In the control group, the intimal area reached (0.240±0.043) mm2, the intima hyperplasy index were 0.52±0.06, stenosis ratio were 30%±9% 14 days afterwards. The intimal area were (0.420±0.063 )mm2, the intima hyperplasy index were 0.67± 0.07, stenosis ratio were 54%±9% on day 28. In the treatment group, the intimal area were (0.063± 0.025)mm2, the intima hyperplasy index were 0.24±0.07, stenosis ratio were 8%±3% after 14 days. The intimal area were (0.116±0.023) mm2, the intima hyperplasy index were 0.38±0.05, stenosis ratio were 16%±4% after 28 days. Compared with control group at the same time, the intimal area (F values were 50.488 and 81.119 respectively, P < 0.05 ), the intima hyperplasy index ( F values were 41.743 and 48.122 respectively, P<0.05) and stenosis ratio (F values were 24.221 and 81.119 respectively, P< 0.05) were decreased in treatment group. The expressions of MMP-2 raised after balloon injury. In control group, the expressions of MMP-2 were 27.16%±7.15% after 3 days, 22.59%±6

  1. Clinical therapeutic efficacy of intra-aortic balloon pump as an adjuvant treatment after percutaneous coronary intervention in patients with coronary heart disease associated with chronic kidney disease

    Directory of Open Access Journals (Sweden)

    Zi-lan JING

    2015-06-01

    Full Text Available Objective To explore the clinical efficacy of intra-aortic balloon pump (IABP as an auxiliary treatment of percutaneous coronary intervention (PCI in patients with coronary heart disease (CHD associated with chronic kidney disease. Methods One hundred and twenty CHD patients with concomitant chronic kidney disease and receiving PCI in our hospital from Jan. 2000 to Jul. 2014, and 123 simple CHD patients without renal dysfunction, who had undergone PCI with concomitant IABP for the cardiac pump failure, cardiogenic shock, acute left heart failure, unstable angina pectoris (UP which was not allayed by medical treatment, or acute myocardial infarction (AMI, were selected for observation of preoperative condition, in-hospital mortality and prognosis of patients in two groups. Results There was no statistically significant difference in general clinical data including gender, age, and concomitant hypertension and diabetes, and preoperative blood lipid, AST, D-dimer, APTT, and international normalized ratio (INR showed also no statistically significant difference before surgery between two groups of patients (P>0.05. The difference in proportion of AMI, the left main trunk and (or three-branches involvement was of no statistical significance (P>0.05, but there was significant difference in the incidence of previous myocardial infarction, TnT, CK-MB, Cr, BUN, stent number, IABP application time (P0.05 between the two groups. Logistic regression analysis revealed that diabetes and the number of stents were independent risk factors for in-hospital and long-term mortalities. Conclusions By means of the effective cardiac assistance of IABP, CHD patients with renal insufficiency have the same short and long term clinical prognosis as simple CHD patients without renal dysfunction who has undergone PCI. Diabetes and the number of stents are independent risk factors for in-hospital and 1-year mortality. DOI: 10.11855/j.issn.0577-7402.2015.04.03

  2. The Development of Coronary Artery Stents: From Bare-Metal to Bio-Resorbable Types

    Directory of Open Access Journals (Sweden)

    Ming-Yun Ho

    2016-07-01

    Full Text Available Coronary artery disease is the leading cause of death worldwide. Conventional balloon angioplasty is associated with high rates of complications such as coronary dissection and vessel recoil. The deployment of bare-metal stents (BMSs can overcome these problems and achieve a better patency rate than simple balloon angioplasty. It has been shown that the stent design including structure platform, size, length, and strut thickness has a major influence on the clinical results. Even though angioplasty with BMS implantation is widely used in coronary interventions, the restenosis rate due to neointimal hyperplasia remains high. Therefore, drug-eluting stents (DESs coated with anti-proliferative agents and polymers have been developed to reduce the restenosis rate and improve the clinical outcomes. Although the repeat revascularization rate of DESs is lower than that of BMSs, the long-term stent thrombosis rate is higher than for BMSs. Therefore, new and emerging generations of stents, in which, for example, thinner struts and bioresorbable polymers are used, are available for clinical use. However, there are only a limited number of clinical trials, in which these newer stents have been compared with BMSs and first- and second-generation DESs. The purpose of this review was to provide up-to-date information on the evolution of coronary artery stents from BMSs to DESs to bioresorbable stents (BRSs.

  3. Patient effective doses during intracoronary irradiation with a Rhenium 188 full filled balloon catheter after percutaneous transluminal coronary artery

    Energy Technology Data Exchange (ETDEWEB)

    Ponce V, L.; Peix G, A.; Llerena R, L.; Santana V, L. [Instituto de Cardiologia, La Habana (Cuba); Lopez D, A. [Hospital Hermanos Amejeiras, La Habana (Cuba)

    2006-07-01

    Intracoronary irradiation with a full filled Re188 balloon catheter treatment technique (IRT) after Percutaneous Transluminal Coronary Artery (PTCA) should represent an addition patient exposure dose with respect to common PTCA procedure. Our proposes were determinate the absorbed doses and estimate the risk for fatal cancer in 25 patients (15 males, mean age: 559 years old) treated during an IRT randomized clinical trial carried out in our institution as part of IAEA technical cooperation project. 20 Gy was always the prescribed doses for each patient. The average Re188 concentrated activity used and treatment time were 5256{+-}2371 MBq/ml in 1.5-2 ml and 466{+-}195 seconds, respectively. Two thermoluminescent dosimeters were attached in the chest and pelvis for each patient treated. Calibration for attenuation and scattered radiations was done. The maximal and mean value effective dose obtained for chest patient region were 18 mSv and 15{+-}6 mSv, respectively and for pelvis patient region the results were 10 mSv and 8{+-}3 mSv, respectively. The total risk to develop fatal cancer was 0.084% for patient treated. The patient effective doses is slightly superior to those reported for common procedures as PTCA. The IRT is considered a quite safe procedure, but in order to exposure radiation level optimization the continuous review of procedure should be constantly done. (Author)

  4. Stunning and Right Ventricular Dysfunction Is Induced by Coronary Balloon Occlusion and Rapid Pacing in Humans: Insights From Right Ventricular Conductance Catheter Studies.

    Science.gov (United States)

    Axell, Richard G; Giblett, Joel P; White, Paul A; Klein, Andrew; Hampton-Til, James; O'Sullivan, Michael; Braganza, Denise; Davies, William R; West, Nick E J; Densem, Cameron G; Hoole, Stephen P

    2017-06-06

    We sought to determine whether right ventricular stunning could be detected after supply (during coronary balloon occlusion [BO]) and supply/demand ischemia (induced by rapid pacing [RP] during transcatheter aortic valve replacement) in humans. Ten subjects with single-vessel right coronary artery disease undergoing percutaneous coronary intervention with normal ventricular function were studied in the BO group. Ten subjects undergoing transfemoral transcatheter aortic valve replacement were studied in the RP group. In both, a conductance catheter was placed into the right ventricle, and pressure volume loops were recorded at baseline and for intervals over 15 minutes after a low-pressure BO for 1 minute or a cumulative duration of RP for up to 1 minute. Ischemia-induced diastolic dysfunction was seen 1 minute after RP (end-diastolic pressure [mm Hg]: 8.1±4.2 versus 12.1±4.1, Pright coronary artery balloon occlusion both cause ischemic right ventricular dysfunction with stunning observed later during the procedure. This may have intraoperative implications in patients without right ventricular functional reserve. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

  5. DK crush technique: modified treatment of bifurcation lesions in coronary artery

    Institute of Scientific and Technical Information of China (English)

    CHEN Shao-liang; GE Jun-bo; YE Fei; ZHANG Jun-jie; ZHU Zhong-sheng; LIN Song; SHAN Shou-jie; LIU Zhi-zhong; LIU Yan; DUAN Bao-xiang

    2005-01-01

    @@ Bifurcation lesions are still technically challenging even in the era of modern stents.1 High incidence of restenosis both in main vessel and side branch limits the long-term prognosis although several kinds of techniques have been identified to be successful for coronary bifurcations.2-5 Reports have demonstrated the main reason for higher incidence of ostial side branch even though drug-eluting stent used in side vessel lies in that there were gaps in metal coverage and drug application.6-9 Therefore, new technique ensuring complete vessel scaffolding without gaps in drug delivery at the bifurcation is crush technique which is similar to other techniques including T- and Y- stenting still needing postdilatation of kissing balloon angioplasty to expand the stent fully in the ostial side branch and to prevent stent distortion in main vessel.10 As a result, kissing balloon angioplasty is a key step to improve the final result and to reduce the restenosis after stenting bifurcation lesions. However, kissing angioplasty is difficult to be underwent or impossible because operators usually fail to rewire two layers of metal strut, which would result in suboptimal stent deployment, a main reason of high incidence of restenosis, and acute- or-late-thrombosus. The present study reports modified DK crush technique improving success rate of kissing balloon angioplasty under the guidance of intravascular ultrasound (IVUS).

  6. Matrix metalloproteinase inhibition reduces adventitial thickening and collagen accumulation following balloon dilation

    NARCIS (Netherlands)

    Sierevogel, MJ; Velema, E; van der Meer, FJ; Nijhuis, MO; de Kleijn, DPV; Borst, C; Pasterkamp, G

    2002-01-01

    Objective: Constrictive arterial remodeling following balloon angioplasty has been related to adventitial collagen accumulation and subsequent thickening and can be prevented by matrix ructalloprotemase (MMP) inhibition. Following balloon dilation, we examined the effect of MMP inhibition on colla-e

  7. Effect of percutaneous transluminal angioplasty on the stenosis of autogenous radiocephalic ateriovenous fistula for hemodialysis

    Energy Technology Data Exchange (ETDEWEB)

    Jeong, Sun Min; Kim, Jeong Ho; Byun, Sung Su; Kang, Jin MMo; Choi, Sang Tae; Kim, Jong Woo; Kim, Hyung Sik; Choi, Hye Young [Gachon University Gil Medical Center, Incheon (Korea, Republic of); Park, Jae Hyung [Dept. of Radiology, Seonam University College of Medicine, Myongji Hospital, Goyang (Korea, Republic of)

    2016-02-15

    The purpose of this study was to evaluate the effectiveness of percutaneous transluminal angioplasty (PTA) on stenosis of autogenous radiocephalic arteriovenous fistula (RCF) for hemodialysis and to determine the factors influencing patency. This retrospective study included 136 patients referred for PTA of RCF stenosis between March 2005 and July 2014. The technical success rate, complications, and patency rate were evaluated. The following factors were analyzed as they might influence patency: age, gender, site and duration of arteriovenous fistula, underlying disease, body mass index, hypercholesterolemia, smoking, peripheral artery or coronary artery occlusive disease, stenosis length/grade, cutting balloon, and balloon size. The initial technical success rate was 91.9% (125/136). Complications included vessel rupture (n = 2) and vessel dissection (n = 2). The patency rates at 6, 12, 24, and 48 months after PTA were 81.9, 67.1, 52.7, and 42.3%, respectively. The patency rate was higher in cases with longer (> 3 cm) stenosis (p = 0.04). Use of cutting balloon and larger size of balloon catheter made the patency longer, but this difference was not statistically significant (p = 0.637, 0.258). PTA is a safe and effective way to manage stenosis in RCF. The length of stenosis was the only factor which affected the patency rate in this study.

  8. Dose rate in intravascular radionuclide therapy using Re-188 coated balloon

    Energy Technology Data Exchange (ETDEWEB)

    Baek, M. Y.; Kim, J. K. [Hanyang Univ., Seoul (Korea, Republic of)

    2001-05-01

    Restenosis is the major drawback problem after percutaneous transluminal coronary angioplasty (PTCA). In order to reduce the restenosis, radionuclide therapy has been used, and these day balloon coating method with radionuclide is investigating to effective therapy. We intend to calculate the activity by Monte Carlo method, which is needed in the investigation of coated balloon using Re-188. We used EGSnrc code system to calculate this activity. Balloons were assumed be a length of 20 mm or 30 mm and to have a central catheter of diameter 0.5 mm. The surface of balloon is coated with 0.01 mm depth Re-188 using poly urethan. We calculated dose distribution as radial distance from the surface of balloon. And we calculate how much activities are needed to irradiate 18Gy at the 0.5 mm, 1.0 mm distance from balloon surface during 3 minutes. As results it is needed 19.3 mCi and 33.6 mCi relatively for each 0.5 mm and 1.0 mm in the 20 mm balloon. It is need 27.8 mCi and 48.3 mCi in the 30 mm balloon. Recent report for Ho-166 using EGS4 suggests 13.04 mCi at 0.5 mm distance in the 20 mm balloon. This value is lower than our result for Re-188 for the same size balloon. It is considered to be a systemic difference between two simulation codes ({approx}10%)

  9. Balloon dacryocystoplasty study in the management of adult epiphora.

    LENUS (Irish Health Repository)

    Fenton, S

    2012-02-03

    PURPOSE: To determine the efficacy of dacryocystoplasty with balloon dilation in the treatment of acquired obstruction of the nasolacrimal system in adults. METHODS: Balloon dacryocystoplasty was performed in 52 eyes of 42 patients under general anaesthetic. A Teflon-coated guidewire was introduced through the canaliculus and manipulated through the nasolacrimal system and out of the nasal aperture. A 4 mm wide 3 cm coronary angioplasty balloon catheter was threaded over the guidewire in a retrograde fashion and dilated at the site of obstruction. RESULTS: There was complete obstruction in 30% of cases and partial obstruction in 70%. The most common site of obstruction was the nasolacrimal duct. The procedure was technically successful in 94% of cases. The overall re-obstruction rate was 29% within 1 year of the procedure. There was an anatomical failure rate of 17% for partial obstruction and 69% for complete obstruction within 1 year. CONCLUSIONS: Balloon dacryocystoplasty has a high recurrence rate. There may be a limited role for this procedure in partial obstructions. Further refinements of the procedure are necessary before it can be offered as a comparable alternative to a standard surgical dacryocystorhinostomy.

  10. Intracoronary {beta}-brachytherapy using a rhenium-188 filled balloon catheter in restenotic lesions of native coronary arteries and venous bypass grafts

    Energy Technology Data Exchange (ETDEWEB)

    Woehrle, Jochen; Nusser, Thorsten; Habig, Thomas; Kochs, Matthias; Hombach, Vinzenz [University of Ulm, Department of Internal Medicine II (Germany); Krause, Bernd J.; Mottaghy, Felix M.; Reske, Sven N. [University of Ulm, Department of Nuclear Medicine (Germany); Kotzerke, Joerg [University of Dresden, Department of Nuclear Medicine (Germany); Hoeher, Martin [Klinikum Bayreuth, Department of Internal Medicine II (Germany)

    2006-11-15

    We have previously demonstrated the efficacy of intracoronary {beta}-brachytherapy using a liquid{sup 188}Re-filled balloon in a randomised trial including de novo lesions. Percutaneous coronary interventions in restenotic lesions and in stenoses of venous bypass grafts are characterised by a high recurrence rate for restenosis and re-interventions. Against this background, we wanted to assess the impact of intracoronary {beta}-brachytherapy using a liquid{sup 188}Re-filled balloon in restenotic lesions in native coronary arteries and venous bypass grafts. In 243 patients, {beta}-brachytherapy with 22.5 Gy was applied at a tissue depth of 0.5 mm. Patients were followed up angiographically after 6 months and clinically for 12 months. The primary clinical endpoint was the incidence of MACE (death, myocardial infarction, target vessel revascularisation). Secondary angiographic endpoints were late loss and binary restenosis rate in the total segment. All irradiation procedures were successfully performed. A total of 222 lesions were in native coronary arteries; 21 were bypass lesions. Mean irradiation length was 41.6{+-}17.3 mm (range 20-150 mm) in native coronary arteries and 48.1{+-}33.9 mm (range 30-180 mm) in bypass lesions; the reference diameter was 2.57{+-}0.52 mm and 2.83{+-}0.76 mm, respectively. There was no vessel thrombosis during antiplatelet therapy. Angiographic/clinical follow-up rate was 84%/100%. MACE rate was 17.6% in the native coronary artery group and 38.1% in the CABG group (p<0.03). Binary restenosis rate was 22.5% and 55.6% (p<0.01), and late loss was 0.38{+-}0.72 mm and 1.33{+-}1.11 mm (p<0.001), respectively. We conclude that intracoronary {beta}-brachytherapy with a liquid{sup 188}Re-filled balloon using 22.5 Gy at a tissue depth of 0.5 mm in restenotic lesions is safe. It is associated with a low binary restenosis rate, resulting in a low occurrence rate of MACE within 12 months in restenotic lesions in native coronary arteries but not in

  11. Changes in coronary bifurcations after stent placement in the main vessel and balloon opening of stent cells:theory and practical verification on a bench-test model

    Institute of Scientific and Technical Information of China (English)

    Dobrin Vassilev; Robert Gil

    2008-01-01

    Objective To describe changes that occur in stent morphology and structure after its implantation in coronary bifurcation.Side branch (SB) compromise after stenting of main vessel in coronary bifurcation is a major intraprocedural problem and for the long term,as a place of restenosis.Methods We created an elastic wall model (parent vessel diameter 3.5mm,daughter branches 3.5mm and 2.75mm)with 30,45 and 60 degree distal angulation between branches.After stent implantation,struts to the side branch were opened with 2.0mm and consequently 3.0mm diameter balloons.Subsequent balloon redilatations and kissing balloon inflations (KBI) were performed.All stages of the procedure were photographed with magnification up to 100 times.Results We found that the leading mechanism for side branch compromise was carina displacement,and discovered theoretical description for expected ostial stenosis severity.Based on our model we found that displacement of bifurcation flow divider cause SB stenosis with almost perfect coincidence with our theoretical predictions.Opening of stent cells through the proximal and distal stent struts always increased interslrut distance,but never achieved good apposition to the wall.Balloon diameter increase didn't give proportional enlargement in stent cell diameters.KBI leads to some small better stent positioning,correcting main vessel strut dislodgment from wall,but never gave full strut-wall contact.Distance between struts and wall was minimal only when the stent cell perfectly faced ostium of SB.This was also our observation that the shape of ostium of SB becomed eUiptically-bean shaped after stent implantation and generally kept that shape during consequent stages of experiment.Measured diameter and area stenosis were perfectly fitted and theoretically predicted from our concept Conclusion We have described stent-wall deformations in stent-balloon technique for treatment of coronary bifurcation demonstrating carina displacement as possibly main

  12. Cardiological-interventional therapy of coronary artery disease today; Kardiologisch-interventionelle Therapie der koronaren Herzerkrankung heute

    Energy Technology Data Exchange (ETDEWEB)

    Reynen, K.; Henssge, R. [Technische Univ. Dresden (Germany). Klinik fuer Kardiologie

    1999-07-01

    The current importance of the interventional therapy of coronary artery disease may be deduced from the exponential increase in procedures performed in Germany in the last decade - at least 125,840 in 1996. Today, by improved catheter and balloon materials as well as by growing experience of the cardiologists, even complex lesions may be treated. Limitations of balloon angioplasty include acute vessel closure and restenosis - newer angioplasty devices like directional or rotational atherectomy or excimer-laser angioplasty did not overcome these limitations; only by coronary stenting, acute vessel closure could be managed and the likelihood of restenosis - at least in particular groups of patients - could be reduced. For a few years, intracoronary brachytherapy of the segments dilated with beta- or gamma-emitters has been seeking to reduce restenosis rate; the department of cardiology of the Dresden Cardiovascular Institute is participating in such a multicentre study using the beta-emitter {sup 188}renium. Further main topics of our department represent primary angioplasty in patients with acute myocardial infarction and invasive diagnostic or interventional procedures by the transradial approach. (orig.)

  13. Lentivirus-mediated RNAi knockdown of the gap junction protein, Cx43, attenuates the development of vascular restenosis following balloon injury.

    Science.gov (United States)

    Han, Xiao-Jian; Chen, Min; Hong, Tao; Zhu, Ling-Yu; He, Dan; Feng, Jiu-Geng; Jiang, Li-Ping

    2015-04-01

    Percutaneous coronary intervention [PCI or percutaneous transluminal coronary angioplasty (PTCA)] has been developed into a mature interventional treatment for atherosclerotic cardiovascular disease. However, the long-term therapeutic effect is compromised by the high incidence of vascular restenosis following angioplasty, and the underlying mechanisms of vascular restenosis have not yet been fully elucidated. In the present study, we investigated the role of the gap junction (GJ) protein, connexin 43 (Cx43), in the development of vascular restenosis. To establish vascular restenosis, rat carotid arteries were subjected to balloon angioplasty injury. At 0, 7, 14 and 2 days following balloon injury, the arteries were removed, and the intimal/medial area of the vessels was measured to evaluate the degree of restenosis. We found that the intimal area gradually increased following balloon injury. Intimal hyperplasia and restenosis were particularly evident at 14 and 28 days after injury. In addition, the mRNA and protein expression of Cx43 was temporarily decreased at 7 days, and subsequently increased at 14 and 28 days following balloon injury, as shown by RT-PCR and western blot analysis. To determine the involvement of Cx43 in vascular restenosis, the lentivirus vector expressing shRNA targeting Cx43, Cx43-RNAi-LV, was used to silence Cx43 in the rat carotid arteries. The knockdown of Cx43 effectively attenuated the development of intimal hyperplasia and vascular restenosis following balloon injury. Thus, our data indicate the vital role of the GJ protein, Cx43, in the development of vascular restenosis, and provide new insight into the pathogenesis of vascular restenosis. Cx43 may prove to be a novel potential pharmacological target for the prevention of vascular restenosis following PCI.

  14. Histopathology of human laser thermal angioplasty recanalization.

    Science.gov (United States)

    White, R A; White, G H; Vlasak, J; Fujitani, R; Kopchok, G E

    1988-01-01

    Laserprobe thermal-assisted balloon, angioplasty (LTBA) has demonstrated promising initial clinical results in recanalizing stenotic or occluded superficial femoral and popliteal arteries. Over the past year we have obtained six specimens of laserprobe thermal (LT) and LTBA treated total occlusions (avg. length 12 cm) for histopathologic examination from patients who were treated for limb salvage. Three tissue specimens were obtained acutely, and one was obtained at 6, 8, and 13 days, respectively, after laser angioplasty at the time of revision for complications or failed procedures. Serial histologic sections of the treated LT segments demonstrated recanalization of atherosclerotic lesions to approximately 60-70% of the probe diameter. The LT channels were lined by a thin layer of carbonized or coagulated tissue and several layers of cell necrosis. The histology of the thermal injury was similar regardless of whether it was produced by the heated metal cap or by free argon laser energy. Stellate balloon angioplasty fractures were frequently filled with thrombus. Analysis of these human LT and LTBA specimens revealed that the thermal device produces a confined injury through the path of least resistance. Balloon dilatation produces fragmented cracks in the vessel wall, which appear to be more thrombogenic than the carbonized LT surface. With improved guidance methods, LTBA shows potential for continuing development.

  15. Rescue AVE Stent Placement for Left Anterior Descending Coronary Artery Occlusion During Diagnostic Angiography.

    Science.gov (United States)

    van Dijk D; Ernst; Six; Plokker

    1996-06-01

    In a 65-year-old male with coronary artery disease a proximal occlusion of the left anterior descending coronary artery occurred during diagnostic coronary angiography. The most likely cause was an occlusive dissection. This resulted in acute myocardial ischemia and immediate cardiogenic shock. The decision was made to proceed to emergency percutaneous transluminal coronary angioplasty (PTCA). After balloon dilatation, a 3.5 mm AVE stent was deployed successfully at the site of the lesion. This resulted in a satisfactory angiographic result and an immediate improvement of the clinical picture. We conclude that placement of an AVE stent can provide a means for restoring flow in case of acute occlusive dissection during coronary angiography.

  16. Distal protection devices during percutaneous coronary and carotid interventions.

    Science.gov (United States)

    Fasseas, Panayotis; Orford, James L; Denktas, Ali E; Berger, Peter B

    2001-01-01

    Distal embolization of particulate matter complicates percutaneous coronary and peripheral interventions more often than had been recognized until recently. A number of distal protection devices are under development. The PercuSurge GuardWiretrade mark is a balloon occlusion thrombectomy device approved by the United States Food and Drug Administration for saphenous vein graft intervention. A number of filter devices utilize an expandable filter mounted on the angioplasty guidewire to facilitate entrapment of particles and safe removal. The Parodi Anti-Emboli Systemtrade mark is an example of a catheter occlusion device that establishes protection by reversing blood flow in the target vessel.

  17. Distal protection devices during percutaneous coronary and carotid interventions

    Directory of Open Access Journals (Sweden)

    Berger Peter B

    2001-11-01

    Full Text Available Abstract Distal embolization of particulate matter complicates percutaneous coronary and peripheral interventions more often than had been recognized until recently. A number of distal protection devices are under development. The PercuSurge GuardWire™ is a balloon occlusion thrombectomy device approved by the United States Food and Drug Administration for saphenous vein graft intervention. A number of filter devices utilize an expandable filter mounted on the angioplasty guidewire to facilitate entrapment of particles and safe removal. The Parodi Anti-Emboli System™ is an example of a catheter occlusion device that establishes protection by reversing blood flow in the target vessel.

  18. Prevention of Intracranial In-stent Restenoses: Predilatation with a Drug Eluting Balloon, Followed by the Deployment of a Self-Expanding Stent

    Energy Technology Data Exchange (ETDEWEB)

    Vajda, Zsolt, E-mail: Z.Vajda@klinikum-stuttgart.de; Guethe, Thomas, E-mail: T.Guethe@klinikum-stuttgart.de; Perez, Marta Aguilar, E-mail: M.Aguilar@klinikum-stuttgart.de; Kurre, Wiebke, E-mail: w.kurre@klinikum-stuttgart.de [Klinikum Stuttgart, Katharinenhospital, Klinik fuer Neuroradiologie, Neurozentrum (Germany); Schmid, Elisabeth, E-mail: ESchmid@klinikum-stuttgart.de; Baezner, Hansjoerg, E-mail: H.Baezner@klinikum-stuttgart.de [Klinikum Stuttgart, Klinik fuer Neurologie, Neurozentrum (Germany); Henkes, Hans, E-mail: hhhenkes@aol.com [Klinikum Stuttgart, Katharinenhospital, Klinik fuer Neuroradiologie, Neurozentrum (Germany)

    2013-04-15

    Stenting in intracranial atherosclerotic disease (ICAD) is increasingly debated, due to issues of procedural safety, technical efficacy, and in-stent recurrent stenoses (ISR). In the present study, feasibility, safety, and efficacy of angioplasty using a drug-eluting balloon (DEB) followed by the implantation of a self-expanding stent (Enterprise) were evaluated for the treatment of ICAD lesions. Fifty-two patients (median age: 71 years; range: 54-86 years; male/female ratio 37:15) underwent stenting of high-grade ICAD lesions between February 2010 and November 2011 in a single center. Angioplasty using a paclitaxel coated SeQuent Please (B. Braun, Germany) or DIOR (Eurocor, Germany) coronary PTCA balloon, followed by the implantation of a self-expanding stent (Enterprise, Codman, USA) was performed in 54 lesions. Angiographic and clinical follow-up was performed at 6 and 12 weeks, 6 and 12 months, and yearly thereafter. Technical success rate, periprocedural complications, occurrence of recurrent ischemic symptoms, and the development of an ISR were analyzed. Angioplasty using a DEB followed by stent implantation was successfully performed in 44 (81 %) cases. DEB insertion failed in 19 % of the cases and angioplasty was finally performed using a conventional PTCA balloon. The combined procedure related permanent neurologic morbidity and mortality rate (stroke, ICH, and subarachnoid hemorrhage) at 30 days and beyond was 5 %. Angiographic and clinical follow-up were obtained in 33 (61 %) lesions in 32 patients. Recurrent stenosis was seen in one (3 %) lesion. Angioplasty and stenting using a DEB is safe and yields encouragingly low ISR rates. Further technical developments to improve lesion accessibility are, nevertheless, mandatory.

  19. Initial experience with the Impella left ventricular assist device for postcardiotomy cardiogenic shock and unprotected left coronary artery angioplasty in patients with a low left ventricular ejection fraction

    National Research Council Canada - National Science Library

    Bautista-Hernández, Víctor; Gutiérrez, Francisco; Pinar, Eduardo; Gimeno, Juan R; Arribas, José M; García-Puente, Julio; Ray, Victor G; Arcas, Ramón; Valdés, Mariano

    2007-01-01

    .... Ventricular assist devices have been used to treat patients who suffer from postoperative cardiogenic shock despite use of an intraaortic balloon pump and maximum inotropic support. The Impella pump...

  20. Rescue coronary stenting in acute myocardial infarction

    Science.gov (United States)

    Barbieri, Enrico; Meneghetti, Paolo; Molinari, Gionata; Zardini, Piero

    1996-01-01

    Failed rescue coronary angioplasty is a high risk situation because of high mortality. Coronary stent has given us the chance of improving and maintaining the patency of the artery. We report our preliminary experience of rescue stenting after unsuccessful coronary angioplasty.

  1. Impact of kissing balloon inflation on the main vessel stent volume, area, and symmetry after side-branch dilation in patients with coronary bifurcation lesions: a serial volumetric intravascular ultrasound study.

    Science.gov (United States)

    Rahman, Shahid; Leesar, Tara; Cilingiroglu, Mehmet; Effat, Mohamed; Arif, Imran; Helmy, Tarek; Leesar, Massoud A

    2013-09-01

    Intravascular ultrasound (IVUS) was performed to investigate the impact of kissing balloon inflation (KBI) on the main vessel (MV) stent volume, area, and symmetry after side-branch (SB) dilation in patients with coronary bifurcation lesions (CBL). It remains controversial whether KBI would restore the MV stent area and symmetry loss after SB dilation. A total of 88 serial IVUS examinations of the MV were performed after MV angioplasty, MV stenting, SB dilation, and KBI in 22 patients with CBL. The MV stent was divided into proximal, bifurcation, and distal segments; the stent volume index (SVI), minimal stent area (MSA), stent symmetry index (SSI), and external elastic membrane (EEM) volume index were measured in 198 stent segments and compared after MV stenting, SB dilation, and KBI. In the bifurcation segment, SVI, MSA, and SSI were significantly smaller after SB dilation than after MV stenting and KBI (SVI was 6.10 ± 1.50 mm(3)/mm vs. 6.68 ± 1.60 mm(3)/mm and 6.57 ± 1.60 mm(3)/mm, respectively, p < 0.05; MSA was 5.15 ± 1.30 mm(2) vs. 6.08 ± 1.40 mm(2) and 5.86 ± 1.50 mm(2), respectively, p < 0.05; and SSI was 0.78 ± 0.02 mm(2) vs. 0.87 ± 0.03 mm(2) and 0.84 ± 0.03 mm(2), respectively, p < 0.05). KBI restored the MV SVI, MSA, and SSI after SB dilation. In the proximal segment, SVI, MSA, and EEM volume index were significantly larger, but SSI was smaller after KBI than after MV stenting and SB dilation. In the distal segment, neither SB dilation nor KBI had a significant impact on the MV stent volume or symmetry. This is the first comprehensive volumetric IVUS analysis of CBL, to our knowledge, demonstrating that KBI restores the MV stent volume, area, and symmetry loss after SB dilation in the bifurcation segment, and induces asymmetric stent expansion in the proximal segment. Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  2. Segmentally enclosed thrombolysis in percutaneous transluminal angioplasty for femoropopliteal occlusions

    DEFF Research Database (Denmark)

    Jørgensen, B; Tønnesen, K H; Nielsen, J D;

    1991-01-01

    Segmentally enclosed thrombolysis (SET) was performed immediately following 34 percutaneous transluminal angioplasties (PTAs) for femoropopliteal occlusions. The dilated segment was sealed off with a double balloon catheter, and recombinant tissue plasminogen activator (rt-PA) 1 mg/ml and heparin...

  3. Role of endovascular irradiation in the prevention of vascular restenosis following angioplasty; Role de la curietherapie endovasculaire dans la prevention de la restenose vasculaire apres angioplastie

    Energy Technology Data Exchange (ETDEWEB)

    Noel, G.; Feuvret, L.; Mazeron, J.J.; Pousset, F. [Hopital Pitie-Salpetriere, 75 - Paris (France); Bourhis, J.; Gerbaulet, A. [Institut Gustave Roussy, 94 - Villejuif (France); Popowski, Y. [Hopital Universitaire, Geneve (Switzerland)

    1998-07-01

    About 30% of patients who underwent percutaneous transluminal coronary angioplasty show evidence of restenosis, which appears to be independent of the angioplasty method used. The restenosis is due of two factors, Firstly migration of smooth vascular muscle cells of the vascular media to the intima and multiplication which lead to the formation of a neo-intima. Irradiation limits the proliferation by acting of the cells in the mitotic stage. The vascular target volume is not very thick and is difficult to define it, that why brachytherapy seems to be the best procedure to prevent restenosis. However, the development of this treatment present many difficulties. Different irradiation techniques have been studied. Such techniques include catheter containing radioactive sealed source, radioactive stent, or balloon containing radioactive liquid inside. Each of these methods have their own advantages, inconveniences, problems and risks. Radioisotope may be either beta or gamma emitters.Gamma emitter presents problems for radioprotection but the satisfactory dose distribution may be difficult to obtain using beta emitter. Choice of dose, dose rate and delay between the end of angioplasty and the beginning of brachytherapy is subject to some discuss. Animal experiments using radioisotope have shown reduction in cell proliferation. Human trials showed feasibility, safety of the method and real impact on restenosis prevention. However, long-term efficacy has not been proved because the follow-up of the patients is too short. A randomized trial of {sup 192}Ir brachytherapy for prevention of restenosis has recently shown the efficacy in short and median term. However, long term efficiency and secondary effects have not yet been established as the follow up time of this study is still too short. That is why, collaboration between cardiologists and radiotherapists and physicists is indispensable to enable the development of an optimal technique. (authors)

  4. Thermal laser-assisted angioplasty of renal artery stenosis for renovascular hypertension.

    Science.gov (United States)

    Tani, M; Mizuno, K; Midorikawa, H; Igari, T; Egawa, M; Niimura, S; Fukuchi, S; Hoshino, S

    1993-01-01

    Percutaneous transluminal laser-assisted angioplasty of a renal artery stenosis was performed in a 16-year-old woman with renovascular hypertension. The stenotic portion of the renal artery was predilated by delivering Nd-YAG laser energy to the terminal tip of a laser catheter. Although the luminal diameter did not increase sufficiently with laser angioplasty alone, it allowed passage of the balloon catheter and subsequent successful balloon angioplasty. Immediately after dilatation, the patient's blood pressure fell to normal, and plasma renin activity decreased. There were no serious complications. Thermal laser angioplasty seems to be an effective adjunct technique for the treatment of severe renal artery stenosis which does not allow initial passage of a balloon catheter.

  5. Distance to invasive heart centre, performance of acute coronary angiography, and angioplasty and associated outcome in out-of-hospital cardiac arrest

    DEFF Research Database (Denmark)

    Tranberg, Tinne; Knudsen Lippert, Freddy; Christensen, Erika F

    2017-01-01

    Aims: To evaluate whether the distance from the site of event to an invasive heart centre, acute coronary angiography (CAG)/percutaneous coronary intervention (PCI) and hospital-level of care (invasive heart centre vs. local hospital) is associated with survival in out-of-hospital cardiac arrest...

  6. Everolimus-eluting coronary stents

    Directory of Open Access Journals (Sweden)

    Alejandro Saez

    2010-09-01

    Full Text Available Alejandro Saez, Raul MorenoDivision of Interventional Cardiology, University Hospital La Paz, Madrid, SpainAbstract: Bare metal stents enabled a reduction in the risk of early procedural complications and restenosis in comparison with balloon angioplasty alone, but introduced a new and device-specific iatrogenic condition, ie, in-stent restenosis due to increased neointimal hyperplasia. Sirolimus- and paclitaxel-eluting stents reduce restenosis and the need for new revascularizations in comparison with bare metal stents, although at the cost of a slight increase in the risk of late stent thrombosis and a need for prolonged dual antiplatelet therapy. Everolimus is an analog of sirolimus with an increased solubility. In this review, the currently available evidence for everolimus-eluting stents is revised, including randomized trials against bare metal stents, and head-to-head trials comparing this stent with other drug-eluting stents.Keywords: coronary stents, restenosis, everolimus, review

  7. Fogarty Maneuver to Restore Coronary Flow in ST-Segment Elevation Myocardial Infarction: Desperate Times Call for Desperate Measures.

    Science.gov (United States)

    Larralde, Mark J; Afzal, Ashwad; Brener, Sorin J

    2016-01-01

    Nonatherosclerotic embolism is a rare cause (4%-7%) of coronary occlusion in ST-segment elevation myocardial infarction (STEMI) patients, approximately half of which occur in inadequately anticoagulated patients with prosthetic valves. We report a rare case of a patient with severe rheumatic heart disease and 3 mechanical valves presenting with STEMI that was successfully managed by Fogarty maneuver thrombus extraction after failed thrombus aspiration and balloon angioplasty. A 56-year-old woman presented with an acute anterior STEMI and Killip class III heart failure. She had severe rheumatic heart disease with mechanical tricuspid, mitral and aortic valve prostheses, and atrial fibrillation on warfarin anticoagulation. The international normalized ratio on admission was 1.1. Emergency coronary angiography revealed normal right and circumflex coronary arteries and a total occlusion in the mid left anterior descending artery with a meniscus appearance. Multiple attempts at thrombus aspiration and balloon angioplasty failed to restore flow in the left anterior descending artery. Ultimately, a Fogarty maneuver using a compliant balloon inflated at a low pressure was performed successfully, removing the thrombus into the guiding catheter. There was Thrombolysis in Myocardial Infarction flow grade 3 and near-normal myocardial blush at the end of the procedure. Signs and symptoms of heart failure resolved quickly.

  8. Anatomical and Physiological Changes after Paclitaxel-Coated Balloon for Atherosclerotic De Novo Coronary Lesions: Serial IVUS-VH and FFR Study.

    Directory of Open Access Journals (Sweden)

    Soe Hee Ann

    Full Text Available To assess the serial changes of de novo coronary lesions treated with paclitaxel-coated balloon (PCB using intravascular ultrasound virtual histology (IVUS-VH and fractional flow reserve (FFR.This prospective observational study enrolled 27 patients with coronary artery disease treated with PCB who underwent coronary angiography, IVUS-VH and FFR before, immediately after intervention and at 9 months. 28 de novo lesions were successfully treated with PCB. Angiographic late luminal loss was 0.02 ± 0.27 mm. Mean vessel and lumen areas showed increase at 9 months (12.0 ± 3.5 mm(2 to 13.2 ± 3.9 mm(2, p <0.001; and 5.4 ± 1.2 mm(2 to 6.5 ± 1.8 mm(2, p <0.001, respectively. Although mean plaque area was unchanged (6.6 ± 2.6 mm2 to 6.6 ± 2.4 mm(2, p = 0.269, percent atheroma volume decreased significantly (53.4 ± 7.9% to 49.5 ± 6.4%, p = 0.002. The proportion of plaque compositions including fibrous, fibrofatty, dense calcium and necrotic core by IVUS-VH was unchanged at 9 months. The FFR of the treated lesion was 0.71 ± 0.13 pre-procedure, 0.87 ± 0.06 post-procedure and 0.84 ± 0.06 at follow-up.De novo coronary lesions treated with PCB showed persistent anatomical and physiological patency with plaque redistribution and vessel remodeling without chronic elastic recoil or plaque compositional change during follow-up.

  9. Pumpkin Balloon

    OpenAIRE

    Nishimura, Jun; 西村, 純

    1992-01-01

    The Pumpkin shaped balloons, which are the extreme case of the heart-type balloons had been studied as one of the promising candidate of the super pressure balloons. Here, detailed studies for the features of the pumpkin balloons are described, particularly by comparing with those of the spherical shaped super pressure balloons.

  10. Restenosis detection; Depistage de la restenose. Evaluation des interventions de revascularisation coronaire par les techniques de cardiologie nucleaire. Surveillance cardiologique des patients ayant beneficie d`une angioplastie: importance de la scintigraphie myocardique avec epreuve d`effort

    Energy Technology Data Exchange (ETDEWEB)

    Py, M.; Karcher, G.; Bertrand, A. [Centre Hospitalier Universitaire, 54 -Nancy (France); Guyon, P.; Caussin, C.; Bourachot, M.L.; Elhadad, S.; Dib, J.C.; Wartski, M.; Zerbib, E.; Lancelin, B. [Centre chirurgical Marie-Lannelongue, 92 - Le Plessis-Robinsson (France)

    1997-12-31

    Coronary angioplasty is now a very useful technique of revascularization. However, restenosis represents a major problem of this technique. P.Y. Marie details the performance of nuclear cardiology techniques in the evaluation of aorto-coronary bypass and coronary angioplasty. P. Guyon reports on the experience of the surgical center Marie-Lannelongue in the follow-up patients having coronary angioplasty. Then, discussions point out the patho-physiological aspects of restenosis. (authors). 31 refs.

  11. The Dutch experience in percutaneous transluminal angioplasty of narrowed saphenous veins used for aortocoronary arterial bypass

    NARCIS (Netherlands)

    W.H.T. Plokker; H.J. Meester (Hannie); P.W.J.C. Serruys (Patrick)

    1991-01-01

    textabstractOf 19,994 percutaneous transluminal coronary angioplasty procedures performed in The Netherlands between April 1980 and January 1989, the long-term follow-up of 454 patients who underwent angioplasty of greater than or equal to 1 saphenous vein bypass graft was reviewed. In 46% of patien

  12. Provisional stenting of coronary bifurcations: insights into final kissing balloon post-dilation and stent design by computational modeling.

    Science.gov (United States)

    Mortier, Peter; Hikichi, Yutaka; Foin, Nicolas; De Santis, Gianluca; Segers, Patrick; Verhegghe, Benedict; De Beule, Matthieu

    2014-03-01

    This study sought to better understand and optimize provisional main vessel stenting with final kissing balloon dilation (FKBD). Main vessel stenting with FKBD is widely used, but many technical variations are possible that may affect the final result. Furthermore, most contemporary stent designs have a large cell size, making the impact of stent platform selection for this procedure unclear. Finite element simulations were used to virtually deploy and post-dilate 3 stent platforms in 3 bifurcation models. Two FKBD strategies were evaluated: simultaneous FKBD (n = 27) and modified FKBD (n = 27). In the simultaneous FKDB technique, both balloons were simultaneously inflated and deflated. In the modified FKBD technique, the side branch balloon was inflated first, then partially deflated, followed by main branch balloon inflation. Modified FKBD results in less ostial stenosis compared with simultaneous FKBD (15 ± 9% vs. 20 ± 11%; p < 0.001) and also reduces elliptical stent deformation (ellipticity index, 1.17 ± 0.05 vs. 1.36 ± 0.06; p < 0.001). The number of malapposed stent struts was not influenced by the FKBD technique (modified FKBD, 6.3 ± 3.6%; simultaneous FKBD, 6.4 ± 3.4%; p = 0.212). Stent design had no significant impact on the remaining ostial stenosis (Integrity [Medtronic, Inc., Minneapolis, Minnesota], 16 ± 11%; Omega [Boston Scientific, Natick, Massachusetts], 17 ± 11%; Multi-Link 8 [Abbott Vascular, Santa Clara, California], 19 ± 8%). The modified FKBD procedure reduces elliptical stent deformation and optimizes side branch access. Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  13. Who is responsible for the consequences? A case of stent thrombosis subsequent to noncompliance with post angioplasty treatment regimen.

    Science.gov (United States)

    Sajwani, Salma Abdul Aziz; Allana, Saleema

    2014-01-01

    Coronary artery disease (CAD) is a major cause of mortality internationally and in Pakistan. Angioplasty has been proven to be an effective treatment for CAD. Stent thrombosis is a known but preventable complication of angioplasty. Several factors may lead to stent thrombosis with non-compliance with the prescribed drug regimen, being one of the most important factors. We report a case of stent thrombosis after four months of angioplasty. After exploring of patient's post angioplasty routines, it was found that the patient was non-compliant with the prescribed anti- platelets and other prescribed drugs. This time the patient presented with another acute myocardial infarction, and he went through angioplasty again.

  14. Effects of a behavioural intervention on quality of life and related variables in angioplasty patients

    DEFF Research Database (Denmark)

    Appels, Ad; van Elderen, Therese; Bär, Frits

    2006-01-01

    The EXhaustion Intervention Trial investigated the effect of a behavioural intervention programme on exhaustion, health-related quality of life (HRQL), depression, anxiety, hostility, and anginal complaints in angioplasty patients who felt exhausted after percutaneous coronary intervention (PCI)....

  15. Aggressive plaque modification with rotational atherectomy and cutting balloon for optimal stent expansion in calcified lesions

    Science.gov (United States)

    Tang, Zhe; Bai, Jing; Su, Shao-Ping; Lee, Pui-Wai; Peng, Liang; Zhang, Tao; Sun, Ting; Nong, Jing-Guo; Li, Tian-De; Wang, Yu

    2016-01-01

    Objective To evaluate the factors affecting optimal stent expansion in calcified lesions treated by aggressive plaque modification with rotational atherectomy (RA) and a cutting balloon (CB). Methods From January 2014 to May 2015, 92 patients with moderate to severe coronary calcified lesions underwent rotational atherectomy and intravascular ultrasound imaging at Chinese PLA General Hospital (Beijing, China) were included in this study. They were divided into a rotational artherectomy combined with cutting balloon (RACB) group (46 patients treated with RA followed by CB angioplasty) and an RA group (46 patients treated with RA followed by plain balloon angioplasty). Another 40 patients with similar severity of their calcified lesions treated with plain old balloon angioplasty (POBA) were demographically matched to the other groups and defined as the POBA group. All patients received a drug-eluting stent after plaque preparation. Lumen diameter and lumen diameter stenosis (LDS) were measured by quantitative coronary angiography at baseline, after RA, after dilatation, and after stenting. Optimal stent expansion was defined as the final LDS < 10%. Results The initial and post-RA LDS values were similar among the three groups. However, after dilatation, the LDS significantly decreased in the RACB group (from 54.5% ± 8.9% to 36.1% ± 7.1%) but only moderately decreased (from 55.7% ± 7.8% to 46.9% ± 9.4%) in the RA group (time × group, P < 0.001). After stenting, there was a higher rate of optimal stent expansion in the RACB group (71.7% in the RACB group, 54.5% in the RA group, and 15% in the POBA group, P < 0.001), and the final LDS was significantly diminished in the RACB group compared to the other two groups (6.0% ± 2.3%, 10.8% ± 3.3%, 12.7% ± 2.1%, P < 0.001). Moreover, an LDS ≤ 40% after plaque preparation (OR = 2.994, 95% CI: 1.297–6.911) was associated with optimal stent expansion, which also had a positive correlation with the appearance of a

  16. Angioplasty and Vascular Stenting

    Science.gov (United States)

    ... flow in the graft or fistula making it inadequate for dialysis, angioplasty is generally the first line ... inform your doctor about recent illnesses or other medical conditions. Women ... does the equipment look like? In these procedures, x-ray imaging ...

  17. To kiss or not to kiss? Impact of final kissing-balloon inflation on early and long-term results of percutaneous coronary intervention for bifurcation lesions.

    Science.gov (United States)

    Biondi-Zoccai, Giuseppe; Sheiban, Imad; De Servi, Stefano; Tamburino, Corrado; Sangiorgi, Giuseppe; Romagnoli, Enrico

    2014-11-01

    Final kissing-balloon inflation is often recommended for percutaneous coronary intervention (PCI) of bifurcation lesions. However, randomized trials focusing on kissing inflation have not confirmed its beneficial impact. We compared outcomes of kissing inflation for PCI of bifurcation lesions, explicitly stratifying results according to stenting strategy. Patients undergoing bifurcation PCI were retrospectively enrolled. Subjects receiving final kissing inflation were compared with those not undergoing kissing inflation, after stratification for a single-stent technique. The primary end point was the long-term rate of major adverse cardiac events (MACE, i.e., death, myocardial infarction, or target lesion revascularization (TLR)). A total of 4314 patients were included: 1176 (27.3 %) treated with a single stent and kissing inflation, 1637 (37.9 %) with a single stent but no kissing, 1072 (24.8 %) with two stents and kissing, and 429 (9.9 %) with two stents but no kissing. At unadjusted analyses kissing was associated with fewer short-term MACE and deaths in the two-stent group, and with fewer long-term MACE, cardiac deaths, and side-branch TLR in the two-stent group (all P kissing appeared detrimental after single stenting. However, after multivariable analyses, kissing no longer significantly affected the risk of adverse events, with the exception of the risk of side-branch TLR, which was lower in those receiving two stents and final kissing inflation (hazard ratio = 0.52, 95 % confidence interval 0.30–0.90, P = 0.020). Kissing inflation can be avoided in bifurcation lesions uneventfully treated with single-stent PCI. However, final kissing-balloon inflation appears beneficial in reducing the risk of side-branch repeat revascularization after using a two-stent strategy.

  18. Cardiovascular devices; reclassification of intra-aortic balloon and control systems for acute coronary syndrome, cardiac and non-cardiac surgery, or complications of heart failure; effective date of requirement for premarket approval for intra-aortic balloon and control systems for septic shock or pulsatile flow generation. Final order.

    Science.gov (United States)

    2013-12-30

    The Food and Drug Administration (FDA) is issuing a final order to reclassify intra-aortic balloon and control system (IABP) devices when indicated for acute coronary syndrome, cardiac and non-cardiac surgery, or complications of heart failure, a preamendments class III device, into class II (special controls), and to require the filing of a premarket approval application (PMA) or a notice of completion of a product development protocol (PDP) for IABPs when indicated for septic shock or pulsatile flow generation.

  19. Knockdown of connexin 43 attenuates balloon injury-induced vascular restenosis through the inhibition of the proliferation and migration of vascular smooth muscle cells.

    Science.gov (United States)

    Han, Xiao-Jian; He, Dan; Xu, Liang-Jing; Chen, Min; Wang, Yi-Qi; Feng, Jiu-Geng; Wei, Min-Jun; Hong, Tao; Jiang, Li-Ping

    2015-11-01

    Coronary artery disease (CAD) or atherosclerotic heart disease is one of the most common types of cardiovascular disease. Although percutaneous coronary intervention [PCI or percutaneous transluminal coronary angioplasty (PTCA)] is a mature, well-established technique used to treat atherosclerotic heart disease, its long‑term therapeutic effects are compromised by a high incidence of vascular restenosis (RS) following angioplasty. In our previous study, we found that the principal gap junction protein, connexin 43 (Cx43), in vascular smooth muscle cells (VSMCs) was involved in the development of vascular RS following angioplasty-induced balloon injury. However, the exact role action of Cx43 in vascular RS remains unclear. In the present study, we aimed to further examine whether the knockdown of Cx43 attenuates the development of vascular RS through the inhibition of the proliferation and migration of VSMCs. We found that the use of a lentiviral vector expressing shRNA targeting Cx43 (Cx43‑RNAi-LV) efficiently silenced the mRNA and protein expression of Cx43 in cultured VSMCs. In addition, MTT and Transwell assays were used to examined the proliferation and migration of the VSMCs, respectively. The results revealed that the knockdown of Cx43 by Cx43-RNAi-LV at a multiplicity of infection (MOI) of 100 significantly inhibited the proliferation and migration of the VSMCs in vitro. Notably, the knockdown of Cx43 also effectively attenuated the development of vascular RS and intimal hyperplasia following balloon injury in vivo. Taken together, our data suggest that Cx43 is involved in the development of vascular RS and intimal hyperplasia through the regulation of the proliferation and migration of VSMCs. Thus, the present study provides new insight into the pathogenesis of vascular RS, and suggests that further comfirms that Cx43 may well be a novel potential pharmacological target for preventing vascular RS following PCI.

  20. Idiopathic, Serial Coronary Vessels Dissection in a Young Woman with Psychological Stress: A Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Alessio Arrivi

    2012-01-01

    Full Text Available Spontaneous coronary artery dissection (SCAD is a very rare disease, associated with high mortality rate, whose etiology and pathogenesis are poorly understood. Its sporadic nature and the varied angiographic extent make firm recommendations regarding revascularization impossible. The case described is that of a young, otherwise healthy woman, without a known underlying condition which may lead to SCAD, but with a history of intense psychological stress. We managed the patient with a conservative approach based on watchful waiting, medical therapy, and plain old balloon angioplasty (POBA with low inflation atmospheres.

  1. Comparative Analysis of Sequential Proximal Optimizing Technique Versus Kissing Balloon Inflation Technique in Provisional Bifurcation Stenting: Fractal Coronary Bifurcation Bench Test.

    Science.gov (United States)

    Finet, Gérard; Derimay, François; Motreff, Pascal; Guerin, Patrice; Pilet, Paul; Ohayon, Jacques; Darremont, Olivier; Rioufol, Gilles

    2015-08-24

    This study used a fractal bifurcation bench model to compare 6 optimization sequences for coronary bifurcation provisional stenting, including 1 novel sequence without kissing balloon inflation (KBI), comprising initial proximal optimizing technique (POT) + side-branch inflation (SBI) + final POT, called "re-POT." In provisional bifurcation stenting, KBI fails to improve the rate of major adverse cardiac events. Proximal geometric deformation increases the rate of in-stent restenosis and target lesion revascularization. A bifurcation bench model was used to compare KBI alone, KBI after POT, KBI with asymmetric inflation pressure after POT, and 2 sequences without KBI: initial POT plus SBI, and initial POT plus SBI with final POT (called "re-POT"). For each protocol, 5 stents were tested using 2 different drug-eluting stent designs: that is, a total of 60 tests. Compared with the classic KBI-only sequence and those associating POT with modified KBI, the re-POT sequence gave significantly (p < 0.05) better geometric results: it reduced SB ostium stent-strut obstruction from 23.2 ± 6.0% to 5.6 ± 8.3%, provided perfect proximal stent apposition with almost perfect circularity (ellipticity index reduced from 1.23 ± 0.02 to 1.04 ± 0.01), reduced proximal area overstretch from 24.2 ± 7.6% to 8.0 ± 0.4%, and reduced global strut malapposition from 40 ± 6.2% to 2.6 ± 1.4%. In comparison with 5 other techniques, the re-POT sequence significantly optimized the final result of provisional coronary bifurcation stenting, maintaining circular geometry while significantly reducing SB ostium strut obstruction and global strut malapposition. These experimental findings confirm that provisional stenting may be optimized more effectively without KBI using re-POT. Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  2. Percutaneous transluminal angioplasty in a patient with chronic cerebrospinal venous insufficiency and persistent left superior vena cava.

    Science.gov (United States)

    Lupattelli, T; Benassi, F; Righi, E; Bavera, P; Bellagamba, G

    2014-04-01

    Chronic cerebrospinal venous insufficiency (CCSVI) is a syndrome characterized by stenoses of the internal jugular veins (IJVs) and/or azygos veins and formation of collateral venous channels. A case of a 57-year-old patient with CCSVI in whom the venous outflow from the left IJV to the right atrium occurred through a venous anomaly, the persistent left superior vena cava (PLSVC), is reported. PLSVC is caused by persistence of the left anterior cardinal vein that drains blood from the limb effluent from the left and the left side of head and neck into coronary sinus (Type a), or in the left atrium (Type b). PLSVC can be associated either with innominate vein hypoplasia or other congenital heart abnormalities. Because of evidence of left innominate vein hypoplasia, angioplasty was not performed using the ordinary route but passing with the balloon directly through the PLSVC up to the left IJV. Finally, angioplasty was carried out in a standard manner in the right IJV as well as in the azygous vein. Confirmation angiogram revealed complete reopening of all treated vessels with no evidence of peri- and postoperative complications. The patient was discharged home the following day in good general conditions. PLSVC is a rare congenital vein anomaly but in case of concomitant innominate vein hypoplasia may prove to be a valuable alternative to treat patients with IJV diseases.

  3. Dual anterior descending coronary artery associated with coronary artery disease

    Directory of Open Access Journals (Sweden)

    Siqueira Luciane da L. V.

    2003-01-01

    Full Text Available The patient is a male with risk factors for coronary artery disease, who was referred for cardiac catheterization after acute myocardial infarction in the inferior wall. The patient underwent transluminal coronary angioplasty in the right coronary artery with successful stent implantation.

  4. Effects of platelet glycoprotein IIb/IIIa receptor blockade by a chimeric monoclonal antibody (abciximab) on acute and six-month outcomes after percutaneous transluminal coronary angioplasty for acute myocardial infarction. EPIC investigators.

    Science.gov (United States)

    Lefkovits, J; Ivanhoe, R J; Califf, R M; Bergelson, B A; Anderson, K M; Stoner, G L; Weisman, H F; Topol, E J

    1996-05-15

    Percutaneous transluminal coronary angioplasty (PTCA) for acute myocardial infarction is an attractive alternative to thrombolysis, but is still limited by recurrent ischemia and restenosis. We determined whether adjunctive platelet glycoprotein IIb/IIIa receptor blockade improved outcomes in patients undergoing direct and rescue PTCA in the Evaluation of c7E3 for Prevention of Ischemic Complications (EPIC) trial. Of the 2,099 patients undergoing percutaneous intervention who randomly received chimeric 7E3 Fab (c7E3) as a bolus, a bolus and 12-hour infusion, or placebo, 42 underwent direct PTCA for acute myocardial infarction and 22 patients had rescue PTCA after failed thrombolysis. The primary composite end point comprised death, reinfarction, repeat intervention, or bypass surgery. Outcomes were assessed at 30 days and 6 months. Baseline characteristics were similar in direct and rescue PTCA patients. Pooling the 2 groups, c7E3 bolus and infusion reduced the primary composite end point by 83% (26.1% placebo vs 4.5% c7E3 bolus and infusion, p = 0.06). No reinfarctions or repeat urgent interventions occurred in c7E3 bolus and infusion patients at 30 days, although there was a trend toward more deaths in c7E3-treated patients. Major bleeding was increased with c7E3 (24% vs 13%, p = 0.28). At 6 months, ischemic events were reduced from 47.8% with placebo to 4.5% with c7E3 bolus and infusion (p = 0.002), particularly reinfarction (p = 0.05) and repeat revascularization (p = 0.002). We conclude that adjunctive c7E3 therapy during direct and rescue PTCA decreased acute ischemic events and clinical restenosis in the EPIC trial. These data provide initial evidence of benefit for glycoprotein IIb/IIIa receptor blockade during PTCA for acute myocardial infarction.

  5. Peroxisome proliferator-activated receptor pathway gene polymorphism associated with extent of coronary artery disease in patients with type 2 diabetes in the bypass angioplasty revascularization investigation 2 diabetes trial.

    Science.gov (United States)

    Cresci, Sharon; Wu, Jun; Province, Michael A; Spertus, John A; Steffes, Michael; McGill, Janet B; Alderman, Edwin L; Brooks, Maria Mori; Kelsey, Sheryl F; Frye, Robert L; Bach, Richard G

    2011-09-27

    Coronary artery disease (CAD) is the major cause of death in patients with type 2 diabetes mellitus. Although demographic and clinical factors associated with extent of CAD in patients with diabetes mellitus have been described, genetic factors have not. We hypothesized that genetic variation in peroxisome proliferator-activated receptor (PPAR) pathway genes, important in diabetes mellitus and atherosclerosis, would be associated with extent of CAD in patients with diabetes mellitus. We genotyped 1043 patients (702 white, 175 blacks) from the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) genetic cohort for 3351 variants in 223 PPAR pathway genes using a custom targeted-genotyping array. Angiographic end points were determined by a core laboratory. In whites, a single variant (rs1503298) in TLL1 was significantly (P=5.5 × 10(-6)) associated with extent of CAD, defined as number of lesions with percent diameter stenosis ≥20%, after stringent Bonferroni correction for all 3351 single nucleotide polymorphisms. This association was validated in the diabetic subgroups of 2 independent cohorts, the Translational Research Investigating Underlying Disparities in Acute Myocardial Infarction Patients' Health Status (TRIUMPH) post-myocardial infarction registry and the prospective Family Heart Study (FHS) of individuals at risk for CAD. TLL1rs1503298 was also significantly associated with extent of severe CAD (≥70% diameter stenosis; P=3.7 × 10(-2)) and myocardial jeopardy index (P=8.7 × 10(-4)). In general linear regression modeling, TLL1rs1503298 explained more variance of extent of CAD than the previously determined clinical factors. We identified a variant in a single PPAR pathway gene, TLL1, that is associated with the extent of CAD independently of clinical predictors, specifically in patients with type 2 diabetes mellitus and CAD. Clinical Trial Registration- URL: http://www.clinicaltrials.gov. Unique identifier: NCT00006305.

  6. Medical operating personnel exposition levels during intracoronary irradiation using a Re188 full filled balloon catheter after percutaneous transluminal coronary artery

    Energy Technology Data Exchange (ETDEWEB)

    Ponce V, F.; Peix G, A.; Llerena R, L.; Santana V, L. [Instituto de Cardiologia, La Habana (Cuba); Lopez D, A. [Hospital Hermanos Amejeiras, La Habana (Cuba)

    2006-07-01

    The intracoronary irradiation using a full filled conventional balloon catheter with Rhenium 188 (Re188) after Percutaneous Transluminal Coronary Artery (PTCA) is a new relative treatment technique to reduce restenosis where the medical operating personnel are exposed to additional radiation ionizing level in the cath lab. In this study a radiation exposure level to medical operating personnel in the cath lab were measured with a Geiger Muller detector in 7 place to different distance from patient (to chest and abdominal region) catheter tabletop during a randomized clinical trial carried out in 25 patients whose were treated. The average concentrated Re188 activity used and treatment time were 5256{+-}2371 MBq/ml in 1.5-2 ml and 466{+-}195 seconds. At 3 cm from right arm patient the average maximum exposition rate were 0,63 mSv/h and 0,51 mSv h, to chest and abdominal patient level, respectively, where also average exposed dose per treated patient was 0,06 mSv and 0,05 mSv, respectively. Our results show that intracoronary irradiation with Re188 in the cath lab do not increase significatively the exposure radiation level to medical operating staff during treatment procedure and it is safe according national and international radiation protection regulations. (Author)

  7. Recanalization strategy of retrograde angioplasty in patients with coronary chronic total occlusion -analysis of 24 cases, focusing on technical aspects and complications.

    Science.gov (United States)

    Lee, Nae-Hee; Seo, Hye-Sun; Choi, Jae-Hyuk; Suh, Jon; Cho, Yoon Haeng

    2010-10-08

    Retrograde approach through collateral channels was recently proposed to increase the success rate of percutaneous coronary intervention (PCI) for coronary chronic total occlusion (CTO), but this approach is still an incompletely described technique. We analyzed 24 cases of retrograde PCI for CTO, which were done from July 2006 to April 2008. Septal collaterals were more frequently used than epicardial collaterals (75% vs. 25%), without showing statistical differences in wire passage rate according to the size or location of the collaterals. Once the retrograde wire successfully crossed collateral (18/24 cases), CTO lesion was successfully crossed in all cases by using 4 different kinds of techniques: retrograde wire crossing (44%), kissing wire (22%), controlled antegrade and retrograde subintimal tracking (22%), and reverse controlled antegrade and retrograde subintimal tracking (11%). Among them, successful recanalization was achieved in 17 cases, yielding 71% retrograde PCI success rate. In failed cases with retrograde approach, 4 cases were recanalized by switching to antegrade approach. Thus, total PCI success rate was 88% (21/24 cases). There were several cases of unexpected complications mainly related to collateral-donor artery without in-hospital major adverse cardiac events (MACE). During clinical follow-up (median 10.3 months), overall MACE rate was 18% in the successful retrograde PCI group. The retrograde approach can improve the success rate with PCI for CTO. However, strict case selection with systemized approach is essential due to the technical complexities accompanied by the potential risk of unexpected complications. Copyright © 2009 Elsevier B.V. All rights reserved.

  8. 可注射珊瑚人工骨与经皮球囊成型修复股骨头坏死%Percutaneous balloon angioplasty combined with injectable coral artificial bone repairs femoral head necrosis

    Institute of Scientific and Technical Information of China (English)

    朱康华; 孟志斌; 黄涛; 谭海涛; 孙博; 庞学毅

    2016-01-01

    BACKGROUND: There are many methods for the treatment of femoral head necrosis, such as core decompression, bone graft, arthroplasty and joint replacement, and each of which has its own shortcomings. So, percutaneous bal oon angioplasty combined with coral artificial bone provides a new attempt for the treatment of femoral head necrosis. OBJECTIVE: To observe the effect of percutaneous bal oon angioplasty combined with coral artificial bone on femoral head necrosis repair. METHODS: Twenty-four Duroc piglets were enrol ed to establish bilateral femoral head necrosis models by liquid nitrogen freezing method. Then, model piglets were randomly treated with percutaneous bal oon angioplasty combined with injectable coral artificial bone (experimental group) or bone cement (control group) on one affected side, and meanwhile, given no treatment on the contralateral side (blank control group). At 2, 4, 8 and 16 weeks after surgery, X-ray examination, biomechanical test and histological detection were conducted. RESULTS AND CONCLUSION: X-ray showed that at 16 weeks after surgery, numerous new bones could be found in the experimental group and there was a fuzzy boundary between the artificial bone and surrounding tissues; no new bone formed in the control group, and the boundary was clear; in the blank control group, the surface of the femoral head col apsed, and bone trabeculae arranged disorderly, which were seriously destroyed. And in the histological detection at 16 weeks after surgery, there were numerous bone trabecula and osteoblasts around the coral bone in the experimental group, and the coral artificial bone almost dissolved; in the control group, bone cement was in an irregular shape and no bone trabecula formed; in the blank control group, bone trabecula were damaged in the col apsed area, whose structure was in disorder. Additional y, biomechanical changes in the experimental group were significantly better than those in the other two groups at different time

  9. Balloon angioplasty to disrupt fibrin sheaths in tunneled dialysis catheters for the treatment of catheter dysfunctionb%球囊破坏纤维鞘纠正血液透析导管功能不良效果观察

    Institute of Scientific and Technical Information of China (English)

    詹申; 杨涛; 张丽红; 刘丽芳; 王玉柱

    2014-01-01

    目的 探索一种处理纤维鞘的新方法以改善透析患者的血流量.方法 6例无法建立动静脉内瘘并有多次多部位中心静脉导管留置史的维持性血液透析患者,经血管造影(Digital Substraction Angiography (DSA)证实存在导管相关纤维鞘.对纤维鞘行经皮腔内球囊扩张血管成形术(percutaneous transluminal angioplasty,PTA),然后经颈内静脉或股静脉途径置入长期中心静脉导管.结果术后应用导管透析,1例患者第2次透析时血流量为220ml/min,其余患者血流量均在250ml/min以上,随访2~6个月,所有患者均未出现导管功能不良及感染.结论球囊破坏纤维鞘可以改善导管的通畅性及血流量.

  10. Aggressive restenosis after percutaneous intervention in two coronary loci in a patient with human immunodeficiency virus infection

    Science.gov (United States)

    Alkhalil, Mohammad; Conlon, Christopher P; Ashrafian, Houman; Choudhury, Robin P

    2017-01-01

    A 54-year-old black African woman, 22 years human immunodeficiency virus (HIV)-positive, presented with an acute coronary syndrome. She was taking two nucleoside reverse transcriptase inhibitors and two protease inhibitors. Viral load and CD4 count were stable. Angiography revealed a right coronary artery lesion, which was treated with everolimus eluting stent. She also underwent balloon angioplasty to the first diagonal. She re-presented on three different occasions and technically successful coronary intervention was performed. The patient has reported satisfactory compliance with dual anti platelet therapy throughout. She was successfully treated with surgical revascularisation. The patient did not experience any clinical recurrence on follow up. This case demonstrates exceptionally aggressive multifocal and recurrent instent restenosis in a patient treated for HIV infection, raising the possibility of an association with HIV infection or potentially components of retro viral therapy. PMID:28255546

  11. ASSOCIATION OF HIGH LIPOPROTEIN(a LEVELS WITH CORONARY ARTERY PATENCY DURING THE FIRST YEAR AFTER PERCUTANEOUS CORONARY INTERVENTIONS

    Directory of Open Access Journals (Sweden)

    M. V. Ezhov

    2011-01-01

    Full Text Available Objective: to study an association of high lipoprotein(a [Lp(a] levels with the development of restenosis and the progression of coronaryatherosclerosis after percutaneous coronary interventions (PCI in patients with chronic coronary heart disease (CHD.Subjects and methods. From 502 enrolled patients (mean age 54.7 ± 8.9 years, 92 underwent routine percutaneous transluminal coronary angioplasty (PTCA, 270 had PTCA with the bare metal stent (BMS being implantation, 140 had PTCA using drug-eluting stents (DES. Functionalclasses III and IV angina have been registered in 337 (67 % patients; history of one myocardial infarction (MI was noted in 234 (47 % cases, 171 (34 % had experienced 2 or more MIs. Blood samples for lipid and Lp(a measurements were taken in all the patients. Restenosis was defined as at least 50 % lumen narrowing of the coronary artery segment after angioplasty. Coronary atherosclerosis progression was established in cases of the new occlusion occurring, as well as identifying a 10 % decrease in lumen diameter in comparison with baseline angiograms.Results. Repeated coronary angiography revealed the signs of restenosis in 103 of 243 patients. Dividing patients into 3 groups according to the type of intervention demonstrated that the level of Lp(a (median 25–75 % quartiles was significantly higher in the restenosis group after implantation of BMS (33; 11–62 and 16; 6–39 mg/dl, respectively; p = 0.014 versus those who had undergone DES implantation (23; 10–30 and 20; 6–60 mg/dl; p = 0.7 or balloon angioplasty (17; 4–48 and 9; 4–36 mg/dl; p = 0.3. Patients with progression of coronary atherosclerosis had difference only in Lp(a levels compared to the group without progression (36; 13–62 versus 12; 4–26 mg/dl, p < 0,001.Conclusion. During the first year after elective PCI Lp(a concentration determined the severity of coronary atherosclerosis in non-culprit lesionsand associated with the risk of in

  12. ASSOCIATION OF HIGH LIPOPROTEIN(a LEVELS WITH CORONARY ARTERY PATENCY DURING THE FIRST YEAR AFTER PERCUTANEOUS CORONARY INTERVENTIONS

    Directory of Open Access Journals (Sweden)

    M. V. Ezhov

    2014-07-01

    Full Text Available Objective: to study an association of high lipoprotein(a [Lp(a] levels with the development of restenosis and the progression of coronaryatherosclerosis after percutaneous coronary interventions (PCI in patients with chronic coronary heart disease (CHD.Subjects and methods. From 502 enrolled patients (mean age 54.7 ± 8.9 years, 92 underwent routine percutaneous transluminal coronary angioplasty (PTCA, 270 had PTCA with the bare metal stent (BMS being implantation, 140 had PTCA using drug-eluting stents (DES. Functionalclasses III and IV angina have been registered in 337 (67 % patients; history of one myocardial infarction (MI was noted in 234 (47 % cases, 171 (34 % had experienced 2 or more MIs. Blood samples for lipid and Lp(a measurements were taken in all the patients. Restenosis was defined as at least 50 % lumen narrowing of the coronary artery segment after angioplasty. Coronary atherosclerosis progression was established in cases of the new occlusion occurring, as well as identifying a 10 % decrease in lumen diameter in comparison with baseline angiograms.Results. Repeated coronary angiography revealed the signs of restenosis in 103 of 243 patients. Dividing patients into 3 groups according to the type of intervention demonstrated that the level of Lp(a (median 25–75 % quartiles was significantly higher in the restenosis group after implantation of BMS (33; 11–62 and 16; 6–39 mg/dl, respectively; p = 0.014 versus those who had undergone DES implantation (23; 10–30 and 20; 6–60 mg/dl; p = 0.7 or balloon angioplasty (17; 4–48 and 9; 4–36 mg/dl; p = 0.3. Patients with progression of coronary atherosclerosis had difference only in Lp(a levels compared to the group without progression (36; 13–62 versus 12; 4–26 mg/dl, p < 0,001.Conclusion. During the first year after elective PCI Lp(a concentration determined the severity of coronary atherosclerosis in non-culprit lesionsand associated with the risk of in

  13. Efficacy of Intra-aortic Balloon Pump before versus after Primary Percutaneous Coronary Intervention in Patients with Cardiogenic Shock from ST-elevation Myocardial Infarction

    Institute of Scientific and Technical Information of China (English)

    Lin Yuan; Shao-Ping Nie

    2016-01-01

    Background:Previous studies showed that patients with cardiogenic shock (CS) from ST-elevation acute myocardial infarction (STEMI) supported by intra-aortic balloon pump (IABP) before primary percutaneous coronary intervention (PCI) decreased the risk of in-hospital mortality than patients who received IABP after PCI.However,little evidence is available on the optimal order of IABP insertion and primary PCI.The aim of this study was to investigate the impact of the sequence of IABP support and PCI and its association with major adverse cardiac and cerebrovascular events (MACCEs).Methods:Data were obtained from 218 consecutive patients with CS due to STEMI in Beijing Anzhen Hospital between 2008 and 2014,who were treated with IABP and PCI.The patients were divided into two groups:Group A in whom IABP received before PCI (n =106)and Group B in whom IABP received after PCI (n =112).We evaluated the myocardial perfusion using myocardial blush grade and resolution of ST-segment elevation.The primary endpoint was 12-month risk of MACCE.Results:Most baseline characteristics were similar in patients between the two groups.However,patients received IABP before PCI were associated with a delay of door-to-balloon time (DBT) and higher troponin Ⅰ level (P < 0.05).However,myocardial perfusion was significantly improved in patients treated with IABP before PCI (P < 0.05).Overall,IABP support before PCI was not associated with significantly lower risk of MACCE (P > 0.05).In addition,risk of all-cause mortality,bleeding,and acute kidney injury (AKI)was similar between two groups (P > 0.05).Multivariate analysis showed that DBT (odds ratio [OR] 2.5,95% confidence interval [CI]1.1-4.8,P=0.04),IABP support after PCI (OR 5.7,95% CI 2.7-8.4,P=0.01),and AKI (OR 7.4,95% CI 4.9-10.8,P=0.01) were the independent predictors of mortality at 12-month follow-up.Conclusions:Early IABP insertion before primary PCI is associated with improved myocardial perfusion although DBT

  14. Percutaneous balloon angioplasty of coarctation of the aorta in children: 12-year follow-up results%经皮球囊血管成形术治疗先天性主动脉缩窄:12年随访结果

    Institute of Scientific and Technical Information of China (English)

    李奋; 周爱卿; 高伟; 王荣发; 余志庆; 黄美蓉; 杨建萍

    2001-01-01

    目的总结我院27例次经皮球囊血管成形术治疗先天性主动脉缩窄12年随访结果,以评价该介人方法的长期疗效及影响疗效的因素。方法 1987年9月至1999年8月,共有24例先天性主动脉缩窄患儿接受了27次经皮球囊血管成形术治疗,其中19例为局限性峡部缩窄(隔膜型),4例为主动脉弓发育不良型,1例为手术后再狭窄。选择的球囊直径一般不超过缩窄段近端主动脉直径(11.06±2.80mm与11.78±3.18mm),球囊/缩窄段之比为2~4(平均2.57±0.68)。术后随访6月~12年,平均6.2±2.8年。跨缩窄段压差≤20 mm Hg为疗效良好。结果术后跨缩窄段压差由48.17±14.68 mm Hg下降至14.96±13.12 mm Hg(P<0.01),缩窄段直径由4.66±2.43 mm增加至8.80±3.32 mm(P<0.01)。19例(79%)患儿即刻疗效良好。5例疗效不良患儿中,4例为发育不良型,1例为隔膜型。19例疗效良好患儿中,18例为隔膜型,1例为手术后再狭窄。1例隔膜型初次疗效良好的患儿随访中压差上升至30 mm Hg,2年半后接受第二次扩张术并获良好疗效;1例发育不良型患儿即刻疗效不佳,7年后再次行扩张术但疗效仍不理想;1例隔膜型但初次疗效不佳的患儿7年后再次行扩张术获良好效果。随访中无动脉瘤及其它并发症发生。结论经皮球囊血管成形术可有效治疗手术后复发性或隔膜型主动脉缩窄,对发育不良型治疗效果不佳。%Objective To evaluate the efficiency of percutaneous balloon angioplasty of coarctation ot the aorta in children and discuss its risk factors that can lead to poor long-term results. Mehods From September 1987 to August 1999, 24 patients underwent 27 balloon angioplasty procedures for native or recurrent coarctation of the aorta at our institution. There were 19 patients with discrete (membranous) coarctation, 4 patients with long-segment and aortic arch hypoplasia, and 1 patient with postoperative

  15. Indirect evidence for a role of a subpopulation of activated neutrophils in the remodelling process after percutaneous coronary intervention

    NARCIS (Netherlands)

    Costa, MA; de Wit, LEA; de Valk, V.; Serrano, P; Wardeh, AJ; Serruys, PW; Sluiter, W

    2001-01-01

    Aim Leukocytes have been implicated in restenosis following percutaneous transluminal coronary angioplasty. We investigated the link between the activated status of circulating neutrophils and restenosis after angioplasty. Methods and Results The population of 108 patients with single, de novo lesio

  16. Long-Term Clinical Outcomes of Final Kissing Ballooning in Coronary Bifurcation Lesions Treated With the 1-Stent Technique: Results From the COBIS II Registry (Korean Coronary Bifurcation Stenting Registry).

    Science.gov (United States)

    Yu, Cheol Woong; Yang, Jeong Hoon; Song, Young Bin; Hahn, Joo-Yong; Choi, Seung-Hyuk; Choi, Jin-Ho; Lee, Hyun Jong; Oh, Ju Hyeon; Koo, Bon-Kwon; Rha, Seung Woon; Jeong, Jin-Ok; Jeong, Myung-Ho; Yoon, Jung Han; Jang, Yangsoo; Tahk, Seung-Jea; Kim, Hyo-Soo; Gwon, Hyeon-Cheol

    2015-08-24

    This study investigated the impact of final kissing ballooning (FKB) after main vessel (MV) stenting on outcomes in patients with coronary bifurcation lesions after application of the 1-stent technique. Although FKB has been established as the standard method for bifurcation lesions treated with a 2-stent strategy, its efficacy in a 1-stent approach is highly controversial. This study enrolled 1,901 patients with a bifurcation lesion with a side branch diameter ≥2.3 mm, treated solely with the 1-stent technique using a drug-eluting stent from 18 centers in Korea between January 1, 2003 and December 31, 2009. The primary outcome was major adverse cardiac events (MACE)-cardiac death, myocardial infarction, or target lesion revascularization. Propensity score-matching analysis was also performed. FKB was performed in 620 patients and the post minimal lumen diameter of the MV and side branch was larger in the FKB group than in the non-FKB group. During follow-up (median 36 months), the incidence of MACE (adjusted hazard ratio [HR]: 0.68, 95% confidence interval [CI]: 0.46 to 0.99; p = 0.048) was lower in the FKB group than the non-FKB group. After propensity score matching (545 pairs), the FKB group had a lower incidence of MACE (adjusted HR: 0.50, 95% CI: 0.30 to 0.85; p = 0.01), and target lesion revascularization in the MV (adjusted HR: 0.51, 95% CI: 0.28 to 0.93; p = 0.03) and both vessels (adjusted HR: 0.47, 95% CI: 0.25 to 0.90; p = 0.02) than in the non-FKB group. In coronary bifurcation lesions, we demonstrated that the 1-stent technique with FKB was associated with a favorable long-term clinical outcome, mainly driven by the reduction of target lesion revascularization in the MV or both vessels as a result of an increase in minimal lumen diameter. (Korean Coronary Bifurcation Stenting Registry II [COBIS II]: NCT01642992). Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  17. Intra-aortic balloon pump use does not affect the renal function in patients undergoing off pump coronary artery bypass surgery

    Directory of Open Access Journals (Sweden)

    Muniraju Geetha

    2011-01-01

    Full Text Available Renal dysfunction is known to occur during cardiac surgery. A few factors such as perioperative hypotension, use of potential nephrotoxic therapeutic agents, radio opaque contrast media in the recent past, intra-aortic balloon pump (IABP and cardiopulmonary bypass have been blamed as the contributing factors to the causation of postoperative renal dysfunction in cardiac surgical patients. At times, in patients with renal failure and low cardiac output status, one may face the dilemma if the use of IABP is safe. We undertook this prospective observational study to determine the degree of possible renal injury when IABP is used by measuring serial values of serum creatinine and Cystatin C. Elective patients scheduled for off-pump coronary artery bypass surgery requiring preoperative use of IABP were included in this study. Cystatin C and serum creatinine levels were checked at fixed intervals after institution of IABP. Twenty-two patients were eligible for enrolment to the study. There was no significant change in the values of serum creatinine; from the basal value of 1.10 ± 0.233 to 0.98 ± 0.363 mg /dL (P value >0.05. Cystatin C levels significantly decreased from the basal level of 0.98 ± 0.29 to 0.89 ± 0.23 (P value <0.05. Contrary to the belief, Cystatin C, the early indicator of renal dysfunction decreases suggesting absence of renal injury after the use of IABP. Absence of elevation of cystatin C levels in our study suggests the lack of potential of the IABP to cause renal dysfunction in patients who received elective IABP therapy preoperatively.

  18. Femoral artery recanalisation with percutaneous angioplasty and segmentally enclosed plasminogen activator

    DEFF Research Database (Denmark)

    Jørgensen, B; Tønnesen, K H; Bülow, J;

    1989-01-01

    To establish whether re-occlusion of the femoral artery could be prevented, in 6 consecutive patients undergoing percutaneous transluminal angioplasty (PTA) for superficial femoral artery occlusion the recanalised segment was isolated, with a 7-French double-balloon catheter. 5 mg recombined human...

  19. Coronary heart disease

    Institute of Scientific and Technical Information of China (English)

    1995-01-01

    950286 Percutaneous transluminal coronary angio-plasty for unstable angina.LIU Meilin(刘梅林),et.al.1st Teach Hosp,Beijing Med Univ,Beijing,100034.Chin J Intern Med 1995;34(3):169-172.Percutaneous transluminal coronary angioplasty(PTCA) was performed in 190 patients with 250 dis-eased vessels and 278 lesions from Dec.1987 to Feb.1994.All the patients had unstable angina (UA).There were 52(18.7%) type A lesions,175(62.9%)type B lesions and 51(18.3%) type C lesions.Of the

  20. Angioplasty simulation using ChainMail method

    Science.gov (United States)

    Le Fol, Tanguy; Acosta-Tamayo, Oscar; Lucas, Antoine; Haigron, Pascal

    2007-03-01

    Tackling transluminal angioplasty planning, the aim of our work is to bring, in a patient specific way, solutions to clinical problems. This work focuses on realization of simple simulation scenarios taking into account macroscopic behaviors of stenosis. It means simulating geometrical and physical data from the inflation of a balloon while integrating data from tissues analysis and parameters from virtual tool-tissues interactions. In this context, three main behaviors has been identified: soft tissues crush completely under the effect of the balloon, calcified plaques, do not admit any deformation but could move in deformable structures, the blood vessel wall undergoes consequences from compression phenomenon and tries to find its original form. We investigated the use of Chain-Mail which is based on elements linked with the others thanks to geometric constraints. Compared with time consuming methods or low realism ones, Chain-Mail methods provide a good compromise between physical and geometrical approaches. In this study, constraints are defined from pixel density from angio-CT images. The 2D method, proposed in this paper, first initializes the balloon in the blood vessel lumen. Then the balloon inflates and the moving propagation, gives an approximate reaction of tissues. Finally, a minimal energy level is calculated to locally adjust element positions, throughout elastic relaxation stage. Preliminary experimental results obtained on 2D computed tomography (CT) images (100x100 pixels) show that the method is fast enough to handle a great number of linked-element. The simulation is able to verify real-time and realistic interactions, particularly for hard and soft plaques.

  1. Life-saving percutaneous coronary interventions on the unprotected left main coronary artery in patients with acute coronary syndrome in the catheterization laboratory without cardiosurgical back-up

    Directory of Open Access Journals (Sweden)

    Šalinger-Martinović Sonja

    2012-01-01

    Full Text Available Introduction. The optimal revascularization strategy for unprotected left main coronary disease (ULMCD is the subject of ongoing debate and patients with ULMCD still represent a challenge for interventionalist, especially in the setting of an acute coronary syndome (ACS. Case report. We presented two cases of percutaneous treatment of ULMCD in the settings of ACS (ST Segment Myocardial Infarction and Non ST Segment Myocardial Infarction - STEMI and NSTEMI in a catheterization laboratory without back-up of cardiosurgical department. Both patients were hemodynamically unstable with clinical signs of cardiogenic shock. Coronary angiography revealed left main thromobosis and using intra-aortic balloon pump as hemodynamic support primary angioplasty procedures were performed. Immediately after the procedures the patients hemodynamically improved and remained stable till discharge from hospital. Conclusion. Percutaneous coronary intervention (PCI has become the most common strategy of revascularization in ACS patients with ULMCD and is generally preferred in patients with multiple comorbidities and/or in very unstable patients. In cases with no cardiosurgical departments PCI is an inevitable, bail-out, life saving procedure.

  2. Randomized Comparison of Final Kissing Balloon Dilatation Versus No Final Kissing Balloon Dilatation in Patients With Coronary Bifurcation Lesions Treated With Main Vessel Stenting. Five Year Clinical Outcome in The Nordic-Baltic Bifurcation Study III

    DEFF Research Database (Denmark)

    Niemelä, Matti; Holm, Niels R; Kervinen, Kari

    2015-01-01

    Background- It is unknown whether the preferred 1-stent bifurcation stenting approach with stenting of the main vessel (MV) and optional side branch stenting using drug-eluting stents should be finalized by a kissing balloon dilatation (FKBD). Therefore, we compared strategies of MV stenting with...

  3. Randomized Comparison of Final Kissing Balloon Dilatation Versus No Final Kissing Balloon Dilatation in Patients With Coronary Bifurcation Lesions Treated With Main Vessel Stenting: The Nordic-Baltic Bifurcation Study III

    DEFF Research Database (Denmark)

    Niemelä, Matti; Kervinen, Kari; Erglis, Andrejs

    2010-01-01

    Background- It is unknown whether the preferred 1-stent bifurcation stenting approach with stenting of the main vessel (MV) and optional side branch stenting using drug-eluting stents should be finalized by a kissing balloon dilatation (FKBD). Therefore, we compared strategies of MV stenting...

  4. Laser angioplasty of totally occluded arteries of the limb

    Science.gov (United States)

    Szopinski, Piotr; Hara, Marek; Noszczyk, Wojciech

    1996-03-01

    The authors summarize their experience in the use of Nd-YAG laser in chronic occlusion of lower limb arteries. Percutaneous transluminal laser angioplasty (PTLA) with laser-heated metal and sapphire tips were used as an adjuvant to conventional balloon angioplasty. In cases of reocclusions, endovascular stents were implanted. Laser recanalization was performed in 46 arteries (iliac, superficial femoral, and popliteal). Indications for the procedure were: limb salvage, claudication below 100 m, and temporal or rest pain. Initial clinical and hemodynamic improvement was observed in 37 (80%) patients. Four perforations occurred without clinical sequel. The one-year cumulative clinical patency was 27 (58%) of the 46 lesions. PTLA may be appropriate for high-risk patients, who are unsuitable for surgical reconstruction because of the concomitant diseases. The combination of laser recanalization and implantation of vascular stents may be a promising method in the management of limb ischemia.

  5. Late thrombosis of coronary bare-metal stent: Case report

    Directory of Open Access Journals (Sweden)

    Apostolović Svetlana

    2006-01-01

    Full Text Available Stent thrombosis remains the primary cause of death after percutaneous coronary interventions (PCI. Despite modern concepts of PCI, stent thrombosis occurs in 0.5% -2% of elective procedures and even 6% of patients with the acute coronary syndrome (ACS. Stent thrombosis most often develops within the first 48 hours after the PCI, and rarely after a week of stent implantation. Angiographically documented late (>6 months thrombosis of coronary bare-metal stent (BMS is rare, because the stent endothelialization is considered to be completed after four weeks of the intervention. Our patient is a 41 year old male and he had BMS thrombosis 345 days after the implantation, which was clinically manifested as an acute myocardial infarction in the inferoposterolateral localization. Stent Clinical Centre of Serbia, Belgrade thrombosis occurred despite a long term dual antiplatelet therapy and control of known risk factors. Thrombolytic therapy (Streptokinase in a dose of 1 500 000 IU was not successful in reopening the occluded vessel, so the flow through the coronary artery was achieved by rescue balloon angioplasty, followed by implantation of drug eluting stent in order to prevent restenosis.

  6. 脉冲电场介导AT2R基因在血管局部表达及其对血管新生内膜的影响%Electroporation-mediated angiotensin Ⅱ type 2 receptor expression improves neo intimal hyperplasia of carotid arteries in rats after balloon angioplasty

    Institute of Scientific and Technical Information of China (English)

    刘德峰; 屈小玲; 刘建平

    2011-01-01

    Objective To determine the effects of electroporation on the transfection of angiotensin Ⅱ type 2 receptor (AT2R) gene into rat carotid arteries and predict its role in neointimal hyperplasia of carotid arteries after balloon angioplasty. Methods After the establishment of rat carotid balloon injury restenosis model, 18 SD rats were divided into AT2R transfection group, empty plasmid transfection group (GFP), and non-transfection group (n = 6 ). AT2R gene plasmid or empty plasmid was transfected by electroporation into rat carotid arteries. Their arteries were harvested at 3, 14 and 21 d after gene transfer, with 2 rats at each time points. The expression of AT2B and morphology of the arteries were evaluated by immunohistochemistry and HE staining respoctively. Results Electroporation-mediated transfection of AT2R gene into injured rat carotid arteries significantly up-regulated the levels of AT2R mRNA in the neointima in a time dependent manner from day 3 to day 14 ( strong to moderate to mild expression). But no expression of AT2B was found in the other 2 groups at these 3 time points. At day 21, AT2R transfection significantly reduced intimal/medial area ratio as compared with non-transfection group and GFP transfection group (0.76 ± 0.08 vs 1.39 ± 0.08 and 1.32 ± 0. 10, P < 0.01 ). No significant difference was found between non-transfection group and GFP transfection group. Conclusion Our results indicate that electroporation is an effective means to introduce naked AT2R DNA into the blood vessel wall, and gene transfer of AT2R in vessel wall may effectively inhibit VSMC proliferation and neointimal hyperplasia in the rat carotid arteries after balloon angioplasty.%目的 研究脉冲电场对血管紧张素2型受体(AT2R)基因在血管局部表达的作用,探讨AT2R基因在体转染对大鼠颈动脉球囊损伤后新生内膜增生的作用.方法 大鼠颈动脉球囊损伤后,用脉冲电穿孔法介导AT2R cDNA真核表达质粒或空质粒载

  7. Intravascular ultrasound guidance to minimize the use of iodine contrast in percutaneous coronary intervention: the MOZART (Minimizing cOntrast utiliZation With IVUS Guidance in coRonary angioplasTy) randomized controlled trial.

    Science.gov (United States)

    Mariani, José; Guedes, Cristiano; Soares, Paulo; Zalc, Silvio; Campos, Carlos M; Lopes, Augusto C; Spadaro, André G; Perin, Marco A; Filho, Antonio Esteves; Takimura, Celso K; Ribeiro, Expedito; Kalil-Filho, Roberto; Edelman, Elazer R; Serruys, Patrick W; Lemos, Pedro A

    2014-11-01

    The aim of this study was to evaluate the impact of intravascular ultrasound (IVUS) guidance on the final volume of contrast agent used in patients undergoing percutaneous coronary intervention (PCI). To date, few approaches have been described to reduce the final dose of contrast agent in PCIs. We hypothesized that IVUS might serve as an alternative imaging tool to angiography in many steps during PCI, thereby reducing the use of iodine contrast. A total of 83 patients were randomized to angiography-guided PCI or IVUS-guided PCI; both groups were treated according to a pre-defined meticulous procedural strategy. The primary endpoint was the total volume contrast agent used during PCI. Patients were followed clinically for an average of 4 months. The median total volume of contrast was 64.5 ml (interquartile range [IQR]: 42.8 to 97.0 ml; minimum, 19 ml; maximum, 170 ml) in the angiography-guided group versus 20.0 ml (IQR: 12.5 to 30.0 ml; minimum, 3 ml; maximum, 54 ml) in the IVUS-guided group (p MOZART]; NCT01947335). Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  8. Letalidade hospitalar nas angioplastias coronárias no Estado do Rio de Janeiro, Brasil, 1999-2003 Hospital case fatality associated with coronary angioplasty in Rio de Janeiro State, Brazil, 1999-2003

    Directory of Open Access Journals (Sweden)

    Paulo Henrique Godoy

    2007-04-01

    Full Text Available O estudo analisa a letalidade hospitalar nas angioplastias coronárias, pagas pelo Sistema Único de Saúde (SUS, realizadas nos hospitais do Estado do Rio de Janeiro, Brasil, de 1999 até 2003. As informações sobre as angioplastias coronárias provieram do banco de Autorizações de Internações Hospitalares da Secretaria de Estado de Saúde do Estado do Rio de Janeiro. As taxas de letalidade foram estimadas segundo faixas etárias, sexo, diagnósticos e hospitais. A letalidade geral foi de 1,9% em 8.735 angioplastias coronárias. A taxa mais baixa ocorreu nas anginas (0,8%, as mais elevadas nos infartos agudos do miocárdio (6% e em outros diagnósticos (7%. A letalidade foi menor nas mulheres na faixa etária entre 50 e 69 anos, e a partir dos setenta anos foi quase três vezes maior que a dos mais jovens (de 1,4 a 4%, em ambos os sexos. Ocorreu grande variabilidade entre as taxas de letalidade nas angioplastias coronárias nos diferentes hospitais (entre 0 e 6,5%. Portanto, é necessário acompanhar de modo contínuo a adequação da utilização da angioplastia coronária. Em conclusão, a performance deste procedimento no âmbito da modalidade de atenção pelo SUS nos hospitais, dentro do período estudado, não foi satisfatória.This study analyzes hospital case fatality associated with percutaneous transluminal coronary angioplasties (PTCA covered by the Brazilian Unified National Health System (SUS and performed in hospitals in the State of Rio de Janeiro from 1999 to 2003. PTCA data were obtained from the State Health Department's database on Authorizations for Hospital Admissions. Case fatality rates were estimated according to age, gender, diagnosis, and hospital. Overall case fatality was 1.9% in 8,735 PTCAs. The lowest rate was associated with angina (0.8% and the highest rates with acute myocardial infarction (6% and other diagnoses (7%. In the 50-69-year bracket, case fatality was higher in women. In the over-70 group, it was

  9. Percutaneous angioplasty of portal vein stenosis that complicated liver transplantation: the mid-term therapeutic results

    Energy Technology Data Exchange (ETDEWEB)

    Park, Kwang Bo; Choo, Sung Wook; Do, Young Soo; Shin, Sung Wook; Cho, Sung Gi; Choo, In Wook [Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)

    2005-09-15

    We wanted to valuate the mid-term therapeutic results of percutaneous transhepatic balloon angioplasty for portal vein stenosis after liver transplantation. From May 1996 to Feb 2005, 420 patients underwent liver transplantation. Percutaneous transhepatic angioplasty of the portal vein was attempted in six patients. The patients presented with the clinical signs and symptoms of portal venous hypertension or they were identified by surveillance doppler ultrasonography. The preangioplasty and postangioplasty pressure gradients were recorded. The therapeutic results were monitored by the follow up of the clinical symptoms, the laboratory values, CT and ultrasonography. The overall technical success rate was 100%. The clinical success rate was 83% (5/6). A total of eight sessions of balloon angioplasty were performed in six patients. The mean pressure gradient decreased from 14.5 mmHg to 2.8 mmHg before and after treatment, respectively. The follow up periods ranged from three months to 64 months (mean period; 32 months). Portal venous patency was maintained in all six patients until the final follow up. Combined hepatic venous stenosis was seen in one patient who was treated with stent placement. One patient showed puncture tract bleeding, and this patient was treated with coil embolization of the right portal puncture tract via the left transhepatic portal venous approach. Percutaneous transhepatic balloon angioplasty is an effective treatment for the portal vein stenosis that occurs after liver transplantation, and our results showed good mid-term patency with using this technique.

  10. A quantitative analysis of the benefits of pre-hospital infarct angioplasty triage on outcome in patients undergoing primary angioplasty for acute myocardial infarction

    NARCIS (Netherlands)

    van 't Hof, AWJ; van de Wetering, H; Ernst, N; Hollak, F; de Pooter, F; Suryapranata, H; Hoorntje, JCA; Gosselink, M; Zijlstra, F; de Boer, MJ; Dambrink, Jan Hendrik Everwijn

    2005-01-01

    Primary coronary angioplasty has been shown to be a very effective reperfusion modality in patients with acute myocardial infarction (MI). However, the time from diagnosis to therapy is often very long, often due to interhospital transfer of the patient. This study evaluates the effect of improving

  11. Properties of nylon 12 balloons after thermal and liquid carbon dioxide treatments.

    Science.gov (United States)

    Ro, Andrew J; Davé, Vipul

    2013-03-01

    Critical design attributes of angioplasty balloons include the following: tear resistance, high burst pressures, controlled compliance, and high fatigue. Balloons must have tear resistance and high burst pressures because a calcified stenosis can be hard and nominal pressures of up to 16 atm can be used to expand the balloon. The inflated balloon diameter must be a function of the inflation pressure, thus compliance is predictable and controlled. Reliable compliance is necessary to prevent damage to vessel walls, which may be caused by over-inflation. Balloons are often inflated multiple times in a clinical setting and they must be highly resistant to fatigue. These design attributes are dependent on the mechanical properties and polymer morphology of the balloon. The effects of residual stresses on shrinkage, crystallite orientation, balloon compliance, and mechanical properties were studied for angioplasty nylon 12 balloons. Residual stresses of these balloons were relieved by oven heat treatment and liquid CO2 exposure. Residual stresses were measured by quantifying shrinkage at 80 °C of excised balloon samples using a dynamic mechanical analyzer. Shrinkage was lower after oven heat treatment and liquid CO2 exposure compared to the as-received balloons, in the axial and radial directions. As-received, oven heat treated, and liquid CO2-exposed balloon samples exhibited similar thermal properties (T(g), T(m), X(t)). Crystallite orientation was not observed in the balloon cylindrical body using X-ray scattering and polarized light microscopy, which may be due to balloon fabrication conditions. Significant differences were not observed between the stress-strain curves, balloon compliance, and average burst pressures of the as-received, oven heat treated, and liquid CO2-exposed balloons.

  12. Uso rutinario del balón de contra-pulsación aórtica preoperatorio en pacientes con enfermedad del tronco común izquierdo sometidos a cirugía de revascularización coronaria Routine use of preoperative intra-aortic balloon pump counterpulsation (IABP implantation in patients with left main coronary artery disease undergoing coronary revascularization surgery

    Directory of Open Access Journals (Sweden)

    Andrés Fernández

    2008-08-01

    cuidados intensivos se infectaron 6,5% de los pacientes con balón y 3% del grupo sin balón (p=0,49 y hubo sepsis en 4,3% del grupo con balón y en ninguno del grupo restante (p=0,23. La letalidad en la unidad de cuidados intensivos se presentó en 2,2% del grupo de balón y en 3% del otro grupo (p=0,06. No ocurrió mortalidad intrahospitalaria fuera de la unidad de cuidados intensivos como tampoco mortalidad a 30 días después del alta. El tiempo de estancia en la misma unidad fue de 4,13 días en el grupo de balón y 2,7 días en el grupo sin balón, sin diferencia estadísticamente significativa entre éstos (p=0,154. El tiempo de ventilación mecánica en el grupo de balón fue de 1,96 días mientras que en el otro grupo fue de 1,18 días sin diferencia estadísticamente significativa (p=0,288. Con respecto a los pacientes que recibieron balón de contra pulsación intra-aórtico, el promedio de uso de balón fue de 1,32 días y no se presentaron complicaciones vasculares relacionadas con su uso. Conclusiones: este estudio sugiere que con el uso rutinario del balón de contra pulsación aórtica previo a la cirugía electiva de revascularización coronaria en pacientes cuya única indicación sea la lesión severa del tronco común izquierdo, no se obtiene beneficio en cuanto a letalidad y tiempo de estancia en la unidad de cuidados intensivos, ni con respecto al tiempo de ventilación mecánica. Tampoco se encontró mayor riesgo de desarrollar infección o sepsis en la misma unidad.Background: Left main coronary artery disease as the only criterion for intra-aortic balloon counterpulsation implantation is an indication which evidence is limited to experts’ recommendations; therefore, studies that may give a higher level of evidence are required. For this reason, we developed in our institution a study that evaluated the experience in the use of IABP in patients with left main coronary artery disease undergoing coronary revascularization surgery. Objective

  13. Prediction of outcome after femoropopliteal balloon angioplasty by intravascular ultrasound

    DEFF Research Database (Denmark)

    Vogt, K C; Just, S; Rasmussen, John Bøje Grønvall

    1997-01-01

    arteries remained patent. Two occlusions and two stenoses developed during the first 3 months after the intervention and one occlusion occurred after 1 year. The following IVUS parameters were related to a favourable patency: presence of calcification; dissection or plaque rupture and residual stenosis...

  14. Shortening the door-to-balloon time for transferring primary percutaneous coronary intervention: physician transfer may be a better way in China

    Institute of Scientific and Technical Information of China (English)

    GAO Run-lin

    2008-01-01

    @@ Reperfusion therapy including primary percutaneous coronary intervention (PCI) and thrombolytic therapy has become the most important strategy for the treatment of acute ST-segment elevation myocardial infraction(STEMI).

  15. Percutaneous laser thermal angioplasty: initial clinical results with a laser probe in total peripheral artery occlusions.

    Science.gov (United States)

    Cumberland, D C; Sanborn, T A; Tayler, D I; Moore, D J; Welsh, C L; Greenfield, A J; Guben, J K; Ryan, T J

    1986-06-28

    A metal-tipped laser fibre was used during percutaneous angioplasty of femoral/popliteal or iliac artery occlusions in 56 patients. Primary success was achieved in 50 (89%) of these total occlusions, providing a channel for subsequent balloon dilatation. Before the procedure, 18 lesions had been judged untreatable by conventional angioplasty and four of the six failures were in these. Complications directly attributable to the laser probe were one case of vessel perforation and two cases of entry into vessel walls; these had no sequelae. Other acute complications were a distal thrombosis in a non-heparinised patient, requiring local streptokinase treatment, and two reocclusions and one transient peripheral embolic episode in the first 24 hours. The laser probe technique has potential for increasing the proportion of patients suitable for angioplasty.

  16. Influences on vascular wall smooth muscle cells with novel short-duration thermal angioplasty

    Science.gov (United States)

    Kunio, M.; Shimazaki, N.; Arai, T.; Sakurada, M.

    2012-02-01

    We investigated the influences on smooth muscle cells after our novel short-duration thermal angioplasty, Photo-thermo Dynamic Balloon Angioplasty (PTDBA), to reveal the mechanism that can suppress neo-intimal hyperplasia after PTDBA. We obtained the sufficient arterial dilatations by short-duration heating (angioplasty in vivo. The measured neo-intimal hyperplasia occupancy rate was less than 20% after PTDBA in vivo. We prospect that the inhibition of the growth factor's expression by stretch-fixing may result to suppress the neo-intimal hyperplasia. In addition, the decrease of smooth muscle cells' density in the vessel media by heating might be another reason for the neo-intimal hyperplasia suppression.

  17. Development of radiolabelled compound using reactor producted RI - Evaluation of Ho-166 endovascular therapy to prevent restenosis after PTCA or stenting for occlusive coronary artery disease

    Energy Technology Data Exchange (ETDEWEB)

    Park, Chan Hee; Choi, Byung Il; Kim, Han Soo [Ajou University, Suwon (Korea)

    2000-04-01

    Occlusive coronary artery disease is managed successfully by percutaneous transfemoral coronary angioplasty (PTCA) or stenting with 95% success rate. However, restenosis after PTCA is not uncommon and the reported incidence of reocclusion is about 30 {approx} 40%. Therefore, the objective of the research was to develop endovascular brachytherapy using liquid form of Ho-166 in order to inhibit neointimal hyperplasia responsible for restenosis following PTCA or stenting. Our research was carried out in 3 stages: First stage - The effectiveness of radiation was confirmed by using animal model. Following over-sized balloon injury to rat carotid artery and porcine coronary artery, various external radiation doses were delivered. Second stage - For radiation dose distribution within the coronary artery and its surrounding tissues, Gafchromic film was used. In vitro dose distribution of Ho-166 utilizing water phantom and Gafchromic film was measured. Third stage - None uniform dose distribution from Ho-166 within the balloon caused by small air bubbles was eliminated by negative suction method. More accurate dose distribution was also possible using newly developed micrometer by our physicist. Limited number of human trial was performed without adverse effect. 40 refs. (Author)

  18. The early percutaneous coronary intervention in elderly patients with acute coronary syndrome

    Institute of Scientific and Technical Information of China (English)

    Xiong HUANG; Xuebin CAO; Gang ZHANG

    2008-01-01

    It is challenging to undo early percutaneous intervention (PCI) in the elderly with acute coronary syndrome (ACS). Fifteen patients older than 65 years with ACS within 24 hours of the event were admitted from April 4, 2004 to December 12, 2005. All the patients had early percutaneous coronary intervention and were followed up for 6-12 months by telephone or in the out-patient department. Nine of the 15 patients exhibited acute myocardial infarction (AMI). Six exhib-ited unstable angina (UA). All the patients had early PCI. The average door-to-balloon time was 78 minutes (40-110 minutes). The average PCI time was 99 minutes (68-120 minutes). Nineteen of 36 lesions in the fifteen angioplasty patients were treated and 20 stents were implanted in total. All the procedures were considered successful. Neither deaths nor recurrent angina occurred in the 6-12 months of follow-up. It was shown that early PCI might be an effective and safe method to treat eld-erly patients with ACS.

  19. Early and late effects of coumarin therapy started before percutaneous coronary intervention

    Science.gov (United States)

    ten Berg, J.M.; Kelder, J.C.; Suttorp, M.J.; Mast, E.G.; Bal, E.T.; Ernst, J.M.P.G.; Plokker, H.W.M.

    2002-01-01

    Background Coronary angioplasty frequently creates a thrombogenic surface with subsequent mural thrombosis that may lead to acute complications and possibly stimulates the development of restenosis. Whether coumarins can prevent these complications is unclear. Methods In the Balloon Angioplasty and Anticoagulation Study (BAAS), the effect of coumarins started before the procedure on early and late outcome was studied. Patients were randomised to aspirin only or to aspirin plus coumarins. Half of the patients were randomised to undergo six-month angiographic follow-up. Study medication was started one week before coronary angioplasty and the target international normalised ratio (INR) was 2.1-4.8 during angioplasty and six-month follow-up. 'Optimal' anticoagulation was defined as an INR in the target range for at least 70% of the follow-up time. In addition, cost-effectiveness of coumarin treatment was measured. Results At one year death, myocardial infarction, target-lesion revascularisation and stroke were observed in 14.3% of the 530 patients randomised to aspirin plus coumarin versus in 20.3% of the 528 patients randomised to aspirin alone (relative risk 0.71; 95% CI 0.54-0.93). The incidence of major bleedings and false aneurysms during hospitalisation was 3.2% and 1.0%, respectively, (relative risk 3.39; 95% CI 1.26-9.11). Optimal anticoagulation was an independent predictor of late thrombotic events (relative risk, 0.33; 95% CI, 0.19-0.57). Quantitative coronary analysis was performed of 301 lesions in the ASA group and of 297 lesions in the coumarin group. At six months, the minimal luminal diameter was similar in the ASA and coumarin group. However, optimal anticoagulation was an independent predictor of angiographic outcome at six months. Optimal anticoagulation led to a 0.21 mm (95% CI: 0.05-0.37) larger MLD as compared with suboptimal anticoagulation whereas aspirin use led to a 0.12 mm (95% CI -0.28-0.04) smaller MLD. When including all costs, the

  20. Successful Venous Angioplasty of Superior Vena Cava Syndrome after Heart Transplantation

    Directory of Open Access Journals (Sweden)

    Thomas Strecker

    2014-01-01

    Full Text Available Introduction. For patients with terminal heart failure, heart transplantation (HTX has become an established therapy. Before transplantation there are many repeated measurements with a pulmonary artery catheter (PAC via the superior vena cava (SVC necessary. After transplantation, endomyocardial biopsy (EMB is recommended for routine surveillance of heart transplant rejection again through the SVC. Case Presentation. In this report, we present a HTX patient who developed a SVC syndrome as a possible complication of all these procedures via the SVC. This 35-year-old Caucasian male could be successfully treated by balloon dilatation/angioplasty. Conclusion. The SVC syndrome can lead to pressure increase in the venous system such as edema in the head and the upper part of the body and further serious complications like cerebral bleeding and ischemia, or respiratory problems. Balloon angioplasty and stent implantation are valid methods to treat stenoses of the SVC successfully.

  1. The clinical application of percutaneous transluminal balloon angioplasty for hemodialysis patients with stenosis of arteriovenous ifstula%经皮腔内血管成形术在血透患者动静脉内瘘血管狭窄中的应用

    Institute of Scientific and Technical Information of China (English)

    郑尘非; 孙文学; 贾秀芬; 缪克凯; 潘慧君; 刘毅; 黄朝兴

    2015-01-01

    Objective: To report the technical success and long-term clinical outcomes of arteriovenous ifstula (AVF) stenosis after percutaneous transluminal balloon angioplasty (PTA).Methods: A total of 30 patients with stenosis of AVF were enrolled. There were 16 men and 14 women, and the median age was 64.8±13.2 years. Mean time between ifstula creation and intervention was 16.5±13.8 months. The mean duration of hemodialysis time was 31.5±30.2 months. They were examined by digital subtraction angiography (DSA) when they under-went PTA. After the treatment of PTA, all of the patients were examined by 64-multislice spiral computed tomog-raphy angiography every 3 months.Results: The technical success rate was 90.0% in the hemodialysis patients (17 native AVFs and 10 arteriovenous grafts). Primary patency at ifrst, second, third, fourth and iffth three months was 100%, 91.3%, 79.5%, 72.6% and 62.2% respectively. Univariate analysis indicated that there was no signiif-cant correlation between the clinical factors (including age, diabetes mellitus, location, length, grade, and number of stenosis) and primary patency (P>0.05).Conclusion: PTA is an effective treatment method for arteriovenous stenosis, which has high rates of technical success and less complication.%目的:探讨经皮腔内血管成形术(PTA)治疗动静脉内瘘(AVF)狭窄的疗效。方法:回顾性分析30例上肢AVF狭窄患者的临床资料,其中男16例,女14例,平均年龄(64.8±13.2)岁;瘘管平均使用时间(16.5±13.8)月,患者平均透析时间(31.5±30.2)月。所有患者在数字减影血管造影(DSA)下行PTA,术后每3个月经64层螺旋CT血管造影对AVF功能进行评估。结果:本组手术成功率90.0%,其中17例自体AVF和10例人工血管动静脉内瘘(AVG)。术后27例患者首次开通率3个月为100%,6个月为91.3%,9个月为79.5%,12个月为72.6%,15个月为62.2%;术后AVF首次通畅率的单因素Cox风

  2. Does the new angiotensin converting enzyme inhibitor cilazapril prevent restenosis after percutaneous transluminal coronary angioplasty? Results of the MERCATOR study: a multicenter, randomized, double-blind placebo-controlled trial

    NARCIS (Netherlands)

    P.W.J.C. Serruys (Patrick); W.R. Rutsch (Wolfgang); N. Danchin (Nicolas); W. Wijns (William); H.U. Emanuelsson (Hakan); F. Chappuis; W.R.M. Hermans (Walter)

    1992-01-01

    textabstractBACKGROUND. Cilazapril is a novel angiotensin converting enzyme inhibitor with antiproliferative effects in the rat model after balloon injury. METHODS AND RESULTS. We conducted a randomized, double-blind placebo-controlled trial to assess the effect of cilazapril in angiographic resteno

  3. Intravascular optical coherence tomography to characterize tissue deformation during angioplasty: preliminary experiments with artery phantoms

    Science.gov (United States)

    Azarnoush, Hamed; Vergnole, Sébastien; Pazos, Valérie; Bisaillon, Charles-Étienne; Boulet, Benoit; Lamouche, Guy

    2012-09-01

    We explored the potential of intravascular optical coherence tomography (IVOCT) to assess deformation during angioplasty balloon inflation. Using a semi-compliant balloon and artery phantoms, we considered two experimental scenarios. The goal for the first scenario was to investigate if variation in the elasticity of the structure surrounding the balloon could be sensed by IVOCT monitoring. In this scenario, we used three single-layer phantoms with various mechanical properties. Image analysis was performed to extract the inner and outer diameters of the phantoms at various pressures. The goal for the second scenario was twofold. First, we investigated the IVOCT capability to monitor a more complex balloon inflation process. The balloon was in a folded state prior to inflation. This allowed studying two stages of deformation: during balloon unfolding and during balloon expansion. Second, we investigated IVOCT capability to monitor the deformation in a three-layer phantom used to better mimic a true artery. So, not only were the IVOCT images processed to provide the inner and outer diameters of the phantom, but the layer thicknesses were also determined. In both scenarios, IVOCT monitoring revealed to be very efficient in providing relevant information about the phantom deformation during balloon inflation.

  4. Surface chemical and physical modification in stent technology for the treatment of coronary artery disease.

    Science.gov (United States)

    Nazneen, Feroze; Herzog, Grégoire; Arrigan, Damien W M; Caplice, Noel; Benvenuto, Pasquale; Galvin, Paul; Thompson, Michael

    2012-10-01

    Coronary artery disease (CAD) kills millions of people every year. It results from a narrowing of the arteries (stenosis) supplying blood to the heart. This review discusses the merits and limitations of balloon angioplasty and stent implantation, the most common treatment options for CAD, and the pathophysiology associated with these treatments. The focus of the review is heavily placed on research efforts geared toward the modification of stent surfaces for the improvement of stent-vascular compatibility and the reduction in the occurrence of related pathophysiologies. Such modifications may be chemical or physical, both of which are surveyed here. Chemical modifications may be passive or active, while physical modification of stent surfaces can also provide suitable substrates to manipulate the responses of vascular cells (endothelial, smooth muscle, and fibroblast). The influence of micro- and nanostructured surfaces on the in vitro cell response is discussed. Finally, future perspectives on the combination of chemical and physical modifications of stent surfaces are also presented.

  5. Anatomical and functional assessment of Tryton bifurcation stent before and after final kissing balloon dilatation: Evaluations by three-dimensional coronary angiography, optical coherence tomography imaging and fractional flow reserve.

    Science.gov (United States)

    Pyxaras, Stylianos A; Toth, Gabor G; Di Gioia, Giuseppe; Ughi, Giovanni J; Tu, Shengxian; Rusinaru, Dan; Adriaenssens, Tom; Reiber, Johan H C; Leon, Martin B; Bax, Jeroen J; Wijns, William

    2017-07-01

    To assess the anatomical and functional impact of final kissing balloon inflation (FKBI) after implantation of a dedicated bifurcation stent system. Current evidence suggests clinical benefit of FKBI in patients undergoing bifurcation dilatation using the Tryton side branch stent (Tryton-SBS). We hypothesized that FKBI improves anatomical reconstruction and functional results of bifurcation treated by Tryton-SBS. An unselected group of patients with complex bifurcation coronary lesions undergoing percutaneous coronary intervention (PCI) with Tryton-SBS underwent paired anatomical assessment with two- and three-dimensional quantitative coronary analysis (2D- and 3D-QCA), and optical coherence tomography (OCT), including 3D reconstruction before and after FKBI. Functional assessment by fractional flow reserve (FFR) was performed in the main branch (MB) and side branch (SB) before and after FKBI. Paired pre- and post-FKBI data were obtained in 10 patients. By OCT imaging, FKBI increased both the SB ostial area (4.93 ± 2.81 vs. 7.43 ± 2.87 mm(2) , P < 0.001) and the SB maximum diameter (3.12 ± 0.98 vs. 3.82 ± 1.10 mm, P = 0.003). These findings were associated with a significant increase in FFR in the SB (0.90 ± 0.05 vs. 0.94 ± 0.03; P = 0.011), with no significant change in the MB (0.91 ± 0.05 vs. 0.92 ± 0.04; P = 0.470). In patients with complex bifurcation stenosis undergoing PCI with a dedicated bifurcation system, FKBI is associated with improved anatomical and functional results at the SB level, without compromising the result at the MB. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  6. Distal Embolization of Hydrophilic-Coating Material From Coronary Guidewires After Percutaneous Coronary Interventions

    NARCIS (Netherlands)

    Grundeken, Maik J.; Li, Xiaofei; Kurpershoek, C. Eline; Kramer, Miranda C.; Vink, Aryan; Piek, Jan J.; Tijssen, Jan G. P.; Koch, Karel T.; Wykrzykowska, Joanna J.; de Winter, Robbert J.; van der Wal, Allard C.

    2015-01-01

    Background-Coronary guidewires are indispensable during percutaneous coronary interventions. Nowadays, most guidewires have hydrophilic coatings to improve their trackability, allowing easy lesion passage and facilitating balloon and stent positioning. Recent reports, however, have raised concerns a

  7. Drug-eluting balloon catheters for lower limb peripheral arterial disease: the evidence to date

    Directory of Open Access Journals (Sweden)

    Barkat M

    2016-05-01

    Full Text Available Mohamed Barkat,1 Francesco Torella,1 George A Antoniou2 1Liverpool Vascular and Endovascular Service, Royal Liverpool University Hospital, Liverpool, 2Department of Vascular and Endovascular Surgery, The Royal Oldham Hospital, Pennine Acute Hospitals NHS Trust, Manchester, UK Abstract: A significant proportion of patients with severe lower limb peripheral arterial disease require revascularization. Over the past decade, an endovascular-first approach even for complex disease has gained widespread use among vascular specialists. An important limitation of percutaneous transluminal balloon angioplasty or stenting remains the occurrence of restenosis. Drug-coated balloons have emerged as an exciting technology developed to overcome the limitations of standard balloon angioplasty and stenting. Drug-eluting devices inhibit neointimal growth of vascular smooth muscle cells with the potential of preventing restenosis. This review provides a synopsis of the up-to-date evidence on the role of drug-coated balloons in the treatment of lower limb peripheral arterial disease. Bibliographic searches were conducted using MEDLINE, EMBASE, and the Cochrane Library electronic database. Eleven randomized clinical trials, two systematic reviews, and a published registry providing the best available evidence were identified. Current evidence suggests that angioplasty with drug-coated balloon is reliable, safe, and efficient in increasing patency rates and reducing target lesion revascularization and restenosis. However, it remains unknown whether these improved results can translate into beneficial clinical outcomes, as current randomized clinical trials have failed to demonstrate a significant benefit in limb salvage and mortality. Further randomized trials focusing on clinical and functional outcomes of drug-eluting balloons and on cost versus clinical benefit are required. Keywords: drug-eluting balloon, drug-coated balloon, angioplasty, peripheral arterial

  8. Emerging Stent and Balloon Technologies in the Femoropopliteal Arteries

    Directory of Open Access Journals (Sweden)

    Georgios Pastromas

    2014-01-01

    Full Text Available Endovascular procedures for the management of the superficial femoral (SFA and popliteal artery disease are increasingly common. Over the past decade, several stent technologies have been established which may offer new options for improved clinical outcomes. This paper reviews the current evidence for SFA and popliteal artery angioplasty and stenting, with a focus on randomized trials and registries of nitinol self-expanding stents, drug-eluting stents, dug-coated balloons, and covered stent-grafts. We also highlight the limitations of the currently available data and the future routes in peripheral arterial disease (PAD stent and balloon technology.

  9. Drug-eluting balloon catheters for lower limb peripheral arterial disease: the evidence to date

    Science.gov (United States)

    Barkat, Mohamed; Torella, Francesco; Antoniou, George A

    2016-01-01

    A significant proportion of patients with severe lower limb peripheral arterial disease require revascularization. Over the past decade, an endovascular-first approach even for complex disease has gained widespread use among vascular specialists. An important limitation of percutaneous transluminal balloon angioplasty or stenting remains the occurrence of restenosis. Drug-coated balloons have emerged as an exciting technology developed to overcome the limitations of standard balloon angioplasty and stenting. Drug-eluting devices inhibit neointimal growth of vascular smooth muscle cells with the potential of preventing restenosis. This review provides a synopsis of the up-to-date evidence on the role of drug-coated balloons in the treatment of lower limb peripheral arterial disease. Bibliographic searches were conducted using MEDLINE, EMBASE, and the Cochrane Library electronic database. Eleven randomized clinical trials, two systematic reviews, and a published registry providing the best available evidence were identified. Current evidence suggests that angioplasty with drug-coated balloon is reliable, safe, and efficient in increasing patency rates and reducing target lesion revascularization and restenosis. However, it remains unknown whether these improved results can translate into beneficial clinical outcomes, as current randomized clinical trials have failed to demonstrate a significant benefit in limb salvage and mortality. Further randomized trials focusing on clinical and functional outcomes of drug-eluting balloons and on cost versus clinical benefit are required. PMID:27274265

  10. The History of Primary Angioplasty and Stenting for Acute Myocardial Infarction.

    Science.gov (United States)

    Smilowitz, Nathaniel R; Feit, Frederick

    2016-01-01

    The evolution of the management of acute myocardial infarction (MI) has been one of the crowning achievements of modern medicine. At the turn of the twentieth century, MI was an often-fatal condition. Prolonged bed rest served as the principal treatment modality. Over the past century, insights into the pathophysiology of MI revolutionized approaches to management, with the sequential use of surgical coronary artery revascularization, thrombolytic therapy, and percutaneous coronary intervention (PCI) with primary coronary angioplasty, and placement of intracoronary stents. The benefits of prompt revascularization inspired systems of care to provide rapid access to PCI. This review provides a historical context for our current approach to primary PCI for acute MI.

  11. Contribution of optical coherence tomography imaging in management of iatrogenic coronary dissection

    Energy Technology Data Exchange (ETDEWEB)

    Barber-Chamoux, Nicolas, E-mail: nbarber-chamoux@chu-clermontferrand.fr [Department of Cardiology, Gabriel Montpied University Hospital, Clermont-Ferrand (France); Souteyrand, Géraud; Combaret, Nicolas [Department of Cardiology, Gabriel Montpied University Hospital, Clermont-Ferrand (France); ISIT, CaVITI, CNRS (UMR-6284), Auvergne University, Clermont-Ferrand (France); Ouedraogo, Edgar; Lusson, Jean René [Department of Cardiology, Gabriel Montpied University Hospital, Clermont-Ferrand (France); Motreff, Pascal [Department of Cardiology, Gabriel Montpied University Hospital, Clermont-Ferrand (France); ISIT, CaVITI, CNRS (UMR-6284), Auvergne University, Clermont-Ferrand (France)

    2016-03-15

    Iatrogenic coronary dissection is a rare but potentially serious complication of coronary angiography and angioplasty. Treatment with angioplasty guided only by angiography is often difficult. Optical coherence tomography imaging seems to be an interesting technique to lead the management of iatrogenic coronary dissection. Diagnosis can be made by optical coherence tomography; it can also eliminate differential diagnosis. Furthermore, this technique can guide safely the endovascular treatment. - Highlights: • Iatrogenic coronary dissection remains a challenging problem in angiography. • Endocoronary imaging is helpful for the diagnosis of iatrogenic coronary dissection. • OCT is a safe option to manage the endovascular treatment of coronary dissection.

  12. Evaluation of Patients’ Exposure during Angiography and Angioplasty Procedures in the Angiography Department of Shahid Madani Hospital in Tabriz

    Directory of Open Access Journals (Sweden)

    Asghar Mesbahi

    2009-03-01

    Full Text Available Introduction: Coronary angiography and angioplasty procedures lead to significant radiation exposure of patients. In the current study, the average radiation dose to patients during angiography in the Angiography Department of Shahid-Madani Hospital was determined. Materials and Methods: An image intensifier based angiography unit (Philips BH 3000 was used for angiography procedures. The accuracy of the internal dosimeter was verified. Dose-area products (DAP of patients (236 cases during fluoroscopy and cine acquisition were recorded. Analyzing the data, the average radiation doses to patients for angiography and angioplasty and also for fluoroscopy and cine acquisition were determined. Additionally, the average fluoroscopy time for all patients was estimated. Results: The average DAPs of 23.7 and 91.5 Gycm2 were estimated for angiography and angioplasty respectively. Patient doses including fluoroscopy, cine acquisition and the total dose for angiography were 2, 7.7 and 3.8 times lower than angioplasty procedures respectively. Average fluoroscopy time was 1.9 times lower for angiography compared to angioplasty. Discussion and Conclusion: Fluoroscopy time and patient dose during fluoroscopy were in good agreement with other studies. However, the dose to patients during angioplasty was higher compared to other reports. To reduce patient dose in angioplasty procedures, the use of the lowest available frame rate, smallest field size and retraining of operators and technologists are recommended.

  13. Peripheral Applications of Drug-Coated Balloons: Past, Present and Future

    Energy Technology Data Exchange (ETDEWEB)

    Krokidis, Miltiadis, E-mail: mkrokidis@hotmail.com; Spiliopoulos, Stavros, E-mail: stavspiliop@upatras.gr; Katsanos, Konstantinos, E-mail: katsanos@med.upatras.gr; Sabharwal, Tarun, E-mail: tarun_sabharwal@yahoo.co.uk [Guy' s and St. Thomas' Hospitals, NHS Foundation Trust, Department of Radiology (United Kingdom)

    2013-04-15

    Drug-coated balloon (DCB) technologies represent the latest and hottest development in the field of endovascular treatment of peripheral arterial disease. Initial experience with paclitaxel-coated balloon use in the femoral artery has demonstrated lower mid-term restenosis and superior mid-term clinical outcomes in terms of improved wound healing and reduced repeat angioplasty rates compared with standard balloon angioplasty. Many companies are presently developing and/or improving DCB catheters and therefore ongoing, technical improvements of the already existing platforms, new drugs, and innovative carriers are expected. The ongoing basic research studies and various multicenter randomized, controlled trials that are currently in progress will offer valuable scientific insights regarding the long-term effectiveness and other crucial issues, such as efficacy in various vascular beds, optimal balloon dosage, and post angioplasty antiplatelet therapy. Future applications of these devices also could include in-stent restenosis, anastomotic stenosis of surgical bypass, and benign stenoses of the central venous system. The authors envision that DCB angioplasty will evolve to a major paradigm shift in the endovascular treatment of occlusive vascular diseases.

  14. Development of a novel catheter preventing the outflow of debris and thrombus on percutaneous transluminal angioplasty for hemodialysis access fistulas.

    Science.gov (United States)

    Horita, Yuki; Namura, Masanobu; Matsumura, Masami

    2006-06-01

    If a large amount of debris or thrombus dislodges from a lesion because of dilation of the stenotic or occluded lesion in the hemodialysis access fistula when angioplasty is performed, it may move into the pulmonary artery via the central vein, resulting in pulmonary embolism. A novel sheath has been developed to prevent the outflow of debris or thrombus to the central vein. The catheter consists of a 5 F sheath introducer and a silicone balloon attached at the tip of the sheath. The silicon balloon is inflated via small inflation lumen on the shaft wall of the sheath. In the case of percutaneous transluminal angioplasty (PTA), the silicone balloon is inflated to block the blood flow by a mixture of contrast medium and physiological saline, and then dilate a stenotic or occluded lesion by PTA balloon. Next, the debris and thrombus are aspirated using the flush-lumen of this device. Finally, the silicone balloon is deflated and the dilation of the lesion is confirmed. A case of hemodialysis access fistula graft with massive thrombotic occlusion was presented. This device enabled Fogarty procedure using PTA balloon and the blood flow of the graft was completely improved and a large amount of thrombus was removed. This novel device is useful to prevent the embolic complication of the intervention for hemodialysis access fistula. Copyright 2006 Wiley-Liss., Inc.

  15. Recent developments in drug-eluting coronary stents.

    Science.gov (United States)

    Yildiz, Mustafa; Yildiz, Banu Sahin; Gursoy, Mustafa Ozan; Akin, Ibrahim

    2014-01-01

    The interventional treatment of coronary artery disease was introduced in 1970`s by Andreas Grüntzig. The initial treatment strategy with plain old balloon angioplasty (POBA) was associated with high restenosis rates. The introduction of coronary stents, especially drug-eluting stents (DES) in 2002 has improved the results by lowering the rate of in-stent restenosis from 20-40% in the era of bare-metal stent (BMS) to 6-8%. However, in 2006 with the observation of late stent thrombosis the reputations of DES have decreased. However, improvements in stent design especially antiproliferative agents, polymeric agents as well as stent platforms improved newer generation DES. In controlled trials as well as registries the use of second-generation DES as compared to bare-metal stents (BMS) was associated with better clinical and angiographic results. A further development of these stents with use of biodegradable polymers, polymer-free stents, and biodegradable stents on the basis of poly L-lactide (PLLA) or magnesium resulted in third-generation DES and has been evaluated in preclinical and first clinical trials. However, to date, there is a lack of data comparing these third-generation DES with first- and second-generatrion DES in a large scale.

  16. Stenting of "unprotected" left main coronary artery stenoses: early and late results.

    Science.gov (United States)

    Laruelle, C J; Brueren, G B; Ernst, S M; Bal, E T; Mast, G E; Suttorp, M J; Brutel de la Rivière, A; Plokker, T H

    1998-02-01

    To assess short and long term efficacy of coronary stent implantation for unprotected left main coronary artery stenosis. Retrospective follow up study. Tertiary referral centre for interventional cardiology and cardiac surgery. Eighteen consecutive patients (12 men; age 70.8 years) between May 1993 and July 1996. Ten patients presented with stable angina and underwent the procedure electively, eight patients presented either with unstable angina or myocardial infarction and underwent the procedure in emergency. Johnson and Johnson Palmaz-Schatz stents were used in 16 patients, and a Microstent and a Gianturco-Roubin in one patient each. An intra-aortic balloon pump was prophylactively used for two patients in the elective group. In the acute group, six required an intra-aortic balloon pump. Procedural success rate and major adverse cardiac events. Successful stent implantation was achieved in all patients. In the elective group, no major adverse cardiac event occurred during the procedure, but one patient had to undergo repeated angioplasty before discharge. All patients of the elective group were discharged alive and there has been one non-cardiac death during a follow up of (mean (SD)) 10 (4) months. In the emergency group, one patient died during the procedure, one patient developed a non Q-wave myocardial infarction, one patient underwent emergency coronary bypass surgery, while another patient died suddenly before hospital discharge. Six patients of the emergency group were discharged alive and there has been one non-cardiac death during a follow up of 7 (4) months. Elective stent implantation for unprotected left main coronary artery stenosis is safe and effective in selected stable patients. Urgent stent implantation, however, cannot be considered as a definitive procedure in emergency situation.

  17. Plasma levels following application of paclitaxel-coated balloon catheters in patients with stenotic or occluded femoropopliteal arteries

    Energy Technology Data Exchange (ETDEWEB)

    Freyhardt, Patrick; Kroencke, T.J.; Schreiter, N.F.; Sixt, S.; Rastan, A. [Charite Universitaetsmedizin, Berlin (Germany). Klinik fuer Strahlenheilkunde; Zeller, T.; Schwarzwaelder, U. [Herzzentrum Bad Krozingen (Germany). Abt. fuer Klinische und Interventionelle Angiologie; Stiepani, H.; Werk, M. [Martin-Luther-Krankenhaus, Berlin (Germany). Klinik fuer Radiologie und Nuklearmedizin

    2011-05-15

    Purpose: Paclitaxel-coated balloon catheters inhibit restenosis after coronary and peripheral angioplasty (PCI,PTA). The aim of this study was to investigate paclitaxel plasma levels and laboratory parameters following PTA with paclitaxel-coated balloons (PCB) in peripheral arteries. Materials and Methods: This single treatment arm, multicenter study included 14 patients with Rutherford stage 1 - 5 with occlusions of up to 5 cm or {>=} 70 % diameter stenosis of the superficial femoral or popliteal arteries (SFA, PA). PTA was performed using up to three PCB catheters. The paclitaxel plasma levels and safety laboratory parameters were determined by collecting blood samples pre-intervention, immediately post-intervention, at 0.5, 1, 2, 4, 8, 24 hours and 1 and 4 weeks post-intervention (p. i.). Vital signs were monitored to assess clinical safety. Results: PTA was performed successfully in all patients. Paclitaxel plasma levels were always below a level and duration known to cause systemic side effects. A mean peak paclitaxel plasma level (40 ng/ml) was reached immediately p. i. and decreased rapidly below detectable levels in more than half of the patients already 2 hours p. i. The paclitaxel plasma concentrations returned to values below detectable levels at 24 hours p. i. in all patients. Laboratory parameters and vital signs did not give any reason for safety concerns. No adverse events associated with balloon coating were observed. Conclusion: The results of 14 patients with peripheral arterial occlusive disease show no systemic bioavailability of paclitaxel > 24 hours after PTA with one or more PCB catheters, indicating that the PCB catheter is safe with regard to possible systemic effects. (orig.)

  18. Hemoglobin A1c is associated with severity of coronary artery stenosis but not with long term clinical outcomes in diabetic and nondiabetic patients with acute myocardial infarction undergoing primary angioplasty.

    Science.gov (United States)

    She, Jianqing; Deng, Yangyang; Wu, Yue; Xia, Yulong; Li, Hongbing; Liang, Xiao; Shi, Rui; Yuan, Zuyi

    2017-08-08

    Acute myocardial infarction (AMI) patients with type 2 diabetes mellitus are known to present with multiple vessel lesions during coronary angiography. The underlying mechanism remains elusive and there is a shortage of serum prediction markers. In this study, we investigate the relationship between admission HbA1c and severity of coronary artery stenosis and subsequent prognosis in AMI patients with or without diabetes. We measured admission HbA1c, and vessel scores based on the number of diseased coronary vessels with significant stenosis in 628 patients diagnosed with AMI. Simple and multi-regression analysis were performed to investigate the correlation between HbA1c and the severity of coronary artery stenosis. Major adverse cardiovascular events (MACE), including new-onset myocardial infarction, acute heart failure and cardiac death, were documented during the follow-up. 272 non-DM participants and 137 DM participants were separated into two groups based on HbA1c levels for survival analysis during a 2-year follow up. 448 non-DM patients and 180 DM patients were included in the initial observational analysis. 272 non-DM patients and 137 DM patients were included in the follow-up survival analysis. The admission HbA1c level was found to be significantly positively correlated to the number of affected vessels suffering from significant coronary artery stenosis both in DM (R square = 0.012; 95% CI 0.002 to 0.623, P = 0.049) and non DM patients (R square = 0.025; 95% CI 0.009 to 0.289, P = 0.037). Kaplan-Meier survival analysis revealed no significant difference with regard to different HbA1c levels either in DM or non-DM patients at the end of follow-up. In patients with AMI, admission HbA1c is an important predictor for the severity of coronary artery stenosis in non-DM and DM patients. Further studies are needed to determine whether longer term follow-up could further identify the prognosis effect of HbA1c on MACE.

  19. Venous rupture complicating hemodialysis access angioplasty: percutaneous treatments and outcomes

    Energy Technology Data Exchange (ETDEWEB)

    La, Young Jong; Goo, Dong Erk; Kim, Dae Ho; Lee, Hae Kyoung; Hong, Hyun Suk; Kwon, Gui Hyang; Choi, Duk Lin; Ynag, Sung Boo [College of Medicine, Soonchunhyang Univ., Seoul (Korea, Republic of)

    2002-03-01

    To evaluate the usefulness of percutaneous management and prognosis in venous rupture during angioplasty of hemodialytic arteriovenous fistulas. Among 814 patients who underwent angioplasty on account of inadequate hemodialysis, 63(39 women and 24 men aged 20-78 (mean, 55.8) years) were included in this study. All 63 had peripheral venous stenosis. Venous rupture was diagnosed when contrast leakage was seen at venography after percutaneous angioplasty (PTA). In order to manage venous rupture, the sites at which this occurred were compressed manually for 3-5 minutes or blood flow was blocked with a balloon catheter for the same period. In one case, a stent was inserted at the rupture site. Using the Kaplan-Meier method, we investigated the patency rate of arteriovenous fistula (AVF) in cases of successful PTA. We also compared PTA patency rates in cases with and without peripheral venous rupture. Venous rupture occurred in 38 cephalic, 16 brachial, and 9 basilic veins. In 63 patients, bleeding stopped and in 54 (85.7 %) of thee, PTA was successful. Among the nine failed cases, dilatation was incomplete in five, though bleeding had stopped. In patients with brachial and cephalic vein rupture the venous tract at the rupture site was not located. Two patients underwent surgery: one of these experienced brachial venous rupture, with incontrollable bleeding, and the other had nerve compression symptoms due to hematoma. Among 54 patients in whom PTA was successful, the primary and secondary six-months rates for angioaccess were 47.9% and 81.2%, and the mean patency period was 6.1 and 15.8 months, respectively. In cases of non-venous rupture, the mean patency period was 9.6 months, significantly longer than in cases involving venous rupture (p=0.02). Venous rupture occurring during the PTA of hemodialytic AVF can be managed percutaneously.

  20. Heparin inhibits human coronary artery smooth muscle cell migration.

    Science.gov (United States)

    Kohno, M; Yokokawa, K; Yasunari, K; Minami, M; Kano, H; Mandal, A K; Yoshikawa, J

    1998-09-01

    Heparin, an anticoagulant, has been shown to reduce neointimal proliferation and restenosis following vascular injury in experimental studies, but the clinical trials of heparin in coronary balloon angioplasty have been negative. The current study, therefore, examined the effect of heparin on basal or stimulated migration by serum and platelet-derived growth factor (PDGF)-BB in cultured human coronary artery smooth muscle cells (SMCs) by Boyden's chamber method. In addition, the reversibility of the heparin effect on human coronary artery SMC migration was examined. Fetal calf serum (FCS) and PDGF-BB stimulated SMC migration in a concentration-dependent manner. Heparin in moderate to high concentration (10 to 100 U/mL) exhibited concentration-related inhibition of FCS- and PDGF-BB-stimulated SMC migration; however, a low concentration (1 U/mL) of heparin had no inhibitory effects. Heparin also had weak inhibitory effects on nonstimulated SMC migration. The SMCs that were exposed to a high concentration (100 U/mL) of heparin for 6 hours were capable of migrating after a short lag period of removal of heparin from the culture medium. These SMCs also showed recovery of responses to FCS and PDGF-BB by migrating significantly greater than the nonstimulated level. Furthermore, heparin-containing medium did not contain detached cells. These results indicate that heparin inhibits human coronary artery SMC migration, especially when stimulated by FCS or PDGF-BB, and that this inhibitory effect of heparin is reversible and not simply a function of killing cells.

  1. Value of first day angiography/angioplasty in evolving Non-ST segment elevation myocardial infarction: an open multicenter randomized trial. The VINO Study.

    Science.gov (United States)

    Spacek, R; Widimský, P; Straka, Z; Jiresová, E; Dvorák, J; Polásek, R; Karel, I; Jirmár, R; Lisa, L; Budesínský, T; Málek, F; Stanka, P

    2002-02-01

    Direct angioplasty is an effective treatment for ST-elevation myocardial infarction. The role of very early angioplasty in non-ST-elevation infarction is not known. Thus, a randomized study of first day angiography/angioplasty vs early conservative therapy of evolving myocardial infarction without persistent ST-elevation was conducted. One hundred and thirty-one patients with confirmed acute myocardial infarction without ST-segment elevations were randomized within 24 h of last rest chest pain: 64 in the first day angiography/angioplasty group and 67 in the early conservative group (coronary angiography only after recurrent or stress induced myocardial ischaemia). All patients in the invasive group underwent coronary angiography on the day of admission (mean randomization-angiography time 6.2 h). First day angioplasty of the infarct related artery was performed in 47% of the patients and bypass surgery in 35%. In the conservative group, 55% underwent coronary angiography, 10% angioplasty and 30% bypass surgery within 6 months. The primary end-point (death/reinfarction) at 6 months occurred in 6.2% vs 22.3% (P<0.001). Six month mortality in the first day angiography/angioplasty group was 3.1% vs 13.4% in the conservative group (P<0.03). Non-fatal reinfarction occurred in 3.1% vs. 14.9% (P<0.02). First day coronary angiography followed by angioplasty whenever possible reduces mortality and reinfarction in evolving myocardial infarction without persistent ST-elevation, in comparison with an early conservative treatment strategy. Copyright 2001 The European Society of Cardiology.

  2. Minimally invasive coronary artery bypass grafting versus stenting for patients with proximal left anterior descending coronary artery disease.

    Science.gov (United States)

    Shirai, Kazuyuki; Lansky, Alexandra J; Mehran, Roxana; Dangas, George D; Costantini, Costantino O; Fahy, Martin; Slack, Steven; Mintz, Gary S; Stone, Gregg W; Leon, Martin B

    2004-04-15

    The purpose of this study was to compare the clinical outcomes of stenting and minimally invasive coronary artery bypass grafting (MIDCAB) in patients with proximal left anterior descending (LAD) coronary artery disease. The Patency, Outcome, Economics of Minimally invasive direct coronary bypass (POEM) study demonstrated that MIDCAB had similar safety and long-term efficacy for LAD revascularization compared with conventional coronary artery bypass grafting. Although LAD stenting is superior to conventional balloon angioplasty, whether it is comparable to MIDCAB is not known. We identified a matched population of 429 consecutive patients with 1-vessel disease who underwent elective proximal LAD stenting and compared their clinical outcomes with those of the 152 patients in the MIDCAB group of the POEM study. The in-hospital event rate was similar in both groups, except for a shorter length of hospital stay with LAD stenting compared with MIDCAB (2.68 vs 4.07 days, p <0.0001). At 6-month follow-up, the incidence of death and Q-wave myocardial infarction or that of cerebrovascular accident was not significantly different between these 2 groups. However, target vessel revascularization was significantly higher with LAD stenting than MIDCAB (13.3% vs 6.6%, p = 0.045). In the subgroup of patients without diabetes, all clinical events were similar in both groups, and the benefit of a shorter hospital stay associated with stenting was maintained. Compared with MIDCAB, LAD stenting is associated with higher repeat revascularization rates but offers the advantage of shorter hospitalization. For nondiabetics with proximal LAD disease, stenting may be the revascularization strategy of choice.

  3. Successful percutaneous transluminal angioplasty and stenting for symptomatic intracranial vertebral artery stenosis using intravascular ultrasound virtual histology.

    Science.gov (United States)

    Takayama, Katsutoshi; Taoka, Toshiaki; Nakagawa, Hiroyuki; Myouchin, Kaoru; Wada, Takeshi; Sakamoto, Masahiko; Fukusumi, Akio; Iwasaki, Satoru; Kurokawa, Shinichiro; Kichikawa, Kimihiko

    2007-06-01

    This is the first report of percutaneous transluminal angioplasty (PTA) of an intracranial artery applying intravascular ultrasound virtual histology (IVUS-VH), which has been recently developed for tissue characterization of coronary artery plaque. We report a case of successful PTA and stenting for symptomatic intracranial vertebral artery stenosis using IVUS-VH.

  4. Efficacy of beta radiation in prevention of post-angioplasty restenosis : An interim report from the beta energy restenosis trial

    NARCIS (Netherlands)

    D. Meerkin; R. Bonan (Raoul); I.R. Crocker; A. Arsenault (André); P. Chougule; V.L.M.A. Coen (Veronique); D.O. Williams (David); P.W.J.C. Serruys (Patrick); S.B. King 3rd (Spencer)

    1998-01-01

    textabstractRestenosis remains a major limitation of coronary angioplasty in spite of major advances in techniques and technology. Recent studies have demonstrated that ionizing radiation may limit the degree of this problem. Gamma radiation has been shown to be effective in reducing in stent resten

  5. Mechanism of Residual Lumen Stenosis at the Side Branch Ostium After Final Kissing Balloon Inflation: A Volumetric Intracoronary Ultrasound Study of Coronary Bifurcation Lesions.

    Science.gov (United States)

    Yamawaki, Masahiro; Murasato, Yoshinobu; Kinoshita, Yoshihisa; Fujii, Kenichi; Fujino, Yoshihisa; Shinke, Toshiro; Takeda, Yoshihiro; Yamada, Shinichiro; Shimada, Yoshihisa; Tsukahara, Reiko; Muramatsu, Toshiya; Suzuki, Takahiko

    2016-04-01

    To investigate the mechanisms of residual stenosis (RS) at side branch ostium (SBO) after final kissing balloon inflation (FKI) and clarify the impact of carina- and plaque-shifts on RS. Carina- and plaque-shift induce SBO compromise. FKI is an effective technique to treat this complication; however, RS often persist, and are associated with restenosis at SBO. We performed serial volumetric analysis of 91 bifurcations in which crossover-stenting with FKI and pre-/post-intravascular ultrasounds (IVUS) were completed in both branches. The plaque- and carina-shifts were defined as an increase in the plaque-volume and a decrease in the vessel-volume at the SBO, respectively. RS at the SBO, defined as area stenosis >50% on IVUS, was identified in 19 lesions. After FKI, the plaque volume- significantly increased at the SBO, with its reduction in the proximal main vessel (MV). However, at the SBO, the volumetric lumen change correlated with vessel change (ρ = 0.690, P < 0.001), but not plaque change (P = 0.390), suggesting that RS at SBO was more likely associated with inadequate vessel stretch, not plaque increase after FKI. Carina-shift was more frequently found in cases with RS, compared to those without RS (37% vs. 11%, P = 0.013). Pre-procedure IVUS findings to predict RS at SBO after FKI were negative-remodeling at distal MV, plaque -burden at distal MV, and plaque-burden at the SBO. Carina-shift has a greater contribution to the formation of RS at SBO after FKI. The pre-procedure IVUS provides helpful information for predicting the RS after FKI. © 2016, Wiley Periodicals, Inc.

  6. Heme oxygenase-1 alleviates cigarette smoke-induced restenosis after vascular angioplasty by attenuating inflammation in rat model.

    Science.gov (United States)

    Ni, Leng; Wang, Zhanqi; Yang, Genhuan; Li, Tianjia; Liu, Xinnong; Liu, Changwei

    2016-03-14

    Cigarette smoke is not only a profound independent risk factor of atherosclerosis, but also aggravates restenosis after vascular angioplasty. Heme oxygenase-1 (HO-1) is an endogenous antioxidant and cytoprotective enzyme. In this study, we investigated whether HO-1 upregulating by hemin, a potent HO-1 inducer, can protect against cigarette smoke-induced restenosis in rat's carotid arteries after balloon injury. Results showed that cigarette smoke exposure aggravated stenosis of the lumen, promoted infiltration of inflammatory cells, and induced expression of inflammatory cytokines and adhesion molecules after balloon-induced carotid artery injury. HO-1 upregulating by hemin treatment reduced these effects of cigarette smoke, whereas the beneficial effects were abolished in the presence of Zincprotoporphyrin IX, an HO-1 inhibitor. To conclude, hemin has potential therapeutic applications in the restenosis prevention after the smokers' vascular angioplasty. Copyright © 2016. Published by Elsevier Ireland Ltd.

  7. Restenosis after infrapopliteal angioplasty - clinical importance, study update and further directions.

    Science.gov (United States)

    Baumann, Frederic; Diehm, Nicolas

    2013-11-01

    Patients with critical limb ischemia (CLI) represent the most severe form of peripheral arterial disease (PAD) and exhibit high mortality rates. Frequently, PAD in CLI patients involves the infrapopliteal arterial segment challenging endovascular revascularization strategies. Restenosis remains the major drawback of tibial angioplasty encountered in more than two thirds of CLI patients undergoing tibial revascularization. In contrast to earlier observations, tibial patency was recently shown to be essential to attain an optimal clinical outcome in CLI patients subsequent to tibial angioplasty. The exact pathopyhsiological mechanisms of tibial restenosis remains unclear. To date, most of our knowledge on tibial restenosis and its pathophysiology is derived from coronary arteries, based on the similarity of coronary arteries to tibial artery morphology. Nervertheless, multiple antirestenosis concepts are investigated within clinical trials to reduce tibial restenosis.Purpose of the present manuscript is to provide a current update on the pathophysiology of tibial restenosis and potential antirestenosis strategies.

  8. Safety, efficacy and costs associated with direct coronary stenting compared with stenting after predilatation

    Science.gov (United States)

    IJsselmuiden, A.; Serruys, P.W.; Tangelder, G.J.; Slagboom, T.; van der Wieken, R.; Kiemeneij, F.; Laarman, G.J.

    2004-01-01

    Objectives Comparison of the in-hospital success rates, procedural costs and short-term clinical outcomes of direct stenting versus stenting after balloon predilatation. Methods Altogether, 400 patients with angina pectoris and/or myocardial ischaemia due to coronary stenoses in a single native vessel were randomised to either direct stenting or stenting after predilatation. Baseline characteristics were evenly distributed between the two groups. Results Procedural success rates were similar (96.0% direct stenting group vs. 94.5% predilatation) as well as final successful stent implantation (98.3 vs. 97.8%), while the primary success rate of direct stenting alone was 88.3%, p=0.01. In multivariate analysis, angiographic lesion calcification was an independent predictor of unsuccessful direct stenting (odds ratio 7.1, 95% confidence interval 2.8-18.2, p0.15 μg/l, used as a measure of distal embolisation, were similar in both groups (17.8 vs. 17.1%). Rates of major adverse cardiac events at 30 days were 4.5% in the direct stenting group versus 5.5% in the predilated group (ns). Direct stenting was associated with savings in fluoroscopy time, and angiographic contrast agent use, and a reduction in utilisation of angioplasty balloons (0.4 vs. 1.17 balloons per patient, p<0.001). Mean per patient procedural costs associated with direct stenting versus predilatation were €2545±914 versus €2763±842 (p=0.01), despite the implantation of more stents in the directly stented group. Conclusion Compared with a strategy of stenting preceded by balloon predilatation, direct stenting was equally safe and effective, with similar in-hospital and 30-day clinical outcomes, and modest procedural cost-savings. A calcified lesion predicted unsuccessful direct stenting. PMID:25696356

  9. How to perform combined cutting balloon and high pressure balloon valvuloplasty for dogs with subaortic stenosis.

    Science.gov (United States)

    Kleman, Mandi E; Estrada, Amara H; Maisenbacher, Herbert W; Prošek, Robert; Pogue, Brandon; Shih, Andre; Paolillo, Joseph A

    2012-01-01

    Subvalvular aortic stenosis (SAS) is one of the most common congenital cardiac malformations in dogs. Unfortunately, the long term success rate and survival data following either open heart surgery or catheter based intervention has been disappointing in dogs with severe subaortic stenosis. Medical therapy is currently the only standard recommended treatment option. A cutting balloon dilation catheter has been used successfully for resistant coronary artery and peripheral pulmonary arterial stenoses in humans. This catheter is unique in that it has the ability to cut, or score, the stenotic region prior to balloon dilatation of the stenosis. The use of cutting balloon valvuloplasty combined with high pressure valvuloplasty for dogs with severe subaortic stenosis has recently been reported to be a safe and feasible alternative therapeutic option. The following report describes this technique, outlines the materials required, and provides some 'tips' for successful percutaneous subaortic balloon valvuloplasty. Copyright © 2012 Elsevier B.V. All rights reserved.

  10. Drug-coated balloons are replacing the need for nitinol stents in the superficial femoral artery.

    Science.gov (United States)

    Kitrou, Panagiotis; Karnabatidis, Dimitrios; Katsanos, Konstantinos

    2016-08-01

    Amassed evidence from several randomized controlled trials and high quality meta-analyses clearly support the primary use of paclitaxel-coated balloons (PCB) in the superficial femoral artery over traditional plain balloon angioplasty or primary bare nitinol stenting with significantly lower vascular restenosis, less need for repeat procedures, improved quality of life and potential cost savings for the healthcare system. Stents may be reserved for bail-out in case of a suboptimal dilatation result, and for selected more complex lesions, or in case of critical limb ischemia in order to eliminate vessel recoil and maximize immediate hemodynamic gain. Debulking atherectomy remains unproven, but holds a lot of promise in particular in combination with PCBs, in order to improve compliance of the vessel wall by plaque removal, allow for a better angioplasty result and optimize drug transfer and bioavailability. The present overview summarizes and discusses current evidence about femoropopliteal PCB angioplasty compared to the historical standard of plain old balloon angioplasty and bare nitinol stents. Available evidence is appraised in the context of clinically meaningful results, relevant unresolved issues are highlighted, and future trends are discussed.

  11. [Changes of content of regulatory lymphocytes and concentration of soluble interleukine-2 receptor in blood of patients with ischemic heart disease after coronary artery angioplasty with implantation of stents with rapamycin covering].

    Science.gov (United States)

    Potekhina, A V; Sokolov, V O; Pylaeva, E A; Provatorov, S I; Masenko, V P; Bosykh, E G; Noeva, E A; Krasnikova, T L; Aref'eva, T I

    2011-01-01

    We studied dynamics of content of subpopulation of lymphocytes including regulatory and effector T-lymphocytes as well as concentration of soluble form of interleukine-2 receptor (sCD25) in peripheral blood of patients after coronary stenting (CS) with implantation of stents with rapamycin covering (SRC). We included into the study 62 patients with stable effort II-III functional class angina. Coronary angiography (CA) was carried out in all, CS with implantation of 1 - 2 SRC - in 42 patients. Blood samples were taken before CA/CS, in 24, 48 hours, 7 days, 1 and 3 months after intervention. Content of T-, helper and cytotoxic T-cells, -, NK-, NKT-cells, activated effector T-lymphocytes (CD4+CD251owCD127high) and regulatory T-lymphocytes (CD4+CD25highCD1271ow) were measured by direct immunofluorescence and flow cytometry. CD4+ lymphocytes were isolated from mononuclear cell fraction of donor blood by magnetic separation. Content of regulatory T-lymphocytes in culture were determined by expression of a specific marker FOXP3+. Concentration of sCD25 was measured by chemiluminescent method. It was shown that content of main subpopulations of lymphocytes in blood changed after CS or CF. Blood content of regulatory T-lymphocytes and sCD25 significantly increased after 7 days and 1 month after CS but not after CA. Plasma sCD25 concentration correlated with content of regulatory T-lymphocytes in 1 month after SRC implantation. During cultivation of CD4+ lymphocytes in the presence of rapamycin we noted antiproliferative effect relative to FOXP3-cells and accumulation of regulatory +-lymphocytes. Thus implantation of SRC in coronary arteries leads to increase of number of circulating regulatory T-lymphocytes and blood concentration of sCD25. Changes of these parameters after CS can reflect peculiarities of local and systemic reaction arising in response to introduction of stent with drug covering and be significant for assessment of prognosis of the disease.

  12. Long term follow up after elective percutaneous coronary intervention for unprotected non-bifurcational left main stenosis: is it time to change the guidelines?

    Science.gov (United States)

    Brueren, B R G; Ernst, J M P G; Suttorp, M J; ten Berg, J M; Rensing, B J W M; Mast, E G; Bal, E T; Six, A J; Plokker, H W M

    2003-11-01

    According to the American College of Cardiology/American Heart Association guidelines, percutaneous coronary intervention (PCI) for left main coronary artery (LMCA) stenosis is contraindicated and coronary artery bypass graft surgery (CABG) is preferred. However, PCI of the LMCA is performed under exceptional circumstances. To analyse the data of patients who underwent PCI of the unprotected LMCA in St Antonius Hospital, Nieuwegein, Netherlands. In a database of 17 683 PCI procedures, 71 patients (0.4%) were found with non-bifurcational LMCA stenosis who underwent an elective PCI between 1991 and 2001. Ages ranged from 26.7-86.5 years. Severe concomitant disease was the most frequent argument in favour of PCI instead of CABG. PCI consisted of only balloon angioplasty in 23 cases (32.4%). A stent was used in 46 cases (64.4%). Average follow up was 43 months (range 0-121 months). One patient died one day after the procedure. The total one year survival rate was 98.6% (70/71). Seven patients died during the follow up period, mostly because of non-cardiac reasons. The annual mortality rate was 2.5%. Recurrent elective percutaneous transluminal coronary angioplasty for restenosis of the LMCA was performed in one patient (1.4%) six weeks after the initial procedure. CABG was required in 13 patients (18.3%) throughout the follow up period. These results suggest that at highly experienced centres, elective PCI of the non-bifurcational LMCA can be performed safely where the anatomy is suitable.

  13. Safety and efficacy of percutaneous transluminal coronary angioplasty in octogenarian Chinese%80岁以上冠心病患者行冠状动脉介入治疗术的安全性和疗效观察

    Institute of Scientific and Technical Information of China (English)

    王挹青; 何世华; 王焱

    2001-01-01

    目的观察80岁以上冠心病患者接受经皮冠状动脉(冠脉)腔内介入治疗术(PCI)的安全性和有效性。方法对43例≥80岁的冠心病患者的48支相关血管进行PCI 45次,其中右主干11支,左前降支25支,回旋支11支,左冠状动脉1支。与237例<80岁行PCI的冠心病患者进行比较。结果 37例患者手术成功,手术成功率86.1%,再通42支病变血管(87.5%),置入冠脉内支架16枚,成功率100.0%。6支血管再通失败,其中5支左前降支(LAD),手术相关并发症2例,均为LAD近端闭塞扩张后再闭塞或引起左主干(LM)夹层,其中1例术后1周死于室性心动过速。随访37例,平均随访时间(18.0±8.8)个月。手术后6~12个月行冠脉造影随访25例,再狭窄率36.0%。结论对80岁以上冠心病患者行PCI治疗是安全有效的,成功率较高,并发症少,但应严格掌握手术适应证。%Objective To evaluate the safety and efficiency of percutaneous coronary interventions(PCI) in octogenarian Chinese with coronary artery disease. Methods A total of 43 patients aged over 80 years old underwent 45 such procedures at Queen Mary Hospital from October 1994 to May 1998. There were 27 male and 16 female 〔 mean age (82.3±2.5), range (80-89)〕. 55.8% of these patients had multi-vessel lesions. A total of 48 lesions in 43 patients was treated 〔25 LAD(52.1%), 11 LCX(22.9%) , 11 RCA(22.9%), 1 LM (2.1%)〕.  Results Thirty-seven (86.1%) patients were successfully performed PCI. Sixteen of them deployed stenting. Among the 6 lesions which failed to cross, 5 of lesions were LAD, 3 of them were total occlusion. The success rate and complication during the procedure were not significant difference compared with the control in 237 patients <80 years of age. At 18 months follow up, 78.5% of these patients was free or much improved of chest pain. The restenosis rate was 36.0% confirmed by coronary angiogram performed

  14. Medical angioplasty - Hope and expectations: An optimistic overview

    Directory of Open Access Journals (Sweden)

    Mohammed F Abdul-Mohsen

    2011-01-01

    Full Text Available Primary and secondary prevention of cardiovascular diseases (CVD are markedly overlooked worldwide. The use of these kinds of preventive methods will greatly improve outcome of or even reverse major CVD, especially coronary atherosclerosis. Comprehensive lifestyle changes combined with aggressive medical therapy [lipid lowering agents "statins", antiplatelet agents, beta-blockers and angiotensin-converting enzyme inhibitors] for patients suffering from coronary heart disease significantly reduce all major adverse cardiovascular events (MACE, especially in those with stable coronary artery disease (CAD, even if their coronary lesions are significant. The main mechanistic pathways for the significant reduction of MACE are: Stabilization of atheromatous plaques through endothelial function reparation, strengthening of the fibrous cap of the atheromatous plaque and reduction of atheroma burden, i.e., reversal of the process of coronary artery stenosis, the great dream of "medical angioplasty". Despite the compelling data indicating the great beneficial effects of both primary and secondary prevention of coronary atherosclerosis, the US national survey data reveals that only a minority of patients eligible by guidelines for these therapies in fact receive them. Hence, we strongly believe that our main duties as cardiologists is to improve the up-to-date knowledge of the practicing physicians about utility of aggressive medical therapy for both prevention and reversal of CVD, and also to promote useful primary and secondary prevention programs among physicians and patients. Meanwhile, further improvement and refinement of the current therapeutic modalities and introduction of new modalities for the management of lipid parameters other than LDL-C, such as HDL-C, triglyceride, lipoprotein (a, LDL particle size and susceptibility to oxidation may add further favourable effects in prevention and reversal of atherosclerotic process. Cardiologists should be

  15. Future of Percutaneous Coronary Intervention From an Asian Perspective

    Institute of Scientific and Technical Information of China (English)

    Yean-Leng LIM

    2002-01-01

    @@ We have come a long-way since Andreas Gruentzig performed the first percutaneous transluminal coronary angioplasty (PTCA) in man in 1977. It is timely to assess what we have actually achieved for patients with coronary heart disease with the advent of this treatment modality and where we are heading from now.

  16. Stenting of unprotected left main coronary artery in a patient with cardiogenic shock

    Directory of Open Access Journals (Sweden)

    Bedson José Lopes de Sá

    1999-09-01

    Full Text Available A 64-year-old female presented with pulmonary edema and cardiogenic shock after coronary arteriography that showed severe suboclusive lesion in the left main coronary artery (LMCA in a dominant left coronary system. The patient succesfully underwent urgent angioplasty with stent deployment in the LMCA. After an uneventful period, the patient was discharged at day six.

  17. Peripheral pulsed laser angioplasty - 4-year clinical experience; Periphere gepulste Laserangioplastie - Erfahrungen nach 4jaehrigem klinischen Einsatz

    Energy Technology Data Exchange (ETDEWEB)

    Huppert, P.E. [Tuebingen Univ. (Germany). Abt. fuer Radiologische Diagnostik; Duda, S.H. [Tuebingen Univ. (Germany). Abt. fuer Radiologische Diagnostik; Kalighi, K. [Tuebingen Univ. (Germany). Abt. fuer Thorax-, Herz- und Gefaesschirurgie; Baumbach, A. [Tuebingen Univ. (Germany). Abt. 3, Medizinische Klinik; Seboldt, H. [Tuebingen Univ. (Germany). Abt. fuer Thorax-, Herz- und Gefaesschirurgie; Claussen, C.D. [Tuebingen Univ. (Germany). Abt. fuer Radiologische Diagnostik

    1994-02-01

    In 134 patients, 21 iliac, 91 femoropopliteal and 22 crural arterial occlusions were treated by percutaneous laser-assisteed angioplasty and in 32 patients femoropopliteal occlusions by conventional balloon angioplasty. Laser angioplasty could be performed in 126 patients following initial guide wire recanalisation using 9, 7 and 4.5-F multifibre catheters, respectively. In 72 patients a 308-nm excimer laser and in 54 patients a 504-nm pulsed day laser was used. Luminal opening by laser angioplasty was obtained in 102 of 126 (81%) procedures (9 incomplete catheter passages, 15 persistent occlusions). 95% of iliac, 90% of femoropopliteal and 77% of crural recanalisations including supplemental balloon dilatations (n=105) and stent implantations (n-24) succeeded technically. Clinical success rates at 1 (2) years after angioplasty weere 95% (89%) for iliac, 66% (63%) for femoropopliteal and 57% (50%) for crural treatments. Technical and clinical results of laser-assissted femoropopliteal recanalisations showed no significant differences in comparison to the results of conventional balloon angioplasty. The use of pulsed lasers for the treatment of peripheral arterial occlusive disease would require further technical improvements. (orig.) [Deutsch] Bei 134 Patienten mit arterieller Verschlusskrankheit wurden 21 iliakale, 91 femoropopliteale und 22 krurale Okklusionen einer Behandlung durch perkutane laserassistierte Angioplastie zugefuehrt und bei 32 Patienten femoropoliteale Okklusionen vergleichsweise einer konventionellen Ballonangioplastie. 126 Laserangioplastien konnten mit 9, 7 und 4,5-F-Multifaserkathetern nach initialer Fuehrungsdrahtpassage durchgefuehrt werden. Bei 72 Eingriffen wurde ein 308-nm-Excimerlaser und bei 54 ein 405-nm-Farbstofflaser verwendet. Eine Lumeneroeffnung gelang bei 102 von 126 (81%) Laserangioplastien (9 inkomplette Katheterpassagen, 15 persistierende Okklusionen). 95% iliakaler, 90% femoropoplitealer und 77% kruraler laserassistierter

  18. Clinical Coronary In-Stent Restenosis Follow-Up after Treatment and Analyses of Clinical Outcomes

    Directory of Open Access Journals (Sweden)

    Barbara Campos Abreu Marino

    2015-05-01

    Full Text Available Background: Clinical in-stent restenosis (CISR is the main limitation of coronary angioplasty with stent implantation. Objective: Describe the clinical and angiographic characteristics of CISR and the outcomes over a minimum follow-up of 12 months after its diagnosis and treatment. Methods: We analyzed in 110 consecutive patients with CISR the clinical presentation, angiographic characteristics, treatment and combined primary outcomes (cardiovascular death, nonfatal acute myocardial infarction [AMI] and combined secondary (unstable angina with hospitalization, target vessel revascularization and target lesion revascularization during a minimal follow-up of one year. Results: Mean age was 61 ± 11 years (68.2% males. Clinical presentations included acute coronary syndrome (ACS in 62.7% and proliferative ISR in 34.5%. CISR was treated with implantation of drug-eluting stents (DES in 36.4%, Bare Metal Stent (BMS in 23.6%, myocardial revascularization surgery in 18.2%, balloon angioplasty in 15.5% and clinical treatment in 6.4%. During a median follow-up of 19.7 months, the primary outcome occurred in 18 patients, including 6 (5.5% deaths and 13 (11.8% AMI events. Twenty-four patients presented a secondary outcome. Predictors of the primary outcome were CISR with DES (HR = 4.36 [1.44–12.85]; p = 0.009 and clinical treatment for CISR (HR = 10.66 [2.53–44.87]; p = 0.001. Treatment of CISR with BMS (HR = 4.08 [1.75–9.48]; p = 0.001 and clinical therapy (HR = 6.29 [1.35–29.38]; p = 0.019 emerged as predictors of a secondary outcome. Conclusion: Patients with CISR present in most cases with ACS and with a high frequency of adverse events during a medium-term follow-up.

  19. Clinical Coronary In-Stent Restenosis Follow-Up after Treatment and Analyses of Clinical Outcomes

    Science.gov (United States)

    Marino, Barbara Campos Abreu; Nascimento, Guilherme Abreu; Rabelo, Walter; Marino, Marcos Antônio; Marino, Roberto Luiz; Ribeiro, Antonio Luiz Pinho

    2015-01-01

    Background Clinical in-stent restenosis (CISR) is the main limitation of coronary angioplasty with stent implantation. Objective Describe the clinical and angiographic characteristics of CISR and the outcomes over a minimum follow-up of 12 months after its diagnosis and treatment. Methods We analyzed in 110 consecutive patients with CISR the clinical presentation, angiographic characteristics, treatment and combined primary outcomes (cardiovascular death, nonfatal acute myocardial infarction [AMI]) and combined secondary (unstable angina with hospitalization, target vessel revascularization and target lesion revascularization) during a minimal follow-up of one year. Results Mean age was 61 ± 11 years (68.2% males). Clinical presentations included acute coronary syndrome (ACS) in 62.7% and proliferative ISR in 34.5%. CISR was treated with implantation of drug-eluting stents (DES) in 36.4%, Bare Metal Stent (BMS) in 23.6%, myocardial revascularization surgery in 18.2%, balloon angioplasty in 15.5% and clinical treatment in 6.4%. During a median follow-up of 19.7 months, the primary outcome occurred in 18 patients, including 6 (5.5%) deaths and 13 (11.8%) AMI events. Twenty-four patients presented a secondary outcome. Predictors of the primary outcome were CISR with DES (HR = 4.36 [1.44–12.85]; p = 0.009) and clinical treatment for CISR (HR = 10.66 [2.53–44.87]; p = 0.001). Treatment of CISR with BMS (HR = 4.08 [1.75–9.48]; p = 0.001) and clinical therapy (HR = 6.29 [1.35–29.38]; p = 0.019) emerged as predictors of a secondary outcome. Conclusion Patients with CISR present in most cases with ACS and with a high frequency of adverse events during a medium-term follow-up. PMID:25651344

  20. A novel fluoroscopic-assisted balloon thrombectomy technique for thrombosed hemodialysis prosthetic grafts [corrected].

    Science.gov (United States)

    Kakkos, Stavros K; Haddad, Joseph A; Haddad, Georges K

    2010-01-01

    Previous studies have shown that stenosis of the arterial anastomosis of thrombosed hemodialysis (HD) grafts, unmasked after conventional thrombectomy, very often necessitate subsequent arterial angioplasty. The aim of this study was to describe a novel fluoroscopic-assisted balloon thrombectomy technique which permits simultaneous arterial angioplasty (should this is required) for thrombosed HD grafts. Thirty patients with 36 thrombotic episodes of their prosthetic HD grafts participated in this study. A balloon angioplasty catheter is placed beyond the arterial anastomosis, over a guidewire; the balloon is inflated with contrast solution under fluoroscopy and pulled back to remove the arterial thrombus from the anastomosis. Any coexisting stenosis revealed by balloon indentation is completely dilated at that time, rather than after the thrombectomy. Mechanical thrombolysis of the graft and venous outflow is then performed with the AngioJet catheter (Possis Medical, Inc). Technical and clinical success rates (the latter defined as one subsequent HD session) of the procedure were 100% and 94%, respectively. No complications, including arterial embolism, vessel rupture or pulmonary embolism, were encountered. Primary assisted patency at 3 and 6 months was 51% and 32%, respectively, while functional secondary patency at the same follow-up points was 78%. Our technique is safe and also effective in both short- and long-term follow-up. Because it offers convenience, since the treatment of arterial anastomotic stenoses is accomplished in one (rather than two) steps, this method deserves further investigation.

  1. Bioresorbable scaffolds: A new paradigm in percutaneous coronary intervention

    NARCIS (Netherlands)

    E. Tenekecioglu (Erhan); V. Farooq (Vasim); C.V. Bourantas (Christos); R.C. Silva (Rafael Cavalcante); Y. Onuma (Yoshinobu); M. Yilmaz (Mustafa); P.W.J.C. Serruys (Patrick)

    2016-01-01

    textabstractNumerous advances and innovative therapies have been introduced in interventional cardiology over the recent years, since the first introduction of balloon angioplasty, but bioresorbable scaffold is certainly one of the most exciting and attracting one. Despite the fact that the metallic

  2. Correlating coating characteristics with the performance of drug-coated balloons--a comparative in vitro investigation of own established hydrogel- and ionic liquid-based coating matrices.

    Directory of Open Access Journals (Sweden)

    Sebastian Kaule

    Full Text Available Drug-coated balloons (DCB, which have emerged as a therapeutic alternative to drug-eluting stents in percutaneous cardiovascular intervention, are well described with regard to clinical efficacy and safety within a number of clinical studies. In vitro studies elucidating the correlation between coating additive and DCB performance are however rare but considered important for the understanding of DCB requirements and the improvement of established DCB. In this regard, we examined three different DCB-systems, which were developed in former studies based on the ionic liquid cetylpyridinium salicylate, the body-own hydrogel hyaluronic acid and the pharmaceutically well-established hydrogel polyvinylpyrrolidone, considering coating morphology, coating thickness, drug-loss, drug-transfer to the vessel wall, residual drug-concentration on the balloon surface and entire drug-load during simulated use in an in vitro vessel model. Moreover, we investigated particle release of the different DCB during simulated use and determined the influence of the three coatings on the mechanical behavior of the balloon catheter. We could show that coating characteristics can be indeed correlated with the performance of DCB. For instance, paclitaxel incorporation in the matrix can reduce the drug wash-off and benefit a high drug transfer. Additionally, a thin coating with a smooth surface and high but delayed solubility can reduce drug wash-off and decrease particle burden. As a result, we suggest that it is very important to characterize DCB in terms of mentioned properties in vitro in addition to their clinical efficacy in order to better understand their function and provide more data for the clinicians to improve the tool of DCB in coronary angioplasty.

  3. Ulcerated Radiodermatitis Induced after Fluoroscopically Guided Stent Implantation Angioplasty

    Science.gov (United States)

    Herz-Ruelas, Maira Elizabeth; Gómez-Flores, Minerva; Moxica-del Angel, Joaquín; Miranda-Maldonado, Ivett; Gutiérrez-Villarreal, Ilse Marilú; Villarreal-Rodríguez, Adriana Orelia

    2014-01-01

    Cases of radiation-induced skin injury after fluoroscopically guided procedures have been reported since 1996, though the majority of them have been published in Radiology and Cardiology literature, less frequently in Dermatology journals. Chronic radiation dermatitis induced by fluoroscopy can be difficult to diagnose; a high grade of suspicion is required. We report a case of an obese 46-year-old man with hypertension, dyslipidemia, and severe coronary artery disease. He developed a pruritic and painful atrophic ulcerated skin plaque over his left scapula, six months after fluoroscopically guided stent implantation angioplasty. The diagnosis of radiodermatitis was confirmed histologically. We report this case to emphasize the importance of recognizing fluoroscopy as a cause of radiation dermatitis. A good clinical follow-up at regular intervals is important after long and complicated procedures, since the most prevalent factor for injury is long exposure time. PMID:25276441

  4. Ulcerated Radiodermatitis Induced after Fluoroscopically Guided Stent Implantation Angioplasty

    Directory of Open Access Journals (Sweden)

    Maira Elizabeth Herz-Ruelas

    2014-01-01

    Full Text Available Cases of radiation-induced skin injury after fluoroscopically guided procedures have been reported since 1996, though the majority of them have been published in Radiology and Cardiology literature, less frequently in Dermatology journals. Chronic radiation dermatitis induced by fluoroscopy can be difficult to diagnose; a high grade of suspicion is required. We report a case of an obese 46-year-old man with hypertension, dyslipidemia, and severe coronary artery disease. He developed a pruritic and painful atrophic ulcerated skin plaque over his left scapula, six months after fluoroscopically guided stent implantation angioplasty. The diagnosis of radiodermatitis was confirmed histologically. We report this case to emphasize the importance of recognizing fluoroscopy as a cause of radiation dermatitis. A good clinical follow-up at regular intervals is important after long and complicated procedures, since the most prevalent factor for injury is long exposure time.

  5. CTO revascularization: Obstacles and options in balloon nonpenetrable lesions.

    Science.gov (United States)

    Topaz, On

    2017-07-01

    CTO lesions resisting balloon crossing are located in moderate/severe tortuous coronary arteries contain more moderate/severe calcification burden and carry a higher J-CTO score as compared with balloon crossable CTO lesions. CTO lesions resisting balloon crossing do not constitute a homogenous group. In 25% of the patients, the resisting CTO was caused by stent restenosis and thrombus is an integral component of CTO in addition to calcium and fibrosis. The excimer laser and rotational/orbital atherectomy are among useful debulking technologies capable of creating a "pilot recanalization channel" in the CTO that enables completion of the revasularization. © 2017 Wiley Periodicals, Inc.

  6. Comparison between primary angioplasty and thrombolytic therapy on erectile dysfunction after acute ST elevation myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    Ramazan Akdemir; Ekrem Yeter; (O)zlem Karakurt; Salih Orcan; Nihat Karakoyunlu; Mustafa Mucahit Balci; Levent Sa(g)nak; Hamit Ersoy; Mehmet Bulent Vatan; Harun Kilic

    2012-01-01

    Acute ST elevation myocarclial infarction has high mortality and morbidity rates.The majority of patients with this condition face erectile dysfunction in addition to other health problems,In this study,we aimed to investigate the effects of two different reperfusion strategies,primary angioplasty and thrombolytic therapy,on the prevalence of erectile dysfunction after acute myocardial infarction.Of the 71 patients matching the selection criteria,45 were treated with primary coronary angioplasty with stenting,and 26 were treated with thrombolytic agents.Erectile function was evaluated using the International Index of Erectile Function in the hospital to characterize each patient's sexual function before the acute myocardial infarction and 6 months after the event.The time required to restore blood flow to the artery affected by the infarct was found to be associated with the occurrence of erectile dysfunction after acute myocardial infarction.The increase in the prevalence of erectile dysfunction after acute myocardial infarction was 44.4% in the angioplasty group and 76.9% in the thrombolytic therapy group (P=0.008).In conclusion,this study has shown that reducing the time of reperfusion decreases the erectile dysfunction prevalence,and primary angioplasty is superior to thrombolytic therapy for decreasing the prevalence of erectile dysfunction after acute myocardial infarction.

  7. Below-the-ankle Angioplasty and Stenting for Limb Salvage: Anatomical Considerations and Long-term Outcomes

    Energy Technology Data Exchange (ETDEWEB)

    Katsanos, Konstantinos, E-mail: katsanos@med.upatras.gr; Diamantopoulos, Athanasios; Spiliopoulos, Stavros; Karnabatidis, Dimitris; Siablis, Dimitris [School of Medicine, Patras University Hospital, Department of Interventional Radiology (Greece)

    2013-08-01

    PurposeTo report the long-term angiographic and clinical results in a series of below-the-ankle (BTA) angioplasty procedures and to present some biomechanical issues related to the unique anatomical geometry of the ankle.MethodsWe performed a retrospective analysis of BTA angioplasty procedures. Clinical end points included technical success, patient mortality, salvage of the treated foot, and repeat target lesion revascularization. Imaging end points included primary patency, binary restenosis of the target lesion at the 50 % threshold, and stent integrity (stent fracture, deformation, or collapse). Univariate subgroup analysis was performed.ResultsIn total, 40 limbs in 37 patients (age 73.5 {+-} 8.2 years) with critical limb ischemia were included and 42 inframalleolar lesions (4.2 {+-} 1.4 cm) were analyzed. Technical success was achieved in 95.2 % (40 of 42). Provisional stent placement was performed in 45.2 % (19 of 42). Two patients died, and two major amputations occurred up to 3 years. At 1 year, overall primary vessel patency was 50.4 {+-} 9.1 %, lesion binary restenosis rate was 64.1 {+-} 8.3 %, and repeat intervention-free survival was 93.6 {+-} 4.3 % according to life table analysis of all treated lesions. Pairwise subgroup analysis showed that BTA self-expanding stents were associated with significantly higher restenosis and poorer primary patency compared to plain balloon angioplasty or sirolimus-eluting balloon-expandable stents. Significant deformation and/or fracture of balloon-expandable stents placed BTA were identified in five of 11. Dynamic imaging showed that the dorsalis pedis artery is kinked during foot dorsiflexion, whereas the distal posterior tibial artery is kinked during plantar flexion of the foot.ConclusionBTA angioplasty for critical limb ischemia treatment is safe and feasible with satisfactory long-term results. BTA stent placement must be reserved for bailout indications.

  8. Direct ambulance transport to catheterization laboratory reduces door-to-balloon time in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: the DIRECT-STEMI study

    Institute of Scientific and Technical Information of China (English)

    QIU Jian-ping; ZHANG Qi; LU Ji-de; WANG Hai-rong; LIN Jie; GE Zhi-ru; ZHANG Rui-yan; SHEN Wei-feng

    2011-01-01

    Background Primary percutaneous coronary intervention (PCI) has been clearly identified as the first therapeutic option for patients with acute ST-segment elevation myocardial infarction (STEMI). The importance of reducing door-to-balloon (D2B) time has gained increased recognition. This study aimed to assess the feasibility, safety and efficacy of the strategy of direct ambulance transportation of patients with acute STEMI to catheterization lab to receive primary PCI.Methods The study population included 141 consecutive patients with chest pain and ST-segment elevation who were admitted to the catheterization laboratory directly by the ambulance and underwent primary PCI (DIRECT group).Another 145 patients with STEMI randomly selected from the PCI database, were served as control group (conventional group); they were transported to catheterization laboratory from emergency room (ER). The primary endpoint of D2B time,and secondary endpoint of in-hospital and 30-day major adverse cardiac events (MACE, including death, non-fatal reinfarction, and target vessel revascularization) were compared.Results Baseline and procedural characteristics between the two groups were comparable, except more patients in the DIRECT group presented TIMI 0-1 flow in culprit vessel at initial angiogram (80.1% and 73.8%, P=0.04). Comparing to conventional group, the primary endpoint of D2B time was reduced ((54±18) minutes and (112±55) minutes, P <0.0001)and the percentage of patients with D2B <90 minutes was increased in the DIRECT group (96.9% and 27.0%, P<0.0001).The success rate of primary PCI with stent implantation with final Thrombolysis in Myocardial Infarction (TIMI) 3 flow was significantly higher in the DIRECT group (93.8% and 85.2%, P=0.03). Although no significant difference was found at 30-day MACE free survival rate between the two groups (95.0% and 89.0%, P=0.06), a trend in improving survival status in the DIRECT group was demonstrated by Kaplan-Meier analysis

  9. Bioresorbable scaffolds: a new paradigm in percutaneous coronary intervention.

    Science.gov (United States)

    Tenekecioglu, Erhan; Farooq, Vasim; Bourantas, Christos V; Silva, Rafael Cavalcante; Onuma, Yoshinobu; Yılmaz, Mustafa; Serruys, Patrick W

    2016-02-12

    Numerous advances and innovative therapies have been introduced in interventional cardiology over the recent years, since the first introduction of balloon angioplasty, but bioresorbable scaffold is certainly one of the most exciting and attracting one. Despite the fact that the metallic drug-eluting stents have significantly diminished the re-stenosis ratio, they have considerable limitations including the hypersensitivity reaction to the polymer that can cause local inflammation, the risk of neo-atherosclerotic lesion formation which can lead to late stent failure as well as the fact that they may preclude surgical revascularization and distort vessel physiology. Bioresorbable scaffolds overcome these limitations as they have the ability to dissolve after providing temporary scaffolding which safeguards vessel patency. In this article we review the recent developments in the field and provide an overview of the devices and the evidence that support their efficacy in the treatment of CAD. Currently 3 devices are CE marked and in clinical use. Additional 24 companies are developing these kind of coronary devices. Most frequently used material is PLLA followed by magnesium.

  10. REPERFUSION THERAPY IN ACUTE CORONARY SYNDROME WITH ST SEGMENT ELEVATION

    Directory of Open Access Journals (Sweden)

    A. L. Alyavi

    2009-01-01

    Full Text Available Aim. To compare effect of percutaneous balloon angioplasty (PCA and a systemic thrombolysis (STL on the central and intracardiac hemodynamics in patients with acute coronary syndrome (ACS with ST segment elevation.Material and methods. 80 patients with ACS with ST segment elevation were included in the study. Patients were split into 2 groups depending on reperfusion strategy. PCA was performed in 55 patients (first group. 25 patients of the second group had STL with Streptokinase, i/v, 1 500 000 units per hour. Echocardiography was performed in all patients at admission and after 3 and 7 days of treatment to evaluate intracardiac hemodynamics.Results. Both reperfusion methods significantly increase of ejection fraction (EF and maximal output speed of left ventricle (LV. Increase of LV EF in patients after PCA was higher than this in patients after STL. PCA improved LV diastolic function; STL did not change this characteristic. After PCA working diagnosis of ACS was transformed to the following final diagnosis: acute myocardial infarction (AMI with Q, AMI without Q and unstable angina in 37,5, 30,4 and 32,1% of patients, respectively. After STL diagnosis of AMI with Q was defined in all patients.Conclusion. PCA in patients with ACS with ST segment elevation results in fast improvement of global systolic and diastolic LV function. Besides, PCA prevents AMI with Q in a half of these patients.

  11. REPERFUSION THERAPY IN ACUTE CORONARY SYNDROME WITH ST SEGMENT ELEVATION

    Directory of Open Access Journals (Sweden)

    A. L. Alyavi

    2016-01-01

    Full Text Available Aim. To compare effect of percutaneous balloon angioplasty (PCA and a systemic thrombolysis (STL on the central and intracardiac hemodynamics in patients with acute coronary syndrome (ACS with ST segment elevation.Material and methods. 80 patients with ACS with ST segment elevation were included in the study. Patients were split into 2 groups depending on reperfusion strategy. PCA was performed in 55 patients (first group. 25 patients of the second group had STL with Streptokinase, i/v, 1 500 000 units per hour. Echocardiography was performed in all patients at admission and after 3 and 7 days of treatment to evaluate intracardiac hemodynamics.Results. Both reperfusion methods significantly increase of ejection fraction (EF and maximal output speed of left ventricle (LV. Increase of LV EF in patients after PCA was higher than this in patients after STL. PCA improved LV diastolic function; STL did not change this characteristic. After PCA working diagnosis of ACS was transformed to the following final diagnosis: acute myocardial infarction (AMI with Q, AMI without Q and unstable angina in 37,5, 30,4 and 32,1% of patients, respectively. After STL diagnosis of AMI with Q was defined in all patients.Conclusion. PCA in patients with ACS with ST segment elevation results in fast improvement of global systolic and diastolic LV function. Besides, PCA prevents AMI with Q in a half of these patients.

  12. Coronary-subclavian steal: presentation and management: two case reports.

    Science.gov (United States)

    Fergus, Todd; Pacanowski, John P; Fasseas, Panayotis; Nanjundappa, A; Habeeb Ahmed, M; Dieter, Robert S

    2007-01-01

    Subclavian stenosis is a highly prevalent and underrecognized clinical entity. In patients with a history of coronary artery bypass grafting utilizing a left internal mammary artery, subclavian artery stenosis can cause coronary-subclavian steal, leading to myocardial ischemia. Traditionally, this has been treated surgically with a vascular bypass operation. Two cases of coronary-subclavian steal syndrome are presented, 1 treated percutaneously with angioplasty and stent, and 1 treated with a combined endovascular-surgical procedure.

  13. Emergency coronary artery bypass surgery after failed percutaneous coronary intervention.

    Science.gov (United States)

    Darwazah, A K; Islim, I; Hanbali, B; Shama, R A; Aloul, J

    2009-12-01

    The incidence of patients subjected to emergency coronary artery bypass graft (CABG) after percutaneous coronary intervention (PCI) is decreasing due to improvement of PCI technique and device technology. The aim of our study is to evaluate cases subjected to emergency CABG after complicated PCI to determine incidence, indications and results of surgery and to compare them with other emergency cases which are not related to angioplasty or stenting. From April 1999 to December 2005, 1 200 patients who underwent PCI were analysed. Those patients who developed complications related to PCI and required surgical intervention were included (PCI group N.=31). These patients were compared with other emergency cases not related to PCI (non-PCI group N.=48). The selection of these patients was based on the criteria of the Society of Thoracic Surgeons. The incidence of PCI complications which necessitated emergency surgical intervention was 2.6%. The main indication was due to unsatisfactory angioplasty with ongoing myocardial ischemia (68%), stent thrombosis (13%), dissection (10%) retained angioplasty wire (6.5%), and perforation (3%). The incidence of cardiogenic shock, ongoing ischemia, acute infarction Emergency coronary artery bypass grafting among patients with PCI complications and those patients not related to PCI is associated with high mortality and morbidity. Although, the percentage of mortality and morbidity was more among PCI patients the difference between both groups was not significant. Surgical backup and collaboration between cardiologist and surgeons is needed to reduce delay in management and patients transfer to obtain the best surgical outcome.

  14. Arterial stenting with self-expandable and balloon-expandable endoprostheses

    NARCIS (Netherlands)

    W.J. van der Giessen (Wim); P.W.J.C. Serruys (Patrick); L.J. van Woerkens (L.); K.J. Beatt (Kevin); W.J. Visser (W.); J.F. Jongkind; R.H. van Bremen (Robert); E. Ridderhof; H. van Loon (Heleen); L.K. Soei (Lou Kie); H.M.M. van Beusekom (Heleen); P.D. Verdouw (Pieter)

    1990-01-01

    textabstractCoronary angioplasty is complicated by acute occlusion (within 24 hours) and late restenosis (within 6 months) in 2-5% and 20-40% of the cases, respectively. Vascular endoprostheses (stents) may provide the cardiologist with a solution to some of these complications. Several stent-device

  15. Conditioned blood reperfusion during angioplasty (CoBRA) treatment of acute myocardial infarction.

    Science.gov (United States)

    Patel, M B; Kilgore, K S; Ortolano, G A; Gryboski, C L; Qureshi, M A; Marcovitz, P; Naylor, K B; Park, J L; Wenz, B; Gikakis, N; Freedman, R J; Lucchesi, B R; O'Neill, W W

    2001-03-01

    Acute myocardial infarct (MI) results in ischemia distal to lesions which puts heart muscle at risk for reperfusion injury (RI). Neutrophils, platelets and complement are putative mediators of RI. Recent advances in filtration technology provide integrated neutrophil and platelet removal together with complement-attenuating properties in a single blood-conditioning device. The present study characterizes the properties of a blood-conditioning filter and describes its clinical effect when used in conjunction with active hemoperfusion for acute MI. The filter reduces leukocytes by 99.9998 +/- 0.0002% (pheart preparation. The deposition of membrane attack complex and the resultant functional myocardial impairments [reflected in hemodynamic and biochemical measurements, including developed pressure, coronary blood flow, lymph-derived myocardial creatine kinase (CK)] are significantly attenuated by blood conditioning. Integration of the blood-conditioning filter into an active hemoperfusion system during primary percutaneous transluminal coronary angioplasty (PTCA) for acute MI (n=8) did not delay the procedure or cause any complications. Reperfusion of occluded coronary arteries with 300 cm3 of conditioned blood led to significant improvement in echocardiographic global wall motion scores (in standard deviations) following treatment (-1.64 +/- 0.18 to -1.45 +/- 0.15, p=0.02). Initial reperfusion of totally occluded coronary arteries with conditioned blood leads to acutely improved ventricular function. Collectively, these data provide a strong indication for continued investigation of conditioned blood reperfusion in angioplasty following acute MI for the long-term effect upon recovery of salvagable myocardium.

  16. Apical ballooning-like syndrome: Hypocalcemia? What else!

    OpenAIRE

    Maria Accadia; Marianna Abitabile; Salvatore Rumolo; Scotto di Uccio Fortunato; Luigi Irace; Andrea Tuccillo; Giuseppe Mercogliano; Bernardino Tuccillo

    2016-01-01

    Apical ballooning syndrome (ABS), also known as Takotsubo or stress cardiomyopathy, is characterised by acute, transient and severe LV dysfunction, mimicking myocardial infarction; it occurs, in most cases, in the absence of obstructive coronary disease and is precipitated by severe emotional or physical stress, but many other potential triggers has been identi ed in the last years. Although the pathogenesis of ABS remains unclear, the most common mechanisms suggested are coronary vasospam an...

  17. Endovascular management of patients with coronary artery disease and diabetic foot syndrome:A long-term follow-up

    Institute of Scientific and Technical Information of China (English)

    Gianluca Rigatelli; Paolo Cardaioli; Fabio dell'Avvocata; Massimo Giordan; Giovanna Lisato; Francesco Mollo

    2011-01-01

    Background To investigate the long-term results of global coronary and peripheral interventional treatment of diabetic foot patients.Methods We retrospectively included 220 diabetic patients (78.5±15.8 years,107 females,all with Fontaine III or IV class) who were referred to our centre for diabetic foot syndrome and severe limb ischemia from January 2006 to December 2010.Patients were evaluated by a team of interventional cardiologists and diabetologists in order to assess presence of concomitant coronary artery disease (CAD) and eventual need for coronary revascularization. Stress-echo was performed in all patients before diagnostic peripheral angiography. Patients with indications for coronary angiography were submitted to combined diagnostic angiography and then to eventual staged peripheral and coronary interventions.Doppler ultrasonography and foot transcutaneous oximetry of transcutaneous oxygen pressure (TcPO2) before and after the procedure were performed as well as stressechocardiography and combined cardiologic and diabetic examination at 1 and 6 month and yearly.Results Stress-echocardiography was performed in 94/220 patients and resulted positive in 56 patients who underwent combined coronary and peripheral angiography.In the rest of 126 patients,combined coronary and peripheral angiography was performed directly for concomitant signs and symptoms of coronary heart disease in 35 patients.Coronary revascularization was judged necessary in 85/129 patients and was performed percutaneously after peripheral interventions in 72 patients and surgically in 13 patients.For Diabetic foot interventions the preferred approach was ipsilateral femoral antegrade in 170/220 patients (77.7%) and contralateral cross-over in 40/220 patients (18.8%) and popliteal retrograde+femoral antegrade in 10/220 patients (4.5%).Balloon angioplasty was performed in 252 legs (32 patients had bilateral disease):the procedure was successful in 239/252 legs with an immediate success rate

  18. Magnetic resonance imaging characterization of circumferential and longitudinal strain under various coronary interventions in swine

    Institute of Scientific and Technical Information of China (English)

    Mohammed; SA; Suhail; Mark; W; Wilson; Steven; W; Hetts; Maythem; Saeed

    2013-01-01

    AIM:To compare the acute changes in circumferential and longitudinal strain after exposing a coronary artery to various interventions in swine.METHODS:Percutaneous balloon angioplasty catheter was guided to location aid device(LAD)under X-ray fluoroscopy to create different patterns of ischemic insults.Pigs(n=32)were equally divided into 4 groups:controls,90 min LAD occlusion/reperfusion,LAD microembolization,and combined LAD occlusion/microembolization/reperfusion.Three days after interventions,cine,tagged and viability magnetic resonance imaging(MRI)were acquired to measure and compare left and right circumferential strain,longitudinal strain and myocardial viability,respectively.Measurements were obtained using HARP and semi-automated threshold method and statistically analyzed using unpaired t-test.Myocardial and vascular damage was characterized microscopically.RESULTS:Coronary microemboli caused greater impairment in l left ventricular(LV)circumferential strain and dyssynchrony than LAD occlusion/reperfusion despite the significant difference in the extent of myocardial damage.Microemboli also caused significant decrease in peak systolic strain rate of remote myocardium and LV dyssynchrony.Cine MRI demonstrated the interaction between LV and right ventricular(RV)at 3 d after interventions.Compensatory increase in RV free wall longitudinal strain was seen in response to all interventions.Viability MRI,histochemical staining and microscopy revealed different patterns of myocardial damage and microvascular obstruction.CONCLUSION:Cine MRI revealed subtle changes in LV strain caused by various ischemic insults.It also demonstrated the interaction between the right and left ventricles after coronary interventions.Coronary microemboli with and without acute myocardial infarction(AMI)cause complex myocardial injury and ventricular dysfunction that is not replicated in solely AMI.

  19. Scientific ballooning in Brazil

    Science.gov (United States)

    Corrêa, R.; Rinke, E.; Fernandes, J. O.; Villela, T.

    We present an overview of the scientific ballooning activities that took place in Brazil over the past 30 years as well as the current ongoing efforts in the area. We also briefly describe the balloon launching facility that exists at the Instituto Nacional de Pesquisas Espaciais (National Institute for Space Research) — INPE. Up to now, over 100 scientific balloon experiments, related to Astrophysics, Aeronomy, and Geophysics were launched from Brazil taking advantage of the country's continental dimensions, a well-defined rain season, and a low population density, which offer excellent conditions for scientific ballooning activities. Balloons with volumes up to 500,000 cubic meters can be launched from INPE's balloon launching base (latitude S 22° 4' 2″; longitude W 044° 58' 41″). The availability of good roads and several inland airports in Brazil provides the necessary structure for safe payload retrieval and its rapid return to the balloon base. There are several airports throughout Brazil that can also be used as balloon launching bases, mainly in the country's Eastern region. Overflights of more than 1,000 kilometers are possible and easily attained. Balloon flights ranging from a few hours to long duration flights can be safely verified. The constant climate monitoring through the use of weather satellites information received at INPE provides the necessary data to determine the necessary conditions for a long duration flight. INPE's Center for Weather Forecast and Climate Studies (CPTEC) provides the necessary weather forecast support for launch and payload retrieval.

  20. GHOST balloons around Antarctica

    Science.gov (United States)

    Stearns, Charles R.

    1988-01-01

    The GHOST balloon position as a function of time data shows that the atmospheric circulation around the Antarctic Continent at the 100 mb and 200 mb levels is complex. The GHOST balloons supposedly follow the horizontal trajectory of the air at the balloon level. The position of GHOST balloon 98Q for a three month period in 1968 is shown. The balloon moved to within 2 deg of the South Pole on 1 October 1968 and then by 9 December 1968 was 35 deg from the South Pole and close to its position on 1 September 1968. The balloon generally moved from west to east but on two occasions moved in the opposite direction for a few days. The latitude of GHOST balloons 98Q and 149Z which was at 200 mb is given. Both balloons tended to get closer to the South Pole in September and October. Other GHOST balloons at the same pressure and time period may not indicate similar behavior.

  1. Initial clinical experience with a new pulsed dye laser device in angioplasty of limb ischemia and shunt fistula obstructions

    Energy Technology Data Exchange (ETDEWEB)

    Zwaan, M.; Weiss, H.D.; Kagel, H.; Gmelin, E.; Rinast, E. (Medical University of Luebeck (Germany). Department of Radiology); Goethlin, J.H. (Sahlgrenska Sjukhuset, Goeteborg (Sweden)); Kummer, D. (Medical University of Luebeck (Germany). Department of Angiology and Geriatry); Scheu, M. (Medical Laser Center Luebeck (Germany))

    Selective plaque ablation with laser radiation at 405-530 nm in vitro has been reported. The possibilities are investigated of a new pulsed dye laser device for in vivo recanalization of arteries in ischemic lower limbs and stenoses/occlusions of arterio-venous hemo-dialysis shunt fistulae. A specially designed 9F or 7F multifiber catheter was used for treatment of 10 patients with lower limb artery obliterations and 11 patients with malfunctioning hemodialysis access fistulae (HAF). The recanalization technical success was 5/5 in the iliac arteries (IA), 4/5 in the superficial femoral arteries (SFA), and 11/11 in the HAF. Early re-occlusions occurred in one SFA and IA, respectively, caused by very bad run-off. There was one clinically insignificant SFA perforation. Additional balloon angioplasty was considered necessary in 10/16 lesions. Mean ankle-arm index increased from 0.68 to 0.97. With two exceptions all HAF patients were re-integrated in the dialysis program. Pulsed dye laser angioplasty promises to be an effective and fast method for plaque ablation debulking. The first clinical experience confirms previous in vitro results. In particular laser recanalization may become the method of choice for treatment of rigid HAF obstructions and it seems to be superior to vascular surgery or balloon angioplasty alone. (author). 15 refs.; 2 figs.

  2. The benefits of drug-eluting stents in the treatment of coronary artery disease

    Directory of Open Access Journals (Sweden)

    Kiramijyan S

    2016-03-01

    Full Text Available Sarkis Kiramijyan,1 Ming W Liu2 1Division of Cardiology, Department of Medicine, Harbor-UCLA Medical Center, Torrance, CA, USA; 2Heart and Vascular Care Center, White Memorial Medical Center, Los Angeles, CA, USA Abstract: The advent of coronary stents has been a landmark development in the treatment of coronary artery disease with percutaneous coronary intervention. Initial percutaneous treatment using balloon angioplasty alone had limited clinical efficacy due to immediate vascular elastic recoil and dissection, in addition to late negative vascular remodeling and neointimal hyperplasia. With the introduction of coronary stents, initially bare-metal stents (BMS, the problems of dissection and negative remodeling due to injury in addition to vascular elastic recoil were eliminated; however, neointimal hyperplasia remained an ongoing obstacle in the long-term efficacy of stents. Neointimal hyperplasia resulted in in-stent restenosis in 20%–30% of cases after intervention with BMS, which led to high rates of target lesion revascularization. Subsequently, drug-eluting stents (DES were introduced, which had the added advantage of releasing an anti-proliferative drug from the stent to reduce the neointimal proliferation, thus resulting in the reduction of the rates of in-stent restenosis. Although the first-generation DES had significantly improved outcomes over its predecessor, the BMS, several challenges including stent thrombosis and delayed endothelialization of the stent remained. The second-generation DES have been significantly improved over their first-generation predecessors in regard to efficacy and safety, ie, improved long-term outcomes and significant reductions in stent thrombosis. The duration of dual antiplatelet therapy after DES has also been studied extensively in multiple large trials. A newer generation of stents, including those with bioresorbable polymers, polymer-free, and fully bioresorbable scaffolds is still in the early

  3. Transient cortical blindness after coronary artery angiography.

    Science.gov (United States)

    Terlecki, Michał; Wojciechowska, Wiktoria; Rajzer, Marek; Jurczyszyn, Artur; Bazan-Socha, Stanisława; Bryniarski, Leszek; Czarnecka, Danuta

    2013-01-01

    Coronary angiography is the current gold standard for the diagnosis of ischemic heart disease and therefore the prevalence of percutaneous coronary procedures such as angiography and angioplasty is high. The occurrence of cerebral complications after coronary angiography and coronary angioplasty is low and it mainly includes transient ischemic attack and stroke. The prevalence of transient cortical blindness after X-ray contrast media is low and it is usually seen after cerebral angiography. Until now only a few cases of transient cortical blindness have been described after coronary artery angiography. Regarding the spread of coronary angiography worldwide and in Poland this complication is uniquely rare. A 32-year-old man with multiple extrasystolic ventricular arrhythmia suggesting Brugada syndrome diagnosis according to morphology of the left bundle branch block and with decreased left ventricular ejection fraction was admitted to the First Department of Cardiology and Hypertension, Medical College of the Jagiellonian University in Krakow. Coronary angiography was performed in order to exclude ischemic etiology of the observed abnormalities. No arteriosclerotic lesions were found in coronary arteries. Transient cortical blindness was observed directly after angiography which may have been caused by the neurotoxic effect of the used X-ray contrast medium. In ophthalmologic and neurologic examination as well as in the cerebral computed tomography scan no pathologies were found. Visual impairment disappeared totally within several hours.

  4. [CARDIOREABILITATION PECULIARITIES AND CORRECTION OF VIOLATIONS OF SISTOLIC, DIASOLIC FUNCTION AND HEART RATE VARIABILITY IN PATIENTS WITH ACUTE CORONARY SYNDROME AND CORONARY ARTERY REVASCULARIZATION].

    Science.gov (United States)

    Shved, M; Tsuglevych, L; Kyrychok, I; Levytska, L; Boiko, T; Kitsak, Ya

    2017-04-01

    In patients with acute coronary syndrome (ACS) who underwent coronary arteries revascularization, violations of hemodynamics, metabolism and heart rate variability often develop in the postoperative period, therefore, the goal of the study was to establish the features of disturbances and the effectiveness of correction of left ventricular systolic and diastolic dysfunction and heart rate variability in stages of cardiorehabilitation in patients with acute coronary syndrome who underwent coronary arteries revascularization. The experimental group included 40 patients with ACS in the postoperative period who underwent balloon angioplasty and stenting of the coronary arteries (25 patients with ST-segment elevation ACS and 15 patients without ST-segment elevation ACS). The age of examined patients was 37 to 74 years, an average of 52.6±6.7 years. The control group consisted of 20 patients, comparable in age and clinico-laboratory manifestations of ACS, who underwent drug treatment with direct anticoagulants, double antiplatelet therapy, β-blockers, ACE inhibitors and statins. Clinical efficacy of cardiorespiratory process in patients of both groups was assessed by the dynamics of general clinical symptoms and parameters of natriuretic propeptide, systolic and diastolic function of the left ventricle and heart rate variability. In the initial state, clinical and laboratory-instrumental signs of myocardial ischemia disappear in patients with ACS undergoing surgical revascularization of the coronary arteries, but clinical and subclinical manifestations of heart failure were diagnosed. The use of the accelerated program of cardiac rehabilitation already during the first month of studies leads to a decreasement of the signs of systolic and diastolic dysfunction, the level of NT-proBNP and improve in the variability of the heart rhythm wich significantly improves the life quality of patients with ACS. To monitor the effectiveness and safety of cardiac rehabilitation in

  5. Fibrin sheath angioplasty: a technique to prevent superior vena cava stenosis secondary to dialysis catheters.

    Science.gov (United States)

    Hacker, Robert I; Garcia, Lorena De Marco; Chawla, Ankur; Panetta, Thomas F

    2012-09-01

    Fibrin sheaths are a heterogeneous matrix of cells and debris that form around catheters and are a known cause of central venous stenosis and catheter failure. A total of 50 cases of central venous catheter fibrin sheath angioplasty (FSA) after catheter removal or exchange are presented. A retrospective review of an outpatient office database identified 70 eligible patients over a 19-month period. After informed consent was obtained, the dialysis catheter exiting the skin was clamped, amputated, and a wire was inserted. The catheter was then removed and a 9-French sheath was inserted into the superior vena cava, a venogram was performed. If a fibrin sheath was present, angioplasty was performed using an 8 × 4 or 10 × 4 balloon along the entire length of the fibrin sheath. A completion venogram was performed to document obliteration of the sheath. During the study, 50 patients were diagnosed with a fibrin sheath, and 43 had no pre-existing central venous stenosis. After FSA, 39 of the 43 patient's (91%) central systems remained patent without the need for subsequent interventions; 3 patients (7%) developed subclavian stenoses requiring repeat angioplasty and stenting; 1 patent (2.3%) developed an occlusion requiring a reintervention. Seven patients with prior central stenosis required multiple angioplasties; five required stenting of their central lesions. Every patient had follow-up fistulograms to document long-term patency. We propose that FSA is a prudent and safe procedure that may help reduce the risk of central venous stenosis from fibrin sheaths due to central venous catheters.

  6. Clefting in pumpkin balloons

    Science.gov (United States)

    Baginski, F.; Schur, W.

    NASA's effort to develop a large payload, high altitude, long duration balloon, the Ultra Long Duration Balloon, focuses on a pumpkin shape super-pressure design. It has been observed that a pumpkin balloon may be unable to pressurize into the desired cyclically symmetric equilibrium configuration, settling into a distorted, undesired stable state instead. Hoop stress considerations in the pumpkin design leads to choosing the lowest possible bulge radius, while robust deployment is favored by a large bulge radius. Some qualitative understanding of design aspects on undesired equilibria in pumpkin balloons has been obtained via small-scale balloon testing. Poorly deploying balloons have clefts, but most gores away from the cleft deploy uniformly. In this paper, we present models for pumpkin balloons with clefts. Long term success of the pumpkin balloon for NASA requires a thorough understanding of the phenomenon of multiple stable equilibria and means for quantitative assessment of measures that prevent their occurrence. This paper attempts to determine numerical thresholds of design parameters that distinguish between properly deploying designs and improperly deploying designs by analytically investigating designs in the vicinity of criticality. Design elements which may trigger the onset undesired equilibria and remedial measures that ensure deployment are discussed.

  7. The usefulness of wire-loop technique for percutaneous angioplasty of insufficient hemodialysis fistula

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Dong Hun; Goo, Dong Erk; Kim, Dae Ho; Choi, Deuk Lin; Moon, Chul [College of Medicine, Soonchunhyang University, Seoul (Korea, Republic of)

    2000-10-01

    To evaluate the usefulness of the wire-loop technique, used to perform percutaneous transluminal angioplasty (PTA) in occluded arteriovenous fistula when standard methods fail to pass the balloon catheter across the stenotic segment. In 30 patients (M:F = 14:16; aged 27-77 (mean, 51.3) years), the Wire-Loop technique was used to perform percutaneous transluminal angioplasty of insufficiently hemodialysed arteriovenous fistula where a balloon catheter had failed to pass through the stenotic lesion after a guide wire had successfully passed. Native and Gore-tex fistula were used in 22 and eight cases, respectively.Sixteen stenoses were located in the central vein, and fourteen in the peripheral. The puncture sites used in order to perform the technique were the femoral vein in all cases of central stenosis; three basilic, four cephalic, and five femoral veins in cases of peripheral stenosis and one femoral and one radial artery in cases of anastomotic stenosis. The guide wire was passed through the stenotic lesion, pulled out using the snare technique, and then stretched in order to tighten it. The balloon catheter was then passed through the lesion and traditional balloon angioplasty was performed. The technical success rate and complications of the technique, and the patency rate of recanalized arteriovenous fistula, were evaluated. In 26 of the thirty patients, (86.7%), the procedure was technically successful. In the remaining four cases, failure was due to venous dissection (n=1), marked residual stenosis (n=2), or cardiac arrest (n=1) during the procedure. The average procedure time was 105 (range, 40-210) minutes, and in three cases rupture of the vein occurred. The patency rate of PTA was 80% (24/30) at four months, 63% (19/30) at six months, and 30% (9/30) at twelve months. The expected technical success rate of traditional PTA, without the Wire-Loop technique, would have been 79.3%, but using the technique, the rate increased to 86.7%. The Wire

  8. Interventional cardiology in Europe 1993. Working Group on Coronary Circulation of the European Society of Cardiology.

    Science.gov (United States)

    Meyer, B J; Meier, B; Bonzel, T; Fabian, J; Heyndrickx, G; Morice, M C; Mühlberger, V; Piscione, F; Rothman, M; Wijns, W; van den Brand, M

    1996-09-01

    An annual survey on cardiac interventions in Europe is performed by the working group on Coronary Circulation of the European Society of Cardiology with the help of the national societies of cardiology. A questionnaire about cardiac interventions in 1993 was mailed to a representative of the national societies of 35 members of the European Society of Cardiology. The data collection of coronary interventions was delayed by slow backreporting and from 10 of the 35 national members data were missing or grossly incomplete. They were excluded from the analysis. A total of 756,822 coronary angiograms were reported resulting in an incidence of 1146 +/- 1024 per 10(6) inhabitants, ranging from 24 (Romania) to 3499 (Germany). This represents an increase of 12% compared to 1992. Germany (279,882 cases), France (157,237), the United Kingdom (77,000), Italy (44,934) and Spain (37,591) registered 79% of all the coronary angiograms performed. A total of 183,728 percutaneous transluminal coronary angioplasty cases were reported in 1993, 24% more than in 1992. On average, they accounted for 18 +/- 7% (range 8 (Romania) to 35% (Sweden) of the coronary angiograms. Most of these percutaneous transluminal coronary angioplasties (82%) were confined to a single vessel. In 13% only, percutaneous transluminal coronary angioplasty took place immediately after the diagnostic study. Adjusted per capita. Germany ranks first with 873 percutaneous transluminal coronary angioplasties per 10(6) inhabitants, followed by France (737), Holland (725), Belgium (713), and Switzerland (665). The European mean of percutaneous transluminal coronary angioplasties per 10(6) inhabitants was 270 +/- 279, representing an increase of 14% compared with 1992. A major in-hospital complication was reported in 3.8% of the patients undergoing percutaneous transluminal coronary angioplasty: 0.6% hospital deaths, 1.5% emergency coronary artery bypass grafting, and 1.7% myocardial infarctions. In 1993 stents were

  9. High-dose aspirin in addition to daily low-dose aspirin decreases platelet activation in patients before and after percutaneous coronary intervention.

    NARCIS (Netherlands)

    Berg, J.M. ten; Gerritsen, W.B.M.; Haas, F.J.L.M.; Kelder, J.C.; Verheugt, F.W.A.; Plokker, H.W.M.

    2002-01-01

    BACKGROUND: Activated platelets play a major role in acute vessel closure after coronary angioplasty. Although aspirin is the routine therapy during angioplasty, it only incompletely prevents acute closure. This might be due to suboptimal dosing. OBJECTIVE: First, to study the effect of additional

  10. Role of interferon-γ on smooth muscle cells proliferation and migration after balloon injury by inhibiting transforming growth factor-β signal pathway

    Institute of Scientific and Technical Information of China (English)

    MEI Yu; WANG Gui-zhao; HUANG Yong-lin

    2003-01-01

    @@ Objective Restenosis after balloon angioplasty resuits from abnormal proliferation of phenotypically modulated vascular smooth muscle cells (SMCs) that migrate and synthesize large amounts of extracellular matrix. A vafety of growth factors have been shown to play a role in the development of restenotic lesions including transforming growth factor-β (TGF-β).

  11. [Subintimal angioplasty and diabetic foot revascularisation].

    Science.gov (United States)

    Pierret, Charles; Tourtier, Jean-Pierre; Bordier, Lise; Blin, Emmanuel; Duverger, Vincent

    2011-01-01

    Diabetic wounds foot are responsible for 5-10% minor or major amputation in France. In fact, amputation risk of lower limbs is 15-30% higher for diabetic patients. University of Texas classification (UT) is the reference for diabetic foot wound. It distinguish non ischemic and ischemic wound with more amputation. If ischaemia is combined, revascularization may be considered for salvage of the limb. Some revascularization techniques are well known: as surgical by-pass, angioplasty with or without stent, or hybrid procedures with the both. Subintimal angioplasty is a more recent endovascular technique, in assessment for old patients who are believed to be unsuitable candidates for conventional by-pass or angioplasty.

  12. Clinical and angiographic outcome of elective stent implantation in small coronary vessels: an analysis of the BENESTENT trial.

    Science.gov (United States)

    Keane, D; Azar, A J; de Jaegere, P; Rutsch, W; de Bruyne, B; Legrand, V; Kiemeneij, F; de Feyter, P; van de Heuvel, P; Ozaki, Y; Morel, M A; Serruys, P W

    1996-12-01

    We examined the influence of vessel size using an intention-to-treat approach in 259 patients who underwent stent implantation and in 257 patients who underwent balloon angioplasty alone in the BENESTENT trial. In the stented population, smaller vessel size was associated with a higher stent:vessel ratio, a greater relative gain and a greater subsequent loss index, and a higher risk of adverse cardiac events. In the balloon angioplasty population small vessel size conveyed an increased requirement for revascularization but did not increase the risk of procedural failure or myocardial infarction during follow-up. Logistic regression indicated that decreasing vessel size (as a continous variable) was associated with an increasing risk of a cardiac event for both the stent and balloon angioplasty populations.

  13. Holmium:YAG laser angioplasty: treatment of acute myocardial infarction

    Science.gov (United States)

    Topaz, On

    1993-06-01

    We report our clinical experience with a group of 14 patients who presented with acute myocardial infarction. A holmium:YAG laser was applied to the infarct-related artery. This laser emits 250 - 600 mJ per pulse, with a pulse length of 250 microseconds and repetition rate of 5 Hz. Potential benefits of acute thrombolysis by lasers include the absence of systemic lytic state; a shortened thrombus clearing time relative to using thrombolytics; safe removal of the intracoronary thrombus and facilitation of adjunct balloon angioplasty. Potential clinical difficulties include targeting the obstructive clot and plaque, creation of debris and distal emboli and laser-tissue damage. It is conceivable that holmium:YAG laser can be a successful thrombolytic device as its wave length (2.1 microns) coincides with strong water absorption peaks. Since it is common to find an atherosclerotic plaque located under or distal to the thrombotic occlusion, this laser can also be applied for plaque ablation, and the patient presenting with acute myocardial infarction can clearly benefit from the combined function of this laser system.

  14. The use of a cutting balloon in contemporary reverse controlled antegrade and retrograde subintimal tracking (reverse CART) technique.

    Science.gov (United States)

    Nakabayashi, Keisuke; Okada, Hisayuki; Oka, Toshiaki

    2016-07-11

    The key concept of reverse controlled antegrade and retrograde tracking (CART) technique is retrograde puncture with a tapered wire to an antegrade balloon (contemporary reverse CART) or new connections between the antegrade and retrograde subintimal space (classical reverse CART). In our case, a 75-year-old man with severe chronic total occlusion of the right coronary artery, reverse CART with conventional balloons could not be accomplished. Externalization wiring was completed by contemporary reverse CART using a cutting balloon as an antegrade balloon to improve the fenestration force of the retrograde guidewire. Thus, the use of a cutting balloon for contemporary reverse CART might be promising.

  15. Treatment of renovascular hypertension by transluminal angioplasty

    DEFF Research Database (Denmark)

    Øvrehus, Kristian A; Andersen, Poul E; Jacobsen, Ib A

    2007-01-01

    OBJECTIVE: The study is a follow-up on treatment of renovascular hypertension (RVH) with percutaneous transluminal renal angioplasty (PTRA). METHODS: Patients were screened on the basis of clinical criteria of increased probability of RVH with renography and in selected cases with renal vein renin...... stable. CONCLUSION: PTRA is an effective treatment of RVH in patients selected by signs of a flow-restricting stenosis. Twelve percent were normotensive after angioplasty and a further 77% had better controlled hypertension. Few complications were seen and renal function was on average unchanged...

  16. Renal angioplasty for atherosclerotic renal artery stenosis: Cardiologist′s perspective

    Directory of Open Access Journals (Sweden)

    A S Gulati

    2013-01-01

    Full Text Available Atherosclerotic renal artery stenosis (ARAS is frequently associated with concomitant coronary and peripheral arterial disease with a significant impact on cardiovascular morbidity and mortality. Renal angioplasty of ARAS is more challenging because of increased incidence of technical failures, complications, and restenosis; while there is barely perceptible control of hypertension and only marginal improvement in renal function. This is because most of the patient population in recent randomized trials had unmanifested or clinically silent renovascular disease. Manifestations of RAS should be looked for and incorporated in the management plan particularly before deciding for revascularization. In the absence of clinical manifestation like renovascular hypertension, ischemic nephropathy, left ventricular failure, or unstable coronary syndromes; mere presence of RAS is analogous to presence of concomitant peripheral arterial disease which increases risk of adverse coronary events. Dormant-RAS in the absence of any manifestations can be managed with masterly inactivity. Chronological sequence of events and clinical condition of the patient help in decision making by identifying progressive renovascular disease. Selecting patients for renal artery stenting who actually will benefit from revascularization shall also decrease the unnecessary complications inherent with any interventional procedure. The present review is an attempt to analyze the current view on the diagnostic and management issues more specifically about the need and rationale behind angioplasty.

  17. 78 FR 79300 - Cardiovascular Devices; Reclassification of Intra-Aortic Balloon and Control Systems for Acute...

    Science.gov (United States)

    2013-12-30

    ... Intra-Aortic Balloon and Control Systems for Acute Coronary Syndrome, Cardiac and Non- Cardiac Surgery... coronary syndrome, cardiac and non- cardiac surgery, or complications of heart failure, a preamendments..., cardiac and non-cardiac surgery, or complications of heart failure from class III to class II. Section 513...

  18. The laser driven short-term heating balloon catheter: Relation between the chronic neointimal hyperplasia formation and thermal damage to arterial smooth muscle cells.

    Science.gov (United States)

    Shimazaki, Natsumi; Hayashi, Tomoaki; Kunio, Mie; Igami, Yuka; Arai, Tsunenori; Sakurada, Masami

    2010-01-01

    We proposed a novel laser-driven short-term heating angioplasty to realize restenosis-suppressive angioplasty for peripheral artery disease. In this study, we investigated the chronic intimal hyperplasia formation after the short-term heating dilatation in vivo, as well as the thermal damage calculation on arterial smooth muscle cells (SMCs). The prototype short-term heating balloon catheter with 5.0, 5.5, 6.0 mm φ in balloon diameter and 25 mm in balloon length were employed. The short-term heating dilatation was performed in porcine iliac arteries with dilatation conditions of 75°C (N=4) and 65°C (N=5) as peak balloon temperature, 18 ± 4s as heating duration, 3.5 atm as balloon dilatation pressure. Four weeks after the balloon dilatation, the balloon-dilated artery segments were extracted and were stained with HE and picrosirius red for histological observation. In the case of 75°C as the peak balloon temperature, neointimal hyperplasia formation was significantly reduced. In this case, the SMCs density in the artery media measured from the HE-stained specimen was 20% lower than that in the reference artery. According to the thermal damage calculation, it was estimated that the SMCs lethality in artery media after the short-term heating angioplasty was 20% in the case of 75°C as the peak balloon temperature. We demonstrated that the short-term heating dilatation reduced the number of SMCs in artery media. We think this SMCs reduction might contribute to the suppression of chronic neointimal hyperplasia.

  19. Percutaneous transluminal coronary angioplasty in acute ischemic syndromes

    NARCIS (Netherlands)

    H. Suryapranata (Haryanto)

    1988-01-01

    textabstractAcute myocardial ischemic syndromes are apparently related to the underlying pathophysiology leading to the clinical instability. Depending on the completeness and the duration of blood deprivation, different clinical syndromes result, such as sudden death, acute transmural infarction, n

  20. Holmium:YAG laser coronary angioplasty in acute myocardial infarction

    Science.gov (United States)

    Topaz, On; Luxenberg, Michael; Schumacher, Audrey

    1994-07-01

    Patients who sustain complicated acute myocardial infarction in whom thrombolytic agents either fail or are contraindicated often need mechanical revascularization other than PTCA. In 24 patients with acute infarction complicated by continuous chest pain and ischemia who either received lytics or with contraindication to lytics, a holmium:YAG laser (Eclipse Surgical Technologies, Palo Alto, CA) was utilized for thrombolysis and plaque ablation. Clinical success was achieved in 23/24 patients, with 23 patients (94%) surviving the acute infarction. Holmium:YAG laser is very effective and safe in thrombolysis and revascularization in this complicated clinical setting.

  1. Percutaneous transluminal angioplasty and stenting for severe stenosis of the intracranial extradural internal carotid artery causing transient ischemic attack or minor stroke.

    Science.gov (United States)

    Ko, Jun Kyeung; Choi, Chang Hwa; Cha, Seung Heon; Choi, Byung Kwan; Cho, Won Ho; Kang, Tae Ho; Sung, Sang Min; Cho, Han Jin; Lee, Tae Hong

    2015-08-01

    The purpose of this study is to assess the technical feasibility and clinical efficacy of percutaneous transluminal angioplasty and stenting (PTAS) for symptomatic stenosis of the intracranial extradural (petrous and cavernous) internal carotid artery (ICA).Review of medical records identified 26 consecutive patients who underwent PTAS using a balloon-expandable coronary stent (n = 15, 57.7%) or a Wingspan self-expandable stent (n = 11, 42.3%) for treatment of severe stenosis (>70%) involving the intracranial extradural ICA. The inclusion criteria were transient ischemic attack with an ABCD(2) score of ≥3 (n = 12, 46.2%) or minor stroke with an NIHSS score of ≤4 (n = 14, 53.8%). Technical success rates, complications, and angiographic and clinical outcomes were analyzed retrospectively.PTAS was technically successful in all patients. The mean stenosis ratio decreased from 77.1% to 10.0% immediately after PTAS. The overall incidence of procedural complications was 23.1%, and the postoperative permanent morbidity/mortality rate was 7.7%. A total of 22 patients were tracked over an average period of 29.9 months. During the observation period, 20 patients (90.9%) had no further cerebrovascular events and stroke recurrence occurred in two patients (9.1%), resulting in an annual stroke risk of 3.7%. Two cases (11.1%) of significant in-stent restenosis (>50%) were found on follow-up angiography (n = 18).PTAS for severe stenosis (>70%) involving the intracranial extradural ICA showed a good technical feasibility and favorable clinical outcome in patients with transient ischemic attack or minor stroke.

  2. Familial hypercholesterolaemic downsized pig with human-like coronary atherosclerosis: a model for preclinical studies

    DEFF Research Database (Denmark)

    Thim, Troels; Hagensen, Mette; Drouet, L.

    2010-01-01

    site-specifically by inflicting coronary artery balloon injury. Both spontaneously developed and balloon accelerated coronary plaques mirrored pertinent human plaque features, including a large necrotic core covered by a thin and inflamed fibrous cap as seen in the most common type of thrombosis...

  3. Aspiration of intact coronary bifurcation thrombus in ST-elevation myocardial infarction: letter to the editor

    NARCIS (Netherlands)

    Birgelen, von Clemens; Tandjung, K.; Lam, Ming Kai

    2014-01-01

    We report a case of a 74-year-old female patient with acute chest pain who was admitted for primary percutaneous coronary angioplasty. The electrocardiogram indicated an acute ST-elevation myocardial infarction of the anterolateral wall. Coronary angiography showed a thrombus-containing lesion in th

  4. Quantitative angiographic follow-up of the coronary wallstent in native vessels and bypass grafts (European experience - March 1986 to March 1990)

    NARCIS (Netherlands)

    B.H. Strauss (Bradley); P.W.J.C. Serruys (Patrick); M.E. Bertrand (Michel); J. Puel (Jacques); B. Meier (Bernard); J-J. Goy (Jean-Jacques); L. Kappenberger (Lukas); A.F. Rickards (Anthony); U. Sigwart (Ulrich); M-A.M. Morel (Marie-Angèle); E.W.J. Montauban van Swijndregt (Eline)

    1992-01-01

    textabstractThe coronary stent has been investigated as an adjunct to percutaneous transluminal coronary angioplasty to obviate the problems of early occlusion and late restenosis. From March 1986 to March 1990, 265 patients (308 lesions) were implanted with the coronary Wallstent in 6 European cent

  5. Paclitaxel-coated balloon fistuloplasty versus plain balloon fistuloplasty only to preserve the patency of arteriovenous fistulae used for haemodialysis (PAVE): study protocol for a randomised controlled trial.

    Science.gov (United States)

    Karunanithy, Narayan; Mesa, Irene Rebollo; Dorling, Anthony; Calder, Francis; Katsanos, Konstantinos; Semik, Vikki; Robinson, Emily; Peacock, Janet; Das, Neelanjan; Forman, Colin; Lawman, Sarah; Steiner, Kate; Wilkins, C Jason; Robson, Michael G

    2016-05-12

    The initial therapy for a stenosis in an arteriovenous fistula used for haemodialysis is radiological balloon dilatation or angioplasty. The benefit of angioplasty is often short-lived, intervention-free survival is reported to be 40-50 % at 1 year. Previous small studies and observational data suggest that paclitaxel-coated balloons may be of benefit in improving outcomes after fistuloplasty of stenotic arteriovenous fistulae. We have designed a multicentre, double-blind randomised controlled trial to test the superiority of paclitaxel-coated balloons for preventing restenosis after fistuloplasty in patients with a native arteriovenous fistula. Two hundred and eleven patients will be followed up for a minimum of 1 year. Inclusion criteria include a clinical indication for a fistuloplasty, an access circuit that is free of synthetic graft material or stents, and a residual stenosis of 30 % or less after plain balloon fistuloplasty. Exclusion criteria include a synchronous venous lesion in the same access circuit, location of the stenosis central to the thoracic inlet or a thrombosed access circuit at the time of treatment. The primary endpoint is time to end of target lesion primary patency. This is defined as a clinically-driven radiological or surgical re-intervention at the treatment segment, thrombosis that includes the treatment segment, or abandonment of the access circuit due to an inability to re-treat the treatment segment. Secondary endpoints include angiographic late lumen loss, time to end of access circuit cumulative patency, the total number of interventions, and quality of life. The trial is funded by the National Institute for Health Research. We anticipate that this trial will provide rigorous data that will determine the efficacy of additional paclitaxel-coated balloon fistuloplasty versus plain balloon fistuloplasty only to preserve the patency of arteriovenous fistulae used for haemodialysis. ISRCTN14284759 . Registered on 28 October 2015.

  6. Apical ballooning-like syndrome: Hypocalcemia? What else!

    Directory of Open Access Journals (Sweden)

    Maria Accadia

    2016-01-01

    Full Text Available Apical ballooning syndrome (ABS, also known as Takotsubo or stress cardiomyopathy, is characterised by acute, transient and severe LV dysfunction, mimicking myocardial infarction; it occurs, in most cases, in the absence of obstructive coronary disease and is precipitated by severe emotional or physical stress, but many other potential triggers has been identi ed in the last years. Although the pathogenesis of ABS remains unclear, the most common mechanisms suggested are coronary vasospam and an exaggerated sympathetic activation associated to high levels of plasma cathecolamine leading to cardiotoxicity.We describe two cases of Apical Ballooning like Syndrome that were triggered by severe, acute hypocalcemia, without evidence of coronary vasospasm and with normal hematic level of cathecolamines.

  7. ANGIOPLASTIA DE RESCATE EN MUJER DE 33 AÑOS CON ANTICONCEPCIÓN ORAL Y CORONARIOPATÍA DILATADA / Rescue angioplasty in a 33-year old woman with oral contraception and dilated coronariopathy

    Directory of Open Access Journals (Sweden)

    Francisco L Moreno-Martínez

    2009-09-01

    Full Text Available Coronary angioplasty is recognized nowadays as the first-choice therapeutic strategy for acute coronary syndrome with ST-segment elevation. Atherosclerotic disease is still the main cause ofthis sickness; however, other disturbances, such is dilated coronariopathy, may favor this coronary event. Although some authors raise that atherosclerosis is the main cause of coronary dilation, it is uncommon that this lipid disorder promotes consequences early in life. We present the case of a 33-year-old female (oral contraceptive user - etinor who had not any apparent coronary risk factor but suffered from inferior acute myocardial infarction. The thrombolysis failed, and fortunately we could perform the angioplasty. Intracoronary thrombosis with distal embolism occurred, that waswhy we administered streptokinase. Possible mechanisms that involve oral contraceptives and dilated coronariopathy are discussed, and angiographic images are shown.

  8. Short-term, high-dose Atorvastatin pretreatment to prevent contrast-induced nephropathy in patients with acute coronary syndromes undergoing percutaneous coronary intervention (from the ARMYDA-CIN [atorvastatin for reduction of myocardial damage during angioplasty--contrast-induced nephropathy] trial.

    Science.gov (United States)

    Patti, Giuseppe; Ricottini, Elisabetta; Nusca, Annunziata; Colonna, Giuseppe; Pasceri, Vincenzo; D'Ambrosio, Andrea; Montinaro, Antonio; Di Sciascio, Germano

    2011-07-01

    Contrast-induced nephropathy (CIN) impairs clinical outcome in patients undergoing angiographic procedures. The aim of this study was to investigate whether short-term high-dose atorvastatin load decreases the incidence of CIN after percutaneous coronary intervention (PCI). Statin-naive patients with acute coronary syndrome undergoing PCI (n = 241) randomly received atorvastatin (80 mg 12 hours before intervention with another 40-mg preprocedure dose, n = 120) or placebo (n = 121). All patients had long-term atorvastatin treatment thereafter (40 mg/day). Primary end point was incidence of CIN defined as postintervention increase in serum creatinine ≥0.5 mg/dl or >25% from baseline. Five percent of patients in the atorvastatin arm developed CIN versus 13.2% of those in the placebo arm (p = 0.046). In the atorvastatin group, postprocedure serum creatinine was significantly lower (1.06 ± 0.35 vs 1.12 ± 0.27 mg/dl in placebo, p = 0.01), creatinine clearance was decreased (80.1 ± 32.2 vs 72.0 ± 26.6 ml/min, p = 0.034), and C-reactive protein peak levels after intervention were decreased (8.4 ± 10.5 vs 13.1 ± 20.8 mg/l, p = 0.01). Multivariable analysis showed that atorvastatin pretreatment was independently associated with a decreased risk of CIN (odds ratios 0.34, 95% confidence interval 0.12 to 0.97, p = 0.043). Prevention of CIN with atorvastatin was paralleled by a shorter hospital stay (p = 0.007). In conclusion, short-term pretreatment with high-dose atorvastatin load prevents CIN and shortens hospital stay in patients with acute coronary syndrome undergoing PCI; anti-inflammatory effects may be involved in this renal protection. These results lend further support to early use of high-dose statins as adjuvant pharmacologic therapy before percutaneous coronary revascularization. Copyright © 2011 Elsevier Inc. All rights reserved.

  9. Laser-driven short-duration heating angioplasty: chronic artery lumen patency and histology in porcine iliac artery

    Science.gov (United States)

    Shimazaki, Natsumi; Kunio, Mie; Naruse, Sho; Arai, Tsunenori; Sakurada, Masami

    2012-02-01

    We proposed a short-duration heating balloon angioplasty. We designed a prototype short-duration heating balloon catheter that can heat artery media to 60-70°C within 15-25 s with a combination of laser-driven heat generation and continuous fluid irrigation in the balloon. The purpose of this study was to investigate chronic artery lumen patency as well as histological alteration of artery wall after the short-duration heating balloon dilatation with porcine healthy iliac artery. The short-term heating balloon dilated sites were angiographically patent in acute (1 hour) and in chronic phases (1 and 4 weeks). One week after the dilatation, smooth muscle cells (SMCs) density in the artery media measured from H&E-stained specimens was approx. 20% lower than that in the reference artery. One and four weeks after the dilatations, normal structure of artery adventitia was maintained without any incidence of thermal injury. Normal lamellar structure of the artery media was also maintained. We found that the localized heating restricted to artery media by the short-duration heating could maintain adventitial function and artery normal structure in chronic phase.

  10. Three-dimensional reconstruction of coronary stents in vivo based on motion compensated X-ray angiography

    Science.gov (United States)

    Schäfer, Dirk; Movassaghi, Babak; Grass, Michael; Schoonenberg, Gert; Florent, Raoul; Wink, Onno; Klein, Andrew J. P.; Chen, James Y.; Garcia, Joel; Messenger, John C.; Carroll, John D.

    2007-03-01

    The complete expansion of the stent during a percutaneous transluminal coronary angioplasty (PTCA) procedure is essential for treatment of a stenotic segment of a coronary artery. Inadequate expansion of the stent is a major predisposing factor to in-stent restenosis and acute thrombosis. Stents are positioned and deployed by fluoroscopic guidance. Although the current generation of stents are made of materials with some degree of radio-opacity to detect their location after deployment, proper stent expansion is hard to asses. In this work, we introduce a new method for the three-dimensional (3D) reconstruction of the coronary stents in-vivo utilizing two-dimensional projection images acquired during rotational angiography (RA). The acquisition protocol consist of a propeller rotation of the X-ray C-arm system of 180°, which ensures sufficient angular coverage for volume reconstruction. The angiographic projections were acquired at 30 frames per second resulting in 180 projections during a 7 second rotational run. The motion of the stent is estimated from the automatically tracked 2D coordinates of the markers on the balloon catheter. This information is used within a motion-compensated reconstruction algorithm. Therefore, projections from different cardiac phases and motion states can be used, resulting in improved signal-to-noise ratio of the stent. Results of 3D reconstructed coronary stents in vivo, with high spatial resolution are presented. The proposed method allows for a comprehensive and unique quantitative 3D assessment of stent expansion that rivals current X-ray and intravascular ultrasound techniques.

  11. New developments in the clinical use of drug-coated balloon catheters in peripheral arterial disease

    Directory of Open Access Journals (Sweden)

    Naghi J

    2016-06-01

    Full Text Available Jesse Naghi, Ethan A Yalvac, Ali Pourdjabbar, Lawrence Ang, John Bahadorani, Ryan R Reeves, Ehtisham Mahmud, Mitul Patel Division of Cardiovascular Medicine, Sulpizio Cardiovascular Center, University of California, San Diego, CA, USA Abstract: Peripheral arterial disease (PAD involving the lower extremity is a major source of morbidity and mortality. Clinical manifestations of PAD span the spectrum from lifestyle limiting claudication to ulceration and gangrene leading to amputation. Advancements including balloon angioplasty, self-expanding stents, drug-eluting stents, and atherectomy have resulted in high technical success rates for endovascular therapy in patients with PAD. However, these advances have been limited by somewhat high rates of clinical restenosis and clinically driven target lesion revascularization. The recent introduction of drug-coated balloon technology shows promise in limiting neointimal hyperplasia induced by vascular injury after endovascular therapies. This review summarizes the contemporary clinical data in the emerging area of drug-coated balloons. Keywords: drug-coated balloons, endovascular, percutaneous transluminal angioplasty, paclitaxel, peripheral arterial disease

  12. Thrombus aspiration catheter is a Dottering balloon.

    Science.gov (United States)

    Sheshagiri Rao, D; Barik, Ramachandra; Prasad, Akula Siva

    2016-01-01

    Coronary angiogram in a young man with history of STEMI with delayed presentation revealed subtotal occlusion of left anterior descending artery (LAD) with large thrombotic filling defect distal to the critical lesion. PCI was preferred without delay because of ongoing chest pain. Several runs of thrombus aspiration failed to detect any visible thrombus. However, the immediate angiogram after thrombus aspiration showed complete distal embolization of the thrombus which could have been achieved by Dottering or balloon dilatation. In contrary to the general perception, does thrombus aspiration push more thrombus than it can aspirate?

  13. Re-implant of the right coronary artery: a surgical technique for the treatment of ostial lesions

    Directory of Open Access Journals (Sweden)

    Bongiovani Hércules Lisboa

    2002-01-01

    Full Text Available Previously described surgical treatment for ostial coronary artery stenosis relied on either venous or arterial bypasses or ostial patch angioplasty. These surgical procedures are performed with bovine pericardium, saphenous vein or internal thoracic artery. We describe a technique of right coronary artery re-implantation into the aorta. The procedure was performed in four patients with right coronary artery ostial stenosis along with other left coronary artery lesions.

  14. Anomalous Origin of a Stenosed Left Circumflex Coronary Artery in a Patient Presenting with Unstable Angina: A Case Report

    Directory of Open Access Journals (Sweden)

    Vakili Hossein

    2016-12-01

    Full Text Available 73 year-old man presented to our emergency department with complaint of retrosternal chest pain since 2 day and admitted with diagnosis of unstable angina. He underwent diagnostic coronary angiography in which left circumflex artery (LCX was not visualized during injection of the left coronary artery; indeed, it was originated, with common origin with RCA, from right coronary sinus of Valsalva. This case report is one of the uncommon cases with aberrant coronary arteries who presented with unstable angina. Moreover, coronary angiography with following coronary angioplasty was performed for him in a challenging course and angle for coronary intervention.

  15. Current status and perspective of percutaneous coronary intervention in China

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    @@ The first percutaneous transluminal coronary angioplasty (PTCA) in China was performed in 1984. Since then the progresses in this field have been achieved gradually. The development process can be divided into 3 phases roughly. According to a national survey organized by Chinese Society of Cardiology,1-3 from 1984 to 1996, as the first phase, percutaneous coronary intervention (PCI) can only be performed in a few centers by a few cardiologists.

  16. The Prognosis of Primary Percutaneous Coronary Intervention after One Year Clinical Follow Up

    Directory of Open Access Journals (Sweden)

    Yahya Dadjoo

    2013-03-01

    Full Text Available Objectives: The aim of this study was to evaluate the clinical outcomes, one year after primary percutaneous coronary intervention(PCI. Patients and Methods: From September 2009 to March 2012, primary PCI was performed on 70 cases, and the data relating to their catheterization were recorded. Peri-interventional treatment data included PCI with drug-eluting or bare-metal stent or balloon angioplasty alone. Results: The mean age of the patients was 61.34+11.31 years, and 72.9% of them were males. The ratios of patients with diabetes, hypertension and, hyperlipidemia were 61.4%, 71.4%, and 52.9% respectively. In clinical follow-up, total incidence of death was 4.3%, with no death occurring during 30 days. However, 3 patients died after one-year, of which one patient (1.4% had cardiac problem and the other 2 (2.9% died because of non-cardiac reasons. Target vessel revascularization, reinfarction within 30 days, and mechanical complication or stroke were not found in any of the patients. Patients with hypertension (6% and those with LAD ST-elevation myocardial infarction (5% died after one year (P= 0.263 and P= 0.319 respectively. However, no mortality was reported in patients with RCA and LCX ST-elevation myocardial infarction. Of subjects with multivessel disease, 7% died after one-year (P= 0.161, but there was no reported mortality in those with single vessel disease.

  17. Management of a subclavian artery thrombosis causing acute anterior wall infarction and concurrent left arm ischemia in a patient with prior coronary bypass.

    Science.gov (United States)

    Akgüllü, Çağdaş; Eryılmaz, Ufuk; Zencir, Cemil; Güngör, Hasan

    2014-12-01

    We report a 57-year-old patient with acute anterior wall infarction with a history of a coronary baypass graft operation in 2007. He also had concurrent left arm cyanosis and severe pain. He had received diagnosis of pancreatic adenocarcinoma one month previously and had had his first chemotherapy in the previous week with gemcitabine and 5-fluorouracil. After the angiography, a giant thrombus was detected in the proximal left subclavian artery, deteriorating the flows of both left internal mammarian artery (LIMA) to left anterior descending (LAD) coronary artery graft, as well as the left brachial artery. The proximal subclavian artery was stented and good flow was achieved. Through the LIMA, the distal part of LAD, which was totally obstructed with probable distal thrombus embolization, was reached and a percutaneous balloon angioplasty performed. However, the no-reflow phenomenon was observed in distal LAD. A Fogarty traction of thrombus was performed successfully for the revascularization of the left arm. Approximately 30 minutes after the procedure, both angina and ST segment elevation in ECG were resolved under unfractioned heparin and nitroglycerin infusion. However, the patient died due to sepsis seven days after admission to hospital. In the literature, there are only a few previous reports on this rare clinical entity. The eitology, presentation, and the possible management strategies of this clinical entity is presented in this report.

  18. [Femoral angioplasty. Long-term results].

    Science.gov (United States)

    Foucart, H; Carlier, C; Baudrillard, J C; Joffre, F; Cécile, J P

    1990-01-01

    A study on the long-term efficacy of femoral-popliteal angioplasty was carried out on 185 angioplasty cases over a 5 year follow-up period. A classification of data according to the type of lesion treated, revealed that results were favorable in case of stenosis (87%), short obstruction (70%) and long obstruction (35%). A special study of the outcome of treatments for stage IV arteritis was carried out. After comparing results with those obtained by other teams, the authors list the complications encountered, hematomas, and thromboses, and show their current tendency for regression. Lastly, the authors stress the advantages of angioscopy, which permits to identify the nature of the treated lesions and to predict possible complications, which are usually underrated by angiography.

  19. Development of a balloon volume sensor for pulsating balloon catheters.

    Science.gov (United States)

    Nolan, Timothy D C; Hattler, Brack G; Federspiel, William J

    2004-01-01

    Helium pulsed balloons are integral components of several cardiovascular devices, including intraaortic balloon pumps (IABP) and a novel intravenous respiratory support catheter. Effective use of these devices clinically requires full inflation and deflation of the balloon, and improper operating conditions that lead to balloon under-inflation can potentially reduce respiratory or cardiac support provided to the patient. The goal of the present study was to extend basic spirographic techniques to develop a system to dynamically measure balloon volumes suitable for use in rapidly pulsating balloon catheters. The dynamic balloon volume sensor system (DBVSS) developed here used hot wire anemometry to measure helium flow in the drive line from console to catheter and integrated the flow to determine the volume delivered in each balloon pulsation. An important component of the DBVSS was an algorithm to automatically detect and adjust flow signals and measured balloon volumes in the presence of gas composition changes that arise from helium leaks occurring in these systems. The DBVSS was capable of measuring balloon volumes within 5-10% of actual balloon volumes over a broad range of operating conditions relevant to IABP and the respiratory support catheter. This includes variations in helium concentration from 70-100%, pulsation frequencies from 120-480 beats per minute, and simulated clinical conditions of reduced balloon filling caused by constricted vessels, increased driveline, or catheter resistance.

  20. Biocompatibility of coronary stent materials: effect of electrochemical polishing

    Energy Technology Data Exchange (ETDEWEB)

    Scheerder, I. de [University Hospital Leuven (Belgium). Dept. of Cardiology; Sohier, J.; Froyen, L.; Humbeeck, J. van [Louvain Univ. (Belgium). Dept. of Metallurgy and Materials Engineering; Verbeken, E. [University Hospital Leuven (Belgium). Dept. of Pathology

    2001-02-01

    Percutaneous Transluminal Coronary Revascularization (PTCR) is now a widely accepted treatment modality for atherosclerotic coronary artery disease. Current multicenter randomized trials comparing PTCR with the more invasive Coronary Artery Bypass Grafting could not show long-term significant survival differences. During the last two decades progress has been made to further optimize PTCR. The most logic approach to treat atherosclerotic coronary narrowings is to remove the atherosclerotic material using especially developed devices. Several trials, however, could not show a significant beneficial outcome after use of these devices compared to plain old balloon angioplasty. Another approach was to implant a