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Sample records for percutaneous interventional procedures

  1. Use of Ultrasound Contrast Agents in Relation to Percutaneous Interventional Procedures

    DEFF Research Database (Denmark)

    Nolsøe, Christian Pállson; Nolsøe, Alexander Bjørneboe; Klubien, Jeanett

    2018-01-01

    The aim of this article is to provide an inventory of the use of contrast-enhanced ultrasound (CEUS) in relation to percutaneous interventional procedures. The article is structured into a systematic literature review followed by a clinical part relating to percutaneous CEUS-guided procedures...

  2. Percutaneous CT-guided interventional procedures in musculoskeletal system (our experience)

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    Thanos, Loukas E-mail: loutharad@yahoo.com; Mylona, Sophia; Kalioras, Vasilios; Pomoni, Maria; Batakis, Nikolaos

    2004-06-01

    Percutaneous interventional procedures include a broad spectrum of minimal invasive techniques, which are a useful diagnostic and therapeutic tool. In this study we present our experience in CT-guided percutaneous musculoskeletal biopsies, drainages of musculoskeletal abscesses, facet and sacroiliac joint injection and radiofrequency thermal ablation of painful metastases or osteoid osteomas.

  3. Percutaneous intervention in obstructive

    International Nuclear Information System (INIS)

    Souftas, V.

    2012-01-01

    Percutaneous intervention procedures in obstructive uropathy include percutaneous nephrostomy tube placements, nephroureteral stents, percutaneous nephrostomy combined with ureteral embolization, percutaneous management of stone disease, suprapubic tube placements into the bladder, and perinephric/retroperitoneal urinomas/abscesses drainages. Percutaneous nephrostomy is performed to relieve urinary obstruction or divert the urinary stream away from the ureter or bladder. Patients are given preprocedure antibiotics. Percutaneous nephrostomies can be emergent cases because of risk of pyuria and sepsis from a stagnant urine collection. The procedure is performed using both ultrasound and fluoroscopy (or fluoroscopy alone using anatomic landmarks, or an internal radiopaque calculus, or delayed phase excretion of the contrast into the renal collecting system) under local anesthesia or conscious sedation. Ureteral stents are placed to bypass an obstructing stone or to stent across of an area of stricture or ureteral laceration. Stents may be placed by the urologist via a transurethral approach or by the interventional radiologist via a percutaneous approach. The decision as to method of stent placement is based upon the location and accessibility of the ureteral pathology. Ureteral embolization is performed in patients with unresectable tumors of the pelvis with long-standing nephrostomy tubes and distal urine leaks refractory to other treatments. Coils, gelfoam and liquid embolic materials can be used. Ureteral embolization for ureteral fistulas and incontinence is technically successful in 100% of the patients. Complications include bleeding, infection, ureteral or renal injury, and deployment (or movement) of the coils within the renal pelvis. Percutaneous management of stone disease, including renal, ureteral, and bladder stones requires close cooperation between the urologist and interventional radiologist, because of availability of sonographic lithotripsy

  4. Efficacy of the RADPAD protective drape during real world complex percutaneous coronary intervention procedures.

    Science.gov (United States)

    Murphy, John C; Darragh, Karen; Walsh, Simon J; Hanratty, Colm G

    2011-11-15

    The RADPAD is a lead-free surgical drape containing bismuth and barium that has been demonstrated to reduce scatter radiation exposure to primary operators during fluoroscopic procedures. It is not known to what degree the RADPAD reduces radiation exposure in operators who perform highly complex percutaneous coronary intervention (PCI) requiring prolonged fluoroscopic screening times. Sixty consecutive patients due to undergo elective complex PCI involving rotational atherectomy, multivessel PCI, or chronic total occlusions were randomized in a 1:1 pattern to have their procedures performed with and without the RADPAD drape in situ. Dosimetry was performed on the left arm of the primary operator. There were 40 cases of chronic total occlusion, including 28 with contralateral injections; 15 cases involving rotational atherectomy; and 5 cases of multivessel PCI. There was no significant difference in screening times or dose-area products between the 2 patient groups. Primary operator radiation dose relative to screening time (RADPAD: slope = 1.44, R² = 0.25; no RADPAD: slope = 4.60, R² = 0.26; analysis of covariance F = 4.81, p = 0.032) and dose-area product (RADPAD: slope = 0.003, R² = 0.26; no RADPAD: slope = 0.011, R² = 0.52; analysis of covariance F = 12.54, p = 0.008) was significantly smaller in the RADPAD cohort compared to the no-RADPAD group. In conclusion, the RADPAD significantly reduces radiation exposure to primary operators during prolonged, complex PCI cases. Copyright © 2011 Elsevier Inc. All rights reserved.

  5. Robotics in percutaneous cardiovascular interventions.

    Science.gov (United States)

    Pourdjabbar, Ali; Ang, Lawrence; Behnamfar, Omid; Patel, Mitul P; Reeves, Ryan R; Campbell, Paul T; Madder, Ryan D; Mahmud, Ehtisham

    2017-11-01

    The fundamental technique of performing percutaneous cardiovascular (CV) interventions has remained unchanged and requires operators to wear heavy lead aprons to minimize exposure to ionizing radiation. Robotic technology is now being utilized in interventional cardiology partially as a direct result of the increasing appreciation of the long-term occupational hazards of the field. This review was undertaken to report the clinical outcomes of percutaneous robotic coronary and peripheral vascular interventions. Areas covered: A systematic literature review of percutaneous robotic CV interventions was undertaken. The safety and feasibility of percutaneous robotically-assisted CV interventions has been validated in simple to complex coronary disease, and iliofemoral disease. Studies have shown that robotically-assisted PCI significantly reduces operator exposure to harmful ionizing radiation without compromising procedural success or clinical efficacy. In addition to the operator benefits, robotically-assisted intervention has the potential for patient advantages by allowing more accurate lesion length measurement, precise stent placement and lower patient radiation exposure. However, further investigation is required to fully elucidate these potential benefits. Expert commentary: Incremental improvement in robotic technology and telecommunications would enable treatment of an even broader patient population, and potentially provide remote robotic PCI.

  6. Image guided percutaneous splenic interventions

    International Nuclear Information System (INIS)

    Kang, Mandeep; Kalra, Naveen; Gulati, Madhu; Lal, Anupam; Kochhar, Rohit; Rajwanshi, Arvind

    2007-01-01

    Aim: The objective of this study is to evaluate the efficacy and safety of image-guided percutaneous splenic interventions as diagnostic or therapeutic procedures. Materials and methods: We performed a retrospective review of our interventional records from July 2001 to June 2006. Ninety-five image-guided percutaneous splenic interventions were performed after informed consent in 89 patients: 64 men and 25 women who ranged in age from 5 months to 71 years (mean, 38.4 years) under ultrasound (n = 93) or CT (n = 2) guidance. The procedures performed were fine needle aspiration biopsy of focal splenic lesions (n = 78) and aspiration (n = 10) or percutaneous catheter drainage of a splenic abscess (n = 7). Results: Splenic fine needle aspiration biopsy was successful in 62 (83.78%) of 74 patients with benign lesions diagnosed in 43 (58.1%) and malignancy in 19 (25.67%) patients. The most common pathologies included tuberculosis (26 patients, 35.13%) and lymphoma (14 patients, 18.91%). Therapeutic aspiration or pigtail catheter drainage was successful in all (100%) patients. There were no major complications. Conclusions: Image-guided splenic fine needle aspiration biopsy is a safe and accurate technique that can provide a definitive diagnosis in most patients with focal lesions in the spleen. This study also suggests that image-guided percutaneous aspiration or catheter drainage of splenic abscesses is a safe and effective alternative to surgery

  7. Single-session versus staged procedures for elective multivessel percutaneous coronary intervention.

    Science.gov (United States)

    Toyota, Toshiaki; Morimoto, Takeshi; Shiomi, Hiroki; Yamaji, Kyohei; Ando, Kenji; Ono, Koh; Shizuta, Satoshi; Saito, Naritatsu; Kato, Takao; Kaji, Shuichiro; Furukawa, Yutaka; Nakagawa, Yoshihisa; Kadota, Kazushige; Horie, Minoru; Kimura, Takeshi

    2018-06-01

    To clarify the effect of single-session multivessel percutaneous coronary intervention (PCI) strategy relative to the staged multivessel strategy on clinical outcomes in patients with stable coronary artery disease (CAD) or non-ST-elevation acute coronary syndrome. In the Coronary REvascularisation Demonstrating Outcome Study in Kyoto PCI/coronary artery bypass grafting registry cohort-2, there were 2018 patients who underwent elective multivessel PCI. Primary outcome measure was composite of all-cause death, myocardial infarction and stroke at 5-year follow-up. Single-session multivessel PCI and staged multivessel PCI were performed in 707 patients (35.0%) and 1311 patients (65.0%), respectively. The cumulative 5-year incidence of and adjusted risk for the primary outcome measure were not significantly different between the single-session and staged groups (26.7% vs 23.0%, p=0.45; HR 0.91, 95% CI 0.72 to 1.16, p=0.47). The 30-day incidence of all-cause death was significantly higher in the single-session group than in the staged group (1.1% vs 0.2%, p=0.009). However, the causes of death in 11 patients who died within 30 days were generally not related to the procedural complications, but related to the serious clinical status before PCI. For the subgroup analyses including age, gender, extent of CAD, severe chronic kidney disease and heart failure, there was no significant interaction between the subgroup factors and the effect of the single-session strategy relative to the staged strategy for the primary outcome measure. The single-session multivessel PCI strategy was associated with at least comparable 5-year clinical outcomes compared with the staged multivessel PCI, although the prevalence of the single-session strategy was low in the present study. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  8. Direct dose measurement on patient during percutaneous coronary intervention procedures using radiophotoluminescence glass dosimeters

    International Nuclear Information System (INIS)

    Kato, Mamoru; Chida, Koichi; Moritake, Takashi; Sato, Tadaya; Oosaka, Hajime; Toyoshima, Hideto; Zuguchi, Masayuki; Abe, Yoshihisa

    2017-01-01

    The purpose of this research was to measure accurate patient entrance skin dose and maximum skin absorbed dose (MSD) to prevent radiation skin injuries in percutaneous coronary interventions (PCIs). We directly measured the MSD on 50 PCIs by using multiple radiophotoluminescence glass dosimeters and a modified dosimetry gown. Also, we analysed the correlation between the MSD and indirect measurement parameters, such as fluoroscopic time (FT), dose-area product (DAP) and cumulative air kerma (C-AK). There were very strong correlations between MSD and FT, DAP and C-AK, with the correlation between MSD and C-AK being the strongest (r = 0.938). In conclusion, the regression lines using MSD as an outcome value (y) and C-AK as predictor variables (x) were y = 1.12x (R"2 = 0.880). From the linear regression equation, MSD is estimated to be ∼1.12 times that of C-AK in real time. (authors)

  9. Radiation dose to patients from the coronary angiography and percutaneous transluminal coronary angioplasty in interventional radiology procedures

    International Nuclear Information System (INIS)

    Zheng, Jun-Zheng; Bai, Mei; Liu, Bin

    2008-01-01

    Full text: Objective: To survey and assess radiation dose to patients from coronary angiography (CA) and percutaneous transluminal coronary angioplasty (PTCA) in Beijing Xuanwu Hospital of Capital University of Medical Sciences. Methods: The dose-area product (DAP) values to the patient and cumulative dose (CD) were recorded from 84 coronary angiographies and 51 percutaneous transluminal coronary angioplasty. A Monte-Carlo based program PCXMC was used to calculate the effective dose from DAP values for each patient. Organ doses were also measured by thermoluminescent dosimeters (TLD) using a human-shaped phantom to compare the calculated organ dose from DAP. Results: The difference between the organ doses measured by TLDs and those from PCXMC software (P>0.05) were tolerable. The DAP value ranged from 7611∼60538 mGy·cm 2 for CA and 16423∼161973 mGy·cm 2 for PTCA. The effective dose for all procedures was determined to be in the range of 1.1∼6.9 mSv for CA and 2.3∼20.1 mSv for PTCA. CD ranged from 120.0 to 1016.0 mGy for CA and 287 to 2883 mGy for PTCA. Conversion factors between effective dose and DAP were 0.114∼0.139 mSv·Gy - 1·cm -2 for CA and 0.124∼0.142 mSv·Gy -1 ·cm -2 for PTCA; Conversion factors between organ dose and CD were derived for CA and PTCA, respectively. Conclusions: DAP and CD can be used as the dose indicator to calculate the organ dose and effective dose of patient based on Monte Carlo simulation. Using this method can provide important information of patient absorbed dose and enhance the radiation protection of patient in interventional radiology procedures. (author)

  10. Imaging in percutaneous musculoskeletal interventions

    International Nuclear Information System (INIS)

    Gangi, Afshin; Guth, Stephane; Guermazi, Ali

    2009-01-01

    This is one of the first books to deal specifically with imaging in percutaneous musculoskeletal interventions. The use of different imaging modalities during these procedures is well described. In the first chapter, the basic procedures and different guidance techniques are presented and discussed. The ensuing chapters describe in exhaustive detail the abilities and uses of imaging in guiding procedures ranging from biopsy and joint injection to management of pain and tumors. These procedures are extensively documented in adults as well as in the pediatric population. The third part of the book describes the different indications for vascular interventions in musculoskeletal lesions. The final chapter focuses on ultrasound-guided interventions, as they are more common and tend to be fashionable. The book is well illustrated with carefully chosen and technically excellent images. Each of the 18 chapters is written by an expert of international repute, making this book the most current and complete treatment of the subject available. It should be of great interest to interventional radiologists and also musculoskeletal and general radiologists. (orig.)

  11. Evaluation of F/E·DOI method as an approximate estimate of skin dose during percutaneous coronary intervention procedure

    International Nuclear Information System (INIS)

    Nakahara, Makoto; Yoshino, Akira; Kitano, K.; Yamaguchi, M.; Morone, Takayuki; Tani, K.

    2005-01-01

    The purpose of this study was to evaluate the efficacy of fluoroscopy time/total exposure times exposure times · in direction of interest (F/E·DOI) method as an approximate estimate of skin dose during percutaneous coronary intervention (PCI) procedure. Up to March 10, 2004, fifty-seven patients (male: 46 cases, female: 11 cases, age range 38-85 years; mean age 67±11 years) had undergone PCI and 157 directions of exposure was measured using X-ray films (KONICA MINOLTA SR-DUP) placed under the back of each patient during the procedure. The fluoroscopy time (minutes), the times of exposure in each direction during the procedure, and the thickness of chest (cm) was recorded. The relation of the skin dose to fluoroscopic time, exposure times in direction of interest, and F/E·DOI was assessed. The relationship between fluoroscopy time and skin dose was shown as y=0.02x+0.22 (r=0.54, p<0.0001, m.e=0.00±0.71 Gy, e.a=-2.19∼l.53 Gy). In addition, the relation of skin dose to exposure times in the direction of interest was y=0.07x+0.27 (r=0.77, p<0.0001, m.e=-0.00±0.53 Gy, e.a=-2.45∼1.76 Gy). The relationship between skin dose and F/E·DOI was y=0.06x+0.30 (r=0.85, p<0.0001, m.e=-0.00±0.44 Gy, e.a=-1.28∼1.06 Gy). Moreover, the relationship between skin dose and (F/E·DOI x 0.06+0.30) x coefficient of direction x coefficient in thickness of chest was y=0.99x-0.02 (r=0.89, p<0.0001, m.e=0.00±0.38 Gy, e.a=-1.12∼l.27 Gy). The calculated results corresponded to the skin dose during the procedure. F/E·DOI method was simple and effective, moreover, that enabled us to inform the skin dose during the PCI procedure to the interventionalist easily. (authors)

  12. Application of Real-Time 3D Navigation System in CT-Guided Percutaneous Interventional Procedures: A Feasibility Study

    Directory of Open Access Journals (Sweden)

    Priya Bhattacharji

    2017-01-01

    Full Text Available Introduction. To evaluate the accuracy of a quantitative 3D navigation system for CT-guided interventional procedures in a two-part study. Materials and Methods. Twenty-two procedures were performed in abdominal and thoracic phantoms. Accuracies of the 3D anatomy map registration and navigation were evaluated. Time used for the navigated procedures was recorded. In the IRB approved clinical evaluation, 21 patients scheduled for CT-guided thoracic and hepatic biopsy and ablations were recruited. CT-guided procedures were performed without following the 3D navigation display. Accuracy of navigation as well as workflow fitness of the system was evaluated. Results. In phantoms, the average 3D anatomy map registration error was 1.79 mm. The average navigated needle placement accuracy for one-pass and two-pass procedures, respectively, was 2.0±0.7 mm and 2.8±1.1 mm in the liver and 2.7±1.7 mm and 3.0±1.4 mm in the lung. The average accuracy of the 3D navigation system in human subjects was 4.6 mm ± 3.1 for all procedures. The system fits the existing workflow of CT-guided interventions with minimum impact. Conclusion. A 3D navigation system can be performed along the existing workflow and has the potential to navigate precision needle placement in CT-guided interventional procedures.

  13. Bivalirudin in percutaneous coronary intervention

    Directory of Open Access Journals (Sweden)

    Sam J Lehman

    2006-12-01

    Full Text Available Sam J Lehman, Derek P ChewDepartment of Medicine, Flinders University, South Australia, AustraliaAbstract: Bivalirudin is a member of the direct thrombin inhibitor group of anticoagulants. It has been evaluated as an alternative to unfractionated and low-molecular-weight heparins in the settings of percutaneous coronary intervention (PCI and acute coronary syndrome (ACS. Results of clinical trials to date suggest bivalirudin is a viable alternative to the use of a heparin combined with a glycoprotein (GP IIb/IIIa inhibitor in these settings. Thrombin has a central role in coagulation and platelet activation in ACS and during PCI. Its direct inhibition is an attractive target for therapy in these settings. Bivalirudin is a 20 amino acid polypeptide hirudin analog. It displays bivalent and reversible binding to the thrombin molecule, inhibiting its action. Direct inhibition of thrombin with bivalirudin has theoretical pharmacokinetic and pharmacodynamic advantages over the indirect anticoagulants. A reduction in rates of bleeding without loss of anti-thrombotic efficacy has been a consistent finding across multiple clinical trials. There may be economic benefits to the use of bivalirudin if it permits a lower rate of use of the GP IIb/IIIa inhibitors. This article reviews the pharmacology of bivalirudin and clinical trial evidence to date. There are now data from multiple clinical trials and meta-analyses in the setting of ACS and PCI. Early results from the acute catheterization and urgent intervention strategy (ACUITY trial are discussed. Keywords: bivalirudin, direct thrombin inhibitor, acute coronary syndrome, percutaneous coronary intervention

  14. Complications of Percutaneous Nephrostomy, Percutaneous Insertion of Ureteral Endoprosthesis, and Replacement Procedures

    International Nuclear Information System (INIS)

    Kaskarelis, Ioannis S.; Papadaki, Marina G.; Malliaraki, Niki E.; Robotis, Epaminondas D.; Malagari, Katerina S.; Piperopoulos, Ploutarchos N.

    2001-01-01

    Purpose: The aim of the present study was to record and identify the frequency of complications following percutaneous nephrostomy, replacement of nephrostomy drains and percutaneous insertion of ureteral endoprostheses.Methods: During a 10-year period 341 patients were referred to our department with indications for percutaneous nephrostomy and/or percutaneous insertion of a ureteral endoprosthesis, and a total of 1036 interventional procedures were performed (nephrostomy, catheter change, stenting).Results: There were three major complications (0.29%): two patients died during the first 30 days after the procedure, due to aggravation of their condition caused by the procedure, and one patient had retroperitoneal bleeding requiring surgery. There were 76 complications of intermediate severity (7.33%): catheter or stent displacement (n = 37, 3.57%) catheter occlusion (n = 18, 1.73%), hematuria (n = 12, 1.16%), and urinary tract infection (n = 9, 0.87%). The 55 minor complications (5.3%) comprised inflammation of the skin at the site of insertion of the percutaneous catheter.Conclusion: The small number of complications observed during acts of interventional uroradiology prove transcutaneous manipulations to be safe medical procedures

  15. Comparison of the boomerang wire vascular access management system versus manual compression alone during percutaneous diagnostic and interventional cardiovascular procedures: The boomerang™ wire vascular access management trial II.

    Science.gov (United States)

    Goswami, Nilesh J; Smalling, Ronnie G; Sinha, Shantanu; Gammon, Roger S; Ramaiah, Venkatesh G

    2016-01-01

    To evaluate the use of the Boomerang™ Wire as an adjunct to manual compression (MC) in patients requiring diagnostic (Dx) or interventional (Ix) percutaneous procedures. MC remains the standard of care for closure of femoral artery access sites. Adjunctive use of a device to facilitate closure, reduce time to hemostasis (TTH) and ambulation (TTA) without increasing complication rates could reduce costs and hospital resource demands. The Boomerang™ Trial was a prospective, multicenter, randomized, controlled trial comparing use of the Boomerang™ wire, (Cardiva Medical, Sunnyvale, CA) in conjunction with MC versus MC alone to achieve hemostasis in Dx and Ix patients undergoing percutaneous procedures requiring femoral artery access. Endpoints included TTH, TTA, major, and minor access-site related complications. Subjects were randomized 3:1, Boomerang versus MC. No minor or major device-related adverse events were reported. Nondevice related complication rates were 3 (0.9%) in the Boomerang arm (n = 327) and 1 (0.8%) in MC arm (n = 123). Mean TTH for Boomerang vs. MC was 11.2 ± 4.3 vs. 23.2 ± 11 min for Dx (P Boomerang vs. MC was 3.3 ± 3.0 vs. 4.5 ± 2.0 hr (P Boomerang™ use, in conjunction with MC, was associated with low rates of complications and demonstrated that Boomerang™ as an adjunct to MC can significantly decrease TTH and TTA after both Dx and Ix procedures. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.

  16. Left main percutaneous coronary intervention.

    Science.gov (United States)

    Teirstein, Paul S; Price, Matthew J

    2012-10-23

    The introduction of drug-eluting stents and advances in catheter techniques have led to increasing acceptance of percutaneous coronary intervention (PCI) as a viable alternative to coronary artery bypass graft (CABG) for unprotected left main disease. Current guidelines state that it is reasonable to consider unprotected left main PCI in patients with low to intermediate anatomic complexity who are at increased surgical risk. Data from randomized trials involving patients who are candidates for either treatment strategy provide novel insight into the relative safety and efficacy of PCI for this lesion subset. Herein, we review the current data comparing PCI with CABG for left main disease, summarize recent guideline recommendations, and provide an update on technical considerations that may optimize clinical outcomes in left main PCI. Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  17. Peri-procedural ST segment resolution during Primary Percutaneous Coronary Intervention (PPCI) for acute myocardial infarction: predictors and clinical consequences.

    Science.gov (United States)

    Karamasis, Grigoris V; Russhard, Paul; Al Janabi, Firas; Parker, Michael; Davies, John R; Keeble, Thomas R; Clesham, Gerald J

    ECG ST segment resolution (STR) has been used to assess myocardial perfusion in STEMI patients undergoing PPCI. However, in most of the studies ECGs recorded at different time points after the actual procedure have been used, limiting the options of therapeutic interventions while the patient is still in the catheterisation laboratory. The aim of this study was to investigate the presence and clinical consequences of intra-procedural STR during PPCI. We analysed 12 lead ECGs recorded at the onset and the end of the PPCI procedure, measuring STR in the lead with maximum ST elevation on the initial recording. STR was defined as good when > 50% compared to baseline. Pre and immediately post PPCI ECGs were recorded in 467 STEMI cases whilst the patient was on the catheter lab table. Mean patient age was 63 (+/- 12) years old and 75% were men. Mean duration of symptoms to admission was 3.8 (+/- 3.4) hours and 51% of infarcts were anterior. Good ST resolution at the end of the procedure was seen in 46.5% of patients and was observed more commonly in inferior compared to anterior infarcts (60.1% vs. 32.6%, pST resolution had a shorter mean hospital length of stay (3.8 vs. 4.5 days, p=0.009) and a higher left ventricular ejection fraction (49.9% vs. 44.2%, pST resolution was seen in less than half of STEMI patients undergoing PPCI. There were important clinical consequences of good ST resolution. Identification of suboptimal peri-procedural ST resolution could help identify patients who may benefit from new treatments aimed at protecting the microcirculation, whilst the patients are still in the angiography laboratory. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. The Association of Peri-Procedural Blood Transfusion with Morbidity and Mortality in Patients Undergoing Percutaneous Lower Extremity Vascular Interventions: Insights from BMC2 VIC.

    Science.gov (United States)

    Henke, Peter K; Park, Yeo Jung; Hans, Sachinder; Bove, Paul; Cuff, Robert; Kazmers, Andris; Schreiber, Theodore; Gurm, Hitinder S; Grossman, P Michael

    2016-01-01

    To determine the predictors of periprocedural blood transfusion and the association of transfusion on outcomes in high risk patients undergoing endoluminal percutaneous vascular interventions (PVI) for peripheral arterial disease. Between 2010-2014 at 47 hospitals participating in a statewide quality registry, 4.2% (n = 985) of 23,273 patients received a periprocedural blood transfusion. Transfusion rates varied from 0 to 15% amongst the hospitals in the registry. Using multiple logistic regression, factors associated with increased transfusion included female gender (OR = 1.9; 95% CI: 1.6-2.1), low creatinine clearance (1.3; 1.1-1.6), pre-procedural anemia (4.7; 3.9-5.7), family history of CAD (1.2; 1.1-1.5), CHF (1.4; 1.2-1.6), COPD (1.2; 1.1-1.4), CVD or TIA (1.2; 1.1-1.4), renal failure CRD (1.5; 1.2-1.9), pre-procedural heparin use (1.8; 1.4-2.3), warfarin use (1.2; 1.0-1.5), critical limb ischemia (1.7; 1.5-2.1), aorta-iliac procedure (1.9; 1.5-2.5), below knee procedure (1.3; 1.1-1.5), urgent procedure (1.7; 1.3-2.2), and emergent procedure (8.3; 5.6-12.4). Using inverse weighted propensity matching to adjust for confounders, transfusion was a significant risk factor for death (15.4; 7.5-31), MI (67; 29-150), TIA/stroke (24; 8-73) and ARF (19; 6.2-57). A focused QI program was associated with a 28% decrease in administration of blood transfusion (p = 0.001) over 4 years. In a large statewide PVI registry, post procedure transfusion was highly correlated with a specific set of clinical risk factors, and with in-hospital major morbidity and mortality. However, using a focused QI program, a significant reduction in transfusion is possible.

  19. Percutaneous Cystgastrostomy as a Single-Step Procedure

    International Nuclear Information System (INIS)

    Curry, L.; Sookur, P.; Low, D.; Bhattacharya, S.; Fotheringham, T.

    2009-01-01

    The purpose of this study was to evaluate the success of percutaneous transgastric cystgastrostomy as a single-step procedure. We performed a retrospective analysis of single-step percutaneous transgastric cystgastrostomy carried out in 12 patients (8 male, 4 female; mean age 44 years; range 21-70 years), between 2002 and 2007, with large symptomatic pancreatic pseudocysts for whom up to 1-year follow-up data (mean 10 months) were available. All pseudocysts were drained by single-step percutaneous cystgastrostomy with the placement of either one or two stents. The procedure was completed successfully in all 12 patients. The pseudocysts showed complete resolution on further imaging in 7 of 12 patients with either enteric passage of the stent or stent removal by endoscopy. In 2 of 12 patients, the pseudocysts showed complete resolution on imaging, with the stents still noted in situ. In 2 of 12 patients, the pseudocysts became infected after 1 month and required surgical intervention. In 1 of 12 patients, the pseudocyst showed partial resolution on imaging, but subsequently reaccumulated and later required external drainage. In our experience, percutaneous cystgastrostomy as a single-step procedure has a high success rate and good short-term outcomes over 1-year follow-up and should be considered in the treatment of large symptomatic cysts.

  20. Percutaneous brachial artery catheterization for coronary angiography and percutaneous coronary interventions (pci): an encouraging experience of 100 cases

    International Nuclear Information System (INIS)

    Islam, Z.U.; Maken, G.R.; Saif, M.; Khattak, Z.A.

    2013-01-01

    Objective: To evaluate the practicability and safety of the percutaneous transbrachial approach (TBA) for diagnostic coronary angiography and therapeutic percutaneous coronary interventions. Study Design: Quasi experimental study. Place and Duration of Study: The study was carried out in Armed Forces Institute of Cardiology- National Institute of Heart Diseases (AFIC-NIHD) from March 2009 to May 2011. Patients and Methods: We collected data of 100 consecutive patients who underwent coronary catheterization by the percutaneous transbrachial approach. Transbrachial catheterization was performed only if the radial access failed or radial pulse was feeble. Study endpoints included successful brachial artery catheterization, vascular and neurological complications at access site and procedure success rate. Results: Mean age of the patients was 54 years (range 33-79 yrs) and 65(65%) were males and 35 (35%) were females. The right brachial artery was used in all of the cases. Procedural success was achieved in 100% of the patients. Coronary angiography was performed in 70 patients and percutaneous coronary interventions were done in 30 cases. Out of these 30 cases, PCI to left coronary arteries (LAD and LCX) were performed in 19 patients while 11 patients had PCI to right coronary artery (RCA). No case of vascular complications such as major access site bleeding, vascular perforation, brachial artery occlusion causing forearm ischemia, compartment syndrome, vascular spasm or failure to catheterize coronary arteries requiring alternate vascular access were observed. Conclusion: Brachial artery is a safe and easily accessible approach for coronary angiography and percutaneous coronary interventions. (author)

  1. 1-year rehospitalization after percutaneous coronary intervention

    DEFF Research Database (Denmark)

    Hansen, Kirstine Nørregaard; Bendix, Kristoffer; Antonsen, Lisbeth

    2018-01-01

    AIMS: To evaluate the incidence and causes of rehospitalization within 1-year after percutaneous coronary intervention (PCI) in a country where the National Health Service provides universal tax-supported health care, guaranteeing residents free hospital access. METHODS AND RESULTS: Between January.......26-1.34) and Charlson Comorbidity Index ≥ 3 (OR 3.03;95% CI 2.71-3.27) Conclusions: In an unselected patient cohort treated with PCI, half of the patients were rehospitalized within 1-year, illuminating the impact of comorbidity in patients with ischemic heart disease....... 2010 and September 2014, 17,111 patients were treated with PCI in two University Hospitals in Western Denmark. Patients who were readmitted within 1-year after PCI were identified. Overall 1-year readmission rate was 50.4%. The cause was angina/myocardial infarction (MI) in 4,282 patients (49...

  2. Percutaneous common femoral artery interventions using angioplasty, atherectomy, and stenting.

    Science.gov (United States)

    Mehta, Manish; Zhou, Yi; Paty, Philip S K; Teymouri, Medhi; Jafree, Kamran; Bakhtawar, Humayun; Hnath, Jeffrey; Feustel, Paul

    2016-08-01

    This study evaluated the feasibility, safety, and effectiveness of endovascular interventions for common femoral artery (CFA) occlusive disease. Using a prospectively maintained multicenter database, we analyzed outcomes in 167 consecutive patients who underwent percutaneous CFA interventions for Rutherford class 3 to class 6 (R3-R6) disease. The standardized treatment approach included primary percutaneous transluminal angioplasty (PTA) only, atherectomy + PTA, and provisional stenting. Outcomes included technical failure rate, recurrence, complications, and major or minor amputation rate. Data were analyzed using multivariate regression analysis. During a 7-year period, 167 patients with R3 (n = 91 [54.5%]) and R4 to R6 (n = 76 [45.5%]) disease underwent CFA interventions that included PTA only (n = 114 [68.2%]), atherectomy ± PTA (n = 38 [22.8%]), and provisional stenting (n = 15 [9.0%]) for failed atherectomy ± PTA. Procedure-related complications included pseudoaneurysm (n = 1 [0.6%]), thrombosis (n = 1 [0.6%]), distal embolization (n = 1 [0.6%]), and death (R6, n = 1 [0.06%]). CFA restenosis was observed in 34 (20.4%) patents; these underwent further percutaneous (n = 18 [10.8%]) or surgical (n = 17 [10.2%]) revascularization that included CFA endarterectomy ± femoral distal bypass. Major or minor amputations were observed in none of the R3 patients and in only three (3.9%) and five (6.5%) of the R4 to R6 patients, respectively. Compared with the atherectomy + PTA group, patients in the PTA-only group had a significantly lower patency. Furthermore, during long-term mean follow-up of 42.5 months, the CFA provisional stent group had a 100% primary patency, which was significantly better than the primary patency in the CFA nonstent groups combined (77.0%; P = .0424). Data from this study to date would suggest that percutaneous CFA interventions in select patients are relatively safe and effective. In the long term, CFA stenting has

  3. Acute Stent Thrombosis After Primary Percutaneous Coronary Intervention

    DEFF Research Database (Denmark)

    Clemmensen, Peter; Wiberg, Sebastian; Van't Hof, Arnoud

    2015-01-01

    OBJECTIVES: This study sought to determine clinical, procedural, and treatment factors associated with acute stent thrombosis (AST) in the EUROMAX (European Ambulance Acute Coronary Syndrome Angiography) trial. BACKGROUND: Bivalirudin started during transport for primary percutaneous coronary...

  4. [Developments in percutaneous coronary intervention and coronary stents].

    Science.gov (United States)

    Simsek, C; Daemen, J; Zijlstra, F

    2014-01-01

    In The Netherlands, more than 30.000 patients undergo a percutaneous coronary intervention every year, during which a coronary stent implantation will be performed in 90% of the cases. It is estimated that more than 5 million coronary stent implantations will be performed worldwide this year. While these numbers are impressive, however, coronary stents still have as a limitation the possibility of stent thrombosis. This has been and is an important stimulus for the development of both coronary stents, from a bare metal stent via a drug eluting stent to the present-day development of bio-absorbable stents, and anti-platelet drugs,from acenocoumarol to thieropyridines. The possibility of shortening the period of use of this powerful medication by developing new kinds of non-thrombogenic stents would, for example, make it possible to achieve significant reductions in subsequent bleeding during (dental) procedures.

  5. Outcome and safety of same-day-discharge percutaneous coronary interventions with femoral access

    DEFF Research Database (Denmark)

    Antonsen, Lisbeth; Jensen, Lisette Okkels; Thayssen, Per

    2013-01-01

    Ongoing development in percutaneous coronary intervention (PCI) techniques and closing devices facilitates same-day-discharge in patients undergoing uncomplicated PCI procedures. We examined the safety and outcome in low-risk patients discharged the same day as PCI with femoral access was performed....

  6. The percutaneous interventional therapy of lung abscess and pyothorax under the CT guidance

    International Nuclear Information System (INIS)

    Gao Xinghan; Zhu Zhenfang; Lv Fanzhen; Yan Dejun; Su Baomin

    2003-01-01

    Objective: To study the indication, the procedure, the necessity and feasibility of the percutaneous interventional therapy of lung abscess and pyothorax under the CT guidance. Methods: The group included 18 patients who received percutaneous interventional therapy of lung abscess and pyothorax. Results: 13 patients were cured by a single procedure, 3 patients received twice intervention. Triple therapies were done in 2 patients. 2 cases out of 18 were eventually diagnosed as peripheral lung cancer. The body temperature and the WBC count returned to normal range after the procedures. 16 patients completely recovered in 1-5 weeks after the therapies. Conclusion: The interventional therapy under CT guidance not only helps the diagnosis and differential diagnosis of chronic or acute lung abscess and pyothorax, but also shortens the course of treatment and avoids the open surgery. It is a safe, simple and convenient method

  7. Delayed percutaneous coronary intervention in patients with acute myocardial infarction

    International Nuclear Information System (INIS)

    Zhu Weiming; Tian Fang; Shi Li; Lan Xi

    2004-01-01

    Objective: To observe the clinical effects, safeness and prognosis of delayed percutaneous coronary intervention (PCI) for infarct related artery (IRA) in post-infarct patients. Methods: In total 53 patients with acute myocardial infarction (AMI) underwent delayed PCI within 5-15 days after the acute event. Conventional treatment (including thrombolytic therapy) was given in all patients as they were admitted. Results: Intervention was performed in 68 branches of IRA were, including 64 cases of PTCA followed by stent implantation and 4 cases of direct stent implantation. In total 68 stents were implanted. The TIMI classification was improved from the pre-PCI 0-2 to post-PCI 3. No patient died during the treatment. No repeated AMI, post-infarct angina and repeated recanalization happened in the hospitalization. A 5-48 month follow up showed there was 1 death (1.9%), 1 case of repeated myocardial infarction (1.9%), 3 cases of unstable angina (5.7%), 2 cases of repeated PCI and 1 case of CABG. The rate of repeated recanalization was 5.7%. Seven patients (13.2%) were admitted for the second time, who survived 6-48 months after the intervention. Conclusion: Delayed PCT can obviously improve the short and long term prognosis as well as the life quality of patients with AMI, which is a safe interventional procedure

  8. Incidence and outcome of surgical procedures after coronary artery bypass grafting compared with those after percutaneous coronary intervention: a report from the Coronary Revascularization Demonstrating Outcome Study in Kyoto PCI/CABG Registry Cohort-2.

    Science.gov (United States)

    Tokushige, Akihiro; Shiomi, Hiroki; Morimoto, Takeshi; Ono, Koh; Furukawa, Yutaka; Nakagawa, Yoshihisa; Kadota, Kazushige; Ando, Kenji; Shizuta, Satoshi; Tada, Tomohisa; Tazaki, Junichi; Kato, Yoshihiro; Hayano, Mamoru; Abe, Mitsuru; Hamasaki, Shuichi; Ohishi, Mitsuru; Nakashima, Hitoshi; Mitsudo, Kazuaki; Nobuyoshi, Masakiyo; Kita, Toru; Imoto, Yutaka; Sakata, Ryuzo; Okabayashi, Hitoshi; Hanyu, Michiya; Shimamoto, Mitsuomi; Nishiwaki, Noboru; Komiya, Tatsuhiko; Kimura, Takeshi

    2014-08-01

    Noncardiac surgery after percutaneous coronary intervention (PCI) has been reported to be carrying high risk for both ischemic and bleeding complications. However, there has been no report comparing the incidence and outcomes of surgical procedures after coronary artery bypass grafting (CABG) with those after PCI. Among 14 383 patients undergoing first coronary revascularization (PCI, n=12 207; CABG, n=2176) enrolled in the Coronary Revascularization Demonstrating Outcome Study in Kyoto (CREDO-Kyoto) PCI/CABG Registry Cohort-2, surgical procedures were performed more frequently after CABG (n=560) than after PCI (n=2398; cumulative 3-year incidence: 27% versus 22%; unadjusted PPCI groups (cumulative incidence: 3.1% versus 3.2%; unadjusted P=0.9; adjusted hazard ratio, 0.97; 95% confidence interval, 0.47-1.89; P=0.9). The risk for the primary bleeding outcome measure (moderate or severe bleeding by Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries classification) was lower in the CABG groups than in the PCI group (cumulative incidence: 1.3% versus 2.6%; unadjusted P=0.07; adjusted hazard ratio, 0.36; 95% confidence interval, 0.12-0.87; P=0.02). There were no interactions between the timing of surgery and the types of coronary revascularization (CABG/PCI) for both ischemic and bleeding outcomes. Surgical procedures were performed significantly more frequently after CABG than after PCI, particularly PCI were associated with similar risk for ischemic events and lower risk for bleeding events, regardless of the timing after coronary revascularization. © 2014 American Heart Association, Inc.

  9. A comparison of the boomerang wire vascular access management system versus manual compression alone during percutaneous diagnostic and interventional cardiovascular procedures.

    Science.gov (United States)

    Echeverria, Angela; Krajcer, Zvonimir

    2016-01-01

    Vascular closure devices allow for early sheath removal, allowing for earlier patient mobilization The Boomerang vascular access management system does not alter arterial integrity for future interventions Access site complications provide significant morbidity in diagnostic and therapeutic interventions. © 2016 Wiley Periodicals, Inc.

  10. Contrast-Induced Nephropathy in Patients Undergoing Percutaneous Coronary Intervention

    Directory of Open Access Journals (Sweden)

    Sana Shoukat

    2010-01-01

    Full Text Available Contrast Induced Nephropathy (CIN is a feared complication of numerous radiological procedures that expose patients to contrast media. The most notorious of these procedures is percutaneous coronary intervention (PCI. Not only is this a leading cause of morbidity and mortality, but it also adds to increased costs in high risk patients undergoing PCI. It is thought to result from direct cytotoxicity and hemodynamic challenge to renal tissue. CIN is defined as an increase in serum creatinine by either ≥0.5 mg/dL or by ≥25% from baseline within the first 2-3 days after contrast administration, after other causes of renal impairment have been excluded. The incidence is considerably higher in diabetics, elderly and patients with pre-existing renal disease when compared to the general population. The nephrotoxic potential of various contrast agents must be evaluated completely, with prevention as the mainstay of focus as no effective treatment exists. The purpose of this article is to examine the pathophysiology, risk factors, and clinical course of CIN, as well as the most recent studies dealing with its prevention and potential therapeutic interventions, especially during PCI. The role of gadolinium as an alternative to iodinated contrast is also discussed.

  11. Barriers to Implementation of Primary Percutaneous Coronary Intervention in Europe

    DEFF Research Database (Denmark)

    Laut, Kristina Grønborg; Pedersen, Alma Becic; Lash, Timothy

    2011-01-01

    Primary percutaneous coronary intervention (PPCI) is the recommended treatment for patients with acute ST-segment elevation myocardial infarction (STEMI). Despite substantial evidence of its effectiveness, only 40–45% of European STEMI patients are currently treated with PPCI and there are large ...... is needed. Keywords Primary percutaneous coronary intervention, acute ST-elevation myocardial infarction, implementation, practice variation, registry data......Primary percutaneous coronary intervention (PPCI) is the recommended treatment for patients with acute ST-segment elevation myocardial infarction (STEMI). Despite substantial evidence of its effectiveness, only 40–45% of European STEMI patients are currently treated with PPCI and there are large...... the diffusion of PPCI in Europe. The lack of complete implementation and large national and regional differences arise from the interplay between technology, patients, policy makers, culture and resources. Explanations for the variation in treatment access still remain a puzzle and access to valid data...

  12. Occupational exposures from selected interventional radiological procedures

    International Nuclear Information System (INIS)

    Janeczek, J.; Beal, A.; James, D.

    2001-01-01

    The number of radiology and cardiology interventional procedures has significantly increased in recent years due to better diagnostic equipment resulting in an increase in radiation dose to the staff and patients. The assessment of staff doses was performed for cardiac catheterization and for three other non-cardiac procedures. The scattered radiation distribution resulting from the cardiac catheterization procedure was measured prior to the staff dose measurements. Staff dose measurements included those of the left shoulder, eye, thyroid and hand doses of the cardiologist. In non-cardiac procedures doses to the hands of the radiologist were measured for nephrostomy, fistulogram and percutaneous transluminal angioplasty procedures. Doses to the radiologist or cardiologist were found to be relatively high if correct protection was not observed. (author)

  13. Optical coherence tomography at follow-up after percutaneous coronary intervention: relationship between procedural dissections, stent strut malapposition and stent healing

    DEFF Research Database (Denmark)

    Radu, Maria; Jørgensen, Erik; Kelbæk, Henning

    2011-01-01

    To analyse the relationship between strut apposition as visualised with optical coherence tomography (OCT) at follow-up and clinical and procedural characteristics at stent implantation, and to examine the relationship between strut apposition and stent healing.......To analyse the relationship between strut apposition as visualised with optical coherence tomography (OCT) at follow-up and clinical and procedural characteristics at stent implantation, and to examine the relationship between strut apposition and stent healing....

  14. Antegrade jj stenting after percutaneous renal procedures: The ‘pull and push’ technique

    Science.gov (United States)

    Ratkal, Jaideep M.; Sharma, Elias

    2014-01-01

    A JJ stent is inserted antegradely after percutaneous renal procedures like percutaneous nephrolithotomy (PCNL) for renal calculus disease, and for endopyelotomy for pelvi-ureteric junction obstruction. We describe a technique for antegrade stent insertion after PCNL. PMID:26413327

  15. Antegrade jj stenting after percutaneous renal procedures: The 'pull and push' technique.

    Science.gov (United States)

    Ratkal, Jaideep M; Sharma, Elias

    2015-06-01

    A JJ stent is inserted antegradely after percutaneous renal procedures like percutaneous nephrolithotomy (PCNL) for renal calculus disease, and for endopyelotomy for pelvi-ureteric junction obstruction. We describe a technique for antegrade stent insertion after PCNL.

  16. Diagnostic CT and percutaneous procedures after pancreatic transplantation

    International Nuclear Information System (INIS)

    Letourneau, J.G.; Hunter, D.W.; Thompson, W.M.; Sutherland, D.E.R.

    1987-01-01

    CT evaluation of the abdomen and pelvis is of great value after pancreatic transplantation. The expected CT appearance after pancreas transportation with both enteric and bladder drainage of exocrine function are presented, as is the appearance of infected and ischemic grafts. The CT detection and CT- and US-guided percutaneous aspiration and drainage of abdominal fluid collections are described. At the authors' institution, such aspiration and drainage procedures have obviated transplant pancreatectomy or surgical abscess drainage in 29% of patients

  17. Interventional spine procedures

    Energy Technology Data Exchange (ETDEWEB)

    Kelekis, A.D. [Attikon University Hospital, 2nd Radiology Department, University of Athens, Rimini 1, 124 61 Athens (Greece)]. E-mail: akelekis@cc.uoa.gr; Somon, T. [Geneva University Hospital, Department of Radiology, Neuroradiology, 24, Rue Micheli-du-Crest, 1211 Geneva 14 (Switzerland); Yilmaz, H. [Geneva University Hospital, Department of Radiology, Neuroradiology, 24, Rue Micheli-du-Crest, 1211 Geneva 14 (Switzerland); Bize, P. [Geneva University Hospital, Department of Radiology, Neuroradiology, 24, Rue Micheli-du-Crest, 1211 Geneva 14 (Switzerland); Brountzos, E.N. [Attikon University Hospital, 2nd Radiology Department, University of Athens, Rimini 1, 124 61 Athens (Greece); Lovblad, K. [Geneva University Hospital, Department of Radiology, Neuroradiology, 24, Rue Micheli-du-Crest, 1211 Geneva 14 (Switzerland); Ruefenacht, D. [Geneva University Hospital, Department of Radiology, Neuroradiology, 24, Rue Micheli-du-Crest, 1211 Geneva 14 (Switzerland); Martin, J.B. [Clinique Generale Beaulieu 12 chemin Beau Soleil 1206 Geneva (Switzerland)]. E-mail: jbmartin@beaulieu.ch

    2005-09-01

    Minimally invasive techniques for the treatment of some spinal diseases are percutaneous treatments, proposed before classic surgery. By using imaging guidance, one can significantly increase accuracy and decrease complication rates. This review report physiopathology and discusses indications, methods, complications and results of performing these techniques on the spine, including different level (cervical, thoracic, lumbar and sacroiliac) and different kind of treatments (nerve block, disc treatment and bone treatment). Finally the present article also reviews current literature on the controversial issues involved.

  18. Percutaneous release of the plantar fascia. New surgical procedure.

    Science.gov (United States)

    Oliva, Francesco; Piccirilli, Eleonora; Tarantino, Umberto; Maffulli, Nicola

    2017-01-01

    Plantar fasciopathy presents with pain at the plantar and medial aspect of the heel. If chronic, it can negatively impact on quality of life. Plantar fasciopathy is not always self-limiting, and can be debilitating. Surgical management involves different procedures. We describe a percutaneous plantar fascia release. A minimally invasive access to the plantar tuberosity of the calcaneus is performed, and a small scalpel blade is used to release the fascia. With this procedure, skin healing problems, nerve injuries, infection and prolonged recovery time are minimised, allowing early return to normal activities. V.

  19. Percutaneous coronary interventions - an investigation of radiation protection in Swedish hospitals; Percutan coronar intervention PCI - en straalskyddsutredning av verksamheten paa landets sjukhus

    Energy Technology Data Exchange (ETDEWEB)

    Almen, Anja; Cederlund, Torsten; Zaar, Britta

    2005-05-01

    The Swedish Radiation Protection Authority has investigated the status of radiation protection in connection with percutaneous coronary interventions (PCI) in Swedish hospitals. A questionnaire was send to hospitals concerning basic radiation protection procedures stated in the Swedish regulations. A questionnaire was also sent out to radiologists and cardiologists and the answers from those who performed interventions were analysed. The study indicates a strong need for improving radiation protection, as an example many hospitals could not present any documents describing methods or radiation protection procedures in connection with these interventions. Moreover, the radiation dose to hands and eyes of the personnel is rarely measured and the fluoroscopic time used for the interventions is not properly analysed. SSI is convinced that many hospitals need to improve radiation protection to meet the demands of the regulations. This could be accomplished by more efficient organized radiation protection work in the hospitals.

  20. Adverse outcomes following percutaneous transcatheter interventions

    NARCIS (Netherlands)

    Hassell, M.E.C.J.

    2017-01-01

    Advancements in the field of interventional cardiology have resulted in better survival and a shorter recovery period for patients with coronary artery and valve disease. Despite the benefits of these less invasive techniques, it is important to keep in mind the adagium “primum non nocere”.

  1. Percutaneous coronary intervention for coronary bifurcation disease

    DEFF Research Database (Denmark)

    Lassen, Jens Flensted; Holm, Niels Ramsing; Banning, Adrian

    2016-01-01

    of combining the opinions of interventional cardiologists with the opinions of a large variety of other scientists on bifurcation management. The present 11th EBC consensus document represents the summary of the up-to-date EBC consensus and recommendations. It points to the fact that there is a multitude...

  2. Increased bleeding risk during percutaneous coronary interventions by arterial hypertension.

    Science.gov (United States)

    Ndrepepa, Gjin; Groha, Philipp; Lahmann, Anna L; Lohaus, Raphaela; Cassese, Salvatore; Schulz-Schüpke, Stefanie; Kufner, Sebastian; Mayer, Katharina; Bernlochner, Isabell; Byrne, Robert A; Fusaro, Massimiliano; Laugwitz, Karl-Ludwig; Schunkert, Heribert; Kastrati, Adnan

    2016-08-01

    We aimed to assess the association between arterial hypertension and bleeding in patients undergoing percutaneous coronary intervention (PCI). The impact of arterial hypertension on bleeding risk of patients with coronary artery disease undergoing PCI is unknown. This study included 14,180 patients who underwent PCI. Bleeding was defined using the Bleeding Academic Research Consortium (BARC) criteria. Arterial hypertension was defined as treatment with antihypertensive drugs or a systolic blood pressure >140 mm Hg and/or diastolic blood pressure value >90 mm Hg documented on at least 2 occasions. The primary outcome was bleeding rate within 30 days of PCI. Overall, 11,066 patients (78.0%) had arterial hypertension. Bleeding events occurred in 1,232 patients with arterial hypertension and 278 patients without arterial hypertension (11.1% vs 8.9%; odds ratio [OR] = 1.28, 95% confidence interval [CI] 1.11-1.46, P arterial hypertension and 175 patients without arterial hypertension (6.6% vs 5.6%: OR = 1.19 [1.01-1.41], P = 0.049). Non-access-site bleeding occurred in 502 patients with and 103 patients without arterial hypertension (4.5% vs 3.3%; OR = 1.39 [1.12-1.72], P = 0.003). After adjustment, arterial hypertension was significantly associated with any bleeding (adjusted OR = 1.41 [1.19-1.67], P arterial hypertension increased the risk of non-access-site bleeding (P = 0.002), whereas systolic blood pressure at the time of PCI increased the risk of access site bleeding (P = 0.018). Arterial hypertension is associated with increased risk of bleeding during PCI procedures. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.

  3. Interventional chest procedures in pregnancy.

    LENUS (Irish Health Repository)

    Morgan, Ross K

    2012-02-01

    Interventional pulmonology encompasses diagnostic and therapeutic bronchoscopic procedures, and pleural interventions. In the last 10 years older techniques have been refined and exciting new technologies have extended the reach and application of the instruments used. The main areas within pulmonary medicine for which these interventions have a role are malignant and nonmalignant airway disease, pleural effusion, pneumothorax, and artificial airways. There are no data from well-designed prospective trials to guide recommendations for interventional pulmonary procedures in pregnancy. The recommendations provided in this article are based on critical review of reported case series, opinion from recognized experts, and personal observations.

  4. Interventional chest procedures in pregnancy.

    LENUS (Irish Health Repository)

    Morgan, Ross K

    2011-03-01

    Interventional pulmonology encompasses diagnostic and therapeutic bronchoscopic procedures, and pleural interventions. In the last 10 years older techniques have been refined and exciting new technologies have extended the reach and application of the instruments used. The main areas within pulmonary medicine for which these interventions have a role are malignant and nonmalignant airway disease, pleural effusion, pneumothorax, and artificial airways. There are no data from well-designed prospective trials to guide recommendations for interventional pulmonary procedures in pregnancy. The recommendations provided in this article are based on critical review of reported case series, opinion from recognized experts, and personal observations.

  5. Use of clopidogrel in the reduction of myocardial damage during percutaneous coronary intervention

    Directory of Open Access Journals (Sweden)

    Arijit Dasgupta

    2009-03-01

    Full Text Available Arijit Dasgupta, Debabrata MukherjeeGill Heart Institute, University of Kentucky, Lexington, KY, USAAbstract: It is estimated that approximately a quarter of patients undergoing coronary intervention may have significant post-procedural creatinine (CK/creatinine kinase myocardial band (CK-MB elevations and approximately half may have post-procedural troponin elevations. Current data suggest that periprocedural infarction is associated with short-, intermediate-, and long-term adverse outcomes, most notably mortality. This review examines the role of clopidogrel in decreasing periprocedural myonecrosis following percutaneous coronary intervention (PCI. Clopidogrel is an important pharmacologic agent used to reduce myocardial infarction post-coronary intervention as assessed directly by the evaluation of cardiac biomarkers and indirectly by the evaluation of short-term ischemic events. The optimal dose of clopidogrel is considered to be at least 300 mg given 6 to 15 hours prior to PCI but there is considerable evidence to suggest that a loading dose of 600 mg given 2 to 6 hours prior to PCI may be more efficacious in limiting post-coronary intervention events. The benefit obtained from clopidogrel appears independent of and incremental to that of other antiplatelet and antithrombotic agents used during and after coronary intervention.Keywords: percutaneous coronary intervention, myonecrosis, clopidogrel, antiplatelet agents, myocardial infarction 

  6. Gender differences following percutaneous coronary intervention

    DEFF Research Database (Denmark)

    Holmvang, L.; Mickley, H.

    2008-01-01

    PCI is effective for reducing symptoms in patients with stable angina pectoris but does not improve prognosis. In earlier trials PCI has been associated with more procedure related complications in women than men, but this difference between genders has been less pronounced in more recent studies....... In acute coronary syndromes there is no evidence of gender differences regarding the benefit of primary PCI for ST-segment elevation myocardial infarction. However, several trials of unstable angina and non-ST-segment elevation myocardial infarction indicate that women do not have the similar benefit...

  7. Prevalence of chronic kidney disease among patients undergoing transradial percutaneous coronary interventions.

    Science.gov (United States)

    Hossain, Mohammad A; Quinlan, Amy; Heck-Kanellidis, Jennifer; Calderon, Dawn; Patel, Tejas; Gandhi, Bhavika; Patel, Shrinil; Hetavi, Mahida; Costanzo, Eric J; Cosentino, James; Patel, Chirag; Dewan, Asa; Kuo, Yen-Hong; Salman, Loay; Vachharajani, Tushar J

    2018-03-01

    While transradial approach to conduct percutaneous coronary interventions offers multiple advantages, the procedure can cause radial artery damage and occlusion. Because radial artery is the preferred site for the creation of an arteriovenous fistula to provide dialysis, patients with chronic kidney disease are particularly dependent on radial artery for their long-term survival. In this retrospective study, we investigated the prevalence of chronic kidney disease in patients undergoing coronary interventions via radial artery. Stage of chronic kidney disease was based on estimated glomerular filtration rate and National Kidney Foundation - Kidney Disease Outcomes Quality Initiative guidelines. A total of 497 patients undergoing transradial percutaneous coronary interventions were included. Over 70.4% (350/497) of the patients had chronic kidney disease. Stage II chronic kidney disease was observed in 243 (69%) patients (estimated glomerular filtration rate = 76.0 ± 8.4 mL/min). Stage III was observed in 93 (27%) patients (estimated glomerular filtration rate = 49 ± 7.5 mL/min). Stage IV chronic kidney disease was observed in 5 (1%) patients (estimated glomerular filtration rate = 25.6 ± 4.3 mL/min) and Stage V chronic kidney disease was observed in 9 (3%) patients (estimated glomerular filtration rate = 9.3 ± 3.5 mL/min). Overall, 107 of 350 patients (30%) had advanced chronic kidney disease, that is, stage III-V chronic kidney disease. Importantly, 14 of the 107 (13%) patients had either stage IV or V chronic kidney disease. This study finds that nearly one-third of the patients undergoing transradial percutaneous coronary interventions have advanced chronic kidney disease. Because many of these patients may require dialysis, the use of radial artery to conduct percutaneous coronary interventions must be carefully considered in chronic kidney disease population.

  8. Intervention procedures for radionuclides

    International Nuclear Information System (INIS)

    Adelstein, S.J.

    1991-01-01

    As in the case of smoking and lung cancer, for large radionuclide releases, an ounce of prevention is worth a pound of cure. On the other hand, we feel compelled to do something sensible after an accident even if the principal benefit of intervention may be to comfort the population at risk. Of course, for populations near the site of an accident, evacuation should be considered, but it is unreasonable to apply this measure to distant populations, e.g., large segments of the European community could not be moved about as we observe the shifting of a radioactive cloud in response to changing winds. If the radionuclides are delivered as particulates, bringing people indoors and employing primitive air filters can temporarily reduce exposures, but these stratagems are not very effective against gaseous or volatile elements. What, then, can be done for populations downwind of a radioactive release whose air, water, and/or food supply are, or are about to become contaminated? 5 refs

  9. Novel design of honeybee-inspired needles for percutaneous procedure.

    Science.gov (United States)

    Sahlabadi, Mohammad; Hutapea, Parsaoran

    2018-04-18

    The focus of this paper is to present new designs of innovative bioinspired needles to be used during percutaneous procedures. Insect stingers have been known to easily penetrate soft tissues. Bioinspired needles mimicking the barbs in a honeybee stinger were developed for a smaller insertion force, which can provide a less invasive procedure. Decreasing the insertion force will decrease the tissue deformation, which is essential for more accurate targeting. In this study, some design parameters, in particular, barb shape and geometry (i.e. front angle, back angle, and height) were defined, and their effects on the insertion force were investigated. Three-dimensional printing technology was used to manufacture bioinspired needles. A specially-designed insertion test setup using tissue mimicking polyvinyl chloride (PVC) gels was developed to measure the insertion and extraction forces. The barb design parameters were then experimentally modified through detailed experimental procedures to further reduce the insertion force. Different scales of the barbed needles were designed and used to explore the size-scale effect on the insertion force. To further investigate the efficacy of the proposed needle design in real surgeries, preliminary ex vivo insertion tests into bovine liver tissue were performed. Our results show that the insertion force of the needles in different scales decreased by 21-35% in PVC gel insertion tests, and by 46% in bovine liver tissue insertion tests.

  10. Fractional flow reserve versus angiography for guiding percutaneous coronary intervention

    DEFF Research Database (Denmark)

    Tonino, Pim A L; De Bruyne, Bernard; Pijls, Nico H J

    2009-01-01

    of maximal blood flow in a stenotic artery to normal maximal flow), in addition to angiography, improves outcomes. METHODS: In 20 medical centers in the United States and Europe, we randomly assigned 1005 patients with multivessel coronary artery disease to undergo PCI with implantation of drug......BACKGROUND: In patients with multivessel coronary artery disease who are undergoing percutaneous coronary intervention (PCI), coronary angiography is the standard method for guiding the placement of the stent. It is unclear whether routine measurement of fractional flow reserve (FFR; the ratio...

  11. Radiation exposure of operator during various interventional procedures

    International Nuclear Information System (INIS)

    Yu, In Kyu; Chung, Jin Wook; Han, Joon Koo; Park, Jae Hyung; Kang, Wee Saing

    1994-01-01

    To investigate the levels of radiation exposure of an operator which may be influenced by the wearing an apron, type of procedure, duration of fluoroscopy and operator's skill during various interventional procedures. Radiation doses were measured both inside and outside the apron(0.5 mm lead equivalent) of the operator by a film badge monitoring method and the duration of fluoroscopy was measured in 96 procedures prospectively. The procedures were 30 transcatheter arterial embolization (TAE), 25 percutaneous transhepatic biliary drainages (PTBD), 16 stone removals (SR), 15 percutaneous needle aspirations (PNCA) and 10 percutaneous nephrostomies(PCN). To assess the difference of exposure by the operator's skill, the procedures of TAE and PTBD were done separately by groups of staffs and residents. Average protective effect of the apron was 72.8%. Average radiation exposure(unit: μ Sv/procedure was 23.3 in PTBD by residents, 10.0 in PTBD by staffs, 10.0 in SR, 8.7 in TAE by residents, 7.3 in TAE by staffs, 9.0 in PCN and 6.0 in PCNA. Average radiation exposure of residents were 1.9 times greater than those of staffs. Radiation exposure was not proportionally related to the duration of fluoroscopy, but influenced by wearing an apron, various types of procedure and operator's skills

  12. On the use of abciximab in percutaneous coronary intervention

    DEFF Research Database (Denmark)

    Iversen, Allan

    2011-01-01

    Introduction: The present thesis ´On the use of abciximab in percutaneous coronary intervention´ is based on 6 papers concerning the glycoprotein IIb/IIIa inhibitor, abciximab. The thesis is divided into 2 sections. One section concerning a randomized trial comparing intracoronary (IC) with intra......Introduction: The present thesis ´On the use of abciximab in percutaneous coronary intervention´ is based on 6 papers concerning the glycoprotein IIb/IIIa inhibitor, abciximab. The thesis is divided into 2 sections. One section concerning a randomized trial comparing intracoronary (IC...... (ACS). Optimal administration route of abciximab. A randomized study Background: The glycoprotein IIb/IIIa inhibitor, abciximab, is used as an adjuvant anti-platelet therapy in PCI-treated patients suffering from ACS. A subgroup of patients with ACS is those with STEMI treated with p...... confer an even more beneficial effect. Firstly, we searched the literature on the subject and found that no large-scaled randomized trials had been published. Most data were derived from small studies evaluating non-clinical endpoints or were of retrospective design. This overview is published...

  13. Post-cardiac injury syndrome: an atypical case following percutaneous coronary intervention.

    Science.gov (United States)

    Paiardi, Silvia; Cannata, Francesco; Ciccarelli, Michele; Voza, Antonio

    2017-12-01

    Post-cardiac injury syndrome (PCIS) is a syndrome characterized by pericardial and/or pleural effusion, triggered by a cardiac injury, usually a myocardial infarction or cardiac surgery, rarely a minor cardiovascular percutaneous procedure. Nowadays, the post-cardiac injury syndrome, is regaining importance and interest as an emerging cause of pericarditis, especially in developed countries, due to a great and continuous increase in the number and complexity of percutaneous cardiologic procedures. The etiopathogenesis seems mediated by the immunitary system producing immune complexes, which deposit in the pericardium and pleura and trigger an inflammatory response. We present the atypical case of a 76-year-old man presenting with a hydro-pneumothorax, low-grade fever and elevated inflammation markers, after two complex percutaneous coronary interventions, executed 30 and 75 days prior. The clinical features of our case are consistent with the diagnostic criteria of PCIS: prior injury of the pericardium and/or myocardium, fever, leucocytosis, elevated inflammatory markers, remarkable steroid responsiveness and latency period. Only one element does not fit with this diagnosis and does not find any further explanation: the air accompanying the pleural effusion, determining a hydro-pneumothorax and requiring a pleural drainage catheter positioning. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. Patient-rated health status predicts prognosis following percutaneous coronary intervention with drug-eluting stenting

    DEFF Research Database (Denmark)

    Pedersen, Susanne S.; Versteeg, Henneke; Denollet, Johan

    2011-01-01

    In patients treated with percutaneous coronary intervention (PCI) with the paclitaxel-eluting stent, we examined whether patient-rated health status predicts adverse clinical events.......In patients treated with percutaneous coronary intervention (PCI) with the paclitaxel-eluting stent, we examined whether patient-rated health status predicts adverse clinical events....

  15. Percutaneous transgluteal drainage of pelvic abscesses in interventional radiology: A safe alternative to surgery.

    Science.gov (United States)

    Robert, B; Chivot, C; Rebibo, L; Sabbagh, C; Regimbeau, J-M; Yzet, T

    2016-02-01

    Interventional radiology plays an important role in the management of deep pelvic abscesses. Percutaneous drainage is currently considered as the first-line alternative to surgery. A transgluteal computed tomography (CT)-guided approach allows to access to deep infected collections avoiding many anatomical obstacles (vessels, nerves, bowel, bladder). The objective of this study was to assess the safety and efficacy of a transgluteal approach by reviewing our clinical experience. We reviewed medical records of patients having undergone percutaneous CT-guided transgluteal drainage for deep pelvic abscesses. We focused on the duration of catheter drainage, the complications related to the procedures and the rate of complete resolution. Between 2005 and 2013, 39patients (27women and 12men; mean age: 52.5) underwent transgluteal approach CT-guided percutaneous drainage of pelvis abscesses in our department. The origins of abscesses were postoperative complications in 34patients (87.2%) and infectious intra-abdominal disease in 5patients (12.8%). The mean duration of drainage was 8.3days (range: 3-33). Laboratory cultures were positive in 35patients (89.7%) and Escherichia coli was present in 71.4% of the positive samples. No major complication was observed. Drainage was successful in 38patients (97.4%). A transpiriformis approach was more significantly associated with intra-procedural pain (P=0.003). Percutaneous CT-guided drainage with a transgluteal approach is a safe, well-tolerated and effective alternative to surgery for deep pelvic abscesses. This approach should be considered as the first-line intention for the treatment of deep pelvic abscesses. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  16. Coronary artery bypass grafting versus percutaneous intervention in coronary revascularization: a historical perspective and review

    Directory of Open Access Journals (Sweden)

    Burgess SN

    2015-06-01

    Full Text Available Sonya N Burgess,1 John J Edmond,2 Craig P Juergens,1 John K French11Department of Cardiology, Liverpool Hospital and South Western Sydney Clinical School, The University of New South Wales, Sydney, NSW, Australia; 2Department of Cardiology, Dunedin Public Hospital, Dunedin, New Zealand Background: Coronary artery bypass graft surgery is arguably the most intensively studied surgical procedure, and percutaneous coronary intervention (PCI has been subjected to more randomized clinical trials than any other interventional procedure. Changes seen in revascularization techniques have been numerous. The rapid evolution of evidence-based revascularization procedures has occurred as a result of many pivotal large randomized clinical trials. Objective: This review compares and contrasts outcomes from two coronary revascularization techniques, coronary artery bypass grafting (CABG and PCI, with particular reference to the landmark trials that inform practice guidelines. Methods: We undertook a comprehensive review of published literature addressing trials in this field performed to address current knowledge both in the predrug-eluting stent and postdrug-eluting stent era. Results and discussion: Surgical and percutaneous revascularization strategies have different strengths and weaknesses, and neither strategy is superior in all patients, clinical presentations, or anatomical subgroups. Current data support the use of percutaneous intervention in ST elevation myocardial infarction and in single-vessel disease. In noncomplex multivessel disease and isolated left main stem PCI, the data support non-inferiority of PCI compared to CABG as reflected in the 2014 European Society of Cardiology guidelines. Landmark revascularization trials of multivessel disease comparing CABG to PCI found no survival benefit to CABG over PCI, except in patients with complex disease. In these trials, revascularization drove differences in primary endpoints and in all but the

  17. Quality of life after percutaneous coronary intervention: part 1.

    Science.gov (United States)

    Cassar, Stephen; R Baldacchino, Donia

    Quality of life (QOL) is a complex concept comprised of biopsychosocial, spiritual and environmental dimensions. However, the majority of research addresses only its physical function perspectives. This two-part series examines the holistic perspective of QOL of patients after percutaneous coronary intervention (PCI). Part 1 explains the research process of a cross-sectional descriptive study and its limitations. Data were collected by a mailed WHOQOL-BREF questionnaire in Maltese from a systematic sample of patients who had undergone PCI; the response rate was 64% (n=228; males n=169, females n=59, age 40-89 years). Part 1 also considers limitations, such as its cross-sectional design and retrospective data collection. The hierarchy of human needs theory (Maslow, 1999) guided the study. Part 2 gives the findings on the holistic view of QOL. Having social and family support, as a characteristic of Maltese culture appeared to contribute towards a better QOL.

  18. Multiphasic helical Computed Tomography of hepatocellular carcinoma. Evaluation after various percutaneous ablation procedures

    International Nuclear Information System (INIS)

    Catalano, O.; Esposito, M.; Lobianco, R.; Cusati, B.; Altei, F.; Siani, A.

    1999-01-01

    The purpose of this paper is to report the personal experience with helical CT evaluation of hepatocellular carcinoma treated with various percutaneous interventional procedures. From December 1996 to September 1998 it were examined with helical CT 41 patients (73 nodules in all) with hepatocellular carcinoma treated with percutaneous ablation therapies: conventional ethanol injection in 18 subjects (31 nodules), one-shot ethanol injection 3 (8 nodules), radiofrequency thermal ablation in 16 (25 nodules), and combined chemo embolization and ethanol injection in 4 (9 nodules). CT performed was 4-27 days after the last session, acquiring biphasic volumetric images in 14 patients and triphasic volumetric images in 27. A second treatment with subsequent CT study was performed for 28 lesions; 15 underwent 3 serial studies and 6 underwent 4 studies. Compared with pretreatment findings, the diameter was unchanged in 62% of the nodules and increased in 38%. Morphology was unchanged in 63% of the lesions while in 37% a mild deformation toward the needle path or a more regular and round shape was evident. Borders were unchanged in 37% of the cases and modified in 63%, appearing well-defined in 73% and ill-defined in 27%. The necrotic portion had a low attenuation with a nodule-to-parenchyma gradient more evident on delayed than on venous and finally arterial acquisitions; 8% of the lesions were not recognizable on unenhanced scans. During the arterial phase the residual tumor appeared hyperdense in 97% of the nodules and isodense in 3%, while during the portal phase it was hyperdense in 22%, isodense in 28% and hypodense in 50%, and during the delayed phase hypodense in 100%. Residual viable tissue was identified in 44% of the nodules and quantified as 100% in 1% of all lesions, > 75% in 3%, > 50% in 4%, > 25% in 23%. In conclusion, multiple-phase helical CT allows optimal depiction of primitive liver nodules treated with percutaneous interventional procedures and has a

  19. Percutaneous intervention in the menagement of insufficient native arteriovenous hemodialysis fistulae

    International Nuclear Information System (INIS)

    Kim, Hye Jung; Seong, Chang Kyu; Kwon, Jae Hyun; Kim, Young Hwan; Park, Noh Hyuck; Kim, Tae Hun; Kim, Yong Joo; Kang, Duck Sik; Shin, Tae Beom

    2002-01-01

    To determine the effectiveness and patency of percutaneous intervention in insufficient native arteriovenous hemodialysis fistulae (AVFs). Between March 1997 and September 2001, 67 cases of insufficient native AVFs resulted from central vein lesion, PTA was performed in 48 cases, and thrombolytic therapy with or without PTA in 11. In eight of the cases, in which central vein stenosis had led to the insufficency, percutaneous transluminal angioplasty (PTA) was performed, and in three of the eight, a stent was inserted. Angiography findings and complications, as well as success and patency rates in the non-thrombosis and thrombosis group, were evaluated; the central vein lesion group was analysed separately. Among 84 lesions observed at angiography, three were 54 cases of stenosis, 17 of occlusion, and 13 of combined thrombosis. The lesions were located in a proximal vein (n=51), distal vein (n=14), artery (n=6), and at the site of anastomosis (n=13). In the central vein lesion group (n=8), seven cases of stenosis and one of occlusion were noted. The overall procedural success rate was 79.1% (53/67). That is, in patients with no central vein lesion, the procedural success rate of PTA of native AVFs was 85.4% (41/48) and the patency rates of this were 83.1% at 6 months and 67.4% at 12 months. In cases of thrombolysis with/without PTA, the procedural success rate was 54.5% (6/11) and the patency rates were 83.3% at 6 months and 62.5% at 12 months. Finally, in patients with a central vein lesion, the procedural success rate was 75% (6/8) and the patency rates were 80% at 6 months and 30% at 12 months. There was one case of pseudoaneurysm formation at the puncture site of the brachial artery, which was used as the access route for intervention; one embolism in the brachial artery; and three cases of vascular spasm and two of hematoma which did not require active treatment. Percutaneous intervention offers effective and safe management of insufficient AVFs. The procedural

  20. Risk prediction models for major adverse cardiac event (MACE) following percutaneous coronary intervention (PCI): A review

    Science.gov (United States)

    Manan, Norhafizah A.; Abidin, Basir

    2015-02-01

    Five percent of patients who went through Percutaneous Coronary Intervention (PCI) experienced Major Adverse Cardiac Events (MACE) after PCI procedure. Risk prediction of MACE following a PCI procedure therefore is helpful. This work describes a review of such prediction models currently in use. Literature search was done on PubMed and SCOPUS database. Thirty literatures were found but only 4 studies were chosen based on the data used, design, and outcome of the study. Particular emphasis was given and commented on the study design, population, sample size, modeling method, predictors, outcomes, discrimination and calibration of the model. All the models had acceptable discrimination ability (C-statistics >0.7) and good calibration (Hosmer-Lameshow P-value >0.05). Most common model used was multivariate logistic regression and most popular predictor was age.

  1. The GuideLiner catheter: A supportive tool in percutaneous coronary intervention of chronic total occlusion

    Directory of Open Access Journals (Sweden)

    Jan-Erik Guelker

    2018-04-01

    Full Text Available Background: Failure of delivering a stent or a balloon across the target lesion during percutaneous coronary intervention (PCI of chronic total occlusion (CTO, especially in arteries with calcified tortuous anatomy, is often due to insufficient backup support from the guiding catheter. The purpose of this study was to assess the feasibility of the GuideLiner (GL catheter use. Methods: We examined 18 patients and used the GL catheter to overcome poor support and excessive friction in standardized antegrade and retrograde CTO procedures. The GL is a coaxial, monorail guiding catheter extension delivered through a standard guiding catheter and is available in different sizes. Results: Almost all lesions were classified as severely calcified (94.4 ± 0.24%. The Japanese CTO score reflecting lesion complexity was 3.56 ± 0.78. All procedures were performed femorally; the retrograde approach was used in 27.8 ± 0.46% of cases. The overall success rate was 88.9 ± 0.32%; there were no relevant complications. Conclusions: The GL catheter is an adjunctive interventional device which enhances and amplifies CTO-PCI. Its use is indicated in cases in which back-up force needs to be strengthened to pass a CTO despite advanced calcification. It can be recommended as an important additional tool in advanced interventional cardiology such as antegrade and retrograde CTO-PCI if other techniques like anchor balloon or anchor wire are not possible. Keywords: Chronic total occlusion, GuideLiner catheter, Percutaneous coronary intervention, Severe calcification

  2. The Current Status of Percutaneous Coronary Intervention in Korea: Based on Year 2014 Cohort of Korean Percutaneous Coronary Intervention (K-PCI) Registry.

    Science.gov (United States)

    Jang, Jae-Sik; Han, Kyoo-Rok; Moon, Keon-Woong; Jeon, Dong Woon; Shin, Dong-Ho; Kim, Jung-Sun; Park, Duk-Woo; Kang, Hyun-Jae; Kim, Juhan; Bae, Jang-Whan; Hur, Seung-Ho; Kim, Byung Ok; Choi, Donghoon; Gwon, Hyeon-Cheol; Kim, Hyo-Soo

    2017-05-01

    Although several multicenter registries have evaluated percutaneous coronary intervention (PCI) procedures in Korea, those databases have been limited by non-standardized data collection and lack of uniform reporting methods. We aimed to collect and report data from a standardized database to analyze PCI procedures throughout the country. Both clinical and procedural data, as well as clinical outcomes data during hospital stay, were collected based on case report forms that used a standard set of 54 data elements. This report is based on 2014 Korean PCI registry cohort data. A total of 92 hospitals offered data on 44967 PCI procedures. The median age was 66.0 interquartile range 57.0-74.0 years, and 70.3% were men. Thirty-eight percent of patients presented with acute myocardial infarction and one-third of all PCI procedures were performed in an urgent or emergency setting. Non-invasive stress tests were performed in 13.9% of cases, while coronary computed tomography angiography was used in 13.7% of cases prior to PCI. Radial artery access was used in 56.1% of all PCI procedures. Devices that used PCI included drug-eluting stent, plain old balloon angioplasty, drug-eluting balloon, and bare-metal stent (around 91%, 19%, 6%, and 1% of all procedures, respectively). The incidences of in-hospital death, non-fatal myocardial infarction, and stroke were 2.3%, 1.6%, and 0.2%, respectively. These data may provide an overview of the current PCI practices and in-hospital outcomes in Korea and could be used as a foundation for developing treatment guidelines and nationwide clinical research.

  3. Aspirin in Patients With Previous Percutaneous Coronary Intervention Undergoing Noncardiac Surgery

    DEFF Research Database (Denmark)

    Graham, Michelle M; Sessler, Daniel I; Parlow, Joel L

    2018-01-01

    Background: Uncertainty remains about the effects of aspirin in patients with prior percutaneous coronary intervention (PCI) having noncardiac surgery. Objective: To evaluate benefits and harms of perioperative aspirin in patients with prior PCI. Design: Nonprespecified subgroup analysis of a mul...

  4. The importance of left ventricular function for long-term outcome after primary percutaneous coronary intervention

    NARCIS (Netherlands)

    van der Vleuten, Pieter A.; Rasoul, Saman; Huurnink, Willem; van der Horst, Iwan C. C.; Slart, Riemer H. J. A.; Reiffers, Stoffer; Dierckx, Rudi A.; Tio, Rene A.; Ottervanger, Jan Paul; De Boer, Menko-Jan; Zijlstra, Felix

    2008-01-01

    Background: In the present study we sought to determine the long-term prognostic value of left ventricular ejection fraction (LVEF), assessed by planar radionuclide ventriculography (PRV), after ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention

  5. Dimensions of socioeconomic status and clinical outcome after primary percutaneous coronary intervention

    DEFF Research Database (Denmark)

    Jakobsen, Lars; Niemann, Troels; Thorsgaard, Niels

    2012-01-01

    The association between low socioeconomic status (SES) and high mortality from coronary heart disease is well-known. However, the role of SES in relation to the clinical outcome after primary percutaneous coronary intervention remains poorly understood.......The association between low socioeconomic status (SES) and high mortality from coronary heart disease is well-known. However, the role of SES in relation to the clinical outcome after primary percutaneous coronary intervention remains poorly understood....

  6. Percutaneous Ureteral stent insertion

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, Yup; Sung, Dong Wook; Choi, Woo Suk; Lee, Dong Ho; Ko, Young Tae; Lee, Sun Wha; Lim, Jae Hoon [Kyung Hee University Hospital, Seoul (Korea, Republic of)

    1990-10-15

    Percutaneous ureteral stent insertion is a treatment of permanent or temporary urinary diversion to maintain continuity and function of the obstructed and injured ureter. We performed 31 cases of percutaneous double pig tall ureteral stent insertion in 21 patients, included 13 patients with malignant ureteral obstruction and eight patients with injured ureter as well as benign inflammatory stricture. Satisfactory resulted was obtained in all patients but one, who need percutaneous nephrostomy on week later for urinary diversion. No significant complication was encountered. The authors concluded that percutaneous ureteral stent insertion, an interventional procedure alternative to urologic retrograde method, is an effective method for urinary diversion.

  7. Decision-making in percutaneous coronary intervention: a survey

    Directory of Open Access Journals (Sweden)

    Rahilly-Tierney Catherine R

    2008-06-01

    Full Text Available Abstract Background Few researchers have examined the perceptions of physicians referring cases for angiography regarding the degree to which collaboration occurs during percutaneous coronary intervention (PCI decision-making. We sought to determine perceptions of physicians concerning their involvement in PCI decisions in cases they had referred to the cardiac catheterization laboratory at a major academic medical center. Methods An anonymous survey was mailed to internal medicine faculty members at a major academic medical center. The survey elicited whether responders perceived that they were included in decision-making regarding PCI, and whether they considered such collaboration to be the best process of decision-making. Results Of the 378 surveys mailed, 35% (133 were returned. Among responding non-cardiologists, 89% indicated that in most cases, PCI decisions were made solely by the interventionalist at the time of the angiogram. Among cardiologists, 92% indicated that they discussed the findings with the interventionalist prior to any PCI decisions. When asked what they considered the best process by which PCI decisions are made, 66% of non-cardiologists answered that they would prefer collaboration between either themselves or a non-interventional cardiologist and the interventionalist. Among cardiologists, 95% agreed that a collaborative approach is best. Conclusion Both non-cardiologists and cardiologists felt that involving another decision-maker, either the referring physician or a non-interventional cardiologist, would be the best way to make PCI decisions. Among cardiologists, there was more concordance between what they believed was the best process for making decisions regarding PCI and what they perceived to be the actual process.

  8. Cost-effectiveness of antiplatelet drugs after percutaneous coronary intervention.

    Science.gov (United States)

    Wisløff, Torbjørn; Atar, Dan

    2016-01-01

    Clopidogrel has, for long time, been accepted as the standard treatment for patients who have undergone a percutaneous coronary intervention (PCI). The introduction of prasugrel-and more recently, ticagrelor-has introduced a decision-making problem for clinicians and governments worldwide: to use the cheaper clopidogrel or the more effective, and also more expensive prasugrel or ticagrelor. We aim to give helpful contributions to this debate by analysing the cost-effectiveness of clopidogrel, prasugrel, and ticagrelor compared with each other. We modified a previously developed Markov model of cardiac disease progression. In the model, we followed up cohorts of patients who have recently had a PCI until 100 years or death. Possible events are revascularization, bleeding, acute myocardial infarction, and death. Our analysis shows that ticagrelor is cost-effective in 77% of simulations at an incremental cost-effectiveness ratio of €7700 compared with clopidogrel. Ticagrelor was also cost-effective against prasugrel at a cost-effectiveness ratio of €7800. Given a Norwegian cost-effectiveness threshold of €70 000, both comparisons appear to be clearly cost-effective in favour of ticagrelor. Ticagrelor is cost-effective compared with both clopidogrel and prasugrel for patients who have undergone a PCI.

  9. Risk score for contrast induced nephropathy following percutaneous coronary intervention

    International Nuclear Information System (INIS)

    Ghani, Amal Abdel; Tohamy, Khalid Y.

    2009-01-01

    Contrast-induced nephropathy (CIN) is an important cause of acute renal failure. Identification of risk factors of CIN and creating a simple risk scoring for CIN after percutaneous coronary intervention (PCI) is important. A prospective single center study was conducted in Kuwait chest disease hospital. All patients admitted to chest disease hospital for PCI from March to May 2005 were included in the study. Total of 247 patients were randomly assigned for the development dataset and 100 for the validation set using the simple random method. The overall occurrence of CIN in the development set was 5.52%. Using multivariate analysis; basal Serum creatinine, shock, female gender, multivessel PCI, and diabetes mellitus were identified as risk factors. Scores assigned to different variables yielded basal creatinine > 115 micron mol/L with the highest score(7), followed by shock (3), female gender, multivessel PCI and diabetes mellitus had the same score (2). Patients were further risk stratified into low risk score ( 1 2). The developed CIN model demonstrated good discriminative power in the validation population. In conclusion, use of a simple risk score for CIN can predict the probability of CIN after PCI; this however needs further validation in larger multicenter trials. (author)

  10. Cangrelor in Percutaneous Coronary Intervention: Current Status and Perspectives.

    Science.gov (United States)

    Alexopoulos, Dimitrios; Pappas, Christos; Sfantou, Danai; Lekakis, John

    2018-01-01

    Cangrelor is an intravenously administered P2Y 12 receptor antagonist with very fast, potent, and quickly reversible action. In the CHAMPION PHOENIX trial, cangrelor provided an improved anti-ischemic protection compared with clopidogrel, without increasing the risk of severe bleeding. Cangrelor is currently approved by drug regulating authorities for patients undergoing percutaneous coronary intervention (PCI) without prior treatment with a P2Y 12 receptor antagonist and not receiving a glycoprotein IIb/IIIa inhibitor, while its use is endorsed with a class IIb recommendation by the European Society of Cardiology guidelines. Several subanalyses of CHAMPION PHOENIX trial have tried to elucidate the role of cangrelor in PCI, including its usefulness during a 2-hour landmark analysis, impact on intraprocedural stent thrombosis, and reduction in myocardial infarction (MI) rate. The influence of gender, geographic region, access site, and bivalirudin use on cangrelor's effects has also been reported. In patients with ST elevation MI and in clinical scenarios of disturbed absorption of oral antiplatelet agents or in need of an intravenous agent, cangrelor may surpass oral agents' drawbacks. Transitioning to an oral agent is mandatory following cangrelor infusion discontinuation, although ticagrelor may be administered earlier without any pharmacodynamic interaction. Nevertheless, the clinical role of cangrelor in conjunction with administration of prasugrel or ticagrelor remains unclear. Accruing real-life experience is expected to improve our understanding of cangrelor's role in everyday clinical practice.

  11. Cath lab costs in patients undergoing percutaneous coronary angioplasty - detailed analysis of consecutive procedures.

    Science.gov (United States)

    Dziki, Beata; Miechowicz, Izabela; Iwachów, Piotr; Kuzemczak, Michał; Kałmucki, Piotr; Szyszka, Andrzej; Baszko, Artur; Siminiak, Tomasz

    2017-01-01

    Costs of percutaneous coronary interventions (PCI) have an important impact on health care expenditures. Despite the present stress upon the cost-effectiveness issues in medicine, few comprehensive data exist on costs and resource use in different clinical settings. To assess catheterisation laboratory costs related to use of drugs and single-use devices in patients undergoing PCI due to coronary artery disease. Retrospective analysis of 1500 consecutive PCIs (radial approach, n = 1103; femoral approach, n = 397) performed due to ST segment elevation myocardial infarction (STEMI; n = 345) and non ST-segment elevation myocardial infarction (NSTEMI; n = 426) as well as unstable angina (UA; n = 489) and stable angina (SA; n = 241) was undertaken. Comparative cost analysis was performed and shown in local currency units (PLN). The cath lab costs were higher in STEMI (4295.01 ± 2384.54PLN, p costs were positively correlated with X-ray dose, fluoroscopy, and total procedure times. Patients' age negatively correlated with cath lab costs in STEMI/NSTEMI patients. Cath lab costs were higher in STEMI patients compared to other groups. In STEMI/NSTEMI they were lower in older patients. In all analysed groups costs were related to the level of procedural difficulty. In female patients, the costs of PCI performed via radial approach were higher compared to femoral approach. Despite younger age, male patients underwent more expensive procedures.

  12. Percutaneous valved stent repair of a failed homograft: implications for the Ross procedure.

    Science.gov (United States)

    Pretorius, Victor; Jones, Alan; Taylor, Dylan; Coe, Yashu; Ross, David B

    2008-08-01

    A case of percutaneous pulmonary valve implantation following a failed homograft in the pulmonary position is reported. A 16-year-old boy developed infective endocarditis of his pulmonary homograft, which was implanted four years earlier during a Ross procedure for congenital aortic stenosis. Following successful medical therapy, the boy was symptomatic due to pulmonary stenosis and regurgitation. A 22 mm Melody valve (Medtronic, USA) was successfully implanted percutaneously. His symptoms resolved and he was discharged home one day after the procedure. Echocardiography at the six-month follow-up demonstrated a normally functioning pulmonary valve. Percutaneous pulmonary valve replacement may make the Ross procedure a more attractive option for patients with aortic stenosis, particularly in the pediatric population.

  13. Treatment of intervertebral disc degenerative disease using percutaneous nucleotomy–an overview of less invasive procedures

    Directory of Open Access Journals (Sweden)

    Miran Jeromel

    2014-04-01

    Full Text Available Background: Less invasive treatment methods for intervertebral disc disease and decompression of neural structures as a consequence of contained disc herniation represent an alternative to surgical procedure. Percutaneus nucleotomy uses a percutaneous approach to the intervertebral disc. The article presents the evolution of numerous procedureds in clinical practice.Methods: Percutaneous nucleoplasty is a fluoroscopy-guided procedure which enables controlled and safe entrance into the intervertebral disc. The procedure is performed under strict aseptic conditions, using a local anaesthesia with the patient under analgosedation. Based on the principle of therapeutic intradiscal action, the procedures can be divided into three groups: chemical (chemonucleolysis with chimopapain, alcohol, ozone, mechanical (automated percutaneous lumbar discectomy – APLD, arthroscopic discectomy and thermical methods (laser, radiofrequency ablation, intradiscal electrothermal annuloplasty – IDET, Coblation®.Results: Percutaneous nucleotomy by the majority of the mentioned procedures results in a therapeutic effect (reduction of pain and decompression of neural structures. Fast recovery represents a major advantage of less invasive treatment.Conclusions: Less invasive method (nucleotomy using different procedures represents a successful alternative approach to surgical discectomy. Proper patient selection and safe technique are mandatory in order to achieve a good clinical outcome.

  14. Radiation exposure and patient experience during percutaneous coronary intervention using radial and femoral artery access

    International Nuclear Information System (INIS)

    Geijer, Haakan; Persliden, Jan

    2004-01-01

    The aim of this study was to evaluate radiation dose and patient discomfort/pain in radial artery access vs femoral artery access in percutaneous coronary intervention (PCI). Dose-area product (DAP) was measured non-randomised for 114 procedures using femoral access and for 55 using radial access. The patients also responded to a questionnaire concerning discomfort and pain during and after the procedure. The mean DAP was 69.8 Gy cm 2 using femoral access and 70.5 Gy cm 2 using radial access. Separating the access site from confounding factors with a multiple regression, there was a 13% reduction in DAP when using radial access (p=0.038). Procedure times did not differ (p=0.81). Bed confinement was much longer in the femoral access group (448 vs 76 min, p=0.000). With femoral access, there was a significantly higher patient grading for chest (p=0.001) and back pain (p=0.003) during the procedure and for access site (p=0.000) and back pain (p=0.000) after the procedure. Thirty-two femoral access patients (28%) were given morphine-type analgesics in the post-procedure period compared to three radial access patients (5%, p=0.001). DAP does not increase when using radial instead of femoral access and the patients grade discomfort and pain much lower when using radial access. Radial access is thus beneficial to use. (orig.)

  15. Early Stent Thrombosis and Mortality After Primary Percutaneous Coronary Intervention in ST-Segment-Elevation Myocardial Infarction

    DEFF Research Database (Denmark)

    Dangas, George D; Schoos, Mikkel M.; Steg, Philippe Gabriel

    2016-01-01

    BACKGROUND: Early stent thrombosis (ST) within 30 days after primary percutaneous coronary intervention in ST-segment-elevation myocardial infarction is a serious event. We sought to determine the predictors of and risk of mortality after early ST according to procedural antithrombotic therapy...... with bivalirudin compared with heparin±GPI because of increased ST within 4 hours after primary percutaneous coronary intervention. However, the mortality attributable to early ST was significantly lower after bivalirudin than after heparin±GPI. CLINICAL TRIAL REGISTRATION: URL: http....... METHODS AND RESULTS: In a patient-level pooled analysis from the Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) and European Ambulance Acute Coronary Syndrome Angiography (EUROMAX) trials, we examined 30-day outcomes in 4935 patients undergoing primary...

  16. Percutaneous intervention for infrainguinal occlusive disease in women: equivalent outcomes despite increased severity of disease compared with men.

    Science.gov (United States)

    DeRubertis, Brian G; Vouyouka, Angela; Rhee, Soo J; Califano, Joseph; Karwowski, John; Angle, Niren; Faries, Peter L; Kent, K Craig

    2008-07-01

    Experience with open surgical bypass suggests similar overall outcomes in women compared with men, but significantly increased risk of wound complications. Percutaneous treatment of lower extremity occlusive disease is therefore an attractive alternative in women, although it is not clear whether there is a difference in outcomes between women and men treated with this technique. We sought to determine the results and predictors of failure in women treated by percutaneous intervention. Percutaneous infrainguinal revascularization was performed on 309 women between 2001 and 2006. Procedures, complications, demographics, comorbidities, and follow-up data were entered into a prospective database for review. Patency was assessed primarily by duplex ultrasonography. Outcomes were expressed by Kaplan-Meier curves and compared by log-rank analysis. A total of 447 percutaneous interventions performed in 309 women were analyzed and compared with 553 interventions in men. Mean age in women was 73.2 years; comorbidities included hypertension (HTN) (86%), diabetes melitus (DM) (58%), chronic renal insufficiency (CRI) (15%), hemodialysis (7%), hypercholesterolemia (52%), coronary artery disease (CAD) (42%), and tobacco use (47%). Indications in women included claudication (38.0%), rest pain (18.8%), and tissue loss (43.2%). Overall primary & secondary patency and limb-salvage rates for women were 38% +/- 4%, 66% +/- 3%, and 80% +/- 4% at 24 months. In this patient sample, women were significantly more likely than men to present with limb-threatening ischemia (61.6% vs 47.3%, P diabetes, and advanced TASC severity lesions were at increased risk of failure overall, there were no differences between women and men with these characteristics. Percutaneous infrainguinal revascularization is a very effective modality in women with lower extremity occlusive disease. Although women in this sample were more likely to present with limb-threat than men, patency and limb-salvage rates were

  17. Percutaneous interventional forceps removal of radiopaque foreign bodies in soft-tissue under fluoroscopic guidance

    International Nuclear Information System (INIS)

    Yang Xiujun; Xing Guangfu; Shi Changwen; Li Wei

    2011-01-01

    Objective: To evaluate the clinical value and limitations of percutaneous interventional forceps retrieval technique under fluoroscopic guidance in removing radiopaque foreign bodies in soft-tissue. Methods: A total of 4 105 consecutive soft-tissue injury patients with radiopaque foreign bodies, encountered in authors' hospital during the period from June 2005 to June 2010, were involved in this study. The diagnosis was confirmed by plain X-ray films in all patients. Additional CT scanning was performed in 1 591 patients, in some of them 3D reconstruction was adopted. With local anesthesia percutaneous interventional forceps retrieval of radiopaque foreign bodies (PIRFB) was carried out under C-arm video-fluoroscopic guidance. Results: Of all patients in this study, 61.34% (2 518/4 105) was treated by PIRFB (study group), and 38.66% (1 587/4 105) was not treated with PIRFB (control group). In study group,the complete and partial curative rate was 95.07% (2 394/2 518) and 4.81% (121/2 518) respectively, and the failure rate was 0.12% (3/2 518). Of 1 587 patients in control group, 25.02% (n=397) left hospital by patient's own reasons and 74.98% (n=1190) was discharged from hospital due to medical or technical reasons. In control group,the foreign objects were close to big vessels in 65.22% (1 035/1 587), large local hematoma was accompanied in 2.90% (46/1 587), associated traumatic pseudoaneurysm was seen in 1.32% (21/1 587) and the foreign objects were glass pieces and the like were found in 5.55% (88/1 587). No serious postoperative complications that required specific therapy, such as bleeding, infection and nerve damage, etc. occurred. CT, especially enhanced CT three-dimensional images, could precisely display the vasculatures nearby the foreign body, which helped make the correct judgment of the removal ability and the operation risk for foreign bodies with interventional procedure. Conclusion: Percutaneous interventional forceps retrieval technique under

  18. Cardiovascular risk factors in Middle Eastern patients undergoing percutaneous coronary intervention: Results from the first Jordanian percutaneous coronary intervention study.

    Science.gov (United States)

    Hammoudeh, Ayman J; Alhaddad, Imad A; Khader, Yousef; Tabbalat, Ramzi; Al-Mousa, Eyas; Saleh, Akram; Jarrah, Mohamad; Nammas, Assem; Izraiq, Mahmoud

    2017-07-01

    Background and aims: Cardiovascular disease (CVD) is the leading cause of death in the Middle East. We sought to study the prevalence and coexistence of 6 cardiovascular risk factors (RFs) among patients who underwent percutaneous coronary intervention (PCI), and to evaluate the impact of age and gender on the presence of multiple RFs. In this prospective, multicenter study, 2426 consecutive patients were enrolled. Mean age was 59.0 ± 10.1 years and 500 (20.6%) were women. Acute coronary syndrome and stable coronary disease were the indications for PCI in 77.1% and 22.9%, respectively. Hypertension was present in 62.3%, diabetes in 53.8%, hypercholesterolemia in 48.8%, smoking in 43.5%, family history of premature CVD 39.4% and obesity in 28.8%. Only 3.8% did not have any of these RFs. Presence of ⩾3 and ⩾4 RFS was observed in 57.4% and 29.5% of patients, respectively. Presence of ⩾3 RFs was more common in women than men (69.0% vs. 54.5%, p  Eastern population undergoing PCI. More than half and more than one-fourth of the patients had at least 3 or 4 RFs; respectively. More women than men and more middle aged patients than older or younger patients had significantly higher rates of presence of multiple RFs.

  19. Dexmedetomidine as a procedural sedative for percutaneous tracheotomy: case report and systematic literature review.

    Science.gov (United States)

    Perrott, Jerrold L; Co, Michelle T; Reynolds, Steven C; Gunning, Derek J R

    2012-01-01

    Purpose. To describe the successful use of dexmedetomidine as the primary procedural sedative for a percutaneous tracheotomy procedure and to systematically present the supporting literature. Materials and Methods. A Case report of our experience and systematic literature search. PubMed, Embase, and Google Scholar were searched without restriction using the key words dexmedetomidine, percutaneous tracheotomy, and tracheotomy procedure. All relevant published references were retrieved irrespective of their methodological quality. Results. In total, only 3 relevant references were found. These include one small placebo controlled randomized trial and 2 case reports. The randomized, placebo controlled trial enrolled patients already sedated on midazolam and included 64 total patients. The 2 other case reports both described the use of dexmedetomidine as the primary procedural sedative. All of the cases reported the successful completion of the percutaneous tracheotomy without any major complication, but none reported the subjective patient experience. Conclusion. Based on the available published literature and our experience, we suggest that dexmedetomidine be considered for use as the primary procedural sedative for percutaneous tracheotomy procedure. Dexmedetomidine's ability to provide adequate sedation and amnesia, without blunting the respiratory drive and protective reflexes of the patient, may make it an optimal agent in specific cases.

  20. Dexmedetomidine as a Procedural Sedative for Percutaneous Tracheotomy: Case Report and Systematic Literature Review

    Directory of Open Access Journals (Sweden)

    Jerrold L. Perrott

    2012-01-01

    Full Text Available Purpose. To describe the successful use of dexmedetomidine as the primary procedural sedative for a percutaneous tracheotomy procedure and to systematically present the supporting literature. Materials and Methods. A Case report of our experience and systematic literature search. PubMed, Embase, and Google Scholar were searched without restriction using the key words dexmedetomidine, percutaneous tracheotomy, and tracheotomy procedure. All relevant published references were retrieved irrespective of their methodological quality. Results. In total, only 3 relevant references were found. These include one small placebo controlled randomized trial and 2 case reports. The randomized, placebo controlled trial enrolled patients already sedated on midazolam and included 64 total patients. The 2 other case reports both described the use of dexmedetomidine as the primary procedural sedative. All of the cases reported the successful completion of the percutaneous tracheotomy without any major complication, but none reported the subjective patient experience. Conclusion. Based on the available published literature and our experience, we suggest that dexmedetomidine be considered for use as the primary procedural sedative for percutaneous tracheotomy procedure. Dexmedetomidine’s ability to provide adequate sedation and amnesia, without blunting the respiratory drive and protective reflexes of the patient, may make it an optimal agent in specific cases.

  1. Recent trends in Australian percutaneous coronary intervention practice: insights from the Melbourne Interventional Group registry.

    Science.gov (United States)

    Yan, Bryan P; Ajani, Andrew E; Clark, David J; Duffy, Stephen J; Andrianopoulos, Nick; Brennan, Angela L; Loane, Philippa; Reid, Christopher M

    2011-08-01

    To evaluate percutaneous coronary intervention (PCI) practice trends and 12-month outcomes in Australia in the era of drug-eluting stents (DES). Prospective study of consecutive patients undergoing 9204 PCIs between 1 April 2004 and 31 March 2008 at seven Victorian public hospitals. Temporal trends in baseline characteristics and in-hospital and 12-month clinical outcomes including death, myocardial infarction (MI), target vessel revascularisation (TVR) and composite major adverse cardiac events (MACE), from year to year. Between 2004-2005 and 2007-2008, the mean age of patients undergoing PCI was stable (65 ± 12 years), and comorbidities such as hypertension, hyperlipidaemia, peripheral arterial disease and stroke increased (P < 0.05). There were fewer elective and more urgent PCIs, especially for MI < 24 hours (17.6% in 2004-2005 to 27.2% in 2007-2008, P < 0.01). Overall stent use remained high (mean, 94.6%), but use of DES declined steadily (53.9% in 2004-2005 to 32.0% in 2007-2008, P < 0.01), despite increases in complex lesions. Planned clopidogrel therapy of ≥ 12 months after insertion of DES increased from 54.7% in 2004-2005 to 98.0% in 2007-2008 (P < 0.01). The overall procedural success rate was high (mean, 95.9%), and 12-month rates of mortality (3.8%), MI (4.8%), TVR (6.8%) and stent thrombosis (1.8%) remained low. Selective use of DES was an independent predictor of freedom from MACE at 12 months (odds ratio, 0.68; 95% CI, 0.56-0.81). Use of DES declined steadily from 2004-2005 to 2007-2008, despite increasing patient risk profile and lesion complexity. Procedural success remained high and 12-month adverse outcomes remained low, with increasing use of prolonged dual antiplatelet therapy.

  2. Temporal spectrum of ischemic complications with percutaneous coronary intervention: the ESPRIT experience.

    Science.gov (United States)

    Cantor, Warren J; Tcheng, James E; Blankenship, James C; O'Shea, J Conor; Pieper, Karen S; Criger, Douglas A; Madan, Mina; Ducas, John; Sheldon, William S; Tannenbaum, Mark A; Smith, Jack E; Kitt, Michael M; Gilchrist, Ian C

    2004-09-01

    We determined the timing of ischemic complications within 30 days after percutaneous coronary intervention (PCI) in patients enrolled in the Enhanced Suppression of the Platelet IIb/IIIa Receptor with Integrilin Therapy (ESPRIT) trial. Complications (death, myocardial infarction [MI], target vessel revascularization) occurred in 178 of 2064 patients (8.6%) within 30 days. More than 85% of complications occurred within the 24 hours following randomization, with the greatest risk hazard at 12-18 hours. Unexpectedly, 31% of patients who ultimately met criteria for an endpoint MI within 24 hours of PCI had completely normal CK-MB concentrations at the first 6-hour measurement. There was no rebound increase in events after cessation of eptifibatide. Treatment benefit persisted to 30 days. Post-procedural MI is often not detected until greater than or equal to 12 hours after PCI. Treatment with a glycoprotein IIb/IIIa inhibitor is the only modifiable parameter that reduces the risk for early ischemic complications.

  3. Prognostic value of Angiographic Perfusion Score (APS) following percutaneous interventions in acute coronary syndromes.

    Science.gov (United States)

    Narain, V S; Fischer, L; Puri, A; Sethi, R; Dwivedi, S K

    2013-01-01

    Identifying reperfusion and predicting post procedure risk is important following Percutaneous Coronary Interventions (PCI). An Angiographic Perfusion Score (APS) combining TIMI flow (TFG) and myocardial perfusion (TMPG) grades before and after PCI can accurately measure both epicardial and myocardial perfusion and predict Major Adverse Cardiac Events (MACE). APS was calculated in 226 (88 ST elevation Myocardial Infarction (STEMI) and 138 Non STEMI) patients. Maximum score being 12, reperfusion was defined as failed: 0-3, partial: 4-9, and full APS: 10-12. Thirty day MACE were observed. APS identified reperfusion significantly more than TMPG alone (STEMI: 50.6% vs 11.8% (p APS group (1.8% vs 22.5%) (p APS detects more low risk reperfused patients, post PCI. Copyright © 2012. Published by Elsevier B.V.

  4. Use of the Boomerang catalyst advantage closure device to facilitate complex multistaged percutaneous revascularization procedures for the treatment of critical limb ischemia.

    Science.gov (United States)

    Garcia, Joel A; Casserly, Ivan P

    2009-07-01

    An increasing spectrum of complex peripheral arterial disease may be successfully treated using percutaneous revascularization techniques. A pair of challenging peripheral revascularization procedures in patients with critical limb ischemia is presented, where an array of interventional tools and techniques were required, and the off-label use of the Boomerang catalyst system closure device was important in managing a variety of complex arterial access issues and ultimately allowing procedural success. Copyright 2009 Wiley-Liss, Inc.

  5. Clinical outcomes of patients with hypothyroidism undergoing percutaneous coronary intervention

    Science.gov (United States)

    Zhang, Ming; Sara, Jaskanwal D.S.; Matsuzawa, Yasushi; Gharib, Hossein; Bell, Malcolm R.; Gulati, Rajiv; Lerman, Lilach O.

    2016-01-01

    Abstract Aims The aim of this study was to investigate the association between hypothyroidism and major adverse cardiovascular and cerebral events (MACCE) in patients undergoing percutaneous coronary intervention (PCI). Methods and results Two thousand four hundred and thirty patients who underwent PCI were included. Subjects were divided into two groups: hypothyroidism ( n = 686) defined either as a history of hypothyroidism or thyroid-stimulating hormone (TSH) ≥5.0 mU/mL, and euthyroidism ( n = 1744) defined as no history of hypothyroidism and/or 0.3 mU/mL ≤ TSH hypothyroidism were further categorized as untreated ( n = 193), or those taking thyroid replacement therapy (TRT) with adequate replacement (0.3 mU/mL ≤ TSH hypothyroidism compared with those with euthyroidism (MACCE: HR: 1.28, P = 0.0001; myocardial infarction (MI): HR: 1.25, P = 0.037; heart failure: HR: 1.46, P = 0.004; revascularization: HR: 1.26, P = 0.0008; stroke: HR: 1.62, P = 0.04). Compared with untreated patients or those with inadequate replacement, adequately treated hypothyroid patients had a lower risk of MACCE (HR: 0.69, P = 0.005; HR: 0.78, P = 0.045), cardiac death (HR: 0.43, P = 0.008), MI (HR: 0.50, P = 0.0004; HR: 0.60, P = 0.02), and heart failure (HR: 0.50, P = 0.02; HR: 0.52, P = 0.017). Conclusion Hypothyroidism is associated with a higher incidence of MACCE compared with euthyroidism in patients undergoing PCI. Maintaining adequate control on TRT is beneficial in preventing MACCE. PMID:26757789

  6. The establishment of enteral nutrition with minimally-invasive interventional procedure under endoscopic or imaging guidance

    International Nuclear Information System (INIS)

    Li Feng; Cheng Yingsheng

    2010-01-01

    For patients unable to get the necessary nutrition orally, a variety of techniques,including surgical way, to make gastrostomy with tube placement have been employed. For recent years, gastrostomy and tube placement with the help of endoscopic guidance or percutaneous interventional management has been developed, which is superior to surgical procedure in minimizing injuries, decreasing cost and reducing complications. In certain clinical situations, both endoscopic method and interventional method can be employed. This paper aims to make a comprehensive review of the indications, techniques and skills, advantages and disadvantages of both the endoscopy-guided and the imaging-guided percutaneous gastrojejunostomy for the establishment of enteral nutrition. (authors)

  7. Prevalence of unrecognized diabetes, prediabetes and metabolic syndrome in patients undergoing elective percutaneous coronary intervention.

    Science.gov (United States)

    Balakrishnan, Revathi; Berger, Jeffrey S; Tully, Lisa; Vani, Anish; Shah, Binita; Burdowski, Joseph; Fisher, Edward; Schwartzbard, Arthur; Sedlis, Steven; Weintraub, Howard; Underberg, James A; Danoff, Ann; Slater, James A; Gianos, Eugenia

    2015-09-01

    Diabetes mellitus (DM) and metabolic syndrome are important targets for secondary prevention in cardiovascular disease. However, the prevalence in patients undergoing elective percutaneous coronary intervention is not well defined. We aimed to analyse the prevalence and characteristics of patients undergoing percutaneous coronary intervention with previously unrecognized prediabetes, diabetes and metabolic syndrome. Data were collected from 740 patients undergoing elective percutaneous coronary intervention between November 2010 and March 2013 at a tertiary referral center. Prevalence of DM and prediabetes was evaluated using Haemoglobin A1c (A1c ≥ 6.5% for DM, A1c 5.7-6.4% for prediabetes). A modified definition was used for metabolic syndrome [three or more of the following criteria: body mass index ≥30 kg/m2; triglycerides ≥ 150 mg/dL; high density lipoprotein prediabetes at time of percutaneous coronary intervention. Overall, 54.9% met criteria for metabolic syndrome (69.2% of patients with DM and 45.8% of patients without DM). Among patients undergoing elective percutaneous coronary intervention, a substantial number were identified with a new DM, prediabetes, and/or metabolic syndrome. Routine screening for an abnormal glucometabolic state at the time of revascularization may be useful for identifying patients who may benefit from additional targeting of modifiable risk factors. Copyright © 2015 John Wiley & Sons, Ltd.

  8. Radiation exposure to patient's skin during percutaneous coronary intervention for various lesions, including chronic total occlusion

    International Nuclear Information System (INIS)

    Suzuki, Shigeru; Furui, Shigeru; Kohtake, Hiroshi; Yokoyama, Naoyuki; Kozuma, Ken; Yamamoto, Yoshito; Isshiki, Takaaki

    2006-01-01

    Radiation skin injuries have been reported as a result of various procedures, so in the present study the patients' entrance skin dose (ESD) during percutaneous coronary intervention (PCI) was evaluated. ESDs were assessed during 97 procedures (13 for chronic total occlusion (CTO), 14 for multivessel stenoses, 22 for single-vessel multiple stenoses, and 48 for single stenosis). The patients wore jackets that had 48 or 52 radiosensitive indicators placed on the back during the PCI procedures, with 8 other indicators placed on both upper arms. After the procedure, the color of the indicators was analyzed with a color measuring instrument, and the patients' ESDs were calculated from the color difference of the indicators. The average maximum ESDs of the patients were 4.5±2.8 Gy (median: 4.6 Gy) for CTO, 2.3±0.7 Gy (median: 2.4 Gy) for multi-vessel stenoses, 1.8±1.0 Gy (median: 1.5 Gy) for single-vessel multiple stenoses, and 1.4±0.9 Gy (median: 1.2 Gy) for single stenosis. Skin injury can occur during PCI, especially for CTO, so it is important to estimate each patient's ESD and attempt to reduce it. (author)

  9. Trends in Percutaneous Coronary Intervention and Coronary Artery Bypass Surgery in Korea

    Directory of Open Access Journals (Sweden)

    Heeyoung Lee

    2016-12-01

    Full Text Available Background: Coronary angioplasty has been replacing coronary artery bypass grafting (CABG because of the relative advantage in terms of recovery time and noninvasiveness of the procedure. Compared to other Organization for Economic Cooperation and Development (OECD countries, Korea has experienced a rapid increase in coronary angioplasty volumes. Methods: We analyzed changes in procedure volumes of CABG and of percutaneous coronary intervention (PCI from three sources: the OECD Health Data, the National Health Insurance Service (NHIS surgery statistics, and the National Health Insurance claims data. Results: We found the ratio of procedure volume of PCI to that of CABG per 100,000 population was 19.12 in 2014, which was more than triple the OECD average of 5.92 for the same year. According to data from NHIS statistics, this ratio was an increase from 11.4 to 19.3 between 2006 and 2013. Conclusion: We found that Korea has a higher ratio of total procedure volumes of PCI with respect to CABG and also a more rapid increase of volumes of PCI than other countries. Prospective studies are required to determine whether this increase in absolute volumes of PCI is a natural response to a real medical need or representative of medical overuse.

  10. Comparative effectiveness and safety of a catheterization laboratory-only eptifibatide dosing strategy in patients undergoing percutaneous coronary intervention.

    Science.gov (United States)

    Gurm, Hitinder S; Hosman, Carrie; Bates, Eric R; Share, David; Hansen, Ben B

    2015-02-01

    Eptifibatide, a small-molecule glycoprotein IIb/IIIa inhibitor, is conventionally administered as a bolus plus infusion. A growing number of clinicians are using a strategy of catheterization laboratory-only eptifibatide (an off-label use) as procedural pharmacotherapy for patients undergoing percutaneous coronary intervention although the comparative effectiveness of this approach is unknown. We compared the in-hospital outcome of patients undergoing percutaneous coronary intervention across 47 hospitals and treated with eptifibatide bolus plus infusion with those treated with a catheterization laboratory-only regimen. We used optimal matching to link the use of catheterization laboratory-only eptifibatide with clinical outcomes, including mortality, myocardial infarction, bleeding, and need for transfusion. Of the 84 678 percutaneous coronary interventions performed during 2010 to 2011, and meeting our inclusion criteria, eptifibatide was administered to 21 296 patients. Of these, a catheterization laboratory-only regimen was used in 4511 patients, whereas 16 785 patients were treated with bolus plus infusion. In the optimally matched analysis, compared with bolus plus infusion, a catheterization laboratory-only regimen was associated with a reduction in bleeding (optimally matched adjusted odds ratio, 0.74; 95% confidence interval, 0.58-0.93; P=0.014) and need for transfusion (optimally matched adjusted odds ratio, 0.70; 95% confidence interval, 0.52-0.92; P=0.012), with no difference in mortality or myocardial infarction. A catheterization laboratory-only eptifibatide regimen is commonly used in clinical practice and is associated with a significant reduction in bleeding complications in patients undergoing contemporary percutaneous coronary intervention. © 2015 American Heart Association, Inc.

  11. Percutaneous coronary interventions in the real world : lessons from the nineties

    NARCIS (Netherlands)

    Brueren, B.R.G.

    2005-01-01

    The use of percutaneous coronary interventions has been expanded tremendously since its introduction in 1977. After the initial experience in the late seventies, the eighties were characterized by mastering elementary techniques in coronary interventions. Still, a common feature of that period was

  12. Percutaneous Transcholecystic Biliary Interventions Using Gallbladder Anchors: Feasibility Study in the Swine

    International Nuclear Information System (INIS)

    Lopera, Jorge E.; Kirsch, David; Qian Zhong; Ruiz, Bernardo; Brazzini, Augusto; Gonzales, Arturo; Castaneda-Zuniga, Wilfrido

    2005-01-01

    The purpose of this study was to report our initial experience with a swine model for biliary interventions by using a percutaneous transcholecystic access after suture anchor of the gallbladder. Telepaque tablets were given to five pigs to opacify the gallbladder. Under fluoroscopy, the opacified gallbladder was punctured percutaneously and three suture anchors were used to fix the anterior wall of the gallbladder to the abdominal wall. Two weeks later, the gallbladder was punctured and access into the distal common bile was obtained through the cystic duct. Balloon expandable stents were deployed into the distal common bile duct. Follow-up cholangiograms were obtained at 1 and 2 weeks. Necropsy was performed after 2 weeks to evaluate the relationship between the gallbladder and abdominal wall. Suture anchor placement was successful in all five pigs. One pig with a deep and highly positioned gallbladder developed fever, anorexia, and vomiting secondary to excessive stretch of the gallbladder. Placement of the guidewire through the extremely tortuous and small cystic ducts proved to be the most challenging step of the procedure. Metallic stents were successfully deployed in all four pigs in which it was attempted. Four animals tolerated the procedures without changes in their clinical conditions and no symptoms. Successful follow-up cholangiograms were performed at 1 and 2 weeks post-stent deployment without complications. All stents remained patent during the follow-up period. Necropsy demonstrated close attachment and adherence of the gallbladders to the antero-lateral abdominal wall in all four animals. Suture anchoring of the gallbladder is feasible in most pigs with superficially located gallbladders. This technique allows a safe and repeat access into the biliary system using a transcholecystic approach

  13. Medical interventional procedures--reducing the radiation risks

    Energy Technology Data Exchange (ETDEWEB)

    Cousins, C. E-mail: claire.cousins@addenbrookes.nhs.uk; Sharp, C

    2004-06-01

    Over the last 40 years, the number of percutaneous interventional procedures using radiation has increased significantly, with many secondary care clinicians using fluoroscopically guided techniques. Many procedures can deliver high radiation doses to patients and staff, with the potential to cause immediate and delayed radiation effects. The challenge for interventionists is to maximize benefit, whilst minimizing radiation risk to patients and staff. Non-radiologist clinicians are often inadequately trained in radiation safety and radiobiology. However, clinical governance and legislation now requires a more rigorous approach to protecting patients and staff. Protection can be ensured, and risks can be controlled, by appropriate design, procurement and commissioning of equipment; quality assurance; and optimal operational technique, backed by audit. Interventionists need knowledge and skills to reduce the risks. Appropriate training should include awareness of the potential for radiation injury, equipment operational parameters, doses measurement and recording methods and dose reduction techniques. Clinical governance requires informed consent, appropriate patient counselling and follow-up.

  14. Medical interventional procedures--reducing the radiation risks

    International Nuclear Information System (INIS)

    Cousins, C.; Sharp, C.

    2004-01-01

    Over the last 40 years, the number of percutaneous interventional procedures using radiation has increased significantly, with many secondary care clinicians using fluoroscopically guided techniques. Many procedures can deliver high radiation doses to patients and staff, with the potential to cause immediate and delayed radiation effects. The challenge for interventionists is to maximize benefit, whilst minimizing radiation risk to patients and staff. Non-radiologist clinicians are often inadequately trained in radiation safety and radiobiology. However, clinical governance and legislation now requires a more rigorous approach to protecting patients and staff. Protection can be ensured, and risks can be controlled, by appropriate design, procurement and commissioning of equipment; quality assurance; and optimal operational technique, backed by audit. Interventionists need knowledge and skills to reduce the risks. Appropriate training should include awareness of the potential for radiation injury, equipment operational parameters, doses measurement and recording methods and dose reduction techniques. Clinical governance requires informed consent, appropriate patient counselling and follow-up

  15. Negative and positive affect are independently associated with patient-reported health status following percutaneous coronary intervention

    DEFF Research Database (Denmark)

    Versteeg, Henneke; Pedersen, Susanne S.; Erdman, Ruud A M

    2009-01-01

    We examined the association between negative and positive affect and 12-month health status in patients treated with percutaneous coronary intervention (PCI) with drug-eluting stents.......We examined the association between negative and positive affect and 12-month health status in patients treated with percutaneous coronary intervention (PCI) with drug-eluting stents....

  16. The Angio-Seal™ femoral closure device allows immediate ambulation after coronary angiography and percutaneous coronary intervention

    DEFF Research Database (Denmark)

    Hvelplund, Anders; Jeger, Raban; Osterwalder, Remo

    2011-01-01

    To test the safety of immediate mobilisation of patients undergoing coronary angiography and percutaneous coronary intervention (PCI) closed with Angio-Seal™ -a femoral vascular closure device.......To test the safety of immediate mobilisation of patients undergoing coronary angiography and percutaneous coronary intervention (PCI) closed with Angio-Seal™ -a femoral vascular closure device....

  17. Cone beam computed tomography and its image guidance technology during percutaneous nucleoplasty procedures at L5/S1 lumbar level

    Energy Technology Data Exchange (ETDEWEB)

    Ierardi, Anna Maria; Piacentino, Filippo; Giorlando, Francesca [University of Insubria, Unit of Interventional Radiology, Department of Radiology, Varese (Italy); Magenta Biasina, Alberto; Carrafiello, Gianpaolo [University of Milan, San Paolo Hospital, Department of Diagnostic and Interventional Radiology, Milan (Italy); Bacuzzi, Alessandro [University of Insubria, Anaesthesia and Palliative Care, Varese (Italy); Novario, Raffaele [University of Insubria, Medical Physics Department, Varese (Italy)

    2016-12-15

    To demonstrate the feasibility of percutaneous nucleoplasty procedures at L5/S1 level using cone beam CT (CBCT) and its associated image guidance technology for the treatment of lumbar disc herniation (LDH). We retrospectively reviewed 25 cases (20 men, 5 women) of LDH at L5/S1 levels. CBCT as guidance imaging was chosen after a first unsuccessful fluoroscopy attempt that was related to complex anatomy (n = 15), rapid pathological changes due to degenerative diseases (n = 7) or both (n = 3). Technical success, defined as correct needle positioning in the target LDH, and safety were evaluated; overall procedure time and radiation dose were registered. A visual analog scale (VAS) was used to evaluate pain and discomfort pre-intervention after 1 week and 1, 3, and 6 months after the procedure. Technical success was 100 %; using CBCT as guidance imaging the needle was correctly positioned at the first attempt in 20 out of 25 patients. Neither major nor minor complications were registered during or after the procedure. The average procedure time was 11 min and 56 s (range, 9-15 min), whereas mean procedural radiation dose was 46.25 Gy.cm{sup 2} (range 38.10-52.84 Gy.cm{sup 2}), and mean fluoroscopy time was 5 min 34 s (range 3 min 40 s to 6 min 55 s). The VAS pain score decreased significantly from 7.6 preoperatively to 3.9 at 1 week, 2.8 at 1 month, 2.1 at 3 months, and 1.6 at 6 months postoperatively. CBCT-guided percutaneous nucleoplasty is a highly effective technique for LDH with acceptable procedure time and radiation dose. (orig.)

  18. three-in-one procedure versus percutaneous spinal fixation alone

    African Journals Online (AJOL)

    Results: All patients showed progressive decrease of NRS pain and ODI scores compared with preoperative ... Patients maintained on rehabilitation medicine for at least ..... the 3-in-1 procedure; however, the results obtained in the current.

  19. CVIT expert consensus document on primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) in 2018.

    Science.gov (United States)

    Ozaki, Yukio; Katagiri, Yuki; Onuma, Yoshinobu; Amano, Tetsuya; Muramatsu, Takashi; Kozuma, Ken; Otsuji, Satoru; Ueno, Takafumi; Shiode, Nobuo; Kawai, Kazuya; Tanaka, Nobuhiro; Ueda, Kinzo; Akasaka, Takashi; Hanaoka, Keiichi Igarashi; Uemura, Shiro; Oda, Hirotaka; Katahira, Yoshiaki; Kadota, Kazushige; Kyo, Eisho; Sato, Katsuhiko; Sato, Tadaya; Shite, Junya; Nakao, Koichi; Nishino, Masami; Hikichi, Yutaka; Honye, Junko; Matsubara, Tetsuo; Mizuno, Sumio; Muramatsu, Toshiya; Inohara, Taku; Kohsaka, Shun; Michishita, Ichiro; Yokoi, Hiroyoshi; Serruys, Patrick W; Ikari, Yuji; Nakamura, Masato

    2018-04-01

    While primary percutaneous coronary intervention (PCI) has significantly contributed to improve the mortality in patients with ST segment elevation myocardial infarction even in cardiogenic shock, primary PCI is a standard of care in most of Japanese institutions. Whereas there are high numbers of available facilities providing primary PCI in Japan, there are no clear guidelines focusing on procedural aspect of the standardized care. Whilst updated guidelines for the management of acute myocardial infarction were recently published by European Society of Cardiology, the following major changes are indicated; (1) radial access and drug-eluting stent over bare metal stent were recommended as Class I indication, and (2) complete revascularization before hospital discharge (either immediate or staged) is now considered as Class IIa recommendation. Although the primary PCI is consistently recommended in recent and previous guidelines, the device lag from Europe, the frequent usage of coronary imaging modalities in Japan, and the difference in available medical therapy or mechanical support may prevent direct application of European guidelines to Japanese population. The Task Force on Primary Percutaneous Coronary Intervention of the Japanese Association of Cardiovascular Intervention and Therapeutics (CVIT) has now proposed the expert consensus document for the management of acute myocardial infarction focusing on procedural aspect of primary PCI.

  20. Percutaneous coronary intervention versus coronary artery bypass grafting: where are we after NOBLE and EXCEL?

    Science.gov (United States)

    Fortier, Jacqueline H; Shaw, Richard E; Glineur, David; Grau, Juan B

    2017-11-01

    The publication of the NOBLE and EXCEL trials, with seemingly conflicting results, brought into question whether percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) is better for low-risk patients with left main coronary artery stenosis (LMCAS). This review appraises the methods and results of NOBLE and EXCEL, contextualizes them within the literature, and determines how they may affect clinical practice. We appraised the trials and describe differences in methodology and results. NOBLE recruited primarily isolated LMCAS, and found that CABG was superior to PCI. EXCEL's population included patients LMCAS in the context of multivessel CAD, and found PCI and CABG were comparable. Both trials enrolled young patients with few comorbidities, and there was more protocol-mandated consistency in the procedural techniques and medical therapy of patients receiving PCI. The generalizability of these trials is limited by the use of young, healthy patients at highly skilled centres that rarely reflect typical clinical practice. If these studies are to maintain relevance, trialists must address the lack of protocolization of surgical interventions and inconsistent medical therapies. Unfortunately, the limitations of NOBLE and EXCEL mean that we are no closer to answering the question of what is the optimal treatment for patients with LMCAS.

  1. Anatomical study of forearm arteries with ultrasound for percutaneous coronary procedures.

    Science.gov (United States)

    Yan, Zhen-xian; Zhou, Yu-jie; Zhao, Ying-xin; Zhou, Zhi-ming; Yang, Shi-wei; Wang, Zhi-jian

    2010-04-01

    In recent years, the radial artery (RA) has become an alternative vascular access site for percutaneous coronary procedures, and the ulnar artery (UA) is another possibility. The objective of this study was to investigate the anatomy of the forearm arteries with ultrasound (US) and to evaluate the effect of the anatomy of the right RA (RRA) on the outcomes of transradial coronary procedures. The 638 patients undergoing transradial coronary procedures were examined with US for measurement of the diameters of the forearm arteries and determination of their anatomical abnormalities before the procedures. The next day the incidence of RA occlusion was recorded. The diameters of the radial and ulnar arteries were similar (P>0.05). The procedure time was longer in patients with anatomical abnormalities (Pforearm arteries of Chinese people are similar. The small diameter and anatomical abnormalities of the RRA could result in longer procedure time, more incidence of procedure failure and RA occlusion.

  2. Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease

    NARCIS (Netherlands)

    P.W.J.C. Serruys (Patrick); M-C. Morice (Marie-Claude); A.P. Kappetein (Arie Pieter); A. Colombo (Antonio); D.R. Holmes Jr (David); M.J. Mack (Michael); E. Stahle (Elisabeth); T.E. Feldman (Ted); M.J.B.M. van den Brand (Marcel); E.J. Bass (Eric); N. van Dyck (Nic); K. Leadly (Katrin); K.D. Dawkins (Keith); F.W. Mohr (Friedrich)

    2009-01-01

    textabstractBACKGROUND Percutaneous coronary intervention (PCI) involving drug-eluting stents is increasingly used to treat complex coronary artery disease, although coronary-artery bypass grafting (CABG) has been the treatment of choice historically. Our trial compared PCI and CABG for treating

  3. Beta blocker therapy is associated with reduced depressive symptoms 12 months post percutaneous coronary intervention

    DEFF Research Database (Denmark)

    Battes, Linda C; Pedersen, Susanne S.; Oemrawsingh, Rohit M

    2012-01-01

    Beta blocker therapy may induce depressive symptoms, although current evidence is conflicting. We examined the association between beta blocker therapy and depressive symptoms in percutaneous coronary intervention (PCI) patients and the extent to which there is a dose-response relationship between...... beta blocker dose and depressive symptoms....

  4. Beta blocker therapy is associated with reduced depressive symptoms 12 months post percutaneous coronary intervention

    NARCIS (Netherlands)

    Battes, L.C.; Pedersen, S.S.; Oemrawsingh, R.M.; van Geuns, R.-J.M.; Al Amri, I.; Regar, E.; de Jaegere, P.T.; Serruys, P.W.; van Domburg, R.T.

    2012-01-01

    Background Beta blocker therapy may induce depressive symptoms, although current evidence is conflicting. We examined the association between beta blocker therapy and depressive symptoms in percutaneous coronary intervention (PCI) patients and the extent to which there is a dose–response

  5. Outcomes After Percutaneous Coronary Intervention or Bypass Surgery in Patients With Unprotected Left Main Disease

    NARCIS (Netherlands)

    Cavalcante, Rafael; Sotomi, Yohei; Lee, Cheol W.; Ahn, Jung-Min; Farooq, Vasim; Tateishi, Hiroki; Tenekecioglu, Erhan; Zeng, Yaping; Suwannasom, Pannipa; Collet, Carlos; Albuquerque, Felipe N.; Onuma, Yoshinobu; Park, Seung-Jung; Serruys, Patrick W.

    2016-01-01

    Currently available randomized data on the comparison between percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) for the treatment of unprotected left main coronary disease (LMD) lacks statistical power due to low numbers of patients enrolled. This study assessed

  6. Sex- and age-related differences in clinical outcome after primary percutaneous coronary intervention

    DEFF Research Database (Denmark)

    Jakobsen, Lars; Niemann, Troels; Thorsgaard, Niels

    2012-01-01

    AIMS: To compare the outcome after primary percutaneous coronary intervention (PPCI) according to sex and age, including comparison of sex- and age-specific mortality of PPCI patients with that of the general population. METHODS AND RESULTS: This population-based follow-up study included 7,385 ST...

  7. Reality of obesity paradox: Results of percutaneous coronary intervention in Middle Eastern patients.

    Science.gov (United States)

    Jarrah, Mohamad; Hammoudeh, Ayman J; Khader, Yousef; Tabbalat, Ramzi; Al-Mousa, Eyas; Okkeh, Osama; Alhaddad, Imad A; Tawalbeh, Loai Issa; Hweidi, Issa M

    2018-04-01

    Objective The aim of this study was to assess the baseline clinical characteristics, coronary angiographic features, and adverse cardiovascular events during hospitalization and at 1 year of follow-up in obese patients compared with overweight and normal/underweight patients. Methods A prospective, multicenter study of consecutive patients undergoing percutaneous coronary intervention was performed. Results Of 2425 enrolled patients, 699 (28.8%) were obese, 1178 (48.6%) were overweight, and 548 (22.6%) were normal/underweight. Obese patients were more likely to be female and to have a higher prevalence of diabetes, hypertension, hypercholesterolemia, or previous percutaneous coronary intervention. Acute coronary syndrome was the indication for percutaneous coronary intervention in 77.0% of obese, 76.4% of overweight, and 77.4% of normal/underweight patients. No significant differences in the prevalence of multi-vessel coronary artery disease or multi-vessel percutaneous coronary intervention were found among the three groups. Additionally, no significant differences were found in stent thrombosis, readmission bleeding rates, or cardiac mortality among the three groups during hospitalization, at 1 month, and at 1 year. Conclusion The major adverse cardiovascular event rate was the same among the three groups throughout the study period. Accordingly, body mass index is considered a weak risk factor for cardiovascular comorbidities in Arab Jordanian patients.

  8. Co-occurrence of diabetes and hopelessness predicts adverse prognosis following percutaneous coronary intervention

    NARCIS (Netherlands)

    S.S. Pedersen (Susanne); J. Denollet (Johan); R.A.M. Erdman (Ruud); P.W.J.C. Serruys (Patrick); R.T. van Domburg (Ron)

    2009-01-01

    textabstractWe examined the impact of co-occurring diabetes and hopelessness on 3-year prognosis in percutaneous coronary intervention patients. Consecutive patients (n = 534) treated with the paclitaxel-eluting stent completed a set of questionnaires at baseline and were followed up for 3-year

  9. Perceptions of advantages and barriers to radial-access percutaneous coronary intervention in VA cardiac catheterization laboratories.

    Science.gov (United States)

    Helfrich, Christian D; Tsai, Thomas T; Rao, Sunil V; Lemon, Jaclyn M; Eugenio, Evercita C; Vidovich, Mladen I; Shroff, Adhir R; Speiser, Bernadette S; Bryson, Chris L

    2014-01-01

    Compared with trans-femoral percutaneous coronary intervention (TFI), trans-radial PCI (TRI) has a lower risk of bleeding, access site complications and hospital costs, and is preferred by patients. However, TRI accounts for a minority of PCIs in the US, and there is currently little research that explores why. We conducted a national survey in February 2013 to assess perceptions of TRI vs. TFI, and barriers to TRI adoption and implementation among interventional cardiologists employed by the US Veterans Health Administration (VHA), and linked these data to site-level TRI annual rates for 2013. We received 78 completed surveys (32% response rate). Respondents at sites that perform few or no TRIs identified increased radiation exposure as the greatest barrier while at sites that perform a high percentage of TRIs respondents identified the steep learning curve as the greatest barrier. Majorities of survey respondents at all sites rated TRI as superior on 5 of 7 criteria, including patient comfort and bleeding complications, but rated TFI as superior on procedure time and procedure success. Even interventional cardiologists at sites that perform few or any TRIs recognized the superiority of TRI for patient comfort and safety, but rated it inferior to TFI on procedure time and technical results. Interventional cardiologists at high-TRI labs rated TRI as equivalent on procedure time and technical results. Efforts to increase TRI adoption and implementation may be more successful if they emphasize that procedure times and technical results depend on achieving proficiency. Published by Elsevier Inc.

  10. Fenestrated atrial septal defect percutaneously occluded by a single device: procedural and financial considerations.

    Science.gov (United States)

    Tal, Roie; Dahud, Qarawani; Lorber, Avraham

    2013-06-01

    A 45-year-old patient presented with a cerebrovascular attack and was subsequently found to have a multi-fenestrated atrial septal defect. Various therapeutic options for percutaneous transcatheter closure with their respective benefits and flaws are discussed, as well as procedural and financial considerations. The decision making process leading to a successful result using a single occlusive device is presented, alongside a review of the literature.

  11. Radiological interventional procedures for the acute abdomen

    International Nuclear Information System (INIS)

    Trumm, C.; Hoffmann, R.T.; Reiser, M.F.

    2010-01-01

    In patients with acute thrombo-embolic occlusion of the superior mesenteric artery, catheter-assisted thrombolytic therapy represents a procedure of increasing importance in addition to surgery and intensive care treatment. The thrombolytic drugs utilized for this purpose are urokinase, streptokinase and recombinant tissue plasminogen activator (rtPA). Therapeutic embolization is predominantly used in the treatment of arterial bleeding from the gastro-intestinal tract, the liver, the intestines (due to an aneurysm or vascular malformation) and in bleeding from intestinal anastomoses. Polyvinyl alcohol particles, embospheres, gelfoam and microcoils can be utilized as embolic agents. Percutaneous transhepatic cholangiodrainage and stent implantation are applied in patients with biliary obstructions caused by inoperable tumors of the gall bladder or bile ducts, of the pancreatic head or duodenum and by metastases located in the liver parenchyma or hepatic hilum. Image-guided percutaneous drainage is a valuable option in the management of abscesses in the peritoneal cavity; less common indications are lymphoceles, biliomas, urinomas, hematomas, necrosis and pseudocysts. (orig.) [de

  12. Percutaneous-endoscopic rendezvous procedure for the management of bile duct injuries after cholecystectomy: short- and long-term outcomes.

    Science.gov (United States)

    Schreuder, Anne Marthe; Booij, Klaske A C; de Reuver, Philip R; van Delden, Otto M; van Lienden, Krijn P; Besselink, Marc G; Busch, Olivier R; Gouma, Dirk J; Rauws, Erik A J; van Gulik, Thomas M

    2018-01-19

     Bile duct injury (BDI) remains a daunting complication of laparoscopic cholecystectomy. In patients with complex BDI, a percutaneous-endoscopic rendezvous procedure may be required to establish bile duct continuity. The aim of this study was to assess short- and long-term outcomes of the rendezvous procedure.  All consecutive patients with BDI referred to our tertiary referral center between 1995 and 2016 were analyzed. A rendezvous procedure was performed when endoscopic or radiologic intervention failed, and when deemed feasible by a dedicated multidisciplinary team including hepatopancreaticobiliary surgeons, gastrointestinal endoscopists, and interventional radiologists. Classification of BDI, technical success of the rendezvous procedure, procedure-related adverse events, and outcomes were assessed.  Among a total of 812 patients, rendezvous was performed in 47 (6 %), 31 (66 %) of whom were diagnosed with complete transection of the bile duct (Amsterdam type D/Strasberg type E injury). The primary success rate of rendezvous was 94 % (44 /47 patients). Overall morbidity was 18 % (10 /55 procedures). No life-threatening adverse events or 90-day mortality occurred. After a median follow-up of 40 months (interquartile range 23 - 54 months), rendezvous was the final successful treatment in 26 /47 patients (55 %). In 14 /47 patients (30 %), rendezvous acted as a bridge to surgery, with hepaticojejunostomy being chosen either primarily or secondarily to treat refractory or relapsing stenosis. In experienced hands, rendezvous was a safe procedure, with a long-term success rate of 55 %. When endoscopic or transhepatic interventions fail to restore bile duct continuity in patients with BDI, rendezvous should be considered, either as definitive treatment or as a bridge to elective surgery. © Georg Thieme Verlag KG Stuttgart · New York.

  13. Glove Perforations During Interventional Radiological Procedures

    International Nuclear Information System (INIS)

    Leena, R. V.; Shyamkumar, N. K.

    2010-01-01

    Intact surgical gloves are essential to avoid contact with blood and other body fluids. The objective of this study was to estimate the incidence of glove perforations during interventional radiological procedures. In this study, a total of 758 gloves used in 94 interventional radiological procedures were examined for perforations. Eleven perforations were encountered, only one of which was of occult type. No significant difference in the frequency of glove perforation was found between the categories with varying time duration.

  14. Deterministic effects of interventional radiology procedures

    International Nuclear Information System (INIS)

    Shope, Thomas B.

    1997-01-01

    The purpose of this paper is to describe deterministic radiation injuries reported to the Food and Drug Administration (FDA) that resulted from therapeutic, interventional procedures performed under fluoroscopic guidance, and to investigate the procedure or equipment-related factors that may have contributed to the injury. Reports submitted to the FDA under both mandatory and voluntary reporting requirements which described radiation-induced skin injuries from fluoroscopy were investigated. Serious skin injuries, including moist desquamation and tissues necrosis, have occurred since 1992. These injuries have resulted from a variety of interventional procedures which have required extended periods of fluoroscopy compared to typical diagnostic procedures. Facilities conducting therapeutic interventional procedures need to be aware of the potential for patient radiation injury and take appropriate steps to limit the potential for injury. (author)

  15. Determinants and Outcomes of Stroke Following Percutaneous Coronary Intervention by Indication.

    Science.gov (United States)

    Myint, Phyo Kyaw; Kwok, Chun Shing; Roffe, Christine; Kontopantelis, Evangelos; Zaman, Azfar; Berry, Colin; Ludman, Peter F; de Belder, Mark A; Mamas, Mamas A

    2016-06-01

    Stroke after percutaneous coronary intervention (PCI) is a serious complication, but its determinants and outcomes after PCI in different clinical settings are poorly documented. The British Cardiovascular Intervention Society (BCIS) database was used to study 560 439 patients who underwent PCI in England and Wales between 2006 and 2013. We examined procedural-type specific determinants of ischemic and hemorrhagic stroke and the likelihood of subsequent 30-day mortality and in-hospital major adverse cardiovascular events (a composite of in-hospital mortality, myocardial infarction or reinfarction, and repeat revascularization). A total of 705 stroke cases were recorded (80% ischemic). Stroke after an elective PCI or PCI for acute coronary syndrome indications was associated with a higher risk of adverse outcomes compared with those without stroke; 30-day mortality and major adverse cardiovascular events outcomes in fully adjusted model were odds ratios 37.90 (21.43-67.05) and 21.05 (13.25-33.44) for elective and 5.00 (3.96-6.31) and 6.25 (5.03-7.77) for acute coronary syndrome, respectively. Comparison of odds of these outcomes between these 2 settings showed no differences; corresponding odds ratios were 1.24 (0.64-2.43) and 0.63 (0.35-1.15), respectively. Hemorrhagic and ischemic stroke complications are uncommon, but serious complications can occur after PCI and are independently associated with worse mortality and major adverse cardiovascular events outcomes in both the elective and acute coronary syndrome setting irrespective of stroke type. Our study provides a better understanding of the risk factors and prognosis of stroke after PCI by procedure type, allowing physicians to provide more informed advice around stroke risk after PCI and counsel patients and their families around outcomes if such neurological complications occur. © 2016 American Heart Association, Inc.

  16. Multimodality imaging to guide cardiac interventional procedures

    NARCIS (Netherlands)

    Tops, Laurens Franciscus

    2010-01-01

    In recent years, a number of new cardiac interventional procedures have been introduced. Catheter ablation procedures for atrial fibrillation (AF) have been refined and are now considered a good treatment option in patients with drug-refractory AF. In cardiac pacing, cardiac resynchronization

  17. Application of CT-guided percutaneous thyroid biopsy in basic study of interventional therapy for Graves disease

    International Nuclear Information System (INIS)

    Yi Genfa; Zhao Wei; Hu Jihong; Jin Cangzheng; Yang Huiying

    2007-01-01

    Objective: To evaluate the value of application of CT-guided percutaneous thyroid biopsy in basic study of interventional treatment for Graves disease. Methods: Fifteen patients of hyperthyroidism caused by Graves' disease had been undertaken transcathter arterial embolizsation with PVA micropheres including 52 core needle biopsy(CNB)of pre-or post-interventional procedure. All procedures were divided into 2 groups according to the size of the thyroid enlargement: (1) II degree enlargement (n=19)under palpation puncture. (2) No enlargement or under II degree enlargement (n=33)with palpation and CT-guided puncture. Results: In group (1), 17 of the 19 procedures with palpation puncture were succeeded, reaching a successful rate of 89.5%. For group (2), the successful rate of CT-guided puncture was 91.7%. The difference between the successful rate of two groups showed statistical significance (P<0.05). No complication occurred during procedures in all cases. Conclusions: CT-guided thyroid core needle biopsy is an accurate, safe and high successful procedure providing the basic study for post-interventional treatment of Graves disease. (authors)

  18. Contrast induced nephropathy in hypertensive patients after elective percutaneous coronary intervention

    Science.gov (United States)

    Aryfa Andra, Cut; Khairul, Andi; Aria Arina, Cut; Mukhtar, Zulfikri; Nyak Kaoy, Isfanuddin

    2018-03-01

    Contrast induced nephropathy (CIN) is the third lead cause of hospital acquired renal failure and was associated with significant morbidity and mortality. We hypothesized that hypertension is an independent risk factor for the development of CIN in patients undergoing elective percutaneous coronary intervention (PCI). The case-control method was used, 138 patients scheduled for elective PCI. We measured serum creatinine at baseline and after 24 hours of the procedure. CIN was defined as arising in serum creatinine of at least 44 μmol/l (0,5 mg/dl) or 25% rise from baseline. All patients received low osmolality nonionic contrast during PCI. Hypertension was defined as self-reported a history of treated or untreated diagnosed high blood pressure. One hundred thirty-eight patients (74,6%) were male, and 35 patients (25,4%) were female. Among the 138 patients, 86 (62,3%) were hypertensive patients whereas 52 (37,7%) were nonhypertensive patients. There was no difference in baseline serum creatinine levels and the amount of contrast media in patient with and without CIN. CIN developed in 42 patients, 39 patients (92,9%) were hypertensive compared to 3 patients (7,1%) without hypertension with p value < 0,05. (Odds ratio 16,8, 95% CI 4.542 - 62,412). This study showed that hypertension was a risk factor for the development of CIN

  19. Coronary plaque morphology on multi-modality imagining and periprocedural myocardial infarction after percutaneous coronary intervention

    Directory of Open Access Journals (Sweden)

    Akira Sato

    2016-06-01

    Full Text Available Percutaneous coronary intervention (PCI may be complicated by periprocedural myocardial infarction (PMI as manifested by elevated cardiac biomarkers such as creatine kinase (CK-MB or troponin T. The occurrence of PMI has been shown to be associated with worse short- and long-term clinical outcome. However, recent studies suggest that PMI defined by biomarker levels alone is a marker of atherosclerosis burden and procedural complexity but in most cases does not have independent prognostic significance. Diagnostic multi-modality imaging such as intravascular ultrasound, optical coherence tomography, coronary angioscopy, near-infrared spectroscopy, multidetector computed tomography, and magnetic resonance imaging can be used to closely investigate the atherosclerotic lesion in order to detect morphological markers of unstable and vulnerable plaques in the patients undergoing PCI. With the improvement of technical aspects of multimodality coronary imaging, clinical practice and research are increasingly shifting toward defining the clinical implication of plaque morphology and patients outcomes. There were numerous published data regarding the relationship between pre-PCI lesion subsets on multi-modality imaging and post-PCI biomarker levels. In this review, we discuss the relationship between coronary plaque morphology estimated by invasive or noninvasive coronary imaging and the occurrence of PMI. Furthermore, this review underlies that the value of the multimodality coronary imaging approach will become the gold standard for invasive or noninvasive prediction of PMI in clinical practice.

  20. Impact of Proximal Cap Ambiguity on Outcomes of Chronic Total Occlusion Percutaneous Coronary Intervention: Insights From a Multicenter US Registry.

    Science.gov (United States)

    Karatasakis, Aris; Danek, Barbara A; Karmpaliotis, Dimitri; Alaswad, Khaldoon; Jaffer, Farouc A; Yeh, Robert W; Patel, Mitul P; Bahadorani, John N; Wyman, R Michael; Lombardi, William L; Grantham, J Aaron; Kandzari, David E; Lembo, Nicholas J; Doing, Anthony H; Moses, Jeffrey W; Kirtane, Ajay J; Garcia, Santiago; Parikh, Manish A; Ali, Ziad A; Karacsonyi, Judit; Kalra, Sanjog; Rangan, Bavana V; Kalsaria, Pratik; Thompson, Craig A; Banerjee, Subhash; Brilakis, Emmanouil S

    2016-10-01

    We sought to determine the impact of proximal cap ambiguity on procedural techniques and outcomes for coronary chronic total occlusion (CTO) percutaneous coronary intervention (PCI). We examined the clinical and angiographic characteristics and outcomes of 1021 CTO-PCIs performed between 2012 and 2015 at 11 United States centers. Proximal cap ambiguity was present in 31% of target lesions and was associated with increased clinical and angiographic complexity (prior coronary artery bypass graft surgery: 43% vs 33%; P=.01; moderate/severe calcification 66% vs 51%; Pambiguity (68% vs 33%; Pambiguity was associated with increased use of intravascular ultrasound (49% vs 36%; P=.01) and contrast (281 mL vs 250 mL; Pambiguity is present in one-third of CTO-PCI target lesions and is associated with lower success rates, higher utilization of the retrograde approach, and lower procedural efficiency, but no significant difference in the incidence of major adverse cardiac events.

  1. Complex intravenous anesthesia in interventional procedures

    International Nuclear Information System (INIS)

    Xie Zonggui; Hu Yuanming; Huang Yunlong; You Yong; Wu Juan; Huang Zengping; Li Jian

    2006-01-01

    Objective: To evaluate the value and safety of Diprivan and Fentany intravenous administration of analgesia in interventional procedures. Methods: Diprivan with Fentany intravenous administration for analgesia was used in eighty interventional procedures of sixty-five patients, without tracheal tube insertion. Vital signs including HR, BP, arterial oxygen saturation (SpO 2 ) and patients' reaction to operating were recorded. Results: Intravenous anesthesia was cared out successfully in eighty interventional procedures, with patients under sleeping condition during the operation, together with no pain and no agony memory of the procedure. The amount of Diprivan was 500±100 mg and Fentany was 0.2±0.025 mg. Mean arterial pressure and SpO 2 were 11.4±2.2 kPa, 10.6±2.1 kPa and 98±1.0, 96±1.5 respectively before and after ten minutes of the operation, with no significant difference. Conclusions: Diprivan with Fentany intravenous administration for interventional procedure analgesia possess good safety, painless and no agony memory of the procedure; therefor ought to be recommended. (authors)

  2. Perceptions of advantages and barriers to radial-access percutaneous coronary intervention in VA cardiac catheterization laboratories

    International Nuclear Information System (INIS)

    Helfrich, Christian D.; Tsai, Thomas T.; Rao, Sunil V.; Lemon, Jaclyn M.; Eugenio, Evercita C.; Vidovich, Mladen I.; Shroff, Adhir R.; Speiser, Bernadette S.; Bryson, Chris L.

    2014-01-01

    Background/Purpose: Compared with trans-femoral percutaneous coronary intervention (TFI), trans-radial PCI (TRI) has a lower risk of bleeding, access site complications and hospital costs, and is preferred by patients. However, TRI accounts for a minority of PCIs in the US, and there is currently little research that explores why. Methods/Material: We conducted a national survey in February 2013 to assess perceptions of TRI vs. TFI, and barriers to TRI adoption and implementation among interventional cardiologists employed by the US Veterans Health Administration (VHA), and linked these data to site-level TRI annual rates for 2013. Results: We received 78 completed surveys (32% response rate). Respondents at sites that perform few or no TRIs identified increased radiation exposure as the greatest barrier while at sites that perform a high percentage of TRIs respondents identified the steep learning curve as the greatest barrier. Majorities of survey respondents at all sites rated TRI as superior on 5 of 7 criteria, including patient comfort and bleeding complications, but rated TFI as superior on procedure time and procedure success. Conclusions: Even interventional cardiologists at sites that perform few or any TRIs recognized the superiority of TRI for patient comfort and safety, but rated it inferior to TFI on procedure time and technical results. Interventional cardiologists at high-TRI labs rated TRI as equivalent on procedure time and technical results. Efforts to increase TRI adoption and implementation may be more successful if they emphasize that procedure times and technical results depend on achieving proficiency. - Highlights: • Sites with few TRIs identified increased radiation exposure as the greatest barrier. • Sites with many TRIs identified the steep learning curve as the greatest barrier. • TFI was rated superior on procedure time and procedure success. • TRI was rated superior on all other criteria

  3. Perceptions of advantages and barriers to radial-access percutaneous coronary intervention in VA cardiac catheterization laboratories

    Energy Technology Data Exchange (ETDEWEB)

    Helfrich, Christian D., E-mail: Christian.Helfrich@va.gov [VA Puget Sound Health Services Research and Development Center of Innovation, US Department of Veterans Affairs, Seattle, WA (United States); Department of Health Services, University of Washington School of Public Health, Seattle, WA (United States); Tsai, Thomas T. [VA Eastern Colorado Health Care System, Denver, CO (United States); Department of Medicine and the Division of Cardiology, University of Colorado School of Medicine, Aurora, CO (United States); Rao, Sunil V. [Cardiac Catheterization Laboratories, Durham VA Medical Center, Durham, NC (United States); Duke Clinical Research Institute, Durham, NC (United States); Lemon, Jaclyn M.; Eugenio, Evercita C. [VA Puget Sound Health Services Research and Development Center of Innovation, US Department of Veterans Affairs, Seattle, WA (United States); Vidovich, Mladen I.; Shroff, Adhir R. [Department of Cardiology, Jesse Brown VA Medical Center, Chicago, IL (United States); Department of Internal Medicine, Section of Interventional Cardiology, University of Illinois at Chicago, Chicago, IL (United States); Speiser, Bernadette S. [Department of Cardiology, Jesse Brown VA Medical Center, Chicago, IL (United States); Bryson, Chris L. [VA Puget Sound Health Services Research and Development Center of Innovation, US Department of Veterans Affairs, Seattle, WA (United States); Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, WA (United States)

    2014-09-15

    Background/Purpose: Compared with trans-femoral percutaneous coronary intervention (TFI), trans-radial PCI (TRI) has a lower risk of bleeding, access site complications and hospital costs, and is preferred by patients. However, TRI accounts for a minority of PCIs in the US, and there is currently little research that explores why. Methods/Material: We conducted a national survey in February 2013 to assess perceptions of TRI vs. TFI, and barriers to TRI adoption and implementation among interventional cardiologists employed by the US Veterans Health Administration (VHA), and linked these data to site-level TRI annual rates for 2013. Results: We received 78 completed surveys (32% response rate). Respondents at sites that perform few or no TRIs identified increased radiation exposure as the greatest barrier while at sites that perform a high percentage of TRIs respondents identified the steep learning curve as the greatest barrier. Majorities of survey respondents at all sites rated TRI as superior on 5 of 7 criteria, including patient comfort and bleeding complications, but rated TFI as superior on procedure time and procedure success. Conclusions: Even interventional cardiologists at sites that perform few or any TRIs recognized the superiority of TRI for patient comfort and safety, but rated it inferior to TFI on procedure time and technical results. Interventional cardiologists at high-TRI labs rated TRI as equivalent on procedure time and technical results. Efforts to increase TRI adoption and implementation may be more successful if they emphasize that procedure times and technical results depend on achieving proficiency. - Highlights: • Sites with few TRIs identified increased radiation exposure as the greatest barrier. • Sites with many TRIs identified the steep learning curve as the greatest barrier. • TFI was rated superior on procedure time and procedure success. • TRI was rated superior on all other criteria.

  4. Patient radiation dose audits for fluoroscopically guided interventional procedures

    International Nuclear Information System (INIS)

    Balter, Stephen; Rosenstein, Marvin; Miller, Donald L.; Schueler, Beth; Spelic, David

    2011-01-01

    Purpose: Quality management for any use of medical x-ray imaging should include monitoring of radiation dose. Fluoroscopically guided interventional (FGI) procedures are inherently clinically variable and have the potential for inducing deterministic injuries in patients. The use of a conventional diagnostic reference level is not appropriate for FGI procedures. A similar but more detailed quality process for management of radiation dose in FGI procedures is described. Methods: A method that takes into account both the inherent variability of FGI procedures and the risk of deterministic injuries from these procedures is suggested. The substantial radiation dose level (SRDL) is an absolute action level (with regard to patient follow-up) below which skin injury is highly unlikely and above which skin injury is possible. The quality process for FGI procedures collects data from all instances of a given procedure from a number of facilities into an advisory data set (ADS). An individual facility collects a facility data set (FDS) comprised of all instances of the same procedure at that facility. The individual FDS is then compared to the multifacility ADS with regard to the overall shape of the dose distributions and the percent of instances in both the ADS and the FDS that exceed the SRDL. Results: Samples of an ADS and FDS for percutaneous coronary intervention, using the dose metric of reference air kerma (K a,r ) (i.e., the cumulative air kerma at the reference point), are used to illustrate the proposed quality process for FGI procedures. Investigation is warranted whenever the FDS is noticeably different from the ADS for the specific FGI procedure and particularly in two circumstances: (1) When the facility's local median K a,r exceeds the 75th percentile of the ADS and (2) when the percent of instances where K a,r exceeds the facility-selected SRDL is greater for the FDS than for the ADS. Conclusions: Analysis of the two data sets (ADS and FDS) and of the

  5. Exposure of Medical Staff during Interventional Procedures

    International Nuclear Information System (INIS)

    Osvay, M.; Turak, O.

    2013-01-01

    The medical staff during interventional procedures receives significant doses on their hands, or parts of their body not covered with protective shielding equipment, as they are close to X-rays field. It can be stated, that interventional radiology and cardiology have one of the highest doses among the X-ray diagnostic procedures. The radiologist use X-ray machine directly in the interventional procedures. The occupational dose is measured only by one Kodak film badge worn under the lead apron for the estimation of the effective dose in Hungary. Our lecture presents the results of dose measurements on eye lens, hands, knees using LiF thermoluminescent dosemeters on the medical staff of two Hungarian hospitals. Results suggest that wearing only one film badge (or other dosemeter system) under the lead apron does not provide proper information on the real occupational dose of medical staff.(author)

  6. Risk stratification of periprocedural myocardial infarction after percutaneous coronary intervention: Analysis based on the SCAI definition.

    Science.gov (United States)

    Zhang, Dong; Li, Yiping; Yin, Dong; He, Yuan; Chen, Changzhe; Song, Chenxi; Yan, Ruohua; Zhu, Chen'gang; Xu, Bo; Dou, Kefei

    2017-03-01

    To investigate the predictors of and generate a risk prediction method for periprocedural myocardial infarction (PMI) after percutaneous coronary intervention (PCI) using the new PMI definition proposed by the Society for Cardiovascular Angiography and Interventions (SCAI). The SCAI-defined PMI was found to be associated with worse prognosis than the PMI diagnosed by other definitions. However, few large-sample studies have attempted to predict the risk of SCAI-defined PMI. A total of 3,371 patients (3,516 selective PCIs) were included in this single-center retrospective analysis. The diagnostic criteria for PMI were set according to the SCAI definition. All clinical characteristics, coronary angiography findings and PCI procedural factors were collected. Multivariate logistic regression analysis was performed to identify independent predictors of PMI. To evaluate the risk of PMI, a multivariable risk score (PMI score) was constructed with incremental weights attributed to each component variable according to their estimated coefficients. PMI occurred in 108 (3.1%) of all patients. Age, multivessel treatment, at least one bifurcation treatment and total treated lesion length were independent predictors of SCAI-defined PMI. PMI scores ranged from 0 to 20. The C-statistic of PMI score was 0.71 (95% confidence interval: 0.66-0.76). PMI rates increased significantly from 1.96% in the non-high-risk group (PMI score < 10) to 6.26% in the high-risk group (PMI score ≥ 10) (P < 0.001). Age, multivessel treatment, at least one bifurcation treatment, and total treated lesion length are predictive of PMI. The PMI score could help identify patients at high risk of PMI after PCI. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  7. FIRST METATARSOPHALANGEAL JOINT OSTEOARTHRITIS: PERCUTANEOUS SURGERY, CHOICE OF A SURGICAL PROCEDURE, CLINICAL AND RADIOGRAPHIC CLASSIFICATION

    Directory of Open Access Journals (Sweden)

    S. Yu. Berezhnoy

    2017-01-01

    Full Text Available Introduction. Hallux rigidus is observed in approximately 2.5% of the adult population. Until now neither a unified classification of hallux rigidus appears to exist nor any clear principles to choose the surgical method. The variety of clinical and radiological signs explains the difficulties in establishing a comprehensive classification system and in selection of the criteria for surgical procedure. There are few published reports about hallux rigidus percutaneous surgical treatment. Existing papers are dedicated to a limited number of percutaneous techniques.The purpose of this study was to evaluate the efficacy of percutaneous techniques for surgical treatment of the first metatarsophalangeal joint osteoarthritis; to specify factors determining the choice of procedure; to develop a grading system of the hallux rigidus severity which will help in selection of surgery. Materials and methods. Based on 156 surgeries (107 patients the author demonstrated the possibilities of percutaneous techniques in the surgical treatment of hallux rigidus of different stages as well as provided a brief description of used surgical techniques.Results. The mean age of patients was 48.8 years (ranged from 18 to 73. The mean follow-up was 7 months (ranged from 3 to 54. At the specified time the treatment outcomes of 103 patients (150 feet were analyzed. Mean hospital stay was 0.78 days (ranged from 0 to 1. No infectious or wound-healing problems were observed. Overall, the patients were completely satisfied with the outcomes of 89 surgical treatment, qualified satisfaction was reported with patients in respect of outcomes of 57 surgeries. Four unsatisfactory outcomes were observed. The role of the relatively long first metatarsal in the development of hallux rigidus was confirmed. Conclusion. Percutaneous techniques provide successful treatment for all stages of hallux rigidus. The choice of a specific surgical technique may be challenging and requires

  8. Safety and efficacy of abciximab as an adjunct to percutaneous coronary intervention

    Directory of Open Access Journals (Sweden)

    Jennifer Vergara-Jimenez

    2010-03-01

    Full Text Available Jennifer Vergara-Jimenez, Pierluigi TricociDepartment of Medicine-Cardiology, Duke Clinical Research Institute, Durham, North Carolina, USAAbstract: Abciximab is a widely studied glycoprotein IIb/IIIa inhibitor, specifically in the setting of patients undergoing percutaneous coronary intervention (PCI. The populations studied have included patients with non-ST-segment acute coronary syndromes, ST-segment elevation myocardial infarction, and elective PCI. This large amount of information provides a clear efficacy and safety profile of the drug, although a few questions on the use of abciximab still exist, particularly on its use and preference in the setting of newer antiplatelet and antithrombotic medications. In this article we review the most relevant data from randomized clinical trials with abciximab in patients undergoing PCI and discuss the recent guideline recommendation on use during PCI.Keywords: abciximab, percutaneous coronary intervention, glycoprotein inhibitor

  9. The Effect of Elective Percutaneous Coronary Intervention of the Right Coronary Artery on Right Ventricular Function

    Directory of Open Access Journals (Sweden)

    Farahnaz Nikdoust

    2014-12-01

    Full Text Available Background: Right Ventricular (RV dysfunction has been introduced as a predictor of mortality in acute myocardial infarction. Objectives: This study aimed to investigate the effect of right coronary revascularization on systolic and diastolic RV dysfunction. Patients and Methods: This study was conducted on unstable angina patients who were candidate for elective Percutaneous Revascularization Intervention (PCI on the right coronary artery. The participants were initially evaluated by transthoracic echocardiography and tissue Doppler imaging prior to PCI and the RV function parameters were assessed. Echocardiography was repeated two months after PCI and the results were compared with baseline. Paired t-test was used to compare the pre- and post-procedural measurements. Besides, Pearson’s correlation was used to find out the linear association between the RV function parameters and Left Ventricular Ejection Fraction (LVEF. P value < 0.05 was considered as statistically significant. Results: This study was conducted on 30 patients (mean age = 60.00 ± 8.44 years; 24 [80%] males. In the pre-procedural echocardiography, 15 patients (50% had normal RV function, 14 patients (46.7% had grade-1 RV dysfunction, and only 1 patient (3.3% had grade-2 RV dysfunction. Following PCI, however, all the patients had normal systolic and diastolic RV functions. Comparison of echocardiographic RV function parameters showed an improvement in both systolic and diastolic functional parameters of the RV. Nonetheless, no significant correlation was observed between these parameters and Left Ventricular (LV function. Conclusions:: A significant improvement was found in RV function, but not LV function, after right coronary PCI. Revascularization of the right coronary artery may be beneficial for the patients who suffer from RV failure due to ischemia

  10. Trans-radial Primary Percutaneous Coronary Intervention in ST-Elevation Myocardial Infarction

    International Nuclear Information System (INIS)

    Hussain, S.; Kayani, A. M.; Munir, R.

    2014-01-01

    Objective: To study the effect of trans-radial approach (TRA) on achievement of a door-to-balloon time (DBT) of A/sup 2/ 90 minutes in primary PCI percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction (STEMI). Study Design: Case series. Place and Duration of Study: Armed Forces Institute of Cardiology - National Institute of Heart Diseases (AFIC -NIHD), Rawalpindi, from October 2011 to August 2012. Methodology: Systems goal for door-to-balloon time (DBT - time elapsed between first medical contact and restoration of flow in the infarct related artery (IRA)) was set at < 90 minutes. Procedural success was defined as restoration of TIMI 3 flow in the IRA with less than 30% residual stenosis and discharge from hospital. Non-infarct related arteries were not treated. Bleeding episodes were defined by TIMI definitions. Results: For vascular access for PPCI in a total of 207 patients, TRA was 91.3% (n = 189), transfemoral approach (TFA) 6.3% (n = 13) and brachial 2.4% (n = 5). Males represented 90.3% of cases and 7% were females. Mean age was 55 A +- 10.86 years. Procedural success rate was 97.1%. Mean DBT was 54.1 minutes. DBT was less A/sup 2/ 60 and 90 minutes in 75% and 94.2% of patients respectively. DBT A/sup 2/ 89.50 minutes was achieved in 90% of patients. The difference in DBT between the different access groups was not markedly different between the three groups. There were 6 (2.9%) in-hospital deaths and no major bleeds. Conclusion: TRA for PPCI poses no hindrance to achieving a DBT of < 90 minutes in PPCI for STEMI. Furthermore, the in-hospital mortality rates are acceptable and within rational limits. (author)

  11. Different postconditioning cycles affect prognosis of aged patients undergoing primary percutaneous coronary intervention.

    Science.gov (United States)

    Zhang, Jie; Zhang, Xin; Cui, Yuqi; Ferdous, Misbahul; Cui, Lianqun; Zhao, Peng

    2017-07-17

    Postconditioning can affect the infarct size in acute myocardial infarction (AMI). However, few studies show an effect of different postconditioning cycles on AMI aged patients. This study sought to assess the effect of different postconditioning cycles on prognosis in aged patients with AMI who underwent primary percutaneous coronary intervention (PCI). 74 aged patients were randomly assigned to three groups. Control group; PC-1 group accepted postconditioning 4 cycles of 30 s inflation and 30 s deflation; PC-2 group accepted postconditioning 4 cycles of 60 s. Creatine kinase MB (CK-MB), troponin I (cTnI), high-sensitive C-reactive protein (hs-CRP) and corrected Thrombolysis in Myocardial Infarction (TIMI) frame counts (CTFC) were analyzed before andafter treatment. All patients received an echocardiographic examination for whole heart function, wall motion score index (WMSI) and single-photon emission computed tomography (SPECT) examination at 7 days and 6 months after treatment. S: The peak of CK-MB, postoperative 72 h cTnI and CTFC were significantly attenuated by postconditioning when compared with the control group. The hs-CRP of the postconditioning group was lower than the control group 24 h postoperative. No difference was observed between PC-1 and PC-2 group about the effect described above. At 7 days, heart function in the postconditioning group was improved when compared with the control group. At 6 months, the WMSI and SPECT score significantly reduced in the PC-2 group compared with the control and PC-1 groups, but there was no difference among the three groups about echo data except the left ventricular end-systolic diameter. Postconditioning is significantly beneficial to prognosis in aged patients with AMI. The cardiac protective effect of 4 cycles of 60 s procedure was observed in WMSI and SPECT. It is favorable to implement this procedure in aged patients with AMI in clinic.

  12. Re-initiating professional working activity after myocardial infarction in primary percutaneous coronary intervention networks era

    OpenAIRE

    Zdravko Babić; Marin Pavlov; Mirjana Oštrić; Milan Milošević; Marjeta Misigoj Duraković; Hrvoje Pintarić

    2015-01-01

    Objectives: To investigate the aspects of return to work, socio-economic and quality of life aspects in 145 employed patients under 60 years of age treated with primary percutaneous coronary intervention for acute ST-elevation myocardial infarction. Material and Methods: During hospital treatment demographic and clinical data was collected. Data about major adverse cardiovascular events, rehabilitation, sick leave, discharge from job and retirement, salary, major life events and estimation of...

  13. Conservative Management of an Epicardial Collateral Perforation During Retrograde Chronic Total Occlusion Percutaneous Coronary Intervention.

    Science.gov (United States)

    Ngo, Christian; Christopoulos, George; Brilakis, Emmanouil S

    2016-01-01

    Coronary artery perforation is a highly feared complication of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) and can lead to pericardial effusion, tamponade, and, rarely, emergent cardiac surgery. Perforation of epicardial collaterals during retrograde CTO-PCI may be particularly challenging to treat, as embolization from both sides of the perforation may be required to control the bleeding. However, conservative measures can occasionally be effective. We present a case of epicardial collateral vessel perforation that was managed conservatively with anticoagulation reversal.

  14. Postconditioning during primary percutaneous coronary intervention: a review and meta-analysis

    DEFF Research Database (Denmark)

    Hansen, Peter Riis; Thibault, Helene; Abdulla, Jawdat

    2010-01-01

    Myocardial postconditioning (POC), defined as intermittent interruptions of blood flow at the onset of reperfusion after sustained ischemia, may attenuate reperfusion injury. In order to weigh the current evidence linking POC to reduction of myocardial infarct size in patients with ST-segment ele......-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI), we performed a systematic review and meta-analysis of the available data from small randomised trials....

  15. Value of intracoronary Doppler for guiding percutaneous interventions

    NARCIS (Netherlands)

    M. Albertal (Mariano)

    2001-01-01

    textabstractFollowing the rapid developments in computer software directed towards the anatomical assessment of coronary arteries by quantitative coronary angiography (QCA), interventional cardiologist felt that the anatomical information obtained was sufficient for clinical decision-making.

  16. An overview of complications associated with open and percutaneous tracheostomy procedures

    Science.gov (United States)

    Cipriano, Anthony; Mao, Melissa L; Hon, Heidi H; Vazquez, Daniel; Stawicki, Stanislaw P; Sharpe, Richard P; Evans, David C

    2015-01-01

    Tracheostomy, whether open or percutaneous, is a commonly performed procedure and is intended to provide long-term surgical airway for patients who are dependent on mechanical ventilatory support or require (for various reasons) an alternative airway conduit. Due to its invasive and physiologically critical nature, tracheostomy placement can be associated with significant morbidity and even mortality. This article provides a comprehensive overview of commonly encountered complications that may occur during and after the tracheal airway placement, including both short- and long-term postoperative morbidity. PMID:26557488

  17. Right Ventricular Function After Acute Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention : (from the Glycometabolic Intervention as Adjunct toPrimary Percutaneous Coronary Intervention in ST-Segment Elevation Myocardial Infarction III Trial)

    NARCIS (Netherlands)

    Gorter, Thomas M; Lexis, Chris P H; Hummel, Yoran M; Lipsic, Erik; Nijveldt, Robin; Willems, Tineke P; van der Horst, Iwan C C; van der Harst, Pim; Melle, van J.P.; van Veldhuisen, Dirk J

    2016-01-01

    Right ventricular (RV) dysfunction is a powerful risk marker after acute myocardial infarction (MI). Primary percutaneous coronary intervention (PCI) has markedly reduced myocardial damage of the left ventricle, but reliable data on RV damage using cardiac magnetic resonance imaging (MRI) are

  18. Primary Percutaneous Coronary Intervention for ST elevation myocardial infarction complicated by Cardiogenic Shock

    International Nuclear Information System (INIS)

    Shaikh, A. H.; Hanif, B.; Pathan, A.; Khan, W.; Hashmani, S.; Raza, M.; Nasir, S.

    2013-01-01

    Objective: To determine the outcomes of primary percutaneous coronary intervention for ST elevation myocardial infarction complicated by cardiogenic shock. Methods: The retrospective study was conducted at the Tabba Heart Institute, a private-sector facility in Karachi. It reviewed the medical records of 56 consecutive patients between January 2009 and June 2011 with acute ST elevation myocardial infarction complicated by cardiogenic shock and subjected to primary percutaneous coronary intervention. The primary end point was in-hospital mortality and its predictors. SPSS 14 was used for statistical analysis. Results: The mean age of the study patients was 63+-11.7 years; 38 (68%) were male; 32 (57%) were hypertensive; and 39 (69%) were diabetic. Most infarcts were anterior in location (n=36; 64%). Besides, 33 (59%) required ventilatory support. Intra-aortic balloon pump was placed in 30 (54%), and 33 (59%) patients had multivessel coronary artery disease. In-hospital mortality occurred in 26 (46%). Multivariate logistic regression analysis showed that age >60 years (p= 0.05), diabetes (p <0.01) and left ventricular ejection fraction <40% (p= 0.01) were independent predictors of in-hospital mortality. Conclusions: Results emphasise the need of aggressive management of patients with cardiogenic shock utilising primary percutaneous coronary intervention as a reperfusion strategy to improve clinical outcomes. (author)

  19. Interventional therapy of hepatic arterial hemorrhage occurred after percutaneous transhepatic biliary drainage

    International Nuclear Information System (INIS)

    Liang Songnian; Feng Bo; Su Hongying; Xu Ke

    2011-01-01

    Objective: To analyze the causes and clinical manifestations of hepatic arterial hemorrhage which occurred after percutaneous transhepatic biliary drainage and to summarize the practical experience in its diagnosis and treatment in order to decrease its incidence and mortality. Methods: During the period from June 2007 to June 2010, percutaneous transhepatic biliary drainage was carried out in 622 cases, of which DSA-proved postoperative hepatic arterial hemorrhage occurred in 11, including bile duct hemorrhage (n=6), abdominal cavity bleeding (n=3) and combination of bile duct and abdominal cavity (n=2). Interventional embolization of the bleeding branches of hepatic artery with Gelfoam and coils was carried out in all 11 patients. The clinical data such as clinical manifestations and therapeutic results were retrospectively analyzed. Results: After interventional embolization therapy for postoperative hepatic arterial hemorrhage the bleeding stopped in ten patients, who were discharged from hospital when the clinical conditions were alleviated. The remaining one patient died of sustained deterioration in hepatic and renal functions although the bleeding was ceased. Conclusion: Though hepatic arterial hemorrhage occurred after percutaneous transhepatic biliary drainage is a rare complication, it is dangerous and fatal. Hepatic arterial angiography together with interventional embolization is a sate and effective therapy for hepatic arterial hemorrhage. (authors)

  20. Efficacy And Safety Of IVUS-Guided Percutaneous Coronary Interventions

    Directory of Open Access Journals (Sweden)

    Popovic Marija

    2015-06-01

    Full Text Available The inclusion of IVUS-guided PCI has yet to become a routine approach in invasive cardiology due to the relatively high cost of the procedure, equivocal positive results in important studies and the steep learning curve. As an additional diagnostic tool, IVUS seems to be irreplaceable in stent apposition research, edge dissections and the determination of plaque composition.

  1. Clinical effect of selective thrombus aspiration during primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction

    Directory of Open Access Journals (Sweden)

    Hai-wei LIU

    2015-06-01

    Full Text Available Objective To assess impact of selective thrombus aspiration (TA during primary percutaneous coronary intervention (pPCI on long-term prognosis in patients with ST-segment elevation myocardial infarction (STEMI. Methods  Between Jan. 2008 and Jan. 2014, a total of 2357 STEMI patients [429 in thrombus aspiration (TA group and 1928 in routine percutaneous coronsry intorventim (PCI group (control group] were eligible for the study criteria and candidates for pPCI were enrolled in this study. The reflow of the involved vessel in pPCI procedure, stent thrombosis and major adverse cardiac events (MACE were comparatively analyzed in the two groups during hospital stay and 12-month follow-up period. Results Although the success rate of TA procedure was significantly lower in TA group compared with that in control group (P<0.001, both the TIMI flow grade ≥2 after TA procedure and stent implantation occurred more frequently in TA group than in control group (P<0.05. The rates of MACE and stent thrombosis showed no difference between two groups during in-hospital and 12-month follow-up period (P>0.05. But the rates of total MACE and target vessel revascularization were significantly higher in control group than in TA group (P=0.04. Conclusion Selective TA procedure before primary PCI could improve final myocardial reperfusion, reduce the incidence of MACE and improve the 1-year clinical result for STEMI patients. DOI: 10.11855/j.issn.0577-7402.2015.04.04

  2. Fractional flow reserve guided percutaneous coronary intervention results in reduced ischemic myocardium and improved outcomes.

    Science.gov (United States)

    Sawant, Abhishek C; Bhardwaj, Aishwarya; Banerjee, Kinjal; Jobanputra, Yash; Kumar, Arnav; Parikh, Parth; Kandregula, Krishna C; Poddar, Kanhaiya; Ellis, Stephen G; Nair, Ravi; Corbelli, John; Kapadia, Samir

    2018-02-06

    To determine if fractional flow reserve guided percutaneous coronary intervention (FFR-guided PCI) is associated with reduced ischemic myocardium compared with angiography-guided PCI. Although FFR-guided PCI has been shown to improve outcomes, it remains unclear if it reduces the extent of ischemic myocardium at risk compared with angiography-guided PCI. We evaluated 380 patients (190 FFR-guided PCI cases and 190 propensity-matched controls) who underwent PCI from 2009 to 2014. Clinical, laboratory, angiographic, stress testing, and major adverse cardiac events [MACE] (all-cause mortality, recurrence of MI requiring PCI, stroke) data were collected. Mean age was 63 ± 11 years; the majority of patients were males (76%) and Caucasian (77%). Median duration of follow up was 3.4 [Range: 1.9, 5.0] years. Procedural complications including coronary dissection (2% vs. 0%, P = .12) and perforation (0% vs. 0%, P = 1.00) were similar between FFR-guided and angiography-guided PCI patients. FFR-guided PCI patients had lower unadjusted (14.7% vs. 23.2%, P = .04) and adjusted [OR = 0.58 (95% CI: 0.34-0.98)] risk of repeat revascularization at one year. FFR-guided PCI patients were less likely (23% vs. 32%, P = .02) to have ischemia and had lower (5.9% vs. 21.1%, P guided PCI, FFR-guided PCI results in less repeat revascularization and a lower incidence of post PCI ischemia translating into improved survival, without an increase in complications. © 2018 Wiley Periodicals, Inc.

  3. Safety of primary percutaneous coronary intervention with and without (selective) thrombus aspiration

    International Nuclear Information System (INIS)

    Farman, M. T.; Saghir, T.; Rizvi, N. H.; Khan, N.; Zaman, K. S.; Sial, J. A.; Malik, A.

    2014-01-01

    Objective: To determine the safety and efficacy of selective thrombus aspiration during Primary Percutaneous Coronary Intervention (PCI). Methods: This observational prospective study was conducted in the catheterization laboratory of a tertiary care cardiovascular centre. A total of 150 consecutive patients who underwent primary PCI were enrolled. Aspiration was done only when thrombus burden was considered significant. After completion of procedure angiographic and electrocardiographic signs were recorded and clinical follow up was documented up to 1 year. Results: No significant difference among the groups was found in age, height, weight and other risk factors like Hypertension, Diabetes Mellitus and Smoking. In general, left anterior descending artery was culprit in 65 % of patients and more than 90 % of culprit vessels had visible thrombus. Multivessel disease was present in 38 % of patients and 22.7% had past history of myocardial infarction. Out of 150 patients 117 (78%) underwent thrombus aspiration. No significant difference was found in ST resolution within 60 minutes (72.6 vs 81.8 %; P<0.285) and myocardial blush grade II and III (41.9 vs 27.3 %; P<0.128). No difference in event free survival was observed among the two groups (80.3 vs 84.8 %; P<0.708) at one year. Conclusion: Selective thrombus aspiration in definite thrombus laden arteries and no aspiration in low or negligible thrombus burden vessels may be a safe and effective strategy in patients undergoing primary PCI. Overall poor risk profile of our patients as compared to western population necessitates further evaluation of this matter in randomized studies. (author)

  4. Prospective registry of percutaneous coronary interventions: Tyumen Cardiology Center’s experience

    Directory of Open Access Journals (Sweden)

    В. А. Кузнецов

    2015-10-01

    Full Text Available Objective. The aim of the study was to evaluate the efficacy and safety of percutaneous coronary interventions (PCI and to identify the factors impacting long-term prognosis.Methods. The register included 1018 patients who underwent PCI at Tyumen Cardiology Center from October 2012 to November 2013.Results. Hospital cardiovascular mortality rate was 0.8%, while that at 1-year follow-up amounted to 2%. Mortality was associated with age (OR = 1.005; 95% CI 1.003-1.103; p = 0.037, left ventricular ejection fraction (OR = 0.91; 95% CI 0.86-0.96; p = 0.001, left anterior descending artery lesions (OR = 4.73; 95% CI 1.06-21.04; p = 0.042, success of PCI (OR = 0.07; 95% CI 0.02-0.35; p = 0.001, hypodynamia (OR = 5.99; 95% CI 1.78-20.2; p = 0.004 and a low level of social support (OR = 0.41; 95% CI 0.20-0 82; p = 0.012. Main adverse cardio-cerebral events (MACCE were associated with the history of coronary artery bypass grafting (OR = 0.08; 95% CI 0.01-0.62; p = 0.016, PCI (OR = 1.66; 95 % CI 1.06-2.62; p = 0.028, SYNTAX score (OR = 1.07; 95% CI 1.04-1.09; p <0.001, success of PCI (OR = 0.33; 95% CI 0.13-0.82; p = 0.017.Conclusion. PCI is a safe and effective procedure for treatment of coronary heart disease, which results in low MACCE and mortality rates.

  5. Informed Decision Making for Percutaneous Coronary Intervention for Stable Coronary Disease.

    Science.gov (United States)

    Rothberg, Michael B; Sivalingam, Senthil K; Kleppel, Reva; Schweiger, Marc; Hu, Bo; Sepucha, Karen R

    2015-07-01

    Patients with stable coronary disease undergoing percutaneous coronary intervention (PCI) are frequently misinformed about the benefits of PCI. Little is known about the quality of decision making before angiography and possible PCI. To assess the quality of informed decision making and its association with patient decisions. We performed a cross-sectional analysis of recorded conversations between August 1, 2008, and August 31, 2012, among adults with known or suspected stable coronary disease at outpatient cardiology practices. Presence of 7 elements of informed decision making and the decision to undergo angiography and possible PCI. Of 59 conversations conducted by 23 cardiologists, 2 (3%) included all 7 elements of informed decision making; 8 (14%) met a more limited definition of procedure, alternatives, and risks. Specific elements significantly associated with not choosing angiography and possible PCI included discussion of uncertainty (odds ratio [OR], 20.5; 95% CI, 2.3-204.9), patient's role (OR, 5.3; 95% CI, 1.3-21.3), exploration of alternatives (OR, 9.5; 95% CI, 2.5-36.5), and exploration of patient preference (OR, 4.8; 95% CI, 1.2-19.4). Neither the presence of angina nor severity of symptoms was associated with choosing angiography and possible PCI. In a multivariable analysis using the total number of elements as a predictor, better informed patients were less likely to choose angiography and possible PCI (OR per additional element, 3.2; 95% CI, 1.4-7.1; P = .005). In conversations between cardiologists and patients with stable angina, informed decision making is often incomplete. More complete discussions are associated with patients choosing not to undergo angiography and possible PCI.

  6. Data on the impact of subclinical hypothyroidism on clinical outcomes following percutaneous coronary intervention

    Directory of Open Access Journals (Sweden)

    Yonggu Lee

    2018-02-01

    Full Text Available This article contains the data showing the different influence of subclinical hypothyroidism (SCH on the risk of cardiovascular events after percutaneous coronary intervention (PCI in various subgroups regarding myocardial infarction, previous PCI, the stent generation, total stent length, the extent of coronary artery disease, diabetes mellitus, obesity, a lipid reduction level and a C-reactive protein level. This article also contains the data showing the association between SCH and the risk of receiving repeat PCI for in-stent restenosis or de novo coronary stenosis. The data are supplemental to our original research article titled “Impact of Subclinical Hypothyroidism on Clinical Outcomes Following Percutaneous Coronary Intervention” (Lee et al., 2017 [1].

  7. Application of intravascular ultrasound in percutaneous coronary interventional therapy

    International Nuclear Information System (INIS)

    Wang Jingping; Li Bao; An Jian; Yang Bin; Wang Zhongchao; Wang Rijun; Zhang Wutang; Lei Xinyu; Wang Huixian; Lu Lifang; Gao Yongli

    2009-01-01

    Objective: To evaluate intravascular ultrasound (IVUS)in demonstrating the characteristics of coronary plaque and in implanting the coronary stent. Methods: Before stent implantation, IVUS was used to observe the plaque character/sties(soft, fibrotic, calcified or mixed) as well as the eccentric degree in 28 patients with angiographically-proved single coronary branch lesion. The minimal luminal diameter, minimal cross-sectional area and plaque area were measured. After stent deployment the above measurements were repeated, and the location, symmetrical index and expansion of the stent were observed. Results: A total of 36 stents was implanted in 28 patients with coronary disease. After the procedure the minimal luminal diameter and the minimal cross-sectional area was increased, while the plaque area was decreased. The difference between the values before and after the stent implantation was statistically significant (P<0.01). IVUS after stent deployment found that in all cases the stent had a nice location and covered the lesion completely with no interlayer at its both ends. Excellent expansion of the stent was seen in 30 cases (83.3%). Insufficient expansion occurred in 3 cases and undesirable contact of the stent to the arterial wall was found in 3 cases (16.7%). In such circumstances, one size bigger low-compliance balloon dilatation was adopted, or the original balloon was used again with higher pressure (18-22 atm), in order to expand the stent once more, and good results accord with IVUS optimal criteria were obtained. Conclusions: IVUS can clearly demonstrate the pathological features of the coronary lesions, such as plaque type, eccentric degree, luminal diameter, cross-sectional area and plaque area, which are very helpful in guiding the selection of the proper stent before the procedure, and are also very useful in evaluating the location, expansion of the stent as well as the stent-to-wall contact condition after the procedure. (authors)

  8. Complications with Outpatient Angiography and Interventional Procedures

    International Nuclear Information System (INIS)

    Young, Noel; Chi, Ka-Kit; Ajaka, Joe; McKay, Lesa; O'Neill, Diane; Wong, Kai Ping

    2002-01-01

    Purpose: To prospectively identify the complications, and rates of complication, in outpatient angiography and interventional procedures. Methods: There were 1050 consecutive patients, 646 men and 404 women, aged 17-89 years, with a total of 1239 procedures studied in a 2-year period, 1997 to 1999. Results: There were 560 cases of aorto-femoral angiography,resulting in 124 complications (22%), with pain or hematoma in 110.There were 206 cases of neck and cerebral angiography, resulting in 51 complications (25%), with pain and hematoma in 34, transient ischemic attack in 2 and cerebrovascular accident in 1. There were 197 interfentional procedures, with 177 being balloon dilatations, resulting in 68 complications (35%), with 2 having hematomas and 1 having hematoma/abscess requiring active treatment. There were 276 cases having various 'other' procedures (e.g., renal angiography),resulting in 65 complications (24%), with pain and hematoma in 61. No procedure-related death occurred. Eighteen cases (1.5%) had significant complications, with contrast allergy in eight. Conclusion: Outpatient angiography and intervention are relatively safe, with low significant complication rates

  9. ST-segment resolution with bivalirudin versus heparin and routine glycoprotein IIb/IIIa inhibitors started in the ambulance in ST-segment elevation myocardial infarction patients transported for primary percutaneous coronary intervention

    DEFF Research Database (Denmark)

    Van't Hof, Arnoud; Giannini, Francesco; Ten Berg, Jurrien

    2017-01-01

    BACKGROUND: Myocardial reperfusion after primary percutaneous coronary intervention (PCI) can be assessed by the extent of post-procedural ST-segment resolution. The European Ambulance Acute Coronary Syndrome Angiography (EUROMAX) trial compared pre-hospital bivalirudin and pre-hospital heparin o...

  10. The Payer and Patient Cost Burden of Open Breast Conserving Procedures Following Percutaneous Breast Biopsy.

    Science.gov (United States)

    Kimball, Chloe C; Nichols, Christine I; Vose, Joshua G

    2018-01-01

    Percutaneous core-needle biopsy (PCNB) is the standard of care to biopsy and diagnose suspicious breast lesions. Dependent on histology, many patients require additional open procedures for definitive diagnosis and excision. This study estimated the payer and patient out-of-pocket (OOP) costs, and complication risk, among those requiring at least 1 open procedure following PCNB. This retrospective study used the Truven Commercial database (2009-2014). Women who underwent PCNB, with continuous insurance, and no history of cancer, chemotherapy, radiation, or breast surgery in the prior year were included. Open procedures were defined as open biopsy or lumpectomy. Study follow-up ended at chemotherapy, radiation, mastectomy, or 90 days-whichever occurred first. In total, 143 771 patients (mean age 48) met selection criteria; 85.1% underwent isolated PCNB, 12.4% one open procedure, and 2.5% re-excision. Incidence of complications was significantly lower among those with PCNB alone (9.2%) vs 1 open procedure (15.6%) or re-excision (25.3%, P  open procedure vs PCNB alone (US $17 125 vs US $3935, P  open procedure vs PCNB alone (US $1527 vs US $669), and US $247 greater for re-excision vs 1 procedure. A meaningful proportion of patients underwent open procedure(s) following PCNB which was associated with increased complication risk and costs to both the payer and the patient. These results suggest a need for technologies to reduce the proportion of cases requiring open surgery and, in some cases, re-excision.

  11. Effect of glycoprotein IIb/IIIa receptor inhibition on angiographic complications during percutaneous coronary intervention in the ESPRIT trial.

    Science.gov (United States)

    Blankenship, J C; Tasissa, G; O'Shea, J C; Iliadis, E A; Bachour, F A; Cohen, D J; Lui, H K; Mann, T; Cohen, E; Tcheng, J E

    2001-09-01

    We sought to determine whether eptifibatide decreases the incidence of in-laboratory angiographic complications and to determine the relationship of angiographically evident complications to elevations of creatine kinase-MB (CK-MB) enzyme levels during percutaneous coronary intervention. In the Enhanced Suppression of the Platelet IIb/IIIa Receptor with Integrilin Therapy (ESPRIT) trial, eptifibatide during coronary intervention was associated with decreased ischemic complications at 48 h and 30 days. Patients (n = 2,064) were randomized to placebo versus eptifibatide (two 180 microg/kg boluses 10 min apart and as a continuous infusion of 2 microg/kg per min) during percutaneous coronary stenting. Angiographic complications including major dissection, distal embolization, residual thrombus, abrupt closure, residual stenosis >50% and side-branch occlusion were prospectively recorded by the operator. Creatine kinase-MB levels were measured after the procedure and every 6 h thereafter. The incidence of angiographic complications and CK-MB elevation was determined for eptifibatide versus placebo groups. Eptifibatide-treated patients demonstrated nonsignificant trends toward fewer angiographic complications (10 vs. 12% for placebo patients, p = 0.13) and, for patients with angiographic complications, fewer subsequent CK-MB elevations (43 vs. 50% for placebo patients, p = 0.31). In patients without any angiographic complications, the incidence of CK-MB elevation >3 times the normal was 7% with placebo and 4% with eptifibatide (p = 0.003). Eptifibatide during nonurgent coronary stent intervention only minimally (and insignificantly) reduces the incidence of angiographic complications and subsequent CK-MB elevations in patients developing an angiographic complication. The greater effect is to reduce myocardial infarction in patients undergoing otherwise uneventful coronary stent implantation as well as in the overall study population.

  12. The New York State risk score for predicting in-hospital/30-day mortality following percutaneous coronary intervention.

    Science.gov (United States)

    Hannan, Edward L; Farrell, Louise Szypulski; Walford, Gary; Jacobs, Alice K; Berger, Peter B; Holmes, David R; Stamato, Nicholas J; Sharma, Samin; King, Spencer B

    2013-06-01

    This study sought to develop a percutaneous coronary intervention (PCI) risk score for in-hospital/30-day mortality. Risk scores are simplified linear scores that provide clinicians with quick estimates of patients' short-term mortality rates for informed consent and to determine the appropriate intervention. Earlier PCI risk scores were based on in-hospital mortality. However, for PCI, a substantial percentage of patients die within 30 days of the procedure after discharge. New York's Percutaneous Coronary Interventions Reporting System was used to develop an in-hospital/30-day logistic regression model for patients undergoing PCI in 2010, and this model was converted into a simple linear risk score that estimates mortality rates. The score was validated by applying it to 2009 New York PCI data. Subsequent analyses evaluated the ability of the score to predict complications and length of stay. A total of 54,223 patients were used to develop the risk score. There are 11 risk factors that make up the score, with risk factor scores ranging from 1 to 9, and the highest total score is 34. The score was validated based on patients undergoing PCI in the previous year, and accurately predicted mortality for all patients as well as patients who recently suffered a myocardial infarction (MI). The PCI risk score developed here enables clinicians to estimate in-hospital/30-day mortality very quickly and quite accurately. It accurately predicts mortality for patients undergoing PCI in the previous year and for MI patients, and is also moderately related to perioperative complications and length of stay. Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  13. Venous malformations: MR imaging features that predict skin burns after percutaneous alcohol embolization procedures

    International Nuclear Information System (INIS)

    Fayad, Laura M.; Hazirolan, Tuncay; Carrino, John A.; Bluemke, David A.; Mitchell, Sally

    2008-01-01

    To examine the value of magnetic resonance (MR) imaging for predicting the occurrence of skin burns in patients with venous malformations who undergo percutaneous alcohol embolization was the objective of the study. Pre-procedural MR imaging at 1.5 T from 40 patients with venous malformations who had undergone percutaneous alcohol embolization was retrospectively reviewed by two observers for these features: anatomic location, definition (well-defined or ill-defined), and the presence of skin, subcutaneous tissue, muscle, tendon, bone, joint, and deep venous system involvement. One observer recorded the length of skin involvement and volume of the malformation. Univariate and multivariate analysis tests were used to determine whether an association between the occurrence of skin burns and MR imaging features existed. The anatomic locations of the venous malformations were the lower extremity (20 out of 40), upper extremity (11 out of 40), trunk (four out of 40), head/neck (three out of 40) and pelvis (two out of 40). Of the 40 subjects, 15% (six out of 40) experienced skin burns. There was a significant association between the absence of muscle involvement (p=0.0198) as well as the length of skin involvement (p=0.027), with the occurrence of skin burns. Malformation size and all other features were not significantly associated with skin burns. Skin burns in patients with venous malformations treated with alcohol embolization are associated with the length of skin involvement and with the absence of deeper tissue involvement, as depicted on MR imaging. (orig.)

  14. Diabetes Mellitus and Glucose as Predictors of Mortality in Primary Coronary Percutaneous Intervention

    Directory of Open Access Journals (Sweden)

    Renato Budzyn David

    2014-10-01

    Full Text Available Background: Diabetes mellitus and admission blood glucose are important risk factors for mortality in ST segment elevation myocardial infarction patients, but their relative and individual role remains on debate. Objective: To analyze the influence of diabetes mellitus and admission blood glucose on the mortality of ST segment elevation myocardial infarction patients submitted to primary coronary percutaneous intervention. Methods: Prospective cohort study including every ST segment elevation myocardial infarction patient submitted to primary coronary percutaneous intervention in a tertiary cardiology center from December 2010 to May 2012. We collected clinical, angiographic and laboratory data during hospital stay, and performed a clinical follow-up 30 days after the ST segment elevation myocardial infarction. We adjusted the multivariate analysis of the studied risk factors using the variables from the GRACE score. Results: Among the 740 patients included, reported diabetes mellitus prevalence was 18%. On the univariate analysis, both diabetes mellitus and admission blood glucose were predictors of death in 30 days. However, after adjusting for potential confounders in the multivariate analysis, the diabetes mellitus relative risk was no longer significant (relative risk: 2.41, 95% confidence interval: 0.76 - 7.59; p-value: 0.13, whereas admission blood glucose remained and independent predictor of death in 30 days (relative risk: 1.05, 95% confidence interval: 1.02 - 1.09; p-value ≤ 0.01. Conclusion: In ST segment elevation myocardial infarction patients submitted to primary coronary percutaneous intervention, the admission blood glucose was a more accurate and robust independent predictor of death than the previous diagnosis of diabetes. This reinforces the important role of inflammation on the outcomes of this group of patients.

  15. Ultrasound guided percutaneous cholecystostomy in high-risk patients for surgical intervention.

    Science.gov (United States)

    Bakkaloglu, Huseyin; Yanar, Hakan; Guloglu, Recep; Taviloglu, Korhan; Tunca, Fatih; Aksoy, Murat; Ertekin, Cemalettin; Poyanli, Arzu

    2006-11-28

    To assess the efficacy and safety of ultrasound guided percutaneous cholecystostomy (PC) in the treatment of acute cholecystitis in a well-defined high risk patients under general anesthesia. The data of 27 consecutive patients who underwent percutaneous transhepatic cholecystostomy for the management of acute cholecystitis from January 1999 to June 2003 was retrospectively evaluated. All of the patients had both clinical and sonographic signs of acute cholecystitis and had comorbid diseases. Ultrasound revealed gallbladder stones in 25 patients and acalculous cholecystitis in two patients. Cholecystostomy catheters were removed 14-32 d (mean 23 d) after the procedure in cases where complete regression of all symptoms was achieved. There were statistically significant reductions in leukocytosis, (13.7 x 10(3)+/-1.3 x 10(3) microg/L vs 13 x 10(3)+/-1 x 10(3) microg/L, P extraction was performed successfully with endoscopic retrograde cholangio-pancreatography (ERCP) in three patients. After cholecystostomy, 5 (18%) patients underwent delayed cholecystectomy without any complications. Three out of 22 patients were admitted with recurrent acute cholecystitis during the follow-up and recovered with medical treatment. Catheter dislodgement occurred in three patients spontaneously, and two of them were managed by reinsertion of the catheter. As an alternative to surgery, percutaneous cholecystostomy seems to be a safe method in critically ill patients with acute cholecystitis and can be performed with low mortality and morbidity. Delayed cholecystectomy and ERCP, if needed, can be performed after the acute period has been resolved by percutaneous cholecystostomy.

  16. Patient doses in interventional cardiology procedures

    International Nuclear Information System (INIS)

    Domienik, J.; Papierz, S.; Jankowski, J.; Peruga, J.Z.

    2008-01-01

    In most countries of European Union legislation requires the determination of the total skin dose to patient resulting from interventional procedures to assess the risk of deterministic effect. To this end, various dose indicators like dose area product (DAP), cumulative dose (CD) and entrance dose at the patient plane (EFD) are used in clinical practice. The study aims at relating those dose indicators with doses ascribe to the most irradiated areas of the patient skin usually expressed in terms of local maximal skin dose (MSD). For the study the local MSD and related to their areas are investigated and compared for coronary angiography CA and intervention (PCI). Two methods implying radiographic films Kodak EDR2 and matrixes of thermoluminescent dosimeters (TLDs) are applied for direct measurements of dose distribution for selected procedures. Both methods are compared. Additionally, for patient dosimetry the following data: MSD, CD, EFD, fluoroscopy time (FT), number of acquired images, total DAP, fluoro-DAP and record-DAP were collected for randomly selected procedure. The statistical quantities like: median, 3 rd quartile, mean and standard deviation for all dosimetric parameters are determined. Preliminary study showed that the values of data collected for coronary procedures are in the ranges 0,7 - 27,3 min for fluoroscopy time, 50 - 350 Gy cm 2 for total DAP, 300 - 2000 mGy for CD, 140 - 2000 mGy for EFD and 100 - 1500 mGy for local maximal skin dose. For interventions the ranges are, accordingly 3,0 - 43,6 min , 25 - 450 Gy cm 2 , 270 - 6600 mGy, 80 - 2600 mGy and 80 - 1500 mGy. As a result of the study the correlations between dose indicators and local MSD are analyzed. The concentration of dose on irradiated films are going to be investigated in some detail as well. (author)

  17. Low Body Mass Index, Serum Creatinine, and Cause of Death in Patients Undergoing Percutaneous Coronary Intervention.

    Science.gov (United States)

    Goel, Kashish; Gulati, Rajiv; Reeder, Guy S; Lennon, Ryan J; Lewis, Bradley R; Behfar, Atta; Sandhu, Gurpreet S; Rihal, Charanjit S; Singh, Mandeep

    2016-10-31

    Low body mass index (BMI) and serum creatinine are surrogate markers of frailty and sarcopenia. Their relationship with cause-specific mortality in elderly patients undergoing percutaneous coronary intervention is not well studied. We determined long-term cardiovascular and noncardiovascular mortality in 9394 consecutive patients aged ≥65 years who underwent percutaneous coronary intervention from 2000 to 2011. BMI and serum creatinine were divided into 4 categories. During a median follow-up of 4.2 years (interquartile range 1.8-7.3 years), 3243 patients (33.4%) died. In the multivariable model, compared with patients with normal BMI, patients with low BMI had significantly increased all-cause mortality (hazard ratio [HR] 1.4, 95% CI 1.1-1.7), which was related to both cardiovascular causes (HR 1.4, 95% CI 1.0-1.8) and noncardiovascular causes (HR 1.4, 95% CI 1.06-1.9). Compared with normal BMI, significant reduction was noted in patients who were overweight and obese in terms of cardiovascular mortality (overweight: HR 0.77, 95% CI 0.67-0.88; obese: HR 0.80, 95% CI 0.70-0.93) and noncardiovascular mortality (overweight: HR 0.85, 95% CI 0.74-0.97; obese: HR 0.82, 95% CI 0.72-0.95). In a multivariable model, in patients with normal BMI, low creatinine (≤0.70 mg/dL) was significantly associated with increased all-cause mortality (HR 1.8, 95% CI 1.3-2.5) and cardiovascular mortality (HR 2.3, 95% CI 1.4-3.8) compared with patients with normal creatinine (0.71-1.0 mg/dL); however, this was not observed in other BMI categories. We identified a new subgroup of patients with low serum creatinine and normal BMI that was associated with increased all-cause mortality and cardiovascular mortality in elderly patients undergoing percutaneous coronary intervention. Low BMI was associated with increased cardiovascular and noncardiovascular mortality. Nutritional support, resistance training, and weight-gain strategies may have potential roles for these patients undergoing

  18. Anticoagulant and Antiplatelet Prescribing Patterns for Patients with Atrial Fibrillation after Percutaneous Coronary Intervention.

    Science.gov (United States)

    Woods, Erin A; Ackman, Margaret L; Graham, Michelle M; Koshman, Sheri L; Boswell, Rosaleen M; Barry, Arden R

    2016-01-01

    Current guidelines recommend triple antithrombotic therapy (TAT), defined as acetylsalicylic acid (ASA), clopidogrel, and warfarin, for patients with nonvalvular atrial fibrillation who have undergone percutaneous coronary intervention with stent implantation. The choice of anticoagulant/antiplatelet therapy in this population is ambiguous and complex, and prescribing patterns are not well documented. To characterize local prescribing patterns for anticoagulant/antiplatelet therapy after percutaneous coronary intervention in patients with nonvalvular atrial fibrillation. A chart review was conducted at a single quaternary cardiology centre. Patients with nonvalvular atrial fibrillation were identified via medical records, and those who underwent percutaneous coronary intervention were identified using a local clinical patient registry. Adult inpatients with nonvalvular atrial fibrillation and a CHADS2 score (based on congestive heart failure, hypertension, age ≥ 75 years, diabetes mellitus, prior stroke) of 1 or higher who underwent percutaneous coronary intervention from 2011 to 2013 were included. Patients undergoing cardiovascular surgery or transcatheter aortic valve replacement, those with mechanical devices requiring anticoagulation, and those with an allergy to any component of TAT were excluded. Seventy patients were included. The median age was 75 years, and 52 (74%) were men. At discharge, 30 (43%) were receiving TAT and 27 (39%) were receiving dual antiplatelet therapy (clopidogrel and ASA). No patients received the combination of warfarin and clopidogrel. Among those who received TAT, 90% (19 of 21) who received a bare metal stent had a recommended duration of 1 month, and 75% (6 of 8) who received a drug-eluting stent had a recommended duration of 1 year. Direct-acting oral anticoagulants with 2 antiplatelet drugs were prescribed for 9% (6 of 70) of the patients, and 10% (7 of 70) received ticagrelor and ASA with or without warfarin. Overall, the

  19. Gender Differences in Associations Between Intraprocedural Thrombotic Events During Percutaneous Coronary Intervention and Adverse Outcomes

    DEFF Research Database (Denmark)

    Schoos, Mikkel; Mehran, Roxana; Dangas, George D

    2016-01-01

    quantitative coronary angiography (QCA) analysis, from the ACUITY and HORIZONS-AMI trials. We compared major adverse cardiac events (MACE) at in-hospital, 30-day, and 1-year follow-up and major bleeding at 30 days according to gender and the presence or absence of IPTE. IPTE was identified in 507 patients (7....... Intraprocedural Thrombotic Events (IPTEs) are defined as new or increasing thrombus, abrupt vessel closure, no reflow or slow reflow, or distal embolization at any time during percutaneous coronary intervention. IPTEs were evaluated in this pooled analysis of 6,591 patients with stent implantation and blinded...

  20. Obesity, health status, and 7-year mortality in percutaneous coronary intervention

    DEFF Research Database (Denmark)

    Younge, John O; Damen, Nikki L; van Domburg, Ron T

    2013-01-01

    Obesity is a growing health problem and is associated with adverse outcomes in coronary artery disease (CAD). However, recent studies have shown better survival in cardiovascular patients with overweight or obesity, which has been referred to as the "obesity paradox". As there is no clear...... understanding of the phenomenon, we examined the association between body mass index (BMI) and all-cause mortality in patients treated with percutaneous coronary intervention (PCI) at 7-year follow-up, and the potential role of health status in explaining the obesity paradox....

  1. System delay and mortality among patients with STEMI treated with primary percutaneous coronary intervention

    DEFF Research Database (Denmark)

    Terkelsen, Christian Juhl; Sørensen, Jacob Thorsted; Maeng, Michael

    2010-01-01

    Timely reperfusion therapy is recommended for patients with ST-segment elevation myocardial infarction (STEMI), and door-to-balloon delay has been proposed as a performance measure in triaging patients for primary percutaneous coronary intervention (PCI). However, focusing on the time from first...... contact with the health care system to the initiation of reperfusion therapy (system delay) may be more relevant, because it constitutes the total time to reperfusion modifiable by the health care system. No previous studies have focused on the association between system delay and outcome in patients...

  2. [Astronauts, asteroids and the universe of antithrombotic therapies in primary percutaneous coronary intervention].

    Science.gov (United States)

    De Luca, Leonardo; Granatelli, Antonino

    2017-06-01

    A sensation of self-awareness on the relativity of our certainties comes over looking to the huge amount of data on antithrombotic therapies assessed in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI). This sensation can be compared to the so-called "overview effect", a cognitive shift in awareness reported by some astronauts during spaceflight, often while viewing the Earth from orbit. In this review we will mention drugs floated like meteors in the Universe of STEMI treatment and we will discuss the body of evidence on oral and intravenous antithrombotic therapies for patients undergoing pPCI.

  3. [Acetylsalicylic acid desensitization in the new era of percutaneous coronary intervention].

    Science.gov (United States)

    Fuertes Ferre, Georgina; Ferrer Gracia, Maria Cruz; Calvo Cebollero, Isabel

    2015-09-21

    Dual antiplatelet therapy is essential in patients undergoing percutaneous coronary intervention with stent implantation. Hypersensitivity to acetylsalicylic acid (ASA) limits treatment options. Desensitization to ASA has classically been studied in patients with respiratory tract disease. Over the last years, many protocols have been described about ASA desensitization in patients with ischemic heart disease, including acute coronary syndrome and the need for coronary stent implantation. It is important to know the efficacy and safety of ASA desensitization in these patients. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

  4. 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.

  5. Revealing the impact of local access-site complications and upper extremity dysfunction post transradial percutaneous coronary procedures

    NARCIS (Netherlands)

    Zwaan, E.M.; Koopman, A.G.M.M.; Holtzer, C.A.J.; Zijlstra, F.; Ritt, M.J.P.F.; Amoroso, G.; Moerman, E.; Kofflard, M.J.M.; Ijsselmuiden, A.J.J.

    2015-01-01

    Objectives Little is known about local access-site complications and upper extremity dysfunction after transradial percutaneous coronary procedures (TR-PCP). This systematic review study aimed to summarise the current knowledge on the incidences of access-site complications and upper extremity

  6. Percutaneous-endoscopic rendezvous procedure for the management of bile duct injuries after cholecystectomy: short- and long-term outcomes

    NARCIS (Netherlands)

    Schreuder, Anne Marthe; Booij, Klaske A. C.; de Reuver, Philip R.; van Delden, Otto M.; van Lienden, Krijn P.; Besselink, Marc G.; Busch, Olivier R.; Gouma, Dirk J.; Rauws, Erik A. J.; van Gulik, Thomas M.

    2018-01-01

    Bile duct injury (BDI) remains a daunting complication of laparoscopic cholecystectomy. In patients with complex BDI, a percutaneous-endoscopic rendezvous procedure may be required to establish bile duct continuity. The aim of this study was to assess short- and long-term outcomes of the rendezvous

  7. Impact of diabetes mellitus on acute outcomes of percutaneous coronary intervention in chronic total occlusions: insights from a US multicentre registry.

    Science.gov (United States)

    Martinez-Parachini, J R; Karatasakis, A; Karmpaliotis, D; Alaswad, K; Jaffer, F A; Yeh, R W; Patel, M; Bahadorani, J; Doing, A; Nguyen-Trong, P-K; Danek, B A; Karacsonyi, J; Alame, A; Rangan, B V; Thompson, C A; Banerjee, S; Brilakis, E S

    2017-04-01

    To examine the impact of diabetes mellitus on procedural outcomes of patients who underwent percutaneous coronary intervention for chronic total occlusion. We assessed the impact of diabetes mellitus on the outcomes of percutaneous coronary intervention for chronic total occlusion among 1308 people who underwent such procedures at 11 US centres between 2012 and 2015. The participants' mean ± sd age was 66 ± 10 years, 84% of the participants were men and 44.6% had diabetes. As compared with participants without diabetes, participants with diabetes were more likely to have undergone coronary artery bypass graft surgery (38 vs 31%; P = 0.006), and to have had previous heart failure (35 vs 22%; P = 0.0001) and peripheral arterial disease (19 vs 13%; P = 0.002). They also had a higher BMI (31 ± 6 kg/m 2 vs 29 ± 6 kg/m 2 ; P = 0.001), similar Japanese chronic total occlusion scores (2.6 ± 1.2 vs 2.5 ± 1.2; P = 0.82) and similar final successful crossing technique: antegrade wire escalation (46 vs 47%; P = 0.66), retrograde (30 vs 28%; P = 0.66) and antegrade dissection re-entry (24 vs 25%; P = 0.66). Technical (91 vs 90%; P = 0.80) and procedural (89 vs 89%; P = 0.93) success was similar in the two groups, as was the incidence of major adverse cardiac events (2.2 vs 2.5%; P = 0.61). In a contemporary cohort of people undergoing percutaneous coronary intervention for chronic total occlusion, nearly one in two (45%) had diabetes mellitus. Procedural success and complication rates were similar in people with and without diabetes. © 2016 Diabetes UK.

  8. [Interventional radiology procedures for malignancies of the liver treatment: Intraarterial procedures].

    Science.gov (United States)

    Cristina, V; Pracht, M; Lachenal, Y; Adib, S; Boubaker, A; Prior, J; Senys, A; Wagner, A D; Bize, P

    2014-05-21

    Intraarterial procedures such as chemoembolization and radioembolization aim for the palliative treatment of advanced hepatocellular carcinoma (stage BCLC B and C with tumoral portal thrombosis). The combination of hepatic intraarterial chemotherapy and systemic chemotherapy can increase the probability of curing colorectal cancer with hepatic metastases not immediately accessible to surgical treatment or percutaneous ablation.

  9. Percutaneous vertebroplasty (pv): indications, contraindications, and technique

    International Nuclear Information System (INIS)

    Hoffmann, R.T.; Jakobs, T.F.; Wallnoefer, A.; Reiser, M.F.; Helmberger, T.K.

    2003-01-01

    Percutaneous vertebroplasty (pv) is a worldwide increasingly performed interventional therapeutic procedure. This article addresses indications, patient preparation, technical requirements and approach as well as possible complications of percutaneous vertebroplasty. Percutaneous vertebroplasty is a technique consisting in an injection of bone cement into a vertebral body under imaging guidance. This procedure is performed to relief pain and support the mechanical stability in partially collapsed vertebral bodies. In the management of spinal compression fractures secondary to osteoporosis, myeloma, osteolytic metastases and aggressive hemangiomas, percutaneous vertebroplasty yields analgesic effect, and provides additional fortification in weakened segments of the vertebral column. Contraindications include major bleeding disorders, radicular pain and pain caused by compression of the myelon. Percutaneous vertebroplasty results in prompt pain relief and rapid rehabilitation. In experienced hands, using correct technique, pv is a safe and effective procedure for treating pain, caused either by osteoporotic or malignant vertebral compression fractures. (orig.) [de

  10. Percutaneous closure of patent foramen ovale and atrial septal defect in adults: the impact of clinical variables and hospital procedure volume on in-hospital adverse events.

    Science.gov (United States)

    Opotowsky, Alexander R; Landzberg, Michael J; Kimmel, Stephen E; Webb, Gary D

    2009-05-01

    Percutaneous closure of patent foramen ovale/atrial septal defect (PFO/ASD) is an increasingly common procedure perceived as having minimal risk. There are no population-based estimates of in-hospital adverse event rates of percutaneous PFO/ASD closure. We used nationally representative data from the 2001-2005 Nationwide Inpatient Sample to identify patients >or-=20 years old admitted to an acute care hospital with an International Classification of Diseases, Ninth Revision code designating percutaneous PFO/ASD closure on the first or second hospital day. Variables analyzed included age, sex, number of comorbidities, year, same-day use of intracardiac or other echocardiography, same-day left heart catheterization, hospital size and teaching status, PFO/ASD procedural volume, and coronary intervention volume. Outcomes of interest included length of stay, charges, and adverse events. The study included 2,555 (weighted to United States population: 12,544 +/- 1,987) PFO/ASD closure procedures. Mean age was 52.0 +/- 0.4 years, and 57.3% +/- 1.0% were women. Annual hospital volume averaged 40.8 +/- 7.7 procedures (range, 1-114). Overall, 8.2 +/- 0.8% of admissions involved an adverse event. Older patients and those with comorbidities were more likely to sustain adverse events. Use of intracardiac echocardiography was associated with fewer adverse events. The risk of adverse events was inversely proportional to annual hospital volume (odds ratio [OR] 0.91, 95% confidence interval [CI] 0.86-0.96, per 10 procedures), even after limiting the analysis to hospitals performing >or=10 procedures annually (OR 0.91, 95% CI 0.85-0.98). Adverse events were more frequent at hospitals in the lowest volume quintile as compared with the highest volume quintile (13.3% vs 5.4%, OR 2.42, 95% CI 1.55-3.78). The risk of adverse events of percutaneous PFO/ASD closure is inversely correlated with hospital volume. This relationship applies even to hospitals meeting the current guidelines

  11. The effects of prior calcium channel blocker therapy on creatine kinase-MB levels after percutaneous coronary interventions

    Directory of Open Access Journals (Sweden)

    Oyku Gulmez

    2008-12-01

    Full Text Available Oyku Gulmez, Ilyas Atar, Bülent Ozin, Mehmet Emin Korkmaz, Aslı Atar, Alp Aydinalp, Aylin Yildirir, Haldun MuderrisogluBaskent University Faculty of Medicine, Department of Cardiology, Ankara, TurkeyBackground: Use of intracoronary calcium channel blockers (CCBs during percutaneous coronary intervention (PCI has been shown to have favorable effects on coronary blood flow. We aimed to investigate the effects of CCBs administrated perorally on creatine kinase-MB (CK-MB levels in patients undergoing elective PCI.Methods: A total of 570 patients who underwent PCI were evaluated for CK-MB elevation. Patients who were on CCB therapy when admitted to the hospital constituted the CCB group. No CCBs were given to the rest of the patients during the periprocedural period and these patients served as the control group. Blood samples for CK-MB were obtained before and at 6 h, 24 h, and 36 h after the procedure.Results: 217 patients were in the CCB group (mean age 60.2 ± 9.3 years, 162 males, and 353 were in the control group (mean age 60.0 ± 10.1 years, 262 males. CK-MB levels increased above the normal values in 41 patients (18.9% of the CCBs group and in 97 patients (27.5% of the control group (p = 0.02. Median CK-MB levels were significantly higher in the control group for all studied hours (for all p < 0.05.Conclusions: Prior oral CCB therapy may have favorable effects in preventing myocyte necrosis after elective PCI.Keywords: calcium channel blockers, myonecrosis, percutaneous coronary interventions

  12. Occupational radiation doses during interventional procedures

    International Nuclear Information System (INIS)

    Nuraeni, N; Hiswara, E; Kartikasari, D; Waris, A; Haryanto, F

    2016-01-01

    Digital subtraction angiography (DSA) is a type of fluoroscopy technique used in interventional radiology to clearly visualize blood vessels in a bony or dense soft tissue environment. The use of DSA procedures has been increased quite significantly in the Radiology departments in various cities in Indonesia. Various reports showed that both patients and medical staff received a noticeable radiation dose during the course of this procedure. A study had been carried out to measure these doses among interventionalist, nurse and radiographer. The results show that the interventionalist and the nurse, who stood quite close to the X-ray beams compared with the radiographer, received radiation higher than the others. The results also showed that the radiation dose received by medical staff were var depending upon the duration and their position against the X-ray beams. Compared tothe dose limits, however, the radiation dose received by all these three medical staff were still lower than the limits. (paper)

  13. Imaging guided interventional procedures in paediatric uroradiology--a case based overview

    Energy Technology Data Exchange (ETDEWEB)

    Riccabona, M. E-mail: michael.riccabona@kfunigraz.ac.at; Sorantin, E.; Hausegger, K

    2002-08-01

    Objective: To describe the potential and application of interventional image guided procedures in the paediatric urinary tract. Patients and methods: The different techniques are illustrated using case reports. The examples comprise established indications such as percutaneous nephrostomy for compromised kidneys in obstructive uropathy and infection, sonographic guided renal biopsy including monitoring or treatment of complications after biopsy, and evaluation and balloon dilatation of childhood renal artery stenosis. There are new applications such as treatment of stenosis in cutaneous ureterostomy or sonographically guided catheterism for deployment of therapeutic agents. Results: Generally, the procedures are safe and successful. However, complications may occur, and peri-/post-interventional monitoring is mandatory to insure early detection and adequate management. Sometimes additional treatment such as percutaneous embolisation of a symptomatic post biopsy arterio-venous fistula, or a second biopsy for recurrent disease may become necessary. Conclusion: Imaging guided interventional procedures are performed successfully in a variety of diseases of the paediatric urinary tract. They can be considered a valuable additional modality throughout infancy and childhood.

  14. Imaging guided interventional procedures in paediatric uroradiology--a case based overview

    International Nuclear Information System (INIS)

    Riccabona, M.; Sorantin, E.; Hausegger, K.

    2002-01-01

    Objective: To describe the potential and application of interventional image guided procedures in the paediatric urinary tract. Patients and methods: The different techniques are illustrated using case reports. The examples comprise established indications such as percutaneous nephrostomy for compromised kidneys in obstructive uropathy and infection, sonographic guided renal biopsy including monitoring or treatment of complications after biopsy, and evaluation and balloon dilatation of childhood renal artery stenosis. There are new applications such as treatment of stenosis in cutaneous ureterostomy or sonographically guided catheterism for deployment of therapeutic agents. Results: Generally, the procedures are safe and successful. However, complications may occur, and peri-/post-interventional monitoring is mandatory to insure early detection and adequate management. Sometimes additional treatment such as percutaneous embolisation of a symptomatic post biopsy arterio-venous fistula, or a second biopsy for recurrent disease may become necessary. Conclusion: Imaging guided interventional procedures are performed successfully in a variety of diseases of the paediatric urinary tract. They can be considered a valuable additional modality throughout infancy and childhood

  15. Pediatric patient doses in interventional cardiology procedures

    International Nuclear Information System (INIS)

    Medeiros, R.B.; Murata, C.H.; Moreira, A.C.

    2014-01-01

    The radiation doses from interventional procedures is relevant when treating children because of their greater radiosensitivity compared with adults. The purposes of this paper were to estimate the dose received by 18 pediatric patients who underwent cardiac interventional procedures and to correlate the maximum entrance surface air kerma (Ke,max), estimated with radiochromic films, with the cumulative air kerma values displayed at the end of procedures. This study was performed in children up to 6 years. The study was performed in two hospitals, one located in Recife and the other one in São Paulo. The x-ray imaging systems used were Phillips Allura 12 model with image intensifier system and a Phillips Allura FD10 flat panel system. To estimate the Ke,max on the patient’s skin radiochromic films(Gafchromic XR-RV2) were used. These values were estimated from the maximum optical density measured on film using a calibration curve. The results showed cumulative air kerma values ranging from 78.3- 500.0mGy, with a mean value of 242,3 mGy. The resulting Ke,max values ranged from 20.0-461.8 mGy, with a mean value of 208,8 mGy. The Ke,max values were correlated with the displayed cumulative air kerma values. The correlation factor R² was 0.78, meaning that the value displayed in the equipment’s console can be useful for monitoring the skin absorbed dose throughout the procedure. The routine fluoroscopy time records is not able by itself alert the physician about the risk of dose exceeding the threshold of adverse reactions, which can vary from an early erythema to serious harmful skin damage. (author)

  16. Radiation exposure and contrast agent use related to radial versus femoral arterial access during percutaneous coronary intervention (PCI)-Results of the FERARI study.

    Science.gov (United States)

    Becher, Tobias; Behnes, Michael; Ünsal, Melike; Baumann, Stefan; El-Battrawy, Ibrahim; Fastner, Christian; Kuschyk, Jürgen; Papavassiliu, Theano; Hoffmann, Ursula; Mashayekhi, Kambis; Borggrefe, Martin; Akin, Ibrahim

    2016-12-01

    Data regarding radiation exposure related to radial versus femoral arterial access in patients undergoing percutaneous coronary intervention (PCI) remain controversial. This study aims to evaluate patients enrolled in the FERARI study regarding radiation exposure, fluoroscopy time and contrast agent use. The Femoral Closure versus Radial Compression Devices Related to Percutaneous Coronary Interventions (FERARI) study evaluated prospectively 400 patients between February 2014 and May 2015 undergoing PCI either using the radial or femoral access. In these 400 patients, baseline characteristics, procedural data such as procedural duration, fluoroscopy time, dose-area product (DAP) as well as the amount of contrast agent used were documented and analyzed. Median fluoroscopy time was not significantly different in patients undergoing radial versus femoral access (12.2 vs. 9.8min, p=0.507). Furthermore, median DAP (54.5 vs. 52.0 Gycm2, p=0.826), procedural duration (46.0 vs. 45.0min, p=0.363) and contrast agent use (185.5 vs. 199.5ml, p=0.742) were also similar in radial and femoral PCI. There was no difference regarding median fluoroscopy time, procedural duration, radiation dose or contrast agent use between radial versus femoral arterial access in PCI. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. Ultrasound guided percutaneous cholecystostomy in high-risk patients for surgical intervention

    Science.gov (United States)

    Bakkaloglu, Huseyin; Yanar, Hakan; Guloglu, Recep; Taviloglu, Korhan; Tunca, Fatih; Aksoy, Murat; Ertekin, Cemalettin; Poyanli, Arzu

    2006-01-01

    AIM: To assess the efficacy and safety of ultrasound guided percutaneous cholecystostomy (PC) in the treatment of acute cholecystitis in a well-defined high risk patients under general anesthesia. METHODS: The data of 27 consecutive patients who underwent percutaneous transhepatic cholecystostomy for the management of acute cholecystitis from January 1999 to June 2003 was retrospectively evaluated. All of the patients had both clinical and sonographic signs of acute cholecystitis and had comorbid diseases. RESULTS: Ultrasound revealed gallbladder stones in 25 patients and acalculous cholecystitis in two patients. Cholecystostomy catheters were removed 14-32 d (mean 23 d) after the procedure in cases where complete regression of all symptoms was achieved. There were statistically significant reductions in leukocytosis, (13.7 × 103 ± 1.3 × 103 μg/L vs 13 × 103 ± 1 × 103 μg/L, P < 0.05 for 24 h after PC; 13.7 × 103 ± 1.3 × 103 μg/L vs 8.3 × 103 ± 1.2 × 103 μg/L, P < 0.0001 for 72 h after PC), C -reactive protein (51.2 ± 18.5 mg/L vs 27.3 ± 10.4 mg/L, P < 0.05 for 24 h after PC; 51.2 ± 18.5 mg/L vs 5.4 ± 1.5 mg/L, P < 0.0001 for 72 h after PC), and fever (38 ± 0.35°C vs 37.3 ± 0.32°C, P < 0.05 for 24 h after PC; 38 ± 0.35°C vs 36.9 ± 0.15°C, P < 0.0001 for 72 h after PC). Sphincterotomy and stone extraction was performed successfully with endoscopic retrograde cholangio-pancreatography (ERCP) in three patients. After cholecystostomy, 5 (18%) patients underwent delayed cholecystectomy without any complications. Three out of 22 patients were admitted with recurrent acute cholecystitis during the follow-up and recovered with medical treatment. Catheter dislodgement occurred in three patients spontaneously, and two of them were managed by reinsertion of the catheter. CONCLUSION: As an alternative to surgery, percutan-eous cholecystostomy seems to be a safe method in critically ill patients with acute cholecystitis and can be performed with low

  18. Prognosis and high-risk complication identification in unselected patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention

    DEFF Research Database (Denmark)

    Andersson, Hedvig; Ripa, Maria Sejersten; Clemmensen, Peter

    2010-01-01

    The aim of this study was to evaluate treatment with primary percutaneous coronary intervention (PCI) in unselected patients with ST-segment elevation myocardial infarction (STEMI).......The aim of this study was to evaluate treatment with primary percutaneous coronary intervention (PCI) in unselected patients with ST-segment elevation myocardial infarction (STEMI)....

  19. Increased mortality associated with low use of clopidogrel in patients with heart failure and acute myocardial infarction not undergoing percutaneous coronary intervention: a nationwide study

    DEFF Research Database (Denmark)

    Bonde, Lisbeth; Sorensen, Rikke; Fosbøl, Emil Loldrup

    2010-01-01

    We studied the association of clopidogrel with mortality in acute myocardial infarction (AMI) patients with heart failure (HF) not receiving percutaneous coronary intervention (PCI).......We studied the association of clopidogrel with mortality in acute myocardial infarction (AMI) patients with heart failure (HF) not receiving percutaneous coronary intervention (PCI)....

  20. Cost of elective percutaneous coronary intervention in Malaysia: a multicentre cross-sectional costing study.

    Science.gov (United States)

    Lee, Kun Yun; Ong, Tiong Kiam; Low, Ee Vien; Liow, Siow Yen; Anchah, Lawrence; Hamzah, Syuhada; Liew, Houng Bang; Ali, Rosli Mohd; Ismail, Omar; Ahmad, Wan Azman Wan; Said, Mas Ayu; Dahlui, Maznah

    2017-05-28

    Limitations in the quality and access of cost data from low-income and middle-income countries constrain the implementation of economic evaluations. With the increasing prevalence of coronary artery disease in Malaysia, cost information is vital for cardiac service expansion. We aim to calculate the hospitalisation cost of percutaneous coronary intervention (PCI), using a data collection method customised to local setting of limited data availability. This is a cross-sectional costing study from the perspective of healthcare providers, using top-down approach, from January to June 2014. Cost items under each unit of analysis involved in the provision of PCI service were identified, valuated and calculated to produce unit cost estimates. Five public cardiac centres participated. All the centres provide full-fledged cardiology services. They are also the tertiary referral centres of their respective regions. The cost was calculated for elective PCI procedure in each centre. PCI conducted for urgent/emergent indication or for patients with shock and haemodynamic instability were excluded. The outcome measures of interest were the unit costs at the two units of analysis, namely cardiac ward admission and cardiac catheterisation utilisation, which made up the total hospitalisation cost. The average hospitalisation cost ranged between RM11 471 (US$3186) and RM14 465 (US$4018). PCI consumables were the dominant cost item at all centres. The centre with daycare establishment recorded the lowest admission cost and total hospitalisation cost. Comprehensive results from all centres enable comparison at the levels of cost items, unit of analysis and total costs. This generates important information on cost variations between centres, thus providing valuable guidance for service planning. Alternative procurement practices for PCI consumables may deliver cost reduction. For countries with limited data availability, costing method tailored based on country setting can be used for

  1. Percutaneous coronary intervention with ABSORB biodegradable vascular scaffold in patients with left anterior descending artery disease

    Directory of Open Access Journals (Sweden)

    К. М. Ваккосов

    2017-04-01

    Full Text Available Aim. The article evaluates 30-day results of percutaneous coronary intervention (PCI with ABSORB biodegradable vascular scaffold (BVS implanted in the case of stenosis of the left anterior descending (LAD coronary artery in patients with stable angina.Methods. 64 patients with significant (≥ 70% LAD disease were included in the study. At 30 days, scaffold thrombosis and major adverse cardiovascular events (all-cause mortality, myocardial infarction, stroke, target vessel revascularization were evaluated. The indicator of successful percutaneous coronary intervention (residual stenosis ≤20% in the presence of counterpulsation corresponding to TIMI 3rd Grade and in the absence of significant in-patient clinical complications and successful intervention assessed by clinical criteria (successful percutaneous coronary intervention alongside with a decrease in objective and subjective symptoms of myocardial ischemia, or their complete disappearance were also analyzed. Results. Mean age of patients was 61.6±8.5 years, with males accounting for 64%; 33% had earlier MI, 14% – diabetes mellitus. Mean left ventricular ejection fraction was 61.3±6.8%. Left anterior descending artery disease was presented in 89% of patients with SYNTAX Score 6.6±2.2. Mean number of implanted stents was 1.2±0.4, with mean length of the stented segment equal to18.7±1.8 mm and mean diameter 3.2±0.3 mm. At 30-day follow-up, the success of intervention assessed by clinical criteria amounted to 96.9% (n=62; that of myocardial infarction 3.1% (n=2; stent thrombosis 1.56% (n=1; repeated revascularization 1.56% (n=1; major adverse cardiovascular events (MACE 3.1%.Conclusion. The implantation of everolimus-eluting BVS for LAD stenosis demonstrates satisfactory results at 30-day follow-up.Received 16 January 2017. Accepted 21 March 2017.Financing: The study did not have sponsorship.Conflict of interest: The authors declare no conflict of interest.

  2. Volume navigation with contrast enhanced ultrasound and image fusion for percutaneous interventions: first results.

    Directory of Open Access Journals (Sweden)

    Ernst Michael Jung

    Full Text Available OBJECTIVE: Assessing the feasibility and efficiency of interventions using ultrasound (US volume navigation (V Nav with real time needle tracking and image fusion with contrast enhanced (ce CT, MRI or US. METHODS: First an in vitro study on a liver phantom with CT data image fusion was performed, involving the puncture of a 10 mm lesion in a depth of 5 cm performed by 15 examiners with US guided freehand technique vs. V Nav for the purpose of time optimization. Then 23 patients underwent ultrasound-navigated biopsies or interventions using V Nav image fusion of live ultrasound with ceCT, ceMRI or CEUS, which were acquired before the intervention. A CEUS data set was acquired in all patients. Image fusion was established for CEUS and CT or CEUS and MRI using anatomical landmarks in the area of the targeted lesion. The definition of a virtual biopsy line with navigational axes targeting the lesion was achieved by the usage of sterile trocar with a magnetic sensor embedded in its distal tip employing a dedicated navigation software for real time needle tracking. RESULTS: The in vitro study showed significantly less time needed for the simulated interventions in all examiners when V Nav was used (p<0.05. In the study involving patients, in all 10 biopsies of suspect lesions of the liver a histological confirmation was achieved. We also used V Nav for a breast biopsy (intraductal carcinoma, for a biopsy of the abdominal wall (metastasis of ovarial carcinoma and for radiofrequency ablations (4 ablations. In 8 cases of inflammatory abdominal lesions 9 percutaneous drainages were successfully inserted. CONCLUSION: Percutaneous biopsies and drainages, even of small lesions involving complex access pathways, can be accomplished with a high success rate by using 3D real time image fusion together with real time needle tracking.

  3. Percutaneous Management of Accidentally Retained Foreign Bodies During Image-Guided Non-vascular Procedures: Novel Technique Using a Large-Bore Biopsy System

    Energy Technology Data Exchange (ETDEWEB)

    Cazzato, Roberto Luigi, E-mail: gigicazzato@hotmail.it; Garnon, Julien, E-mail: juleiengarnon@gmail.com [Hôpitaux Universitaires de Strasbourg, HUS, Department of Interventional Radiology, Nouvel Hôpital Civil (France); Ramamurthy, Nitin, E-mail: nitin-ramamurthy@hotmail.com [Norfolk and Norwich University Hospital, Department of Radiology (United Kingdom); Tsoumakidou, Georgia, E-mail: georgia.tsoumakidou@chru-strasbourg.fr; Caudrelier, Jean, E-mail: jean.caudrelier@chru-strasbourg.fr; Thénint, Marie-Aude, E-mail: marie-aude.thenint@chru-strasbourg.fr; Rao, Pramod, E-mail: pramodrao@me.com; Koch, Guillaume, E-mail: guillaume.koch@chru-strasbourg.fr; Gangi, Afshin, E-mail: gangi@unistra.fr [Hôpitaux Universitaires de Strasbourg, HUS, Department of Interventional Radiology, Nouvel Hôpital Civil (France)

    2016-07-15

    ObjectiveTo describe a novel percutaneous image-guided technique using a large-bore biopsy system to retrieve foreign bodies (FBs) accidentally retained during non-vascular interventional procedures.Materials and MethodsBetween May 2013 and October 2015, five patients underwent percutaneous retrieval of five iatrogenic FBs, including a biopsy needle tip in the femoral head following osteoblastoma biopsy and radiofrequency ablation (RFA); a co-axial needle shaft within a giant desmoid tumour following cryoablation; and three post-vertebroplasty cement tails within paraspinal muscles. All FBs were retrieved immediately following original procedures under local or general anaesthesia, using combined computed tomography (CT) and fluoroscopic guidance. The basic technique involved positioning a 6G trocar sleeve around the FB long axis and co-axially advancing an 8G biopsy needle to retrieve the FB within the biopsy core. Retrospective chart review facilitated analysis of procedures, FBs, technical success, and complications.ResultsMean FB size was 23 mm (range 8–74 mm). Four FBs were located within 10 mm of non-vascular significant anatomic structures. The basic technique was successful in 3 cases; 2 cases required technical modifications including using a stiff guide-wire to facilitate retrieval in the case of the post-cryoablation FB; and using the central mandrin of the 6G trocar to push a cement tract back into an augmented vertebra when initial retrieval failed. Overall technical success (FB retrieval or removal to non-hazardous location) was 100 %, with no complications.ConclusionPercutaneous image-guided retrieval of iatrogenic FBs using a large-bore biopsy system is a feasible, safe, effective, and versatile technique, with potential advantages over existing methods.

  4. Percutaneous management of tumoral biliary obstruction in children

    Energy Technology Data Exchange (ETDEWEB)

    Akinci, Devrim; Gumus, Burcak; Ozkan, Orhan S.; Ozmen, Mustafa N.; Akhan, Okan [Hacettepe School of Medicine, Department of Radiology, Sihhiye, Ankara (Turkey); Ekinci, Saniye [Hacettepe School of Medicine, Department of Paediatric Surgery, Sihhiye, Ankara (Turkey); Akcoren, Zuhal [Hacettepe School of Medicine, Department of Paediatric Pathology, Sihhiye, Ankara (Turkey); Kutluk, Tezer [Hacettepe School of Medicine, Department of Paediatric Oncology, Sihhiye, Ankara (Turkey)

    2007-10-15

    There is limited experience of percutaneous biliary interventions in children although they are safe and effective procedures. To evaluate the efficacy and safety of percutaneous management of tumoral biliary obstruction in children. Percutaneous biliary interventions were performed in eight children (six boys, two girls) with a mean age of 10.5 years (range 4-17 years). The interventions included percutaneous biliary drainage (five patients), percutaneous biliary drainage and placement of a self-expanding metallic stent (two patients), and percutaneous cholecystostomy (one patient). All patients had signs of obstructive jaundice and two had cholangitis. All procedures were successful. No procedure-related mortality was observed. Bilirubin levels returned to normal in four of the eight patients. Findings of cholangitis resolved in the two affected patients after the procedure and antibiotic treatment. Two patients underwent surgery after percutaneous biliary drainage procedures. A self-expanding metallic stent was placed in two patients with malignancy and the stents remained patent until death. Percutaneous biliary interventions can be performed safely for the management of tumoral biliary obstruction in children. (orig.)

  5. Percutaneous management of tumoral biliary obstruction in children

    International Nuclear Information System (INIS)

    Akinci, Devrim; Gumus, Burcak; Ozkan, Orhan S.; Ozmen, Mustafa N.; Akhan, Okan; Ekinci, Saniye; Akcoren, Zuhal; Kutluk, Tezer

    2007-01-01

    There is limited experience of percutaneous biliary interventions in children although they are safe and effective procedures. To evaluate the efficacy and safety of percutaneous management of tumoral biliary obstruction in children. Percutaneous biliary interventions were performed in eight children (six boys, two girls) with a mean age of 10.5 years (range 4-17 years). The interventions included percutaneous biliary drainage (five patients), percutaneous biliary drainage and placement of a self-expanding metallic stent (two patients), and percutaneous cholecystostomy (one patient). All patients had signs of obstructive jaundice and two had cholangitis. All procedures were successful. No procedure-related mortality was observed. Bilirubin levels returned to normal in four of the eight patients. Findings of cholangitis resolved in the two affected patients after the procedure and antibiotic treatment. Two patients underwent surgery after percutaneous biliary drainage procedures. A self-expanding metallic stent was placed in two patients with malignancy and the stents remained patent until death. Percutaneous biliary interventions can be performed safely for the management of tumoral biliary obstruction in children. (orig.)

  6. Demonstration of the Safety and Feasibility of Robotically Assisted Percutaneous Coronary Intervention in Complex Coronary Lesions: Results of the CORA-PCI Study (Complex Robotically Assisted Percutaneous Coronary Intervention).

    Science.gov (United States)

    Mahmud, Ehtisham; Naghi, Jesse; Ang, Lawrence; Harrison, Jonathan; Behnamfar, Omid; Pourdjabbar, Ali; Reeves, Ryan; Patel, Mitul

    2017-07-10

    The aims of this study were to evaluate the feasibility and technical success of robotically assisted percutaneous coronary intervention (R-PCI) for the treatment of coronary artery disease (CAD) in clinical practice, especially in complex lesions, and to determine the safety and clinical success of R-PCI compared with manual percutaneous coronary intervention (M-PCI). R-PCI is safe and feasible for simple coronary lesions. The utility of R-PCI for complex coronary lesions is unknown. All consecutive PCI procedures performed robotically (study group) or manually (control group) over 18 months were included. R-PCI technical success, defined as the completion of the procedure robotically or with partial manual assistance and without a major adverse cardiovascular event, was determined. Procedures ineligible for R-PCI (i.e., atherectomy, planned 2-stent strategy for bifurcation lesion, chronic total occlusion requiring hybrid approach) were excluded for analysis from the M-PCI group. Clinical success, defined as completion of the PCI procedure without a major adverse cardiovascular event, procedure time, stent use, and fluoroscopy time were compared between groups. A total of 315 patients (mean age 67.7 ± 11.8 years; 78% men) underwent 334 PCI procedures (108 R-PCIs, 157 lesions, 78.3% type B2/C; 226 M-PCIs, 336 lesions, 68.8% type B2/C). Technical success with R-PCI was 91.7% (rate of manual assistance 11.1%, rate of manual conversion 7.4%, rate of major adverse cardiovascular events 0.93%). Clinical success (99.1% with R-PCI vs. 99.1% with M-PCI; p = 1.00), stent use (stents per procedure 1.59 ± 0.79 with R-PCI vs. 1.54 ± 0.75 with M-PCI; p = 0.73), and fluoroscopy time (18.2 ± 10.4 min with R-PCI vs. 19.2 ± 11.4 min with M-PCI; p = 0.39) were similar between the groups, although procedure time was longer in the R-PCI group (44:30 ± 26:04 min:s vs. 36:34 ± 23:03 min:s; p = 0.002). Propensity-matched analysis confirmed that procedure time was longer

  7. Antithrombotic strategies in patients undergoing percutaneous coronary intervention for acute coronary syndrome

    Directory of Open Access Journals (Sweden)

    Son V Pham

    2010-09-01

    Full Text Available Son V Pham1, Phuong-Chi T Pham2, Phuong-Mai T Pham3, Jeffrey M Miller4, Phuong-Thu T Pham5, Phuong-Anh T Pham61Bay Pines VA Medical Center, Department of Cardiology, Bay Pines, FL, USA; 2Department of Medicine, Nephrology Division, UCLA-Olive View Medical Center, 3Department of Medicine, Greater Los Angeles VA Medical Center, 4Department of Medicine, Hematology-Oncology Division, UCLA-Olive View Medical Center, 5Department of Medicine, Nephrology Division, Kidney and Pancreas Transplant Program, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; 6Mercy General Hospital, Heart and Vascular Institute, Department of Cardiology, Sacramento, CA, USAAbstract: In patients undergoing percutaneous coronary intervention (PCI for acute coronary syndrome (ACS, both periprocedural acute myocardial infarction and bleeding complications have been shown to be associated with early and late mortality. Current standard antithrombotic therapy after coronary stent implantation consists of lifelong aspirin and clopidogrel for a variable period depending in part on the stent type. Despite its well-established efficacy in reducing cardiac-related death, myocardial infarction, and stroke, dual antiplatelet therapy with aspirin and clopidogrel is not without shortcomings. While clopidogrel may be of little beneficial effect if administered immediately prior to PCI and may even increase major bleeding risk if coronary artery bypass grafting is anticipated, early discontinuation of the drug may result in insufficient antiplatelet coverage with thrombotic complications. Optimal and rapid inhibition of platelet activity to suppress ischemic and thrombotic events while minimizing bleeding complications is an important therapeutic goal in the management of patients undergoing percutaneous coronary intervention. In this article we present an overview of the literature on clinical trials evaluating the different aspects of antithrombotic therapy in patients

  8. Percutaneous CT-Guided Biopsy of C3 Vertebral Body: Modified Approach for an Old Procedure

    International Nuclear Information System (INIS)

    Pua, Uei; Chan, Stephen Yung-Wei

    2013-01-01

    Percutaneous biopsy of upper cervical vertebrae is challenging due to the various critical structures in the location and often requires difficult trajectory such as transoral or paramaxillary approaches. The purpose of this manuscript is to illustrate the utility of head rotation in creating a potential space for direct percutaneous access to C3 vertebral body for safe biopsy.

  9. Percutaneous CT-Guided Biopsy of C3 Vertebral Body: Modified Approach for an Old Procedure

    Energy Technology Data Exchange (ETDEWEB)

    Pua, Uei, E-mail: druei@yahoo.com [Tan Tock Seng Hospital, Department of Diagnostic Radiology (Singapore); Chan, Stephen Yung-Wei [Tan Tock Seng Hospital, Department of Anaesthesiology, Intensive Care and Pain Medicine (Singapore)

    2013-06-15

    Percutaneous biopsy of upper cervical vertebrae is challenging due to the various critical structures in the location and often requires difficult trajectory such as transoral or paramaxillary approaches. The purpose of this manuscript is to illustrate the utility of head rotation in creating a potential space for direct percutaneous access to C3 vertebral body for safe biopsy.

  10. A pilot randomized trial of pentoxifylline for the reduction of periprocedural myocardial injury in patients undergoing elective percutaneous coronary intervention.

    Science.gov (United States)

    Aslanabadi, Naser; Shirzadi, Hamid Reza; Asghari-Soufi, Hossein; Dousti, Samaneh; Ghaffari, Samad; Sohrabi, Bahram; Mashayekhi, Simin Ozar; Hamishehkar, Hadi; Entezari-Maleki, Taher

    2015-02-01

    Periprocedural myocardial injury (PMI) following percutaneous coronary intervention (PCI) has received great attention due to its significant association with mortality and morbidity. Accordingly, cardioprotection during PCI is one of the important therapeutic concerns. Regarding the potential cardiovascular benefits of pentoxifylline this study was performed to evaluate whether the pretreatment pentoxifylline could reduce PMI in patients who are undergoing elective PCI. A randomized clinical trial on 85 patients undergoing elective PCI was performed. The intervention group (n = 41) received 1200 mg pentoxifylline in divided doses plus the standard treatment before PCI, while the control group (n = 44) received the standard treatment. For assessing myocardial damage during PCI, the levels of CK-MB and troponin-I were measured at baseline, 8, and 24 h after the procedure. Then, patients were followed up for a 1-month period regarding the major adverse cardiac effect. Comparing with the control group, no significant change of CK-MB at 8 (p = 0.315) and 24 h (p = 0.896) after PCI was documented in pentoxifylline group. Similarly, no significant change was found in troponin-I at 8 (p = 0.141) and 24 h (p = 0.256) after PCI. This study could not support the pretreatment with pentoxifylline in the prevention of PMI in patients undergoing elective PCI. However, the trend was toward the potential benefit of pentoxifylline.

  11. Influence of the Target Vessel on the Location and Area of Maximum Skin Dose during Percutaneous Coronary Intervention

    International Nuclear Information System (INIS)

    Chida, K.; Fuda, K.; Kagaya, Y.; Saito, H.; Takai, Y.; Kohzuki, M.; Takahash i, S.; Yamada, S.; Zuguchi, M.

    2007-01-01

    Background: A number of cases involving radiation-associated patient skin injury attributable to percutaneous coronary intervention (PCI) have been reported. Knowledge of the location and area of the patient's maximum skin dose (MSD) in PCI is necessary to reduce the risk of skin injury. Purpose: To determine the location and area of the MSD in PCI, and separately analyze the effects of different target vessels. Material and Methods: 197 consecutive PCI procedures were studied, and the location and area of the MSD were calculated by a skin-dose mapping software program: Caregraph. The target vessels of the PCI procedures were divided into four groups based on the American Heart Association (AHA) classification. Results: The sites of the MSD for AHA no.1-3, AHA no.4, and AHA no.11-15 were located mainly on the right back skin, the lower right or center back skin, and the upper back skin areas, respectively, whereas the MSD sites for the AHA no. 5-10 PCI were widely spread. The MSD area for the AHA no. 4 PCI was larger than that for the AHA no. 11-15 PCI (P<0.0001). Conclusion: Although the radiation associated with PCI can be widely spread and variable, we observed a tendency regarding the location and area of the MSD when we separately analyzed the data for different target vessels. We recommend the use of a smaller radiation field size and the elimination of overlapping fields during PCI

  12. Association of elevated radiation dose with mortality in patients with acute myocardial infarction undergoing percutaneous coronary intervention

    Energy Technology Data Exchange (ETDEWEB)

    Parikh, Puja B.; Prakash, Sheena; Tahir, Usman; Kort, Smadar; Gruberg, Luis; Jeremias, Allen, E-mail: allen.jeremias@stonybrook.edu

    2014-09-15

    Objectives: This study sought to identify clinical and procedural predictors of elevated radiation dose received by patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI) and to determine if elevated radiation dose was predictive of mortality in this population. Background: Little data exist regarding the impact of excessive radiation burden on clinical outcomes in patients undergoing PCI. Methods: The study population included 1,039 patients who underwent PCI for an AMI between January 1, 2007 and December 31, 2008 at an academic tertiary care teaching hospital. Cumulative skin dose (measured in milligray [mGy]) was selected as a measurement of patient radiation burden. Clinical and procedural variables were analyzed in multiple logistic and linear regression models to determine predictors of higher skin dose, and its impact was evaluated on all-cause intermediate-term mortality at two years. Results: Median skin dose was 2120 mGy (IQR 1379–3190 mGy) in the overall population, of which 153 (20.8%) patients received an elevated skin dose (defined as a skin dose > 4,000 mGy). Independent predictors of elevated skin dose included male gender, obesity, multivessel intervention, and presentation with a non-ST-elevation MI (NSTEMI) versus an ST-elevation MI (STEMI). Increased skin dose was not predictive of intermediate-term mortality by multivariate analysis in the overall population or in either subgroup of STEMI and NSTEMI. Conclusions: In this contemporary observational study examining patients with AMI undergoing PCI, male gender, obesity, multivessel intervention, and presentation with a NSTEMI were associated with increased radiation exposure.

  13. Single-Pass Percutaneous Liver Biopsy for Diffuse Liver Disease Using an Automated Device: Experience in 154 Procedures

    International Nuclear Information System (INIS)

    Rivera-Sanfeliz, Gerant; Kinney, Thomas B.; Rose, Steven C.; Agha, Ayad K.M.; Valji, Karim; Miller, Franklin J.; Roberts, Anne C.

    2005-01-01

    Purpose: To describe our experience with ultrasound (US)-guided percutaneous liver biopsies using the INRAD 18G Express core needle biopsy system.Methods: One hundred and fifty-four consecutive percutaneous core liver biopsy procedures were performed in 153 men in a single institution over 37 months. The medical charts, pathology reports, and radiology files were retrospectively reviewed. The number of needle passes, type of guidance, change in hematocrit level, and adequacy of specimens for histologic analysis were evaluated.Results: All biopsies were performed for histologic staging of chronic liver diseases. The majority of patients had hepatitis C (134/153, 90.2%). All patients were discharged to home after 4 hr of postprocedural observation. In 145 of 154 (94%) biopsies, a single needle pass was sufficient for diagnosis. US guidance was utilized in all but one of the procedures (153/154, 99.4%). The mean hematocrit decrease was 1.2% (44.1-42.9%). Pain requiring narcotic analgesia, the most frequent complication, occurred in 28 of 154 procedures (18.2%). No major complications occurred. The specimens were diagnostic in 152 of 154 procedures (98.7%).Conclusions: Single-pass percutaneous US-guided liver biopsy with the INRAD 18G Express core needle biopsy system is safe and provides definitive pathologic diagnosis of chronic liver disease. It can be performed on an outpatient basis. Routine post-biopsy monitoring of hematocrit level in stable, asymptomatic patients is probably not warranted

  14. Type D personality and diabetes predict the onset of depressive symptoms in patients after percutaneous coronary intervention

    DEFF Research Database (Denmark)

    Pedersen, Susanne S.; Ong, Andrew T L; Sonnenschein, Karel

    2006-01-01

    Depression is common in cardiac patients and has been associated with adverse clinical outcome. However, little is known about predictors of the onset of depressive symptoms. We examined predictors of the onset of depressive symptoms at 12 months post-percutaneous coronary intervention (PCI...

  15. Negative and positive affect are independently associated with patient-reported health status following percutaneous coronary intervention

    NARCIS (Netherlands)

    H. Versteeg (Henneke); S.S. Pedersen (Susanne); R.A.M. Erdman (Ruud); J.W.I. van Nierop; P.P.T. de Jaegere (Peter); R.T. van Domburg (Ron)

    2009-01-01

    textabstractPurpose: We examined the association between negative and positive affect and 12-month health status in patients treated with percutaneous coronary intervention (PCI) with drug-eluting stents. Methods: Consecutive PCI patients (n = 562) completed the Global Mood Scale at baseline to

  16. Impact of triple antithrombotic therapy in patients with acute coronary syndrome undergoing percutaneous coronary intervention in real-world practice

    NARCIS (Netherlands)

    Yan, Yan; Wang, Xiao; Fan, Jing-Yao; Nie, Shao-Ping; Raposeiras-Roubín, Sergio; Abu-Assi, Emad; Henriques, Jose P. Simao; D'Ascenzo, Fabrizio; Saucedo, Jorge; González-Juanatey, José R.; Wilton, Stephen B.; Kikkert, Wouter J.; Nuñez-Gil, Iván; Ariza-Sole, Albert; Song, Xian-Tao; Alexopoulos, Dimitrios; Liebetrau, Christoph; Kawaji, Tetsuma; Moretti, Claudio; Huczek, Zenon; Fujii, Toshiharu; Correia, Luis Cl; Kawashiri, Masa-Aki; Kedev, Sasko

    2017-01-01

    The optimal antithrombotic regimen for patients on oral anticoagulation (OAC) after acute coronary syndrome (ACS) and percutaneous coronary intervention (PCI) remains debated. This study sought to evaluate the efficacy and safety of OAC plus clopidogrel with or without aspirin in a real-world

  17. 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

  18. Primary Percutaneous Coronary Intervention as a National Reperfusion Strategy in Patients With ST-Segment Elevation Myocardial Infarction

    DEFF Research Database (Denmark)

    Terkelsen, Christian J; Jensen, Lisette O; Hansen, Hans-Henrik Tilsted

    2011-01-01

    In Denmark, primary percutaneous coronary intervention (PPCI) was chosen as a national reperfusion strategy for patients with ST-segment elevation myocardial infarction in 2003. This study describes the temporal implementation of PPCI in Western Denmark, the gradual introduction of field triage...

  19. Correlates and Impact of Coronary Artery Calcifications in Women Undergoing Percutaneous Coronary Intervention With Drug-Eluting Stents

    DEFF Research Database (Denmark)

    Giustino, Gennaro; Mastoris, Ioannis; Baber, Usman

    2016-01-01

    OBJECTIVES: The aim of this study was to investigate the clinical correlates and prognostic impact of coronary artery calcification (CAC) in women undergoing percutaneous coronary intervention with drug-eluting stents (DES). BACKGROUND: The clinical correlates and the prognostic significance of CAC...

  20. Impact of presentation and transfer delays on complete ST-segment resolution before primary percutaneous coronary intervention

    DEFF Research Database (Denmark)

    Fabris, Enrico; van't Hof, Arnoud; Hamm, Christian W.

    2017-01-01

    AIMS: The aim of this study was to identify predictors of complete ST-segment resolution (STR) pre-primary percutaneous coronary intervention (PCI) in patients enrolled in the ATLANTIC trial. METHODS AND RESULTS: ECGs recorded at the time of inclusion (pre-hospital [pre-H]-ECG) and in the cathete...

  1. Early Intravenous Beta-Blockers in Patients With ST-Segment Elevation Myocardial Infarction Before Primary Percutaneous Coronary Intervention

    NARCIS (Netherlands)

    Roolvink, Vincent; Ibanez, Borja; Ottervanger, Jan Paul; Pizarro, Gonzalo; van Royen, Niels; Mateos, Alonso; Dambrink, Jan-Henk E.; Escalera, Noemi; Lipsic, Erik; Albarran, Agustin; Fernandez-Ortiz, Antonio; Fernandez-Aviles, Francisco; Goicolea, Javier; Botas, Javier; Remkes, Wouter; Hernandez-Jaras, Victoria; Kedhi, Elvin; Zamorano, Jose L.; Navarro, Felipe; Alfonso, Fernando; Garcia-Lledo, Alberto; Alonso, Joaquin; van Leeuwen, Maarten; Nijveldt, Robin; Postma, Sonja; Kolkman, Evelien; Gosselink, Marcel; de Smet, Bart; Rasoul, Saman; Piek, Jan J.; Fuster, Valentin; Van 't Hof, Arnoud W. J.

    2016-01-01

    BACKGROUND The impact of intravenous (IV) beta-blockers before primary percutaneous coronary intervention (PPCI) on infarct size and clinical outcomes is not well established. OBJECTIVES This study sought to conduct the first double-blind, placebo-controlled international multicenter study testing

  2. Early Intravenous Beta-Blockers in Patients With ST-Segment Elevation Myocardial Infarction Before Primary Percutaneous Coronary Intervention

    NARCIS (Netherlands)

    Roolvink, Vincent; Ibáñez, Borja; Ottervanger, Jan Paul; Pizarro, Gonzalo; van Royen, Niels; Mateos, Alonso; Dambrink, Jan-Henk E.; Escalera, Noemi; Lipsic, Erik; Albarran, Agustín; Fernández-Ortiz, Antonio; Fernández-Avilés, Francisco; Goicolea, Javier; Botas, Javier; Remkes, Wouter; Hernandez-Jaras, Victoria; Kedhi, Elvin; Zamorano, José L.; Navarro, Felipe; Alfonso, Fernando; García-Lledó, Alberto; Alonso, Joaquin; van Leeuwen, Maarten; Nijveldt, Robin; Postma, Sonja; Kolkman, Evelien; Gosselink, Marcel; de Smet, Bart; Rasoul, Saman; Piek, Jan J.; Fuster, Valentin; van 't Hof, Arnoud W. J.

    2016-01-01

    The impact of intravenous (IV) beta-blockers before primary percutaneous coronary intervention (PPCI) on infarct size and clinical outcomes is not well established. This study sought to conduct the first double-blind, placebo-controlled international multicenter study testing the effect of early IV

  3. ST peak during primary percutaneous coronary intervention predicts final infarct size, left ventricular function, and clinical outcome

    DEFF Research Database (Denmark)

    Lønborg, Jacob Thomsen; Kelbæk, Henning Skov; Holmvang, Lene

    2012-01-01

    One third of patients treated with primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction develop a secondary increase in electrocardiographic ST segment (ST peak) during reperfusion. The purpose was to determine the clinical importance of ST peak during primary PCI....

  4. Percutaneous coronary intervention and antiplatelet therapy in patients with atrial fibrillation receiving apixaban or warfarin: Insights from the ARISTOTLE trial

    NARCIS (Netherlands)

    Kopin, D.; Jones, W.S.; Sherwood, M.W.; Wojdyla, D.M.; Wallentin, L.; Lewis, B.S.; Verheugt, F.W.A.; Vinereanu, D.; Bahit, M.C.; Halvorsen, S.; Huber, K.; Parkhomenko, A.; Granger, C.B.; Lopes, R.D.; Alexander, J.H.

    2018-01-01

    BACKGROUND: We assessed antiplatelet therapy use and outcomes in patients undergoing percutaneous coronary intervention (PCI) during the ARISTOTLE trial. METHODS: Patients were categorized based on the occurrence of PCI during follow-up (median 1.8 years); PCI details and outcomes post-PCI are

  5. Comparative Outcomes After Percutaneous Coronary Intervention Among Black and White Patients Treated at US Veterans Affairs Hospitals.

    Science.gov (United States)

    Kobayashi, Taisei; Glorioso, Thomas J; Armstrong, Ehrin J; Maddox, Thomas M; Plomondon, Mary E; Grunwald, Gary K; Bradley, Steven M; Tsai, Thomas T; Waldo, Stephen W; Rao, Sunil V; Banerjee, Subhash; Nallamothu, Brahmajee K; Bhatt, Deepak L; Rene, A Garvey; Wilensky, Robert L; Groeneveld, Peter W; Giri, Jay

    2017-09-01

    Current comparative outcomes among black and white patients treated with percutaneous coronary intervention (PCI) in the Veterans Affairs (VA) health system are not known. To compare outcomes between black and white patients undergoing PCI in the VA health system. This study compared black and white patients who underwent PCI between October 1, 2007, and September 30, 2013, at 63 VA hospitals using data recorded in the VA Clinical Assessment, Reporting, and Tracking System for Cardiac Catheterization Laboratories (CART-CL) program. A generalized linear mixed model with a random intercept for site assessed the relative difference in odds of outcomes between black and white patients. The setting was integrated institutionalized hospital care. Excluded were all patients of other races or those with multiple listed races and those with missing data regarding race or the diagnostic cardiac catheterization. The dates of analysis were January 7, 2016, to April 17, 2017. Percutaneous coronary intervention at a VA hospital. The primary outcome was 1-year mortality. Secondary outcomes were 30-day all-cause readmission rates, 30-day acute kidney injury, 30-day blood transfusion, and 1-year readmission rates for myocardial infarction. In addition, variations in procedural and postprocedural care were examined, including the use of intravascular ultrasound, optical coherence tomography, fractional flow reserve measurements, bare-metal stents, postprocedural medications, and radial access. A total of 42 391 patients (13.3% black and 98.4% male; mean [SD] age, 65.2 [9.1] years) satisfied the inclusion and exclusion criteria. In unadjusted analyses, black patients had higher rates of 1-year mortality (7.1% vs 5.9%, P < .001) as well as secondary outcomes of 30-day acute kidney injury (20.8% vs 13.8%, P < .001), 30-day blood transfusion (3.4% vs 2.7%, P < .01), and 1-year readmission rates for myocardial infarction (3.3% vs 2.7%, P = .01) compared with white

  6. Percutaneous angioscopy

    International Nuclear Information System (INIS)

    Beck, A.

    1987-01-01

    In dogs and 11 patients a new endoscopic method for arteries has been developed. The approach is transfemoral, and endoscopy is combined with angiography, percutaneous transluminal angioplasty (PTA), and local lysis. An ultrathin endoscope with a diameter of 2.4 mm is used, which also provides a working channel with a diameter of 0.4 mm. Guide wires, contrast media, and drugs for local lysis can be inserted through this channel. Under fluoroscopic control, the endoscope is placed in the region of interest, followed by a special method for decreasing blood flow. Endoscopy is documented by video or by a high-speed camera. No complications have occurred. In all patients, it was possible to demonstrate the results of dilatation, recanalization, or local lysis before and after the interventional procedure. (orig.) [de

  7. Percutaneous drainage of lung abscess

    Energy Technology Data Exchange (ETDEWEB)

    Ri, Jong Min; Kim, Yong Joo; Kang, Duk Sik [Kyung-Pook National University Hospital, Daegu (Korea, Republic of)

    1992-05-15

    Medical treatment using antibiotics and postural drainage has been widely adopted as a treatment method of pulmonary abscess, accompanied by surgical methods in cases intractable to drug therapy. However long-term therapy may be required, and the tolerance of organisms to antibiotics or other complications are apt to be encountered, during medical treatment. To shorten the convalescent period or to decrease the risk of invasive procedures, rather simple and relatively easy interventional techniques such as transbronchial or percutaneous catheter drainage have been successfully tried. We have performed 12 cases of percutaneous drainages of lung abscesses under fluoroscope guidance. This report is on the results of this procedure.

  8. Percutaneous drainage of lung abscess

    International Nuclear Information System (INIS)

    Ri, Jong Min; Kim, Yong Joo; Kang, Duk Sik

    1992-01-01

    Medical treatment using antibiotics and postural drainage has been widely adopted as a treatment method of pulmonary abscess, accompanied by surgical methods in cases intractable to drug therapy. However long-term therapy may be required, and the tolerance of organisms to antibiotics or other complications are apt to be encountered, during medical treatment. To shorten the convalescent period or to decrease the risk of invasive procedures, rather simple and relatively easy interventional techniques such as transbronchial or percutaneous catheter drainage have been successfully tried. We have performed 12 cases of percutaneous drainages of lung abscesses under fluoroscope guidance. This report is on the results of this procedure

  9. Cerebrovascular accidents after percutaneous coronary interventions from 2002 to 2014: Incidence, outcomes, and associated variables.

    Science.gov (United States)

    Didier, Romain; Gaglia, Michael A; Koifman, Edward; Kiramijyan, Sarkis; Negi, Smita I; Omar, Al Fazir; Gai, Jiaxing; Torguson, Rebecca; Pichard, Augusto D; Waksman, Ron

    2016-02-01

    Cerebrovascular accident (CVA) and transient ischemic attack (TIA) related to percutaneous coronary intervention (PCI) are relatively rare complications, but they are associated with high morbidity and mortality. Given the evolution of both CVA risk and PCI techniques over time, this study was conducted to evaluate trends in CVA and TIA associated with PCI and to identify variables associated with neurologic events. Consecutive patients undergoing PCI at the Washington Hospital Center between January 2002 and June 2015 were included. Prespecified data were prospectively collected, including baseline and procedural characteristics, in-hospital outcomes, and 1-year mortality. The subjects who had a CVA or TIA during or immediately after PCI were compared with those without procedure-associated CVA or TIA. Overall, 25,626 patients were included in the study. The mean age was 65.0 ± 12.4 years, 16,949 (65.2%) were male, and 7,436 (28.6%) were African American. From 2002 to 2015, 110 neurologic events post-PCI were diagnosed (0.43%); this included 86 CVAs (0.34%) and 24 TIAs (0.09%). The annual rate of postprocedural neurologic events was 0.42% ± 0.12%. There were significant changes in baseline risk factors over time, with increasing age, incidence of insulin-dependent diabetes, and chronic kidney disease. Patients with neurologic events were more often African American (43.6% vs 28.6%, P < .001) with prior history of CVA (24.5% vs 7.8%, P < .001), chronic renal insufficiency (26.6% vs 15.2%, P < .001), and insulin-dependent diabetes (19.1% vs 12.4%, P = .03). Acute myocardial infarction (56% vs 30.4%, P < .001) and cardiogenic shock (20.2% vs 3%, P < .001) were also more common among patients with neurologic events post-PCI. After multivariable adjustment, use of an intraaortic balloon pump was strongly associated with neurologic events (odds ratio [OR] 4.9, 95% CI 2.7-8.8, P < .001), as was prior CVA (OR 2.4, 95% CI 1.4-4.4, P = .002) and African American race (OR

  10. Length of stay following percutaneous coronary intervention: An expert consensus document update from the society for cardiovascular angiography and interventions.

    Science.gov (United States)

    Seto, Arnold H; Shroff, Adhir; Abu-Fadel, Mazen; Blankenship, James C; Boudoulas, Konstantinos Dean; Cigarroa, Joaquin E; Dehmer, Gregory J; Feldman, Dmitriy N; Kolansky, Daniel M; Lata, Kusum; Swaminathan, Rajesh V; Rao, Sunil V

    2018-04-24

    Since the publication of the 2009 SCAI Expert Consensus Document on Length of Stay Following percutaneous coronary intervention (PCI), advances in vascular access techniques, stent technology, and antiplatelet pharmacology have facilitated changes in discharge patterns following PCI. Additional clinical studies have demonstrated the safety of early and same day discharge in selected patients with uncomplicated PCI, while reimbursement policies have discouraged unnecessary hospitalization. This consensus update: (1) clarifies clinical and reimbursement definitions of discharge strategies, (2) reviews the technological advances and literature supporting reduced hospitalization duration and risk assessment, and (3) describes changes to the consensus recommendations on length of stay following PCI (Supporting Information Table S1). These recommendations are intended to support reasonable clinical decision making regarding postprocedure length of stay for a broad spectrum of patients undergoing PCI, rather than prescribing a specific period of observation for individual patients. © 2018 Wiley Periodicals, Inc.

  11. Pre-procedural fasting for coronary interventions: is it time to change practice?

    Science.gov (United States)

    Hamid, Tahir; Aleem, Qaiser; Lau, Yeecheng; Singh, Ravi; McDonald, John; Macdonald, John E; Sastry, Sanjay; Arya, Sanjay; Bainbridge, Anthony; Mudawi, Telal; Balachandran, Kanarath

    2014-04-01

    Traditionally, patients are kept nil-per-os/nil-by-mouth (NPO/NBM) prior to invasive cardiac procedures, yet there exists neither evidence nor clear guidance about the benefits of this practice. To demonstrate that percutaneous cardiac catheterisation does not require prior fasting. The data source is a retrospective analysis of data registry of consecutive patients who underwent percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) and stable angina at two district general hospitals in the UK with no on-site cardiac surgery services. A total of 1916 PCI procedures were performed over a 3-year period. None of the patients were kept NPO/NBM prior to their coronary procedures. The mean age was 67±16 years. 1349 (70%) were men; 38.5% (738/1916) had chronic stable angina, while the rest had ACS. 21% (398/1916) were diabetics while 53% (1017/1916) were hypertensive. PCI was technically successful in 95% (1821/1916) patients. 88.5% (1697/1916) had transradial approach. 77% (570/738) of elective PCI patients were discharged within 6 h postprocedure. No patients required emergency endotracheal intubation and there were no occurrences of intraprocedural or postprocedural aspiration pneumonia. Our observational study demonstrates that patients undergoing PCI do not need to be fasted prior to their procedures.

  12. Anomalous Coronary Artery From the Opposite Sinus (ACAOS): Technical Challenges During Percutaneous Coronary Intervention.

    Science.gov (United States)

    Sinha, Santosh Kumar; Razi, Mahmodula; Mahrotra, Anupam; Aggarwal, Puneet; Singh, Anupam; Rekwal, Lokendra; Tripathi, Sunil; Abhishekh, Nishant Kumar; Krishna, Vinay

    2018-04-01

    Anomalies of the coronary arteries are reported in 1-2% of patients among diagnostic angiogram. Ectopic origin of right coronary artery (RCA) from opposite sinus is one of the most common and they are mainly benign, but at times may be malignant. We report a case of a 69-year-old male who underwent early invasive percutaneous coronary intervention for non-ST-segment elevation myocardial infarction (NSTEMI) where RCA arising from left sinus at the root of left main artery was culprit and various technical challenges were encountered while intervening in form of cannulation to tracking of hardwares. RCA was cannulated with floating wire technique using hockey stick guide catheter and revascularized by deployment of 3.5 × 38 mm Promus Premier Everolimus eluting stent (Boston Scientific, USA). To the best of our knowledge, this is the first ever report of ectopic RCA being revascularized by using hockey stick catheter.

  13. Optimal duration of eptifibatide infusion in percutaneous coronary intervention (an ESPRIT substudy).

    Science.gov (United States)

    Rebeiz, Abdallah G; Dery, Jean-Pierre; Tsiatis, Anastasios A; O'shea, J Conor; Johnson, Brent A; Hellkamp, Anne S; Pieper, Karen S; Gilchrist, Ian C; Slater, James; Muhlestein, J Brent; Joseph, Diane; Kitt, Michael M; Tcheng, James E

    2004-10-01

    Although randomized trials have clearly demonstrated the clinical efficacy with regimens of platelet glycoprotein IIb/IIIa antagonists that result in >80% inhibition of baseline platelet aggregation in percutaneous coronary intervention (PCI), there are no data available concerning the optimal duration of infusion of these agents. In an era when the length of hospitalization has a major impact on health care costs, the determination of the optimal duration of the infusion of these drugs after PCI is of great relevance. The investigators therefore sought to determine the optimal length of the infusion of eptifibatide after PCI by analyzing the outcomes of patients enrolled in the Enhanced Suppression of the Platelet IIb/IIIa Receptor With Integrilin Therapy trial who were randomized to treatment with eptifibatide.

  14. Co-registration of optical coherence tomography and X-ray angiography in percutaneous coronary intervention

    DEFF Research Database (Denmark)

    Hebsgaard, Lasse; Nielsen, Troels Munck; Tu, Shengxian

    2014-01-01

    Background Intracoronary imaging provides accurate lesion delineation and precise measurements for sizing and positioning of coronary stents. During percutaneous coronary intervention (PCI), it may be challenging to identify corresponding segments between intracoronary imaging and angiography....... Computer based online co-registration may aid the target segment identification. Methods The DOCTOR fusion study was a prospective, single arm, observational study including patients admitted for elective PCI. Optical coherence tomography (OCT) was acquired pre-stent implantation for sizing of stents...... to the computer-based co-registration, segments of the target lesion indicated on OCT were left uncovered by stent in 14 patients (70%). Conclusion Computer based online co-registration of OCT and angiography is feasible. Frequent inaccuracies in operator based registration indicate that computer aided co...

  15. Acupuncture-induced Popliteal Arteriovenous Fistula Successfully Treated With Percutaneous Endovascular Intervention

    Directory of Open Access Journals (Sweden)

    Hsuan-Fu Kuo

    2010-03-01

    Full Text Available A 39-year-old female visited our cardiovascular outpatient department with paresthesia and soreness around the right popliteal fossa, where thrill was palpable. There was no history of trauma, apart from her having undergone acupuncture several years previously. An arteriovenous fistula (AVF was diagnosed by vascular ultrasonography and magnetic resonance imaging. Angiography confirmed the presence of an AVF fed by the medial geniculate artery. Transarterial embolization was performed to close the AVF using coils and tissue adhesive. To the best of our knowledge, acupuncture-induced AVF has not been previously reported. We present a case demonstrating the merits of percutaneous endovascular intervention for treating this rare complication. The additional administration of a tissue adhesive can achieve complete closure of the AVF in the event of an unsatisfactory result following coil embolization. Doctors should be aware of the potential vascular complications of acupuncture, and of the management options.

  16. Prevention of Contrast-Induced Nephropathy in STEMI Patients Undergoing Primary Percutaneous Coronary Intervention

    DEFF Research Database (Denmark)

    Busch, Sarah Victoria Ekeløf; Jensen, Svend Eggert; Rosenberg, Jacob

    2012-01-01

    -acetylcysteine, one study of early and late hydration regimens, one study of recombinant human brain natriuretic peptide and one study comparing a low-osmolar contrast agent with an iso-osmolar contrast agent. Results: Recombinant human brain natriuretic peptide and the regimens of hydration significantly reduced...... the incidence of CIN and administration of N-acetylcysteine in one of the six studies significantly reduced the occurrence of CIN. The iso-osmolar contrast agent was not proven to be superior to the low-osmolar contrast agent in terms of preventing CIN. Conclusion: Preliminary studies are promising but further......Objective: To evaluate the current prophylactic strategies against CIN in patients with STEMI treated by primary percutaneous coronary intervention. Background: Contrast-induced nephropathy (CIN) is the third leading course of acute renal failure and a recognized complication to cardiac...

  17. Marked improvements in outcomes of contemporary percutaneous coronary intervention in patients with diabetes mellitus.

    Science.gov (United States)

    Freeman, Andrew M; Abbott, J Dawn; Jacobs, Alice K; Vlachos, Helen A; Selzer, Faith; Laskey, Warren K; Detre, Katherine M; Williams, David O

    2006-12-01

    We sought to determine if advances in percutaneous coronary intervention (PCI) are associated with better outcomes among patients with diabetes mellitus (DM). Patients with DM enrolled in the National Heart, Lung, and Blood Institute (NHLBI) early PTCA Registry (1985-1986) were compared to those in the subsequent contemporary Dynamic Registry (1999-2002) for in-hospital and one-year cardiovascular outcomes. The study population included 945 adults with DM, 325 from the PTCA Registry and 620 from the Dynamic Registry. Multivariable Cox regression models were built to estimate the risk of clinical events. Dynamic Registry patients were older, had more noncardiac comorbidities, and a lower mean ejection fraction (50.5% vs 57.8%, P diabetes had more advanced coronary disease, in-hospital and late adverse events were lower. A combination of the use of stents and an increase in adjunctive medical therapy are likely responsible for the observed improvements in outcomes in contemporary PCI.

  18. Relation of body mass index to risk of stent thrombosis after percutaneous coronary intervention

    DEFF Research Database (Denmark)

    Schmiegelow, Michelle; Torp-Pedersen, Christian; Gislason, Gunnar H

    2012-01-01

    Stent thrombosis is a devastating complication after percutaneous coronary intervention (PCI), but the influence of obesity on risk of stent thrombosis is unclear, and it is unknown if this relation is dependent on stent type. The objective of this study was to examine the relation between body...... mass index (BMI) and stent thrombosis after PCI with bare-metal stent (BMS) or drug-eluting stent (DES). We followed 5,515 patients who underwent PCI with implantation of ≥1 BMS or DES at a high-volume tertiary invasive cardiology center from 2000 through 2006. Only patients with a single type of stent...... (BMS or DES) implanted at the index PCI were included. Median follow-up period was 26 months (interquartile range 12 to 44) and definite stent thrombosis occurred in 78 patients. Hazard ratio of definite stent thrombosis adjusted for number of stents at the index PCI was 0.92 (95% confidence interval...

  19. Co-occurrence of diabetes and hopelessness predicts adverse prognosis following percutaneous coronary intervention

    DEFF Research Database (Denmark)

    Pedersen, Susanne S.; Denollet, Johan; Erdman, Ruud A M

    2009-01-01

    We examined the impact of co-occurring diabetes and hopelessness on 3-year prognosis in percutaneous coronary intervention patients. Consecutive patients (n = 534) treated with the paclitaxel-eluting stent completed a set of questionnaires at baseline and were followed up for 3-year adverse...... clinical events. The incidence of 3-year death/non-fatal myocardial infarction was 3.5% in patients with no risk factors (neither hopelessness nor diabetes), 8.2% in patients with diabetes, 11.2% in patients with high hopelessness, and 15.9% in patients with both factors (p = 0.001). Patients...... with hopelessness (HR: 3.28; 95% CI: 1.49-7.23) and co-occurring diabetes and hopelessness (HR: 4.89; 95% CI: 1.86-12.85) were at increased risk of 3-year adverse clinical events compared to patients with no risk factors, whereas patients with diabetes were at a clinically relevant but not statistically significant...

  20. Recruitable collateral blood flow index predicts coronary instent restenosis after percutaneous coronary intervention

    DEFF Research Database (Denmark)

    Jensen, Lisette Okkels; Thayssen, Per; Lassen, Jens Flensted

    2007-01-01

    AIMS: Collateral flow may influence long-term results after percutaneous coronary intervention (PCI) because of haemodynamic forces compete with the antegrade flow through the dilated lesion. The aim of the study was to assess the influence of recruitable collateral blood flow on restenosis...... in patients undergoing PCI with bare metal stents and using optimal antithrombotic treatment. METHODS AND RESULTS: In 95 patients, 95 de novo lesions were treated with PCI and a bare metal stent. Fractional flow reserve (FFR) at maximum hyperaemia induced by intravenous adenosine was determined. The pressure.......02-1.12, P = 0.016). CONCLUSION: Recruitable collateral blood flow measured during balloon inflation predicts angiographic instent restenosis in PCI patients treated with bare metal stents. Udgivelsesdato: 2007-Aug...

  1. Fractional Flow Reserve-guided Percutaneous Coronary Intervention: Standing the Test of Time

    Directory of Open Access Journals (Sweden)

    Frederik M. Zimmermann, MD

    2016-05-01

    Full Text Available Percutaneous coronary intervention (PCI improves symptoms and prognosis in ischemia-inducing, functionally significant, coronary lesions. Use of fractional flow reserve allows physicians to investigate the ischemia-inducing potential of a specific lesion and can be used to guide coronary revascularization, especially in multivessel coronary artery disease. Fractional flow reserve-guided PCI has been extensively investigated. Results show that deferral of stenting in non-significant lesions is safe, whereas deferral of stenting in functionally significant lesions worsens outcome. FFR-guided PCI improves outcome in multivessel disease over angiography-guided PCI. Until recently, there was little known about the long-term outcome of FFR-guided revascularization and its validity in acute coronary syndromes. This review aims to address the new evidence regarding long-term appropriateness of FFR-guided PCI, the need for hyperemia to evaluate functional severity, and the use of FFR in acute coronary syndromes.

  2. Comparison of primary coronary percutaneous coronary intervention between Diabetic Men and Women with acute myocardial infarction.

    Science.gov (United States)

    Liu, Heng-Liang; Liu, Yang; Hao, Zhen-Xuan; Geng, Guo-Ying; Zhang, Zhi-Fang; Jing, Song-Bin; Ba, Ning; Guo, Wei

    2015-01-01

    This study aimed to explore the short-term efficacy and safety of primary percutaneous coronary intervention (PCI) in female diabetic patients complicated with acute myocardial infarction (AMI). A total of 169 diabetic patients with AMI who underwent primary PCI were selected and divided into group A (52 females) and group B (117 males). The clinical data, characteristics of coronary artery lesions, lengths of hospital stay, and incidences of complications were then compared between two groups. The average age, history of hyperlipidemia, double branch lesions, triple branch lesions, and left main lesions were significantly higher in group A than in group B (P paid to the therapy of diabetic women with acute myocardial infarction as well as the control of risk factors.

  3. Clinical impact and predictors of complete ST segment resolution after primary percutaneous coronary intervention: A subanalysis of the ATLANTIC Trial.

    Science.gov (United States)

    Fabris, Enrico; van 't Hof, Arnoud; Hamm, Christian W; Lapostolle, Frédéric; Lassen, Jens F; Goodman, Shaun G; Ten Berg, Jurriën M; Bolognese, Leonardo; Cequier, Angel; Chettibi, Mohamed; Hammett, Christopher J; Huber, Kurt; Janzon, Magnus; Merkely, Béla; Storey, Robert F; Zeymer, Uwe; Cantor, Warren J; Tsatsaris, Anne; Kerneis, Mathieu; Diallo, Abdourahmane; Vicaut, Eric; Montalescot, Gilles

    2017-08-01

    In the ATLANTIC (Administration of Ticagrelor in the catheterization laboratory or in the Ambulance for New ST elevation myocardial Infarction to open the Coronary artery) trial the early use of aspirin, anticoagulation, and ticagrelor coupled with very short medical contact-to-balloon times represent good indicators of optimal treatment of ST-elevation myocardial infarction and an ideal setting to explore which factors may influence coronary reperfusion beyond a well-established pre-hospital system. This study sought to evaluate predictors of complete ST-segment resolution after percutaneous coronary intervention in ST-elevation myocardial infarction patients enrolled in the ATLANTIC trial. ST-segment analysis was performed on electrocardiograms recorded at the time of inclusion (pre-hospital electrocardiogram), and one hour after percutaneous coronary intervention (post-percutaneous coronary intervention electrocardiogram) by an independent core laboratory. Complete ST-segment resolution was defined as ≥70% ST-segment resolution. Complete ST-segment resolution occurred post-percutaneous coronary intervention in 54.9% ( n=800/1456) of patients and predicted lower 30-day composite major adverse cardiovascular and cerebrovascular events (odds ratio 0.35, 95% confidence interval 0.19-0.65; pST-segment resolution were the time from symptoms to pre-hospital electrocardiogram (odds ratio 0.91, 95% confidence interval 0.85-0.98; pST-segment resolution (odds ratio 1.22, 95% confidence interval 0.99-1.51; p=0.06). This study confirmed that post-percutaneous coronary intervention complete ST-segment resolution is a valid surrogate marker for cardiovascular clinical outcomes. In the current era of ST-elevation myocardial infarction reperfusion, patients' delay and diabetes mellitus are independent predictors of poor reperfusion and need specific attention in the future.

  4. Study of Patient Information after percutaneous Coronary Intervention (SPICI): should prevention programmes become more effective?

    Science.gov (United States)

    Perk, Joep; Hambraeus, Kristina; Burell, Gunilla; Carlsson, Roland; Johansson, Pelle; Lisspers, Jan

    2015-03-22

    This cross-sectional observational study was designed to evaluate the uptake and outcome of patient education after percutaneous coronary intervention (PCI). A questionnaire containing 41 items was handed out to consecutive patients from randomly selected Swedish hospitals after PCI. Questions concerned the patient's attribution of the cause of the cardiac event, perception of the information provided by physicians and nurses, and a self-assessment of changes in lifestyle post PCI regarding tobacco, physical activity, food habits and stress. Replies were obtained from 1,073 patients (reply rate 67%). Non-modifiable risk factors (age, heredity) were attributed a higher rate as the cause of disease compared to modifiable factors (smoking, physical activity, food habits). Most patients (67%) perceived they were cured, and 38% perceived from the given information that there was no need to change their habits. A mere 27% reported that they still had cardiovascular disease and needed behavioural change. After PCI, 16% continued to use tobacco; half of these were offered smoking cessation support. In spite of an 80% referral rate to cardiac rehabilitation, one out of two patients did not enrol. Fewer than half were regularly physically active. Nutritional counselling was provided to 71%, but only 40% changed food habits. Stress management programmes were rarely provided. Current preventive practice scarcely meets the challenge posed by the progress in modern invasive cardiology. The Study of Patient Information after percutaneous Coronary Intervention (SPICI) motivates an in-depth revision and adaptation of cardiac rehabilitation programmes in order to improve patient understanding of the disease, and to support greater compliance with a cardioprotective lifestyle.

  5. Percutaneous Retrieval of Foreign Bodies Around Vital Vessels Aided with Vascular Intervention: A Technical Note

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Xiu-Jun, E-mail: woothingyang2008@126.com [Shanghai Eighth People’s Hospital, Department of Radiology (China); Xing, Guang-Fu, E-mail: xgf8848@126.com [Shanghai Eighth People’s Hospital, Department of General Surgery (China)

    2015-10-15

    ObjectiveTo describe a new interventional technique to remove foreign bodies (FBs) embedded in soft tissues around vital vessels.MethodsUnder fluoroscopic guidance and using local anesthesia, percutaneous removal of FBs was performed using forceps in nine patients. All patients suffered from a metallic soft tissue FB located in close proximity to important vessels and one also had a small traumatic pseudoaneurysm adjacent to the FB. Prior to removal of the FB, the position of the nearest vessel was identified using a guide wire or catheter placed into the vessel. Balloon catheter was also simultaneously used to temporarily stop the blood flow of the nearest artery during the FB removal in three of the nine patients.ResultsAll of the nine FBs with 0–2 mm interval to the nearest vessel were successfully removed in the nine patients without any serious complications. The removed FBs measured 3–12 mm in length and 1–3 mm in width. The total fluoroscopic time of retrieval of each FB was 5–9 min (mean, 6.4 min). The volume of intraoperative bleeding ranged from 5 to 12 ml (mean, 7.5 ml). The length of hospital stay for each patient ranged from 4 to 8 days (mean, 5.5 days).ConclusionVascular intervention-aided percutaneous FB removal is minimally invasive and an effective method for removal of FBs around vital vessels.

  6. Coronary collaterals and risk for restenosis after percutaneous coronary interventions: a meta-analysis

    Directory of Open Access Journals (Sweden)

    Meier Pascal

    2012-06-01

    Full Text Available Abstract Background The benefit of the coronary collateral circulation (natural bypass network on survival is well established. However, data derived from smaller studies indicates that coronary collaterals may increase the risk for restenosis after percutaneous coronary interventions. The purpose of this systematic review and meta-analysis of observational studies was to explore the impact of the collateral circulation on the risk for restenosis. Methods We searched the MEDLINE, EMBASE and ISI Web of Science databases (2001 to 15 July 2011. Random effects models were used to calculate summary risk ratios (RR for restenosis. The primary endpoint was angiographic restenosis > 50%. Results A total of 7 studies enrolling 1,425 subjects were integrated in this analysis. On average across studies, the presence of a good collateralization was predictive for restenosis (risk ratio (RR 1.40 (95% CI 1.09 to 1.80; P = 0.009. This risk ratio was consistent in the subgroup analyses where collateralization was assessed with intracoronary pressure measurements (RR 1.37 (95% CI 1.03 to 1.83; P = 0.038 versus visual assessment (RR 1.41 (95% CI 1.00 to 1.99; P = 0.049. For the subgroup of patients with stable coronary artery disease (CAD, the RR for restenosis with 'good collaterals' was 1.64 (95% CI 1.14 to 2.35 compared to 'poor collaterals' (P = 0.008. For patients with acute myocardial infarction, however, the RR for restenosis with 'good collateralization' was only 1.23 (95% CI 0.89 to 1.69; P = 0.212. Conclusions The risk of restenosis after percutaneous coronary intervention (PCI is increased in patients with good coronary collateralization. Assessment of the coronary collateral circulation before PCI may be useful for risk stratification and for the choice of antiproliferative measures (drug-eluting stent instead bare-metal stent, cilostazol.

  7. The Practice Pattern of Percutaneous Coronary Intervention in Korea: Based on Year 2014 Cohort of Korean Percutaneous Coronary Intervention (K-PCI) Registry.

    Science.gov (United States)

    Gwon, Hyeon-Cheol; Jeon, Dong Woon; Kang, Hyun-Jae; Jang, Jae-Sik; Park, Duk-Woo; Shin, Dong-Ho; Moon, Keon-Woong; Kim, Jung-Sun; Kim, Juhan; Bae, Jang-Whan; Hur, Seung-Ho; Kim, Byung Ok; Choi, Donghoon; Han, Kyoo-Rok; Kim, Hyo-Soo

    2017-05-01

    Appropriate use criteria (AUC) was developed to improve the quality of percutaneous coronary intervention (PCI). However, these criteria should consider the current practice pattern in the country where they are being applied. The algorithm for the Korean PCI practice pattern (KP3) was developed by modifying the United States-derived AUC in expert consensus meetings. KP3 class A was defined as any strategy with evidence from randomized trials that was more conservative for PCI than medical therapy or coronary artery bypass graft (CABG). Class C was defined as any strategy with less evidence from randomized trials and more aggressive for PCI than medical therapy or CABG. Class B was defined as a strategy that was partly class A and partly class C. We applied the KP3 classification system to the Korean PCI registry. The KP3 class A was noted in 67.7% of patients, class B in 28.8%, and class C in 3.5%. The median proportion of class C cases per center was 2.0%. The distribution of KP3 classes varied significantly depending on clinical and angiographic characteristics. The proportion of KP3 class C cases per center was not significantly dependent on PCI volume, but rather on the percentage of ACS cases in each center. We report the current PCI practice pattern by applying the new KP3 classification in a nationwide PCI registry. The results should be interpreted carefully with due regard for the complex relationships between the determining variables and the healthcare system in Korea.

  8. Radiation doses in endoscopic interventional procedures

    International Nuclear Information System (INIS)

    Tsapaki, V.; Paraskeva, K.; Mathou, N.; Aggelogiannopoulou, P.; Triantopoulou, C.; Karagianis, J.; Giannakopoulos, A.; Paspatis, G.; Voudoukis, E.; Athanasopoulos, N.; Lydakis, I.; Scotiniotis, H.; Georgopoulos, P.; Finou, P.; Kadiloru, E.

    2012-01-01

    Purpose: Extensive literature exists on patient radiation doses in various interventional procedures. This does not stand for endoscopic retrograde cholangiopancreatography (ERCP) where the literature is very limited. This study compares patient dose during ERCP procedures performed with different types of X-ray systems. Methods and Materials: Four hospitals participated in the study with the following X-ray systems: A) X-ray conventional system (X-ray tube over table), 137 pts, B) X-ray conventional system (X-ray tube under table), 114 pts, C) C-arm system, 79 pts, and D) angiography system, 57 pts. A single experienced endoscopist performed the ERCP in each hospital. Kerma Area Product (KAP), fluoroscopy time (T) and total number of X-ray films (F) were collected. Results: Median patient dose was 6.2 Gy.cm 2 (0.02-130.2 Gy.cm 2 ). Medium linear correlation between KAP and T (0.6) and F (0.4) were observed. Patient doses were 33 % higher than the reference value in UK (4.15 Gy.cm 2 with a sample of 6089 patients). Median KAP for each hospital was: A) 3.1, B) 9.2, C) 3.9 and D) 6.2 Gy.cm 2 . Median T was: A) 2.6, B) 4.1, C) 2.8 and D) 3.4 min. Median F was: A) 2, B) 7, C) 2 and D) 2 films. Conclusion: Patient radiation dose during ERCP depends on: a) fluoroscopy time and films taken, b) the type of the X-ray system used, with the C arm and the conventional over the couch systems carrying the lower patient radiation dose and the angiography system the higher. (authors)

  9. Smart surgical needle actuated by shape memory alloys for percutaneous procedures

    Science.gov (United States)

    Konh, Bardia

    Background: Majority of cancer interventions today are performed percutaneously using needle-based procedures, i.e. through the skin and soft tissue. Insufficient accuracy using conventional surgical needles motivated researchers to provide actuation forces to the needle's body for compensating the possible errors of surgeons/physicians. Therefore, active needles were proposed recently where actuation forces provided by shape memory alloys (SMAs) are utilized to assist the maneuverability and accuracy of surgical needles. This work also aims to introduce a novel needle insertion simulation to predict the deflection of a bevel tip needle inside the tissue. Methods: In this work first, the actuation capability of a single SMA wire was studied. The complex response of SMAs was investigated via a MATLAB implementation of the Brinson model and verified via experimental tests. The material characteristics of SMAs were simulated by defining multilinear elastic isothermal stress-strain curves. Rigorous experiments with SMA wires were performed to determine the material properties as well as to show the capability of the code to predict a stabilized SMA transformation behavior with sufficient accuracy. The isothermal stress-strain curves of SMAs were simulated and defined as a material model for the Finite Element Analysis of the active needle. In the second part of this work, a three-dimensional finite element (FE) model of the active steerable needle was developed to demonstrate the feasibility of using SMA wires as actuators to bend the surgical needle. In the FE model, birth and death method of defining boundary conditions, available in ANSYS, was used to achieve the pre-strain condition on SMA wire prior to actuation. This numerical model was validated with needle deflection experiments with developed prototypes of the active needle. The third part of this work describes the design optimization of the active using genetic algorithm aiming for its maximum flexibility

  10. Abdominal Plain Film Before Gastrostomy Tube Placement to Predict Success of Percutaneous Endoscopic Procedure

    NARCIS (Netherlands)

    Pruijsen, J. M.; de Bruin, A.; Sekema, G.; Koetse, H. A.; van Rheenen, P. F.

    Objectives: Percutaneous endoscopic gastrostomy (PEG) tube feeding is a convenient method for children requiring long-term enteral nutrition. Preoperative fitness of the majority of pediatric PEG candidates is graded as American Society of Anesthesiologists physical status >= III, indicating

  11. Multiphasic helical Computed Tomography of hepatocellular carcinoma. Evaluation after various percutaneous ablation procedures; Tomografia Computerizzata spirale multifasica dell'epatocarcinoma. Valutazione dopo differenti procedure ablative percutanee

    Energy Technology Data Exchange (ETDEWEB)

    Catalano, O.; Esposito, M.; Lobianco, R.; Cusati, B.; Altei, F.; Siani, A. [Ospedale S. Maria delle Grazie, Pozzuoli, NA (Italy). Servizio di Radiologia

    1999-12-01

    The purpose of this paper is to report the personal experience with helical CT evaluation of hepatocellular carcinoma treated with various percutaneous interventional procedures. From December 1996 to September 1998 it were examined with helical CT 41 patients (73 nodules in all) with hepatocellular carcinoma treated with percutaneous ablation therapies: conventional ethanol injection in 18 subjects (31 nodules), one-shot ethanol injection 3 (8 nodules), radiofrequency thermal ablation in 16 (25 nodules), and combined chemo embolization and ethanol injection in 4 (9 nodules). CT performed was 4-27 days after the last session, acquiring biphasic volumetric images in 14 patients and triphasic volumetric images in 27. A second treatment with subsequent CT study was performed for 28 lesions; 15 underwent 3 serial studies and 6 underwent 4 studies. Compared with pretreatment findings, the diameter was unchanged in 62% of the nodules and increased in 38%. Morphology was unchanged in 63% of the lesions while in 37% a mild deformation toward the needle path or a more regular and round shape was evident. Borders were unchanged in 37% of the cases and modified in 63%, appearing well-defined in 73% and ill-defined in 27%. The necrotic portion had a low attenuation with a nodule-to-parenchyma gradient more evident on delayed than on venous and finally arterial acquisitions; 8% of the lesions were not recognizable on unenhanced scans. During the arterial phase the residual tumor appeared hyperdense in 97% of the nodules and isodense in 3%, while during the portal phase it was hyperdense in 22%, isodense in 28% and hypodense in 50%, and during the delayed phase hypodense in 100%. Residual viable tissue was identified in 44% of the nodules and quantified as 100% in 1% of all lesions, > 75% in 3%, > 50% in 4%, > 25% in 23%. In conclusion, multiple-phase helical CT allows optimal depiction of primitive liver nodules treated with percutaneous interventional procedures and has a

  12. Characteristics and risk factors of cerebrovascular accidents after percutaneous coronary interventions in patients with history of stroke.

    Science.gov (United States)

    Zhang, Hua; Feng, Li-qun; Bi, Qi; Wang, Yu-ping

    2010-06-01

    Percutaneous coronary intervention (PCI) is a well-established method for managing coronary diseases. However, the increasing use of PCI has led to an increased incidence of acute cerebrovascular accidents (CVA) related to PCI. In this study, we investigated the characteristics and risk factors of CVA after PCI in patients with known stroke history. Between January 1, 2005 and March 1, 2009, 621 patients with a history of stroke underwent a total of 665 PCI procedures and were included in this retrospective study. Demographic and clinical characteristics, previous medications, procedures, neurologic deficits, location of lesion and in-hospital clinical outcomes of patients who developed a CVA after the cardiac catheterization laboratory visit and before discharge were reviewed. Acute CVA was diagnosed in 53 (8.5%) patients during the operation or the perioperative period. Seventeen patients suffered from transient ischemic attack, thirty-four patients suffered from cerebral infarction and two patients suffered from cerebral hemorrhage. The risk factors for CVA after PCI in stroke patients were: admission with an acute coronary syndrome, use of an intra-aortic balloon pump, urgent or emergency procedures, diabetes mellitus, and poor left ventricular systolic function, arterial fibrillation, previous myocardial infarction, dyslipidemia, tobacco use, and no/irregular use of anti-platelet medications. The incidence of CVA during and after PCI in patients with history of stroke is much higher than that in patients without history of stroke. Patients with atrial fibrillation, previous myocardial infarction, diabetes mellitus, dyslipidemia, tobacco use, and no or irregular use of anti-platelet medications were at higher risk for recurrent stroke. This study showed a strong association between acute coronary syndromes and in-hospital stroke after PCI.

  13. Comparison of Percutaneous Cementoplasty with and Without Interventional Internal Fixation for Impending Malignant Pathological Fracture of the Proximal Femur

    Energy Technology Data Exchange (ETDEWEB)

    Tian, Qing-Hua, E-mail: ddqinghua-tian@163.com; He, Cheng-Jian, E-mail: tianhechengjian@163.com; Wu, Chun-Gen, E-mail: 649514608@qq.com; Li, Yong-Dong, E-mail: tianliyongdong@163.com; Gu, Yi-Feng, E-mail: tianyifenggu@163.com; Wang, Tao, E-mail: tianandwangtao@163.com; Xiao, Quan-Ping, E-mail: tianxiaoquanping@163.com; Li, Ming-Hua, E-mail: tianminghuali@163.com [Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Department of Diagnostic and Interventional Radiology (China)

    2016-01-15

    PurposeTo compare the efficacy of percutaneous cementoplasty (PCP) with and without interventional internal fixation (IIF) on malignant impending pathological fracture of proximal femur.MethodsA total of 40 patients with malignant impending pathological fracture of proximal femur were selected for PCP and IIF (n = 19, group A) or PCP alone (n = 21, group B) in this non-randomized prospective study. Bone puncture needles were inserted into the proximal femur, followed by sequential installation of the modified trocar inner needles through the puncture needle sheath. Then, 15–45 ml cement was injected into the femur lesion.ResultsThe overall excellent and good pain relief rate during follow-ups were significantly higher in group A than that in group B (89 vs. 57 %, P = 0.034). The average change of VAS, ODI, KPS, and EFES in group A were significantly higher than those in group B at 1-, 3-, 6-month, 1-year (P < 0.05). Meanwhile, The stability of the treated femur was significantly higher in group A than that in group B (P < 0.05).ConclusionPCP and IIF were not only a safe and effective procedure, but resulted in greater pain relief, bone consolidation, and also reduced the risk of fracture than the currently recommended approach of PCP done on malignant proximal femoral tumor.

  14. Comparison of Percutaneous Cementoplasty with and Without Interventional Internal Fixation for Impending Malignant Pathological Fracture of the Proximal Femur

    International Nuclear Information System (INIS)

    Tian, Qing-Hua; He, Cheng-Jian; Wu, Chun-Gen; Li, Yong-Dong; Gu, Yi-Feng; Wang, Tao; Xiao, Quan-Ping; Li, Ming-Hua

    2016-01-01

    PurposeTo compare the efficacy of percutaneous cementoplasty (PCP) with and without interventional internal fixation (IIF) on malignant impending pathological fracture of proximal femur.MethodsA total of 40 patients with malignant impending pathological fracture of proximal femur were selected for PCP and IIF (n = 19, group A) or PCP alone (n = 21, group B) in this non-randomized prospective study. Bone puncture needles were inserted into the proximal femur, followed by sequential installation of the modified trocar inner needles through the puncture needle sheath. Then, 15–45 ml cement was injected into the femur lesion.ResultsThe overall excellent and good pain relief rate during follow-ups were significantly higher in group A than that in group B (89 vs. 57 %, P = 0.034). The average change of VAS, ODI, KPS, and EFES in group A were significantly higher than those in group B at 1-, 3-, 6-month, 1-year (P < 0.05). Meanwhile, The stability of the treated femur was significantly higher in group A than that in group B (P < 0.05).ConclusionPCP and IIF were not only a safe and effective procedure, but resulted in greater pain relief, bone consolidation, and also reduced the risk of fracture than the currently recommended approach of PCP done on malignant proximal femoral tumor

  15. Intracoronary versus Intravenous eptifibatide during percutaneous coronary intervention for acute ST-segment elevation myocardial infarction; a randomized controlled trial.

    Science.gov (United States)

    Sanati, Hamid Reza; Zahedmehr, Ali; Firouzi, Ata; Farrashi, Melody; Amin, Kamyar; Peighambari, Mohammad Mehdi; Shakerian, Farshad; Kiani, Reza

    2017-10-01

    Although aspirin and clopidogrel seem to be quite enough during low risk percutaneous coronary intervention (PCI), the combination may need some reinforcement in complex situations such as primary PCI. By modifying the route and also the duration of administration, glycoprotein IIb/IIIa inhibitors might be a viable option. The aim of this study is to compare the benefits and disadvantages of three different methods of administration of eptifibatide in primary PCI population. Primary PCI candidates were randomized in three groups on which three different methods of administration of eptifibitide were tested: intravenous bolus injection followed by 12-h infusion (IV-IV), intracoronary bolus injection followed by intravenous infusion (IC-IV) and, only intracoronary bolus injection (IC). 99 patients were included in the present study. There was no significant difference among the three groups regarding all cause in hospital and one month mortality (p value = 0.99), re-myocardial infarction (p value = 0.89), post-PCI TIMI flow grade 3 (p value = 0.97), ST segment resolution (p value = 0.77) and peak troponin levels (p value = 0.82). The comparison of vascular access and major bleeding complications were not possible due to low events rate. By modifying the route of administration of eptifibitide, the clinical effect might be preserved without increasing the short-term mortality and procedural failure.

  16. Effects of baseline and early acquired thrombocytopaenia on long-term mortality in patients undergoing percutaneous coronary intervention with bivalirudin.

    Science.gov (United States)

    Ali, Ziad A; Qureshi, Yasir H; Karimi Galougahi, Keyvan; Poludasu, Shyam; Roye, Swathi; Krishnan, Prakash; Zalewski, Adrian; Shah, Zainab Z; Bhatti, Navdeep; Kalapatapu, Kumar; Mehran, Roxana; Dangas, George; Kini, Annapoorna S; Sharma, Samin K

    2016-04-08

    Bivalirudin use as a procedural anticoagulant in patients undergoing percutaneous coronary intervention (PCI) is associated with a lower incidence of thrombocytopaenia compared to other antithrombotic agents. We aimed to evaluate the prognostic impact of baseline thrombocytopaenia and early changes in platelet counts among patients undergoing PCI with exclusive use of bivalirudin. We evaluated 7,505 patients who underwent PCI over a period of eight years. Patients who received unfractionated heparin and glycoprotein IIb/IIIa receptor inhibitors were specifically excluded. Eight hundred and fifty-eight (11.4%) patients had baseline thrombocytopaenia and 451 (6.0%) developed acquired thrombocytopaenia. After adjustment for potential covariates, moderate to severe acquired thrombocytopaenia was the strongest independent predictor (HR 4.34, 95% CI: 2.13-8.84; pevents, which included major adverse cardiac events and major bleeding complications. Age, male gender, baseline platelet count and intra-aortic balloon pump (IABP) insertion were independent predictors of in-hospital acquired thrombocytopaenia. After a mean follow-up of 2.6±1.7 years, moderate to severe baseline thrombocytopaenia (HR 2.42, 95% CI: 1.79-3.29; p67 k) were significant predictors of mortality. In patients undergoing PCI with bivalirudin, moderate to severe baseline and acquired thrombocytopaenia along with severe changes in platelet count are associated with higher long-term mortality.

  17. Blood Transfusion and the Risk of Acute Kidney Injury Among Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention.

    Science.gov (United States)

    Karrowni, Wassef; Vora, Amit Navin; Dai, David; Wojdyla, Daniel; Dakik, Habib; Rao, Sunil V

    2016-09-01

    Acute kidney injury (AKI) complicating percutaneous coronary intervention (PCI) is associated with adverse clinical outcomes. To date, no studies have evaluated the association of blood transfusion with AKI in patients undergoing PCI. We used a retrospective cohort study of all patients with acute coronary syndrome undergoing PCI from CathPCI Registry (n=1 756 864). The primary outcome was AKI defined as the rise in serum creatinine post procedure ≥0.5 mg/dL or ≥25% above baseline values. AKI developed in 9.0% of study sample. Patients with AKI were older, more often women, and had high prevalence of comorbidities, including diabetes mellitus, hypertension, and advanced stages of chronic kidney disease at baseline. Blood transfusion was utilized in 2.2% of patients. In the overall sample, AKI developed in 35.1% of patients who received transfusion versus 8.4% of patients without transfusion (adjusted odds ratio, 4.87 [4.71-5.04]). In the subgroup of patients who sustained bleeding event and received transfusion, the rate of AKI was significantly increased across all preprocedure hemoglobin levels versus no blood transfusion. Similar findings were seen in the subgroup of patients with no bleeding event. Blood transfusion is strongly associated with AKI in patients with acute coronary syndrome undergoing PCI. Further investigation is needed to determine whether a restrictive blood transfusion strategy might improve PCI outcomes by reducing the risk of AKI. © 2016 American Heart Association, Inc.

  18. Histopathological features of aspirated thrombi after primary percutaneous coronary intervention in patients with ST-elevation myocardial infarction.

    Directory of Open Access Journals (Sweden)

    Miranda C Kramer

    Full Text Available BACKGROUND: Plaque disruption with superimposed thrombus is the predominant mechanism responsible for the onset of acute coronary syndromes. Studies have shown that plaque disruption and thrombotic occlusion are frequently separated in time. We established the histopathological characteristics of material aspirated during primary percutaneous coronary intervention (PCI in a large consecutive ST-elevation myocardial infarction (STEMI population. METHODOLOGY/PRINCIPAL FINDINGS: Thrombus aspiration during primary PCI was performed in 1,362 STEMI patients. Thrombus age was classified as fresh (5 day. Further, the presence of plaque was documented. The histopathological findings were related to the clinical, angiographic, and procedural characteristics. Material could be aspirated in 1,009 patients (74%. Components of plaque were found in 395 of these patients (39%. Fresh thrombus was found in 577 of 959 patients (60% compared to 382 patients (40% with lytic or organized thrombi. Distal embolization was present in 21% of patients with lytic thrombus compared to 12% and 15% of patients with fresh or organized thrombus. CONCLUSIONS/SIGNIFICANCE: Material could be obtained in 74% of STEMI patients treated with thrombus aspiration during primary PCI. In 40% of patients thrombus age is older than 24 h, indicating that plaque disruption and thrombus formation occur significantly earlier than the onset of symptoms in many patients.

  19. Quality of Care at Hospitals Identified as Outliers in Publicly Reported Mortality Statistics for Percutaneous Coronary Intervention.

    Science.gov (United States)

    Waldo, Stephen W; McCabe, James M; Kennedy, Kevin F; Zigler, Corwin M; Pinto, Duane S; Yeh, Robert W

    2017-05-16

    Public reporting of percutaneous coronary intervention (PCI) outcomes may create disincentives for physicians to provide care for critically ill patients, particularly at institutions with worse clinical outcomes. We thus sought to evaluate the procedural management and in-hospital outcomes of patients treated for acute myocardial infarction before and after a hospital had been publicly identified as a negative outlier. Using state reports, we identified hospitals that were recognized as negative PCI outliers in 2 states (Massachusetts and New York) from 2002 to 2012. State hospitalization files were used to identify all patients with an acute myocardial infarction within these states. Procedural management and in-hospital outcomes were compared among patients treated at outlier hospitals before and after public report of outlier status. Patients at nonoutlier institutions were used to control for temporal trends. Among 86 hospitals, 31 were reported as outliers for excess mortality. Outlier facilities were larger, treating more patients with acute myocardial infarction and performing more PCIs than nonoutlier hospitals ( P fashion (interaction P =0.50) after public report of outlier status. The likelihood of in-hospital mortality decreased at outlier institutions (RR, 0.83; 95% CI, 0.81-0.85) after public report, and to a lesser degree at nonoutlier institutions (RR, 0.90; 95% CI, 0.87-0.92; interaction P <0.001). Among patients that underwent PCI, in-hospital mortality decreased at outlier institutions after public recognition of outlier status in comparison with prior (RR, 0.72; 9% CI, 0.66-0.79), a decline that exceeded the reduction at nonoutlier institutions (RR, 0.87; 95% CI, 0.80-0.96; interaction P <0.001). Large hospitals with higher clinical volume are more likely to be designated as negative outliers. The rates of percutaneous revascularization increased similarly at outlier and nonoutlier institutions after report of outlier status. After outlier

  20. Percutaneous interventional mitral regurgitation treatment using the Mitra-Clip system

    DEFF Research Database (Denmark)

    Boekstegers, P; Hausleiter, J; Baldus, S

    2014-01-01

    The interventional treatment of mitral valve regurgitation by the MitraClip procedure has grown rapidly in Germany and Europe during the past years. The MitraClip procedure has the potential to treat high-risk patients with secondary mitral valve regurgitation and poor left ventricular function....... Furthermore, patients with primary mitral valve regurgitation may be treated successfully by the MitraClip procedure in case of high surgical risk or in very old patients. At the same time it has been emphasised that the MitraClip interventional treatment is still at an early stage of clinical development....... The largest clinical experience with the MitraClip procedure so far is probably present in some German cardiovascular centers, which here summarise their recommendations on the current indications and procedural steps of the MitraClip treatment. These recommendations of the AGIK and ALKK may present a basis...

  1. Relationship between colon and kidney: a critical point for percutaneous procedures.

    Science.gov (United States)

    Atar, Murat; Hatipoglu, Namik Kemal; Soylemez, Haluk; Penbegul, Necmettin; Bozkurt, Yasar; Gumus, Hatice; Sancaktutar, Ahmet Ali; Kuday, Suzan; Bodakci, Mehmet Nuri

    2013-04-01

    The aim of this study was to determine the frequency of anatomical variations of the colon associated with the kidney. A retrospective analysis was performed on 1000 consecutive abdominal computed tomography (CT) scans performed between July 2010 and September 2011. A line parallel to the horizontal plane was drawn through the posterior edge of each kidney at three renal levels: upper, middle and lower pole. The bowel between the psoas muscle and the kidney was determined as the interposition of the colon. The amount of perinephric fat was estimated and graded. The total number of patients undergoing CT scans was 1000 (male/female = 510/490). The mean age of patients was 42.2 years. Seventeen patients (1.7%) had retrorenal colon, of which 12 (1.2%) were on the left side, three (0.3%) on the right side and two (0.2%) were bilateral. Of these 17 cases, 11 were found at the lower, two at the middle and four at the upper pole of the kidney. There was grade I perirenal fat tissue in 13 and grade II in four cases. Interposition of the colon was detected in 32 (3.2%) patients, 30 (3%) on the right and two (0.2%) on the left. The grade of perirenal fat tissue in patients with colon interposition was as follows: 25 patients grade I, six patients grade II and one patient grade III. In accessing the lower pole of the kidney, especially on the left side, the risk of colonic injury should be taken into consideration during percutaneous procedures, regardless of the patient's age and gender.

  2. The Guy's stone score--grading the complexity of percutaneous nephrolithotomy procedures.

    Science.gov (United States)

    Thomas, Kay; Smith, Naomi C; Hegarty, Nicholas; Glass, Jonathan M

    2011-08-01

    To report the development and validation of a scoring system, the Guy's stone score, to grade the complexity of percutaneous nephrolithotomy (PCNL). Currently, no standardized method is available to predict the stone-free rate after PCNL. The Guy's stone score was developed through a combination of expert opinion, published data review, and iterative testing. It comprises 4 grades: grade I, solitary stone in mid/lower pole or solitary stone in the pelvis with simple anatomy; grade II, solitary stone in upper pole or multiple stones in a patient with simple anatomy or a solitary stone in a patient with abnormal anatomy; grade III, multiple stones in a patient with abnormal anatomy or stones in a caliceal diverticulum or partial staghorn calculus; grade IV, staghorn calculus or any stone in a patient with spina bifida or spinal injury. It was assessed for reproducibility using the kappa coefficient and validated on a prospective database of 100 PCNL procedures performed in a tertiary stone center. The complications were graded using the modified Clavien score. The clinical outcomes were recorded prospectively and assessed with multivariate analysis. The Guy's stone score was the only factor that significantly and independently predicted the stone-free rate (P = .01). It was found to be reproducible, with good inter-rater agreement (P = .81). None of the other factors tested, including stone burden, operating surgeon, patient weight, age, and comorbidity, correlated with the stone-free rate. The Guy's stone score accurately predicted the stone-free rate after PCNL. It was easy to use and reproducible. Copyright © 2011 Elsevier Inc. All rights reserved.

  3. Decade-long trends in the timeliness of receipt of a primary percutaneous coronary intervention

    Directory of Open Access Journals (Sweden)

    Chen HY

    2016-06-01

    Full Text Available Han-Yang Chen,1 Joel M Gore,1,2 Kate L Lapane,1 Jorge Yarzebski,1 Sharina D Person,1 Catarina I Kiefe,1 Robert J Goldberg1,3 1Department of Quantitative Health Sciences, 2Department of Medicine, 3Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, MA, USA Objectives: The purpose of this study was to examine decade-long trends (2001–2011 in, and factors associated with, door-to-balloon time within 90 minutes of hospital presentation among patients hospitalized with ST-segment elevation myocardial infarction (STEMI who received a primary percutaneous coronary intervention (PCI. Methods: Residents of central Massachusetts hospitalized with STEMI who received a primary PCI at two major PCI-capable medical centers in central Massachusetts on a biennial basis between 2001 and 2011 comprised the study population (n=629. Multivariable regression analyses were used to examine factors associated with failing to receive a primary PCI within 90 minutes after emergency department (ED arrival. Results: The average age of this patient population was 61.9 years; 30.5% were women, and 91.7% were White. During the years under study, 50.9% of patients received a primary PCI within 90 minutes of ED arrival; this proportion increased from 2001/2003 (17.2% to 2009/2011 (70.5% (P<0.001. Having previously undergone coronary artery bypass graft surgery, arriving at the ED by car/walk-in and during off-hours were significantly associated with a higher risk of failing to receive a primary PCI within 90 minutes of ED arrival. Conclusion: The likelihood of receiving a timely primary PCI in residents of central Massachusetts hospitalized with STEMI at the major teaching/community medical centers increased dramatically during the years under study. Several groups were identified for purposes of heightened surveillance and intervention efforts to reduce the likelihood of failing to receive a timely primary PCI among patients acutely

  4. Impact of robotics and a suspended lead suit on physician radiation exposure during percutaneous coronary intervention.

    Science.gov (United States)

    Madder, Ryan D; VanOosterhout, Stacie; Mulder, Abbey; Elmore, Matthew; Campbell, Jessica; Borgman, Andrew; Parker, Jessica; Wohns, David

    Reports of left-sided brain malignancies among interventional cardiologists have heightened concerns regarding physician radiation exposure. This study evaluated the impact of a suspended lead suit and robotic system on physician radiation exposure during percutaneous coronary intervention (PCI). Real-time radiation exposure data were prospectively collected from dosimeters worn by operating physicians at the head- and chest-level during consecutive PCI cases. Exposures were compared in three study groups: 1) manual PCI performed with traditional lead apparel; 2) manual PCI performed using suspended lead; and 3) robotic PCI performed in combination with suspended lead. Among 336 cases (86.6% manual, 13.4% robotic) performed over 30weeks, use of suspended lead during manual PCI was associated with significantly less radiation exposure to the chest and head of operating physicians than traditional lead apparel (chest: 0.0 [0.1] μSv vs 0.4 [4.0] μSv, probotic PCI performed in combination with suspended lead was 0.0 [0.0] μSv, which was significantly less chest exposure than manual PCI performed with traditional lead (probotic PCI the median head-level exposure was 0.1 [0.2] μSv, which was 99.3% less than manual PCI performed with traditional lead (probotics were observed to result in significantly less radiation exposure to the chest and head of operating physicians during PCI. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. Reconsidering the Gatekeeper Paradigm for Percutaneous Coronary Intervention in Stable Coronary Disease Management.

    Science.gov (United States)

    Schulman-Marcus, Joshua; Weintraub, William S; Boden, William E

    2017-10-15

    Major randomized clinical trials over the last decade support the role of optimal medical therapy for the initial management approach for patients with stable coronary artery disease (CAD), whereas percutaneous coronary intervention (PCI) ought to be reserved for patients with persistent symptoms despite optimal medical therapy. Likewise, several studies have continued to demonstrate the superiority of coronary artery bypass grafting surgery over PCI in many patients with extensive multivessel CAD, especially those with diabetes. Nevertheless, the decision-making paradigm for patients with stable CAD often continues to propagate the upfront use of "ad hoc PCI" and disadvantages alternative therapeutic approaches. In our editorial, we discuss how multiple systemic and interpersonal factors continue to favor early revascularization with PCI in stable patients. We discuss whether the interventional cardiologist can be an unbiased "gatekeeper" for the use of PCI or whether other physicians should also be involved with the patient in decision-making. Finally, we offer suggestions that can redefine the gatekeeper role to facilitate an evidence-based approach that embraces shared decision-making. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. 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.

  7. Impact of abciximab in elderly patients with high-risk acute coronary syndrome undergoing percutaneous coronary intervention: an observational registry study

    DEFF Research Database (Denmark)

    Iversen, Allan Z; Galatius, Soeren; Haahr-Pedersen, Sune Ammentorp

    2011-01-01

    BACKGROUND: An increasing proportion of patients with acute coronary syndrome (ACS) requiring percutaneous coronary intervention (PCI) are classified as elderly (aged =70 years). The glycoprotein IIb/IIIa inhibitor abciximab is known to reduce adverse outcomes in patients aged

  8. Pharmaco-Mechanical Strategies to Optimize the Balance between Ischemia and Bleeding after Percutaneous Coronary Intervention –Navigating between Scylla and Charybdis–

    NARCIS (Netherlands)

    F. Costa (Francesco)

    2018-01-01

    textabstractBeing between Scylla and Charybdis is an idiomatic form originating from Greek mythology, which means the obligation of choosing between two evils. Dual antiplatelet therapy after percutaneous coronary intervention is the cornerstone of the treatment for secondary prevention

  9. Impact of anticoagulation strategy with bivalirudin or heparin on nonaccess site bleeding in percutaneous coronary interventions: A meta-analysis of randomized trials

    NARCIS (Netherlands)

    Verdoia, M.; Barbieri, L.; Parodi, G.; Bellandi, B.; Schaffer, A.; Suryapranata, H.; Luca, G. De

    2017-01-01

    BACKGROUND: Transradial approach has significantly decreased the rate of access site bleeding in patients undergoing percutaneous coronary interventions (PCI), therefore potentially mitigating the benefits offered by bivalirudin in lowering major bleeding complications as compared to heparin.

  10. Acute and subacute stent thrombosis after primary percutaneous coronary intervention for ST-segment elevation myocardial infarction : incidence, predictors and clinical outcome

    NARCIS (Netherlands)

    Hesstermans, A. A. C. M.; van Werkum, J. W.; Zwart, B.; van der Heyden, J. A.; Kelder, J. C.; Breet, N. J.; van't Hof, A. W. J.; Koolen, J. J.; Brueren, B. R. G.; Zijlstra, F.; ten Berg, J. M.; Dambrink, Jan Hendrik Everwijn

    2010-01-01

    Background: Early coronary stent thrombosis occurs most frequent after primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI). Objectives: To identify the specific predictors of, respectively, acute and subacute stent thrombosis in patients after

  11. Outcomes after primary percutaneous coronary intervention in octogenarians and nonagenarians with ST segment elevation myocardial infarction from the western denmark heart registry

    DEFF Research Database (Denmark)

    Antonsen, Lisbeth; Jensen, Lisette Okkels; Terkelsen, Christian Juhl

    2012-01-01

    BACKGROUND: Elderly patients with ST-segment elevation myocardial infarction (STEMI) constitute a particular risk group in relation to primary percutaneous coronary intervention (PPCI). OBJECTIVE: We examined the proportion of octogenarians and nonagenarians undergoing PPCI in Western Denmark...

  12. Inferior vena cava filter insertion through the popliteal vein: enabling the percutaneous endovenous intervention of deep vein thrombosis with a single venous access approach in a single session

    Science.gov (United States)

    Kim, Hyoung Ook; Kim, Jae Kyu; Park, Jin Gyoon; Yim, Nam Yeol; Kang, Yang Jun; Jung, Hye Doo

    2016-01-01

    PURPOSE We aimed to evaluate the efficiency of placing an inferior vena cava (IVC) filter through the same popliteal vein access site used for percutaneous endovenous intervention in patients with extensive lower extremity deep vein thrombosis. METHODS This retrospective study included 21 patients who underwent IVC filter insertion through the popliteal vein over a three-year period. Patient medical records were reviewed for the location of the deep vein thrombosis, result of filter removal, and total number of endovascular procedures needed for filter insertion and recanalization of the lower extremity venous system. Follow-up lower extremity computed tomography (CT) venography was also reviewed in each patient to assess the degree of filter tilt in the IVC. RESULTS All patients had extensive lower extremity deep vein thrombosis involving the iliac vein and/or femoral vein. Seventeen patients showed deep vein thrombosis of the calf veins. In all patients, IVC filter insertion and the recanalization procedure were performed during a single procedure through the single popliteal vein access site. In the 17 patients undergoing follow-up CT, the mean tilt angle of the filter was 7.14°±4.48° in the coronal plane and 8.77°±5.49° in the sagittal plane. Filter retrieval was successful in 16 of 17 patients (94.1%) in whom filter retrieval was attempted. CONCLUSION Transpopliteal IVC filter insertion is an efficient technique that results in low rates of significant filter tilt and enables a single session procedure using a single venous access site for filter insertion and percutaneous endovenous intervention. PMID:27559713

  13. Radiation exposure and contrast agent use related to radial versus femoral arterial access during percutaneous coronary intervention (PCI)—Results of the FERARI study

    Energy Technology Data Exchange (ETDEWEB)

    Becher, Tobias, E-mail: Tobias.Becher@umm.de [First Department of Medicine, University Medical Centre Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim (Germany); DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim (Germany); Behnes, Michael; Ünsal, Melike; Baumann, Stefan; El-Battrawy, Ibrahim; Fastner, Christian; Kuschyk, Jürgen; Papavassiliu, Theano; Hoffmann, Ursula [First Department of Medicine, University Medical Centre Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim (Germany); DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim (Germany); Mashayekhi, Kambis [Division of Cardiology and Angiology II, University Heart Center Freiburg Bad Krozingen, Bad Krozingen (Germany); Borggrefe, Martin; Akin, Ibrahim [First Department of Medicine, University Medical Centre Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim (Germany); DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim (Germany)

    2016-12-15

    Summary: Background: Data regarding radiation exposure related to radial versus femoral arterial access in patients undergoing percutaneous coronary intervention (PCI) remain controversial. This study aims to evaluate patients enrolled in the FERARI study regarding radiation exposure, fluoroscopy time and contrast agent use. Methods: The Femoral Closure versus Radial Compression Devices Related to Percutaneous Coronary Interventions (FERARI) study evaluated prospectively 400 patients between February 2014 and May 2015 undergoing PCI either using the radial or femoral access. In these 400 patients, baseline characteristics, procedural data such as procedural duration, fluoroscopy time, dose–area product (DAP) as well as the amount of contrast agent used were documented and analyzed. Results: Median fluoroscopy time was not significantly different in patients undergoing radial versus femoral access (12.2 vs. 9.8 min, p = 0.507). Furthermore, median DAP (54.5 vs. 52.0 Gycm2, p = 0.826), procedural duration (46.0 vs. 45.0 min, p = 0.363) and contrast agent use (185.5 vs. 199.5 ml, p = 0.742) were also similar in radial and femoral PCI. Conclusion: There was no difference regarding median fluoroscopy time, procedural duration, radiation dose or contrast agent use between radial versus femoral arterial access in PCI. - Highlights: • Data comparing radiation exposure in radial versus femoral PCI remain controversial. • 400 enrolled in the FERARI study were prospectively evaluated. • There was no difference regarding radiation exposure in radial versus femoral access. • Furthermore, there was no significant difference regarding contrast agent use.

  14. Radiation exposure and contrast agent use related to radial versus femoral arterial access during percutaneous coronary intervention (PCI)—Results of the FERARI study

    International Nuclear Information System (INIS)

    Becher, Tobias; Behnes, Michael; Ünsal, Melike; Baumann, Stefan; El-Battrawy, Ibrahim; Fastner, Christian; Kuschyk, Jürgen; Papavassiliu, Theano; Hoffmann, Ursula; Mashayekhi, Kambis; Borggrefe, Martin; Akin, Ibrahim

    2016-01-01

    Summary: Background: Data regarding radiation exposure related to radial versus femoral arterial access in patients undergoing percutaneous coronary intervention (PCI) remain controversial. This study aims to evaluate patients enrolled in the FERARI study regarding radiation exposure, fluoroscopy time and contrast agent use. Methods: The Femoral Closure versus Radial Compression Devices Related to Percutaneous Coronary Interventions (FERARI) study evaluated prospectively 400 patients between February 2014 and May 2015 undergoing PCI either using the radial or femoral access. In these 400 patients, baseline characteristics, procedural data such as procedural duration, fluoroscopy time, dose–area product (DAP) as well as the amount of contrast agent used were documented and analyzed. Results: Median fluoroscopy time was not significantly different in patients undergoing radial versus femoral access (12.2 vs. 9.8 min, p = 0.507). Furthermore, median DAP (54.5 vs. 52.0 Gycm2, p = 0.826), procedural duration (46.0 vs. 45.0 min, p = 0.363) and contrast agent use (185.5 vs. 199.5 ml, p = 0.742) were also similar in radial and femoral PCI. Conclusion: There was no difference regarding median fluoroscopy time, procedural duration, radiation dose or contrast agent use between radial versus femoral arterial access in PCI. - Highlights: • Data comparing radiation exposure in radial versus femoral PCI remain controversial. • 400 enrolled in the FERARI study were prospectively evaluated. • There was no difference regarding radiation exposure in radial versus femoral access. • Furthermore, there was no significant difference regarding contrast agent use

  15. A navigation system for percutaneous needle interventions based on PET/CT images: design, workflow and error analysis of soft tissue and bone punctures.

    Science.gov (United States)

    Oliveira-Santos, Thiago; Klaeser, Bernd; Weitzel, Thilo; Krause, Thomas; Nolte, Lutz-Peter; Peterhans, Matthias; Weber, Stefan

    2011-01-01

    Percutaneous needle intervention based on PET/CT images is effective, but exposes the patient to unnecessary radiation due to the increased number of CT scans required. Computer assisted intervention can reduce the number of scans, but requires handling, matching and visualization of two different datasets. While one dataset is used for target definition according to metabolism, the other is used for instrument guidance according to anatomical structures. No navigation systems capable of handling such data and performing PET/CT image-based procedures while following clinically approved protocols for oncologic percutaneous interventions are available. The need for such systems is emphasized in scenarios where the target can be located in different types of tissue such as bone and soft tissue. These two tissues require different clinical protocols for puncturing and may therefore give rise to different problems during the navigated intervention. Studies comparing the performance of navigated needle interventions targeting lesions located in these two types of tissue are not often found in the literature. Hence, this paper presents an optical navigation system for percutaneous needle interventions based on PET/CT images. The system provides viewers for guiding the physician to the target with real-time visualization of PET/CT datasets, and is able to handle targets located in both bone and soft tissue. The navigation system and the required clinical workflow were designed taking into consideration clinical protocols and requirements, and the system is thus operable by a single person, even during transition to the sterile phase. Both the system and the workflow were evaluated in an initial set of experiments simulating 41 lesions (23 located in bone tissue and 18 in soft tissue) in swine cadavers. We also measured and decomposed the overall system error into distinct error sources, which allowed for the identification of particularities involved in the process as well

  16. Comparison of no-reflow phenomenon after percutaneous coronary intervention for acute myocardial infarction between smokers and nonsmokers

    Directory of Open Access Journals (Sweden)

    Hassan Shemirani

    2014-01-01

    Full Text Available Background: No-reflow phenomenon after percutaneous coronary intervention (PCI in patients with acute ST-segment-elevation myocardial infarction (STEMI is relatively common and has therapeutic and prognostic implications. Cigarette smoking is known as deleterious in patients with coronary artery disease (CAD, but the effect of smoking on no-reflow phenomenon is less investigated. The aim of this study was to compare no-reflow phenomenon after percutneous coronary intervention for acute myocardial infarction, between smokers and non smokers. Materials and Methods: A total of 141 patients who were admitted to Chamran Hospital (Isfahan, Iran between March and September, 2012 with a diagnosis of STEMI, enrolled into our Cohort study. Patients were divided into current smoker and nonsmoker groups (based on patient′s information. All patients underwent primary PCI or rescue PCI within the first 12-h of chest pain. No-reflow phenomenon, thrombolysis in myocardial infarction (MI flow, and 24-h complications were assessed in both groups. Results: A total of 47 current smoker cases (32.9% and 94 (65.7% nonsmoker cases were evaluated. Smokers in comparison to nonsmokers were younger (53.47 ± 10.59 vs. 61.46 ± 10.55, P < 0.001 and they were less likely to be hypertensive (15.2% vs. 44.7%, P < 0.001, diabetic (17% vs. 36.2%, P < 0.05, and female gender (4.3% vs. 25.5%, P < 0.01. Angiographic and procedural characteristics of both groups were similar. 9 patients died during the first 24-h after PCI (4.3% of smokers and 6.4% of nonsmokers, P: 0.72. No-reflow phenomenon was observed in 29.8% of current smokers and 31.5% of nonsmokers (P = 0.77. Conclusion: No-reflow phenomenon or short-term complications were not significantly different between current smokers and non smokers.

  17. A contemporary risk model for predicting 30-day mortality following percutaneous coronary intervention in England and Wales.

    Science.gov (United States)

    McAllister, Katherine S L; Ludman, Peter F; Hulme, William; de Belder, Mark A; Stables, Rodney; Chowdhary, Saqib; Mamas, Mamas A; Sperrin, Matthew; Buchan, Iain E

    2016-05-01

    The current risk model for percutaneous coronary intervention (PCI) in the UK is based on outcomes of patients treated in a different era of interventional cardiology. This study aimed to create a new model, based on a contemporary cohort of PCI treated patients, which would: predict 30 day mortality; provide good discrimination; and be well calibrated across a broad risk-spectrum. The model was derived from a training dataset of 336,433 PCI cases carried out between 2007 and 2011 in England and Wales, with 30 day mortality provided by record linkage. Candidate variables were selected on the basis of clinical consensus and data quality. Procedures in 2012 were used to perform temporal validation of the model. The strongest predictors of 30-day mortality were: cardiogenic shock; dialysis; and the indication for PCI and the degree of urgency with which it was performed. The model had an area under the receiver operator characteristic curve of 0.85 on the training data and 0.86 on validation. Calibration plots indicated a good model fit on development which was maintained on validation. We have created a contemporary model for PCI that encompasses a range of clinical risk, from stable elective PCI to emergency primary PCI and cardiogenic shock. The model is easy to apply and based on data reported in national registries. It has a high degree of discrimination and is well calibrated across the risk spectrum. The examination of key outcomes in PCI audit can be improved with this risk-adjusted model. Copyright © 2016 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

  18. Perceived Cognition after Percutaneous Coronary Intervention: Association with Quality of Life, Mood and Fatigue in the THORESCI Study.

    Science.gov (United States)

    Duijndam, Stefanie; Denollet, Johan; Nyklíček, Ivan; Kupper, Nina

    2017-08-01

    Percutaneous coronary intervention (PCI) is a common invasive procedure for the treatment of coronary artery diseases. Long-term cognitive functioning after PCI and its association with health-related quality of life (HRQL) and psychological factors is relatively unknown. The aim of this study is to examine whether perceived cognitive functioning during the year after PCI is associated with HRQL over this time period, and whether mood, fatigue, and age are associated with changes in perceived cognition and HRQL. Patients undergoing PCI (n = 384, 79% male, mean age = 63, SD = 10) were recruited in the observational Tilburg Health Outcome Registry of Emotional Stress after Coronary Intervention (THORESCI) cohort study. Perceived concentration and attention problems, HRQL, mood, and fatigue were assessed at baseline, at 1-month and 12-month follow-up. General linear mixed modeling analysis showed that across time, between- and within-subject differences in perceived concentration problems were associated with a reduced HRQL in all domains independent of clinical and demographic covariates. Only a part of this association could be explained by negative mood, fatigue, and older age. Similar findings were found for between-subject differences in perceived attention problems. Between-subject differences and within-subject changes in perceived cognition in PCI patients were strongly associated with HRQL across time, such that poorer perceived cognition was associated with poorer HRQL, independent of demographic and clinical variables. Most of the associations were also independent of mood and fatigue. The results should increase the awareness of clinicians for the role of cognition in the cardiac rehabilitation and recovery post-PCI.

  19. Noise reduction technology reduces radiation dose in chronic total occlusions percutaneous coronary intervention: a propensity score-matched analysis.

    Science.gov (United States)

    Maccagni, Davide; Benincasa, Susanna; Bellini, Barbara; Candilio, Luciano; Poletti, Enrico; Carlino, Mauro; Colombo, Antonio; Azzalini, Lorenzo

    2018-03-23

    Chronic total occlusions (CTO) percutaneous coronary intervention (PCI) is associated with high radiation dose. Our study aim was to evaluate the impact of the implementation of a noise reduction technology (NRT) on patient radiation dose during CTO PCI. A total of 187 CTO PCIs performed between February 2016 and May 2017 were analyzed according to the angiographic systems utilized: Standard (n = 60) versus NRT (n = 127). Propensity score matching (PSM) was performed to control for differences in baseline characteristics. Primary endpoints were Cumulative Air Kerma at Interventional Reference Point (AK at IRP), which correlates with patient's tissue reactions; and Kerma Area Product (KAP), a surrogate measure of patient's risk of stochastic radiation effects. An Efficiency Index (defined as fluoroscopy time/AK at IRP) was calculated for each procedure. Image quality was evaluated using a 5-grade Likert-like scale. After PSM, n = 55 pairs were identified. Baseline and angiographic characteristics were well matched between groups. Compared to the Standard system, NRT was associated with lower AK at IRP [2.38 (1.80-3.66) vs. 3.24 (2.04-5.09) Gy, p = 0.035], a trend towards reduction for KAP [161 (93-244) vs. 203 (136-363) Gycm 2 , p = 0.069], and a better Efficiency Index [16.75 (12.73-26.27) vs. 13.58 (9.92-17.63) min/Gy, p = 0.003]. Image quality was similar between the two groups (4.39 ± 0.53 Standard vs. 4.34 ± 0.47 NRT, p = 0.571). In conclusion, compared with a Standard system, the use of NRT in CTO PCI is associated with lower patient radiation dose and similar image quality.

  20. Impact of Triple Therapy in Elderly Patients with Atrial Fibrillation Undergoing Percutaneous Coronary Intervention.

    Directory of Open Access Journals (Sweden)

    Antonia Sambola

    Full Text Available Selecting an ideal antithrombotic therapy for elderly patients with atrial fibrillation (AF undergoing percutaneous coronary intervention (PCI can be challenging since they have a higher thromboembolic and bleeding risk than younger patients. The current study aimed to assess the efficacy and safety of triple therapy (TT: oral anticoagulation plus dual antiplatelet therapy: aspirin plus clopidogrel in patients ≥75 years of age with atrial fibrillation (AF undergoing percutaneous coronary intervention (PCI.A prospective multicenter study was conducted from 2003 to 2012 at 6 Spanish teaching hospitals. A cohort study of consecutive patients with AF undergoing PCI and treated with TT or dual antiplatelet therapy (DAPT was analyzed. All outcomes were evaluated at 1-year of follow-up.Five hundred and eighty-five patients, 289 (49% of whom were ≥75 years of age (79.6±3.4 years; 33% women were identified. TT was prescribed in 55.9% of patients at discharge who had a higher thromboembolic risk (CHA2DS2VASc score: 4.23±1.51 vs 3.76±1.40, p = 0.007 and a higher bleeding risk (HAS-BLED ≥3: 88.6% vs 79.2%, p = 0.02 than those on DAPT. Therefore, patients on TT had a lower rate of thromboembolism than those on DAPT (0.6% vs 6.9%, p = 0.004; HR 0.08, 95% CI: 0.01-0.70, p = 0.004. Major bleeding events occurred more frequently in patients on TT than in those on DAPT (11.7% vs 2.4%, p = 0.002; HR 5.2, 95% CI: 1.53-17.57, p = 0.008. The overall mortality rate was similar in both treatment groups (11.9% vs 13.9%, p = 0.38; however, after adjustment for confounding variables, TT was associated with a reduced mortality rate (HR 0.33, 95% CI: 0.12-0.86, p = 0.02.In elderly patients with AF undergoing PCI, the use of TT compared to DAPT was associated with reduced thromboembolism and mortality rates, although a higher rate of major bleeding.

  1. Temporal changes in outcomes of women and men undergoing percutaneous coronary intervention for chronic total occlusion: 2005-2013.

    Science.gov (United States)

    Toma, Aurel; Stähli, Barbara E; Gick, Michael; Ferenc, Miroslaw; Mashayekhi, Kambis; Buettner, Heinz Joachim; Neumann, Franz-Josef; Gebhard, Catherine

    2018-06-01

    Percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) has undergone impressive progress during the last decade, both in strategies and equipment. It is unknown whether technical refinement has translated into improved outcomes in women undergoing CTO-PCI. A total of 2002 consecutive patients (17% females, mean age 65.2 ± 10.7 years) undergoing PCI of at least one CTO lesion at our center between 01/2005 and 12/2013 were evaluated. The incidence of adverse events was compared between two time series (2005-2009 and 2010-2013). A significant increase in adverse lesion characteristics over time was noted in both, women and men (p men but not in women (p trend  men and p trend =0.9 in women). The incidence of procedural complications was significantly higher in women as compared to men and increased over the study period in women (p men. Accordingly, multivariate logistic regression analysis identified female sex as a strong predictor of PCI-related complications in recent years, while this was not the case in earlier years (adjusted HR 2.03, 95% CI 0.62-6.6, p = 0.2 and adjusted HR 4.7, 95% CI 1.8-12.3, p = 0.002, respectively, p men (log rank = 0.046), while no changes were observed in women. While higher success rates and a reduced rate of MACE have been achieved in men, the incidence of procedural complications in women undergoing CTO-PCI has increased over time.

  2. Social inhibition modulates the effect of negative emotions on cardiac prognosis following percutaneous coronary intervention in the drug-eluting stent era

    DEFF Research Database (Denmark)

    Denollet, Johan; Pedersen, Susanne S.; Ong, Andrew T L

    2006-01-01

    Negative emotions have an adverse effect on cardiac prognosis. We investigated whether social inhibition (inhibited self-expression in social interaction) modulates the effect of negative emotions on clinical outcome following percutaneous coronary intervention (PCI).......Negative emotions have an adverse effect on cardiac prognosis. We investigated whether social inhibition (inhibited self-expression in social interaction) modulates the effect of negative emotions on clinical outcome following percutaneous coronary intervention (PCI)....

  3. A Simple Numerical Body Surface Mapping Parameter Signifies Successful Percutaneous Coronary Artery Intervention.

    Science.gov (United States)

    Simonyi, Gábor; Kirschner, Róbert; Szűcs, Endre; Préda, István; Duray, Gábor; Medvegy, Nóra; Horvath, Bálint; Medvegy, Mihály

    2016-03-01

    In coronary artery disease (CAD), body surface potential mapping (BSPM) may reveal minor electrical potential changes appearing in the depolarization phase even if pathological changes are absent on the conventional 12-lead ECG. We hypothesized that a simple BSPM parameter, Max/Min signifies successful percutaneous coronary intervention (PCI). Ninety-two adult Caucasian patients with stable CAD and positive exercise test underwent coronary angiography. Seventy patients (age, 59 ± 8; 46 males) were revascularized by PCI (left anterior descending [LAD] in 38, right [RCA] in 17 and left circumflex [LCX] coronary artery in 15). Control groups contained 22 patients (age, 60 ± 8; 14 males) without intervention and 35 healthy subjects (age, 58 ± 2; 15 males). Left ventricular ejection fraction (LVEF, transthoracic echocardiography) and Max/Min BSPM parameter (63-lead Montreal system) were evaluated before and 4-40 days following coronary angiography. Max/Min was defined by the ratio of the highest maximum to the deepest minimum potential of all leads recorded by BSPM. Before PCI, Max/Min value of patients with LAD lesion (0.83 [0.74; 0.93]) was significantly lower while that with RCA lesion (1.63 [1.35; 1.99]) was significantly higher than that of healthy group (1.01 [0.970; 1.13]) (P intervention. LVEF significantly increased (from 46.50% [43.00; 51.00] to 49.00% [46.00; 51.00]) only after LAD PCI. Max/Min parameter is suitable to follow patients after LAD and RCA PCI. © 2015 Wiley Periodicals, Inc.

  4. Impact of obstructive sleep apnea on the occurrence of restenosis after elective percutaneous coronary intervention in ischemic heart disease

    Directory of Open Access Journals (Sweden)

    Behrendt Dominik

    2008-06-01

    Full Text Available Abstract Rationale There is growing evidence that obstructive sleep apnea is associated with coronary artery disease. However, there are no data on the course of coronary stenosis after percutaneous coronary intervention in patients with obstructive sleep apnea. Objectives To determine whether sleep apnea is associated with increased late lumen loss and restenosis after percutaneous coronary intervention. Methods 78 patients with coronary artery disease who underwent elective percutaneous coronary intervention were divided in 2 groups: 43 patients with an apnea hypopnea – Index 10/h (group II. Late lumen loss, a marker of restenosis, was determined using quantitative coronary angiography after 6.9 ± 3.1 months. Main results Angiographic restenosis (>50% luminal diameter, was present in 6 (14% of group I and in 9 (25% of group II (p = 0.11. Late lumen loss was significant higher in pt. with an AHI > 10/h (0.7 ± 0.69 mm vs. 0.38 ± 0.37 mm, p = 0.01. Among these 35 patients, 21(60% used their CPAP devices regularly. There was a marginally lower late lumen loss in treated patients, nevertheless, this difference did not reach statistical significance (0.57 ± 0.47 mm vs. 0.99 ± 0.86 mm, p = 0.08. There was no difference in late lumen loss between treated patients and the group I (p = 0.206. Conclusion In summary, patients with OSA and coronary artery disease have a higher degree of late lumen loss, which is a marker of restenosis and vessel remodeling after elective percutaneous intervention.

  5. Cost-effectiveness of drug-eluting stents versus bare-metal stents in patients undergoing percutaneous coronary intervention

    OpenAIRE

    Baschet, Louise; Bourguignon, Sandrine; Marque, S?bastien; Durand-Zaleski, Isabelle; Teiger, Emmanuel; Wilquin, Fanny; Levesque, Karine

    2016-01-01

    Objective To determine the cost-effectiveness of drug-eluting stents (DES) compared with bare-metal stents (BMS) in patients requiring a percutaneous coronary intervention in France, using a recent meta-analysis including second-generation DES. Methods A cost-effectiveness analysis was performed in the French National Health Insurance setting. Effectiveness settings were taken from a meta-analysis of 117?762 patient-years with 76 randomised trials. The main effectiveness criterion was major c...

  6. The effects of prior calcium channel blocker therapy on creatine kinase-MB levels after percutaneous coronary interventions

    OpenAIRE

    Gulmez, Oyku; Atar, Ilyas; Ozin, B?lent; Korkmaz, Mehmet Emin; Atar, Asli; Aydinalp, Alp; Yildirir, Aylin; Muderrisoglu, Haldun

    2008-01-01

    Background: Use of intracoronary calcium channel blockers (CCBs) during percutaneous coronary intervention (PCI) has been shown to have favorable effects on coronary blood flow. We aimed to investigate the effects of CCBs administrated perorally on creatine kinase-MB (CK-MB) levels in patients undergoing elective PCI. Methods: A total of 570 patients who underwent PCI were evaluated for CK-MB elevation. Patients who were on CCB therapy when admitted to the hospital constituted the CCB group. ...

  7. The effects of prior calcium channel blocker therapy on creatine kinase-MB levels after percutaneous coronary interventions

    OpenAIRE

    Gulmez, Oyku

    2008-01-01

    Oyku Gulmez, Ilyas Atar, Bülent Ozin, Mehmet Emin Korkmaz, Aslı Atar, Alp Aydinalp, Aylin Yildirir, Haldun MuderrisogluBaskent University Faculty of Medicine, Department of Cardiology, Ankara, TurkeyBackground: Use of intracoronary calcium channel blockers (CCBs) during percutaneous coronary intervention (PCI) has been shown to have favorable effects on coronary blood flow. We aimed to investigate the effects of CCBs administrated perorally on creatine kinase-MB (CK-MB) levels in pa...

  8. The effects of prior calcium channel blocker therapy on creatine kinase-MB levels after percutaneous coronary interventions

    OpenAIRE

    Oyku Gulmez; Ilyas Atar; Bülent Ozin; Mehmet Emin Korkmaz; Asli Atar; et al

    2008-01-01

    Oyku Gulmez, Ilyas Atar, Bülent Ozin, Mehmet Emin Korkmaz, Asli Atar, Alp Aydinalp, Aylin Yildirir, Haldun MuderrisogluBaskent University Faculty of Medicine, Department of Cardiology, Ankara, TurkeyBackground: Use of intracoronary calcium channel blockers (CCBs) during percutaneous coronary intervention (PCI) has been shown to have favorable effects on coronary blood flow. We aimed to investigate the effects of CCBs administrated perorally on creatine kinase-MB (CK-MB) levels in pat...

  9. High-degree atrioventricular block complicating ST-segment elevation myocardial infarction in the era of primary percutaneous coronary intervention

    DEFF Research Database (Denmark)

    Gang, Uffe Jakob Ortved; Hvelplund, Anders; Pedersen, Sune

    2012-01-01

    Primary percutaneous coronary intervention (pPCI) has replaced thrombolysis as treatment-of-choice for ST-segment elevation myocardial infarction (STEMI). However, the incidence and prognostic significance of high-degree atrioventricular block (HAVB) in STEMI patients in the pPCI era has been only...... sparsely investigated. The objective of this study was to assess the incidence, predictors and prognostic significance of HAVB in STEMI patients treated with pPCI....

  10. Real-time fluoroscopic needle guidance in the interventional radiology suite using navigational software for percutaneous bone biopsies in children

    Energy Technology Data Exchange (ETDEWEB)

    Shellikeri, Sphoorti; Srinivasan, Abhay; Krishnamurthy, Ganesh; Vatsky, Seth; Zhu, Xiaowei; Keller, Marc S.; Cahill, Anne Marie [The Children' s Hospital of Philadelphia, Department of Radiology, Philadelphia, PA (United States); Setser, Randolph M. [Siemens Medical Solutions USA, Inc., Hoffman Estates, IL (United States); Hwang, Tiffany J. [University of Southern California, Keck School of Medicine, Los Angeles, CA (United States); Girard, Erin [Siemens Medical Solutions USA, Inc., Princeton, NJ (United States)

    2017-07-15

    Navigational software provides real-time fluoroscopic needle guidance for percutaneous procedures in the Interventional Radiology (IR) suite. We describe our experience with navigational software for pediatric percutaneous bone biopsies in the IR suite and compare technical success, diagnostic accuracy, radiation dose and procedure time with that of CT-guided biopsies. Pediatric bone biopsies performed using navigational software (Syngo iGuide, Siemens Healthcare) from 2011 to 2016 were prospectively included and anatomically matched CT-guided bone biopsies from 2008 to 2016 were retrospectively reviewed with institutional review board approval. C-arm CT protocols used for navigational software-assisted cases included institution-developed low-dose (0.1/0.17 μGy/projection), regular-dose (0.36 μGy/projection), or a combination of low-dose/regular-dose protocols. Estimated effective radiation dose and procedure times were compared between software-assisted and CT-guided biopsies. Twenty-six patients (15 male; mean age: 10 years) underwent software-assisted biopsies (15 pelvic, 7 lumbar and 4 lower extremity) and 33 patients (13 male; mean age: 9 years) underwent CT-guided biopsies (22 pelvic, 7 lumbar and 4 lower extremity). Both modality biopsies resulted in a 100% technical success rate. Twenty-five of 26 (96%) software-assisted and 29/33 (88%) CT-guided biopsies were diagnostic. Overall, the effective radiation dose was significantly lower in software-assisted than CT-guided cases (3.0±3.4 vs. 6.6±7.7 mSv, P=0.02). The effective dose difference was most dramatic in software-assisted cases using low-dose C-arm CT (1.2±1.8 vs. 6.6±7.7 mSv, P=0.001) or combined low-dose/regular-dose C-arm CT (1.9±2.4 vs. 6.6±7.7 mSv, P=0.04), whereas effective dose was comparable in software-assisted cases using regular-dose C-arm CT (6.0±3.5 vs. 6.6±7.7 mSv, P=0.7). Mean procedure time was significantly lower for software-assisted cases (91±54 vs. 141±68 min, P=0

  11. Pre-procedural peripheral endothelial function is associated with increased serum creatinine following percutaneous coronary procedure in stable patients with a preserved estimated glomerular filtration rate.

    Science.gov (United States)

    Sumida, Hitoshi; Matsuzawa, Yasushi; Sugiyama, Seigo; Sugamura, Koichi; Nozaki, Toshimitsu; Akiyama, Eiichi; Ohba, Keisuke; Konishi, Masaaki; Matsubara, Junichi; Fujisue, Koichiro; Maeda, Hirofumi; Kurokawa, Hirofumi; Iwashita, Satomi; Ogawa, Hisao; Tsujita, Kenichi

    2017-11-01

    Worsening renal function, indicated by increased serum creatinine (SCr), is a common complication of percutaneous coronary procedures. Risk factors for increased SCr overlap with coronary risk factors involved in endothelial dysfunction. We hypothesized that endothelial dysfunction, measured using the reactive hyperemia peripheral arterial tonometry index (RHI), can predict periprocedure-increased SCr. RHI was assessed before elective coronary procedures in 316 consecutive stable patients with a preserved estimated glomerular filtration rate (eGFR, >60mL/min/1.73m 2 ). SCr was measured before and 2 days after procedures. There was no significant correlation between natural logarithmic transformations of RHI (Ln-RHI) and basal Ln-eGFR. Periprocedure increase in SCr was observed in 148 (47%) patients. The increased SCr group had significantly lower Ln-RHI [0.48 (0.36, 0.62) vs. 0.59 (0.49, 0.76), pfunction by RHI is an effective strategy to assess the patient's risk conditions for worsening renal function after percutaneous coronary procedures. Copyright © 2017 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

  12. Efficacy and safety of transradial percutaneous coronary intervention using sheathless guide catheter technique

    Directory of Open Access Journals (Sweden)

    Mohamed Aboel-Kassem F. Abdelmegid

    2014-03-01

    Conclusions: TR PCI via standard and sheathless hydrophilic-coated GC techniques are effective and safe with high rate of procedural success and low rate of asymptomatic radial artery occlusion. Moreover, TR PCI using sheathless GC technique has the advantage of performing complex intervention requiring large bore catheters that can not be performed via standard TR PCI using 6F GC.

  13. Percutaneous coronary intervention in asians- are there differences in clinical outcome?

    Directory of Open Access Journals (Sweden)

    Chua Terrance S

    2011-05-01

    Full Text Available Abstract Background Ethnic differences in clinical outcome after percutaneous coronary intervention (PCI have been reported. Data within different Asian subpopulations is scarce. We aim to explore the differences in clinical profile and outcome between Chinese, Malay and Indian Asian patients who undergo PCI for coronary artery disease (CAD. Methods A prospective registry of consecutive patients undergoing PCI from January 2002 to December 2007 at a tertiary care center was analyzed. Primary endpoint was major adverse cardiovascular events (MACE of myocardial infarction (MI, repeat revascularization and all-cause death at six months. Results 7889 patients underwent PCI; 7544 (96% patients completed follow-up and were included in the analysis (79% males with mean age of 59 years ± 11. There were 5130 (68% Chinese, 1056 (14% Malays and 1001 (13.3% Indian patients. The remaining 357 (4.7% patients from other minority ethnic groups were excluded from the analysis. The primary end-point occurred in 684 (9.1% patients at six months. Indians had the highest rates of six month MACE compared to Chinese and Malays (Indians 12% vs. Chinese 8.2% vs. Malays 10.7%; OR 1.55 95%CI 1.24-1.93, p Conclusion These data indicate that ethnic variations in clinical outcome exist following PCI. In particular, Indian patients have higher six month event rates compared to Chinese and Malays. Future studies are warranted to elucidate the underlying mechanisms behind these variations.

  14. Implications of bleeding in acute coronary syndrome and percutaneous coronary intervention

    Science.gov (United States)

    Pham, Phuong-Anh; Pham, Phuong-Thu; Pham, Phuong-Chi; Miller, Jeffrey M; Pham, Phuong-Mai; Pham, Son V

    2011-01-01

    The advent of potent antiplatelet and antithrombotic agents over the past decade has resulted in significant improvement in reducing ischemic events in acute coronary syndrome (ACS). However, the use of antiplatelet and antithrombotic combination therapy, often in the settings of percutaneous coronary intervention (PCI), has led to an increase in the risk of bleeding. In patients with non-ST elevation myocardial infarction treated with antithrombotic agents, bleeding has been reported to occur in 0.4%–10% of patients, whereas in patients undergoing PCI, periprocedural bleeding occurs in 2.2%–14% of cases. Until recently, bleeding was considered an intrinsic risk of antithrombotic therapy, and efforts to reduce bleeding have received little attention. There have been increasing data demonstrating that bleeding is associated with adverse outcomes, including myocardial infarction, stroke, and death. Therefore, it is imperative to optimize patient outcomes by adopting pharmacological and nonpharmacological strategies to minimize bleeding while maximizing treatment efficacy. In this paper, we present a review of the bleeding classifications used in large-scale clinical trials in patients with ACS and those undergoing PCI treated with antiplatelets and antithrombotic agents, adverse outcomes, particularly mortality associated with bleeding complications, and suggested predictive risk factors. Potential mechanisms of the association between bleeding and mortality and strategies to reduce bleeding complications are also discussed. PMID:21915172

  15. Role of depression in secondary prevention of Chinese coronary heart disease patients receiving percutaneous coronary intervention.

    Directory of Open Access Journals (Sweden)

    Can Feng

    Full Text Available Coronary heart disease (CHD patients who have undergone percutaneous coronary intervention (PCI have higher rates of depression than the general population. However, few researchers have assessed the impact of depression on the secondary prevention of CHD in China.The main purpose of this investigation was to explore the relationship between depression and secondary prevention of CHD in Chinese patients after PCI.This descriptive, cross-sectional one-site study recruited both elective and emergency PCI patients one year after discharge. Data from 1934 patients were collected in the clinic using questionnaires and medical history records between August 2013 and September 2015. Depression was evaluated by the 9-item Patient Health Questionnaire. Secondary prevention of CHD was compared between depression and non-depression groups.We found that depression affected secondary prevention of CHD in the following aspects: lipid levels, blood glucose levels, smoking status, physical activity, BMI, and rates of medication use.Depressive patients with CHD are at increased risk of not achieving the lifestyle and risk factor control goals recommended in the 2006 AHA guidelines. Screening should focus on patients after PCI because treating depression can improve outcomes by improving secondary prevention of CHD.

  16. Subadventitial techniques for chronic total occlusion percutaneous coronary intervention: The concept of "vessel architecture".

    Science.gov (United States)

    Azzalini, Lorenzo; Carlino, Mauro; Brilakis, Emmanouil S; Vo, Minh; Rinfret, Stéphane; Uretsky, Barry F; Karmpaliotis, Dimitri; Colombo, Antonio

    2018-03-01

    Despite improvements in guidewire technologies, the traditional antegrade wire escalation approach to chronic total occlusion (CTO) recanalization is successful in only 60-80% of selected cases. In particular, long, calcified, and tortuous occlusions are less successfully approached with a true-to-true lumen approach. Frequently, the guidewire tracks into the subadventitial space, with no guarantee of distal re-entry into the true lumen. The ability to manage the subadventitial space has been a key step in the tremendous improvement in success rates of contemporary CTO percutaneous coronary intervention (PCI), whether operating antegradely or retrogradely. A modern approach to CTO PCI involves understanding the concept of "vessel architecture," which is based on the distinction between coronary structures (occlusive plaque, comprising the disrupted intima and media, and the outer adventitia) and extravascular space. The vessel architecture represents a safe work environment for guidewire and device manipulation. This review provides an anatomy-based description of the concept of vessel architecture, along with a historical perspective of subadventitial techniques for CTO PCI, and outcome data of CTO PCI utilizing the subadventitial space. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  17. Percutaneous coronary intervention and the management of acute coronary syndromes in patients with von Willebrand disease.

    Science.gov (United States)

    Rathore, Sulaiman; Deleon, Dexter; Akram, Hafsa; Sane, David; Ball, Timothy

    2013-04-01

    Von Willebrand disease (vWD) results from quantitative or qualitative deficiency of von Willebrand factor (vWF). The occurrence of myocardial infarction is very rare in patients with vWD. A few case reports of acute coronary syndrome (ACS) in vWD patients are present in the literature, but no definite management recommendations are available for such patients. We report a case of successful percutaneous coronary intervention (PCI) with bare-metal stent (BMS) implantation in a 46-year-old woman with type 1 vWD and history of coronary artery disease (CAD). She received periprocedural dual-antiplatelet therapy for 2 weeks and then continued aspirin without any bleeding complications. The optimal management of patients with vWD and ACS is complex and presents a therapeutic challenge. We propose that dual-antiplatelet therapy can be used safely in most vWD patients presenting with ACS as most of them are type 1 vWD. PCI with BMS can be done safely. Long-term management of these patients requires a systemic approach including hematological consultation, ascertaining vWF levels, as well as patient education and close outpatient follow-up.

  18. The impact on persistent ST-segment elevation to the effect of direct percutaneous coronary intervention

    International Nuclear Information System (INIS)

    Yang Wei; Jin Huigen; Liu Zongjun; Wang Weiqing; Shi Jia; Wang Dongyi; Wang Daying; Zhu Huafang; Chen Yixun; Fang Ping; Chen Wenchun

    2005-01-01

    Objective: To discuss the value of persistent ST-segment elevation on infarct related leads of electrocardiogram to judge the effect of direct percutaneous coronary intervention (PCI) in acute myocardial infarction (AMI). Methods: 229 AMI patients already been undertaken direct PCI with the flow of TIMI III were divided into two groups. According to the results of ST-segment elevation resolution on infarct related leads in electrocardiogram: the group of ST-segment elevation resolution more than 50% (group A) and the group of ST-segment elevation resolution less than 50%(group B). The basic clinical features between the two groups, and the followed up frequency of cardiac events were compared. Results: The comparisons between group A with group B showed: no-reflow as 14/147 (9.52%)VS 21/82 (25.61%); the mortality during in-hospital period 5/147 (3.40%)VS 9/82 (10.98%); MACE 8/147 (5.44%)VS 11/82 (13.4%); the value of LVEF 56.99%±9.78% VS 49.82%±8.78%, P 0.05, showing statistically insignificant. Conclusions: That the results of ST-segment elevation resolution on infarct related leads in electrocardiogram can be used as an index for reperfusion of myocardial tissue level and judgment of prognosis after direct PCI. (authors)

  19. The importance of left ventricular function for long-term outcome after primary percutaneous coronary intervention

    Directory of Open Access Journals (Sweden)

    Tio René A

    2008-02-01

    Full Text Available Abstract Background In the present study we sought to determine the long-term prognostic value of left ventricular ejection fraction (LVEF, assessed by planar radionuclide ventriculography (PRV, after ST-elevation myocardial infarction (STEMI treated with primary percutaneous coronary intervention (PPCI. Methods In total 925 patients underwent PRV for LVEF assessment after PPCI for myocardial infarction before discharge from the hospital. PRV was performed with a standard dose of 500 Mbq of 99mTc-pertechnetate. Average follow-up time was 2.5 years. Results Mean (± SD age was 60 ± 12 years. Mean (± SD LVEF was 45.7 ± 12.2 %. 1 year survival was 97.3 % and 3 year survival was 94.2 %. Killip class, multi vessel-disease, previous cardiovascular events, peak creatin kinase and its MB fraction, age and LVEF proved to be univariate predictors of mortality. When entered in a forward conditional Cox regression model age and LVEF were independent predictors of 1 and 3 year mortality. Conclusion LVEF assessed by PRV is a powerful independent predictor of long term mortality after PPCI for STEMI.

  20. Complete Versus Incomplete Angiography Prior to Percutaneous Coronary Intervention in ST-Elevation Myocardial Infarction.

    Science.gov (United States)

    Stiver, Kevin; Gao, Xu; Shreenivas, Satya; Boudoulas, Konstantinos Dean; Mazzaferri, Ernie; Makki, Nader; Lilly, Scott M

    2017-08-01

    Shorter reperfusion times in ST-elevation myocardial infarction (STEMI) are associated with improved survival. Prehospital strategies have been developed to minimize door-to-balloon (DTB) time, but few strategies within the catheterization laboratory itself have been evaluated. Incomplete angiography (IA) prior to percutaneous coronary intervention (PCI) is undertaken in clinical practice as a means to further reduce DTB time. We sought to determine whether or not those with STEMI who underwent IA prior to PCI had different preprocedural characteristics or post-PCI outcomes. We retrospectively reviewed patients presenting to our institution between March 2013 and December 2015. Clinical, demographic, and angiographic data were reviewed. The frequency, predictors, and outcomes among those who received IA vs complete angiography (CA) prior to PCI were compared with analysis of variance. Two hundred fifty-six patients were identified; 68 patients (26.6%) underwent IA and 188 patients (73.4%) had CA prior to PCI. Patients who received IA were younger, but no other preprocedural factors were predictive of IA. The practice of IA did vary by operator (range, 0%-47%; P<.01). DTB times were shorter in the IA group (28.1 min vs 37.3 min; P<.01). Overall outcomes, including peak troponin values, length of stay, in-hospital mortality, and discharge ejection fraction did not differ between the groups. IA is associated with shorter DTB times, although in this population was not associated with improvements in short-term outcomes.

  1. Aspirin desensitization in patients undergoing percutaneous coronary intervention: a survey of current practice.

    Science.gov (United States)

    Chapman, Andrew R; Rushworth, Gordon F; Leslie, Stephen J

    2013-01-01

    Aspirin remains the mainstay of anti-platelet therapy in cardiac patients. However, if a patient is allergic to aspirin and dual anti-platelet therapy is indicated - such as with percutaneous coronary intervention (PCI), then there is no clear guidance. One possibility is aspirin desensitization. A variety of protocols exist for the rapid desensitization of patients with aspirin allergy. The aim of this survey was to assess current knowledge and practice regarding aspirin desensitization in the UK. We conducted a UK wide survey of all UK 116 PCI centers and obtained complete responses from 40 (35.4%) centers. Of these, just 7 (17.5%) centers had previously desensitised patients; 29 (87.9%) centers suggested a lack of a local protocol prevented them from desensitizing, with 10 (30.3%) unsure of how to conduct desensitization. Only 5 (12.5%) centers had a local policy for aspirin desensitization although 25 (64.1%) units had a clinical strategy for dealing with aspirin allergy; the majority (72%) giving higher doses of thienopyridine class drugs. In the UK, there appears to be no consistent approach to patients with aspirin allergy. Patients undergoing PCI benefit from dual anti-platelet therapy (including aspirin), and aspirin desensitization in those with known allergy may facilitate this. Sustained effort should be placed on encouraging UK centers to use desensitization as a treatment modality prior to PCI rather than avoiding aspirin altogether.

  2. Utilization of a modified Clavien Classification System in reporting complications after ultrasound-guided percutaneous nephrostomy tube placement: comparison to standard Society of Interventional Radiology practice guidelines.

    Science.gov (United States)

    Degirmenci, Tansu; Gunlusoy, Bulent; Kozacioglu, Zafer; Arslan, Murat; Ceylan, Yasin; Ors, Bumin; Minareci, Suleyman

    2013-06-01

    To report our results on percutaneous nephrostomy (PCN) and classify our complications with the Standard of Practice Committee of the Society of Interventional Radiology guidelines and the modified Clavien Classification System (CCS). Three hundred eighty-nine PCN insertions were performed in 322 patients (224 men and 98 women) at our institution. PCN insertion was performed under ultrasound for dilated pelvicalyceal system and ultrasound/fluoroscopy for nondilated system. PCN was considered successful if the catheter was drained urine spontaneously. Number of complications was registered. Primary successful PCN insertion was achieved in 368 of the 389 procedures (94.6%). The success rates for nondilated and dilated systems were 82.7% and 96.4%, respectively. Major complications occurred in 9.6% and minor complications in 9.9% according to the Society of Interventional Radiology. According to the modified CCS grades I, II, III, IV, and V was 9.9%, 1.2%, 6.8%, 1.2%, and 0.3%, respectively. Age, grade of the hydronephrosis, serum creatinine levels, and mean hemoglobin levels were statistically significant parameters for the occurrence of complications on univariate analysis. The nondilated system has statistically significant parameters affecting the complication rates on multivariate analysis (P = .001, odds ratio [OR] = 6.1, 95% confidence interval [CI] = 2-18.4). Percutaneous nephrostomy is a well-known procedure in the treatment of temporary or permanent drainage of an obstructed system. It is very important to define the complications related to interventions for interpretation of clinical comparisons more accurately. Modified CCS is a reproducible system to evaluate the complications. Copyright © 2013 Elsevier Inc. All rights reserved.

  3. Clinical use of intracoronary imaging. Part 1: guidance and optimization of coronary interventions. An expert consensus document of the European Association of Percutaneous Cardiovascular Interventions: Endorsed by the Chinese Society of Cardiology.

    Science.gov (United States)

    Räber, Lorenz; Mintz, Gary S; Koskinas, Konstantinos C; Johnson, Thomas W; Holm, Niels R; Onuma, Yoshinubo; Radu, Maria D; Joner, Michael; Yu, Bo; Jia, Haibo; Menevau, Nicolas; de la Torre Hernandez, Jose M; Escaned, Javier; Hill, Jonathan; Prati, Francesco; Colombo, Antonio; di Mario, Carlo; Regar, Evelyn; Capodanno, Davide; Wijns, William; Byrne, Robert A; Guagliumi, Giulio

    2018-05-22

    This Consensus Document is the first of two reports summarizing the views of an expert panel organized by the European Association of Percutaneous Cardiovascular Interventions (EAPCI) on the clinical use of intracoronary imaging including intravascular ultrasound (IVUS) and optical coherence tomography (OCT). The first document appraises the role of intracoronary imaging to guide percutaneous coronary interventions (PCIs) in clinical practice. Current evidence regarding the impact of intracoronary imaging guidance on cardiovascular outcomes is summarized, and patients or lesions most likely to derive clinical benefit from an imaging-guided intervention are identified. The relevance of the use of IVUS or OCT prior to PCI for optimizing stent sizing (stent length and diameter) and planning the procedural strategy is discussed. Regarding post-implantation imaging, the consensus group recommends key parameters that characterize an optimal PCI result and provides cut-offs to guide corrective measures and optimize the stenting result. Moreover, routine performance of intracoronary imaging in patients with stent failure (restenosis or stent thrombosis) is recommended. Finally, strengths and limitations of IVUS and OCT for guiding PCI and assessing stent failures and areas that warrant further research are critically discussed.

  4. Gaps in referral to cardiac rehabilitation of patients undergoing percutaneous coronary intervention in the United States.

    Science.gov (United States)

    Aragam, Krishna G; Dai, Dadi; Neely, Megan L; Bhatt, Deepak L; Roe, Matthew T; Rumsfeld, John S; Gurm, Hitinder S

    2015-05-19

    Rates of referral to cardiac rehabilitation after percutaneous coronary intervention (PCI) have been historically low despite the evidence that rehabilitation is associated with lower mortality in PCI patients. This study sought to determine the prevalence of and factors associated with referral to cardiac rehabilitation in a national PCI cohort, and to assess the association between insurance status and referral patterns. Consecutive patients who underwent PCI and survived to hospital discharge in the National Cardiovascular Data Registry between July 1, 2009 and March 31, 2012 were analyzed. Cardiac rehabilitation referral rates, and patient and institutional factors associated with referral were evaluated for the total study population and for a subset of Medicare patients presenting with acute myocardial infarction. Patients who underwent PCI (n = 1,432,399) at 1,310 participating hospitals were assessed. Cardiac rehabilitation referral rates were 59.2% and 66.0% for the overall population and the AMI/Medicare subgroup, respectively. In multivariable analyses, presentation with ST-segment elevation myocardial infarction (odds ratio 2.99; 95% confidence interval: 2.92 to 3.06) and non-ST-segment elevation myocardial infarction (odds ratio: 1.99; 95% confidence interval: 1.94 to 2.03) were associated with increased odds of referral to cardiac rehabilitation. Models adjusted for insurance status showed significant site-specific variability in referral rates, with more than one-quarter of all hospitals referring rehabilitation. Site-specific variation in referral rates is significant and is unexplained by insurance coverage. These findings highlight the potential need for hospital-level interventions to improve cardiac rehabilitation referral rates after PCI. Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  5. Evaluation of medical radiation exposure in pediatric interventional radiology procedures

    Energy Technology Data Exchange (ETDEWEB)

    Navarro, Valeria Coelho Costa; Navarro, Marcus Vinicius Teixeira; Oliveira, Aline da Silva Pacheco, E-mail: vccnavarro@gmail.com [Instituto Federal de Educacao, Ciencia e Tecnologia da Bahia (IFBA), Salvador, BA (Brazil); Maia, Ana Figueiredo [Universidade Federal de Sergipe (UFS), Aracaju, SE (Brazil); Oliveira, Adriano Dias Dourado [Sociedade Brasileira de Hemodinamica e Cardiologia Intervencionista, Salvador, BA (Brazil)

    2012-07-15

    Objective: To evaluate pediatric radiation exposure in procedures of interventional radiology in two hospitals in the Bahia state, aiming at contributing to delineate the scenario at the state and national levels. The knowledge of exposure levels will allow an evaluation of the necessity of doses optimization, considering that peculiarities of radiology and pediatrics become even more significant in interventional radiology procedures which involve exposure to higher radiation doses. Materials and Methods: A total of 32 procedures were evaluated in four rooms of the two main hospitals performing pediatric interventional radiology procedures in the Bahia state. Air kerma rate and kerma-area product were evaluated in 27 interventional cardiac and 5 interventional brain procedures. Results: Maximum values for air kerma rate and kerma-area product and air kerma obtained in cardiac procedures were, respectively, 129.9 Gy.cm{sup 2} and 947.0 mGy; and, for brain procedures were 83.3 Gy.cm{sup 2} and 961.0 mGy. Conclusion: The present study results showed exposure values up to 14 times higher than those found in other foreign studies, and approximating those found for procedures in adults. Such results demonstrate excessive exposure to radiation, indicating the need for constant procedures optimization and evaluation of exposure rates. (author)

  6. Short term outcome of Percutanous Coronary Intervention in diabetic and non-diabetic patients

    Directory of Open Access Journals (Sweden)

    Nouzari Y

    2007-05-01

    Full Text Available Background: Despite recent improvement in coronary intervention, there are many controversies about it’s results in diabetic patients. The goal of this study is comparison of in hospital outcome of diabetics after coronary intervention with nondiabetics. Methods: In this study 115 diabetic and 115non diabetic patients who admitted for coronary intervention in our center during 1383&84 were entered in an analytic study of Cohort type. Datas about clinical, aniographic, procedural and post procedural (24hours characteristics were entered in each patient’s form. Independent T test,chi-square and Fisher’s exact test were used for analyzing datas. Results: The Diabetic Patients were most often older men, and they had higher angina class, more co-risk factors and lower ejection fractions. Diabetic’s lesions were longer and more located in proximal portion of vessels. But success rate, major complication (death, revascularization, Q Wave MI and CVA, and minor complications (coronary/peripheral arteries complication, pulmonary edema, ischemic ECG had no significant differences between two groups. Conclusion: Diabetes mellitus does not affect short outcomes of coronary intervention as an independent factor. So intervention could be done in these patients with considering favorable outcomes.

  7. Percutaneous coronary intervention patients’ and cardiologists’ experiences of the informed consent process in Northern England: a qualitative study

    Science.gov (United States)

    Probyn, Joy; Greenhalgh, Joanne; Holt, Janet; Conway, Dwayne; Astin, Felicity

    2017-01-01

    Objective Informed consent is central to ethical medical practice, but little is known about how the process takes place in clinical practice. Percutaneous coronary intervention (PCI) is a common revascularisation procedure. Studies report that patients overestimate benefits, forget the risks and are unaware of alternative treatments. The aim of this study was to describe PCI patients’ and cardiologists’ experiences of the informed consent process in acute care settings. Design/setting/participants A qualitative study with a maximum variation sample of elective and acute PCI patients and cardiologists taking their consent, recruited from a district general hospital and tertiary centre. In-depth interviews were conducted, and consent discussions were audio recorded. Data collection, coding and theorising occurred simultaneously. Findings Forty-one (26 male) patients scheduled for elective (20) or urgent (21) PCI and 19 cardiologists (5 female) participated. Despite diversity in patients’ experiences of informed consent, elective and acute patients experienced a common four-stage process of consent. Most patients made the decision to have treatment at PCI referral and took a passive role in the discussions we recorded. They recognised cardiologists as experts, trusted the medical system to ‘fix’ their health problem and were unaware of their role in the informed consent process. Informed consent discussions functioned as a formal ‘event’,enabling cardiologists to check patients’ understanding and enabling patients to access treatment. Conclusions The configuration of services and patients’ perceptions of their role in informed consent underpin a mismatch between legal and ethical principles of informed consent and current practice. The variation in patients’ experiences of the current place of informed consent in service delivery represents a missed opportunity for cardiologists to work in decision-making partnerships with patients. In light of

  8. Percutaneous coronary intervention patients' and cardiologists' experiences of the informed consent process in Northern England: a qualitative study.

    Science.gov (United States)

    Probyn, Joy; Greenhalgh, Joanne; Holt, Janet; Conway, Dwayne; Astin, Felicity

    2017-06-24

    Informed consent is central to ethical medical practice, but little is known about how the process takes place in clinical practice. Percutaneous coronary intervention (PCI) is a common revascularisation procedure. Studies report that patients overestimate benefits, forget the risks and are unaware of alternative treatments. The aim of this study was to describe PCI patients' and cardiologists' experiences of the informed consent process in acute care settings. A qualitative study with a maximum variation sample of elective and acute PCI patients and cardiologists taking their consent, recruited from a district general hospital and tertiary centre. In-depth interviews were conducted, and consent discussions were audio recorded. Data collection, coding and theorising occurred simultaneously. Forty-one (26 male) patients scheduled for elective (20) or urgent (21) PCI and 19 cardiologists (5 female) participated. Despite diversity in patients' experiences of informed consent, elective and acute patients experienced a common four-stage process of consent. Most patients made the decision to have treatment at PCI referral and took a passive role in the discussions we recorded. They recognised cardiologists as experts, trusted the medical system to 'fix' their health problem and were unaware of their role in the informed consent process. Informed consent discussions functioned as a formal 'event',enabling cardiologists to check patients' understanding and enabling patients to access treatment. The configuration of services and patients' perceptions of their role in informed consent underpin a mismatch between legal and ethical principles of informed consent and current practice. The variation in patients' experiences of the current place of informed consent in service delivery represents a missed opportunity for cardiologists to work in decision-making partnerships with patients. In light of recent changes in the law, a new approach to informed consent is required.

  9. Percutaneous Coronary Intervention in Severely Calcified Unprotected Left Main Coronary Artery Disease: Initial Experience With Orbital Atherectomy.

    Science.gov (United States)

    Lee, Michael S; Shlofmitz, Evan; Kaplan, Barry; Shlofmitz, Richard

    2016-04-01

    We report the clinical outcomes of patients who underwent percutaneous coronary intervention (PCI) with orbital atherectomy for severely calcified unprotected left main coronary artery (ULMCA) disease. Although surgical revascularization is the gold standard for patients with ULMCA disease, not all patients are candidates for this. PCI is increasingly used to treat complex coronary artery disease, including ULMCA disease. The presence of severely calcified lesions increases the complexity of PCI. Orbital atherectomy can be used to facilitate stent delivery and expansion in severely calcified lesions. The clinical outcomes of patients treated with orbital atherectomy for severely calcified ULMCA disease have not been reported. From May 2014 to July 2015, a total of 14 patients who underwent PCI with orbital atherectomy for ULMCA disease were retrospectively evaluated. The primary endpoint was major cardiac and cerebrovascular event (cardiac death, myocardial infarction, stroke, and target-lesion revascularization) at 30 days. The mean age was 78.2 ± 5.8 years. The mean ejection fraction was 41.8 ± 19.8%. Distal bifurcation disease was present in 9 of 14 patients. Procedural success was achieved in all 14 patients. The 30-day major adverse cardiac and cerebrovascular event rate was 0%. One patient had coronary dissection that was successfully treated with stenting. No patient had perforation, slow flow, or thrombosis. Orbital atherectomy in patients with severely calcified ULMCA disease is feasible, even in high-risk patients who were considered poor surgical candidates. Randomized trials are needed to determine the role of orbital atherectomy in ULMCA disease.

  10. Registration of angiographic image on real-time fluoroscopic image for image-guided percutaneous coronary intervention.

    Science.gov (United States)

    Kim, Dongkue; Park, Sangsoo; Jeong, Myung Ho; Ryu, Jeha

    2018-02-01

    In percutaneous coronary intervention (PCI), cardiologists must study two different X-ray image sources: a fluoroscopic image and an angiogram. Manipulating a guidewire while alternately monitoring the two separate images on separate screens requires a deep understanding of the anatomy of coronary vessels and substantial training. We propose 2D/2D spatiotemporal image registration of the two images in a single image in order to provide cardiologists with enhanced visual guidance in PCI. The proposed 2D/2D spatiotemporal registration method uses a cross-correlation of two ECG series in each image to temporally synchronize two separate images and register an angiographic image onto the fluoroscopic image. A guidewire centerline is then extracted from the fluoroscopic image in real time, and the alignment of the centerline with vessel outlines of the chosen angiographic image is optimized using the iterative closest point algorithm for spatial registration. A proof-of-concept evaluation with a phantom coronary vessel model with engineering students showed an error reduction rate greater than 74% on wrong insertion to nontarget branches compared to the non-registration method and more than 47% reduction in the task completion time in performing guidewire manipulation for very difficult tasks. Evaluation with a small number of experienced doctors shows a potentially significant reduction in both task completion time and error rate for difficult tasks. The total registration time with real procedure X-ray (angiographic and fluoroscopic) images takes [Formula: see text] 60 ms, which is within the fluoroscopic image acquisition rate of 15 Hz. By providing cardiologists with better visual guidance in PCI, the proposed spatiotemporal image registration method is shown to be useful in advancing the guidewire to the coronary vessel branches, especially those difficult to insert into.

  11. A cross-sectional analysis of variation in charges and prices across California for percutaneous coronary intervention.

    Directory of Open Access Journals (Sweden)

    Renee Y Hsia

    Full Text Available Though past studies have shown wide variation in aggregate hospital price indices and specific procedures, few have documented or explained such variation for distinct and common episodes of care.We sought to examine the variability in charges for percutaneous coronary intervention (PCI with a drug-eluting stent and without major complications (MS-DRG-247, and determine whether hospital and market characteristics influenced these charges.We conducted a cross-sectional analysis of adults admitted to California hospitals in 2011 for MS-DRG-247 using patient discharge data from the California Office of Statewide Health Planning and Development. We used a two-part linear regression model to first estimate hospital-specific charges adjusted for patient characteristics, and then examine whether the between-hospital variation in those estimated charges was explained by hospital and market characteristics.Adjusted charges for the average California patient admitted for uncomplicated PCI ranged from $22,047 to $165,386 (median: $88,350 depending on which hospital the patient visited. Hospitals in areas with the highest cost of living, those in rural areas, and those with more Medicare patients had higher charges, while government-owned hospitals charged less. Overall, our model explained 43% of the variation in adjusted charges. Estimated discounted prices paid by private insurers ranged from $3,421 to $80,903 (median: $28,571.Charges and estimated discounted prices vary widely between hospitals for the average California patient undergoing PCI without major complications, a common and relatively homogeneous episode of care. Though observable hospital characteristics account for some of this variation, the majority remains unexplained.

  12. The effects of dextromethorphan on the outcome of percutaneous coronary intervention with bare-metal stent implantation

    Directory of Open Access Journals (Sweden)

    Wen-Cheng Liu

    2018-01-01

    Full Text Available Background: In the era of drug-eluting stents, although bare-metal stent (BMS remains an option for percutaneous coronary intervention (PCI, restenosis remains the Achilles' heel of BMS implantation. A recent study demonstrated several pleiotropic anti-inflammatory effects of dextromethorphan (DXM. This study aims to evaluate the effects of DXM on the outcome of PCI with BMS implantation.Methods: In this prospective, double-blind, randomized trial, we enrolled 55 patients who underwent PCI with BMS implantation from May 2006 to February 2009. The patients were divided into DXM (60 mg once daily and placebo groups. We compared mortality rates, myocardial infarction (MI, target lesion revascularization (TLR, restenosis, stent thrombosis, and plasma levels of high-sensitivity C-reactive protein (hs-CRP with repeated coronary angiography 6 months after the initial procedure.Results: During the 6-month follow-up period, no events of death, MI and stent thrombosis were reported in both groups. The TLR rate was 16.7% in patients receiving DXM compared to 24% receiving a placebo (P = 0.521. The restenosis rate was 30% in patients receiving DXM as compared to 40% receiving the placebo (P = 0.571. Although nonsignificant, the percentage of hs-CRP elevation was lower in the DXM group (20% compared to the placebo group 32%; P = 0.363.Conclusions: DXM is safe to use in patients who underwent PCI. Although DXM therapy following BMS implantation did not significantly reduce the TLR and restenosis rates, it implied a trend toward a lower TLR and restenosis and reduced inflammation in the DXM group compared to the placebo group. Nonetheless, further extensive studies are warranted to elucidate the anti-restenosis effects of DXM.

  13. Outcome of Diabetic and Non-Diabetic Patients Undergoing Successful Percutaneous Coronary Intervention of Chronic Total Occlusion

    Directory of Open Access Journals (Sweden)

    Bahram Sohrabi

    2011-05-01

    Full Text Available Introduction: Diabetes mellitus is associated with an increased risk of adverse clinical outcomes after percutaneous coronary intervention (PCI. The prognosis of patients with diabetes mellitus and chronic total occlusion (CTO treated with PCI is poorly investigated. Current study evaluates outcome of successful PCI on CTO in patients with and without diabetes. Methods: One hundred and sixty three patients treated with successful PCI on CTO between January 2009 and March 2011 were prospectively identified from the PCI registry at the Madani Heart Center, Tabriz, Iran. Patients were followed for 15±3 months, were evaluated for the occurrence of major adverse cardiac events (MACE comprising death, acute myocardial infarction, and need for repeat revascularization.Results: No differences were found in baseline clinical and procedural variables between patients with (n=34 and without diabetes (n=129, unless for hypertension (p=0.03. Hospitalization period after PCI in diabetics (3.26±0.61 days and non-diabetics (2.86±0.52 days was similar. In-hospital MACE occurred in 8 (23.5% individuals of diabetics and 10 (7.8% individuals of non-diabetics (p=0.02, among them revascularization was significantly higher in diabetics (20.6% vs. 7%, p=0.04. Follow-up events in diabetic and non-diabetic groups were 12 (35.3% and 37 (28.5%, respectively (p was not significant. Conclusion: In patients undergoing successful PCI on CTO, diabetes is associated with higher in-hospital adverse events; however diabetes does not affect long term outcomes in these patients.

  14. Transradial percutaneous coronary intervention for left main bifurcation lesions using 7.5-Fr sheathless guide catheter.

    Science.gov (United States)

    Zhao, Huiqiang; Banerjee, Subhash; Chen, Hui; Li, Hongwei

    2018-05-01

    Recent studies have shown sheathless guide catheters (GCs) to be safe and effective during complex lesions such as bifurcations, chronic total occlusion (CTO), and/or calcified lesions. We investigated the feasibility and safety of using 7.5-Fr sheathless GC for transradial percutaneous coronary intervention (PCI) to treat left main bifurcation lesions.A total of 82 patients were consecutively enrolled from March 2013 to February 2016. They underwent transradial PCI for left main bifurcation lesions using the 7.5-Fr sheathless GC.The mean syntax score was 28.1 ± 6.1, and the majority (n = 55, 67.1%) was intermediate scores (23∼32). The unprotected LM disease was present in 67 of 82 patients (81.7%), and true bifurcation (Medina 1, 1, 1) was present in 46 of 82 patients (56.1%). The 2-stent technique was used in 62 of 82 patients (75.6%). The 2-stent technique included 31 cases (37.8%) of "Crush," 18 cases (22.0%) of "Cullote," and 13 (15.8%) cases of "T stent and modified T stent" (T stent). Immediate angiographic success rate was 100% (82/82), and procedural success rate was 97.6% (80/82). The vascular complications occurred in 3 patients (3/82, 3.7%).The use of 7.5-Fr sheathless GC is safe and allows PCI for complex bifurcation lesions located in the distal of left main to be performed transradially with a high success rate.

  15. An epidural catheter removal after recent percutaneous coronary intervention and coronary artery stenting: Epidural catheter and antiaggregation therapy

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    Joksić Nikola

    2016-01-01

    Full Text Available Introduction: Anticoagulation and antiplatelet therapy in the presence of the epidural catheter is still controversial. It is well known that dual antiplatelet therapy is indicated for 12 months after the placement of drug-eluting stents (DES. Removal of an epidural catheter during that period is related to an increased risk of stent occlusion in case of discontinuation of platelet function inhibitors or, on the other hand, increased risk of epidural hematoma associated with neurological deficit if suppressed platelet function is still present. Case Report: Here we present a case of a 63-year-old man who was admitted to Institute for Cardiovascular Diseases Dedinje for elective aortic surgery. Before the induction, an epidural catheter was inserted at the Th10-Th11 epidural space. Uneventful surgery was performed under the combined epidural and general anesthesia. On the 2nd postoperative day, the patient sustained a ST depression myocardial infarction treated with percutaneous coronary intervention with DES placement, while epidural catheter was still in place. Dual antiplatelet therapy with 600mg of clopidogrel, 100 mg of acetilsalicylic acid (ASA and low molecular weight heparin (LMWH were started during the procedure. The next day, clopidogrel (75 mg and ASA (100 mg were continued as well as LMWH. The decision to remove the epidural catheter was made on the 9th postoperative day, after platelet aggregation assays were performed. Six hours after catheter removal the patient again received clopidogrel, ASA and LMWH. There were no signs of epidural hematoma. Conclusion: This case shows that point-of-care testing with platelet aggregation assays may be useful in increasing the margin of safety for epidural catheter removal during dual antiplatelet therapy.

  16. Supported high-risk percutaneous coronary intervention with the Impella 2.5 device the Europella registry

    DEFF Research Database (Denmark)

    Sjauw, Krischan D; Konorza, Thomas; Erbel, Raimund

    2009-01-01

    OBJECTIVES: This retrospective multicenter registry evaluated the safety and feasibility of left ventricular (LV) support with the Impella 2.5 (Abiomed Europe GmbH, Aachen, Germany) during high-risk percutaneous coronary intervention (PCI). BACKGROUND: Patients with complex or high-risk coronary...... with poor LV function. The Impella 2.5, a percutaneous implantable LV assist device, might be a superior alternative to the traditionally used intra-aortic balloon pump. METHODS: The Europella registry included 144 consecutive patients who underwent a high-risk PCI. Safety and feasibility end points.......5%. Rates of myocardial infarction, stroke, bleeding requiring transfusion/surgery, and vascular complications at 30 days were 0%, 0.7%, 6.2%, and 4.0%, respectively. CONCLUSIONS: This large multicenter registry supports the safety, feasibility, and potential usefulness of hemodynamic support with Impella 2...

  17. A first-in-man study of the Reitan catheter pump for circulatory support in patients undergoing high-risk percutaneous coronary intervention.

    Science.gov (United States)

    Smith, Elliot J; Reitan, Oyvind; Keeble, Thomas; Dixon, Kerry; Rothman, Martin T

    2009-06-01

    To investigate the safety of a novel percutaneous circulatory support device during high-risk percutaneous coronary intervention (PCI). The Reitan catheter pump (RCP) consists of a catheter-mounted pump-head with a foldable propeller and surrounding cage. Positioned in the descending aorta the pump creates a pressure gradient, reducing afterload and enhancing organ perfusion. Ten consecutive patients requiring circulatory support underwent PCI; mean age 71 +/- 9; LVEF 34% +/- 11%; jeopardy score 8 +/- 2.3. The RCP was inserted via the femoral artery. Hemostasis was achieved using Perclose sutures. PCI was performed via the radial artery. Outcomes included in-hospital death, MI, stroke, and vascular injury. Hemoglobin (Hb), free plasma Hb (fHb), platelets, and creatinine (cre) were measured pre PCI and post RCP removal. The pump was inserted and operated successfully in 9/10 cases (median 79 min). Propeller rotation at 10,444 +/- 1,424 rpm maintained an aortic gradient of 9.8 +/- 2 mm Hg. Although fHb increased, there was no significant hemolysis (4.7 +/- 2.4 mg/dl pre vs. 11.9 +/- 10.5 post, P = 0.04, reference 20 mg/dl). Platelets were unchanged (pre 257 +/- 74 x 10(9) vs. 245 +/- 63, P = NS). Renal function improved (cre pre 110 +/- 27 micromol/l vs. 99 +/- 28, P = 0.004). The RCP was not used in one patient following femoral introducer sheath related aortic dissection. All PCI procedures were successful with no deaths or strokes, one MI, and no vascular complications following pump removal. The RCP can be used safely in high-risk PCI patients. This device may be an alternative to other percutaneous systems when substantial cardiac support is needed. (c) 2009 Wiley-Liss, Inc.

  18. Paediatric Interventional Uroradiology

    International Nuclear Information System (INIS)

    Barnacle, Alex M.; Wilkinson, A. Graham; Roebuck, Derek J.

    2011-01-01

    Paediatric interventional uroradiology lies at the intersection of the disciplines of paediatric interventional radiology and paediatric endourology. Interdisciplinary collaboration has led to the development of new techniques and refinement of procedures adopted from adult practice. This article reviews the major procedures used in paediatric interventional uroradiology, with emphasis on nephrostomy, percutaneous nephrolithotomy, balloon-burst pyeloplasty, and antegrade ureteric stenting.

  19. Progress in intervention procedure of achalasia

    International Nuclear Information System (INIS)

    Liang Xinmei; Cheng Yingsheng

    2008-01-01

    Achalasia is a primary esophageal motility disorder, with the main symptom of dysphagia; and caused by the tonus increase and abnormal relaxation of the lower esophageal sphincter(LES). The etiology remains unclear, the objective of the current treatment approaches for achalasia containing the reduction of the LES tone and obstruction to relieve the patients' symptoms; including pharmacologic treatment, botulinum toxin treatment, surgical myotomy, pneumatic dilatation and cardia stent dilatation. The temporary cardia stent dilatation possesses some better advantages and effects; and ought to be the first choice of minimal invasive interventional management for achalasia. (authors)

  20. Factors Associated with In-stent Restenosis in Patients Following Percutaneous Coronary Intervention

    Directory of Open Access Journals (Sweden)

    Dedi Wihanda

    2015-07-01

    Full Text Available Aim: to determine factors associated with In-Stent Restenosis (ISR in patients following Percutaneous Coronary Intervention (PCI. Methods: a retrospective cross-sectional study was conducted using secondary information from medical records of post-PCI patients who underwent follow-up of angiography PCI between January 2009 and March 2014 at The Integrated Cardiovascular Service Unit, Cipto Mangunkusumo Hospital, Jakarta. Angiographic ISR was defined when the diameter of stenosis ≥50% at follow-up angiography including the diameter inside the stent and diameter with five-mm protrusion out of the proximal and distal ends of the stent. Results: there were 289 subjects including 133 subjects with and 156 subjects without ISR. The incidence of ISR in patients using of bare-metal stent (BMS and drug-eluting stent (DES were 61.3% and 40.7%, respectively. Factors associated with ISR are stent-type (OR=4.83, 95% CI 2.51-9.30, stent length (OR=3.71, 95% CI 1.99-6.90, bifurcation lesions (OR=2.43, 95% CI 1.16-5.10, smoking (OR=2.30, 95% CI 1.33-3.99, vascular diameter (OR=2.18, 95% CI 1.2-3.73, hypertension (OR=2.16, 95% CI 1.16-4.04 and diabetes mellitus (OR=2.14, 95% CI 1.23-3.70. Conclusion: stent type, stent length, bifurcation lesions, smoking, vascular diameter, hypertension and DM are factors associated with ISR in patients following PCI. Key words: bare-metal stent; drug-eluting stent; in-stent restenosis.

  1. Re-initiating professional working activity after myocardial infarction in primary percutaneous coronary intervention networks era

    Directory of Open Access Journals (Sweden)

    Zdravko Babić

    2015-12-01

    Full Text Available Objectives: To investigate the aspects of return to work, socio-economic and quality of life aspects in 145 employed patients under 60 years of age treated with primary percutaneous coronary intervention for acute ST-elevation myocardial infarction. Material and Methods: During hospital treatment demographic and clinical data was collected. Data about major adverse cardiovascular events, rehabilitation, sick leave, discharge from job and retirement, salary, major life events and estimation of quality of life after myocardial infarction were obtained after follow-up (mean: 836±242 days. Results: Average sick leave was 126±125 days. Following myocardial infarction, 3.4% of patients were discharged from their jobs while 31.7% retired. Lower salary was reported in 17.9% patients, major life events in 9.7%, while 40.7% estimated quality of life as worse following the event. Longer hospitalization was reported in patients transferred from surrounding counties, those with inferior myocardial wall and right coronary artery affected. Age, hyperlipoproteinemia and lower education degree were connected to permanent working cessation. Significant salary decrease was observed in male patients. Employer type was related to sick leave duration. Impaired quality of life was observed in patients who underwent in-hospital rehabilitation and those from surrounding counties. Longer sick leave was observed in patients with lower income before and after myocardial infarction. These patients reported lower quality of life after myocardial infarction. Conclusions: Inadequate health policy and delayed cardiac rehabilitation after myocardial infarction may lead to prolonged hospitalization and sick leave as well as lower quality of life after the event, regardless of optimal treatment in acute phase of disease.

  2. Re-initiating professional working activity after myocardial infarction in primary percutaneous coronary intervention networks era.

    Science.gov (United States)

    Babić, Zdravko; Pavlov, Marin; Oštrić, Mirjana; Milošević, Milan; Misigoj Duraković, Marjeta; Pintarić, Hrvoje

    2015-01-01

    To investigate the aspects of return to work, socio-economic and quality of life aspects in 145 employed patients under 60 years of age treated with primary percutaneous coronary intervention for acute ST-elevation myocardial infarction. During hospital treatment demographic and clinical data was collected. Data about major adverse cardiovascular events, rehabilitation, sick leave, discharge from job and retirement, salary, major life events and estimation of quality of life after myocardial infarction were obtained after follow-up (mean: 836±242 days). Average sick leave was 126±125 days. Following myocardial infarction, 3.4% of patients were discharged from their jobs while 31.7% retired. Lower salary was reported in 17.9% patients, major life events in 9.7%, while 40.7% estimated quality of life as worse following the event. Longer hospitalization was reported in patients transferred from surrounding counties, those with inferior myocardial wall and right coronary artery affected. Age, hyperlipoproteinemia and lower education degree were connected to permanent working cessation. Significant salary decrease was observed in male patients. Employer type was related to sick leave duration. Impaired quality of life was observed in patients who underwent in-hospital rehabilitation and those from surrounding counties. Longer sick leave was observed in patients with lower income before and after myocardial infarction. These patients reported lower quality of life after myocardial infarction. Inadequate health policy and delayed cardiac rehabilitation after myocardial infarction may lead to prolonged hospitalization and sick leave as well as lower quality of life after the event, regardless of optimal treatment in acute phase of disease. This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.

  3. Platelet density per monocyte predicts adverse events in patients after percutaneous coronary intervention.

    Science.gov (United States)

    Rutten, Bert; Roest, Mark; McClellan, Elizabeth A; Sels, Jan W; Stubbs, Andrew; Jukema, J Wouter; Doevendans, Pieter A; Waltenberger, Johannes; van Zonneveld, Anton-Jan; Pasterkamp, Gerard; De Groot, Philip G; Hoefer, Imo E

    2016-01-01

    Monocyte recruitment to damaged endothelium is enhanced by platelet binding to monocytes and contributes to vascular repair. Therefore, we studied whether the number of platelets per monocyte affects the recurrence of adverse events in patients after percutaneous coronary intervention (PCI). Platelet-monocytes complexes with high and low median fluorescence intensities (MFI) of the platelet marker CD42b were isolated using cell sorting. Microscopic analysis revealed that a high platelet marker MFI on monocytes corresponded with a high platelet density per monocyte while a low platelet marker MFI corresponded with a low platelet density per monocyte (3.4 ± 0.7 vs 1.4 ± 0.1 platelets per monocyte, P=0.01). Using real-time video microscopy, we observed increased recruitment of high platelet density monocytes to endothelial cells as compared with low platelet density monocytes (P=0.01). Next, we classified PCI scheduled patients (N=263) into groups with high, medium and low platelet densities per monocyte and assessed the recurrence of adverse events. After multivariate adjustment for potential confounders, we observed a 2.5-fold reduction in the recurrence of adverse events in patients with a high platelet density per monocyte as compared with a low platelet density per monocyte [hazard ratio=0.4 (95% confidence interval, 0.2-0.8), P=0.01]. We show that a high platelet density per monocyte increases monocyte recruitment to endothelial cells and predicts a reduction in the recurrence of adverse events in patients after PCI. These findings may imply that a high platelet density per monocyte protects against recurrence of adverse events.

  4. Reexamining the Efficacy and Value of Percutaneous Coronary Intervention for Patients With Stable Ischemic Heart Disease

    Science.gov (United States)

    Weintraub, William S.; Boden, William E.

    2017-01-01

    Percutaneous coronary intervention (PCI) continues to be performed frequently for patients with stable ischemic heart disease, despite uncertain efficacy. Individual randomized trial data and meta-analyses have not demonstrated that PCI in addition to optimal medical therapy reduces the incidence of death or myocardial infarction in patients with stable disease. The Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) Trial did not show benefit for cardiovascular outcomes or mortality but did find a modest improvement in quality of life that did not persist at 3 years. Long-term follow-up from COURAGE (up to 15 years) found no differences in mortality, consistent with other published literature. How PCI could reduce long-term mortality or prevent myocardial infarction is not clear because sites of future plaque rupture leading to myocardial infarction are unpredictable and PCI can only treat localized anatomic segments of obstructive atherosclerosis. In addition, PCI is expensive, and the value to society of PCI for stable disease has not been demonstrated. The ISCHEMIA trial will assess the role of PCI for stable ischemic heart disease using newer technology and in patients with greater ischemic burden than in COURAGE. After nearly a decade, the COURAGE trial and other studies have given us pause to critically reexamine the role of PCI for patients with stable ischemic heart disease. Until further research can show that PCI can reduce cardiovascular events in these patients, a first-line strategy of optimal medical therapy is known to be safe, effective, and noninferior to PCI, and our practice should more closely follow this strategy. PMID:27380178

  5. Residual Angina After Elective Percutaneous Coronary Intervention in Patients With Diabetes Mellitus.

    Science.gov (United States)

    Grodzinsky, Anna; Kosiborod, Mikhail; Tang, Fengming; Jones, Philip G; McGuire, Darren K; Spertus, John A; Beltrame, John F; Jang, Jae-Sik; Goyal, Abhinav; Butala, Neel M; Yeh, Robert W; Arnold, Suzanne V

    2017-09-01

    Previous studies suggest that among patients with stable coronary artery disease, patients with diabetes mellitus (DM) have less angina and more silent ischemia when compared with those without DM. However, the burden of angina in diabetic versus nondiabetic patients after elective percutaneous coronary intervention (PCI) has not been recently examined. In a 10-site US PCI registry, we assessed angina before and at 1, 6, and 12 months after elective PCI with the Seattle Angina Questionnaire angina frequency score (range, 0-100, higher=better). We also examined the rates of antianginal medication prescriptions at discharge. A multivariable, repeated-measures Poisson model was used to examine the independent association of DM with angina over the year after treatment. Among 1080 elective PCI patients (mean age, 65 years; 74.7% men), 34.0% had DM. At baseline and at each follow-up, patients with DM had similar angina prevalence and severity as those without DM. Patients with DM were more commonly prescribed calcium channel blockers and long-acting nitrates at discharge (DM versus not: 27.9% versus 20.9% [ P =0.01] and 32.8% versus 25.5% [ P =0.01], respectively), whereas β-blockers and ranolazine were prescribed at similar rates. In the multivariable, repeated-measures model, the risk of angina was similar over the year after PCI in patients with versus without DM (relative risk, 1.04; range, 0.80-1.36). Patients with stable coronary artery disease and DM exhibit a burden of angina that is at least as high as those without DM despite more antianginal prescriptions at discharge. These findings contradict the conventional teachings that patients with DM experience less angina because of silent ischemia. © 2017 American Heart Association, Inc.

  6. Contemporary sex differences among patients with acute coronary syndrome treated by emergency percutaneous coronary intervention.

    Science.gov (United States)

    Wada, Hideki; Ogita, Manabu; Miyauchi, Katsumi; Tsuboi, Shuta; Konishi, Hirokazu; Shitara, Jun; Kunimoto, Mitsuhiro; Sonoda, Taketo; Iso, Takashi; Ebina, Hideki; Aoki, Eriko; Kitamura, Kenichi; Tamura, Hiroshi; Suwa, Satoru; Daida, Hiroyuki

    2017-10-01

    Acute coronary syndrome (ACS) is an important cause of mortality and morbidity in the general population. Recent advances in percutaneous coronary intervention (PCI) and optimal medical treatment have helped to improve the prognosis of patients with ACS. The previous reports indicated that women with ACS have a higher risk of adverse outcomes. However, sex differences in clinical outcomes with contemporary coronary revascularization and medical therapy for ACS have not been elucidated. We analyzed data from 676 consecutive patients with ACS (female, n = 166; male, n = 510) who were treated by emergency PCI between 2011 and 2014 at Juntendo Shizuoka Hospital. The patients were grouped according to sex. We defined major adverse cardiovascular events as a composite of all-cause death and ACS recurrence at 1 year and compared rates of major adverse cardiac events (MACE) between the groups. Women were older (75.4 ± 11.0 vs. 66.2 ± 12.2 years) and had a higher rate of multi-vessel disease, chronic kidney disease, and Killip IV at presentation. The cumulative rate of MACE at 1 year was significantly higher among women than men (17.5 vs. 10.2 %, p = 0.02, log-rank test). However, the association between women and a higher risk of MACE was attenuated after adjusting for age (HR 1.25, 95 % CI 0.77-2.00, p = 0.36) and other variables (HR 0.93, 95 % CI 0.36-2.44, p = 0.88). Adjustment for age and other risk factors attenuated sex differences in mid-term clinical outcomes among patients with ACS after emergency PCI.

  7. Underdiagnosis and prognosis of chronic obstructive pulmonary disease after percutaneous coronary intervention: a prospective study

    Science.gov (United States)

    Almagro, Pere; Lapuente, Anna; Pareja, Julia; Yun, Sergi; Garcia, Maria Estela; Padilla, Ferrán; Heredia, Josep Ll; De la Sierra, Alex; Soriano, Joan B

    2015-01-01

    Background Retrospective studies based on clinical data and without spirometric confirmation suggest a poorer prognosis of patients with ischemic heart disease (IHD) and chronic obstructive pulmonary disease (COPD) following percutaneous coronary intervention (PCI). The impact of undiagnosed COPD in these patients is unknown. We aimed to evaluate the prognostic impact of COPD – previously or newly diagnosed – in patients with IHD treated with PCI. Methods Patients with IHD confirmed by PCI were consecutively included. After PCI they underwent forced spirometry and evaluation for cardiovascular risk factors. All-cause mortality, new cardiovascular events, and their combined endpoint were analyzed. Results A total of 133 patients (78%) male, with a mean (SD) age of 63 (10.12) years were included. Of these, 33 (24.8%) met the spirometric criteria for COPD, of whom 81.8% were undiagnosed. IHD patients with COPD were older, had more coronary vessels affected, and a greater history of previous myocardial infarction. Median follow-up was 934 days (interquartile range [25%–75%]: 546–1,160). COPD patients had greater mortality (P=0.008; hazard ratio [HR]: 8.85; 95% confidence interval [CI]: 1.76–44.47) and number of cardiovascular events (P=0.024; HR: 1.87; 95% CI: 1.04–3.33), even those without a previous diagnosis of COPD (P=0.01; HR: 1.78; 95% CI: 1.12–2.83). These differences remained after adjustment for sex, age, number of coronary vessels affected, and previous myocardial infarction (P=0.025; HR: 1.83; 95% CI: 1.08–3.1). Conclusion Prevalence and underdiagnosis of COPD in patients with IHD who undergo PCI are both high. These patients have an independent greater mortality and a higher number of cardiovascular events during follow-up. PMID:26213464

  8. Patient Versus Physician Variation in Use of Transradial Percutaneous Coronary Intervention.

    Science.gov (United States)

    Shamim, Shariq; Tang, Fengming; Safley, David; Jones, Philip; Spertus, John A; Baklanov, Dmitri

    2017-06-15

    The prevalence of radial access for transradial catheterization remains low in the United States, occurring in only 28% of cases in the National Cardiovascular Data Registry (NCDR) CathPCI. It is unknown whether the low adoption rate has been influenced by patient characteristics or is more operator dependent. In a 10-center study, we compared clinical and demographic characteristics among 323 radial and 1,506 femoral access percutaneous coronary intervention (PCIs) performed by 65 interventionists capable of radial PCI. We created a hierarchical logistic regression model to identify operator and patient characteristics associated with radial PCI and the median rate ratio to quantify the variation across operators. A subset was interviewed to assess health literacy and preferences in shared medical decision making. Radial access was used in 17.7% of patients. Patient factors associated with lower rate of radial PCI were previous PCI (33.4% vs 41.4%, p = 0.008), history of coronary artery bypass graft (8.4% vs 23.0%, p <0.001), and chronic total occlusion PCI (10.2% vs 17.9%, p <0.001). Operator characteristics associated with lower rate of radial PCI are being older, being longer in practice, lower number of publications, and Southern practice location. The range of radial use across operators was 1% to 99% and the median rate ratio was 1.97. Patients with radial access had lower health literacy, as assessed by the Rapid Estimate of Adult Literacy in Medicine Revised (REALM) score (6.6 ± 2.6 vs 7.1 ± 2.0, p = 0.03) but did not differ in their preferences for shared decision making. In conclusion, our study demonstrates a high degree of variability of radial access for PCI among different operators, with few differences in patient characteristics, suggesting that improvement efforts should focus on operators. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. Gender differences in risk profile and outcome of Middle Eastern patients undergoing percutaneous coronary intervention.

    Science.gov (United States)

    Jarrah, Mohamad I; Hammoudeh, Ayman J; Al-Natour, Dalal B; Khader, Yousef S; Tabbalat, Ramzi A; Alhaddad, Imad A; Kullab, Susan M

    2017-02-01

    To determine the gender differences in cardiovascular risk profile and outcomes among patients undergoing percutaneous coronary intervention (PCI). Methods: In a prospective multicenter study of consecutive Middle Eastern patients managed with PCI from January 2013 to February 2014 in 12 tertiary care centers in Amman and Irbid, Jordan. Clinical and coronary angiographic features, and major cardiovascular events were assessed for both genders from hospital stay to 1 year. Results: Women comprised 20.6% of 2426 enrolled patients, were older (mean age 62.9 years versus 57.2 years), had higher prevalence of hypertension (81% versus 57%), diabetes (66% versus 44%), dyslipidemia (58% versus 46%), and obesity (44% versus 25%) compared with men, p less than 0.001. The PCI for ST-segment elevation myocardial infarction was indicated for fewer women than men (23% versus 33%; p=0.001). Prevalence of single or multi-vessel coronary artery disease was similar in women and men. More women than men had major bleeding during hospitalization (2.2% versus 0.6%; p=0.003) and at one year (2.5% versus 0.9%; p=0.007). There were no significant differences between women and men in mortality (3.1% versus 1.7%) or stent thrombosis (2.1% versus 1.8%) at 1 year. Conclusion: Middle Eastern women undergoing PCI had worse baseline risk profile compared with men.Except for major bleeding, no gender differences in the incidence of major adverse cardiovascular events were demonstrated.

  10. Cardiac Rehabilitation After Percutaneous Coronary Intervention in a Multiethnic Asian Country: Enrollment and Barriers.

    Science.gov (United States)

    Poh, Ruth; Ng, Hsuen-Nin; Loo, Germaine; Ooi, Lean-See; Yeo, Tee-Joo; Wong, Raymond; Lee, Chi-Hang

    2015-09-01

    To determine the enrollment or barriers to cardiac rehabilitation (CR) among Asian patients who have undergone percutaneous coronary intervention (PCI). Prospective observational study. Department of cardiology at a university hospital. Patients (N=795) who underwent PCI between January 2012 and December 2013 at a tertiary medical institution. Not applicable. Data on enrollment in phase 2 CR and its barriers were collected by dedicated CR nurses. Of 795 patients, 351 patients (44.2%) were ineligible for CR because of residual coronary stenosis, while 30 patients (3.8%) were not screened because of either early discharge or death. Of the remaining 416 patients (90.8% men; mean age, 55 y), 365 (87.7%) declined CR participation and 51 (12.3%) agreed to participate. Of these 51 patients, 20 (39%) did not proceed to enroll and 4 (8%) dropped out, leaving 27 patients (53%) who completed at least 6 sessions of the CR program. The top 3 reasons provided by patients who declined to participate in CR were (1) busy work schedules (37.5%), (2) no specific reason (26.7%), and (3) preference for self-exercise (20.1%). Nonsmokers were more likely to participate in CR (P=.001). CR participation of Asian patients after PCI was found to be lower than that reported in Western countries. The exclusion criteria used in the institution under study differed from those provided by international associations. A busy work schedule was the most common reason for declining CR after PCI. Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  11. Percutaneous Coronary Intervention Is More Beneficial Than Optimal Medical Therapy in Elderly Patients with Angina Pectoris.

    Science.gov (United States)

    Won, Hoyoun; Her, Ae Young; Kim, Byeong Keuk; Kim, Yong Hoon; Shin, Dong Ho; Kim, Jung Sun; Ko, Young Guk; Choi, Donghoon; Kwon, Hyuck Moon; Jang, Yangsoo; Hong, Myeong Ki

    2016-03-01

    Data comparing the clinical benefits of medical treatment with those of percutaneous coronary intervention (PCI) in an elderly population with angina pectoris are limited. Therefore, we evaluated the efficacy of elective PCI versus optimal medical treatment (OMT) in elderly patients (between 75 and 84 years old) with angina pectoris. One hundred seventy-seven patients with significant coronary artery stenosis were randomly assigned to either the PCI group (n=90) or the OMT group (n=87). The primary outcome was a composite of major adverse events in the 1-year follow-up period that included cardiovascular death, non-fatal myocardial infarction, coronary revascularization, and stroke. Major adverse events occurred in 5 patients (5.6%) of the PCI group and in 17 patents (19.5%) of the OMT group (p=0.015). There were no significant differences between the PCI group and the OMT group in cardiac death [hazard ratio (HR) for the PCI group 0.454; 95% confidence interval (CI) 0.041-5.019, p=0.520], myocardial infarction (HR 0.399; 95% CI 0.039-4.050, p=0.437), or stroke (HR 0.919; 95% CI 0.057-14.709, p=0.952). However, the PCI group showed a significant preventive effect of the composite of major adverse events (HR 0.288; 95% CI 0.106-0.785, p=0.015) and against the need for coronary revascularization (HR 0.157; 95% CI 0.035-0.703, p=0.016). Elective PCI reduced major adverse events and was found to be an effective treatment modality in elderly patients with angina pectoris and significant coronary artery stenosis, compared to OMT.

  12. Frequency of Angina Pectoris After Percutaneous Coronary Intervention and the Effect of Metallic Stent Type.

    Science.gov (United States)

    Gaglia, Michael A; Torguson, Rebecca; Lipinski, Michael J; Gai, Jiaxiang; Koifman, Edward; Kiramijyan, Sarkis; Negi, Smita; Rogers, Toby; Steinvil, Arie; Suddath, William O; Satler, Lowell F; Pichard, Augusto D; Waksman, Ron

    2016-02-15

    Although metallic coronary stents significantly reduce angina pectoris compared with optimal medical therapy, angina after percutaneous coronary intervention (PCI) remains frequent. We, therefore, sought to compare the incidence of any angina during the 1 year after PCI among the spectrum of commercially available metallic stents. Metallic stent type was classified as bare metal stent, Cypher, Taxus Express, Xience V, Promus Element, and Resolute. The primary end point was patient-reported angina within 1 year of PCI. Multivariable logistic regression was performed to assess the independent association of stent type with any angina at 1 year. Overall, 8,804 patients were queried in regard to angina symptoms; 32.3% experienced angina at some point in the first year after PCI. Major adverse cardiovascular events, a composite of all-cause mortality, target vessel revascularization, and Q-wave myocardial infarction, increased with angina severity: 6.8% for patients without angina, 10.0% for patients with class 1 or 2 angina, and 19.7% for patients with class 3 or 4 angina (p angina at 1 year after PCI. Baseline Canadian Cardiovascular Society class 3 or 4 angina, history of coronary artery bypass grafting, and history of PCI were associated with a higher likelihood of angina at 1 year; increasing age, male gender, presentation with acute coronary syndrome, and higher stented length were associated with less angina. In conclusion, metallic stent type is not associated with the occurrence of angina at up to 1 year after PCI. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. Safety and Tolerability of Transitioning from Cangrelor to Ticagrelor in Patients Who Underwent Percutaneous Coronary Intervention.

    Science.gov (United States)

    Badreldin, Hisham A; Carter, Danielle; Cook, Bryan M; Qamar, Arman; Vaduganathan, Muthiah; Bhatt, Deepak L

    2017-08-01

    The 3 phase 3 CHAMPION (Cangrelor vs Standard Therapy to Achieve Optimal Management of Platelet Inhibition) trials collectively demonstrated the safety of transitioning from cangrelor, a potent, parenteral rapidly-acting P2Y 12 inhibitor, to clopidogrel in patients who underwent percutaneous coronary intervention (PCI). However, variation in timing of therapy, site-specific binding, and drug half-lives may theoretically complicate switching to other oral P2Y 12 inhibitors. Since regulatory approval, limited data are available regarding the "real-world" safety and tolerability of transitioning to these more potent oral P2Y 12 antagonists. From November 2015 to January 2017, we evaluated the clinical profiles and efficacy and safety outcomes in cangrelor-treated patients who underwent PCI transitioned to clopidogrel (n = 42) or ticagrelor (n = 82) at a large, tertiary care center. Most patients receiving cangrelor underwent PCI with a drug-eluting stent for acute coronary syndrome via a radial approach in the background of unfractionated heparin. Stent thrombosis within 48 hours was rare and occurred in 1 patient treated with ticagrelor. Global Use of Strategies to Open Occluded Coronary Arteries-defined bleeding occurred in 20% of patients switched to ticagrelor and 29% of patients switched to clopidogrel, but none were severe or life-threatening. In conclusion, rates of stent thrombosis and severe/life-threatening bleeding were low and comparable with those identified in the CHAMPION program, despite use of more potent oral P2Y 12 inhibition. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. Beta blocker therapy is associated with reduced depressive symptoms 12 months post percutaneous coronary intervention.

    Science.gov (United States)

    Battes, Linda C; Pedersen, Susanne S; Oemrawsingh, Rohit M; van Geuns, Robert J; Al Amri, Ibtihal; Regar, Evelyn; de Jaegere, Peter P T; Serruys, Patrick; van Domburg, Ron T

    2012-02-01

    Beta blocker therapy may induce depressive symptoms, although current evidence is conflicting. We examined the association between beta blocker therapy and depressive symptoms in percutaneous coronary intervention (PCI) patients and the extent to which there is a dose-response relationship between beta blocker dose and depressive symptoms. Patients treated with PCI (N=685) completed the depression scale of the Hospital Anxiety and Depression Scale 1 and 12 months post PCI. Information about type and dose of beta blocker use was extracted from medical records. Of all patients, 68% (466/685) were on beta blocker therapy at baseline. In adjusted analysis, beta blocker use at 1 month post PCI (OR: 0.82; 95% CI: 0.53-1.26) was not significantly associated with depressive symptoms. At 12 months post PCI, there was a significant relationship between beta blocker use and depressive symptoms (OR: 0.51; 95% CI: 0.31-0.84), with beta blocker therapy associated with a 49% risk reduction in depressive symptoms. There was a dose-response relationship between beta blocker dose and depressive symptoms 12 months post PCI, with the risk reduction in depressive symptoms in relation to a low dose being 36% (OR: 0.64; 95% CI: 0.37-1.10) and 58% (OR: 0.42; 95% CI: 0.24-0.76) in relation to a high dose. Patients treated with beta blocker therapy were less likely to experience depressive symptoms 12 months post PCI, with there being a dose-response relationship with a higher dose providing a more pronounced protective effect. Copyright © 2011 Elsevier B.V. All rights reserved.

  15. Patient characteristics associated with self-presentation, treatment delay and survival following primary percutaneous coronary intervention.

    Science.gov (United States)

    Austin, David; Yan, Andrew T; Spratt, James C; Kunadian, Vijay; Edwards, Richard J; Egred, Mohaned; Bagnall, Alan J

    2014-09-01

    Delayed arrival to a primary percutaneous coronary intervention (PPCI)-capable hospital following ST-elevation myocardial infarction (STEMI) is associated with poorer outcome. The influence of patient characteristics on delayed presentation during STEMI is unknown. This was a retrospective observational study. Patients presenting for PPCI from March 2008 to November 2011 in the north of England (Northumbria, Tyne and Wear) were included. The outcomes were self-presentation to a non-PPCI-capable hospital, symptom to first medical contact (STFMC) time, total ischaemic time and mortality during follow-up. STEMI patients included numbered 2297; 619 (26.9%) patients self-presented to a non-PPCI-capable hospital. STFMC of >30 min and total ischaemic time of >180 min was present in 1521 (70.7%) and 999 (44.9%) cases, respectively. Self-presentation was the strongest predictor of prolonged total ischaemic time (odds ratio, OR (95% confidence interval, CI): 5.05 (3.99-6.39)). Married patients (OR 1.38 (1.10-1.74)) and patients living closest to an Emergency Room self-presented more commonly (driving time (vs. ≤10 min) 11-20 min OR 0.66 (0.52-0.83), >20 minutes OR 0.46 (0.33-0.64). Unmarried females waited longest to call for help (OR vs. married males 1.89 (1.29-2.78) and experienced longer total ischaemic times (OR 1.51 (1.10-2.07)). Married patients had a borderline association with lower mortality (hazard ratio 0.75 (0.53-1.05), p=0.09). Unmarried female patients had the longest treatment delays. Married patients and those living closer to an Emergency Room self-present more frequently. Early and exclusive use of the ambulance service may reduce treatment delay and improve STEMI outcome. © The European Society of Cardiology 2014.

  16. Assessment of radiation protection of patients and staff in interventional procedures in four Algerian hospitals

    International Nuclear Information System (INIS)

    Khelassi-Toutaoui, N.; Toutaoui, A.; Merad, A.; Sakhri-Brahimi, Z.; Baggoura, B.; Mansouri, B.

    2016-01-01

    This study was aimed to assess patient dosimetry in interventional cardiology (IC) and radiology (IR) and radiation safety of the medical operating staff. For this purpose, four major Algerian hospitals were investigated. The data collected cover radiation protection tools assigned to the operating staff and measured radiation doses to some selected patient populations. The analysis revealed that lead aprons are systematically worn by the staff but not lead eye glasses, and only a single personal monitoring badge is assigned to the operating staff. Measured doses to patients exhibited large variations in the maximum skin dose (MSD) and in the dose area product (DAP). The mean MSD registered values are as follows: 0.20, 0.14 and 1.28 Gy in endoscopic retrograde cholangio-pancreatography (ERCP), coronary angiography (CA) and percutaneous transluminal coronary angioplasty (PTCA) procedures, respectively. In PTCA, doses to 3 out of 22 patients (13.6 %) had even reached the threshold value of 2 Gy. The mean DAP recorded values are as follows: 21.6, 60.1 and 126 Gy cm 2 in ERCP, CA and PTCA procedures, respectively. Mean fluoroscopic times are 2.5, 5 and 15 min in ERCP, CA and PTCA procedures, respectively. The correlation between DAP and MSD is fair in CA (r = 0.62) and poor in PTCA (r = 0.28). Fluoroscopic time was moderately correlated with DAP in CA (r = 0.55) and PTCA (r = 0.61) procedures. Local diagnostic reference levels (DRLs) in CA and PTCA procedures have been proposed. In conclusion, this study stresses the need for a continuous patient dose monitoring in interventional procedures with a special emphasis in IC procedures. Common strategies must be undertaken to substantially reduce radiation doses to both patients and medical staff. (authors)

  17. A framework for the evaluation of new interventional procedures.

    Science.gov (United States)

    Lourenco, Tania; Grant, Adrian M; Burr, Jennifer M; Vale, Luke

    2012-03-01

    The introduction of new interventional procedures is less regulated than for other health technologies such as pharmaceuticals. Decisions are often taken on evidence of efficacy and short-term safety from small-scale usually observational studies. This reflects the particular challenges of evaluating interventional procedures - the extra facets of skill and training and the difficulty defining a 'new' technology. Currently, there is no framework to evaluate new interventional procedures before they become available in clinical practice as opposed to new pharmaceuticals. This paper proposes a framework to guide the evaluation of a new interventional procedure. A framework was developed consisting of a four-stage progressive evaluation for a new interventional procedure: Stage 1: Development; Stage 2: Efficacy and short-term safety; Stage 3: Effectiveness and cost-effectiveness; and Stage 4: Implementation. The framework also suggests the types of studies or data collection methods that can be used to satisfy each stage. This paper makes a first step on a framework for generating evidence on new interventional procedures. The difficulties and limitations of applying such a framework are discussed. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  18. Radiation injury of the skin following diagnostic and interventional fluoroscopic procedures

    International Nuclear Information System (INIS)

    Koenig, T.R.; Wagner, L.K.; Mettler, F.A.

    2001-01-01

    Many radiation injuries to the skin, resulting from diagnostic and interventional fluoroscopic procedures, have been reported in recent years. In some cases skin damage was severe and debilitating. We analyzed 72 reports of skin injuries for progression and location of injury, type and number of procedures, and contributing patient and operator factors. Most cases (46) were related to coronary angiography and percutaneous transluminal coronary angioplasty (PTCA). A smaller number was documented after cardiac radiofrequency catheter ablation (12), transjugular intrahepatic portosystemic shunt (TIPS) placement (7), neuroradiological interventions (3) and other procedures (4). Important factors leading to skin injuries were long exposure times over the same skin area, use of high dose rates, irradiation through thick tissue masses, hypersensitivity to radiation, and positioning of arms or breasts into the radiation entrance beam. Physicians were frequently unaware of the high radiation doses involved and did not recognize the injuries as radiation induced. Based on these findings, recommendations to reduce dose and improve patient care are provided. (author)

  19. Impact of robotics and a suspended lead suit on physician radiation exposure during percutaneous coronary intervention

    Energy Technology Data Exchange (ETDEWEB)

    Madder, Ryan D., E-mail: ryan.madder@spectrumhealth.org; VanOosterhout, Stacie; Mulder, Abbey; Elmore, Matthew; Campbell, Jessica; Borgman, Andrew; Parker, Jessica; Wohns, David

    2017-04-15

    Background: Reports of left-sided brain malignancies among interventional cardiologists have heightened concerns regarding physician radiation exposure. This study evaluated the impact of a suspended lead suit and robotic system on physician radiation exposure during percutaneous coronary intervention (PCI). Methods: Real-time radiation exposure data were prospectively collected from dosimeters worn by operating physicians at the head- and chest-level during consecutive PCI cases. Exposures were compared in three study groups: 1) manual PCI performed with traditional lead apparel; 2) manual PCI performed using suspended lead; and 3) robotic PCI performed in combination with suspended lead. Results: Among 336 cases (86.6% manual, 13.4% robotic) performed over 30 weeks, use of suspended lead during manual PCI was associated with significantly less radiation exposure to the chest and head of operating physicians than traditional lead apparel (chest: 0.0 [0.1] μSv vs 0.4 [4.0] μSv, p < 0.001; head: 0.5 [1.9] μSv vs 14.9 [51.5] μSv, p < 0.001). Chest-level radiation exposure during robotic PCI performed in combination with suspended lead was 0.0 [0.0] μSv, which was significantly less chest exposure than manual PCI performed with traditional lead (p < 0.001) or suspended lead (p = 0.046). In robotic PCI the median head-level exposure was 0.1 [0.2] μSv, which was 99.3% less than manual PCI performed with traditional lead (p < 0.001) and 80.0% less than manual PCI performed with suspended lead (p < 0.001). Conclusions: Utilization of suspended lead and robotics were observed to result in significantly less radiation exposure to the chest and head of operating physicians during PCI. - Highlights: • Use of suspended lead during manual PCI reduced cranial radiation among operators by 97%. • Robotic PCI reduced cranial radiation among operators by 99%. • Suspended lead and robotics together achieved the lowest levels of radiation exposure.

  20. Impact of robotics and a suspended lead suit on physician radiation exposure during percutaneous coronary intervention

    International Nuclear Information System (INIS)

    Madder, Ryan D.; VanOosterhout, Stacie; Mulder, Abbey; Elmore, Matthew; Campbell, Jessica; Borgman, Andrew; Parker, Jessica; Wohns, David

    2017-01-01

    Background: Reports of left-sided brain malignancies among interventional cardiologists have heightened concerns regarding physician radiation exposure. This study evaluated the impact of a suspended lead suit and robotic system on physician radiation exposure during percutaneous coronary intervention (PCI). Methods: Real-time radiation exposure data were prospectively collected from dosimeters worn by operating physicians at the head- and chest-level during consecutive PCI cases. Exposures were compared in three study groups: 1) manual PCI performed with traditional lead apparel; 2) manual PCI performed using suspended lead; and 3) robotic PCI performed in combination with suspended lead. Results: Among 336 cases (86.6% manual, 13.4% robotic) performed over 30 weeks, use of suspended lead during manual PCI was associated with significantly less radiation exposure to the chest and head of operating physicians than traditional lead apparel (chest: 0.0 [0.1] μSv vs 0.4 [4.0] μSv, p < 0.001; head: 0.5 [1.9] μSv vs 14.9 [51.5] μSv, p < 0.001). Chest-level radiation exposure during robotic PCI performed in combination with suspended lead was 0.0 [0.0] μSv, which was significantly less chest exposure than manual PCI performed with traditional lead (p < 0.001) or suspended lead (p = 0.046). In robotic PCI the median head-level exposure was 0.1 [0.2] μSv, which was 99.3% less than manual PCI performed with traditional lead (p < 0.001) and 80.0% less than manual PCI performed with suspended lead (p < 0.001). Conclusions: Utilization of suspended lead and robotics were observed to result in significantly less radiation exposure to the chest and head of operating physicians during PCI. - Highlights: • Use of suspended lead during manual PCI reduced cranial radiation among operators by 97%. • Robotic PCI reduced cranial radiation among operators by 99%. • Suspended lead and robotics together achieved the lowest levels of radiation exposure.

  1. Controlling radiation exposure during interventional procedures in childhood cancer patients

    International Nuclear Information System (INIS)

    Racadio, John M.

    2009-01-01

    Many pediatric cancer patients undergo multiple diagnostic and therapeutic radiologic procedures over the course of their illnesses and are therefore at high risk for radiation exposure. There are a variety of measures that radiologists can employ to reduce this risk. These include limiting the use of radiation whenever possible, using specific strategies to reduce radiation exposure during interventional procedures, using quality assurance programs to ensure compliance, and maintaining continuing staff radiation safety educational programs. Some of the diagnostic and therapeutic interventional radiologic procedures that are performed in pediatric oncology patients are discussed here, along with specific tips for managing radiation exposure. (orig.)

  2. Percutaneous vertebroplasty in the treatment of vertebral body compression fracture secondary to osteogenesis imperfecta

    International Nuclear Information System (INIS)

    Rami, Parag M.; Heatwole, Eric V.; Boorstein, Jeffrey M.; McGraw, Kevin J.

    2002-01-01

    Percutaneous vertebroplasty, a minimally invasive interventional radiological procedure, has recently been used effectively for the treatment of symptomatic vertebral body compression fractures. Primary indications for vertebroplasty include osteoporotic compression fracture, osteolytic vertebral metastasis and myeloma, and vertebral hemangioma. We present a case and extend the indication of percutaneous vertebroplasty in a patient with a vertebral body compression fracture secondary to osteogenesis imperfecta. (orig.)

  3. Percutaneous vertebroplasty in the treatment of vertebral body compression fracture secondary to osteogenesis imperfecta

    Energy Technology Data Exchange (ETDEWEB)

    Rami, Parag M.; Heatwole, Eric V.; Boorstein, Jeffrey M. [Center for Vascular and Interventional Radiology, St. Vincent Mercy Medical Center, Toledo, OH (United States); McGraw, Kevin J. [Riverside Methodist Hospital, Columbus, OH (United States)

    2002-03-01

    Percutaneous vertebroplasty, a minimally invasive interventional radiological procedure, has recently been used effectively for the treatment of symptomatic vertebral body compression fractures. Primary indications for vertebroplasty include osteoporotic compression fracture, osteolytic vertebral metastasis and myeloma, and vertebral hemangioma. We present a case and extend the indication of percutaneous vertebroplasty in a patient with a vertebral body compression fracture secondary to osteogenesis imperfecta. (orig.)

  4. Decreased bed rest post-percutaneous coronary intervention with a 7-French arterial sheath and its effects on vascular complications.

    Science.gov (United States)

    Wentworth, Laura J; Bechtum, Elizabeth L; Hoffman, Jessica G; Kramer, Robert R; Bartel, David C; Slusser, Joshua P; Tilbury, Ralph Thomas

    2018-01-01

    To compare the incidence of femoral access puncture site complications in the control group, who underwent 6 hr of bed rest, with patients in the case group, who underwent 4 hr of bed rest. The ideal bed rest length after percutaneous coronary intervention with a 7-French arterial sheath has been investigated by nursing practice. However, in this larger-sheath-size group, best practices have not been determined, and bed rest time continues to vary markedly among institutions. Retrospective study. Data were retrieved from the National Cardiovascular Data Registry and electronic health records in this retrospective study. Sample size was 401 patients: 152 case patients with 4-hr bed rest and 249 controls with 6-hr bed rest. Case group data were obtained from 20 May 2013-31 December 2014; and control group data, 15 June 2011-20 May 2013. National Cardiovascular Data Registry event rates were generally low in both groups: Only three patients in each group had a bleeding event within 72 hr (2% vs. 1%) and no patient and only two controls had arteriovenous fistula (0% vs. 1%). Complications documented in the electronic health records with institutional femoral access puncture site complication definitions identified bleeding at the access site in eight case patients (5%) and nine controls (4%). Haematoma at the access site occurred in 21 case patients (14%) and 25 controls (10%). The practice change of decreasing bed rest from 6-4 hr for patients with 7-French arterial sheaths post-percutaneous coronary intervention was associated with no significant change in femoral access puncture site complications in either National Cardiovascular Data Registry data or institutional electronic health records data. This introduces expanded evidence of safety in decreasing bed rest length in larger (7-French) arterial sheaths post-percutaneous coronary intervention. © 2017 John Wiley & Sons Ltd.

  5. Survival outcomes post percutaneous coronary intervention: Why the hype about stent type? Lessons from a healthcare system in India.

    Directory of Open Access Journals (Sweden)

    Bhanu Duggal

    Full Text Available A prospective, multicenter study was initiated by the Government of Maharashtra, India, to determine predictors of long-term outcomes of percutaneous coronary intervention (PCI for coronary artery disease, and to compare the effectiveness of drug-eluting stents (DESs and bare-metal stents (BMSs in patients undergoing PCI under government-funded insurance. The present analysis included 4595 patients managed between August 2012 and November 2016 at any of 110 participating centers. Using the classical multivariable regression and propensity-matching approach, we found age to be the most important predictor of 1-year mortality and target lesion revascularization at 1 year post-PCI. However, using machine learning methods to account for unmeasured confounders and bias in this large observational study, we determined total stent length and number of stents deployed as the most important predictors of 1-year survival, followed by age and employment status. The unadjusted death rates were 5.0% and 3.8% for the BMS and DES groups, respectively (p = 0.185, log-rank test. The rate of re-hospitalization (p<0.001 and recurrence of unstable angina (p = 0.08 was significantly lower for DESs than for BMSs. Increased use of DES after 2015 (following establishment of a price cap on DESs was associated with a sharp decrease in adjusted hazard ratios of DESs versus BMSs (from 0.94 in 2013 to 0.58 in 2016, suggesting that high price was limiting DES use in some high-risk patients. Since stented length and stent number were the most important predictors of survival outcomes, adopting an ischemia-guided revascularization strategy is expected to help improve outcomes and reduce procedural costs. In the elderly, PCI should be reserved for cases where the benefits outweigh the higher risk of the procedure. As unemployed patients had poorer long-term outcomes, we expect that implementation of a post-PCI cardiovascular rehabilitation program may improve long-term outcomes.

  6. Cost implications of intraprocedural thrombotic events and bleeding in percutaneous coronary intervention: Results from the CHAMPION PHOENIX ECONOMICS Study.

    Science.gov (United States)

    Tamez, Hector; Généreux, Philip; Yeh, Robert W; Amin, Amit P; Fan, Weihong; White, Harvey D; Kirtane, Ajay J; Stone, Gregg W; Gibson, C Michael; Harrington, Robert A; Bhatt, Deepak L; Pinto, Duane S

    2018-05-04

    Despite improvements in percutaneous coronary intervention (PCI), intraprocedural thrombotic events (IPTE) and bleeding complications occur and are prognostically important. These have not been included in prior economic studies. PHOENIX ECONOMICS was a substudy of the CHAMPION PHOENIX trial, evaluating cangrelor during PCI. Hospital bills were reviewed from 1,171 patients enrolled at 22 of 63 US sites. Costs were estimated using standard methods including resource-based accounting, hospital billing data, and the Medicare fee schedule. Bleeding and IPTE, defined as abrupt vessel closure (transient or sustained), new/suspected thrombus, new clot on wire/catheter, no reflow, side-branch occlusion, procedural stent thrombosis or urgent need for CABG were identified. Costs were calculated according to whether a complication occurred and type of event. Multivariate analyses were used to estimate the incremental costs of IPTE and postprocedural events. IPTE occurred in 4.3% and were associated with higher catheterization laboratory and overall index hospitalization costs by $2,734 (95%CI $1,117, $4,351; P = 0.001) and $6,354 (95% CI $4,122, $8,586; P < 0.001), respectively. IPTE were associated with MI (35.4% vs. 3.6%; P < 0.001), out-of-laboratory stent thrombosis (4.2% vs. 0.1%; 0 = 0.005), ischemia driven revascularization (12.5% vs. 0.3%; P < 0.001), but not mortality (2.1% vs. 0.2%; P = 0.12) vs. no procedural thrombotic complication. By comparison, ACUITY minor bleeding increased hospitalization cost by $1,416 (95%CI = 312, $2,519; P = 0.012). ACUITY major bleeding increased cost of hospitalization by $7,894 (95%CI $4,154, $11,635; P < 0.001). IPTE and bleeding complications, though infrequent, are associated with substantial increased cost. These complications should be collected in economic assessments of PCI. © 2018 Wiley Periodicals, Inc.

  7. Interventional diagnostic breast procedures; Diagnostische Mammainterventionen

    Energy Technology Data Exchange (ETDEWEB)

    Bick, U. [Inst. fuer Radiologie, Universitaetsklinikum Charite, Berlin (Germany); Dept. of Radiology, The Univ. of Chicago (United States); Diekmann, S.; Diekmann, F. [Inst. fuer Radiologie, Universitaetsklinikum Charite, Berlin (Germany)

    2001-09-01

    The comprehensive survey describes in great detail the indications, performance, and advantages and drawbacks of the various biopsy and localization techniques available today for interventional diagnostic evaluation of lesions of the breast. (orig./CB) [German] Die Feinnadelaspirationszytologie ist einfach und rasch durchfuehrbar, ist jedoch insbesondere in der Hand von unerfahrenen Untersuchern mit einer relativ hohen Rate von nicht auswertbaren und falsch-negativen Befunden verbunden. Das Verfahren wird am haeufigsten bei soliden oder zystischen Herdbefunden eingesetzt, die palpabel oder sonographisch nachweisbar sind. Bei inadaequatem Zellmaterial muss eine erneute Biopsie, ggf. mit einem anderen Verfahren, erfolgen. Die Nadelstanzbiopsie ist heutzutage das Verfahren der Wahl bei mammographisch oder sonographisch sichtbaren soliden Herdbefunden. Das Verfahren ist einfach und kostenguenstig durchfuehrbar und weist bei soliden Herdbefunden eine extrem hohe Sensitivitaet und Spezifitaet auf. Bei Mikroverkalkungen sollten immer ausreichend viele Stanzen (5 und mehr) entnommen werden. Bei Stanzbiopsien besteht grundsaetzlich die Gefahr einer Unterschaetzung des histologischen Befundes (ADH statt DCIS, in situ statt invasiv). Bei Diagnose ADH in der Stanzbiopsie sollte eine Exzision des Befundes erfolgen. Die vakuumassistierte Stanzbiopsie ist besonders beeignet zur Biopsie von unklaren Mikroverkalkungen, da durch die groessere entnommene Gewebemenge eine hoehere Spezifitaet und Sensitivitaet erreicht werden kann. Fuer MR-gesteuerte Biopsien hat dieses Verfahren den Vorteil, dass die Nadel nur einmal platziert werden muss. Die stereotaktische Exzisionsbiopsie ist ein relativ teures und invasives Verfahren, das insbesondere zur diagnostischen Abklaerung von unklaren Mikroverkalkungen eingesetzt wird. Hierbei steht das Verfahren in direkter Konkurrenz zur vakuumassistierten Stanzbiopsie. Inwieweit es fuer die stereotaktische Exzisionsbiopsie wirklich ein

  8. Eye dose to staff involved in interventional and procedural fluoroscopy

    International Nuclear Information System (INIS)

    McLean, D; Hadaya, D; Tse, J

    2016-01-01

    In 2011 the International Commission on Radiological Protection (ICRP) lowered the occupational eye dose limit from 150 to 20 mSv/yr [1]. While international jurisdictions are in a process of adopting these substantial changes, medical physicists at the clinical level have been advising medical colleagues on specific situations based on dose measurements. Commissioned and calibrated TLDs mounted in commercially available holders designed to simulate the measurement of Hp(3), were applied to staff involved in x-ray procedures for a one month period. During this period clinical procedure data was concurrently collected and subject to audit. The use or not of eye personal protective equipment (PPE) was noted for all staff. Audits were conducted in the cardiac catheterisation laboratory, the interventional angiography rooms and the procedural room where endoscopic retrograde cholangiopancreatography (ERCP) procedures are performed. Significant levels of occupational dose were recorded in the cardiac and interventional procedures, with maximum reading exceeding the new limit for some interventional radiologists. No significant eye doses were measured for staff performing ERCP procedures. One outcome of the studies was increased use of eye PPE for operators of interventional equipment with increased availability also to nursing staff, when standing in close proximity to the patient during procedures. (paper)

  9. 1-Year Outcomes With Intracoronary Abciximab in Diabetic Patients Undergoing Primary Percutaneous Coronary Intervention

    DEFF Research Database (Denmark)

    Piccolo, Raffaele; Eitel, Ingo; Galasso, Gennaro

    2016-01-01

    BACKGROUND: Diabetic patients are at increased risk for future cardiovascular events after ST-segment elevation myocardial infarction (STEMI). Administration of an intracoronary abciximab bolus during primary percutaneous coronary intervention (PCI) may be beneficial in this high-risk subgroup.......68 to 1.33; p = 0.77), resulting in a significant interaction (p = 0.034). Among diabetic patients, intracoronary versus intravenous abciximab bolus was associated with a significantly reduced risk of death (5.8% vs. 11.2%; HR: 0.51; 95% CI: 0.26 to 0.98; p = 0.043) and definite/probable stent thrombosis...

  10. Safety of Prasugrel Loading Doses in Patients Pre-Loaded With Clopidogrel in the Setting of Primary Percutaneous Coronary Intervention

    DEFF Research Database (Denmark)

    Räber, Lorenz; Klingenberg, Roland; Heg, Dik

    2015-01-01

    OBJECTIVES: The aim of this study was to assess the safety of the concurrent administration of a clopidogrel and prasugrel loading dose in patients undergoing primary percutaneous coronary intervention. BACKGROUND: Prasugrel is one of the preferred P2Y12 platelet receptor antagonists for ST-segment.......62, p = 0.36). CONCLUSIONS: This observational, nonrandomized study of ST-segment elevation myocardial infarction patients suggests that the administration of a loading dose of prasugrel in patients pre-treated with a loading dose of clopidogrel is not associated with an excess of major bleeding events...

  11. Long-term outcomes after percutaneous coronary intervention for chronic total occlusion (from the CREDO-Kyoto registry cohort-2).

    OpenAIRE

    Yamamoto, Erika; Natsuaki, Masahiro; Morimoto, Takeshi; Furukawa, Yutaka; Nakagawa, Yoshihisa; Ono, Koh; Mitsudo, Kazuaki; Nobuyoshi, Masakiyo; Doi, Osamu; Tamura, Takashi; Tanaka, Masaru; Kimura, Takeshi

    2013-01-01

    Despite improving success rate of percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) lesions, the clinical benefit of recanalization of CTO is still a matter of debate. Of 13, 087 patients who underwent PCI in the CREDO-Kyoto registry cohort-2, 1, 524 patients received PCI for CTO (CTO-PCI). Clinical outcomes were compared between 1, 192 patients with successful CTO-PCI and 332 patients with failed CTO-PCI. In-hospital death tended to occur less frequently in the succe...

  12. Contrast Media–Induced Anaphylaxis Causing a Stress-Related Cardiomyopathy Post Percutaneous Coronary Intervention: Case Report

    Directory of Open Access Journals (Sweden)

    Rajeev Seecheran

    2017-05-01

    Full Text Available Anaphylaxis is a sudden-onset, severe hypersensitivity reaction that can be potentially fatal. It can often transition to refractory hemodynamic instability, eventually resulting in death. Stress-related cardiomyopathies (SRCs have multifactorial etiologies, including being linked to excessive catecholamine release in periods of intense stress. This novel case report recounts a SRC caused by contrast-induced anaphylaxis within 1 hour post percutaneous coronary intervention. Both acutely life-threatening conditions may occur simultaneously and are implicated with devastating complications. Further research is required to understand this cardiac-neuroaxis interplay in SRC to identify risk factors and develop management strategies.

  13. Effective dose to patient during cardiac interventional procedures (Prague workplaces)

    International Nuclear Information System (INIS)

    Stisova, V.

    2004-01-01

    The aim of this study was to assess effective dose to a patient during cardiac procedures, such as coronary angiography (CA) and percutaneous transluminal angioplasty (PTCA). Measurements were performed on 185 patients in four catheterisation laboratories in three hospitals in Prague using the dose area product (DAP) meter. Calculations of surface and effective dose were performed with Monte-Carlo-based program PCXMC. The mean DAP value per procedure determined in all workplaces ranged between 25.0 and 54.5 Gy cm 2 for CA and 43.0-104.5 Gy cm 2 for PTCA. In three cases, the surface dose exceeded the 2 Gy level for occurrence of transient erythema. The mean effective dose per procedure in an workplaces was determined to be in the range of 2.7-8.8 mSv for CA and 5.7-15.3 mSv for CA + PTCA combined. The results presented are comparable with those published by other authors. (authors)

  14. Importance of a Patient Dosimetry and Clinical Follow-up Program in the Detection of Radiodermatitis After Long Percutaneous Coronary Interventions

    Energy Technology Data Exchange (ETDEWEB)

    Vano, Eliseo, E-mail: eliseov@med.ucm.es [Instituto de Investigacion Sanitaria Hospital Clinico San Carlos and Complutense University, Medical Physics Service and Radiology Department (Spain); Escaned, Javier [Hospital Clinico San Carlos, Cardiovascular Institute (Spain); Vano-Galvan, Sergio [Hospital Ramon y Cajal, Dermatology Service (Spain); Fernandez, Jose M. [Instituto de Investigacion Sanitaria Hospital Clinico San Carlos and Complutense University, Medical Physics Service and Radiology Department (Spain); Galvan, Carmen, E-mail: cgalvan@med.ucm.es [Instituto de Investigacion Sanitaria Hospital Clinico San Carlos and Complutense University, Radiotherapy Service and Radiology Department (Spain)

    2013-04-15

    Complex percutaneous interventions often require high radiation doses likely to produce skin radiation injuries. We assessed the methodology used to select patients with potential skin injuries in cardiac procedures and in need of clinical follow-up. We evaluated peak skin dose and clinical follow-up in a case of radiodermatitis produced during a total occlusion recanalization. This prospective study followed CIRSE and ACC/AHA/SCAI recommendations for patient radiation dose management in interventional procedures carried out in a university hospital with a workload of 4200 interventional cardiac procedures per year. Patient dose reports were automatically transferred to a central database. Patients exceeding trigger levels for air kerma area product (500 Gy cm{sup 2}) and cumulative skin dose (5 Gy) were counseled and underwent follow-up for early detection of skin injuries, with dermatologic support. The Ethical Committee and the Quality Assurance and Radiation Safety Committee approved the program. During 2010, a total of 13 patients (3.0/1,000 that year) received dose values exceeding trigger levels in the cardiovascular institute. Only one patient, who had undergone two consecutive procedures resulting in 970 Gy cm{sup 2} and 13.0 Gy as cumulative skin dose, showed signs of serious radiodermatitis that resolved in 3.7 months. The remaining patients did not manifest skin lesions during follow-up, and whenever patient examination was not feasible as part of the follow-up, neither patients nor families reported any skin injuries. Peak skin dose calculation and close clinical follow-up were feasible and appropriate, with a moderate additional workload for the staff and satisfaction for the patient.

  15. Importance of a Patient Dosimetry and Clinical Follow-up Program in the Detection of Radiodermatitis After Long Percutaneous Coronary Interventions

    International Nuclear Information System (INIS)

    Vano, Eliseo; Escaned, Javier; Vano-Galvan, Sergio; Fernandez, Jose M.; Galvan, Carmen

    2013-01-01

    Complex percutaneous interventions often require high radiation doses likely to produce skin radiation injuries. We assessed the methodology used to select patients with potential skin injuries in cardiac procedures and in need of clinical follow-up. We evaluated peak skin dose and clinical follow-up in a case of radiodermatitis produced during a total occlusion recanalization. This prospective study followed CIRSE and ACC/AHA/SCAI recommendations for patient radiation dose management in interventional procedures carried out in a university hospital with a workload of 4200 interventional cardiac procedures per year. Patient dose reports were automatically transferred to a central database. Patients exceeding trigger levels for air kerma area product (500 Gy cm 2 ) and cumulative skin dose (5 Gy) were counseled and underwent follow-up for early detection of skin injuries, with dermatologic support. The Ethical Committee and the Quality Assurance and Radiation Safety Committee approved the program. During 2010, a total of 13 patients (3.0/1,000 that year) received dose values exceeding trigger levels in the cardiovascular institute. Only one patient, who had undergone two consecutive procedures resulting in 970 Gy cm 2 and 13.0 Gy as cumulative skin dose, showed signs of serious radiodermatitis that resolved in 3.7 months. The remaining patients did not manifest skin lesions during follow-up, and whenever patient examination was not feasible as part of the follow-up, neither patients nor families reported any skin injuries. Peak skin dose calculation and close clinical follow-up were feasible and appropriate, with a moderate additional workload for the staff and satisfaction for the patient.

  16. The transjugular intrahepatic portosystemic stentshunt (TIPSS): A new nonoperative, transjugular percutaneous procedure. [Radiological studies

    Energy Technology Data Exchange (ETDEWEB)

    Richter, G M; Noeldge, G; Siegerstetter, V; Franke, M; Wenz, W; Palmaz, J C; Roessle, M

    1989-08-01

    In a 49-year-old male patient suffering from severe symptoms of end-stage portal hypertension and Child's stage C metabolic status, an intrahepatic stent-assisted portosystemic shunt was established for the first time exclusively by means of interventional radiology. Via transjugular access, a modified Brockenbrough needle was used to puncture the right branch of the portal vein via the right liver vein. As a target, a Dormia-basket was used that had previously been exposed in the right main portal branch. After successful puncture and balloon dilation of the artificial tract, two Palmaz stents were implanted to keep the tract permanently open. The portosystemic pressure gradient dropped from 38 to 18 mm Hg. The clinical status of the patient improved substantially during the following days. However, the patient died on day 11 after the procedure because of sudden onset of acute respiratory distress arising from acute nosocomial fungus and cytomegalovirus infection worsened by his primary immunoincompetence. Autopsy demonstrated a totally patent shunt without superficial thrombus. Microscopically, a thin endothelial layer on the inner shunt surface was found to be present. (orig.).

  17. Towards Clinically Optimized MRI-guided Surgical Manipulator for Minimally Invasive Prostate Percutaneous Interventions: Constructive Design*

    Science.gov (United States)

    Eslami, Sohrab; Fischer, Gregory S.; Song, Sang-Eun; Tokuda, Junichi; Hata, Nobuhiko; Tempany, Clare M.; Iordachita, Iulian

    2013-01-01

    This paper undertakes the modular design and development of a minimally invasive surgical manipulator for MRI-guided transperineal prostate interventions. Severe constraints for the MRI-compatibility to hold the minimum artifact on the image quality and dimensions restraint of the bore scanner shadow the design procedure. Regarding the constructive design, the manipulator kinematics has been optimized and the effective analytical needle workspace is developed and followed by proposing the workflow for the manual needle insertion. A study of the finite element analysis is established and utilized to improve the mechanism weaknesses under some inevitable external forces to ensure the minimum structure deformation. The procedure for attaching a sterile plastic drape on the robot manipulator is discussed. The introduced robotic manipulator herein is aimed for the clinically prostate biopsy and brachytherapy applications. PMID:24683502

  18. High event rate after a first percutaneous coronary intervention in patients with diabetes mellitus: results from the Swedish coronary angiography and angioplasty registry.

    Science.gov (United States)

    Ritsinger, Viveca; Saleh, Nawsad; Lagerqvist, Bo; Norhammar, Anna

    2015-06-01

    Patients with diabetes mellitus have reduced longevity after acute coronary syndromes and revascularization. However, knowledge of the long-term complication rates and patterns from an everyday life setting is lacking. Consecutive patients undergoing percutaneous coronary intervention included in the Swedish Coronary Angiography Angioplasty Registry (SCAAR) between 2006 and 2010 and with no previous revascularization were prospectively followed up for combined cardiovascular events (first of all-cause mortality, myocardial infarction, stroke, and heart failure) until December 31, 2010. The mean follow-up period was 920 days (SD, 530 days). Differences in background and procedural characteristics were adjusted for in a multivariate Cox regression model. Of 58 891 patients, mean age 67 years, 19% had diabetes mellitus; 27% of them were on diet treatment, 33% on oral glucose lowering, and 40% on insulin treatment. At admission, cardiovascular risk factors, multiple coronary vessel, and left main stem disease were more frequent in patients with diabetes mellitus and their revascularization was less often complete. The adjusted risk for combined cardiovascular events was higher in patients on insulin (hazard ratio [95% confidence interval], 1.63 [1.55-1.72]), on oral treatment (1.23 [1.15-1.31]), and on diet alone (1.21 [1.12-1.29]) compared with patients without diabetes mellitus. Insulin-treated patients ran an increased risk of restenosis (1.54 [1.39-1.71]) and stent thrombosis (1.56 [1.25-1.96]). The prognosis after a first percutaneous coronary intervention is more severe in patients with diabetes mellitus, in particular, in patients treated with insulin, with higher rates of mortality, cardiovascular events, and stent thrombosis over the following 5 years. © 2015 American Heart Association, Inc.

  19. Medical therapy, percutaneous coronary intervention and prognosis in patients with chronic total occlusions.

    Science.gov (United States)

    Ladwiniec, Andrew; Allgar, Victoria; Thackray, Simon; Alamgir, Farquad; Hoye, Angela

    2015-12-01

    There is little published data reporting outcomes for those found to have a chronic total coronary occlusion (CTO) that is electively treated medically versus those treated by percutaneous coronary intervention (PCI). We sought to compare long-term clinical outcomes between patients treated by PCI and elective medical therapy in a consecutive cohort of patients with an identified CTO. Patients found to have a CTO on angiography between January 2002 and December 2007 in a single tertiary centre were identified using a dedicated database. Those undergoing CTO PCI and elective medical therapy to the CTO were propensity matched to adjust for baseline clinical and angiographic differences. In total, 1957 patients were identified, a CTO was treated by PCI in 405 (20.7%) and medical therapy in 667 (34.1%), 885 (45.2%) patients underwent coronary artery bypass graft surgery. Of those treated by PCI or medical therapy, propensity score matching identified 294 pairs of patients, PCI was successful in 177 patients (60.2%). All-cause mortality at 5 years was 11.6% for CTO PCI and 16.7% for medical therapy HR 0.63 (0.40 to 1.00, p=0.052). The composite of 5-year death or myocardial infarction occurred in 13.9% of the CTO PCI group and 19.6% in the medical therapy group, HR 0.64 (0.42 to 0.99, p=0.043). Among the CTO PCI group, if the CTO was revascularised by any means during the study period, 5-year mortality was 10.6% compared with 18.3% in those not revascularised in the medical therapy group, HR 0.50 (0.28-0.88, p=0.016). Revascularisation, but not necessarily PCI of a CTO, is associated with improved long-term survival relative to medical therapy alone. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  20. Successful percutaneous coronary intervention significantly improves coronary sinus blood flow as assessed by transthoracic echocardiography.

    Science.gov (United States)

    Lyubarova, Radmila; Boden, William E; Fein, Steven A; Schulman-Marcus, Joshua; Torosoff, Mikhail

    2018-06-01

    Transthoracic echocardiography (TTE) has been used to assess coronary sinus blood flow (CSBF), which reflects total coronary arterial blood flow. Successful angioplasty is expected to improve coronary arterial blood flow. Changes in CSBF after percutaneous coronary intervention (PCI), as assessed by TTE, have not been systematically evaluated. TTE can be utilized to reflect increased CSBF after a successful, clinically indicated PCI. The study cohort included 31 patients (18 females, 62 ± 11 years old) referred for diagnostic cardiac catheterization for suspected coronary artery disease and possible PCI, when clinically indicated. All performed PCIs were successful, with good angiographic outcome. CSBF per cardiac cycle (mL/beat) was measured using transthoracic two-dimensional and Doppler flow imaging as the product of coronary sinus (CS) area and CS flow time-velocity integral. CSBF per minute (mL/min) was calculated as the product of heart rate and CSBF per cardiac cycle. In each patient, CSBF was assessed prospectively, before and after cardiac catheterization with and without clinically indicated PCI. Within- and between-group differences in CSBF before and after PCI were assessed using repeated measures analysis of variance. Technically adequate CSBF measurements were obtained in 24 patients (77%). In patients who did not undergo PCI, there was no significant change in CSBF (278.1 ± 344.1 versus 342.7 ± 248.5, p = 0.36). By contrast, among patients who underwent PCI, CSBF increased significantly (254.3 ± 194.7 versus 618.3 ± 358.5 mL/min, p < 0.01, p-interaction = 0.03). Other hemodynamic and echocardiographic parameters did not change significantly before and after cardiac catheterization in either treatment group. Transthoracic echocardiographic assessment can be employed to document CSBF changes after angioplasty. Future studies are needed to explore the clinical utility of this noninvasive metric.

  1. Comparison of percutaneous coronary intervention versus conservative treatment in unstable angina pectoris

    International Nuclear Information System (INIS)

    Hu Chunyan; Lv Bei; Shen Weifeng; Lu Guoping

    2002-01-01

    Objective: To evaluate the efficacies of percutaneous coronary intervention (PCI) and drug treatment in patients with unstable angina (UAP). Methods: 248 patients with UAP were divided into two groups: conservative group of 123 patients who received antiplatelet, anticoagulant and antianginal therapies only and invasive group of 125 patients who underwent additional PCI 4.4 days after admission. The occurrence of death, AMI, recurrent angina, readmission were assessed during the first hospitalization year. Results: There was no difference in the incidence of composite endpoint of death or AMI between the two groups during the hospitalization (0.8 % vs 1.6 %, P > 0.05 ), but hospitalization duration was shorter in the invasive group than in the conservative group (10.3 ± 5.6 days vs 14.6 ± 10.7 days, P < 0.01 ). In duration of one year, the incidence of AMI (2.4% vs 8.9%, P<0.03), death (1.6% vs 6.5%, P<0.05), composite endpoint of death or AMI (4.0 % vs 13.0 % P < 0.02), recurrent angina pectoris (26.4 % vs 48.7, P <0.001), CABG (1.6% vs 10.5%, P<0.01) and readmission (24.8% vs 45.5%, P<0.01) were also lower in the invasive group than in the conservative group. Survival rate free of composite death or AMI for 1 year was higher in the invasive group than in the conservative group(96.0 % vs 86.9 %, P < 0.02). There was a definite benefit of the invasive treatment in reducing the risk of composite endpoint of death or AMI in patients with chest pain at rest, troponin T positive and three vessel diseases. Old age, three vessel diseases, LAD disease, lower LVEF, ST-segment depression, diabetes and hypertension were the independent factors associated with composite of death or AMI. Conclusions: In patients with UAP, PCI associated with routine antiplatelet, anticoagulant and antiischemic treatment significantly decreases the incidence of adverse cardiac events and improves the survival rate in one year. Such beneficial effects can be more obvious for high-risk patients

  2. Percutaneous coronary intervention for poor coronary microcirculation reperfusion of patients with stable angina pectoris.

    Science.gov (United States)

    Li, J S; Zhao, X J; Ma, B X; Wang, Z

    2016-01-01

    Percutaneous coronary intervention (PCI) has been extensively applied to repair the forward flow of diseased coronary artery and can achieve significant curative results. However, some patients with acute myocardial infarction (AMI) develop non-perfusion or poor perfusion of cardiac muscle tissue after PCI, which increases the incidence of cardiovascular events and the death rate. PCI can dredge narrowed or infarct-related artery (IRA) and thus induce full reperfusion of ischemic myocardium. It is found in practice that some cases of AMI still have no perfusion or poor perfusion in myocardial tissue even though coronary angiography suggests opened coronary artery after PCI, which increases the incidence of vascular events and mortality. Therefore, to explore the detailed mechanism of PCI in treating coronary microcirculation of patients with stable angina pectoris, we selected 140 patients with stable angina pectoris for PCI, observing the index of microcirculatory resistance (IMR) of descending branch and changes of myocardial injury markers and left ventricular systolic function, and made a subgroup analysis based on the correlation between clinical indexes, IMR and other variables of diabetic and non-diabetic patients, PCI-related and non-PCI-related myocardial infarction patients. The results suggest that IMR of anterior descending branch after PCI was higher compared to that before PCI, and the difference was significant (P less than 0.05); creatine kinase-MB (CK-MB), myohemoglobin and high sensitive troponin T were all increased after PCI, and the difference was also significant (P less than 0.05); brain natriuretic peptide (BNP) level became higher after PCI, with significant difference (P less than 0.05); left ventricular ejection fraction (LVEF) declined after PCI, and the difference before and after PCI was statistically significant (P less than 0.05). Moreover, subgroup analysis results of the three groups all demonstrated statistically significant

  3. Underdiagnosis and prognosis of chronic obstructive pulmonary disease after percutaneous coronary intervention: a prospective study

    Directory of Open Access Journals (Sweden)

    Almagro P

    2015-07-01

    Full Text Available Pere Almagro,1 Anna Lapuente,2 Julia Pareja,1 Sergi Yun,1 Maria Estela Garcia,3 Ferrán Padilla,4 Josep Ll Heredia,2 Alex De la Sierra,1 Joan B Soriano5 1Department of Internal Medicine, 2Pneumology Service, Mutua de Terrassa University Hospital, Terrassa, Spain; 3Medical Department, Menarini Pharmaceutical, Barcelona, Spain; 4Cardiology Service, Mutua de Terrassa University Hospital, Terrassa, Spain; 5Instituto de Investigación Sanitaria Princesa (IP, Universidad Autónoma de Madrid, Madrid, Spain Background: Retrospective studies based on clinical data and without spirometric confirmation suggest a poorer prognosis of patients with ischemic heart disease (IHD and chronic obstructive pulmonary disease (COPD following percutaneous coronary intervention (PCI. The impact of undiagnosed COPD in these patients is unknown. We aimed to evaluate the prognostic impact of COPD – previously or newly diagnosed – in patients with IHD treated with PCI.Methods: Patients with IHD confirmed by PCI were consecutively included. After PCI they underwent forced spirometry and evaluation for cardiovascular risk factors. All-cause mortality, new cardiovascular events, and their combined endpoint were analyzed.Results: A total of 133 patients (78% male, with a mean (SD age of 63 (10.12 years were included. Of these, 33 (24.8% met the spirometric criteria for COPD, of whom 81.8% were undiagnosed. IHD patients with COPD were older, had more coronary vessels affected, and a greater history of previous myocardial infarction. Median follow-up was 934 days (interquartile range [25%–75%]: 546–1,160. COPD patients had greater mortality (P=0.008; hazard ratio [HR]: 8.85; 95% confidence interval [CI]: 1.76–44.47 and number of cardiovascular events (P=0.024; HR: 1.87; 95% CI: 1.04–3.33, even those without a previous diagnosis of COPD (P=0.01; HR: 1.78; 95% CI: 1.12–2.83. These differences remained after adjustment for sex, age, number of coronary vessels affected

  4. Severe Mental Illness and Clinical Outcome After Primary Percutaneous Coronary Intervention

    DEFF Research Database (Denmark)

    Jakobsen, Lars; Terkelsen, Christian J; Christiansen, Evald H

    2017-01-01

    The mechanisms behind the increased mortality in patients with acute myocardial infarction and co-existing severe mental illness (SMI) compared with non-SMI patients remain unclear. We studied 12,102 patients with ST-elevation myocardial infarction treated with primary percutaneous coronary...

  5. Evaluating the maximum patient radiation dose in cardiac interventional procedures

    International Nuclear Information System (INIS)

    Kato, M.; Chida, K.; Sato, T.; Oosaka, H.; Tosa, T.; Kadowaki, K.

    2011-01-01

    Many of the X-ray systems that are used for cardiac interventional radiology provide no way to evaluate the patient maximum skin dose (MSD). The authors report a new method for evaluating the MSD by using the cumulative patient entrance skin dose (ESD), which includes a back-scatter factor and the number of cine-angiography frames during percutaneous coronary intervention (PCI). Four hundred consecutive PCI patients (315 men and 85 women) were studied. The correlation between the cumulative ESD and number of cine-angiography frames was investigated. The irradiation and overlapping fields were verified using dose-mapping software. A good correlation was found between the cumulative ESD and the number of cine-angiography frames. The MSD could be estimated using the proportion of cine-angiography frames used for the main angle of view relative to the total number of cine-angiography frames and multiplying this by the cumulative ESD. The average MSD (3.0±1.9 Gy) was lower than the average cumulative ESD (4.6±2.6 Gy). This method is an easy way to estimate the MSD during PCI. (authors)

  6. Evaluation of patients skin dose undergoing interventional cardiology procedure using radiochromic films

    International Nuclear Information System (INIS)

    Silva, Mauro W. Oliveira da; Canevaro, Lucia V.; Rodrigues, Barbara B. Dias

    2011-01-01

    In interventional cardiology (IC), coronary angiography (CA) and percutaneous transluminal coronary angioplasty (PTCA) procedures are the most frequent ones. Since the 1990s, the number of IC procedures has increased rapidly. It is also known that these procedures are associated with high radiation doses due to long fluoroscopy time (FT) and large number of cine-frames (CF) acquired to document the procedure. Mapping skin doses in IC is useful to find the probability of skin injuries, to detect areas of overlapping field, and to get a permanent record of the most exposed areas of skin. The purpose of this study was to estimate the maximum skin dose (MSD) in patients undergoing CA and PTCA, and to compare these values with the reference levels proposed in the literature. Patients' dose measurements were carried out on a sample of 38 patients at the hemodynamic department, in four local hospitals in Rio de Janeiro, Brazil, using Gafchromic XR-RV2 films. In PTCA procedures, the median and third quartile values of MSD were estimated at 2.5 and 5.3 Gy, respectively. For the CA procedures, the median and third quartile values of MSD were estimated at 0.5 and 0.7 Gy, respectively. In this paper, we used the Pearson's correlation coefficient (r), and we found a fairly strong correlation between FT and MSD (r=0.8334, p<0.0001), for CA procedures. The 1 Gy threshold for deterministic effects was exceeded in nine patients. The use of Gafchromic XR-RV2 films was shown to be an effective method to measure MSD and the dose distribution map. The method is effective to identify the distribution of radiation fields, thus allowing the follow-up of the patient to investigate the appearance of skin injuries. (author)

  7. Relationship between the total length of the stents and patients' quality of life after percutaneous coronary intervention.

    Science.gov (United States)

    Liu, Wei; Yang, Xuming; Dong, Pingshuan; Li, Zhijuan

    2015-01-01

    The aim of this study was to examine the relationship between the total length of the stents and the postoperative life quality of patients with multi-vessel coronary artery disease who undergo percutaneous coronary intervention (PCI). Using the short-form health survey (SF-36) items, we analyzed the data on the postoperative life quality of 166 patients with multi-vessel coronary artery disease who underwent percutaneous transluminal coronary intervention in the Department of Cardiology of the First Affiliated Hospital of Henan University of Science and Technology from September 2011 to September 2013. Follow-up was performed 6 months later. All of the dimensionalities, except general health and mental health, showed significantly higher scores after PCI. No significant relationships were observed between the total length of the stents and the postoperative life quality of patients with multi-vessel coronary artery disease who underwent PCI. PCI can effectively improve the postoperative life quality of patients; however, there was no significant relationship between the total length of the stents and postoperative life quality of patients.

  8. Stent underexpansion in angiographic guided percutaneous coronary intervention, despite adjunctive balloon post-dilatation, in drug eluting stent era

    Directory of Open Access Journals (Sweden)

    Mehrdad Taherioun

    2014-01-01

    Full Text Available BACKGROUND: Stent underexpansion is the most powerful predictor of long-term stent patency and clinical outcome. The purpose of this study was to evaluate the incidence and predictors of stent underexpansion despite adjunctive post-dilatation with non-compliant balloon. METHODS: After elective coronary stent implantation and adjunctive post-dilatation with non-compliant balloon and optimal angiographic result confirmed by the operator, intravascular ultrasound (IVUS was performed for all the treated lesions. If the treated lesions fulfilled the IVUS criteria, they are considered as the optimal stent group; if not, they are considered as the suboptimal group. RESULTS: From 50 patients enrolled in this study 39 (78% had optimal stent deployment and 11 (22% had suboptimal stent deployment. In the suboptimal group 7 (14% had underexpansion, 2 (4% malposition, and 2 (4% had asymmetry. There were no stent edge dissections detected by IVUS. We did not find any correlation between lesion calcification, ostial lesions, stent length, and stent underexpansion. Stent diameter ≤ 2.75 mm had a strong correlation with stent underexpansion. CONCLUSION: Despite adjunctive post-dilatation with noncompliant balloon, using a relatively small stent diameter was a strong predictor for underexpansion. IVUS guided percutaneous coronary intervention (PCI may be considered for drug eluting stent (DES implantation in relatively small vessels.   Keywords: Stent, Percutaneous Coronary Intervention, Ultrasound, Post-dilatation 

  9. Doppler Tissue Imaging Is an Independent Predictor of Outcome in Patients with ST-Segment Elevation Myocardial Infarction Treated with Primary Percutaneous Coronary Intervention

    DEFF Research Database (Denmark)

    Biering-Sørensen, Tor; Jensen, Jan Skov; Pedersen, Sune

    2014-01-01

    in patients treated with primary percutaneous coronary intervention. METHOD: In total, 391 patients who were admitted with STEMIs and treated with primary percutaneous coronary intervention were prospectively included. All participants were examined by echocardiography 2 days (interquartile range, 1-3 days......) after STEMI. Longitudinal systolic (s'), early diastolic (e'), and late diastolic (a') myocardial velocities were measured using color DTI at six mitral annular sites and averaged to provide global estimates. RESULTS: The median follow-up period was 25 months (interquartile range, 19-32 months...

  10. Performance of interventional procedures in a day-hospital system

    International Nuclear Information System (INIS)

    Bae, Jae Ik; Park, Auh Whan; Cho, Hye Seon; Park, Eun Hee; Choi, Gap Suk; Lee, Seon Ju; Kim, Yong Woo; Juhn, Je Ryang

    2007-01-01

    We wanted to describe the practice and results of applying the day-hospital system in an interventional radiology clinic. From Oct. 2004 to Dec. 2005, the day-hospital system was applied to various interventional procedures with using a part of the recovery room of an angiography suite as a facility for hospital admission. The study included 91 cases in 73 patients. The source of the patient referral, the procedures, hospital courses and complications were analyzed and questionnaire surveys were conducted for the available 55 patients. Among the patients, 70% (n=64) were referred form other departments, 5% (n=5) from other hospitals, 5% (n=4) were new patients and 20% (n=18) were re-admissions. The procedures included gastrointestinal, biliary, urinary, hemodialysis related-and implantable port related interventions. 96% (n=87) of the patients were successfully discharged in a day and admission to the general ward was only 4% (n=4). Minor complications occurred after discharges in 3% (n=3). The questionnaire survey revealed that 96% (n=53) of the patients were satisfied with the service and they were not anxious after discharge. Most of common interventional procedures were safely done under the day-hospital system with the patients being highly satisfied. The day-hospital system can be a good tool for establishing admitting privileges for an interventional radiology clinic

  11. Measurement of fractional flow reserve to guide decisions for percutaneous coronary intervention.

    Science.gov (United States)

    Siebert, Uwe; Bornschein, Bernhard; Schnell-Inderst, Petra; Rieber, Johannes; Pijls, Nico; Wasem, Jürgen; Klauss, Volker

    2008-08-27

    Coronary artery disease (CAD) is one of the leading causes of premature death in Germany. Percutaneous coronary interventions (PCI) are frequently performed in patients with angiographically intermediate stenoses. However, the necessity of PCI has not been proven for all patients. Pressure-based fractional flow reserve (FFR) is an invasive test that can be used to assess the functional significance of intermediate coronary stenoses in order to guide decisions on PCI. This health technology assessment (HTA) aims to evaluate (1) the diagnostic accuracy, (2) the risk-benefit trade-off and (3) the long-term cost-effectiveness of FFR measurement to guide the decision on PCI in patients with stable angina pectoris and intermediate coronary stenoses. We performed a literature search in medical and HTA databases. We used the DIMDI instruments (DIMDI = Deutsches Institut für Medizinische Dokumentation und Information/German Institute for Medical Information and Documentation) to assess study quality and to extract and summarize the information in evidence tables. We performed a meta-analysis to calculate the pooled overall estimate for sensitivity and specificity of FFR with 95% confidence intervals (95% CI). Individual studies' case numbers were used as weights. The influence of single studies and important covariates on the results was tested in sensitivity analyses. We developed the German Coronary Artery Disease Outcome Model (German CADOM), a decision-analytic Markov model, to estimate the long-term effectiveness and cost-effectiveness of FFR measurement in the context of the German healthcare system. Our literature search identified twelve studies relevant to this HTA-report including ten diagnostic accuracy studies of FFR measurement, one randomized clinical trial (RCT) investigating the clinical benefits of this technique as well as one economic evaluation. Pooled estimates for sensitivity and specificity were 81.7% (95% CI: 77.0-85.7%) and 78.7% (95% CI: 74

  12. Measurement of fractional flow reserve to guide decisions for percutaneous coronary intervention

    Directory of Open Access Journals (Sweden)

    Wasem, Jürgen

    2008-08-01

    Full Text Available Background: Coronary artery disease (CAD is one of the leading causes of premature death in Germany. Percutaneous coronary interventions (PCI are frequently performed in patients with angiographically intermediate stenoses. However, the necessity of PCI has not been proven for all patients. Pressure-based fractional flow reserve (FFR is an invasive test that can be used to assess the functional significance of intermediate coronary stenoses in order to guide decisions on PCI. Objectives: This health technology assessment (HTA aims to evaluate (1 the diagnostic accuracy, (2 the risk-benefit trade-off and (3 the long-term cost-effectiveness of FFR measurement to guide the decision on PCI in patients with stable angina pectoris and intermediate coronary stenoses. Methods: We performed a literature search in medical and HTA databases. We used the DIMDI instruments (DIMDI = Deutsches Institut für Medizinische Dokumentation und Information/German Institute for Medical Information and Documentation to assess study quality and to extract and summarize the information in evidence tables. We performed a meta-analysis to calculate the pooled overall estimate for sensitivity and specificity of FFR with 95% confidence intervals (95% CI. Individual studies’ case numbers were used as weights. The influence of single studies and important covariates on the results was tested in sensitivity analyses. We developed the German Coronary Artery Disease Outcome Model (German CADOM, a decision-analytic Markov model, to estimate the long-term effectiveness and cost-effectiveness of FFR measurement in the context of the German healthcare system. Results: Our literature search identified twelve studies relevant to this HTA-report including ten diagnostic accuracy studies of FFR measurement, one randomized clinical trial (RCT investigating the clinical benefits of this technique as well as one economic evaluation. Pooled estimates for sensitivity and specificity were 81

  13. Fractional flow reserve versus angiography for guiding percutaneous coronary intervention in patients with multivessel coronary artery disease: 2-year follow-up of the FAME (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation) study

    DEFF Research Database (Denmark)

    Pijls, Nico H J; Fearon, William F; Tonino, Pim A L

    2010-01-01

    The purpose of this study was to investigate the 2-year outcome of percutaneous coronary intervention (PCI) guided by fractional flow reserve (FFR) in patients with multivessel coronary artery disease (CAD).......The purpose of this study was to investigate the 2-year outcome of percutaneous coronary intervention (PCI) guided by fractional flow reserve (FFR) in patients with multivessel coronary artery disease (CAD)....

  14. Effect of Shenzhu Guanxin Recipe () on patients with angina pectoris after percutaneous coronary intervention: A prospective, randomized controlled trial.

    Science.gov (United States)

    Xu, Dan-Ping; Wu, Huan-Lin; Lan, Tao-Hua; Wang, Xia; Sheng, Xiao-Gang; Lin, Yu; Li, Song; Zheng, Chao-Yang

    2015-06-01

    To evaluate the efficacy and safety of a combination therapy using Chinese medicine (CM) Shenzhu Guanxin Recipe (, SGR) and standard Western medicine treatment (SWMT) in patients with angina pectoris after percutaneous coronary intervention (PCI). Double-blind randomized controlled trial was used in this experimental procedure. One hundred and eighty-seven patients with coronary heart disease receiving SWMT after PCI were randomly assigned to the treatment (SGR) and control (placebo) groups. Outcome measures including angina pectoris score (APS), CM symptom score, and Seattle Angina Questionnaire (SAQ) score were evaluated in 1, 2, 3 and 12 months, and the death rate, restenosis and other emergency treatments were observed. The mixed-effects models were employed for the data analysis. In the treatment group, a larger within-treatment effect size (d=1.74) was found, with a 76.7% reduction in APS from pretreatment to 12-month follow-up assessment compared with the control group (d=0.83, 53.8% symptom reduction); betweentreatment (BT) effect size was d=0.66. CM symptom scores included an 18.3% reduction in the treatment group (d=0.46), and a 16.1% decrease in the control group (d=0.31); d=0.62 for BT effect size. In regard to scores of SAQ, the BT effect size of cognition level of disease was larger in the treatment group (d=0.63), followed by the level of body limitation of activity (d=0.62), condition of angina pectoris attacks (d=0.55), satisfaction level of treatments (d=0.31), and steady state of angina pectoris (d=0.30). Two cardiovascular related deaths and one incidental death were recorded in the control and treatment groups, respectively. No significant difference in any cardiovascular event (including death toll, frequency of cardiovascular hospitalization or emergency room visits) was found between the two groups. The combination therapy of SGR and SWMT is effective and safe in patients with angina pectoris after PCI when compared with SWMT alone.

  15. Impact of a Disposable Sterile Radiation Shield on Operator Radiation Exposure During Percutaneous Coronary Intervention of Chronic Total Occlusions.

    Science.gov (United States)

    Shorrock, Deborah; Christopoulos, Georgios; Wosik, Jedrek; Kotsia, Anna; Rangan, Bavana; Abdullah, Shuaib; Cipher, Daisha; Banerjee, Subhash; Brilakis, Emmanouil S

    2015-07-01

    Daily radiation exposure over many years can adversely impact the health of medical professionals. Operator radiation exposure was recorded for 124 percutaneous coronary interventions (PCIs) performed at our institution between August 2011 and May 2013: 69 were chronic total occlusion (CTO)-PCIs and 55 were non-CTO PCIs. A disposable radiation protection sterile drape (Radpad; Worldwide Innovations & Technologies, Inc) was used in all CTO-PCI cases vs none of the non-CTO PCI cases. Operator radiation exposure was compared between CTO and non-CTO PCIs. Mean age was 64.6 ± 6.2 years and 99.2% of the patients were men. Compared with non-CTO PCI, patients undergoing CTO-PCI were more likely to have congestive heart failure, to be current smokers, and to have longer lesions, and less likely to have prior PCI and a saphenous vein graft target lesion. CTO-PCI cases had longer procedural time (median: 123 minutes [IQR, 85-192 minutes] vs 27 minutes [IQR, 20-44 minutes]; P<.001), fluoroscopy time (35 minutes [IQR, 19-54 minutes] vs 8 minutes [IQR, 5-16 minutes]; P<.001), number of stents placed (2.4 ± 1.5 vs 1.7 ± 0.9; P<.001), and patient air kerma radiation exposure (3.92 Gray [IQR, 2.48-5.86 Gray] vs 1.22 Gray [IQR, 0.74-1.90 Gray]; P<.001), as well as dose area product (267 Gray•cm² [IQR, 163-4.25 Gray•cm²] vs 84 Gray•cm² [IQR, 48-138 Gray•cm²]; P<.001). In spite of higher patient radiation exposure, operator radiation exposure was similar between the two groups (20 μSv [IQR, 9.5-31 μSv] vs 15 μSv [IQR, 7-23 μSv]; P=.07). Operator radiation exposure during CTO-PCI can be reduced to levels similar to less complicated cases with the use of a disposable sterile radiation protection shield.

  16. Comparative effectiveness of coronary artery bypass grafting (CABG) surgery and percutaneous coronary intervention (PCI) in elderly patients with diabetes.

    Science.gov (United States)

    Shah, Ruchit; Yang, Yi; Bentley, John P; Banahan, Benjamin F

    2016-11-01

    To compare the relative effectiveness of coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) among elderly patients with diabetes regarding acute myocardial infarction (AMI), stroke, repeat revascularization, and all-cause mortality. A retrospective cohort study was conducted using the 2006-2008 5% national sample of Medicare claims data. Elderly (≥65 years) beneficiaries with at least two claims of diabetes separated by ≥30 days and who had at least one inpatient claim for multi-vessel CABG or PCI between 1 July 2006 and 30 June 2008 were identified. The date of beneficiary's first CABG or PCI was defined as the index date. All patients were followed from the index date to 31 December 2008 for outcomes. CABG and PCI patients were 1:1 matched on propensity scores and index dates. Cox proportional hazards models were used to compare postoperative outcomes between patients undergoing CABG versus PCI. The matched sample consisted of 4430 patients (2215 in each group). The Cox proportional hazards models showed that, compared to patients undergoing PCI, CABG was associated with a lower risk of postoperative AMI (hazard ratio [HR]: 0.494; 95% CI: 0.396-0.616; p < .0001), repeat revascularization (HR: 0.194; 95% CI: 0.149-0.252; p < .0001), the composite outcome (HR: 0.523; 95% CI: 0.460-0.595; p < .0001), and all-cause mortality (HR: 0.775; 95% CI: 0.658-0.914; p = .0024); postoperative risk of stroke was not significantly different between the two groups (HR: 0.965; 95% CI: 0.812-1.148; p = .691). CABG appears to be the preferred revascularization strategy for elderly patients with diabetes and coronary heart disease. However, this result should be interpreted considering study limitations, for example, several patient clinical variables and physician-related factors which may affect procedure outcomes are not available in the data. Clinical decisions should be individualized considering all patient- and physician

  17. Percutaneous coronary intervention of osteal lesions in newly established tertiary care cardiac hospital

    International Nuclear Information System (INIS)

    Sultana, R.; Sultana, N.; Rasheed, S.J.; Jafary, M.H.; Ishaq, M.; Samad, A.

    2010-01-01

    To assess the outcome of percutanious Angioplasty in patients with osteal lesions in Coronary artery Diseases. This is a retrospective analysis of all coronary angiograms performed at the catheterization laboratory of Karachi Institute of Heart Diseases (KIHD), a tertiary referral center in Karachi, Pakistan, between the periods August 2006 to August 2008. Fifty patients were enrolled which included thirty-five men and fifteen women and all were >40 years of age. Each patient had a single target osteal lesion: twenty nine patients underwent PCI for ostial LAD lesion (among them twenty males and nine females), six had ostial LCX (five males and one female), and fifteen patients had osteal RCA stenosis (10-male patients and 5- female patients). After high-pressure balloon dilatation residual stenosis was reduced. Twelve patients were treated with bare metal stents (BMS) while thirty eight with drug eluting stents (DES). In all cases the procedure was successful without any pre and post procedural complications. A key issue in the treatment of an osteal lesion is to assure that the stent is inserted proximal enough to fully cover the osteal junction. Improvements in technique, equipment, adjunctive drug therapy and better understanding of the procedure have remarkably changed the practice of interventional cardiology. (author)

  18. Effects of Aromatherapy on the Anxiety, Vital Signs, and Sleep Quality of Percutaneous Coronary Intervention Patients in Intensive Care Units

    Science.gov (United States)

    Cho, Mi-Yeon; Min, Eun Sil; Hur, Myung-Haeng; Lee, Myeong Soo

    2013-01-01

    The purpose of this study was to investigate the effects of aromatherapy on the anxiety, sleep, and blood pressure (BP) of percutaneous coronary intervention (PCI) patients in an intensive care unit (ICU). Fifty-six patients with PCI in ICU were evenly allocated to either the aromatherapy or conventional nursing care. Aromatherapy essential oils were blended with lavender, roman chamomile, and neroli with a 6 : 2 : 0.5 ratio. Participants received 10 times treatment before PCI, and the same essential oils were inhaled another 10 times after PCI. Outcome measures patients' state anxiety, sleeping quality, and BP. An aromatherapy group showed significantly low anxiety (t = 5.99, P aromatherapy effectively reduced the anxiety levels and increased the sleep quality of PCI patients admitted to the ICU. Aromatherapy may be used as an independent nursing intervention for reducing the anxiety levels and improving the sleep quality of PCI patients. PMID:23476690

  19. ST peak during percutaneous coronary intervention serves as an early prognostic predictor in patients with ST-segment elevation myocardial

    DEFF Research Database (Denmark)

    Lønborg, Jacob; Kelbæk, Henning; Engstrøm, Thomas

    2014-01-01

    AIMS: To evaluate the clinical importance of the ST peak phenomenon during primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI). METHODS AND RESULTS: Continuous ST monitoring was performed in 942 STEMI patients from arrival until 90...... minutes after revascularisation. ST peak was defined as ≥1 mm increase in the ST-segment during PCI compared with the ST elevation before intervention. ST peak was observed in 26.9% of patients. During median follow-up of 4.1 years, 20.7% of patients experienced a major adverse cardiac event (MACE). ST...... and ST peak including ST resolution and epicardial flow, ST peak remained significantly associated with MACE: adjusted hazard ratio (HR) 1.40 (95% confidence interval [CI] 1.01-1.95) and 1.41 (95% CI: 1.02-1.96). CONCLUSIONS: In the largest study hitherto evaluating the ST peak phenomenon during primary...

  20. Main clinical, therapeutic and technical factors related to patient's maximum skin dose in interventional cardiology procedures

    Science.gov (United States)

    Journy, N; Sinno-Tellier, S; Maccia, C; Le Tertre, A; Pirard, P; Pagès, P; Eilstein, D; Donadieu, J; Bar, O

    2012-01-01

    Objective The study aimed to characterise the factors related to the X-ray dose delivered to the patient's skin during interventional cardiology procedures. Methods We studied 177 coronary angiographies (CAs) and/or percutaneous transluminal coronary angioplasties (PTCAs) carried out in a French clinic on the same radiography table. The clinical and therapeutic characteristics, and the technical parameters of the procedures, were collected. The dose area product (DAP) and the maximum skin dose (MSD) were measured by an ionisation chamber (Diamentor; Philips, Amsterdam, The Netherlands) and radiosensitive film (Gafchromic; International Specialty Products Advanced Materials Group, Wayne, NJ). Multivariate analyses were used to assess the effects of the factors of interest on dose. Results The mean MSD and DAP were respectively 389 mGy and 65 Gy cm−2 for CAs, and 916 mGy and 69 Gy cm−2 for PTCAs. For 8% of the procedures, the MSD exceeded 2 Gy. Although a linear relationship between the MSD and the DAP was observed for CAs (r=0.93), a simple extrapolation of such a model to PTCAs would lead to an inadequate assessment of the risk, especially for the highest dose values. For PTCAs, the body mass index, the therapeutic complexity, the fluoroscopy time and the number of cine frames were independent explanatory factors of the MSD, whoever the practitioner was. Moreover, the effect of technical factors such as collimation, cinematography settings and X-ray tube orientations on the DAP was shown. Conclusion Optimising the technical options for interventional procedures and training staff on radiation protection might notably reduce the dose and ultimately avoid patient skin lesions. PMID:22457404

  1. Failure of acute procedural success predicts adverse outcome after percutaneous edge-to-edge mitral valve repair with MitraClip.

    Science.gov (United States)

    Puls, Miriam; Tichelbäcker, Tobias; Bleckmann, Annalen; Hünlich, Mark; von der Ehe, Katrin; Beuthner, Bo Eric; Rüter, Karin; Beißbarth, Tim; Seipelt, Ralf; Schöndube, Friedrich; Hasenfuß, Gerd; Schillinger, Wolfgang

    2014-01-01

    MitraClip implantation is evolving as a potential alternative treatment to conventional surgery in high-risk patients with significant mitral regurgitation (MR). However, outcome predictors are under-investigated. The aim of this study was to identify predictors of midterm mortality and heart failure rehospitalisation after percutaneous mitral valve repair with MitraClip. A total of 150 consecutive patients were followed for a median of 463 days. Survival analyses were performed for baseline characteristics, risk scores and failure of acute procedural success (APS) defined as persisting MR grade 3+ or 4+. Univariate significant risk stratifiers were tested in multivariate analyses using a Cox proportional hazards model. Overall survival was 96% at 30 days, 79.5% at 12 months, and 62% at two years. Multivariate analysis identified APS failure (HR 2.13, p=0.02), NYHA Class IV at baseline (HR 2.11, p=0.01) and STS score ≥12 (HR 2.20, pfailure (HR 2.31, p=0.01) and NYHA Class IV at baseline (HR 1.89, p=0.03) as significant independent predictors of heart failure rehospitalisation. Furthermore, a post-procedural significant decrease in hospitalisation rate could only be observed after successful interventions (0.89±1.07 per year before vs. 0.54±0.96 after implantation, p=0.01). Patients with severely dilated and overloaded ventricles who did not meet EVEREST II eligibility criteria were at higher risk of APS failure. The failure of acute procedural success proved to have the most important impact on outcome after MitraClip implantation.

  2. The use of nitrates in the prevention of contrast-induced nephropathy in patients hospitalized after undergoing percutaneous coronary intervention.

    Science.gov (United States)

    Peguero, Julio G; Cornielle, Vertilio; Gomez, Sabas I; Issa, Omar M; Heimowitz, Todd B; Santana, Orlando; Goldszer, Robert C; Lamas, Gervasio A

    2014-05-01

    Contrast-induced nephropathy (CIN) is a significant cause of morbidity and mortality and effective strategies for its prevention are greatly needed. The purpose of this retrospective, single-center study was to investigate whether nitrate use during percutaneous coronary artery intervention reduces the incidence of CIN. Chart review of all individuals who underwent percutaneous coronary intervention (PCI) from April 2010 to March 2011 was done. Included in the study were patients who were admitted to the hospital after percutaneous coronary artery intervention and had baseline and follow-up creatinine measured. Patients with end-stage renal disease requiring dialysis and those patients with insufficient information to calculate Mehran score were excluded. There were 199 patients who met the eligibility criteria for inclusion in this study. In the identified population, postprocedure renal function was compared between 112 patients who received nitrates prior to coronary intervention and 87 who did not. Baseline characteristics were similar between the 2 groups. Contrast-induced nephropathy was defined as either a 25% or a 0.5 mg/dL, or greater, increase in serum creatinine during the first 48 to 72 hours after contrast exposure. Overall, 43 (21.6%) patients developed CIN post-PCI. Of the patients who received nitrates, 15.2% developed renal impairment when compared to 29.9% in those who did not (odds ratio [OR] = 0.42, 95% confidence interval [CI] 0.21-0.84, P = .014). Multivariate logistic regression analysis demonstrated that nitrate use was independently correlated with a reduction in the development of contrast nephropathy (OR = 0.334, 95% CI 0.157-0.709, P = .004). Additionally, of the various methods of nitrate administration, intravenous infusion was shown to be the most efficacious route in preventing renal impairment (OR = 0.42, 95% CI 0.20-0.90, P = .03). In conclusion, the use of nitrates prior to PCI, particularly intravenous nitroglycerin infusion, may

  3. Unexplained occurrence of multiple de novo pseudoaneurysms in patients with chronic kidney disease undergoing angioembolization for bleeding following percutaneous renal intervention: Are we dealing with infection or vasculitis?

    Directory of Open Access Journals (Sweden)

    Debansu Sarkar

    2013-01-01

    Full Text Available Background and Objectives: Patients with chronic kidney disease (CKD are more prone for bleeding following percutaneous renal intervention, as compared to those with normal renal function. Causes are multi-factorial. Finding multiple aneurysms away from the site of renal intervention following initial angioembolization for hemorrhage is very unusual in these patients. Materials and Methods: Clinical and radiological findings of all the patients who underwent renal angiography for post-intervention bleed for a period of 5 years were reviewed and analyzed. Results: A total of 29 patients required angiography for post-intervention hemorrhage. Six patients had recurrence of hemorrhage for which they underwent repeat angiography. Four of these patients had appearance of multiple new aneurysms away from the site of percutaneous nephrostomy (PCN/percutaneous nephrolithotomy (PNL puncture and the site of previous bleeding. All the patients had CKD (creatinine >2.5 mg/dl. They were on prolonged preoperative urinary diversion and had polymicrobial urinary infection. Three patients had candiduria. None of these patients had re-bleeding after repeat embolization and treatment with antibacterial and antifungal agents. Conclusions: Development of multiple aneurysms away from the sites of punctures in patients with CKD following percutaneous intervention is very unusual. Its causation including infection with bacteria and fungus, reaction of embolizing material, and angiopathy needs to be explored.

  4. Percutaneous rendezvous technique for the management of a bile duct injury.

    Science.gov (United States)

    Meek, James; Fletcher, Savannah; Crumley, Kristen; Culp, W C; Meek, Mary

    2018-02-01

    The rendezvous technique typically involves combined efforts of interventional radiology, endoscopy, and surgery. It can be done solely percutaneously, whereby the interventionalist gains desired access to one point in the body by approaching it from two different access sites. We present the case of a woman who underwent cholecystectomy complicated by a bile duct injury. A percutaneous rendezvous procedure enabled placement of an internal-external drain from the intrahepatic ducts through the biloma and distal common bile duct and into the duodenum. Thus, a percutaneous rendezvous technique is feasible for managing a bile duct injury when endoscopic retrograde cholangio-pancreatography or percutaneous transhepatic cholangiogram alone has been unsuccessful.

  5. Percutaneous rendezvous technique for the management of a bile duct injury

    Directory of Open Access Journals (Sweden)

    James Meek, DO

    2018-02-01

    Full Text Available The rendezvous technique typically involves combined efforts of interventional radiology, endoscopy, and surgery. It can be done solely percutaneously, whereby the interventionalist gains desired access to one point in the body by approaching it from two different access sites. We present the case of a woman who underwent cholecystectomy complicated by a bile duct injury. A percutaneous rendezvous procedure enabled placement of an internal-external drain from the intrahepatic ducts through the biloma and distal common bile duct and into the duodenum. Thus, a percutaneous rendezvous technique is feasible for managing a bile duct injury when endoscopic retrograde cholangio-pancreatography or percutaneous transhepatic cholangiogram alone has been unsuccessful.

  6. Incidence, feasibility and outcome of percutaneous coronary intervention after transcatheter aortic valve implantation with a self-expanding prosthesis. Results from a single center experience.

    Science.gov (United States)

    Allali, Abdelhakim; El-Mawardy, Mohamed; Schwarz, Bettina; Sato, Takao; Geist, Volker; Toelg, Ralph; Richardt, Gert; Abdel-Wahab, Mohamed

    2016-09-01

    Percutaneous coronary intervention (PCI) after transcatheter aortic valve implantation (TAVI) can become technically challenging after implantation of the self-expanding Medtronic CoreValve (MCV) device, which completely covers the aortic root. The aim of this study was to report on the incidence, feasibility and outcome of PCI after TAVI with the MCV device. Between 2007 and 2014, all patients subjected to PCI after MCV implantation in a single-center institutional TAVI database were retrospectively identified. Clinical, angiographic and procedural characteristics were reviewed and analyzed. We identified a total of 17 patients (5.7%) treated with 24 PCI procedures for 29 lesions at a median of 17.7months (range 1-72) after MCV implantation. The mean age was 79.7±6.8years and the mean logistic EuroSCORE was 30.3%±18.9%. Nine procedures were performed for patients with acute coronary syndrome. 89.6% of the treated lesions were of type B2/C and 79.3% were de novo ones. A median of one guiding catheter was necessary to intubate the target coronary ostium (range 1-10) and 95% of the lesions on the left coronary artery were treated through a Judkins catheter. In one primary PCI for STEMI the intubation of the right coronary ostium was not successful. Final procedural success was obtained in 95.8%, and peri-procedural death occurred in one patient. The need for PCI after MCV is not uncommon and is mostly related to coronary artery disease progression. PCI after MCV is usually feasible and safe, but coronary intubation in an emergency setting can be challenging. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. Neuropsychological outcome after percutaneous coronary intervention or coronary artery bypass grafting: results from the Stent or Surgery (SoS) Trial.

    Science.gov (United States)

    Währborg, Peter; Booth, Jean E; Clayton, Tim; Nugara, Fiona; Pepper, John; Weintraub, William S; Sigwart, Ulrich; Stables, Rod H

    2004-11-30

    Coronary artery bypass surgery (CABG) has been associated with a range of neurological and neuropsychological complications from stroke to cognitive problems such as memory and problem solving disturbance. However, little is known about the impact of percutaneous coronary intervention (PCI) on neuropsychological outcome. In the Stent or Surgery Trial (SoS), 988 patients were randomized in equal proportions between PCI supported by stent implantation and CABG. As a substudy of this trial, we undertook an evaluation of neurological and neuropsychological outcomes after intervention. A clinical examination and neuropsychological assessment consisting of 5 tests (Digit Span Forwards and Backwards, Visual Reproduction, Bourdon, and Block Design) were performed at baseline and 6 and 12 months after the procedure. A total of 145 patients were included in the substudy analysis: 77 in the PCI group and 68 in the CABG group. One patient in the PCI arm had a stroke. There was no significant difference between treatment groups at 6 and 12 months for any of the 5 tests. The mean change from baseline was also similar in both groups. We were not able to demonstrate an important and significant difference in neuropsychological outcome in patients treated with different revascularization strategies. This important finding needs to be examined in further research.

  8. Outcomes of Percutaneous Coronary Interventions for Chronic Total Occlusion Performed by Highly Experienced Japanese Specialists: The First Report From the Japanese CTO-PCI Expert Registry.

    Science.gov (United States)

    Suzuki, Yoriyasu; Tsuchikane, Etsuo; Katoh, Osamu; Muramatsu, Toshiya; Muto, Makoto; Kishi, Koichi; Hamazaki, Yuji; Oikawa, Yuji; Kawasaki, Tomohiro; Okamura, Atsunori

    2017-11-13

    This report describes the registry and presents an initial analysis of outcomes for the different PCI approaches taken by the specialists. Strategies for percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) are complex. The Japanese Board of CTO Interventional Specialists has developed a prospective, nonrandomized registry of patients undergoing CTO-PCIs performed by 41 highly experienced Japanese specialists. Over the study period of January 2014 to December 2015, the registry included 2,846 consecutive CTO-PCI cases undertaken in Japan. The authors compared clinical outcomes between the different PCI approaches, following the intention-to-treat principle. The overall technical success rate of the procedures was 89.9%. The specialists frequently chose a retrograde approach as the primary CTO-PCI strategy (in 27.8% of cases). The technical success rate of the primary antegrade approach was significantly better than that of the primary retrograde approach (91.0% vs. 87.3%; p PCI with a high technical success rate (75.0% to 88.9%). Severe lesion calcification was a strong predictor of failed CTO-PCI. CTO-PCI performed by highly experienced specialists achieved a high technical success rate. Copyright © 2017 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  9. Percutaneous transesophageal gastro-tubing (PTEG) as an alternative long-term tube feeding procedure when gastrostomy is not feasible.

    Science.gov (United States)

    Toh Yoon, Ezekiel Wong; Nishihara, Kazuki

    2017-12-01

    Percutaneous transesophageal gastro-tubing (PTEG) is a minimally invasive technique to access the gut via an esophagostomy. However, this procedure is not well known and the literature available is still fairly limited. This observational study was conducted to evaluate our experience using this method as an alternative long-term tube feeding procedure when gastrostomy is not suitable. A total of 15 patients (10 males and 5 females) who underwent PTEG at our institution from 2012 to 2016 were observed and analyzed in this study. The average age was 80.1 (71-93) years. Underlying conditions that required PTEG were previous gastric resection in 11 patients, left diaphragm disorder in 2 patients, interposing transverse colon between the abdominal wall and anterior gastric wall in 1 patient, and severe gastrostomy site leakage in 1 patient. Tube placement was successful in all patients by approaching the left side of the neck, using a 15 Fr size tube. The mean postoperative length of stay was 22 (8-48) days. Postoperative adverse events included accidental tube dislodgement in three patients, tracheoesophageal fistula in one patient, inferior thyroid artery injury in one patient and thyroid gland mispuncture in one patient. There was no procedure-related mortality nor mortality at 30 days. Eight patients were discharged with some oral intake. PTEG is feasible in patients requiring long-term tube feeding for whom gastrostomy is unsuitable. It is an effective long-term tube feeding procedure and should be offered as a more comfortable alternative to nasogastric tubing.

  10. Late complications after percutaneous tracheostomy and oral intubation: Evaluation of 1,628 procedures.

    Science.gov (United States)

    Storm, Benjamin; Dybwik, Knut; Nielsen, Erik Waage

    2016-05-01

    In large international studies, upper airway-related stenosis, granulomas, malacias, and laryngeal nerve palsies following percutaneous tracheostomy have an estimated incidence of 6% to 31%. The incidence following prolonged oral intubation is estimated to be 10% to 22%. The purpose of this study was to assess the incidence of late complications in our unit. Retrospective search of a single-unit intensive care patient population. Patient records for a defined period were searched using a predefined search string, identifying those who received invasive mechanical ventilation and split in subgroups by orotracheal tube or tracheostomy tube. This search was cross-linked with the International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) codes associated with recognized complications (J38.0, J38.3,J38.6, J38.7, J39.8, J39.9, J95.0, J95.5, J95.8, J95.9, J99, R04.8,S27.5). During the period January 1, 1997 to December 31, 2013, 32,852 patients were admitted to the intensive care unit. Of these, 1,620 patients received invasive mechanical ventilation. Out of this group, 519 had a tracheostomy and 1,109 were orally intubated. Four tracheostomized and zero orotracheally intubated patients had ICD-10 codes related to complications. From the patient records it became clear that three of four patients with tracheostomy had airway symptoms before being tracheostomized, and the fourth patient had her tracheostomy following a postintubation airway stenosis. Spanning a 17-year period, our study did not show any long-term symptomatic upper airway complications following tracheostomy and only one following orotracheal intubation. This contrasts the internationally estimated incidence. 4 Laryngoscope, 126:1077-1082, 2016. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

  11. Tips of the dual-lumen microcatheter-facilitated reverse wire technique in percutaneous coronary interventions for markedly angulated bifurcated lesions.

    Science.gov (United States)

    Nomura, Tetsuya; Kikai, Masakazu; Hori, Yusuke; Yoshioka, Kenichi; Kubota, Hiroshi; Miyawaki, Daisuke; Urata, Ryota; Sugimoto, Takeshi; Keira, Natsuya; Tatsumi, Tetsuya

    2018-04-01

    In practical settings of percutaneous coronary intervention (PCI), we sometimes encounter difficulty in introducing a guidewire (GW) to the markedly angulated side branch (SB), and the reverse wire technique is considered as a last resort to overcome such a situation. We analyzed 12 cases that underwent PCI with dual-lumen microcatheter-facilitated reverse wire technique between January 2013 and July 2016. We retrospectively investigated the lesion's characteristics and the details of the PCI procedures, and discussed tips about the use of this technique. The SB that exhibits both a smaller take-off angle and a larger carina angle is considered to be the most suitable candidate for this technique. The first step of this technique involves the delivery of the reverse wire system to the target bifurcation. However, most cases exhibit significant stenosis proximal to the bifurcation, which often hampers the delivery of the reverse wire system. Because the sharply curved reverse wire system is easier to pass the stenosis as compared to the roundly curved system, we recommend a sharp curve should be adopted for this technique. On the other hand, it is sure that device delivery is much easier on the GW with a round curve as compared to that with a sharp curve. Therefore, it is important to modify the details of this procedure on a case-by-case basis according to the lesion's characteristics.

  12. Temporal Trends in the Risk Profile of Patients Undergoing Outpatient Percutaneous Coronary Intervention: A Report from the National Cardiovascular Data Registry's CathPCI Registry.

    Science.gov (United States)

    Vora, Amit N; Dai, Dadi; Gurm, Hitinder; Amin, Amit P; Messenger, John C; Mahmud, Ehtisham; Mauri, Laura; Wang, Tracy Y; Roe, Matthew T; Curtis, Jeptha; Patel, Manesh R; Dauerman, Harold L; Peterson, Eric D; Rao, Sunil V

    2016-03-01

    Because of recent changes in criteria for coverage for inpatient hospital stays, most nonacute percutaneous coronary intervention (PCI) procedures are reimbursed on an outpatient basis regardless of underlying patient risk. Downstream effects of these changes on the risk profile of patients undergoing outpatient PCI have not been evaluated. Using the American College of Cardiology National Cardiovascular Data Registry's CathPCI Registry, we assessed temporal trends in risk profiles and rates of hospital admission among 999 279 patients undergoing PCI qualifying for outpatient reimbursement. We estimated mortality and bleeding risk using validated models from the registry. From 2009 to 2014, the proportion of outpatients not admitted to a hospital after PCI increased from 32.8% to 66.3% (Prisk for predicted mortality increased significantly from 17.0% to 19.8% during the study period (Prisk for mortality. Among patients undergoing PCI procedures that qualify for outpatient reimbursement, there has been a temporal decrease in postprocedure hospital admission. Concomitantly, the proportion of these outpatients at high risk for mortality has significantly increased over time. These data suggest that current reimbursement classification could be improved by incorporating patient risk to appropriately match the necessary resources to the needed level of care. © 2016 American Heart Association, Inc.

  13. Association Between Contrast Media Volume-Glomerular Filtration Rate Ratio and Contrast-Induced Acute Kidney Injury After Primary Percutaneous Coronary Intervention.

    Science.gov (United States)

    Celik, Omer; Ozturk, Derya; Akin, Fatih; Ayca, Burak; Yalcın, Ahmet Arif; Erturk, Mehmet; Bıyık, Ismail; Ayaz, Ahmet; Akturk, Ibrahim Faruk; Enhos, Asım; Aslan, Serkan

    2015-07-01

    We hypothesized that contrast media volume-estimated glomerular filtration rate (CV-e-GFR) ratio may be a predictor of contrast media-induced acute kidney injury (CI-AKI). We investigated the associations between CV-e-GFR ratio and CI-AKI in 597 patients undergoing primary percutaneous coronary intervention (pPCI). An absolute ≥0.3 mg/dL increase in serum creatinine compared with baseline levels within 48 hours after the procedure was considered as CI-AKI; 78 (13.1%) of the 597 patients experienced CI-AKI. The amount of contrast during procedure was higher in the CI-AKI group than in those without CI-AKI (153 vs 135 mL, P = .003). The CV-e-GFR ratio was significantly higher in patients with CI-AKI than without (2.3 vs 1.5, P 2 (P < .001, OR = 5.917). In conclusion, CV-e-GFR ratio is significantly associated with CI-AKI after pPCI. © The Author(s) 2014.

  14. Percutaneous transluminal angioplasty of an occluded surgical splenorenal shunt in a 4-year-old child after liver transplantation

    Energy Technology Data Exchange (ETDEWEB)

    Yussim, Ethan; Belenky, Alexander; Atar, Eli [Department of Diagnostic Radiology, Rabin Medical Center, Vascular and Interventional Radiology Unit, Petah Tikva (Israel); Shapiro, Rivka [Schneider Children' s Medical Center, Institute of Pediatric Gastroenterology and Nutrition, Petah Tikva (Israel); Mor, Eytan [Rabin Medical Center, Department of Organ Transplantation, Petah Tikva (Israel)

    2005-07-01

    Percutaneous transluminal angioplasty is increasingly used in children. We present a case of successful balloon angioplasty of an occluded surgical splenorenal shunt in a 4-year-old child who underwent liver transplantation because of biliary atresia. Percutaneous reopening of the shunt is a relatively safe procedure that may spare patients of surgical intervention. (orig.)

  15. Percutaneous transluminal angioplasty of an occluded surgical splenorenal shunt in a 4-year-old child after liver transplantation

    International Nuclear Information System (INIS)

    Yussim, Ethan; Belenky, Alexander; Atar, Eli; Shapiro, Rivka; Mor, Eytan

    2005-01-01

    Percutaneous transluminal angioplasty is increasingly used in children. We present a case of successful balloon angioplasty of an occluded surgical splenorenal shunt in a 4-year-old child who underwent liver transplantation because of biliary atresia. Percutaneous reopening of the shunt is a relatively safe procedure that may spare patients of surgical intervention. (orig.)

  16. Association between body mass index and outcomes after percutaneous coronary intervention in multiethnic South East Asian population: a retrospective analysis of the Malaysian National Cardiovascular Disease Database-Percutaneous Coronary Intervention (NCVD-PCI) registry.

    Science.gov (United States)

    Azhari, Zaid; Ismail, Muhammad Dzafir; Zuhdi, Ahmad Syadi Mahmood; Md Sari, Norashikin; Zainal Abidin, Imran; Wan Ahmad, Wan Azman

    2017-11-09

    To examine the relationship between body mass index (BMI) and outcomes after percutaneous coronary intervention (PCI) in a multiethnic South East Asian population. Fifteen participating cardiology centres contributed to the Malaysian National Cardiovascular Disease Database-Percutaneous Coronary Intervention (NCVD-PCI) registry. 28 742 patients from the NCVD-PCI registry who had their first PCI between January 2007 and December 2014 were included. Those without their BMI recorded or BMI 70 kg/m 2 were excluded. In-hospital death, major adverse cardiovascular events (MACEs), vascular complications between different BMI groups were examined. Multivariable-adjusted HRs for 1-year mortality after PCI among the BMI groups were also calculated. The patients were divided into four groups; underweight (BMI PCI. Multivariable Cox proportional hazard regression analysis showed that compared with normal BMI group the underweight group had a non-significant difference (HR 1.02, p=0.952), while the overweight group had significantly lower risk of 1-year mortality (HR 0.71, p=0.005). The obese group also showed lower HR but this was non-significant (HR 0.78, p=0.056). Using Asian-specific BMI cut-off points, the overweight group in our study population was independently associated with lower risk of 1-year mortality after PCI compared with the normal BMI group. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  17. Randomized comparison of distal protection versus conventional treatment in primary percutaneous coronary intervention: the drug elution and distal protection in ST-elevation myocardial infarction (DEDICATION) trial

    DEFF Research Database (Denmark)

    Kelbaek, Henning; Terkelsen, Christian J; Helqvist, Steffen

    2008-01-01

    OBJECTIVES: The purpose of this study was to evaluate the use of distal protection during percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) in native coronary vessels. BACKGROUND: Embolization of material from the infarct-related lesion during PCI may...

  18. Cost-effectiveness of remote ischaemic conditioning as an adjunct to primary percutaneous coronary intervention in patients with ST-elevation myocardial infarction

    DEFF Research Database (Denmark)

    Sloth, Astrid D; Schmidt, Michael R; Munk, Kim

    2016-01-01

    AIMS: Remote ischaemic conditioning seems to improve long-term clinical outcomes in patients undergoing primary percutaneous coronary intervention. Remote ischaemic conditioning can be applied with cycles of alternating inflation and deflation of a blood-pressure cuff. We evaluated the cost...

  19. Frequency of Cardiac Death and Stent Thrombosis in Patients With Chronic Obstructive Pulmonary Disease Undergoing Percutaneous Coronary Intervention (from the BASKET-PROVE I and II Trials)

    DEFF Research Database (Denmark)

    Jatene, Tannas; Biering-Sørensen, Tor; Nochioka, Kotaro

    2017-01-01

    Chronic obstructive pulmonary disease (COPD) is associated with long-term all-cause death after percutaneous coronary intervention with bare-metal stents. Regarding other outcomes, previous studies have shown conflicting results and the impact of drug-eluting stent (DES) in this population is not...

  20. Data on administration of cyclosporine, nicorandil, metoprolol on reperfusion related outcomes in ST-segment Elevation Myocardial Infarction treated with percutaneous coronary intervention

    DEFF Research Database (Denmark)

    Campo, Gianluca; Pavasini, Rita; Morciano, Giampaolo

    2017-01-01

    Mortality and morbidity in patients with ST elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI) are still high [1]. A huge amount of the myocardial damage is related to the mitochondrial events happening during reperfusion [2]. Several drugs direc...

  1. Second generation drug-eluting stents versus bare-metal stents for percutaneous coronary intervention of the proximal left anterior descending artery

    DEFF Research Database (Denmark)

    Mangione, Fernanda Marinho; Biering-Sørensen, Tor; Nochioka, Kotaro

    2017-01-01

    OBJECTIVES: To compare mid-term outcomes between patients undergoing proximal left anterior descending artery (LAD) percutaneous coronary intervention (PCI) with second generation drug-eluting stent (DES) or bare-metal stent (BMS). BACKGROUND: PCI with BMS and first-generation DES have shown to b...

  2. Implementation of a Prehospital Triage System for Patients With Chest Pain and Logistics for Primary Percutaneous Coronary Intervention in the Region of Amsterdam, The Netherlands

    NARCIS (Netherlands)

    Adams, Rob; Appelman, Yolande; Bronzwaer, Jean G.; Slagboom, Ton; Amoroso, Giovanni; van Exter, Pieternel; Tijssen, G. P. Jan; de Winter, Robbert J.

    2010-01-01

    We aimed to describe the logistics of a prehospital triage system for patients with acute chest pain in the region of Amsterdam, The Netherlands. Ambulance electrocardiograms (ECGs) were evaluated immediately in 1 of the percutaneous coronary intervention (PCI)-capable centers. Patients accepted for

  3. Risk factors for impaired health status differ in women and men treated with percutaneous coronary intervention in the drug-eluting stent era

    DEFF Research Database (Denmark)

    Pedersen, Susanne S.; Ong, Andrew T L; Lemos, Pedro A

    2006-01-01

    In patients treated with percutaneous coronary intervention (PCI) in the drug-eluting stent era, we compared women's and men's health status 6 and 12 months post-PCI and investigated whether predictors of poor health status at 12 months are similar for women and men....

  4. Use of clopidogrel with or without aspirin in patients taking oral anticoagulant therapy and undergoing percutaneous coronary intervention: an open-label, randomised, controlled trial

    NARCIS (Netherlands)

    Dewilde, Willem J. M.; Oirbans, Tom; Verheugt, Freek W. A.; Kelder, Johannes C.; de Smet, Bart J. G. L.; Herrman, Jean-Paul; Adriaenssens, Tom; Vrolix, Mathias; Heestermans, Antonius A. C. M.; Vis, Marije M.; Tijsen, Jan G. P.; van 't Hof, Arnoud W.; ten Berg, Jurriën M.; Schölzel, B. E.; van den Branden, B. J.; Plokker, H. W. M.; Bosschaert, M. A.; Slagboom, T.; Vos, J.; Brueren, B. R. G.; Breet, N. J.; Sheikjoesoef, K.; Aarnoudse, W.; Rasoul, S.; van Mieghem, C.; Vandendriessche, T.; Cornelis, K.

    2013-01-01

    If percutaneous coronary intervention (PCI) is required in patients taking oral anticoagulants, antiplatelet therapy with aspirin and clopidogrel is indicated, but such triple therapy increases the risk of serious bleeding. We investigated the safety and efficacy of clopidogrel alone compared with

  5. Inter-Ethnic Differences in Quantified Coronary Artery Disease Severity and All-Cause Mortality among Dutch and Singaporean Percutaneous Coronary Intervention Patients

    NARCIS (Netherlands)

    Gijsberts, Crystel M; Seneviratna, Aruni; Höfer, IE; Agostoni, Pierfrancesco; Rittersma, Saskia Z. H.; Pasterkamp, Gerard; Hartman, Mikael; Pinto de Carvalho, Leonardo; Richards, A Mark; Asselbergs, Folkert W; de Kleijn, Dominique P V; Chan, Mark Y

    2015-01-01

    BACKGROUND: Coronary artery disease (CAD) is a global problem with increasing incidence in Asia. Prior studies reported inter-ethnic differences in the prevalence of CAD rather than the severity of CAD. The angiographic "synergy between percutaneous coronary intervention (PCI) with taxus and cardiac

  6. Predictive Value of Plasma Glucose Level on Admission for Short and Long Term Mortality in Patients With ST-Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention

    NARCIS (Netherlands)

    Hoebers, Loes P.; Damman, Peter; Claessen, Bimmer E.; Vis, Marije M.; Baan, Jan; van Straalen, Jan P.; Fischer, Johan; Koch, Karel T.; Tijssen, Jan G. P.; de Winter, Robbert J.; Piek, Jan J.; Henriques, Jose P. S.

    2012-01-01

    Published reports describe a strong association between plasma glucose levels on admission and mortality in patients who undergo primary percutaneous coronary intervention for ST-segment elevation myocardial infarction. The aim of this study was to assess the predictive value of admission glucose

  7. ICRP Publication 139: Occupational Radiological Protection in Interventional Procedures.

    Science.gov (United States)

    López, P Ortiz; Dauer, L T; Loose, R; Martin, C J; Miller, D L; Vañó, E; Doruff, M; Padovani, R; Massera, G; Yoder, C

    2018-03-01

    In recent publications, such as Publications 117 and 120, the Commission provided practical advice for physicians and other healthcare personnel on measures to protect their patients and themselves during interventional procedures. These measures can only be effective if they are encompassed by a framework of radiological protection elements, and by the availability of professionals with responsibilities in radiological protection. This framework includes a radiological protection programme with a strategy for exposure monitoring, protective garments, education and training, and quality assurance of the programme implementation. Professionals with responsibilities in occupational radiological protection for interventional procedures include: medical physicists; radiological protection specialists; personnel working in dosimetry services; clinical applications support personnel from the suppliers and maintenance companies; staff engaged in training, standardisation of equipment, and procedures; staff responsible for occupational health; hospital administrators responsible for providing financial support; and professional bodies and regulators. This publication addresses these elements and these audiences, and provides advice on specific issues, such as assessment of effective dose from dosimeter readings when an apron is worn, estimation of exposure of the lens of the eye (with and without protective eyewear), extremity monitoring, selection and testing of protective garments, and auditing the interventional procedures when occupational doses are unusually high or low (the latter meaning that the dosimeter may not have been worn).

  8. Thrombolysis in the age of Primary Percutaneous Coronary Intervention: Mini-Review and Meta-analysis of Early PCI.

    Science.gov (United States)

    Al Shammeri, O; Garcia, LA

    2013-01-01

    Primary Percutaneous Coronary Intervention (PCI) is the treatment of choice for ST-segment Elevation Myocardial Infarction (STEMI) if performed within 90 minutes from first medical contact. However, primary PCI is only available for less than 25% of patients with STEMI. Early PCI or Pharmaco-invasive strategy has evolved from facilitated PCI but with more delayed timing from thrombolysis to PCI. Assess the safety and effectiveness of Early PCI. We reviewed the data of the available therapy options for patients with STEMI. Then we performed a meta-analysis for all randomized controlled trials of early PCI versus standard therapy. Five studies fulfilled our inclusion criteria. Our meta-analysis showed improved cardiovascular events with early PCI compared to standard therapy (odd ratio of 0.54; 95% Confidence interval 0.47-0.7, pearly PCI 4 to 24 hours after successful thrombolysis. Early PCI should be done to all STEMI patients within 24 hours after successful thrombolysis.

  9. Admission hyperglycemia predicts inhospital mortality and major adverse cardiac events after primary percutaneous coronary intervention in patients without diabetes mellitus.

    Science.gov (United States)

    Ekmekci, Ahmet; Cicek, Gokhan; Uluganyan, Mahmut; Gungor, Baris; Osman, Faizel; Ozcan, Kazim Serhan; Bozbay, Mehmet; Ertas, Gokhan; Zencirci, Aycan; Sayar, Nurten; Eren, Mehmet

    2014-02-01

    Admission hyperglycemia is associated with high inhospital and long-term adverse events in patients that undergo primary percutaneous coronary intervention (PCI). We aimed to evaluate whether hyperglycemia predicts inhospital mortality. We prospectively analyzed 503 consecutive patients. The patients were divided into tertiles according to the admission glucose levels. Tertile I: glucose 145 mg/dL (n = 169). Inhospital mortality was 0 in tertile I, 2 in tertile II, and 9 in tertile III (P < .02). Cardiogenic shock occurred more frequently in tertile III compared to tertiles I and II (10% vs 4.1% and 0.6%, respectively, P = .01). Multivariate logistic regression analysis revealed that patients in tertile III had significantly higher risk of inhospital major adverse cardiac events compared to patients in tertile I (odds ratio: 9.55, P < .02). Admission hyperglycemia predicts inhospital adverse cardiac events in mortality and acute ST-segment elevation myocardial infarction in patients that underwent primary PCI.

  10. Sex-related differences after contemporary primary percutaneous coronary intervention for ST-segment elevation myocardial infarction.

    Science.gov (United States)

    Barthélémy, Olivier; Degrell, Philippe; Berman, Emmanuel; Kerneis, Mathieu; Petroni, Thibaut; Silvain, Johanne; Payot, Laurent; Choussat, Remi; Collet, Jean-Philippe; Helft, Gerard; Montalescot, Gilles; Le Feuvre, Claude

    2015-01-01

    Whether outcomes differ for women and men after percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) remains controversial. To compare 1-year outcomes after primary PCI in women and men with STEMI, matched for age and diabetes. Consecutive women with STEMI of0.05 for all). After exclusion of patients with shock (10.7%) and out-of-hospital cardiac arrest (6.6%), death rates were even more similar (11.3% vs 11.8%; P=0.10). Female sex was not independently associated with death (odds ratio 1.01, 95% confidence interval 0.55-1.87; P=0.97). In our consecutive unselected patient population, women had similar 1-year outcomes to men matched for age and diabetes, after contemporary primary PCI for STEMI, despite having a higher risk profile at baseline. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  11. Bivalirudin versus heparin with or without glycoprotein IIb/IIIa inhibitors in patients with STEMI undergoing primary percutaneous coronary intervention

    DEFF Research Database (Denmark)

    Stone, Gregg W; Mehran, Roxana; Goldstein, Patrick

    2015-01-01

    BACKGROUND: In the HORIZONS-AMI (Harmonizing Outcomes with RevasculariZatiON and Stents in Acute Myocardial Infarction) trial, 3,602 patients undergoing primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) treated with bivalirudin had lower......, given the evolution in primary PCI. METHODS: Databases from HORIZONS-AMI and EUROMAX were pooled for patient-level analysis. The Breslow-Day test evaluated heterogeneity between trials. RESULTS: A total of 5,800 patients were randomized to bivalirudin (n = 2,889) or heparin ± GPI (n = 2,911). The radial....... Bivalirudin resulted in increased acute (events were lower with bivalirudin (8.8% vs. 11.9%; RR: 0.74; 95% CI: 0...

  12. Extension of a Coronary Intramural Hematoma as a Complication of Early Percutaneous Coronary Intervention after Thrombolytic Therapy

    Directory of Open Access Journals (Sweden)

    Mohamed El-Mawardy

    2013-01-01

    Full Text Available The optimal treatment approach for coronary intramural hematomas has not been well defined, and discussion is limited to scarce data. In addition, the impact of prior thrombolytic therapy in the setting of coronary artery dissections with possible development and/or extension of an intramural hematoma is not well understood. We describe a case of iatrogenic periprocedural dissection of the left anterior descending artery (LAD with development of an intramural hematoma and the extension of this hematoma to the left main (LM and left circumflex (LCX arteries in a middle-aged female, where prior recent thrombolytic therapy may have played a role in its triggering or facilitation of its extension. This case highlights the importance of facilitation of bleeding complications by prior use of thrombolytic therapy not only peripherally but intracoronary too and the use of intravascular ultrasound for both diagnosis, followup, and percutaneous coronary intervention (PCI guidance.

  13. Glyburide increases risk in patients with diabetes mellitus after emergent percutaneous intervention for myocardial infarction - A nationwide study

    DEFF Research Database (Denmark)

    Jørgensen, C H; Gislason, G H; Bretler, D

    2011-01-01

    Danish patients receiving glucose-lowering drugs admitted with myocardial infarction between 1997 and 2006 who underwent emergent percutaneous coronary intervention were identified from national registers. Multivariable Cox proportional hazards models were used to analyze the risk of cardiovascular.......9%) received metformin. Cox proportional hazard regression analyses adjusted for age, sex, calendar year, comorbidity and concomitant pharmacotherapy showed an increased risk of cardiovascular mortality (hazard ratio [HR] 2.91, 95% confidence interval [CI] 1.26-6.72 ; p=0.012), cardiovascular mortality...... and nonfatal myocardial infarction (HR 2.69 , 95% CI 1.21-6.00; p=0.016), and all-cause mortality (HR 2.46, 95% CI 1.11-5.47; p=0.027), respectively, with glyburide compared to metformin. CONCLUSIONS: Glyburide is associated with increased cardiovascular mortality and morbidity in patients with diabetes...

  14. High prevalence of ulcer bleeding risk factors in dual antiplatelet-treated patients after percutaneous coronary intervention

    DEFF Research Database (Denmark)

    Jensen, Berit Elin S; Hansen, Jane M; Junker, Anders B

    2015-01-01

    INTRODUCTION: Dual antiplatelet therapy is standard treatment following percutaneous coronary intervention (PCI) and stenting. However, such therapy increases the risk of upper gastrointestinal bleeding (UGIB). The risk factors of UGIB are well-documented and proton pump inhibitor (PPI) treatment...... reduces the risk. The aim was to describe the prevalence of risk factors of UGIB in dual antiplatelet-treated patients. METHODS: A questionnaire was used to assess the prevalence of risk factors of upper gastrointestinal bleeding among dual antiplatelet-treated first-time PCI patients in Western Denmark......: A total of 1,358 patients with a mean age of 64.1 years (range: 33-92 years) were included. The distribution of risk factors was as follows: dyspepsia: 681 patients (50.1%); previous ulcer: 110 (8.1%; 2.3% with bleeding); use of NSAIDs: 214 (15.8%); corticosteroids (2.9%), SSRIs (5.8%) and anticoagulants...

  15. Radiologically assisted percutaneous gastrostomy or enterostomy. A retrospective analysis of 90 procedures

    International Nuclear Information System (INIS)

    Mildenberger, P.; Oberholzer, K.; Kauczor, H.U.; Dueber, C.; Kurz, S.; Schild, H.; Thelen, M.

    1996-01-01

    To analyse retrospectively the indications, technique and results of radiologically induced gastrostomies or enterostomies. Radiologically assisted gastrostomies or enterostomies were induced in 90 patients, mostly with high grade obstructions due to head and neck tumours or oesophageal tumours. 19/90 patients had had previous resection of the oesophagus or gastric operations. A catheter was successfully introduced in all patients. In 11/90 patients this was followed by a two-stage procedure. In 16/90 patients puncture was performed under CT control because of some anatomical peculiarity. Serious complication occurred in 9/90 patients but in only one was surgery necessary. There were no deaths resulting from the procedure but mortality after 30 days was 6.7%. Radiologically assisted gastrostomies or enterostomies are a reliable and effective form of treatment even amongst difficult patients. The results and complications are comparable to those from endoscopic procedures. (orig.) [de

  16. Results of the Croatian Primary Percutaneous Coronary Intervention Network for patients with ST-segment elevation acute myocardial infarction.

    Science.gov (United States)

    Nikolić Heitzler, Vjeran; Babic, Zdravko; Milicic, Davor; Bergovec, Mijo; Raguz, Miroslav; Mirat, Jure; Strozzi, Maja; Plazonic, Zeljko; Giunio, Lovel; Steiner, Robert; Starcevic, Boris; Vukovic, Ivica

    2010-05-01

    The Republic of Croatia, with a gross domestic product per capita of US$11,554 in 2008, is an economically less-developed Western country. The goal of the present investigation was to prove that a well-organized primary percutaneous coronary intervention network in an economically less-developed country equalizes the prospects of all patients with acute ST-segment elevation myocardial infarction at a level comparable to that of more economically developed countries. We prospectively investigated 1,190 patients with acute ST-segment elevation myocardial infarction treated with primary PCI in 8 centers across Croatia (677 nontransferred and 513 transferred). The postprocedural Thrombolysis In Myocardial Infarction flow, in-hospital mortality, and incidence of major adverse cardiovascular events (ie, mortality, pectoral angina, restenosis, reinfarction, coronary artery bypass graft, and cerebrovascular accident rate) during 6 months of follow-up were compared between the nontransferred and transferred subgroups and in the subgroups of older patients, women, and those with cardiogenic shock. In all investigated patients, the average door-to-balloon time was 108 minutes, and the total ischemic time was 265 minutes. Postprocedural Thrombolysis In Myocardial Infarction 3 flow was established in 87.1% of the patients, and the in-hospital mortality rate was 4.4%. No statistically significant difference was found in the results of treatment between the transferred and nontransferred patients overall or in the subgroups of patients >75 years, women, and those with cardiogenic shock. In conclusion, the Croatian Primary Percutaneous Coronary Intervention Network has ensured treatment results of acute ST-segment elevation myocardial infarction comparable to those of randomized studies and registries of more economically developed countries. Copyright 2010 Elsevier Inc. All rights reserved.

  17. Perceived social support following percutaneous coronary intervention is a crucial factor in patients with coronary heart disease.

    Science.gov (United States)

    Kähkönen, Outi; Kankkunen, Päivi; Miettinen, Heikki; Lamidi, Marja-Leena; Saaranen, Terhi

    2017-05-01

    To describe perceived social support among patients with coronary heart disease following percutaneous coronary intervention. A low level of social support is considered a risk factor for coronary heart disease in healthy individuals and reduces the likelihood that people diagnosed with coronary heart disease will have a good prognosis. A descriptive cross-sectional study. A survey of 416 patients was conducted in 2013. A self-report instrument, Social Support of People with Coronary Heart Disease, was used. The instrument comprises three dimensions of social support: informational, emotional, functional supports and 16 background variables. Data were analysed using descriptive statistics, factor analysis, mean sum variables and multivariate logistic regression. Perceived informational support was primarily high, but respondents' risk factors were not at the target level. The weakest items of informational support were advice on physical activity, continuum of care and rehabilitation. Regarding the items of emotional support, support from other cardiac patients was the weakest. The weakest item of functional support was respondents' sense of the healthcare professionals' care of patients coping with their disease. Background variables associated with perceived social support were gender, marital status, level of formal education, profession, physical activity, duration of coronary heart disease and previous myocardial infarction. Healthcare professionals should pay extra attention to women, single patients, physically inactive patients, those demonstrating a lower level of education, those with a longer duration of CHD, and respondents without previous acute myocardial infarction. Continuum of care and counselling are important to ensure especially among them. This study provides evidence that healthcare professionals should be more aware of the individual needs for social support among patients with coronary heart disease after percutaneous coronary intervention

  18. Usefulness and Limitation of Manual Aspiration Immediately After Pneumothorax Complicating Interventional Radiological Procedures with the Transthoracic Approach

    International Nuclear Information System (INIS)

    Yamagami, Takuji; Kato, Takeharu; Hirota, Tatsuya; Yoshimatsu, Rika; Matsumoto, Tomohiro; Nishimura, Tsunehiko

    2006-01-01

    The goal of this study was to evaluate the efficacy of simple aspiration of air from the pleural space to prevent increased pneumothorax and avoid chest tube placement in cases of pneumothorax following interventional radiological procedures performed under computed tomography fluoroscopic guidance with the transthoracic percutaneous approach. While still on the scanner table, 102 cases underwent percutaneous manual aspiration of a moderate or large pneumothorax that had developed during mediastinal, lung, and transthoracic liver biopsies and ablations of lung and hepatic tumors (independent of symptoms). Air was aspirated from the pleural space by an 18- or 20-gauge intravenous catheter attached to a three-way stopcock and 20- or 50-mL syringe. We evaluated the management of each such case during and after manual aspiration. In 87 of the 102 patients (85.3%), the pneumothorax had resolved completely on follow-up chest radiographs without chest tube placement, but chest tube placement was required in 15 patients. Requirement of chest tube insertion significantly increased in parallel with the increased volume of aspirated air. When receiver-operating characteristic curves were applied retrospectively, the optimal cutoff level of aspirated air on which to base a decision to abandon manual aspiration alone and resort to chest tube placement was 670 mL. Percutaneous manual aspiration of the pneumothorax performed immediately after the procedure might prevent progressive pneumothorax and eliminate the need for chest tube placement. However, when the amount of aspirated air is large (such as more than 670 mL), chest tube placement should be considered

  19. Cost-effectiveness of procedures for treatment of ostium secundum atrial septal defects occlusion comparing conventional surgery and septal percutaneous implant.

    Science.gov (United States)

    da Costa, Márcia Gisele Santos; Santos, Marisa da Silva; Sarti, Flávia Mori; Simões e Senna, Kátia Marie; Tura, Bernardo Rangel; Correia, Marcelo Goulart; Goulart, Marcelo Correia

    2014-01-01

    The study performs a cost-effectiveness analysis of procedures for atrial septal defects occlusion, comparing conventional surgery to septal percutaneous implant. A model of analytical decision was structured with symmetric branches to estimate cost-effectiveness ratio between the procedures. The decision tree model was based on evidences gathered through meta-analysis of literature, and validated by a panel of specialists. The lower number of surgical procedures performed for atrial septal defects occlusion at each branch was considered as the effectiveness outcome. Direct medical costs and probabilities for each event were inserted in the model using data available from Brazilian public sector database system and information extracted from the literature review, using micro-costing technique. Sensitivity analysis included price variations of percutaneous implant. The results obtained from the decision model demonstrated that the percutaneous implant was more cost effective in cost-effectiveness analysis at a cost of US$8,936.34 with a reduction in the probability of surgery occurrence in 93% of the cases. Probability of atrial septal communication occlusion and cost of the implant are the determinant factors of cost-effectiveness ratio. The proposal of a decision model seeks to fill a void in the academic literature. The decision model proposed includes the outcomes that present major impact in relation to the overall costs of the procedure. The atrial septal defects occlusion using percutaneous implant reduces the physical and psychological distress to the patients in relation to the conventional surgery, which represent intangible costs in the context of economic evaluation.

  20. Cost-effectiveness of procedures for treatment of ostium secundum atrial septal defects occlusion comparing conventional surgery and septal percutaneous implant.

    Directory of Open Access Journals (Sweden)

    Márcia Gisele Santos da Costa

    Full Text Available OBJECTIVES: The study performs a cost-effectiveness analysis of procedures for atrial septal defects occlusion, comparing conventional surgery to septal percutaneous implant. METHODS: A model of analytical decision was structured with symmetric branches to estimate cost-effectiveness ratio between the procedures. The decision tree model was based on evidences gathered through meta-analysis of literature, and validated by a panel of specialists. The lower number of surgical procedures performed for atrial septal defects occlusion at each branch was considered as the effectiveness outcome. Direct medical costs and probabilities for each event were inserted in the model using data available from Brazilian public sector database system and information extracted from the literature review, using micro-costing technique. Sensitivity analysis included price variations of percutaneous implant. RESULTS: The results obtained from the decision model demonstrated that the percutaneous implant was more cost effective in cost-effectiveness analysis at a cost of US$8,936.34 with a reduction in the probability of surgery occurrence in 93% of the cases. Probability of atrial septal communication occlusion and cost of the implant are the determinant factors of cost-effectiveness ratio. CONCLUSIONS: The proposal of a decision model seeks to fill a void in the academic literature. The decision model proposed includes the outcomes that present major impact in relation to the overall costs of the procedure. The atrial septal defects occlusion using percutaneous implant reduces the physical and psychological distress to the patients in relation to the conventional surgery, which represent intangible costs in the context of economic evaluation.

  1. Interventional procedures of the isolated iliac arterial aneurysm

    Energy Technology Data Exchange (ETDEWEB)

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

    2012-05-15

    To report the results of treatment isolated iliac arterial aneurysms by interventional procedures. Over a period of 5 years, 7 isolated iliac artery aneurysms (4 in the common iliac artery, 3 in the internal iliac artery) in 7 patients (3 women, 4 men; mean age, 65.7 years) were treated using interventional procedures. The mean aneurysm size was 35 mm (range, 30-45 mm). The common iliac aneurysms were treated using a unilateral stent graft (2 balloon expandable, 2 self expandable) with coil embolization of the internal iliac artery (n = 3), except for 1 aneurysm that ruptured. Coil embolization alone was performed for aneurysms involving only the internal iliac artery (n = 3). All patients were treated successfully, except for 1 with an initial remnant of type 2 endoleak. There were no perioperative complications. No leakage or complication occurred at the mean follow up of 14 months (range 2-29 months). One patient with a ruptured aneurysm died of multi organ failure during the follow up period. Three aneurysms had decreased in size on follow up CT. Interventional procedures with stent grafting and coil embolization are safe and effective treatments for isolated iliac artery aneurysms.

  2. Effects of Aromatherapy on the Anxiety, Vital Signs, and Sleep Quality of Percutaneous Coronary Intervention Patients in Intensive Care Units

    Directory of Open Access Journals (Sweden)

    Mi-Yeon Cho

    2013-01-01

    Full Text Available The purpose of this study was to investigate the effects of aromatherapy on the anxiety, sleep, and blood pressure (BP of percutaneous coronary intervention (PCI patients in an intensive care unit (ICU. Fifty-six patients with PCI in ICU were evenly allocated to either the aromatherapy or conventional nursing care. Aromatherapy essential oils were blended with lavender, roman chamomile, and neroli with a 6 : 2 : 0.5 ratio. Participants received 10 times treatment before PCI, and the same essential oils were inhaled another 10 times after PCI. Outcome measures patients' state anxiety, sleeping quality, and BP. An aromatherapy group showed significantly low anxiety (t=5.99, P<.001 and improving sleep quality (t=−3.65, P=.001 compared with conventional nursing intervention. The systolic BP of both groups did not show a significant difference by time or in a group-by-time interaction; however, a significant difference was observed between groups (F=4.63, P=.036. The diastolic BP did not show any significant difference by time or by a group-by-time interaction; however, a significant difference was observed between groups (F=6.93, P=.011. In conclusion, the aromatherapy effectively reduced the anxiety levels and increased the sleep quality of PCI patients admitted to the ICU. Aromatherapy may be used as an independent nursing intervention for reducing the anxiety levels and improving the sleep quality of PCI patients.

  3. Effects of aromatherapy on the anxiety, vital signs, and sleep quality of percutaneous coronary intervention patients in intensive care units.

    Science.gov (United States)

    Cho, Mi-Yeon; Min, Eun Sil; Hur, Myung-Haeng; Lee, Myeong Soo

    2013-01-01

    The purpose of this study was to investigate the effects of aromatherapy on the anxiety, sleep, and blood pressure (BP) of percutaneous coronary intervention (PCI) patients in an intensive care unit (ICU). Fifty-six patients with PCI in ICU were evenly allocated to either the aromatherapy or conventional nursing care. Aromatherapy essential oils were blended with lavender, roman chamomile, and neroli with a 6 : 2 : 0.5 ratio. Participants received 10 times treatment before PCI, and the same essential oils were inhaled another 10 times after PCI. Outcome measures patients' state anxiety, sleeping quality, and BP. An aromatherapy group showed significantly low anxiety (t = 5.99, P < .001) and improving sleep quality (t = -3.65, P = .001) compared with conventional nursing intervention. The systolic BP of both groups did not show a significant difference by time or in a group-by-time interaction; however, a significant difference was observed between groups (F = 4.63, P = .036). The diastolic BP did not show any significant difference by time or by a group-by-time interaction; however, a significant difference was observed between groups (F = 6.93, P = .011). In conclusion, the aromatherapy effectively reduced the anxiety levels and increased the sleep quality of PCI patients admitted to the ICU. Aromatherapy may be used as an independent nursing intervention for reducing the anxiety levels and improving the sleep quality of PCI patients.

  4. Percutaneous ethanol injection under interventional radiographic computed tomography-fluoroscopic guidance for the treatment of small hepatocellular carcinomas

    Energy Technology Data Exchange (ETDEWEB)

    Furuse, Junji; Satake, Mitsuo; Iwasaki, Masahiko; Sekiguchi, Ryuzo; Moriyama, Noriyuki; Yoshino, Masahiro [National Cancer Center, Kashiwa, Chiba (Japan). Hospital East

    1998-04-01

    Some small hepatocellular carcinoma (HCC) lesions show as tumor stains by dynamic CT, but cannot be detected by ultrasonography. Percutaneous ethanol injection (PEI) is effective for treating small HCC lesions, but lack of adequate visualization of some lesions can limit its use. In this study, interventional radiographic, CT-fluoroscopically-guided PEI was performed as a new method for treating small HCC lesions that were difficult to detect by ultrasonography. Interventional radiographic, CT-fluoroscopically-guided PEI was performed on 11 patients (12 lesions) with HCC lesions measuring 2 cm or less in diameter. A thin needle was introduced into each tumor under CT-fluoroscopic guidance, with injection of contrast medium into the dominant hepatic artery. While lesions were observed using CT-fluoroscopy with the arteriogram, absolute ethanol was injected into the tumors. The ethanol injection rate and volume were monitored by observation of loss of tumor staining during real-time CT angiography. Needle introduction was successful in all 12 lesions, and disappearance of tumor staining was immediately observed on CT images after ethanol injection. Complications noted after treatment were local abdominal pain in all 11 patients, a slight fever in 9 patients, pneumothorax, right pleural effusion, and ascites, each in 1 patient. No other serious complications were observed. Interventional radiographic, CT-fluoroscopically-guided PEI is effective in the treatment of small HCC lesions, which are difficult to show by ultrasonography and treat by conventional PEI. (author)

  5. The study protocol for a non-randomized controlled clinical trial using a genotype-guided strategy in a dataset of patients who undergone percutaneous coronary intervention with stent

    Directory of Open Access Journals (Sweden)

    Cristina Lucía Dávila-Fajardo

    2017-02-01

    Full Text Available This article contains data related to the research article entitled “Results of genotype–guided antiplatelet therapy in patients undergone percutaneous coronary intervention with stent” (J. Sánchez-Ramos, C.L. Dávila-Fajardo, P. Toledo Frías, X. Díaz Villamarín, L.J. Martínez-González, S. Martínez Huertas, F. Burillo Gómez, J. Caballero Borrego, A. Bautista Pavés, M.C. Marín Guzmán, J.A. Ramirez Hernández, C. Correa Vilches, J. Cabeza Barrera, 2016 (1. This data article reports, for the first time, about the non-randomized clinical trial protocol that check if CYP2C19/ABCB1 genotype–guided strategy in which the choice of antiplatelet therapy is based on the genetic test, reduces the rates of cardiovascular events and bleeding compared to a non-tailored strategy in patients undergone percutaneous coronary intervention (PCI with stent. The data included in this article are: design and setting of the study, study population, inclusion and exclusion criteria, definition of the intervention, objectives, variables (baseline characteristics and during the follow-up, study procedures, collection and treatment of the biological sample, genotyping, withdrawal criteria, sample size, statistic analysis, ethical aspects, information sheet and consent form. The authors confirm that this study has been registered in Eudra CT (Eudra CT: 2016-001294-33.

  6. Patient and staff doses in fluoroscopically guided invasive diagnostic and interventional urology procedures

    International Nuclear Information System (INIS)

    Ivanova, D.; Hristova-Popova, J.; Avramova-Cholakova, S.; Deyanova, Ts.; Dobrikov, R.

    2015-01-01

    Full text: The aim of this study is to evaluate patient and staff doses in fluoroscopically guided invasive diagnostic and interventional urology procedures. All the data were collected in the Emergency Hospital 'N. I. Pirogov'. While recording data for the patients, a real time dosimetry measurement of the medical staff was made. Air kerma-area product (KAP) was recorded for intravenous pyelogram (IVP), percutaneous nephrostomy (PN) and ureteral 'double-J' stenting. Patient data sex, age and weight were also taken. Staff doses were estimated with the system RaySafe i2. It contains four dosimeters, with a wireless connection to a real time display. The dosimeters were worn on the unprotected upper part of the body and measured the personal dose equivalent Hp(10). The mean KAP values for the procedures are: 3.21 Gy.cm 2 for IVP, 10.37 Gy.cm 2 for PN and 4.15 Gy.cm 2 for 'double-J' respectively. The highest staff dose for PN and 'double-J' is received by the urologist (160 μSv and 47.3 μSv, respectively), while for the IVP the radiographer has the highest exposure (20 μSv). Each member of the medical staff was on a different position in respect to the X-ray tube and the patient, which is the main reason for the differences in the staff doses. The variations in the mean patient and staff doses are mostly due to the interventions themselves, their complexity and the individual treatment of every patient. RaySafe i2 is very useful as guideline for making a choice of a better position and in the decreasing of radiation exposure to the staff

  7. A Comparison of Transjugular and Plugged-Percutaneous Liver Biopsy in Patients with Contraindications to Ordinary Percutaneous Liver Biopsy and an 'In-House' Protocol for Selecting the Procedure of Choice

    International Nuclear Information System (INIS)

    Atar, Eli; Ben Ari, Ziv; Bachar, Gil N.; Amlinski, Yelena; Neyman, Chaim; Knizhnik, Michael; Litvin, Sergey; Schmilovitz-Weiss, Hemda; Shapiro, Riki; Bruckhaimer, Elchanan; Tur-Kaspa, Ran; Belenky, Alexander

    2010-01-01

    The purpose of this study was to evaluate the effectiveness and safety of transjugular liver biopsy (TJLB) and plugged-percutaneous liver biopsy (PB) in consecutive patients with severe liver disease associated with impaired coagulation, ascites, or both and to verify the in-house protocol used to select the appropriate procedure. In 2000-2006, 329 patients (208 male [62.8%] and 121 female [37.2%]), aged 1 month to 81 years (mean, 46.8 years), underwent 150 TJLBs (39.1%) or 233 PBs (60.9%) procedures at a major tertiary center, as determined by an in-house protocol. The groups were compared for specimen characteristics, technical success, and complications. Technical success rates were 97.4% for TJLB (146/150) and 99.1% for PB (231/233). TJLB was associated with a lower average core length (1.29 vs. 1.43 cm) and lower average number of specimens obtained (2.44 vs. 2.8), but both methods yielded sufficient tissue for a definitive diagnosis. There were no major complications in either group. TJLB and PB can be safely and effectively performed for the diagnosis of hepatic disease in patients with contraindications for standard percutaneous liver biopsy. When both are technically available, we suggest PB as the procedure of choice, especially in transplanted livers.

  8. A comparison of transjugular and plugged-percutaneous liver biopsy in patients with contraindications to ordinary percutaneous liver biopsy and an "in-house" protocol for selecting the procedure of choice.

    Science.gov (United States)

    Atar, Eli; Ben Ari, Ziv; Bachar, Gil N; Amlinski, Yelena; Neyman, Chaim; Knizhnik, Michael; Litvin, Sergey; Schmilovitz-Weiss, Hemda; Shapiro, Riki; Bruckhaimer, Elchanan; Tur-Kaspa, Ran; Belenky, Alexander

    2010-06-01

    The purpose of this study was to evaluate the effectiveness and safety of transjugular liver biopsy (TJLB) and plugged-percutaneous liver biopsy (PB) in consecutive patients with severe liver disease associated with impaired coagulation, ascites, or both and to verify the in-house protocol used to select the appropriate procedure. In 2000-2006, 329 patients (208 male [62.8%] and 121 female [37.2%]), aged 1 month to 81 years (mean, 46.8 years), underwent 150 TJLBs (39.1%) or 233 PBs (60.9%) procedures at a major tertiary center, as determined by an in-house protocol. The groups were compared for specimen characteristics, technical success, and complications. Technical success rates were 97.4% for TJLB (146/150) and 99.1% for PB (231/233). TJLB was associated with a lower average core length (1.29 vs. 1.43 cm) and lower average number of specimens obtained (2.44 vs. 2.8), but both methods yielded sufficient tissue for a definitive diagnosis. There were no major complications in either group. TJLB and PB can be safely and effectively performed for the diagnosis of hepatic disease in patients with contraindications for standard percutaneous liver biopsy. When both are technically available, we suggest PB as the procedure of choice, especially in transplanted livers.

  9. Long-Term Follow-Up of Patients after Percutaneous Coronary Intervention with Everolimus-Eluting Bioresorbable Vascular Scaffold.

    Science.gov (United States)

    Meneguz-Moreno, Rafael Alexandre; Costa, José de Ribamar; Moscoso, Freddy Antônio Britto; Staico, Rodolfo; Tanajura, Luiz Fernando Leite; Centemero, Marinella Patrizia; Chaves, Auréa Jacob; Abizaid, Andrea Claudia Leão de Sousa; Sousa, Amanda Guerra de Moraes Rego E; Abizaid, Alexandre Antonio Cunha

    2017-02-01

    Bioresorbable vascular scaffolds (BVS) were developed to improve the long-term results of percutaneous coronary intervention, restoring vasomotion. To report very late follow-up of everolimus-eluting Absorb BVS (Abbott Vascular, Santa Clara, USA) in our center. Observational retrospective study, in a single Brazilian center, from August 2011 to October 2013, including 49 patients submitted to Absorb BVS implantation. Safety and efficacy outcomes were analyzed in the in-hospital and very late follow-up phases (> 2 years). All 49 patients underwent a minimum follow-up of 2.5 years and a maximum of 4.6 years. Mean age was 56.8 ± 7.6 years, 71.4% of the patients were men, and 26.5% were diabetic. Regarding clinical presentation, the majority (94%) had stable angina or silent ischemia. Device success was achieved in 100% of cases with 96% overall procedure success rate. Major adverse cardiovascular events rate was 4% at 30 days, 8.2% at 1 year, and 12.2% at 2 years, and there were no more events until 4.6 years. There were 2 cases of thrombosis (1 subacute and 1 late). In this preliminary analysis, Absorb BVS showed to be a safe and effective device in the very late follow-up. Establishing the efficacy and safety profiles of these devices in more complex scenarios is necessary. Os suportes vasculares bioabsorvíveis (SVB) foram desenvolvidos com o intuito de melhorar os resultados da intervenção coronária percutânea a longo prazo, restabelecendo-se a vasomotricidade. Reportar o seguimento muito tardio do implante do SVB eluidor de everolimus Absorb® (Abbot Vascular, Santa Clara, EUA) em nosso centro. Estudo observacional, retrospectivo, em um único centro brasileiro, que incluiu 49 pacientes submetidos ao implante do SVB Absorb® entre agosto/2011 e outubro/2013. Foram analisados os desfechos de segurança e eficácia na fase hospitalar e bastante tardia (> 2 anos). Todos os 49 pacientes completaram um seguimento mínimo de 2,5 anos, sendo o máximo de 4,6 anos

  10. Referral to Cardiac Rehabilitation After Percutaneous Coronary Intervention, Coronary Artery Bypass Surgery, and Valve Surgery: Data From the Clinical Outcomes Assessment Program.

    Science.gov (United States)

    Beatty, Alexis L; Bradley, Steven M; Maynard, Charles; McCabe, James M

    2017-06-01

    Despite guideline recommendations that patients undergoing percutaneous coronary intervention (PCI), coronary artery bypass surgery, or valve surgery be referred to cardiac rehabilitation, cardiac rehabilitation is underused. The objective of this study was to examine hospital-level variation in cardiac rehabilitation referral after PCI, coronary artery bypass surgery, and valve surgery. We analyzed data from the Clinical Outcomes Assessment Program, a registry of all nonfederal hospitals performing PCI and cardiac surgery in Washington State. We included eligible PCI, coronary artery bypass surgery, and valve surgery patients from 2010 to 2015. We analyzed PCI and cardiac surgery separately by performing multivariable hierarchical logistic regression for the outcome of cardiac rehabilitation referral at discharge, clustered by hospital. Patient-level covariates included age, sex, race/ethnicity, comorbidities, and procedure indication/status. Cardiac rehabilitation referral was reported in 48% (34 047/71 556) of PCI patients and 91% (21 831/23 972) of cardiac surgery patients. The hospital performing the procedure was a stronger predictor of referral than any individual patient characteristic for PCI (hospital referral range 3%-97%; median odds ratio, 5.94; 95% confidence interval, 4.10-9.49) and cardiac surgery (range 54%-100%; median odds ratio, 7.09; 95% confidence interval, 3.79-17.80). Hospitals having an outpatient cardiac rehabilitation program explained only 10% of PCI variation and 0% of cardiac surgery variation. Cardiac rehabilitation referral at discharge was less prevalent after PCI than cardiac surgery. The strongest predictor of cardiac rehabilitation referral was the hospital performing the procedure. Efforts to improve cardiac rehabilitation referral should focus on increasing referral after PCI, especially in low referral hospitals. © 2017 American Heart Association, Inc.

  11. Percutaneous management of staghorn renal calculi

    International Nuclear Information System (INIS)

    Lee, Won Jay

    1989-01-01

    During a four year period, ending May 1987, 154 cases of symptomatic staghorn calculi have been treated by percutaneous nephrolithotomy. Of these patients,86% were discharged completely stone free with the remainder having fragments less than 5 mm in greatest diameter. More than one operative procedure during the same hospitalizations was required in 24% of patients and multiple percutaneous tracts were established in excess of 73% of them. Significant complications occurred in 16% of patients and there was one death. Most complications can be generally by minimized by careful approach and manageable by interventional radiological means. The management of patients with staghorn calculi requires a comprehensive understanding of the renal anatomy, selection of appropriate percutaneous nephrostomy tract sites, and radiologic-urologic expertise needed to remove the large stone mass. The advent of extracorporeal shock wave lithotripsy will not abolish the need for nephrolithotomy, particularly complex stones such as staghorn calculi

  12. Assessment of patients' skin dose during interventional cardiology procedures

    International Nuclear Information System (INIS)

    Tsapaki, V.; Vardalaki, E.; Kottou, S.; Molfetas, M.; Neofotistou, V.

    2002-01-01

    During the last 30 years the use of Interventional Cardiology (IC) procedures has increased significantly, mainly due to the benefits and advantages of the method that offers more accurate diagnosis and treatment along with less complications and hospitalization. However, IC procedures are based on the use of x-ray radiation, mostly localized at certain areas of patient's body and for extended periods of time. Consequently, patient may receive high radiation dose and deterministic effects, such as erythema, epilation or even dermal necrosis may be observed. Therefore, the need for reducing radiation dose is highly important. In order to achieve this, good knowledge of the dose levels delivered to the patient during IC procedures is essential since radiation effects are known to increase with dose. It is of great interest to know the point where the maximum skin dose (MSD) is noted since individual sensitivity may vary. MSDs greater than 1 Gy should be recorded. Patient dosimetry during IC procedures is a complex task since these type of procedures depend on various factors, such as complexity and severity of case, different specifications of x-ray equipment and patient's physical characteristics. Moreover, cardiologist's experience plays an important role. For these reasons, Food and Drug Administration (FDA), the International Commission on Radiological Protection (ICRP) as well as the World Health Organization (WHO), have published documents on radiation safety and ways to reduce skin injuries during IC procedures. Various methods have been proposed for measuring MSD such as the use of slow radiotherapy films, thermoluminescent detectors (TLD), scintillation detectors, Dose-Area Product (DAP) meter, as well as a combination of DAP and air kerma. A literature review on MSDs measured during IC procedures showed that doses ranged from 300 to 43000 mGy

  13. Percutaneous cholecystostomy

    International Nuclear Information System (INIS)

    Akhan, Okan; Akinci, Devrim; Oezmen, Mustafa N.

    2002-01-01

    Percutaneous cholecystostomy (PC), a technique that consists of percutaneous catheter placement in the gallbladder lumen under imaging guidance, has become an alternative to surgical cholecystostomy in recent years. Indications of PC include calculous or acalculous cholecystitis, cholangitis, biliary obstruction and opacification of biliary ducts. It also provides a potential route for stone dissolution therapy and stone extraction. Under aseptic conditions and ultrasound guidance, using local anesthesia, the procedure is carried out by using either modified Seldinger technique or trocar technique. Transhepatic or transperitoneal puncture can be performed as an access route. Several days after the procedure transcatheter cholangiography is performed to assess the patency of cystic duct, presence of gallstones and catheter position. The tract is considered mature in the absence of leakage to the peritoneal cavity, subhepatic, subcapsular, or subdiaphragmatic spaces. Response rates to PC in the literature are between the range of 56-100% as the variation of different patient population. Complications associated with PC usually occur immediately or within days and include haemorrhage, vagal reactions, sepsis, bile peritonitis, pneumothorax, perforation of the intestinal loop, secondary infection or colonisation of the gallbladder and catheter dislodgment. Late complications have been reported as catheter dislodgment and recurrent cholecystitis. PC under ultrasonographic guidance is a cost-effective, easy to perform and reliable procedure with low complication and high success rates for critically ill patients with acute cholecystitis. It is generally followed by elective cholecystectomy, if possible. However, it may be definitive treatment, especially in acalculous cholecystitis

  14. Percutaneous cholecystostomy

    Energy Technology Data Exchange (ETDEWEB)

    Akhan, Okan E-mail: akhano@tr.net; Akinci, Devrim; Oezmen, Mustafa N

    2002-09-01

    Percutaneous cholecystostomy (PC), a technique that consists of percutaneous catheter placement in the gallbladder lumen under imaging guidance, has become an alternative to surgical cholecystostomy in recent years. Indications of PC include calculous or acalculous cholecystitis, cholangitis, biliary obstruction and opacification of biliary ducts. It also provides a potential route for stone dissolution therapy and stone extraction. Under aseptic conditions and ultrasound guidance, using local anesthesia, the procedure is carried out by using either modified Seldinger technique or trocar technique. Transhepatic or transperitoneal puncture can be performed as an access route. Several days after the procedure transcatheter cholangiography is performed to assess the patency of cystic duct, presence of gallstones and catheter position. The tract is considered mature in the absence of leakage to the peritoneal cavity, subhepatic, subcapsular, or subdiaphragmatic spaces. Response rates to PC in the literature are between the range of 56-100% as the variation of different patient population. Complications associated with PC usually occur immediately or within days and include haemorrhage, vagal reactions, sepsis, bile peritonitis, pneumothorax, perforation of the intestinal loop, secondary infection or colonisation of the gallbladder and catheter dislodgment. Late complications have been reported as catheter dislodgment and recurrent cholecystitis. PC under ultrasonographic guidance is a cost-effective, easy to perform and reliable procedure with low complication and high success rates for critically ill patients with acute cholecystitis. It is generally followed by elective cholecystectomy, if possible. However, it may be definitive treatment, especially in acalculous cholecystitis.

  15. Safety of combination therapy with milrinone and esmolol for heart protection during percutaneous coronary intervention in acute myocardial infarction.

    Science.gov (United States)

    Poh, Kian-Keong; Xu, Xin; Chan, Mark Y; Lee, Chi-Hang; Tay, Edgar L; Low, Adrian F; Chan, Koo Hui; Sia, Winnie; Tang, Liang-Qiu; Tan, Huay Cheem; Lui, Charles Y; Nguyen, Vincent; Fujise, Kenichi; Huang, Ming-He

    2014-05-01

    Ischemia/reperfusion injury remains an untreated clinical problem in patients with acute myocardial infarction (AMI) despite significant advances in emergent revascularization through percutaneous coronary intervention (PCI). Pharmacological intervention for infarct size reduction is unavailable. We have identified that the medications milrinone and esmolol, when administered together at the beginning of the reperfusion, significantly decrease infarct size via reducing reperfusion injury in an experimental model. The present study tested the safety of combination therapy of milrinone and esmolol (M + E) in patients with AMI. Sixteen subjects with AMI requiring PCI were consecutively recruited. M + E was intravenously infused simultaneously for 10 min started at 5 min before anticipated angioplasty balloon inflation. Another 16 consecutively recruited AMI patients requiring PCI served as a placebo arm treated per routine clinical protocol. Blood pressure (BP) and heart rate (HR) were monitored continuously during PCI. M + E combination therapy resulted in a trend of non-significant reduction in BP compared with a control group. There was a modest but significant increase in HR at the later phase of M + E infusion compared with a control group. No significant cardiac arrhythmia was induced during M + E infusion. The combination therapy with M + E produces a minimal change in hemodynamics and appears safe as an adjunctive therapy to PCI in AMI patients. Further studies are warranted.

  16. Motivation is a crucial factor for adherence to a healthy lifestyle among people with coronary heart disease after percutaneous coronary intervention.

    Science.gov (United States)

    Kähkönen, Outi; Kankkunen, Päivi; Saaranen, Terhi; Miettinen, Heikki; Kyngäs, Helvi; Lamidi, Marja-Leena

    2015-10-01

    To test the Theory of Adherence of People with Chronic Disease with regard to adherence to treatment among patients with coronary heart disease after a percutaneous coronary intervention. Increased knowledge of the concept of adherence is needed for the development of nursing interventions and nursing guidelines for patients with coronary heart disease. A cross-sectional, multi-centre study. This study was conducted from February-December 2013 with 416 patients with coronary heart disease 4 months after undergoing a percutaneous coronary intervention. A self-reported questionnaire was used to assess their adherence to treatment. Data were analysed using structural equation modelling. The theory explained 45% of the adherence to a healthy lifestyle and 7% of the adherence to medication. Structural equation modelling confirmed that motivation and results of care had the highest association with adherence to a healthy lifestyle. Responsibility was associated with adherence to medication. Support from next of kin, support from nurses and physicians, and motivation, co-operation, fear of complications and a sense of normality were associated with adherence. Patients who are motivated to perform self-care and consider the results of care to be important were more likely to adhere to a healthy lifestyle. Responsible patients were more likely to adhere to their medication. It is important to account for these elements as a part of secondary prevention strategies among patients with coronary heart disease after a percutaneous coronary intervention. © 2015 John Wiley & Sons Ltd.

  17. Fundamental study on the characteristics of a radiophotoluminescence glass dosemeter with no energy compensation filter for measuring patient entrance doses in cardiac interventional procedures

    International Nuclear Information System (INIS)

    Kato, Mamoru; Chida, Koichi; Moritake, Takashi; Koguchi, Yasuhiro; Sato, Tadaya; Kadowaki, Ken; Oosaka, Hajime; Tosa, Tetsuo

    2014-01-01

    Cardiac interventional procedures have been increasing year by year. However, radiation skin injuries have been still reported. There is a necessity to measure the patient entrance skin dose (ESD), but an accurate dose measurement method has not been established. To measure the ESD, a lot of radiophotoluminescence dosemeters (RPLDs) provide an accurate measurement of the direct actual ESD at the points they are arrayed. The purpose of this study was to examine the characteristics of RPLD to measure the ESD. As a result, X-ray permeable RPLD (with no tin filter) did not interfere with the percutaneous coronary intervention procedure. The RPLD also had good fundamental performance characteristics. Although the RPLD had a little energy dependence, it showed excellent dose and dose-rate linearity, and good angular dependence. In conclusion, by calibrating the energy dependence, RPLDs are useful dosemeter to measure the ESD in cardiac intervention. (authors)

  18. Entrance surface dose in cerebral interventional radiology procedures

    International Nuclear Information System (INIS)

    Barrera-Rico, M.; López-Rendón, X.; Rivera-Ordóñez, C. E.; Gamboa-deBuen, I.

    2012-01-01

    At the Instituto Nacional de Neurología y Neurocirugía (INNN) diagnostic as well as therapeutic procedures of interventional radiology are carried out. Since the procedures can last from some minutes to several hours, the absorbed dose for the patient could increase dangerously. An investigation had begun in order to determine the entrance surface dose (ESD) using 25 thermoluminiscent dosimeters TLD-100 and 8 strips of 15 ×1 cm 2 of Gafchromic XR-QA2 film bound in a holder of 15×15 cm 2 in the posteroanterior (PA) and lateral (LAT) positions during all the procedure. The results show that maximum ESD could be from 0.9 to 2.9 Gy for the PA position and between 1.6 and 2.5 Gy for the lateral position. The average ESD was between 0.7 and 1.3 Gy for the PA position, and from 0.44 to 1.1 Gy for the lateral position in a therapeutic procedure.

  19. Entrance surface dose in cerebral interventional radiology procedures

    Energy Technology Data Exchange (ETDEWEB)

    Barrera-Rico, M.; Lopez-Rendon, X.; Rivera-Ordonez, C. E.; Gamboa-deBuen, I. [Instituto de Ciencias Nucleares, Universidad Nacional Autonoma de Mexico, 04510 DF (Mexico); Instituto Nacional de Neurologia y Neurocirugia Manuel Velasco Suarez, 14269 DF (Mexico); Instituto de Ciencias Nucleares, Universidad Nacional Autonoma de Mexico, 04510 DF (Mexico)

    2012-10-23

    At the Instituto Nacional de Neurologia y Neurocirugia (INNN) diagnostic as well as therapeutic procedures of interventional radiology are carried out. Since the procedures can last from some minutes to several hours, the absorbed dose for the patient could increase dangerously. An investigation had begun in order to determine the entrance surface dose (ESD) using 25 thermoluminiscent dosimeters TLD-100 and 8 strips of 15 Multiplication-Sign 1 cm{sup 2} of Gafchromic XR-QA2 film bound in a holder of 15 Multiplication-Sign 15 cm{sup 2} in the posteroanterior (PA) and lateral (LAT) positions during all the procedure. The results show that maximum ESD could be from 0.9 to 2.9 Gy for the PA position and between 1.6 and 2.5 Gy for the lateral position. The average ESD was between 0.7 and 1.3 Gy for the PA position, and from 0.44 to 1.1 Gy for the lateral position in a therapeutic procedure.

  20. New innovations in interventional cardiac procedures - role of ...

    African Journals Online (AJOL)

    percutaneous closure of the left atrial appendage as well as closure of a patent foramen ovale are usually performed without the help of anaesthesiologists and will therefore not be discussed furthermore. The transapical NeoChord DS 1000 system (NeoChord Inc,. USA) is a new treatment option for patients with severe.

  1. Fractional flow reserve versus angiography for guiding percutaneous coronary intervention in patients with multivessel coronary artery disease: 2-year follow-up of the FAME (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation) study

    DEFF Research Database (Denmark)

    Pijls, Nico H J; Fearon, William F; Tonino, Pim A L

    2010-01-01

    The purpose of this study was to investigate the 2-year outcome of percutaneous coronary intervention (PCI) guided by fractional flow reserve (FFR) in patients with multivessel coronary artery disease (CAD)....

  2. An open-label, randomized, controlled, multicenter study exploring two treatment strategies of rivaroxaban and a dose-adjusted oral vitamin K antagonist treatment strategy in subjects with atrial fibrillation who undergo percutaneous coronary intervention (PIONEER AF-PCI)

    NARCIS (Netherlands)

    Gibson, C.M.; Mehran, R.; Bode, C.; Halperin, J.; Verheugt, F.W.A.; Wildgoose, P.; Eickels, M. van; Lip, G.Y.; Cohen, M.; Husted, S.; Peterson, E.; Fox, K.

    2015-01-01

    BACKGROUND: Guidelines recommendations regarding anticoagulant therapy after percutaneous coronary intervention (PCI) among patients with atrial fibrillation (AF) rely on retrospective, nonrandomized observational data. Currently, patients are treated with triple-therapy (dual antiplatelet therapy

  3. Asymptomatic acute ischemic stroke after primary percutaneous coronary intervention in patients with acute coronary syndrome might be caused mainly by manipulating catheters or devices in the ascending aorta, regardless of the approach to the coronary artery

    International Nuclear Information System (INIS)

    Murai, Motonobu; Hazui, Hiroshi; Sugie, Akira

    2007-01-01

    Asymptomatic acute ischemic stroke (aAIS) following primary percutaneous coronary intervention (p-PCI) in patients with acute coronary syndrome (ACS) has not been studied in detail. Of 75 patients who underwent p-PCI, 26 (34.7%) developed aAIS as determined by diffusion-weighted magnetic resonance imaging (MRI). Including the approach to the coronary artery (via lower limb or right upper limb), 23 factors were compared between patients with (n=26) and without (n=49) aAIS. Age, hypertension, smoking, plasma glucose levels, Killip grade, right coronary artery (RCA) as culprit vessel, percutaneous coronary intervention (PCI) time, and the frequency of device insertion into the coronary artery differed in a statistically significant manner. However, multivariate analysis showed that the RCA (odds ratio 3.477) and the frequency of device insertion (1.375) were independent factors linked to the incidence of aAIS. Moreover, anterior or posterior location and left or right cerebral circulation of aAIS were equivalent in both approaches. Cranial MRI images following emergency PCI revealed that 34.7% of the patients with ACS had aAIS that might be caused by manipulating the catheter or devices in the ascending aorta, micro-air bubble embolism during injection, or micro-thrombus embolism derived from the ACS lesions during the PCI procedure. (author)

  4. Renoprotective effect of remote ischemic postconditioning in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention

    Directory of Open Access Journals (Sweden)

    Cao B

    2018-02-01

    Full Text Available Bangming Cao,* Chi Zhang,* Haipeng Wang, Ming Xia, Xiangjun Yang Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People’s Republic of China *These authors contributed equally to this work Background: Whether upper arm remote ischemic postconditioning (RIPostC exerts protection to kidney in patients with ST-elevation myocardial infarction (STEMI undergoing primary percutaneous coronary intervention (PPCI remains unknown. Methods: Sixty-four patients with STEMI were randomized to PPCI + RIPostC (n=29 and PPCI (n=35 groups. RIPostC consisting of 4 cycles of 5 minutes occlusion/reperfusion by cuff inflation/deflation of the upper arm was started within 1 minute after the first balloon dilatation. Peripheral venous blood samples were collected before PPCI and at 0.5, 8, 24, 48, and 72 hours after PPCI to detect serum creatinine (SCr and creatine kinase-MB (CK-MB. Acute kidney injury (AKI rate and estimated glomerular filtration rate (eGFR were calculated. The transthoracic echocardiography was performed 7 days after PPCI to assess left ventricular ejection fraction (LVEF. Results: The patients in the PPCI + RIPostC group had a lower AKI rate compared with those in the PPCI group (P=0.04. The eGFR after PPCI increased in the PPCI + RIPostC group compared to the PPCI group (P<0.01. The peak of CK-MB concentration in the PPCI + RIPostC group was significantly lower than that in the PPCI group (P<0.01. The area under the curve of CK-MB decreased in the PPCI + RIPostC group compared with that in the PPCI group. LVEF in the PPCI + RIPostC group was significantly higher than that in the PPCI group (P=0.04. Conclusion: Upper arm RIPostC exerts renal and cardiac protection following cardiac ischemia–reperfusion in patients with STEMI. Keywords: myocardial ischemia reperfusion, ST-segmental elevation myocardial infarction, primary percutaneous coronary intervention, remote ischemic postconditioning

  5. 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

  6. 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

  7. Guidewire and microcatheter utilization patterns during antegrade wire escalation in chronic total occlusion percutaneous coronary intervention: Insights from a contemporary multicenter registry.

    Science.gov (United States)

    Karatasakis, Aris; Tarar, Muhammad Nauman J; Karmpaliotis, Dimitri; Alaswad, Khaldoon; Yeh, Robert W; Jaffer, Farouc A; Wyman, R Michael; Lombardi, William L; Grantham, J Aaron; Kandzari, David E; Lembo, Nicholas J; Moses, Jeffrey W; Kirtane, Ajay J; Parikh, Manish; Garcia, Santiago; Doing, Anthony; Pershad, Ashish; Shah, Alpesh; Patel, Mitul; Bahadorani, John; Shoultz, Charles A; Danek, Barbara A; Thompson, Craig A; Banerjee, Subhash; Brilakis, Emmanouil S

    2017-03-01

    We sought to describe contemporary guidewire and microcatheter utilization for antegrade wire escalation (AWE) during chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Equipment utilization for AWE has been variable and evolving over time. We examined device utilization during 694 AWE attempts in 679 patients performed at 15 experienced US centers between May 2012 and April 2015. Mean age was 65.6 ± 9.7 years, and 85% of the patients were men. Successful wiring occurred in 436 AWE attempts (63%). Final technical and procedural success was 91% and 89%, respectively. The mean number of guidewire types used for AWE was 2.2 ± 1.4. The most frequently used guidewire types were the Pilot 200 (Abbott Vascular, 56% of AWE procedures), Fielder XT (Asahi Intecc, 45%), and the Confianza Pro 12 (Asahi Intecc, 28%). The same guidewires were the ones that most commonly crossed the occlusion: Pilot 200 (36% of successful AWE crossings), Fielder XT (20%), and Confianza Pro 12 (11%). A microcatheter or over-the-wire balloon was used for 81% of AWE attempts; the Corsair microcatheter (Asahi Intecc) was the most commonly used (44%). No significant association was found between guidewire type and incidence of major adverse cardiac events (MACE). Our contemporary, multicenter CTO PCI registry demonstrates that the most commonly used wires for AWE are polymer-jacketed guidewires. "Stiff" and polymer-jacketed guidewires appear to provide high crossing rates without an increase in MACE or perforation, and may thus be considered for upfront use. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  8. Comparison of Safety and Effectiveness Between Right Versus Left Radial Arterial Access in Primary Percutaneous Coronary Intervention for Acute ST Segment Elevation Myocardial Infarction.

    Science.gov (United States)

    Elmahdy, Mahmoud Farouk; ElMaghawry, Mohamed; Hassan, Mohamed; Kassem, Hussien Heshmat; Said, Karim; Elfaramawy, Amr AbdelAziz

    2017-01-01

    Transradial approach (TRA) is now considered the standard of care in many centres for elective and primary percutaneous intervention (PCI). The use of the radial approach in ST segment elevation myocardial infarction (STEMI) patients has been associated with a significant reduction in major adverse cardiac events. However, it is still unclear if the side of radial access (right vs. left) has impact on safety and effectiveness of TRA in primary PCI. So this study was conducted to compare the safety, feasibility, and outcomes of right radial access (RRA) vs. left radial access (LRA) in the setting of primary PCI. We retrospectively analysed the data of 400 consecutive patients presenting to our institution with STEMI for whom primary PCIs were performed via RRA and LRA. Mean age of the whole studied population was 57±12.8 years, with male predominance (77.2%). There were 202 cases in the RRA group and 198 in the LRA group, with no significant difference in demographics and clinical characteristics for patients included in both groups. There was no significant difference in procedure success rate (97.5% for RRA vs. 98.4% for LRA; P=0.77). In addition, no significant difference between both approaches was observed in the contrast volume, number of catheters, fluoroscopy time (FT), needle-to-balloon time, post-procedure vascular complications, in hospital reinfarction, stroke/transient ischaemic attack (TIA) or death. Right radial access and LRA are equally safe and effective in the setting of primary PCI. Both approaches have a high success rate and comparable needle-to-balloon time. Copyright © 2016 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

  9. Optical coherence tomography following percutaneous coronary intervention with Excimer laser coronary atherectomy

    Energy Technology Data Exchange (ETDEWEB)

    Rawlins, John, E-mail: john.rawlins@doctors.net.uk; Talwar, Suneel; Green, Mark; O’Kane, Peter

    2014-01-15

    The indications for Excimer laser coronary atherectomy (ELCA) have been refined in modern interventional practice. With the expanding role for optical coherence tomography (OCT) providing high-resolution intra-coronary imaging, this article examines the appearance of the coronary lumen after ELCA. Each indication for ELCA is discussed and illustrated with a clinical case, followed by detailed analysis of the OCT imaging pre and post ELCA. The aim of the article is to provide information to interventional cardiologists to facilitate decision making during PCI, when ELCA has been used as part of the interventional strategy.

  10. Comparative efficacy and safety of the left versus right radial approach for percutaneous coronary procedures: a meta-analysis including 6870 patients

    Directory of Open Access Journals (Sweden)

    S.L. Xia

    2015-08-01

    Full Text Available The radial approach is widely used in the treatment of patients with coronary artery disease. We conducted a meta-analysis of published results on the efficacy and safety of the left and right radial approaches in patients undergoing percutaneous coronary procedures. A systematic search of reference databases was conducted, and data from 14 randomized controlled trials involving 6870 participants were analyzed. The left radial approach was associated with significant reductions in fluoroscopy time [standardized mean difference (SMD=-0.14, 95% confidence interval (CI=-0.19 to -0.09; P<0.00001] and contrast volume (SMD=-0.07, 95%CI=-0.12 to -0.02; P=0.009. There were no significant differences in rate of procedural failure of the left and the right radial approaches [risk ratios (RR=0.98; 95%CI=0.77-1.25; P=0.88] or procedural time (SMD=-0.05, 95%CI=0.17-0.06; P=0.38. Tortuosity of the subclavian artery (RR=0.27, 95%CI=0.14-0.50; P<0.0001 was reported more frequently with the right radial approach. A greater number of catheters were used with the left than with the right radial approach (SMD=0.25, 95%CI=0.04-0.46; P=0.02. We conclude that the left radial approach is as safe as the right radial approach, and that the left radial approach should be recommended for use in percutaneous coronary procedures, especially in percutaneous coronary angiograms.

  11. Percutaneous BioOrganic Sealing of Duodenal Fistulas: Case Report and Review of Biological Sealants with Potential Use in Interventional Radiology

    Energy Technology Data Exchange (ETDEWEB)

    Wadhwa, Vibhor, E-mail: vwadhwa1@jhmi.edu [Johns Hopkins University School of Medicine, Division of Vascular & Interventional Radiology (United States); Leeper, William R., E-mail: rob.leeper@jhmi.edu [Johns Hopkins University School of Medicine, Department of Surgery (United States); Tamrazi, Anobel, E-mail: atamraz1@jhmi.edu [Johns Hopkins University School of Medicine, Division of Vascular & Interventional Radiology (United States)

    2015-08-15

    Biological sealants are being increasingly used in a variety of surgical specialties for their hemostatic and sealing capabilities. However, their use in interventional radiology has not been widely reported. The authors describe a case of duodenal perforation occurring after 15 years of gastric bypass surgery, in whom surgical diversion was unsuccessfully attempted and the leakage was successfully controlled using percutaneous administration of a combination of biological and organic sealants.

  12. Urban and rural implementation of pre-hospital diagnosis and direct referral for primary percutaneous coronary intervention in patients with acute ST-elevation myocardial infarction

    DEFF Research Database (Denmark)

    Sørensen, Jacob Thorsted; Terkelsen, Christian Juhl; Nørgaard, Bjarne Linde

    2011-01-01

    Primary percutaneous coronary intervention (PCI) is the preferred treatment for ST-elevation myocardial infarction (STEMI). The distance to primary PCI centres and the inherent time delay in delivering primary PCI, however, limit widespread use of this treatment. This study aimed to evaluate...... the impact of pre-hospital diagnosis on time from emergency medical services contact to balloon inflation (system delay) in an unselected cohort of patients with STEMI recruited from a large geographical area comprising both urban and rural districts....

  13. Prognostic value of N-terminal pro-B-type natriuretic peptide in patients with acute coronary syndromes undergoing left main percutaneous coronary intervention

    OpenAIRE

    Jaberg, L; Toggweiler, S; Puck, M; Frank, M; Rufibach, K; Lüscher, T F; Corti, R

    2011-01-01

    BACKGROUND: Patients undergoing acute left main (LM) coronary artery revascularization have a high mortality and natriuretic peptides such as N-terminal pro-B-type (NT-proBNP) have been shown to have prognostic value in patients with acute coronary syndromes. The present study looked at the prognostic value of NT-proBNP in these patients. METHODS AND RESULTS: We studied all consecutive patients undergoing acute LM coronary artery percutaneous coronary intervention between January 2005 and Dec...

  14. Clinical study on the effect of Tongxinluo combined with trimetazidine on cardiac function in patients with acute ST-segment elevation myocardial infarction after percutaneous coronary intervention

    Directory of Open Access Journals (Sweden)

    Qun-Xiong Fan

    2017-07-01

    Full Text Available Objective: To investigate the clinical effect of Tongxinluo combined with trimetazidine on cardiac function in patients with acute ST-segment elevation myocardial infarction after percutaneous coronary intervention. Method: From March 2014 to September 2016, we selected 190 patients with ST-segment elevation myocardial infarction with percutaneous coronary intervention, according to the admission time is divided into observation group and control group, the control group was treated with conventional therapy (aspirin, isosorbide dinitrate, metoprolol tartrate, clopidogrel sulfate, captopril, atorvastatin calcium and diuretics and trimetazidine, observation group in the control group based on Tongxinluo combined treatment, each group of 95 cases, and hs-CRP, aldosterone, NT-proBNP, TNF-α, IL-6, and cardiac function (LVEDV, LVESV, LVEF, SV were compared. Result: The Hs-CRP in the observation group was significantly lower than that in the control group; The aldosterone in the observation group was significantly lower than that in the control group; The levels of NT-proBNP, TNF-α and IL-6 in the observation group were significantly lower than those in the control group; LVVEV and LVESV were significantly lower in the observation group than in the control group, LVEF and SV were significantly higher than those in the control group. Conclusion: Tongxinluo combined with trimetazidine in patients with acute STsegment elevation myocardial infarction after percutaneous coronary intervention in patients with clinical effect is better, stable plaque, effectively improve microcirculation and cardiac function, recommended a wide range of clinical application.

  15. Organ doses in interventional radiology procedures: Evaluation of software

    International Nuclear Information System (INIS)

    Tort, I.; Ruiz-Cruces, R.; Perez-Martinez, M.; Carrera, F.; Ojeda, C.; Diez de los Rios, A.

    2001-01-01

    Interventional Radiology (IR) procedures require large fluoroscopy times and important number of radiological images, so the levels of radiation to patient are high, which leads us to calculate the organ doses. The objective of this work is to estimate and make a comparison of the results given by the different software that we have to do the calculation of organ doses in complex procedures of IR. To do this, 28 patients have been selected, distributed in the 3 procedures with highest doses. The determination of organ doses and effective doses has been made using the projections utilized and different software based on Monte Carlo Methods: Eff-dose, PCXMC and Diasoft. We have obtained very high dispersion in the average organ dose between the 3 programs. In many cases, it is higher than 25% and in some particular cases, it is greater than 100%. Dispersion obtained in effective doses is not so high, being under 20% in all cases. This shows that a better solution is needed to solve the problem of the organ doses calculation; a more accurate method is necessary that brings us to a trustworthy approach to reality, and, at the moment, that we do not dispose of it. (author)

  16. Percutaneous transhepatic biliary drainage

    International Nuclear Information System (INIS)

    Park, Jae Hyung; Hong, Seong Mo; Han, Man Chung

    1982-01-01

    Percutaneous transhepatic biliary drainage was successfully made 20 times on 17 patients of obstructive jaundice for recent 1 year since June 1981 at Department of Radiology in Seoul National University Hospital. The causes of obstructive jaundice was CBD Ca in 13 cases, metastasis in 2 cases, pancreatic cancer in 1 case and CBD stone in 1 case. Percutaneous transhepatic biliary drainage is a relatively ease, safe and effective method which can be done after PTC by radiologist. It is expected that percutaneous transhepatic biliary drainage should be done as an essential procedure for transient permanent palliation of obstructive jaundice

  17. Percutaneous Tracheostomy

    Science.gov (United States)

    Mehta, Chitra; Mehta, Yatin

    2017-01-01

    Percutaneous dilatational tracheostomy (PDT) is a commonly performed procedure in critically sick patients. It can be safely performed bedside by intensivists. This has resulted in decline in the use of surgical tracheostomy in intensive care unit (ICU) except in few selected cases. Most common indication of tracheostomy in ICU is need for prolonged ventilation. About 10% of patients requiring at least 3 days of mechanical ventilator support get tracheostomised during ICU stay. The ideal timing of PDT remains undecided at present. Contraindications and complications become fewer with increase in experience. Various methods of performing PDT have been discovered in last two decades. Preoperative work up, patient selection and post tracheostomy care form key components of a successful PDT. Bronchoscopy and ultrasound have been found to be useful procedural adjuncts, especially in presence of unfavorable anatomy. This article gives a brief overview about the use of PDT in ICU. PMID:28074819

  18. Acute Myocardial Infarction, Use of Percutaneous Coronary Intervention, and Mortality: A Comparative Effectiveness Analysis Covering Seven European Countries.

    Science.gov (United States)

    Hagen, Terje P; Häkkinen, Unto; Belicza, Eva; Fatore, Giovanni; Goude, Fanny

    2015-12-01

    Percutaneous coronary interventions (PCI) on acute myocardial infarction (AMI) patients have increased substantially in the last 12-15 years because of its clinical effectiveness. The expansion of PCI treatment for AMI patients raises two questions: How did PCI utilization rates vary across European regions, and which healthcare system and regional characteristic variables correlated with the utilization rate? Were the differences in use of PCI associated with differences in outcome, operationalized as 30-day mortality? We obtained our results from a dataset based on the administrative information systems of the populations of seven European countries. PCI rates were highest in the Netherlands, followed by Sweden and Hungary. The probability of receiving PCI was highest in regions with their own PCI facilities and in healthcare systems with activity-based reimbursement systems. Thirty-day mortality rates differed considerably between the countries with the highest rates in Hungary, Scotland, and Finland. Mortality was lowest in Sweden and Norway. The associations between PCI and mortality were remarkable in all age groups and across most countries. Despite extensive risk adjustment, we interpret the associations both as effects of selection and treatments. We observed a lower effect of PCI in the higher age groups in Hungary. Copyright © 2015 John Wiley & Sons, Ltd.

  19. IVUS and OCT guided primary percutaneous coronary intervention for spontaneous coronary artery dissection with bioresorbable vascular scaffolds

    Energy Technology Data Exchange (ETDEWEB)

    Mahmood, Muhammad Muzaffar; Austin, David, E-mail: david.austin@stees.nhs.uk

    2017-01-15

    Summary: Spontaneous coronary artery dissection (SCAD) is an uncommon but important cause of acute coronary syndrome. The diagnosis of SCAD by an angiogram alone can be challenging and the increasing use of intracoronary imaging has proven an invaluable diagnostic adjunct in this regard. The appropriate initial management of SCAD has been a matter of significant debate. Owing to frequent spontaneous healing of coronary dissection and a higher risk of complications with percutaneous coronary intervention (PCI) in the setting of SCAD, a default approach of mechanical revascularization is not recommended. However in the presence of vessel occlusion and on-going myocardial infarction PCI is mandated. Bioresorbable vascular scaffolds (BVS) offer potential advantages over the conventional stents in the setting of SCAD. We describe a state-of-the-art approach to the acute treatment of SCAD causing STEMI, utilizing intravascular ultrasound (IVUS), optical coherence tomography (OCT) and BVS and discuss management strategies for the modern era. - Highlights: • SCAD is an infrequent but important cause of acute coronary syndrome. • Intracoronary imaging is a useful adjunct in the diagnosis of SCAD. • Revascularization is recommended in the presence on-going myocardial infarction. • BVS may be considered preferable to conventional stents in the setting of SCAD.

  20. Correlations among Psychological Resilience, Self-Efficacy, and Negative Emotion in Acute Myocardial Infarction Patients after Percutaneous Coronary Intervention.

    Science.gov (United States)

    Liu, Neng; Liu, Shaohui; Yu, Nan; Peng, Yunhua; Wen, Yumei; Tang, Jie; Kong, Lingyu

    2018-01-01

    We investigated the influencing factors of the psychological resilience and self-efficacy of acute myocardial infarction (AMI) patients after percutaneous coronary intervention (PCI) and the relationships of psychological resilience and self-efficacy with negative emotion. Eighty-eight participants were enrolled. Psychological resilience, self-efficacy, and negative emotion were assessed with the Psychological Resilience Scale, Self-Efficacy Scale, Zung Self-Rating Anxiety Scale (SAS), and Zung Self-Rating Depression Scale (SDS), respectively. Furthermore, the relationships of psychological resilience and self-efficacy with negative emotion were investigated. The average scores of psychological resilience, self-efficacy, anxiety, and depression were 70.08 ± 13.26, 21.56 ± 9.66, 53.68 ± 13.10, and 56.12 ± 12.37, respectively. The incidences of anxiety and depression were 23.90% (21/88) and 28.40% (25/88), respectively. The psychological resilience and self-efficacy scores of AMI patients after PCI varied significantly with age and economic status. SAS scores and SDS scores were significantly negatively correlated with psychological resilience and self-efficacy. Negative emotions in AMI patients after PCI are closely related to psychological resilience and self-efficacy. Therefore, anxiety and depression could be alleviated by improving the psychological resilience and self-efficacy of patients undergoing PCI, thus improving patients' quality of life.

  1. [Effect of intensive pretreatment with atorvastatin calcium on outcomes of percutaneous coronary intervention in elderly patients with coronary heart disease].

    Science.gov (United States)

    Guo, Xiaoyan; Huang, Xuecheng; Wang, Qiwu

    2015-02-01

    To observe the effects of different loading doses of atorvastatin calcium on the outcomes of percutaneous coronary intervention (PCI) in elderly patients with coronary heart disease (CHD). A total of 120 CHD patients aged over 80 years were randomly assigned into 3 equal groups to receive intensive pretreatment with statin at the doses of 20, 40, or 60 mg prior to PCI performed within 48 to 72 h after admission. The changes of postoperative cardiac biochemical markers including creatine kinase isoenzyme (CKMB), troponin I (cTNI) and high-sensitivity c-reactive protein (hs-CRP) were observed and the incidence of major adverse cardiac events (MACE, including cardiac death, myocardial infarction, and target vessel revascularization) were recorded within 30 days after PCI. Thirty-four patients in 20 mg statin group, 40 in 40 mg statin group, and 38 in 60 mg statin group completed this study. In all the 3 groups, hs-CRP level significantly increased at 12 and 24 h after PCI compared with the preoperative levels (P0.05). Intensive pretreatment with 60 mg/day atorvastatin calcium can significantly reduce myocardial infarction related to PCI with good safety in elderly patients with CHD.

  2. Impact of Polypharmacy on Adherence to Evidence-Based Medication in Patients who Underwent Percutaneous Coronary Intervention.

    Science.gov (United States)

    Mohammed, Shaban; Arabi, Abdulrahaman; El-Menyar, Ayman; Abdulkarim, Sabir; AlJundi, Amer; Alqahtani, Awad; Arafa, Salah; Al Suwaidi, Jassim

    2016-01-01

    The primary objective of this study was to evaluate the impact of polypharmacy on primary and secondary adherence to evidence-based medication (EBM) and to measure factors associated with non-adherence among patients who underwent percutaneous coronary intervention (PCI). We conducted a retrospective analysis for patients who underwent PCI at a tertiary cardiac care hospital in Qatar. Patients who had polypharmacy (defined as ≥6 medications) were compared with those who had no polypharmacy at hospital discharge in terms of primary and secondary adherence to dual antiplatelet therapy (DAPT), beta-blockers (BB), angiotensin converting enzyme inhibitors (ACEIs) and statins. A total of 557 patients (mean age: 53±10 years; 85%; males) who underwent PCI were included. The majority of patients (84.6%) received ≥6 medications (polypharmacy group) while only 15.4% patients received ≥5 medications (nonpolypharmacy group). The two groups were comparable in term of gender, nationality, socioeconomic status and medical insurance. The non-polypharmacy patients had significantly higher adherence to first refill of DAPT compared with patients in the polypharmacy group (100 vs. 76.9%; p=0.001). Similarly, the non-polypharmacy patients were significantly more adherent to secondary preventive medications (BB, ACEI and statins) than the polypharmacy group. In patients who underwent PCI, polypharmacy at discharge could play a negative role in the adherence to the first refill of EBM. Further studies should investigate other parameters that contribute to long term non-adherence.

  3. Negative and positive affect are independently associated with patient-reported health status following percutaneous coronary intervention.

    Science.gov (United States)

    Versteeg, Henneke; Pedersen, Susanne S; Erdman, Ruud A M; van Nierop, Josephine W I; de Jaegere, Peter; van Domburg, Ron T

    2009-10-01

    We examined the association between negative and positive affect and 12-month health status in patients treated with percutaneous coronary intervention (PCI) with drug-eluting stents. Consecutive PCI patients (n = 562) completed the Global Mood Scale at baseline to assess affect and the EuroQoL-5D (EQ-5D) at baseline and 12-month follow-up to assess health status. Negative affect [F(1, 522) = 17.14, P positive affect [F(1, 522) = 5.11, P = .02] at baseline were independent associates of overall health status at 12-month follow-up, adjusting for demographic and clinical factors. Moreover, there was a significant interaction for negative by positive affect [F(1, 522) = 6.11, P = .01]. In domain-specific analyses, high negative affect was associated with problems in mobility, self-care, usual activities, pain/discomfort, and anxiety/depression with the risk being two to fivefold. Low positive affect was only associated with problems in self-care (OR: 8.14; 95% CI: 1.85-35.9; P = .006) and usual activities (OR: 1.87; 95% CI: 1.17-3.00; P = .009). Baseline negative and positive affect contribute independently to patient-reported health status 12 months post PCI. Positive affect moderated the detrimental effects of negative affect on overall health status. Enhancing positive affect might be an important target to improve patient-centered outcomes in coronary artery disease.

  4. The Incidence and the Risk Factors of Silent Embolic Cerebral Infarction After Coronary Angiography and Percutaneous Coronary Interventions.

    Science.gov (United States)

    Deveci, Onur Sinan; Celik, Aziz Inan; Ikikardes, Firat; Ozmen, Caglar; Caglıyan, Caglar Emre; Deniz, Ali; Bicakci, Kenan; Bicakci, Sebnem; Evlice, Ahmet; Demir, Turgay; Kanadasi, Mehmet; Demir, Mesut; Demirtas, Mustafa

    2016-05-01

    Silent embolic cerebral infarction (SECI) is a major complication of coronary angiography (CAG) and percutaneous coronary intervention (PCI). Patients with stable coronary artery disease (CAD) who underwent CAG with or without PCI were recruited. Cerebral diffusion-weighted magnetic resonance imaging was performed for SECI within 24 hours. Clinical and angiographic characteristics were compared between patients with and without SECI. Silent embolic cerebral infarction occurred in 12 (12%) of the 101 patients. Age, total cholesterol, SYNTAX score (SS), and coronary artery bypass history were greater in the SECI(+) group (65 ± 10 vs 58 ± 11 years,P= .037; 223 ± 85 vs 173 ± 80 mg/dL,P= .048; 30.1 ± 2 vs 15 ± 3,PSECI was more common in the PCI group (8/24 vs 4/77,P= .01). On subanalysis, the SS was significantly higher in the SECI(+) patients in both the CAG and the PCI groups (29.3 ± 1.9 vs 15 ± 3,PSECI after CAG and PCI increases with the complexity of CAD (represented by the SS). The SS is a predictor of the risk of SECI, a complication that should be considered more often after CAG. © The Author(s) 2015.

  5. The impact of different doses of clopidogrel used after percutaneous coronary intervention on cardiovascular events: a Meta-analysis

    International Nuclear Information System (INIS)

    Li Diangeng; Chen Yao; Li Rongshan

    2011-01-01

    Objective: To make a comprehensive evaluation of the efficacy and safety of different doses of clopidogrel that was used after percutaneous coronary intervention (PCI) in preventing the cardiovascular events in order to provide scientific basis for physician in making therapeutic strategic decision. Methods: The authors searched the electronic databases (PubMed, Cochrane Central Register of Controlled Trials, CNKI and Wan Fan) and reference lists from original studies and reviewed the related articles.Statistical analysis was performed by using RevMan 4.2 software. Results: A total of 6 studies containing 1027 patients were included. The results of meta-analysis showed that significant differences in the rate of cardiovascular events [OR = 0.52, 95%CI (0.36, 0.77)] existed between higher clopidogrel maintenance dose and standard dose. No obvious difference was found in major or minor bleeding [OR=1.25, 95%CI(0.43, 3.63)] and [OR = 1.25, 95%CI (0.77, 2.02)]. Conclusion: A higher maintenance dose of clopidogrel employed in patients undergoing PCI can reduce the occurrence of cardiovascular events after PCI without increasing the bleeding risk. (J Intervent Radiol, 2011, 20 : 97-102) (authors)

  6. Correlation of QRS complex after percutaneous coronary intervention with myocardial ischemia reperfusion injury and apoptosis molecule contents

    Directory of Open Access Journals (Sweden)

    Ming-Min Jiang

    2017-11-01

    Full Text Available Objective: To study the correlation of QRS complex after percutaneous coronary intervention (PCI with myocardial ischemia reperfusion injury and apoptosis molecule contents. Methods: Patients with non-ST-segment elevation myocardial infarction who were treated in Nanchong Central Hospital between June 2014 and August 2016 were selected and divided into the PCI group who received emergency PCI surgery and the control group who accepted selective PCI or refused emergency PCI after the medical data were retrospectively analyzed. The fQRS as well as the contents of ischemia reperfusion injury indexes and apoptosis molecules was determined after 1 week of treatment. Results: The incidence of fQRS in PCI group was significantly lower than that in control group; serum MDA, cTnI, H-FABP, sTWEAK, sFas, sTRAIL and Caspase-3 contents as well as peripheral blood Nrf-2 and HO-1 expression of PCI group were greatly lower than those of control group; serum MDA, cTnI, H-FABP, sTWEAK, sFas, sTRAIL and Caspase-3 contents as well as peripheral blood Nrf-2 and HO-1 expression of PCI group of patients with fQRS complex (+ were greatly higher than those of patients with fQRS complex (-. Conclusion: The occurrence of fQRS after PCI is closely related to myocardial ischemia reperfusion injury and apoptosis.

  7. Age- and Gender-related Disparities in Primary Percutaneous Coronary Interventions for Acute ST-segment elevation Myocardial Infarction.

    Directory of Open Access Journals (Sweden)

    Thomas Pilgrim

    Full Text Available Previous analyses reported age- and gender-related differences in the provision of cardiac care. The objective of the study was to compare circadian disparities in the delivery of primary percutaneous coronary intervention (PCI for acute myocardial infarction (AMI according to the patient's age and gender.We investigated patients included into the Acute Myocardial Infarction in Switzerland (AMIS registry presenting to one of 11 centers in Switzerland providing primary PCI around the clock, and stratified patients according to gender and age.A total of 4723 patients presented with AMI between 2005 and 2010; 1319 (28% were women and 2172 (54% were ≥65 years of age. More than 90% of patients 90 minutes was found in elderly males (adj HR 1.66 (95% CI 1.40-1.95, p<0.001 and females (adj HR 1.57 (95% CI 1.27-1.93, p<0.001, as well as in females <65 years (adj HR 1.47 (95% CI 1.13-1.91, p = 0.004 as compared to males <65 years of age, with significant differences in circadian patterns during on- and off-duty hours.In a cohort of patients with AMI in Switzerland, we observed discrimination of elderly patients and females in the circadian provision of primary PCI.

  8. [Clinical significance of early percutaneous coronary intervention in patients with Braunwald III-B type unstable angina pectoris].

    Science.gov (United States)

    Nozaki, Katsuhiro; Nakao, Koichi; Horiuchi, Kenji; Kasanuki, Hiroshi; Honda, Takashi

    2003-06-01

    To assess the efficacy of early invasive strategy for the treatment of Braunwald III-B type unstable angina pectoris. This study included 573 consecutive patients of whom 267 underwent percutaneous coronary intervention (PCI) (312 lesions). The patients were divided into two groups, 95 treated with the early invasive strategy of coronary angiography within 24 hr of admission (Group PCI-I) and the remaining 172 treated with the early conservative strategy of coronary angiography 24 hr after admission (Group PCI-C). No significant differences were noted in the baseline characteristics of the two groups except for ST segment elevation on electrocardiography at presentation, which occurred significantly less frequently in Group PCI-C (36.8% vs 8.1%, p strategy for unstable angina pectoris were almost equivalent to those of the early conservative strategy, despite more frequent ST segmental elevation at admission in Group PCI-I. These findings suggest that the early invasive strategy for unstable angina pectoris may be acceptable even in the current Japanese clinical setting without the use of GP IIb/IIIa receptor antagonist, low molecular weight heparin or clopidogrel.

  9. IVUS and OCT guided primary percutaneous coronary intervention for spontaneous coronary artery dissection with bioresorbable vascular scaffolds

    International Nuclear Information System (INIS)

    Mahmood, Muhammad Muzaffar; Austin, David

    2017-01-01

    Summary: Spontaneous coronary artery dissection (SCAD) is an uncommon but important cause of acute coronary syndrome. The diagnosis of SCAD by an angiogram alone can be challenging and the increasing use of intracoronary imaging has proven an invaluable diagnostic adjunct in this regard. The appropriate initial management of SCAD has been a matter of significant debate. Owing to frequent spontaneous healing of coronary dissection and a higher risk of complications with percutaneous coronary intervention (PCI) in the setting of SCAD, a default approach of mechanical revascularization is not recommended. However in the presence of vessel occlusion and on-going myocardial infarction PCI is mandated. Bioresorbable vascular scaffolds (BVS) offer potential advantages over the conventional stents in the setting of SCAD. We describe a state-of-the-art approach to the acute treatment of SCAD causing STEMI, utilizing intravascular ultrasound (IVUS), optical coherence tomography (OCT) and BVS and discuss management strategies for the modern era. - Highlights: • SCAD is an infrequent but important cause of acute coronary syndrome. • Intracoronary imaging is a useful adjunct in the diagnosis of SCAD. • Revascularization is recommended in the presence on-going myocardial infarction. • BVS may be considered preferable to conventional stents in the setting of SCAD.

  10. The effect of TIcagrelor administered through a nasogastric tube to COMAtose patients undergoing acute percutaneous coronary intervention

    DEFF Research Database (Denmark)

    Ratcovich, Hanna; Sadjadieh, Golnaz; Andersson, Hedvig B

    2017-01-01

    resuscitated after an out of hospital cardiac arrest (OHCA) and undergoing primary percutaneous coronary intervention (pPCI). METHODS AND RESULTS: Blood samples were drawn at baseline and at two, four, six, eight, 12, and 24 hours and then daily for up to five days after administration of a 180 mg ticagrelor...... loading dose (LD), followed by 90 mg twice daily in 44 patients. The primary endpoint was the occurrence of high platelet reactivity (HPR) 12 hours after the LD. Assessment by VerifyNow (VFN) showed 96 (15.25-140.5) platelet reactivity units (PRU), and five (12%) patients exhibited HPR. Multiplate...... analysis showed 19 (12-29) units (U) at twelve hours, and three patients (7%) had HPR. Ticagrelor and its main metabolite AR-C124910XX concentrations were 85.2 (37.2-178.5) and 18.3 (6.4-52.4) ng/mL. Median times to sufficient platelet inhibition below the HPR limit were 3 (2-6) hours (VFN) and 4 (2...

  11. Relation between the Change in Mean Platelet Volume and Clopidogrel Resistance in Patients Undergoing Percutaneous Coronary Intervention.

    Science.gov (United States)

    Koh, Young-Youp; Kim, Hyung Ho; Choi, Dong-Hyun; Lee, Young-Min; Ki, Young-Jae; Kang, Seong-Ho; Park, Geon; Chung, Joong-Wha; Chang, Kyong-Sig; Hong, Soon-Pyo

    2015-01-01

    We aimed to determine the association between the change in mean platelet volume (MPV) over time and aspirin/ clopidogrel resistance in patients undergoing percutaneous coronary intervention (PCI). The MPV and platelet function were analysed in 302 patients who underwent PCI. MPV changes were associated with increased aspirin reaction units (ARU, r = 0.114; P = 0.047), increased P2Y12 reaction units (PRU, r = 0.193; P = 0.001), and decreased P2Y12% inhibition (PI%, r = - 0.273; P resistant group (≥235 PRU or ≤15% of PI%) showed a significantly higher positive change in MPV (ΔMPV) values than the clopidogrel responder group (0.53 ± 0.78 vs. 0.13 ± 0.69 fL, P resistant and responder groups were 72.6% and 59.3%, respectively. After adjusting for traditional risk factors, the odds ratio in the clopidogrel resistant group with ΔMPV ≥0.2 fL was 4.10 (95% confidence interval; 1.84-9.17). In conclusion, ΔMPV was associated with PRU and PI%; a positive ΔMPV was an independent predictive marker for clopidogrel resistance after PCI.

  12. Outcomes of Middle Eastern Patients Undergoing Percutaneous Coronary Intervention: The Primary Analysis of the First Jordanian PCI Registry.

    Science.gov (United States)

    Alhaddad, Imad A; Tabbalat, Ramzi; Khader, Yousef; Al-Mousa, Eyas; Izraiq, Mahmoud; Nammas, Assem; Jarrah, Mohammad; Saleh, Akram; Hammoudeh, Ayman

    2017-01-01

    This is a prospective multicenter registry designed to evaluate the incidence of adverse cardiovascular events in Middle Eastern patients undergoing percutaneous coronary interventions (PCI). The registry was also designed to determine the predictors of poor outcomes in such patients. We enrolled 2426 consecutive patients who underwent PCI at 12 tertiary care centers in Jordan between January 2013 and February 2014. A case report form was used to record data prospectively at hospital admission, discharge, and 12 months of follow-up. Mean age was 56 ± 11 years, females comprised 21% of the study patients, 62% had hypertension, 53% were diabetics, and 57% were cigarette smokers. Most patients (77%) underwent PCI for acute coronary syndrome. In-hospital and 1-year mortality rates were 0.78% and 1.94%, respectively. Definite or probable stent thrombosis occurred in 9 patients (0.37%) during hospitalization and in 47 (1.94%) at 1 year. Rates of target vessel repeat PCI and coronary artery bypass graft surgery at 1 year were 3.4% and 0.6%, respectively. The multivariate analysis revealed that cardiogenic shock, congestive heart failure, ST-segment deviation, diabetes, and major bleeding were significantly associated with higher risk of 1-year mortality. In this first large Jordanian registry of Middle Eastern patients undergoing PCI, patients treated were relatively young age population with low in-hospital and 1-year adverse cardiovascular events. Certain clinical features were associated with worse outcomes and may warrant aggressive therapeutic strategies.

  13. Thrombolysis in the age of Primary Percutaneous Coronary Intervention: Mini-Review and Meta-analysis of Early PCI

    Science.gov (United States)

    Al Shammeri, O; Garcia, LA

    2013-01-01

    Objective Primary Percutaneous Coronary Intervention (PCI) is the treatment of choice for ST-segment Elevation Myocardial Infarction (STEMI) if performed within 90 minutes from first medical contact. However, primary PCI is only available for less than 25% of patients with STEMI. Early PCI or Pharmaco-invasive strategy has evolved from facilitated PCI but with more delayed timing from thrombolysis to PCI. Aim Assess the safety and effectiveness of Early PCI. Patients and Method We reviewed the data of the available therapy options for patients with STEMI. Then we performed a meta-analysis for all randomized controlled trials of early PCI versus standard therapy Results Five studies fulfilled our inclusion criteria. Our meta-analysis showed improved cardiovascular events with early PCI compared to standard therapy (odd ratio of 0.54; 95% Confidence interval 0.47-0.7, pPCI 4 to 24 hours after successful thrombolysis Conclusion Early PCI should be done to all STEMI patients within 24 hours after successful thrombolysis. PMID:23559909

  14. Evaluation of Patient Radiation Dose during Cardiac Interventional Procedures: What Is the Most Effective Method?

    International Nuclear Information System (INIS)

    Chida, K.; Saito, H.; Ishibashi, T.; Zuguchi, M.; Kagaya, Y.; Takahashi, S.

    2009-01-01

    Cardiac interventional radiology has lower risks than surgical procedures. This is despite the fact that radiation doses from cardiac intervention procedures are the highest of any commonly performed general X-ray examination. Maximum radiation skin doses (MSDs) should be determined to avoid radiation-associated skin injuries in patients undergoing cardiac intervention procedures. However, real-time evaluation of MSD is unavailable for many cardiac intervention procedures. This review describes methods of determining MSD during cardiac intervention procedures. Currently, in most cardiac intervention procedures, real-time measuring of MSD is not feasible. Thus, we recommend that physicians record the patient's total entrance skin dose, such as the dose at the interventional reference point when it can be monitored, in order to estimate MSD in intervention procedures

  15. Radiation exposure of cardiologists eye lenses during interventional procedures

    International Nuclear Information System (INIS)

    Treckova, V.; Nikodemova, D.; Salat, D.

    2014-01-01

    Recently published studies have indicated a lower threshold of eye lens doses for developing cataracts than previously used. These studies have shown that the latency period responsible for cataract development depends on the absorbed eye lens dose. The recommendations of the ICRP, the new BSS of IAEA and the 2013/59/EURATOM Directive revise the old occupational limit of equivalent dose (150 mSv) to the new lower value of 20 mSv per year. Probably this value will be exceeded mainly during specific interventional procedures. The main aim of the present study was to investigate the received eye lens doses by monitoring and assessment of radiation load of cardiologists in the particular Cardiologic Healthcare Facility in Slovakia. The measurements were realized by using TLD located on the both sides of the protective lead glasses of five cardiologists during CA/PTCA procedures, performed in the period of 1 month. Evaluation of the dosimeters was performed by HARSHAW TLD 3500. Collected parameters of each individual examination were expressed in the quantity personal dose equivalent Hp(0,07). The whole body doses during the CA/PTCA procedures were controlled by RaySafe i2 dosimetry system, allowing the collection of real time radiation exposure of medical staff. Values of personal dose equivalent Hp(0,07) on the left eye lens (where we observed higher dose values), were extrapolated to annual doses and compared with the new eye lens limit. The comparison of the results (calculating the average annual dose from the gathered annual workload of each cardiologist) indicates that the new proposed limit for eye lens doses (20 mSv/year) should be exceeded. Important information comes from the results of RaySafe measurements, which refer to the fact, that although the whole-body annual doses obtained by the followed cardiologists doses not exceed the annual limit of effective dose, the equivalent doses to the lens of the eye obtained from TLD, reached the overflow value

  16. Radiation exposure of cardiologists eye lenses during interventional procedures

    International Nuclear Information System (INIS)

    Treckova, V.; Nikodemova, D.; Salat, D.

    2014-01-01

    Recently published studies have indicated a lower threshold of eye lens doses for developing cataracts than previously used. These studies have shown that the latency period responsible for cataract development depends on the absorbed eye lens dose. The recommendations of the ICRP, the new BSS of IAEA and the 2013/59/EURATOM Directive revise the old occupational limit of equivalent dose (150 mSv) to the new lower value of 20 mSv per year. Probably this value will be exceeded mainly during specific interventional procedures. The main aim of the present study was to investigate the received eye lens doses by monitoring and assessment of radiation load of cardiologists in the particular Cardio logic Healthcare Facility in Slovakia. The measurements were realized by using TLD located on the both sides of the protective lead glasses of five cardiologists during CA/PTCA procedures, performed in the period of 1 month. Evaluation of the dosimeters was performed by HARSHAW TLD 3500. Collected parameters of each individual examination were expressed in the quantity personal dose equivalent Hp(0,07). The whole body doses during the CA/PTCA procedures were controlled by RaySafe i2 dosimetry system, allowing the collection of real time radiation exposure of medical staff. Values of personal dose equivalent Hp(0,07) on the left eye lens (where we observed higher dose values), were extrapolated to annual doses and compared with the new eye lens limit. The comparison of the results (calculating the average annual dose from the gathered annual workload of each cardiologist) indicates that the new proposed limit for eye lens doses (20 mSv/year) should be exceeded. Important information comes from the results of RaySafe measurements, which refer to the fact, that although the whole-body annual doses obtained by the followed cardiologists doses not exceed the annual limit of effective dose, the equivalent doses to the lens of the eye obtained from TLD, reached the overflow value

  17. Comparison of no-reflow phenomenon after percutaneous coronary intervention for acute myocardial infarction between smokers and nonsmokers.

    Science.gov (United States)

    Shemirani, Hassan; Tafti, Faezeh Dehghani; Amirpour, Afshin

    2014-11-01

    No-reflow phenomenon after percutaneous coronary intervention (PCI) in patients with acute ST-segment-elevation myocardial infarction (STEMI) is relatively common and has therapeutic and prognostic implications. Cigarette smoking is known as deleterious in patients with coronary artery disease (CAD), but the effect of smoking on no-reflow phenomenon is less investigated. The aim of this study was to compare no-reflow phenomenon after percutneous coronary intervention for acute myocardial infarction, between smokers and non smokers. A total of 141 patients who were admitted to Chamran Hospital (Isfahan, Iran) between March and September, 2012 with a diagnosis of STEMI, enrolled into our Cohort study. Patients were divided into current smoker and nonsmoker groups (based on patient's information). All patients underwent primary PCI or rescue PCI within the first 12-h of chest pain. No-reflow phenomenon, thrombolysis in myocardial infarction (MI) flow, and 24-h complications were assessed in both groups. A total of 47 current smoker cases (32.9%) and 94 (65.7%) nonsmoker cases were evaluated. Smokers in comparison to nonsmokers were younger (53.47 ± 10.59 vs. 61.46 ± 10.55, P vs. 44.7%, P vs. 36.2%, P vs. 25.5%, P smokers and 6.4% of nonsmokers, P: 0.72). No-reflow phenomenon was observed in 29.8% of current smokers and 31.5% of nonsmokers (P = 0.77). No-reflow phenomenon or short-term complications were not significantly different between current smokers and non smokers.

  18. A random forest based risk model for reliable and accurate prediction of receipt of transfusion in patients undergoing percutaneous coronary intervention.

    Directory of Open Access Journals (Sweden)

    Hitinder S Gurm

    Full Text Available BACKGROUND: Transfusion is a common complication of Percutaneous Coronary Intervention (PCI and is associated with adverse short and long term outcomes. There is no risk model for identifying patients most likely to receive transfusion after PCI. The objective of our study was to develop and validate a tool for predicting receipt of blood transfusion in patients undergoing contemporary PCI. METHODS: Random forest models were developed utilizing 45 pre-procedural clinical and laboratory variables to estimate the receipt of transfusion in patients undergoing PCI. The most influential variables were selected for inclusion in an abbreviated model. Model performance estimating transfusion was evaluated in an independent validation dataset using area under the ROC curve (AUC, with net reclassification improvement (NRI used to compare full and reduced model prediction after grouping in low, intermediate, and high risk categories. The impact of procedural anticoagulation on observed versus predicted transfusion rates were assessed for the different risk categories. RESULTS: Our study cohort was comprised of 103,294 PCI procedures performed at 46 hospitals between July 2009 through December 2012 in Michigan of which 72,328 (70% were randomly selected for training the models, and 30,966 (30% for validation. The models demonstrated excellent calibration and discrimination (AUC: full model  = 0.888 (95% CI 0.877-0.899, reduced model AUC = 0.880 (95% CI, 0.868-0.892, p for difference 0.003, NRI = 2.77%, p = 0.007. Procedural anticoagulation and radial access significantly influenced transfusion rates in the intermediate and high risk patients but no clinically relevant impact was noted in low risk patients, who made up 70% of the total cohort. CONCLUSIONS: The risk of transfusion among patients undergoing PCI can be reliably calculated using a novel easy to use computational tool (https://bmc2.org/calculators/transfusion. This risk prediction

  19. Usefulness of a functional tracheobronchial phantom for interventional procedure

    International Nuclear Information System (INIS)

    Kim, Tae Hyung; Lim, Cheong Hwan; Kim, Jeong Koo

    2003-01-01

    To evaluate usefulness of a functional tracheobronchial phantom for interventional procedure. The functional phantom was made as a actual size with human normal anatomy used silicone and a paper clay mold. A tracheobronchial-shape clay mold was placed inside a square box and liquid silicone was poured. After the silicone was formed, the clay was removed. We measured film density and tracheobronchial angle at the human, animal and phantom respectively. The film density of trachea part were 0.76 (± 0.011) in human, 0.97 (± 0.015) in animal, 0.45 (± 0.016) in phantom. The tracheobronchial bifurcation part measured 0.51 (± 0.006) in human, 0.65 (± 0.005) in animal, 0.65 (± 0.008) in phantom. The right bronchus part measured 0.14 (± 0.008) in human, 0.59 (± 0.014) in animal and 0.04 (± 0.007) in phantom. The left bronchus were 0.54 (± 0.004) in human, 0.54 (± 0.008) in animal and 0.08 (± 0.008) in phantom. At the stent part were 0.54 (± 0.004) in human, 0.59 (± 0.011) in animal and 0.04 (± 0.007) in phantom, respectively. The tracheobronchial angle of the left bronchus site were 42.6 (± 2.07).deg. in human, 43.4 (± 2.40).deg. in animal and 35 (± 2.00).deg. in phantom, respectively. The right bronchus site were 32.8 (± 2.77).deg. in human, 34.6 (± 1.94).deg. in animal and 50.2 (± 1.30).deg. in phantom, respectively. The phantom was useful for in-vitro testing of tracheobronchial interventional procedure, since it was easy to reproduce

  20. Complications after elective percutaneous coronary interventions: A comparison between public and private hospitals

    Directory of Open Access Journals (Sweden)

    Roberto Muniz Ferreira

    2018-01-01

    Conclusions: Clinical complications after elective PCI are common both in public and private hospitals. Meticulous pre-procedural clinical assessment and patient selection as well as adherence to guideline-based practices could minimize the risk of PCI-related adverse events.

  1. A real-time haptic interface for interventional radiology procedures.

    Science.gov (United States)

    Moix, Thomas; Ilic, Dejan; Fracheboud, Blaise; Zoethout, Jurjen; Bleuler, Hannes

    2005-01-01

    Interventional Radiology (IR) is a minimally-invasive surgery technique (MIS) where guidewires and catheters are steered in the vascular system under X-ray imaging. In order to perform these procedures, a radiologist has to be correctly trained to master hand-eye coordination, instrument manipulation and procedure protocols. This paper proposes a computer-assisted training environment dedicated to IR. The system is composed of a virtual reality (VR) simulation of the anatomy of the patient linked to a robotic interface providing haptic force feedback.The paper focuses on the requirements, design and prototyping of a specific part of the haptic interface dedicated to catheters. Translational tracking and force feedback on the catheter is provided by two cylinders forming a friction drive arrangement. The whole friction can be set in rotation with an additional motor providing torque feedback. A force and a torque sensor are integrated in the cylinders for direct measurement on the catheter enabling disturbance cancellation with a close-loop force control strategy.

  2. Interventional procedures and future drug therapy for hypertension

    Science.gov (United States)

    Lobo, Melvin D.; Sobotka, Paul A.; Pathak, Atul

    2017-01-01

    Hypertension management poses a major challenge to clinicians globally once non-drug (lifestyle) measures have failed to control blood pressure (BP). Although drug treatment strategies to lower BP are well described, poor control rates of hypertension, even in the first world, suggest that more needs to be done to surmount the problem. A major issue is non-adherence to antihypertensive drugs, which is caused in part by drug intolerance due to side effects. More effective antihypertensive drugs are therefore required which have excellent tolerability and safety profiles in addition to being efficacious. For those patients who either do not tolerate or wish to take medication for hypertension or in whom BP control is not attained despite multiple antihypertensives, a novel class of interventional procedures to manage hypertension has emerged. While most of these target various aspects of the sympathetic nervous system regulation of BP, an additional procedure is now available, which addresses mechanical aspects of the circulation. Most of these new devices are supported by early and encouraging evidence for both safety and efficacy, although it is clear that more rigorous randomized controlled trial data will be essential before any of the technologies can be adopted as a standard of care. PMID:27406184

  3. 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

    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

  4. Impact of the Occlusion Duration on the Performance of J-CTO Score in Predicting Failure of Percutaneous Coronary Intervention for Chronic Total Occlusion.

    Science.gov (United States)

    de Castro-Filho, Antonio; Lamas, Edgar Stroppa; Meneguz-Moreno, Rafael A; Staico, Rodolfo; Siqueira, Dimytri; Costa, Ricardo A; Braga, Sergio N; Costa, J Ribamar; Chamié, Daniel; Abizaid, Alexandre

    2017-06-01

    The present study examined the association between Multicenter CTO Registry in Japan (J-CTO) score in predicting failure of percutaneous coronary intervention (PCI) correlating with the estimated duration of chronic total occlusion (CTO). The J-CTO score does not incorporate estimated duration of the occlusion. This was an observational retrospective study that involved all consecutive procedures performed at a single tertiary-care cardiology center between January 2009 and December 2014. A total of 174 patients, median age 59.5 years (interquartile range [IQR], 53-65 years), undergoing CTO-PCI were included. The median estimated occlusion duration was 7.5 months (IQR, 4.0-12.0 months). The lesions were classified as easy (score = 0), intermediate (score = 1), difficult (score = 2), and very difficult (score ≥3) in 51.1%, 33.9%, 9.2%, and 5.7% of the patients, respectively. Failure rate significantly increased with higher J-CTO score (7.9%, 20.3%, 50.0%, and 70.0% in groups with J-CTO scores of 0, 1, 2, and ≥3, respectively; PJ-CTO score predicted failure of CTO-PCI independently of the estimated occlusion duration (P=.24). Areas under receiver-operating characteristic curves were computed and it was observed that for each occlusion time period, the discriminatory capacity of the J-CTO score in predicting CTO-PCI failure was good, with a C-statistic >0.70. The estimated duration of occlusion had no influence on the J-CTO score performance in predicting failure of PCI in CTO lesions. The probability of failure was mainly determined by grade of lesion complexity.

  5. Persistent elevation of neutrophil/lymphocyte ratio associated with new onset atrial fibrillation following percutaneous coronary intervention for acute st segment elevation myocardial infarction

    International Nuclear Information System (INIS)

    Chavarria, N.; Wong, C.; Hussain, H.; Joiya, H.U.

    2015-01-01

    Increasing evidence suggests that inflammation plays an important role in initiation and maintaining of atrial fibrillation (AF). The Neutrophil to Lymphocyte (N/L) Ratio is an easily derived and readily available parameter that has emerged as marker of inflammation with predictive and prognostic value. We investigated the association between N/L ratio and incidence of atrial fibrillation in patients undergoing cardiac catheterization for acute ST-segment elevation myocardial infarction (STEMI). Methods: This cross sectional descriptive study was carried out at New York Hospital Queens. We retrospectively analysed clinical, hematologic and angiographic data of 290 patients who underwent coronary angiography with stent placement for acute ST-segment elevation myocardial infarction between 2008-2011. Results: Study cohort of 290 patients had mean age 63.3 ± 13.0 years consisting of 81.4% male. The N/L ratio was measured at time points: <6 hours pre-catheterization, <12, 48 and 96 hours post catheterization. Patients who developed AF (n=40, 13.8%), had higher post catheterization N/L ratios at 48 hours (median 5.23 vs 3.00, p=0.05) and 96 hours (median 4.67 vs 3.56, p=0.03), with no differences in the immediate pre and post procedural measurements, <6 hours pre catheterization (median 2.49 vs 2.82, p=0.467) and <12 hours post catheterization (median 5.93 vs 5.03, p=0.741) respectively. Conclusion: In conclusion, these findings support an inflammatory aetiology contributing to new onset AF following percutaneous coronary intervention for acute STEMI. Further studies are warranted to elucidate these findings. (author)

  6. Percutaneous coronary intervention with second-generation paclitaxel-eluting stents versus everolimus-eluting stents in United States contemporary practice (REWARDS TLX Trial).

    Science.gov (United States)

    Waksman, Ron; Ghali, Magdi; Goodroe, Randy; Ryan, Thomas; Turco, Mark; Ring, Michael; McGarry, Thomas; Dobies, David; Shammas, Nicolas; Steinberg, Daniel H; Swymelar, Stacy; Kaneshige, Kimberly; Torguson, Rebecca

    2012-10-15

    Registry Experience at the Washington Hospital Center, DES - Taxus Liberte Versus Xience V (REWARDS TLX) is a physician-initiated, retrospective, real-world, multicenter, observational study for all patients >18 years of age subjected to percutaneous coronary intervention with everolimus-eluting stents (EESs) or paclitaxel-eluting stents (PESs). Outcomes of patients receiving a TAXUS Liberté or XIENCE V drug-eluting stent were compared. Baseline clinical, procedural, and follow-up data at 12 months were collected from 10 clinical centers by an electronic data capture system. The study's primary end point was major adverse cardiac events: a composite of all-cause death, Q-wave myocardial infarction, target vessel revascularization, and stent thrombosis. The trial is registered with http://www.clinicaltrials.gov (NCT01134159). Data were entered for 1,195 patients (PES, n = 595; EES, n = 600). Baseline clinical characteristics were similar except for higher dyslipidemia, systemic hypertension, and family history of coronary artery disease in the EES group. In-hospital outcome was similar between groups, with an overall in-hospital stent thrombosis rate of 0.2%. The primary end point at 12 months was similar (EES 7.8% vs 10.8%, p = 0.082). Overall stent thrombosis rate was lower in the EES group (0.3% vs 1.2%, respectively, p = 0.107); however, target lesion revascularization was similar (PES, hazard ratio 1.46, 95% confidence interval 0.98 to 2.19, p = 0.064). There was no difference in overall mortality between groups. In conclusion, second-generation EESs and PESs demonstrated similar efficacy and safety profiles for broadened patient and lesion subsets compared to a selected population from the pivotal trials. However, for composite efficacy and safety end points, EESs outperformed second-generation PESs. Copyright © 2012 Elsevier Inc. All rights reserved.

  7. [Percutaneous coronary intervention of unprotected left main coronary compared with coronary artery bypass grafting; 3 years of experience in the National Institute of Cardiology, Mexico].

    Science.gov (United States)

    López-Aguilar, Carlos; Abundes-Velasco, Arturo; Eid-Lidt, Guering; Piña-Reyna, Yigal; Gaspar-Hernández, Jorge

    The best revascularisation method of the unprotected left main artery is a current and evolving topic. A total of 2439 percutaneous coronary interventions (PCI) were registered during a 3-year period. The study included all the patients with PCI of the unprotected left main coronary (n=48) and matched with patients who underwent coronary artery bypass graft (CABG) (n=50). Major adverse cerebral and cardiac events (MACCE) were assessed within the hospital and in outpatients during a 16 month follow up. The cardiovascular risk was greater in the PCI group; logEuroSCORE 16±21 vs. 5±6, P=.001; clinical Syntax 77±74 vs 53±39, P=.04. On admission, the PCI group of patients had a higher frequency of ST segment elevation myocardial infarction (STEMI) and cardiogenic shock. The MACCE were similar in both groups (14% vs. 18%, P=.64). STEMI was less frequent in the PCI group (0% vs. 10%, P=.03). Cardiovascular events were lower in the PCI group (2.3% vs. 18%, P=.01), and there was a decrease in general and cardiac mortality (2.3% vs. 12%, P=.08 y 2.3% vs. 8%, P=.24), on excluding the patients with cardiogenic shock as a presentation. MACCE were similar in both groups in the out-patient phase (15% vs. 12%, P=.46). Survival without MACCE, general and cardiac death were comparable between groups (log rank, P=.38, P=.44 and P=.16, respectively). Even though the clinical and peri-procedural risk profile of the PCI patients were higher, the in-hospital and out-hospital efficacy and safety were comparable with CABG. Copyright © 2016 Instituto Nacional de Cardiología Ignacio Chávez. Publicado por Masson Doyma México S.A. All rights reserved.

  8. One-year Outcomes in Patients with ST-segment Elevation Myocardial Infarction Caused by Unprotected Left Main Coronary Artery Occlusion Treated by Primary Percutaneous Coronary Intervention.

    Science.gov (United States)

    Liu, Hai-Wei; Han, Ya-Ling; Jin, Quan-Min; Wang, Xiao-Zeng; Ma, Ying-Yan; Wang, Geng; Wang, Bin; Xu, Kai; Li, Yi; Chen, Shao-Liang

    2018-06-20

    Very few data have been reported for ST-segment elevation myocardial infarction (STEMI) caused by unprotected left main coronary artery (ULMCA) occlusion, and very little is known about the results of this subgroup of patients who underwent primary percutaneous coronary intervention (PCI). The aim of this study was to determine the clinical features and outcomes of patients with STEMI who underwent primary PCI for acute ULMCA occlusion. From January 2000 to February 2014, 372 patients with STEMI caused by ULMCA acute occlusion (ULMCA-STEMI) who underwent primary PCI at one of two centers were enrolled. The 230 patients with non-ST-segment elevation MI (NSTEMI) caused by ULMCA lesion (ULMCA-NSTEMI) who underwent emergency PCI were designated the control group. The main indexes were the major adverse cardiac events (MACEs) in-hospital, at 1 month, and at 1 year. Compared to the NSTEMI patients, the patients with STEMI had significantly higher rates of Killip class≥III (21.2% vs. 3.5%, χ 2 = 36.253, P 0.05) and TVR (all P > 0.05) in the intervals of 0-1 month as well as 1 month to 1 year. The results of Cox regression analysis showed that the differences in the independent predictors for MACE included the variables of Killip class ≥ III and intra-aortic balloon pump support for the STEMI patients and the variables of previous MI, ULMCA distal bifurcation, and 2-stent for distal ULMCA lesions for the NSTEMI patients. Compared to the NSTEMI patients, the patients with STEMI and ULMCA lesions still remain at a much higher risk for adverse events at 1 year, especially on 1 month. If a successful PCI procedure is performed, the 1-year outcomes in those patients might improve.