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Sample records for total coronary occlusions

  1. Acute complications of percutaneous transluminal coronary angioplasty for total occlusion

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    S. Plante (Sylvain); G-J. Laarman (GertJan); P.J. de Feyter (Pim); M. Samson; B.J.W.M. Rensing (Benno); V.A.W.M. Umans (Victor); H. Suryapranata (Harry); M.J.B.M. van den Brand (Marcel); P.W.J.C. Serruys (Patrick)

    1991-01-01

    markdownabstractAbstract The incidence of major complications after percutaneous coronary angioplasty (PTCA) of a totally occluded artery was assessed retrospectively. A total of 1649 PTCA procedures were analyzed. After exclusion of procedures for acute myocardial infarction or total occlusion

  2. Utility of adjunctive modalities in Coronary chronic total occlusion intervention

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    Hemal Bhatt

    2017-05-01

    Full Text Available Coronary chronic total occlusion (CTO intervention remains one of the most challenging domains in interventional cardiology. Due to the technical challenges involved and potential procedural complications, CTO percutaneous coronary intervention (PCI attempt and success rates remain less than standard PCI. However, the use of several adjunctive tools such as intravascular ultrasound, optical coherence tomography, rotational atherectomy, orbital atherectomy, excimer laser coronary atherectomy and percutaneous left ventricular assist device may contribute to improved CTO PCI success rates or provide better hemodynamic assessment of CTO lesion (i.e., using fractional flow reserve. In this review we present the current literature describing the utility and efficacy of these adjunctive modalities in CTO intervention.

  3. Differentiation of acute total occlusion of coronary artery from chronic total occlusion in coronary computed tomography angiography

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    Kwag, Hyon Joo [Sungkyunkwan Univ. School of Medicine, Seoul (Korea, Republic of)

    2012-08-15

    To compare the features of coronary computed tomography angiography (CCTA) imaging of the patients with acute total occlusion (ATO) of coronary artery with those of chronic total occlusion (CTO). CCTA of 26 patients with complete interruption of the coronary artery in CCTA and occlusion in conventional coronary angiography, were retrospectively analyzed. Discrimination between the ATO group (n = 11, patients with non ST elevation myocardial infarction or unstable angina) and the CTO group (n = 15, patients with stable angina or nonspecific symptom) was arbitrarily determined by clinical diagnosis. Lesion length, remodeling index (RI), plaque density measured by Hounsfield units (HU), plaque composition, percentage attenuation drop across the lesion, and presence of myocardial thinning were evaluated. Comparisons between the ATO and CTO groups revealed significantly shorter lesion length in the ATO group (0.40 cm vs. 1.87 cm, respectively; p = 0.001), and significantly higher RI (1.56 vs. 1.10, respectively; p = 0.004). Plaque density of the ATO group was lower (37.0 HU vs. 104.7 HU, respectively; p < 0.001) and non calcified plaque was frequently seen in the ATO group (72.7% vs. 26.7%, respectively; p = 0.02). Percentage attenuation drop across the lesion was lower for the ATO group (10.92% vs. 25.44%, respectively; p = 0.005). Myocardial thinning was exclusively observed in the CTO group (seven of 15 patients, p = 0.01). CCTA shows various statistically significant differences between the ATO and CTO groups.

  4. Initial Experience With the Gaia Composite Core Guidewires in Coronary Chronic Total Occlusion Crossing.

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    Khalili, Houman; Vo, Minh N; Brilakis, Emmanouil S

    2016-02-01

    Inability to cross the occlusion with a guidewire is the most common cause of failure of coronary chronic total occlusion (CTO) interventions. We describe two cases of successful application of the novel Gaia family of coronary guidewires (Asahi Intecc) for crossing coronary CTOs using all available crossing strategies, namely antegrade wire escalation, antegrade dissection/reentry, and retrograde.

  5. Total occlusion of the left main and proximal right coronary artery: case report and review of the literature.

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    Leon, M N; Abu-Halawa, S; Ramanna, N; Kokotsakis, J N; Treistman, B; Anderson, H V

    1996-11-01

    Chronic total left main coronary artery occlusion at angiography is very rare, and there are only four cases reported with concomitant total right coronary artery occlusion. We describe a case of total left main and proximal right coronary artery occlusion and review the clinical and angiographic characteristics of this condition which represents the most severe from of coronary artery disease compatible with life.

  6. Gender Differences in Long-Term Clinical Outcomes After Percutaneous Coronary Intervention of Chronic Total Occlusions

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    Claessen, Bimmer E.; Chieffo, Alaide; Dangas, George D.; Godino, Cosmo; Lee, Seung-Whan; Obunai, Kotaro; Carlino, Mauro; Chantziara, Vaso; Apostolidou, Irini; Henriques, José P. S.; Leon, Martin B.; Di Mario, Carlo; Park, Seung-Jung; Stone, Gregg W.; Moses, Jeffrey W.; Colombo, Antonio; Mehran, Roxana

    2012-01-01

    Introduction. Little is known about gender differences among patients undergoing percutaneous coronary intervention (PCI) for chronic total occlusion (CTO). Methods. A total of 1791 patients with 1852 CTOs underwent PCI at 3 centers in the United States, Italy, and South Korea between 1998 and 2007.

  7. Left Circumflexus Coronary Artery Total Occlusion with Clinical Presentation as NSTEMI and Acute Pulmonary Oedema

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    Budi Yuli Setianto

    2017-04-01

    Full Text Available Current guidelines for the management of patients with acute coronary syndromes (ACSs focus on the electrocardiogram to divide patients into ST-elevation acute myocardial infarction (STEMI or non-ST-elevation acute myocardial infarction (NSTEMI/unstable angina (UA. Patients with STEMI in the earliest time will receive reperfusion therapy to destruct occlusive thrombus. An ST segment elevation is the ‘sine qua non’ for diagnosing acute total coronary occlusion causing transmural myocardial infarction. Left circumflex coronary artery (LCx occlusion is often categorized as NSTEMI because of the absence of significant ST-elevation on the 12 lead standard electrocardiogram. An ST segment elevation is presented in fewer than 50% of patients with LCx total occlusion, such that the reperfusion therapy is delayed. We reported a 77 years old woman whom being diagnosed with NSTEMI because a 12 lead electrocardiogram showed ST segment depression in lead V2-V5. On coronary angiography, we found a total occlusion in the LCx artery as the culprit lession.

  8. Determinants of successful recanalization of chronic coronary arterial total occlusion by percutaneous intervention and the prognosis

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    Zheng Xing; Qin Yongwen; Ding Jijun; Xu Rongliang; Zhang Zhenyuan; Chen Shaoping; Ma Liping; Chen Ling; Cui Jifu

    2004-01-01

    Objective: To evaluate the determinants of successful recanalization of chronic coronary arterial total occlusion (CTO) by percutaneous coronary intervention (PCI) as well as the effect of the recanalization on the prognosis of the patients. Methods: Fifty-two patients with CTO were treated by PCI. 30 patients (duration more than one month) were successfully recanalized with stent implantation. Their clinical features and prognosis were compared with those without successful recanalization. Results: Compared with patients without successful recanalization, patients with successful recanalization had a higher incidence of hypertension (53% vs 23%, P<0.05), shorter duration of the predicted occlusion (P<0.01), lower plasma concentration of total cholesterol [(4.8 ± 0.85) vs (5.6 ± 1.5) mmol/L, P<0.05], lower percentage of the lesions with clear out stump or with bridging collaterals or with a branch at orifice or of long segment (17% vs 45%, P<0.05); more frequently free of angina (73% vs 50%, P<0.05) and had lower combination end points including repeated PCI, CABG and hospilization (13% vs 36% P<0.05) during follow-up. Conclusions: Duration of occlusion, the length of occlusion, the occlusion with a missing stump or bridging collaterals are key factors for success or failure of recanalization of TCO by PCI. Patients with successful PCI of CTO have a better prognosis. (authors)

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

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    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.

  10. Association between duration of coronary occlusion and high-intensity signal on T1-weighted magnetic resonance imaging among patients with angiographic total occlusion

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    Matsumoto, Kenji; Ehara, Shoichi; Hasegawa, Takao; Sakaguchi, Mikumo; Shimada, Kenei [Osaka City University Graduate School of Medicine, Department of Cardiovascular Medicine, Abeno-ku, Osaka (Japan)

    2017-09-15

    To evaluate the association between duration of the coronary occlusion and high-intensity signal (HIS) on noncontrast T1-weighted imaging using a 1.5-T magnetic resonance imager among patients with angiographic coronary total occlusion. The signal intensity of the coronary target area divided by the signal intensity of the left ventricular muscle near the target area at each site (TMR) was measured. Areas with a TMR >1.0 were defined as HIS. Thirty five lesions from 33 patients were divided into the following three groups: subacute occlusion (up to 3 months; n = 7), short-duration chronic total occlusion (SD-CTO: 3-6 months; n = 9) and long-duration CTO (LD-CTO: ≥6 months; n = 19). All subacute occlusion lesions showed a HIS within the occlusion site. Among patients with CTO, the frequency of a HIS within the occlusion site was significantly higher in SD-CTO than in LD-CTO lesions (p = 0.013). In multivariate analyses, only an occlusion duration of less than 6 months was an independent factor associated with the presence of HIS (odds ratio 7.6, 95% CI 1.1-54.5; p = 0.044). The presence of a HIS in the occlusion site was associated more with SD-CTO than with LD-CTO among patients with CTO. (orig.)

  11. Coronary collateral circulation in patients with chronic coronary total occlusion; its relationship with cardiac risk markers and SYNTAX score.

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    Börekçi, A; Gür, M; Şeker, T; Baykan, A O; Özaltun, B; Karakoyun, S; Karakurt, A; Türkoğlu, C; Makça, I; Çaylı, M

    2015-09-01

    Compared to patients without a collateral supply, long-term cardiac mortality is reduced in patients with well-developed coronary collateral circulation (CCC). Cardiovascular risk markers, such as N-terminal pro-brain natriuretic peptide (NT-proBNP), high-sensitive C-reactive protein (hs-CRP) and high-sensitive cardiac troponin T (hs-cTnT) are independent predictors for cardiovascular mortality. The main goal of this study was to examine the relationship between CCC and cardiovascular risk markers. We prospectively enrolled 427 stable coronary artery disease patients with chronic total occlusion (mean age: 57.5±11.1 years). The patients were divided into two groups, according to their Rentrop scores: (a) poorly developed CCC group (Rentrop 0 and 1) and (b) well-developed CCC group (Rentrop 2 and 3). NT-proBNP, hs-CRP, hs-cTnT, uric acid and other biochemical markers were also measured. The SYNTAX score was calculated for all patients. The patients in the poorly developed CCC group had higher frequencies of diabetes and hypertension (prisk markers, such as NT-proBNP, hs-cTnT and hs-CRP are independently associated with CCC in stable coronary artery disease with chronic total occlusion. © The Author(s) 2014.

  12. Increased epicardial fat volume quantified by 64-multidetector computed tomography is associated with coronary atherosclerosis and totally occlusive lesions

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    Ueno, Koji; Anzai, Toshihisa; Jinzaki, Masahiro

    2009-01-01

    The relationship between the epicardial fat volume measured by 64-slice multidetector computed tomography (MDCT) and the extension and severity of coronary atherosclerosis was investigated. Both MDCT and conventional coronary angiography (CAG) were performed in 71 consecutive patients who presented with effort angina. The volume of epicardial adipose tissue (EAT) was measured by MDCT. The severity of coronary atherosclerosis was assessed by evaluating the extension of coronary plaques in 790 segments using MDCT data, and the percentage diameter stenosis in 995 segments using CAG data. The estimated volume of EAT indexed by body surface area was defined as VEAT. Increased VEAT was associated with advanced age, male sex, degree of metabolic alterations, a history of acute coronary syndrome (ACS) and the presence of total occlusions, and showed positive correlation with the stenosis score r=0.28, P=0.02) and the atheromatosis score (r=0.67, P 3 /m 2 ) to be the strongest independent determinant of the presence of total occlusions odds ratio 4.64. P=0.02). VEAT correlates with the degree of metabolic alterations and coronary atheromatosis. Excessive accumulation of EAT might contribute to the development of ACS and coronary total occlusions. (author)

  13. Transradial percutaneous coronary intervention for chronic total occlusion of coronary artery disease using sheathless standard guiding catheters.

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    Chen, Huang-Chung; Lee, Wei-Chieh; Hsueh, Shu-Kai; Cheng, Cheng-I; Chen, Chien-Jen; Yang, Cheng-Hsu; Fang, Chih-Yuan; Hang, Chi-Ling; Yip, Hon-Kan; Wu, Chiung-Jen; Fang, Hsiu-Yu

    2015-03-01

    Our aim was to evaluate the feasibility and safety of routine transradial approach (TRA) percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) lesions using the sheathless technique with standard guiding catheters. Transradial approach PCI was applied for CTO lesions. A major limitation of TRA CTO PCI is the inability to use large guiding catheters because of the relatively small size of the radial artery. Therefore, the sheathless technique for TRA PCI has been recently developed. However, reports on TRA CTO PCI using the sheathless technique are still lacking. Sixty-eight patients with CTO lesions were enrolled for TRA PCI using the sheathless technique with standard guiding catheters. The baseline characteristics, coronary angiographic characteristics and major procedure or access site related complications were compared between procedure success and procedure failure group to determine the predictors of success in sheathless CTO PCI. In-hospital and 30-day clinical outcomes were also evaluated in this study. Routine assessments of radial artery occlusion via Doppler ultrasound and pulse oximeter were recorded during one-year clinical follow-up. The mean duration of CTO by history was 31.8 ± 42.3 months. The 7 Fr standard guiding catheter was used with the sheathless technique in 91.2%, and bilateral sheathless approach in 42.6% of the study patients. The procedure-related complications included coronary perforation needing covered stent deployment (2.9%), cardiac tamponade (2.9%), collateral perforation needing coil deployment (4.4%), and contrast induced nephropathy (2.9%). Only 2 patients (2.9%) experienced forearm ecchymosis at the radial artery access sites. In-hospital mortality and 30-day all-cause mortality were 2.9%, and 30-day MACEs were 1.5%. The rate of radial artery occlusion during one-year clinical follow-up was only 3.0%. It is feasible and safe to routinely use the sheathless technique with standard guiding catheters for

  14. Vascular endothelial growth factor and hypoxia-inducible factor-1α gene polymorphisms and coronary collateral formation in patients with coronary chronic total occlusions

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    Vincent Amoah

    2016-06-01

    Full Text Available Introduction: We evaluated the association between two single nucleotide polymorphisms of the vascular endothelial growth factor gene and one of the hypoxia-inducible factor-1α gene and the degree of coronary collateral formation in patients with a coronary chronic total occlusion. Methods: Totally, 98 patients with symptomatic coronary artery disease and a chronic total occlusion observed during coronary angiography were recruited. Genotyping of two vascular endothelial growth factor promoter single nucleotide polymorphisms (−152G>A and −165C>T and the C1772T single nucleotide polymorphism of hypoxia-inducible factor-1α were performed using polymerase chain reaction and restriction fragment length polymorphism analysis. The presence and extent of collateral vessel filling was scored by blinded observers using the Rentrop grade. Results: We found no association between the vascular endothelial growth factor −152G>A, −165C>T and hypoxia-inducible factor-1α −1772C>T with the presence and filling of coronary collateral vessels. A history of percutaneous coronary intervention and transient ischaemic attack/cerebrovascular accident were associated with the presence of enhanced collateral vessel formation following binary logistic regression analysis. Conclusion: The study findings suggest that coronary collateral formation is not associated with the tested polymorphic variants of vascular endothelial growth factor and hypoxia-inducible factor-1α in patients with symptomatic coronary artery disease and the presence of a chronic total occlusion.

  15. Effect of Chronic Total Occlusion Percutaneous Coronary Intervention on Clinical Outcomes in Elderly Patients.

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    Zhang, Hui-Ping; Ai, Hu; Zhao, Ying; Li, Hui; Tang, Guo-Dong; Zheng, Nai-Xin; Sun, Fu-Cheng; Liu, Jing-Hua

    2018-02-01

    There are little published data reporting the effect of coronary artery chronic total occlusion (CTO) percutaneous coronary intervention (PCI) on the prognosis of elderly patients with identified CTOs. We sought to evaluate the clinical effect of CTO PCI on the prognosis of elderly patients with CTOs. A total of 445 consecutive patients diagnosed with a CTO by angiography from January 2011 to December 2013 were enrolled. We compared long-term clinical outcomes between the elderly group (≥75 years; n = 120, 27.0%), and the nonelderly group (elderly CTO patients had left main (LM) disease (25.0 versus 15.1%, P = 0.015), 3-vessel disease (96.4% versus 73.8%, P elderly patients had a higher syntax score than nonelderly patients (27.0 [25.0, 30.0] versus 26.0 [23.0, 30.0], P = 0.006). PCI was attempted for 33 out of 135 CTO lesions (24.4%) in the elderly group, and 127 out of 378 lesions (33.6%) in the nonelderly group (P = 0.049); however, there were no statistically significant differences in the CTO PCI success rates between the 2 groups (69.7% versus 82.7%, P = 0.097). The 3-year cardiac mortality rate was 15.0% and 4.6% (P elderly and nonelderly groups, respectively. Elderly patients with CTOs who were recanalized by PCI and those with unopened CTOs exhibited comparable 3-year cardiac mortality rates (15.0% versus 16.0%, P = 1.000). There was no significant difference in primary endpoint incidence (25.0% versus 33.0%, P = 0.486). Multivariate analysis revealed that after corrections for baseline and procedural differences, right coronary artery CTO (odds ratio = 4.600, 95% CI: 1.320-16.031; P = 0.017) and LM disease combined with 3-vessel disease (odds ratio = 4.296, 95% CI: 1.166-15.831; P = 0.028) were independent predictors of 3-year cardiac mortality among elderly patients with CTOs. Elderly patients with CTOs presented with seriously diseased coronary arteries and poor prognoses. CTO PCI did not seem to significantly improve long-term clinical outcomes among

  16. Coronary Arteriovenous Fistula Secondary to Percutaneous Coronary Intervention of Chronic Total Occlusion

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    Seshasayee Narasimhan

    2013-01-01

    Full Text Available This is a case report of a 61-year-old female presenting with ongoing chest pain in the setting of an NSTEMI with lateral ST-T changes. On attempting to open the left circumflex (LCX, it resulted in a proximal LCX dissection. The patient remained stable with no further chest pain. She was treated with IV Eptifibatide for 48 hours and restudied in 72 hours. Repeat coronary angiography showed a marginally improved proximal dissection plane with a coronary AV fistula. She was managed conservatively and discharged with a non-invasive assessment in 8 weeks. The patient had a negative stress echocardiogram and was managed with maximal medical therapy.

  17. Monocytic microRNA profile associated with coronary collateral artery function in chronic total occlusion patients.

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    Hakimzadeh, Nazanin; Elias, Joëlle; Wijntjens, Gilbert W M; Theunissen, Ruud; van Weert, Angela; Smulders, Martijn W; van den Akker, Nynke; Moerland, Perry D; Verberne, Hein J; Hoebers, Loes P; Henriques, Jose P S; van der Laan, Anja M; Ilhan, Mustafa; Post, Mark; Bekkers, Sebastiaan C A M; Piek, Jan J

    2017-05-08

    An expansive collateral artery network is correlated with improved survival in case of adverse cardiac episodes. We aimed to identify cellular microRNAs (miRNA; miR) important for collateral artery growth. Chronic total occlusion (CTO) patients (n = 26) were dichotomized using pressure-derived collateral flow index (CFI p ) measurements; high collateral capacity (CFI p  > 0.39; n = 14) and low collateral (CFI p  collateral capacity patients. Validation by real-time polymerase chain reaction demonstrated significantly decreased expression of miR339-5p in all stimulated monocyte phenotypes of low collateral capacity patients. MiR339-5p showed significant correlation with CFI p values in stimulated monocytes. Ingenuity pathway analysis of predicted gene targets of miR339-5p and differential gene expression data from high versus low CFI p patients (n = 20), revealed significant association with STAT3 pathway, and also suggested a possible regulatory role for this signaling pathway. These results identify a novel association between miR339-5p and coronary collateral function. Future work examining modulation of miR339-5p and downstream effects on the STAT3 pathway and subsequent collateral vessel growth are warranted.

  18. Predicting Successful Recanalization in Patients with Native Coronary Chronic Total Occlusion: The Busan CTO Score.

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    Jin, Cai De; Kim, Moo Hyun; Kim, Soo Jin; Lee, Kwang Min; Kim, Tae Hyung; Cho, Young-Rak; Serebruany, Victor L

    The optimal strategy to manage chronic total occlusion (CTO) remains unclear. The Japanese CTO multicenter registry (J-CTO) score is an established tool for predicting successful recanalization. However, it does not take into account nonangiographic predictors for final technique success. In the present study, we designed and tested a scoring model called the Busan single-center CTO registry (B-CTO) score combining clinical and angiographic characteristics to predict successful CTO recanalization in Korean patients. Prospectively enrolled CTO patients (n = 438) undergoing coronary intervention (1999-2015) were assessed. The B-CTO score comprises 6 independent predictors: age 60-74 years and lesion length ≥20 mm were assigned 1 point each, while age ≥75 years, female gender, lesion location in the right coronary artery, blunt stump, and bending >45° were assigned 2 points each. For each predictor, the points assigned were based on the associated odds ratio by multivariate analysis. The lesions were classified into 4 groups according to the summation of points scored to assess the probability of successful CTO recanalization: easy (score 0-1), intermediate (score 2-3), difficult (score 4-5), and very difficult (score ≥6). CTO opening was designated as the primary endpoint regardless of the interventional era or the skill of the operator. The final success rate for B-CTO was 81.1%. The probability of successful recanalization for patient groups classified as easy (n = 64), intermediate (n = 148), difficult (n = 134), and very difficult (n = 92) was 95.3, 86.5, 79.1 and 65.2%, respectively (p for trend <0.001). When compared to the J-CTO, the B-CTO score demonstrated a significant improvement in discrimination as indicated by the area under the receiver-operator characteristic curve (AUC 0.083; 95% CI 0.025-0.141), with a positive integrated discrimination improvement of 0.042 and a net reclassification improvement of 56.0%. The B-CTO score has been designed and

  19. Retrograde approach for the recanalization of coronary chronic total occlusion: collateral selection and collateral related complication.

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    Ma, Jian-Ying; Qian, Ju-Ying; Ge, Lei; Fan, Bing; Wang, Qi-Bing; Yan, Yan; Zhang, Feng; Yao, Kang; Huang, Dong; Ge, Jun-Bo

    2013-03-01

    The retrograde approach through collaterals has been applied in the treatment of chronic total occlusion (CTO) lesions during percutaneous recanalization of coronary arteries. This study was to investigate the success rate of recanalization and collateral related complications in patients when using the retrograde approach. Eighty-four cases subjected to retrograde approach identified from July 2005 to July 2012 were included in this study. Patient characteristics, procedural outcomes and in-hospital clinical events were evaluated. Mean age of the patient was (59.6 ± 11.2) years old and 91.7% were men. The target CTO lesions were distributed among the left anterior descending artery in 45 cases (53.5%), left circumflex artery in one case (1.2%), right coronary artery in 34 cases (40.5%), and left main in four cases (4.8%). The overall success rate of recanalization was 79.8%. The septal collateral was three times more frequently used for retrograde access than the epicardial collateral, 68/84 (81%) vs. 16/84 (19%). Successful wire passage through the collateral channel was achieved in 58 (72.6%) patients. The success rate of recanalization was 93.1% (54/58) in patients with and 50% (13/26) in patients without successful retrograde wire passage of the collateral channel (P collaterals was achieved in 49 of 68 septal collaterals (72.1%) and in 9 of 16 epicardial collaterals (56.3%) (P = NS). There was no significant difference between the septal collateral group and the epicardial group in the success rate of recanalization after retrograde wire crossing the collaterals (91.8% vs. 100%, P > 0.05). CART or reverse CART technique was used in 15 patients, and 14 patients (93.3%) were recanalized successfully. Collateral related perforation occurred in three (18.8%) cases with the epicardial collateral as the first choice (compared with the septal collateral group (0), P collaterals. The retrograde approach is an effective technique to recanalize CTO lesions, the septal

  20. Clinical results with the Resolute zotarolimus-eluting stent in total coronary occlusions

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    Kelbæk, Henning; Holmvang, Lene; Richardt, Gert

    2015-01-01

    Aims: We conducted a pooled post hoc analysis (RESOLUTE All Comers and RESOLUTE International) of patients who had the Resolute® zotarolimus-eluting stent (R-ZES) implanted in revascularised total occlusions (TO) compared with patients treated with R-ZES for non-occluded lesions. Methods and resu......Aims: We conducted a pooled post hoc analysis (RESOLUTE All Comers and RESOLUTE International) of patients who had the Resolute® zotarolimus-eluting stent (R-ZES) implanted in revascularised total occlusions (TO) compared with patients treated with R-ZES for non-occluded lesions. Methods...

  1. Impact of the Occlusion Duration on the Performance of J-CTO Score in Predicting Failure of Percutaneous Coronary Intervention for Chronic Total Occlusion.

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    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.

  2. The innovation of composite core dual coil coronary guide-wire technology: A didactic coronary chronic total occlusion revascularization case report.

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    Tomasello, Salvatore Davide; Giudice, Pietro; Attisano, Tiziana; Boukhris, Marouane; Galassi, Alfredo R

    2014-10-01

    The treatment of coronary chronic total occlusions (CTO) continues to solicit technical innovations. As success primarily depends on crossing the lesion with a wire, all aspects regarding tip shape retention, torque precision, and penetration ability of the guide-wire have greatly influenced new techniques and strategies. The world of interventional cardiology has to look carefully at these developments, and to use them accordingly to improve the success rate in ordinary percutaneous coronary interventions. We present a didactical case report of a CTO revascularization treated with a new 'dual core' technology guide-wire.

  3. Real-time fusion of coronary CT angiography with X-ray fluoroscopy during chronic total occlusion PCI

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    Ghoshhajra, Brian B.; Takx, Richard A.P. [Harvard Medical School, Cardiac MR PET CT Program, Massachusetts General Hospital, Department of Radiology and Division of Cardiology, Boston, MA (United States); Stone, Luke L.; Yeh, Robert W.; Jaffer, Farouc A. [Harvard Medical School, Cardiac Cathetrization Laboratory, Cardiology Division, Massachusetts General Hospital, Boston, MA (United States); Girard, Erin E. [Siemens Healthcare, Princeton, NJ (United States); Brilakis, Emmanouil S. [Cardiology Division, Dallas VA Medical Center and UT Southwestern Medical Center, Dallas, TX (United States); Lombardi, William L. [University of Washington, Cardiology Division, Seattle, WA (United States)

    2017-06-15

    The purpose of this study was to demonstrate the feasibility of real-time fusion of coronary computed tomography angiography (CTA) centreline and arterial wall calcification with X-ray fluoroscopy during chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Patients undergoing CTO PCI were prospectively enrolled. Pre-procedural CT scans were integrated with conventional coronary fluoroscopy using prototype software. We enrolled 24 patients who underwent CTO PCI using the prototype CT fusion software, and 24 consecutive CTO PCI patients without CT guidance served as a control group. Mean age was 66 ± 11 years, and 43/48 patients were men. Real-time CTA fusion during CTO PCI provided additional information regarding coronary arterial calcification and tortuosity that generated new insights into antegrade wiring, antegrade dissection/reentry, and retrograde wiring during CTO PCI. Overall CTO success rates and procedural outcomes remained similar between the two groups, despite a trend toward higher complexity in the fusion CTA group. This study demonstrates that real-time automated co-registration of coronary CTA centreline and calcification onto live fluoroscopic images is feasible and provides new insights into CTO PCI, and in particular, antegrade dissection reentry-based CTO PCI. (orig.)

  4. Influence of collaterals on the left ventricular end-diastolic pressure and serum NT-proBNP levels in patients with coronary chronic total occlusion

    Directory of Open Access Journals (Sweden)

    Fuad Samadov

    2017-06-01

    Conclusion: In patients with coronary chronic total occlusion even well-developed coronary collaterals are not capable of protecting the rise of left ventricular end diastolic pressure and NT-proBNP levels which are reliable markers of the left ventricular dysfunction.

  5. Radial approach and single wiring as first intentional strategies in chronic total occlusions of the left anterior descending coronary artery.

    Science.gov (United States)

    Nassar, Yasser; Boudou, Nicolas; Carrie, Didier

    2013-04-01

    Percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) of the left anterior descending coronary artery (LAD) specifically is associated with improved long-term 5 years survival as compared to PCI failure. Simpler PCI techniques may be successful and safer than complex techniques which are perceived to have high failure rates and technical complexity. We aimed to describe the safety and effectiveness of first intentional single wiring and radial approach in the treatment of patients with a CTO of the native LAD coronary artery at Toulouse Rangueil university hospitals. The study was a single center prospective registry. All patients showed evidence of myocardial viability in LAD territory. The operators' initial strategy was to start by a radial access as a first choice whenever feasible; if not, a femoral access was chosen. The initial strategy for lesion crossing in either antegrade or retrograde approaches was single wiring by lesion crossing using one guidewire (GW) as a simple technique. A total of 30 patients with 30 LAD CTO lesions (100%) were recorded. Mean age was 71.6 + 15 years, 77% were males and 23% were females. The access route was radial 66% of the time and femoral 54% of the time and with double access for contralateral injection in 40% of the patients. Sheaths and catheters sizes 6F were used in 53% of the patients, and 7F in 73% of the patients. Overall lesion success rate was 83% of lesions. Single wiring was the prevailing technique used in 97% of successful lesions (83% of total cases), while only 3% were by multiple wiring techniques. Successful single antegrade wiring represented 63% of our total study cases with a GW success rate of 92% of cases. Successful single retrograde wiring represented 13% of our cases with a GW success rate of 67%. Q-wave myocardial infarction (MI), stent thrombosis, stroke, emergency coronary artery bypass graft (CABG), major bleeding, radiation dermatitis, cardiac tamponade or clinical

  6. Relationship of myocardial hibernation, scar, and angiographic collateral flow in ischemic cardiomyopathy with coronary chronic total occlusion.

    Science.gov (United States)

    Wang, Li; Lu, Min-Jie; Feng, Lei; Wang, Juan; Fang, Wei; He, Zuo-Xiang; Dou, Ke-Fei; Zhao, Shi-Hua; Yang, Min-Fu

    2018-03-07

    The relationship between myocardial viability and angiographic collateral flow is not fully elucidated in ischemic cardiomyopathy (ICM) with coronary artery chronic total occlusion (CTO). We aimed to clarify the relationship between myocardial hibernation, myocardial scar, and angiographic collateral flow in these patients. Seventy-one consecutive ICM patients with 122 CTOs and 652 dysfunctional segments within CTO territories were retrospectively analyzed. Myocardial hibernation (perfusion-metabolism mismatch) and the extent of 18 F-fluorodeoxyglucose (FDG) abnormalities were assessed using 99m Tc-sestamibi and 18 F-FDG imaging. Myocardial scar was evaluated by late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) imaging. Collateral flow observed on coronary angiography was assessed using Rentrop classification. In these patients, neither the extent nor frequency of myocardial hibernation or scar was related to the status of collateral flow. Moreover, the matching rate in determining myocardial viability was poor between any 2 imaging indices. The extent of 18 F-FDG abnormalities was linearly related to the extent of LGE rather than myocardial hibernation. Of note, nearly one-third (30.4%) of segments with transmural scar still had hibernating tissue. Hibernation and non-transmural scar had higher sensitivity (63.0% and 66.7%) than collateral flow (37.0%) in predicting global functional improvement. Angiographic collateral cannot accurately predict myocardial viability, and has lower sensitivity in prediction of functional improvement in CTO territories in ICM patients. Hence, assessment of myocardial viability with non-invasive imaging modalities is of importance. Moreover, due to the lack of correlation between myocardial hibernation and scar, these two indices are complementary but not interchangeable.

  7. Chronic total occlusion in an infarct-related coronary artery and the risk of appropriate ICD therapies.

    Science.gov (United States)

    Di Marco, Andrea; Anguera, Ignasi; Teruel, Luis; Muntane, Guillem; Campbell, Niall G; Fox, David J; Brown, Benjamin; Skene, Chris; Davidson, Neil; Leon, Valentina; Dallaglio, Paolo; Elzein, Hind; Garcia-Romero, Elena; Gomez-Hospital, Joan Antoni; Cequier, Angel

    2017-10-01

    Risk stratification for ventricular arrhythmias in patients with ischemic cardiomyopathy needs to be improved. Coronary chronic total occlusions in an infarct-related artery (IRA-CTOs) have been associated with an increased arrhythmic risk. This study aimed to evaluate the association between IRA-CTOs and appropriate implantable cardioverter-defibrillator (ICD) therapies. Observational cohort study that included 342 patients with ischemic cardiomyopathy, an ICD implanted for primary or secondary prevention, and a coronary angiography performed shortly before ICD implantation. The ICD was implanted for primary prevention in 163 patients (48%). IRA-CTO was found in 161 patients (47%). During a median follow-up of 33 months, 41% of patients experienced at least one appropriate ICD therapy. Patients with IRA-CTO had higher proportions of appropriate ICD therapies (57% vs. 26%, P < 0.001) and appropriate ICD shocks (40% vs. 17%, P < 0.001). At multivariate Cox regression, IRA-CTO was the only variable that consistently resulted as independent predictor of appropriate ICD therapies and shocks both in the global population of the study (HR 2.3, P < 0.001 and HR 3, P < 0.001, respectively) and when analyzing separately patients with primary or secondary prevention ICD. IRA-CTO is an independent predictor of appropriate ICD therapies, including appropriate ICD shocks. This association is consistent across all the subgroups analyzed. Patients with IRA-CTO have a very high risk of appropriate ICD therapies. These findings may help improving risk stratification as well as the management of ventricular arrhythmias in patients with ischemic cardiomyopathy. © 2017 Wiley Periodicals, Inc.

  8. Cannabis, Collaterals, and Coronary Occlusion

    Directory of Open Access Journals (Sweden)

    Kalpa De Silva

    2011-01-01

    Full Text Available A 51-year-old gentleman, who regularly smoked cannabis, presented with chest pain and diaphoresis. He was haemodynamically stable. ECG showed ST depression, inferiorly, and 1 mm ST elevation in lead aVR. Emergent coronary angiography showed thrombotic occlusion of the left main coronary artery (LMCA, the dominant RCA provided Rentrop grade II collaterals to the LAD. The LMCA was successfully reopened by deployment of a bare-metal stent. Animal heart models suggest that endogenous cannibinoids may cause ischaemic preconditioning. This case suggests that the severity of ischaemia, and hence ECG changes and haemodynamic consequences following an acute occlusion of the LMCA, can be ameliorated by coronary collateralisation and possibly by preconditioning of the myocardium.

  9. Guidewires used in first intentional single wiring strategy for chronic total occlusions of the left anterior descending coronary artery.

    Science.gov (United States)

    Nassar, Yasser S; Boudou, Nicolas; Dumonteil, Nicolas; Lhermusier, Thibault; Carrie, Didier

    2013-04-01

    Percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) of the left anterior descending (LAD) specifically is associated with improved long-term 5 year survival as compared to PCI failure. The procedure is associated with usage of different types of dedicated guidewires by simple or complex techniques aiming to reopen the occluded artery. To describe types and outcome of guidewires used in LAD-CTO utilizing a first intentional single wiring simple strategy. A single center prospective registry for all consecutive patients with a PCI attempt to a native LAD CTO. The initial strategy for lesion crossing was Single wiring. A total of 30 patients with LAD CTO lesions (100%), were recorded. Mean age was 71.6 + 15 years, 77% were Males, risk factors Hypertension in 63%, Diabetes 27%, Dyslipidemia 57%, smoking 40%, hereditary in 13% of patients. Isolated guidewire (GW) success rate was very high 93%. Single wiring was the prevailing technique used in 97% of successfull lesions (83% of total cases) while only 3% were by multiple wiring techniques. Successful single antegrade wiring represented 63% with a GW success rate of 92% of cases. Successful single retrograde wiring represented 13% with a GW success rate of 67%. Successful Crossing GW types in our patients were 44% Soft Tapered GWs; fielder XT (44%), 36% were Soft Non Tapered Pilot 50 (28%), whisper (8%), while 16% were Stiff Non tapered GWs; Miracle 12 (8%), Miracle 6 (4%), Miracle 3 (4%), and 4% were Stiff Tapered GWs; Progress 200 (4%). Single wiring as an initial strategy in PCI for LAD-CTO lesions has a high success rate and is associated with a 44% majority of Soft Tapered GWs, 36% Soft Non Tapered, 16% Stiff Non tapered GWs, and 4% Stiff Tapered GWs.

  10. Outcomes of Chronic Total Occlusion Percutaneous Coronary Intervention in Patients With Diabetes: Insights From the OPEN CTO Registry.

    Science.gov (United States)

    Salisbury, Adam C; Sapontis, James; Grantham, J Aaron; Qintar, Mohammed; Gosch, Kensey L; Lombardi, William; Karmpaliotis, Dimitri; Moses, Jeffrey; Cohen, David J; Spertus, John A; Kosiborod, Mikhail

    2017-11-13

    Few studies have evaluated the relationship of diabetes with technical success and periprocedural complications, and no studies have compared patient-reported health status after chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in patients with and without diabetes. CTOs are more common in patients with diabetes, yet CTO PCI is less often attempted in patients with diabetes than in patients without. The association between diabetes and health status after CTO PCI is unknown. In the 12-center OPEN-CTO PCI registry (Outcomes, Patient Health Status, and Efficiency in Chronic Total Occlusion Registry), patients with and without diabetes were assessed for technical success, periprocedural complications, and health status over 1 year following CTO PCI using the Seattle Angina Questionnaire and the Rose Dyspnea Scale. Hierarchical modified Poisson regression was used to examine the independent association between diabetes and technical success, and hierarchical multivariable linear regression was used to assess the association between diabetes and follow-up health status. Diabetes was common (41.2%) and associated with a lower crude rate of technical success (83.5% vs. 88.1%; p = 0.04). After adjustment, there was no significant difference between diabetic and nondiabetic patients (relative risk: 0.96, 95% confidence interval: 0.91 to 1.01). There were no significant differences in complication rates between patients with and without diabetes. Angina burden, quality of life, and overall health status scores were similar between diabetic and nondiabetic patients over 1 year. Although technical success was lower in patients with diabetes, this reflected lower success among patients with prior bypass surgery, without any significant difference in success rate after adjusting for prior bypass and disease complexity. CTO PCI complication rates are similar in diabetic and nondiabetic patients, and symptom improvement following CTO PCI is robust

  11. 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.

  12. Temporal Trends of Fluoroscopy time and Contrast Utilization in Coronary Chronic Total Occlusion Revascularization: Insights from a Multicenter United States Registry

    Science.gov (United States)

    Michael, Tesfaldet T.; Karmpaliotis, Dimitri; Brilakis, Emmanouil S.; Alomar, Mohammed; Abdullah, Shuaib M.; Kirkland, Ben L.; Mishoe, Katrina L.; Lembo, Nicholas; Kalynych, Anna; Carlson, Harold; Banerjee, Subhash; Luna, Michael; Lombardi, William; Kandzari, David E.

    2014-01-01

    Background The impact of operator experience on fluoroscopy time and contrast utilization during percutaneous coronary intervention (PCI) of coronary chronic total occlusions (CTOs) has received limited study. Methods We evaluated temporal trends in fluoroscopy time and contrast utilization among 1,363 consecutive CTO PCIs performed at 3 US institutions between January 2006 and November 2011. Results Mean age was 65±11 years, 85% of patients were men, 40% had diabetes, 37% had prior coronary artery bypass graft surgery and 42% had prior PCI. The CTO target vessel was the right coronary artery (55%), circumflex (23%), left anterior descending artery (21%), and left main or bypass graft (1%). The retrograde approach was used in 34% of all procedures. The technical and procedural success rates were 85.5% and 84.2%, respectively. The mean procedural time, fluoroscopy time and contrast utilization was 113±61 minutes, 42±29 minutes, and 294±158 ml, respectively. Years since initiation of CTO PCI was independently associated with higher technical success rate (OR=1.52, 95% CI 1.52 to 1.70, p fluoroscopy time (OR=0.84, 95% confidence intervals (CI) 0.75 to 0.95, p=0.005) and contrast utilization (OR=0.84, 95% CI 0.62 to 0.79, p fluoroscopy time and contrast utilization paralleled with an improved technical success rate over time. PMID:24407867

  13. A Novel Risk Score in Predicting Failure or Success for Antegrade Approach to Percutaneous Coronary Intervention of Chronic Total Occlusion: Antegrade CTO Score.

    Science.gov (United States)

    Namazi, Mohammad Hasan; Serati, Ali Reza; Vakili, Hosein; Safi, Morteza; Parsa, Saeed Ali Pour; Saadat, Habibollah; Taherkhani, Maryam; Emami, Sepideh; Pedari, Shamseddin; Vatanparast, Masoomeh; Movahed, Mohammad Reza

    2017-06-01

    Total occlusion of a coronary artery for more than 3 months is defined as chronic total occlusion (CTO). The goal of this study was to develop a risk score in predicting failure or success during attempted percutaneous coronary intervention (PCI) of CTO lesions using antegrade approach. This study was based on retrospective analyses of clinical and angiographic characteristics of CTO lesions that were assessed between February 2012 and February 2014. Success rate was defined as passing through occlusion with successful stent deployment using an antegrade approach. A total of 188 patients were studied. Mean ± SD age was 59 ± 9 years. Failure rate was 33%. In a stepwise multivariate regression analysis, bridging collaterals (OR = 6.7, CI = 1.97-23.17, score = 2), absence of stump (OR = 5.8, CI = 1.95-17.9, score = 2), presence of calcification (OR = 3.21, CI = 1.46-7.07, score = 1), presence of bending (OR = 2.8, CI = 1.28-6.10, score = 1), presence of near side branch (OR = 2.7, CI = 1.08-6.57, score = 1), and absence of retrograde filling (OR = 2.5, CI = 1.03-6.17, score = 1) were independent predictors of PCI failure. A score of 7 or more was associated with 100% failure rate whereas a score of 2 or less was associated with over 80% success rate. Most factors associated with failure of CTO-PCI are related to lesion characteristics. A new risk score (range 0-8) is developed to predict CTO-PCI success or failure rate during antegrade approach as a guide before attempting PCI of CTO lesions.

  14. Collateral Circulation in Chronic Total Occlusions - An Interventional Perspective

    Science.gov (United States)

    Choo, Gim-Hooi

    2015-01-01

    Human coronary collaterals are inter-coronary communications that are believed to be present from birth. In the presence of chronic total occlusions, recruitment of flow via these collateral anastomoses to the arterial segment distal to occlusion provide an alternative source of blood flow to the myocardial segment at risk. This mitigates the ischemic injury. Clinical outcome of coronary occlusion ie. severity of myocardial infarction/ischemia, impairment of cardiac function and possibly survival depends not only on the acuity of the occlusion, extent of jeopardized myocardium, duration of ischemia but also to the adequacy of collateral circulation. Adequacy of collateral circulation can be assessed by various methods. These coronary collateral channels have been used successfully as a retrograde access route for percutaneous recanalization of chronic total occlusions. Factors that promote angiogenesis and further collateral remodeling ie. arteriogenesis have been identified. Promotion of collateral growth as a therapeutic target in patients with no suitable revascularization option is an exciting proposal.

  15. Collateral Circulation in Chronic Total Occlusions - an interventional perspective.

    Science.gov (United States)

    Choo, Gim-Hooi

    2015-09-09

    Human coronary collaterals are inter-coronary communications that are believed to be present from birth. In the presence of chronic total occlusions, recruitment of flow via these collateral anastomoses to the arterial segment distal to occlusion provide an alternative source of blood flow to the myocardial segment at risk. This mitigates the ischemic injury. Clinical outcome of coronary occlusion ie. severity of myocardial infarction/ischemia, impairment of cardiac function and possibly survival depends not only on the acuity of the occlusion, extent of jeopardized myocardium, duration of ischemia but also to the adequacy of collateral circulation. Adequacy of collateral circulation can be assessed by various methods. These coronary collateral channels have been used successfully as a retrograde access route for percutaneous recanalization of chronic total occlusions. Factors that promote angiogenesis and further collateral remodeling ie. arteriogenesis have been identified. Promotion of collateral growth as a therapeutic target in patients with no suitable revascularization option is an exciting proposal.

  16. [Value of evaluating the coronary collateral circulation by transluminal attenuation gradient in patients with chronic total occlusion and related influencing factors].

    Science.gov (United States)

    Chen, Y L; Wang, R; He, Y; Li, J N; Yuan, F; Tian, R; Ge, C J; Zhou, Y; Huang, R C; Cui, S; Song, X T

    2017-10-24

    Objective: To observe the value of evaluating the coronary collateral circulation of chronic total occlusion (CTO) by transluminal attenuation gradient (TAG) and Rentrop grading, and analyze the influencing factors for coronary collateral circulation. Methods: A total of 179 CTO patients admitted to Beijing Anzhen hospital during June 2013 to August 2016 were included in this study.All patients received coronary computed tomographic angiography (CCTA) examination before coronary angiography.Finally, 75 patients (79 vessels) were enrolled.Patients were divided into two groups on the basis of Rentrop classification.The Rentrop 3 was defined as a well-developed coronary collateral circulation group, including 50 CTO vessels, Rentrop 2 or below was defined as poorly-developed collateral circulation group, including 29 vessels.TAG values in patients with various Rentrop grades were analyzed.Univariate and multivariate analysis were used to determine the predictors of collateral circulation. Results: TAG increased consistently in proportion to the angiographic extent of collateral flow (TAG was (-33.6±24.4), (-16.5±15.7) and (-12.8±15.8) HU/10 mm in patients with Rentrop grade 0 or 1, 2 and 3, respectively, P =0.007). Number of good collateral circulation vessels predicted by TAG≥15.6 HU/10 mm was 45(57.0%, 45/79), and 50 (63.3%, 50/79) by Rentrop grade ( P =0.383). Prevalence of diabetes was significantly lower (20.8%(10/48) vs. 48.1%(13/27), P =0.01), while history of previous myocardial infarction (MI) was significantly higher (35.4%(17/48) vs. 11.1%(3/27), P =0.02) in patients with good collateral circulation than in patients with poor collateral circulation.The TAG of the good collateral circulation group was significantly higher than in poorly collateral circulation group ((-12.8±15.8) HU/10 mm vs. (-21.2±19.6) HU/10mm, P =0.041). Multiple logistic regression analysis revealed that history of MI ( OR =0.196, 95% CI 0.041-0.936, P =0.041) and diabetes( OR =6

  17. Long-term survival benefit of revascularization compared with medical therapy in patients with coronary chronic total occlusion and well-developed collateral circulation.

    Science.gov (United States)

    Jang, Woo Jin; Yang, Jeong Hoon; Choi, Seung-Hyuk; Song, Young Bin; Hahn, Joo-Yong; Choi, Jin-Ho; Kim, Wook Sung; Lee, Young Tak; Gwon, Hyeon-Cheol

    2015-02-01

    The purpose of this study was to compare the long-term clinical outcomes of patients with chronic total occlusion (CTO) and well-developed collateral circulation treated with revascularization versus medical therapy. Little is known about the clinical outcomes and optimal treatment strategies of CTO with well-developed collateral circulation. We screened 2,024 consecutive patients with at least 1 CTO detected on coronary angiogram. Of these, we analyzed data from 738 patients with Rentrop 3 grade collateral circulation who were treated with medical therapy alone (n = 236), coronary artery bypass grafting (n = 170) or percutaneous coronary intervention (n = 332; 80.1% successful). Patients who underwent revascularization and medical therapy (revascularization group, n = 502) were compared with those who underwent medical therapy alone (medication group, n = 236) in terms of cardiac death and major adverse cardiac events (MACE), defined as the composite of cardiac death, myocardial infarction, and repeat revascularization. During a median follow-up duration of 42 months, multivariate analysis revealed a significantly lower incidence of cardiac death (hazard ratio [HR]: 0.29; 95% confidence interval [CI]: 0.15 to 0.58; p collateral circulation, aggressive revascularization may reduce the risk of cardiac mortality and MACE. Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  18. Detection of severe stenosis and total occlusion in the left anterior descending coronary artery with transthoracic Doppler echocardiography in the emergency room.

    Science.gov (United States)

    Tani, Tomoko; Tanabe, Kazuaki; Kitai, Takeshi; Yamane, Takafumi; Kureha, Fumie; Katayama, Minako; Tamita, Koichi; Kaji, Shuichiro; Oda, Tomoyuki; Ehara, Natsuhiko; Kinoshita, Makoto; Yamamuro, Atsushi; Morioka, Shigefumi; Kihara, Yasuki

    2009-01-01

    The noninvasive measurement of coronary flow velocity in the left anterior descending artery (LAD) has recently been realized by using the transthoracic Doppler echocardiography (TTDE). A couple of investigations demonstrated that the diastolic-to-systolic peak velocity ratio (DSVR) by TTDE is a simple and noninvasive method for the detection of severe stenosis in the elective settings. However, the usefulness of DSVR by TTDE in the emergency settings has not been evaluated. The purpose of this study was to assess the clinical feasibility to document the LAD flow by TTDE in emergency patients who complained of chest pain. We studied 49 consecutive patients with acute coronary syndrome who were going to undergo emergency coronary angiography (CAG) for the anatomical diagnosis and the facilitated percutaneous coronary intervention (PCI). Prior to CAG, we recorded the LAD flow by TTDE and measured the diastolic peak velocity (DVp), systolic peak velocity (SVp), and their ratio, DSVR (DVp/SVp) of LAD flow. By CAG, the culprit lesions actually resided in the proximal LAD in 36 patients. Among the 36 patients, we detected the Doppler LAD flow in 29. Five out of 7 patients who were unable to detect the LAD flow revealed total occlusions by CAG. DSVR of the LAD is significantly lower in 17 patients who showed severe stenoses (>90%) than those in the rest of 12 patients who did not show such critical stenoses (1.44 +/- 0.16 vs 2.10 +/- 0.26, P < 0.0001). In the emergency settings, a noninvasive assessment of the LAD flow by TTDE accurately estimates the critical stenotic lesions of the LAD.

  19. Beyond the balloon: excimer coronary laser atherectomy used alone or in combination with rotational atherectomy in the treatment of chronic total occlusions, non-crossable and non-expansible coronary lesions.

    Science.gov (United States)

    Fernandez, Juan P; Hobson, Alex R; McKenzie, Daniel; Shah, Nimit; Sinha, Manas K; Wells, Tim A; Levy, Terry M; Swallow, Rosie A; Talwar, Suneel; O'Kane, Peter D

    2013-06-22

    To establish success and complication rates of excimer laser coronary atherectomy (ELCA) in a contemporary series of patients with balloon failure during percutaneous coronary intervention (PCI) of both chronic total occlusions (CTO) and lesions with distal TIMI 3 flow. We identified 58 cases of balloon failure treated with ELCA±rotational atherectomy (RA) over four years, representing 0.84% of all PCI performed in our centre during this period. Balloon failures were classified according to: (i) mechanism of balloon failure; and (ii) whether this occurred in the context of treating a CTO. ELCA was performed following balloon failure using the CVX-300 Excimer Laser System and a 0.9 mm catheter with saline flush. For the entire cohort, procedure success was achieved in 91% (with ELCA successful: alone in 76.1%, after RA failure in 6.8% and in combination with RA for 8.6%). Only in one case did RA succeed where ELCA had failed. There were four procedure-related complications, including transient no-reflow, side branch occlusion and two coronary perforations, of which one was directly attributable to ELCA and led to subsequent mortality. ELCA provides safe and effective adjunctive therapy in contemporary PCI to treat lesions associated with balloon failure due to an inability either to cross the lesion or to expand a balloon sufficiently to permit stenting. ELCA was successful in the majority of these selected cases when used independently with further effectiveness achieved when combined with RA or after RA failure.

  20. Feasibility and safety of augmented-reality glass for computed tomography-assisted percutaneous revascularization of coronary chronic total occlusion: A single center prospective pilot study.

    Science.gov (United States)

    Opolski, Maksymilian P; Debski, Artur; Borucki, Bartosz A; Staruch, Adam D; Kepka, Cezary; Rokicki, Jakub K; Sieradzki, Bartosz; Witkowski, Adam

    2017-11-01

    Percutaneous coronary intervention (PCI) of chronic total occlusion (CTO) may be facilitated by projection of coronary computed tomography angiography (CTA) datasets in the catheterization laboratory. There is no data on the feasibility and safety outcomes of CTA-assisted CTO PCI using a wearable augmented-reality glass. A total of 15 patients scheduled for elective antegrade CTO intervention were prospectively enrolled and underwent preprocedural coronary CTA. Three-dimensional and curved multiplanar CT reconstructions were transmitted to a head-mounted hands-free computer worn by interventional cardiologists during CTO PCI to provide additional information on CTO tortuosity and calcification. The results of CTO PCI using a wearable computer were compared with a time-matched prospective angiographic registry of 59 patients undergoing antegrade CTO PCI without a wearable computer. Operators' satisfaction was assessed by a 5-point Likert scale. Mean age was 64 ± 8 years and the mean J-CTO score was 2.1 ± 0.9 in the CTA-assisted group. The voice-activated co-registration and review of CTA images in a wearable computer during CTO PCI were feasible and highly rated by PCI operators (4.7/5 points). There were no major adverse cardiovascular events. Compared with standard CTO PCI, CTA-assisted recanalization of CTO using a wearable computer showed more frequent selection of the first-choice stiff wire (0% vs 40%, p augmented-reality glass is feasible and safe, and might reduce the resources required for the interventional treatment of CTO. Copyright © 2017 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.

  1. Intercoronary communication in chronic total occlusion: In search of recognition.

    Science.gov (United States)

    Gupta, Mohit D; Girish, M P; Parida, Sudhansu Sekhar; Tyagi, Sanjay

    2016-09-01

    Intercoronary communications (ICC) or open-ended coronary circulation is rare. We describe intercoronary communication in a case of chronic total occlusion, and discuss the pathophysiological and clinical significance of these rare entities. The present case also demonstrates the anatomical presence of ICC despite angiographic absence for the first time using CT coronary angiography. Copyright © 2016. Published by Elsevier B.V.

  2. [Association between collateral circulation and myocardial viability evaluated by cardiac magnetic resonance imaging in patients with coronary artery chronic total occlusion].

    Science.gov (United States)

    Li, J N; Zhang, L J; He, Y; Chen, Y L; Huang, R C; Lyu, S Z; Song, X T

    2017-07-24

    Objective: Late gadolinium enhancement(LGE) cardiac magnetic resonance imaging(CMR) was used to evaluate the myocardial viability of chronic total occlusion(CTO) in patients with coronary heart disease and to observe the relationship between collateral circulation and myocardium viability in these patients. Methods: This retrospective study included 40 patients with CTO diagnosed by invasive coronary angiography (CAG) from September 2015 to June 2016 in our department, all patients performed CMR examination within one week after CAG.The collateral circulation of CTO was graded with Rentrop classification as follows: poor or no collateral circulation group, moderate collateral circulation group and good collateral circulation group.According to CMR images, the delayed enhancement transmural extent of myocardial segments were scored, the ventricular wall motion of the myocardial segment were graded, and the wall motion score index (WMSI) was calculated.Spearman correlation analysis was used to analyze the relationship between the delayed enhancement transmural extent of myocardial segments and WMSI. Results: In the no or poor collateral group of 6 myocardial regions, 1 myocardial region had viable myocardium and 3 myocardial regions had no viable myocardium; in the moderate collateral group of 16 myocardial regions, 11 myocardial regions had viable myocardium and 5 myocardial regions had no viable myocardium; in the good collateral group of 24 myocardial regions, 21 myocardial regions had viable myocardium and 3 myocardial regions had no viable myocardium, there was significant difference between the groups ( P =0.002). The WMSI of poor or no collateral circulation group, moderate collateral circulation group and good collateral circulation group were 1.54±0.50, 1.21±0.34 and 1.26±0.40, respectively, there was no significant difference between the groups ( P =0.063). Spearman correlation analysis showed that the extent of delayed enhancement transmural extent of

  3. First-Generation Versus Second-Generation Drug-Eluting Stents in Coronary Chronic Total Occlusions: Two-Year Results of a Multicenter Registry.

    Directory of Open Access Journals (Sweden)

    Jong-Hwa Ahn

    Full Text Available Limited data are available regarding the long-term clinical outcomes of second-generation drug-eluting stents (DES versus first-generation DES in patients with coronary chronic total occlusion (CTO who undergo percutaneous coronary intervention (PCI. The aim of this study was to compare the clinical outcomes of second-generation DES with those of first-generation DES for the treatment of CTO.Between March 2003 and February 2012, 1,006 consecutive patients with CTO who underwent successful PCI using either first-generation DES (n = 557 or second-generation DES (n = 449 were enrolled in a multicenter, observational registry. Propensity-score matching was also performed. The primary outcome was cardiac death over a 2-year follow-up period. No significant differences were observed between the two groups regarding the incidence of cardiac death (first-generation DES versus second-generation DES; 2.5% vs 2.0%; hazard ratio [HR]: 0.86; 95% confidence interval [CI]: 0.37 to 1.98; p = 0.72 or major adverse cardiac events (MACE, 11.8% vs 11.4%; HR: 1.00; 95% CI: 0.67 to 1.50; p = 0.99. After propensity score matching, the incidences of cardiac death (HR: 0.86; 95% CI: 0.35 to 2.06; p = 0.86 and MACE (HR: 0.93; 95% CI: 0.63 to 1.37; p = 0.71 were still similar in both groups. Furthermore, no significant differences were observed between sirolimus-eluting, paclitaxel-eluting, zotarolimus-eluting, and everolimus-eluting stents regarding the incidence of cardiac death or MACE.This study shows that the efficacy of second-generation DES is comparable to that of first-generation DES for treatment of CTO over 2 years of follow-up.

  4. Immediate- and short-term outcome following recanalization of long chronic total occlusions (> 50 mm) of native coronary arteries with the Frontrunner catheter.

    Science.gov (United States)

    Loli, Akil; Liu, Rex; Pershad, Ashish

    2006-06-01

    Thirty percent of diagnostic angiograms have at least 1 chronic total occlusion (CTO). The 10-year survival of patients with a CTO is improved if they have the CTO successfully recanalized. The success of recanalization with conventional wires is 50% and the impact of new technology on recanalization is unknown. This abstract reports a single center experience with one such new device, the Lumend Frontrunner catheter in revascularization of this difficult lesion subset. A consecutive series of 18 patients with CTO's of native coronary arteries were enrolled in this single center, single operator series. The mean age of the CTO was 5.3 years. The indication for attempt at recanalization was ischemia in the territory of the CTO on SPECT imaging. Success was defined as TIMI flow restoration and < 40% residual stenosis. Primary success (defined as TIMI 3 Flow restoration and < 40% residual stenosis) was achieved in 77% of patients. At 30 days and out to 6 months, clinical TVR was 11% (2/18) in this difficult lesion subset. Conventional predictors of failure to recanalize CTOs do not appear to hold true with the use of the Frontrunner catheter. In this small series, dual cusp injections and use of the Microglide catheter appears to correlate with favorable outcomes. Fluoroscopy times and contrast use are high when attempting recanalization of CTOs with this technology.

  5. Meta-Analysis of the Impact on Mortality of Noninfarct-Related Artery Coronary Chronic Total Occlusion in Patients Presenting With ST-Segment Elevation Myocardial Infarction

    NARCIS (Netherlands)

    O'Connor, Stephen A.; Garot, Philippe; Sanguineti, Francesca; Hoebers, Loes P.; Unterseeh, Thierry; Benamer, Hakim; Chevalier, Bernard; Hovasse, Thomas; Morice, Marie-Claude; Lefèvre, Thierry; Louvard, Yves

    2015-01-01

    Several observational studies have compared clinical outcome in patients with a co-existing noninfarct-related artery chronic total occlusion (n-IRA CTO) versus those without, suggesting increased all-cause mortality. The goal of this study was to provide a systematic review and meta-analysis

  6. Impact of revascularization of coronary chronic total occlusion on left ventricular function and electrical stability: analysis by speckle tracking echocardiography and signal-averaged electrocardiogram.

    Science.gov (United States)

    Sotomi, Yohei; Okamura, Atsunori; Iwakura, Katsuomi; Date, Motoo; Nagai, Hiroyuki; Yamasaki, Tomohiro; Koyama, Yasushi; Inoue, Koichi; Sakata, Yasushi; Fujii, Kenshi

    2017-06-01

    The present study aimed to assess the mechanisms of effects of percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) from two different aspects: left ventricular (LV) systolic function assessed by two-dimensional speckle tracking echocardiography (2D-STE) and electrical stability evaluated by late potential on signal-averaged electrocardiogram (SAECG). We conducted a prospective observational study with consecutive CTO-PCI patients. 2D-STE and SAECG were performed before PCI, and after 1-day and 3-months of procedure. 2D-STE computed global longitudinal strain (GLS) and regional longitudinal strain (RLS) in CTO area, collateral blood-supplying donor artery area, and non-CTO/non-donor area. A total of 37 patients (66 ± 11 years, 78% male) were analyzed. RLS in CTO and donor areas and GLS were significantly improved 1-day after the procedure, but these improvements diminished during 3 months. The improvement of RLS in donor area remained significant after 3-months the index procedure (pre-PCI -13.4 ± 4.8% vs. post-3M -15.1 ± 4.5%, P = 0.034). RLS in non-CTO/non-donor area and LV ejection fraction were not influenced. Mitral annulus velocity was improved at 3-month follow-up (5.0 ± 1.4 vs. 5.6 ± 1.7 cm/s, P = 0.049). Before the procedure, 12 patients (35%) had a late potential. All components of the late potential (filtered QRS duration, root-mean-square voltage in the terminal 40 ms, and duration of the low amplitude signal <40 μV) were not improved. CTO-PCI improved RLS in the donor area at 3-month follow-up without changes of LV ejection fraction. Although higher prevalence of late potential in the current population compared to healthy population was observed, late potential as a surrogate of arrhythmogenic substrate was not influenced by CTO-PCI.

  7. Custom total occlusal convergence angle sticker fabrication.

    Science.gov (United States)

    Cho, Seok-Hwan; Nagy, William W

    2015-09-01

    This article describes a method of fabricating a custom total occlusal convergence angle sticker with photo editing software and label stickers. The custom total occlusal convergence angle sticker can help clinicians achieve an accurate degree of taper during axial wall reduction of tooth preparation. Copyright © 2015 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.

  8. Collateral Function in Patients with Coronary Occlusion Evaluated by 201Thallium Scintigraphy

    Directory of Open Access Journals (Sweden)

    Aida Hasanović

    2008-11-01

    Full Text Available The present study evaluated the impact of the angiographically documented collaterals on regional myocardial perfusion measured by 201thallium scintigraphy in patients with a chronic total occlusion.The study included 60 patients with chronic total occlusion who underwent rest-stress myocardial perfusion scintigraphy and coronary angiography. All patients had angiographic evidence of coronary collaterals. Patients were divided into two groups: group one had well-developed coronary collateral vessels (n=35 and group II had poor coronary collateral development (n=25.Patients with chronic total occlusion had severe and extensive stress-induced myocardial perfusion defects regardless of the grade of angiographic coronary collaterals. The perfusion defects in the group with good collaterals were predominantly reversible, suggesting that coronary collaterals preserved myocardial viability in the regions subtended by a total coronary occlusion. A significant correlation between good collaterals with complete protection and poor collaterals with no protection was noted.Our results demonstrate a protective effect of collaterals on myocardial perfusion during coronary occlusion. The effective angiographic collaterals may prevent resting regional wall motion abnormalities but do not appear to protect against stress-induced perfusion defect.

  9. Sinus bradycardia as a predictor of right coronary artery occlusion in patients with inferior myocardial infarction.

    Science.gov (United States)

    Serrano, C V; Bortolotto, L A; César, L A; Solimene, M C; Mansur, A P; Nicolau, J C; Ramires, J A

    1999-01-01

    Differentiation of right coronary artery (RCA) from left circumflex artery (LCxA) occlusion may be difficult since both can present an electrocardiographic pattern of inferior myocardial infarction (IMI). We studied 133 patients with IMI, 92 patients with RCA occlusion and 41 patients with LCxA occlusion. Risk factors such as previous MI, arterial hypertension, diabetes, smoking, and dislipemia, were similar for RCA and LCxA occlusions. Patients with RCA occlusion had a higher incidence of isolated IMI than patients with LCxA occlusion, 50% vs. 17%, respectively (P<0.001). Arterial hypotension was more prevalent (P<0.05) among patients with RCA (18%) rather than those with LCxA occlusion (2%). RCA occlusion presented an association with sinus bradycardia, an association not observed with LCxA occlusion (15% vs. 0%, respectively; P<0.01). Total atrioventricular block was only present among patients with RCA (18%). Proximal occlusions of the RCA presented lower heart rates (sinus bradycardia) than medial and distal occlusions (13% vs. 1% and 1%, respectively; P<0.0001 and P<0.001). Therefore, regarding patients with IMI: (1) sinus bradycardia is more frequent when the infarct-related artery is the RCA; (2) proximal occlusions of the right coronary predispose low heart rates; and (3) occlusion of the LCxA rarely induces sinus bradycardia.

  10. 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.

  11. A randomized multicenter comparison of hybrid sirolimus-eluting stents with bioresorbable polymer versus everolimus-eluting stents with durable polymer in total coronary occlusion: rationale and design of the Primary Stenting of Occluded Native Coronary Arteries IV study

    Directory of Open Access Journals (Sweden)

    Teeuwen Koen

    2012-12-01

    Full Text Available Abstract Background Percutaneous recanalization of total coronary occlusion (TCO was historically hampered by high rates of restenosis and reocclusions. The PRISON II trial demonstrated a significant restenosis reduction in patients treated with sirolimus-eluting stents compared with bare metal stents for TCO. Similar reductions in restenosis were observed with the second-generation zotarolimus-eluting stent and everolimus-eluting stent. Despite favorable anti-restenotic efficacy, safety concerns evolved after identifying an increased rate of very late stent thrombosis (VLST with drug-eluting stents (DES for the treatment of TCO. Late malapposition caused by hypersensitivity reactions and chronic inflammation was suggested as a probable cause of these VLST. New DES with bioresorbable polymer coatings were developed to address these safety concerns. No randomized trials have evaluated the efficacy and safety of the new-generation DES with bioresorbable polymers in patients treated for TCO. Methods/Design The prospective, randomized, single-blinded, multicenter, non-inferiority PRISON IV trial was designed to evaluate the safety, efficacy, and angiographic outcome of hybrid sirolimus-eluting stents with bioresorbable polymers (Orsiro; Biotronik, Berlin, Germany compared with everolimus-eluting stents with durable polymers (Xience Prime/Xpedition; Abbott Vascular, Santa Clara, CA, USA in patients with successfully recanalized TCOs. In total, 330 patients have been randomly allocated to each treatment arm. Patients are eligible with estimated duration of TCO ≥4 weeks with evidence of ischemia in the supply area of the TCO. The primary endpoint is in-segment late luminal loss at 9-month follow-up angiography. Secondary angiographic endpoints include in-stent late luminal loss, minimal luminal diameter, percentage of diameter stenosis, in-stent and in-segment binary restenosis and reocclusions at 9-month follow-up. Additionally, optical coherence

  12. Crossing Total Occlusions : Navigating Towards Recanalization

    NARCIS (Netherlands)

    Sakes, A.; Regar, E.; Dankelman, J.; Breedveld, P.

    2016-01-01

    Chronic total occlusions (CTOs) represent the “last frontier” of percutaneous interventions. The main technical challenges lies in crossing the guidewire into the distal true lumen, which is primarily due to three problems: device buckling during initial puncture, inadequate visualization, and the

  13. Crossing Total Occlusions: Navigating Towards Recanalization

    NARCIS (Netherlands)

    A. Sakes (Aimée); E.S. Regar (Eveline); J. Dankelman (Jenny); P. Breedveld (Paul)

    2016-01-01

    textabstractChronic total occlusions (CTOs) represent the “last frontier” of percutaneous interventions. The main technical challenges lies in crossing the guidewire into the distal true lumen, which is primarily due to three problems: device buckling during initial puncture, inadequate

  14. [Acute occlusion after coronary angioplasty. Early management and late course].

    Science.gov (United States)

    Nunes, G L; Sousa, A G; Tanajura, L F; Cano, M N; Maldonado, G; Feres, F; Mattos, L A; Pinto, I M; Sousa, J E

    1993-06-01

    Assess the efficacy of the different strategies employed in the management of acute closure and verify the late prognosis of patients who develop this complication. From january 1987, through December 1990, 2315 consecutive patients underwent percutaneous transluminal coronary angioplasty (PTCA) in our Institution. We analyzed 100 patients who had had acute closure of the dilated vessel determining the total incidence of myocardial infarction and death, the effectiveness of the different treatment strategies and clinical and angiographic predictors of poor in-hospital outcome. Late follow-up was obtained in the hospital survivors. The incidence of acute myocardial infarction in the group of 100 patients was 57%; death occurred in 12% of the patients. Forty-one individuals were referred to emergency bypass surgery, 35 received clinical treatment and 24 underwent redilatation of the vessel. Those managed clinically had a higher incidence of myocardial infarction compared to the ones who underwent either redilatation or surgery (74.3% versus 50% and 48.8%). The in-hospital mortality rate was significantly higher in patients with left ventricular ejection fraction p > 0.05). Acute coronary occlusion is a serious complication of angioplasty and is associated with high rates of major complications (myocardial infarction, death). Low left ventricular ejection fraction and PTCA involving the left anterior descending are predictors of higher in-hospital mortality in patients with acute closure. Late outcome is less favourable in patients submitted to clinical treatment in the acute phase.

  15. Acute Thrombotic Coronary Occlusion in a Patient with Coronary Artery Anomaly

    Directory of Open Access Journals (Sweden)

    Beganu Elena

    2017-09-01

    Full Text Available Patients with coronary artery anomalies are more susceptible to develop acute thrombotic coronary occlusions due to the abnormal anatomy of these arteries and the disturbance of the pathophysiological mechanisms that lead to an accelerated atherosclerosis development. The following article presents the case of a 64-year-old female patient diagnosed with anterior ST-segment elevation myocardial infarction. The patient underwent primary percutaneous coronary intervention, which revealed the absence of the right coronary artery and separated origins of the left anterior descending artery and the left circumflex artery from the aorta.

  16. Infections as a stimulus for coronary occlusion, obstruction, or acute coronary syndromes.

    Science.gov (United States)

    Pesonen, Erkki; El-Segaier, Milad; Persson, Kenneth; Puolakkainen, Mirja; Sarna, Seppo; Ohlin, Hans; Pussinen, Pirkko J

    2009-12-01

    Atherosclerosis is considered to be an inflammatory disease. Infections are a significant cause of inflammation. Acute infections might precipitate acute coronary syndromes (ACS) whereas chronic infections might be stimuli for the development of atherosclerosis. Coronary angiograms were done on 211 of 335 patients with ACS and the percentage of coronary obstruction was determined. Serum antibody levels to Chlamydia pneumoniae, C. pneumoniae heat shock protein 60 (CpnHSP60), human heat shock protein 60 (hHSP60), enterovirus (EV), herpes simplex virus (HSV), cytomegalovirus (CMV), and two major periodontal pathogens, Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis, were measured in healthy controls (n = 355) and all patients. Serum antibody levels to periodontal pathogens did not correlate with ACS. However, IgA-class antibody levels to Aggregatibacter actinomycetemcomitans (p = 0.021), CpnHSP60 (p = 0.048) an hHSP60 (p = 0.038) were higher in patients with coronary occlusion or obstruction compared to those without any obstruction. Odds ratios for coronary changes in the highest quartile as compared to the lower quartiles were for A. actinomycetemcomitans IgA 7.84 (95% CI 1.02-60.39, p = 0.048), for CpnHSP60 IgA 8.61 (1.12-65.89, p = 0.038), and for human HSP60 IgA 3.51 (0.79-15.69, p = 0.100). We have previously reported that EV and HSV titres correlated significantly to acute coronary events. They do not correlate to the degree of coronary obstruction as shown here. However, infection by A. actinomycetemcomitans or C. pneumoniae or host response against them associated with coronary obstruction. Clinical coronary events may arise by the effect of acute infections and obstructing lesions by a chronic inflammatory stimulus.

  17. Incidence, predicting factors, and clinical outcomes of periprocedural myocardial infarction after percutaneous coronary intervention for chronic total occlusion in the era of new-generation drug-eluting stents.

    Science.gov (United States)

    Kim, Jin-Ho; Kim, Byeong-Keuk; Kim, Seunghwan; Ahn, Chul-Min; Kim, Jung-Sun; Ko, Young-Guk; Choi, Donghoon; Hong, Myeong-Ki; Jang, Yangsoo

    2017-12-20

    This study aimed to examine predictors and clinical outcomes of periprocedural myocardial infarction (PMI) after chronic total occlusion (CTO) intervention. There are limited data on the clinical implications of PMI after CTO intervention in the new-generation drug-eluting stent (DES) era. We enrolled 337 patients who underwent CTO intervention and met the study criteria. We evaluated the incidence and predictors of PMI, defined as an increase in creatine kinase-MB ≥3× the upper limit of normal (ULN) after intervention and compared the occurrence rates of major adverse cardiac and cerebrovascular events (MACCE, defined as the composite of cardiac death, myocardial infarction, stent thrombosis, target-vessel revascularization, or cerebrovascular accidents) between the PMI and non-PMI groups. PMI occurred in 23 (6.8%) patients after CTO intervention. Significant independent predictors were previous bypass surgery [odds ratio (OR) = 5.52, 95% confidence interval (CI) = 1.17-25.92; P = 0.03], Japan-CTO score ≥3 (OR = 7.06, 95%CI = 2.57-19.39; P PMI group had a significantly higher MACCE rate than the non-PMI group (23.7 vs. 5.6%, P = 0.008 by log-rank test). PMI was an independent predictor of MACCE (HR = 4.26, 95%CI = 1.35-13.43; P = 0.01). The MACCE rate gradually increased in a CK-MB-dependent fashion and was highest in patients with ≥10× ULN (P = 0.005). Previous bypass surgery, high Japan-CTO score, side branch occlusion, and longer procedure time were strongly related to PMI occurrence after CTO intervention. PMI was significantly associated with worse clinical outcomes in the new-generation DES era. © 2017 Wiley Periodicals, Inc.

  18. Everolimus-eluting bioresorbable vascular scaffolds versus second generation drug-eluting stents for percutaneous treatment of chronic total coronary occlusions: Technical and procedural outcomes from the GHOST-CTO registry.

    Science.gov (United States)

    La Manna, Alessio; Chisari, Alberto; Giacchi, Giuseppe; Capodanno, Davide; Longo, Giovanni; Di Silvestro, Michele; Capranzano, Piera; Tamburino, Corrado

    2016-11-15

    We aimed at comparing the acute performance of bioresorbable scaffolds (BRS) and second-generation drug-eluting stents (DES) for the treatment of chronic total occlusions (CTO). There is a lack of knowledge regarding the use of BRS in CTO. Key outcomes of interest were technical and procedural success. Technical success was defined as successful stent delivery and implantation, postprocedural residual diameter stenosis BRS (Abbott Vascular, Santa Clara, CA) and were compared with a historical control group of 54 patients who had undergone CTO PCI with second-generation DES. Baseline characteristics were similar between the BRS and DES groups, with the exception of a larger mean reference vessel diameter in the BRS group (2.92 ± 0.34 vs 2.50 ± 0.68; P BRS group compared with the DES group (78.1% vs 96.3%, P = 0.012). Procedural success rates were 78.1% and 94.4% in the BRS and DES group, respectively (P = 0.035). Compared with second-generation DES for PCI of CTO lesions, BRS were associated with lower rates of technical and procedural success. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  19. Percutaneous recanalization of chronic total occlusions: wherein lies the body of proof?

    Science.gov (United States)

    Tamburino, Corrado; Capranzano, Piera; Capodanno, Davide; Dangas, George; Zimarino, Marco; Bass, Theodore A; Mehran, Roxana; Antoniucci, David; Colombo, Antonio; La Manna, Alessio; Di Salvo, Maria E; Stone, Gregg W

    2013-02-01

    Although interventional technology and skills have markedly advanced, percutaneous coronary intervention (PCI) for coronary chronic total occlusion (CTO) lesions remains challenging. Indeed, CTO PCI is technically complex, carries the potential for a relatively high likelihood of failure and acute complications, and requires specifically skilled operators and a demanding use of resources. In addition, controversy persists surrounding appropriate indications for attempting CTO revascularization. Finally, there is a wide uncertainty on the actual benefits achieved with successful CTO recanalization. A growing number of studies have reported procedural results and/or assessed functional effects and long-term clinical outcomes of CTO PCI. We therefore sought to review and critically appraise the evidence base for procedural outcomes and potential clinical benefits of CTO PCI. Copyright © 2013 Mosby, Inc. All rights reserved.

  20. Coronary collateral circulation: clinical significance and influence on survival in patients with coronary artery occlusion

    DEFF Research Database (Denmark)

    Hansen, J F

    1989-01-01

    In a consecutive series of 96 patients with coronary artery occlusion, 67 had good and 29 had no or poor collateral circulation. Patients with good collaterals had the severest degree of coronary artery disease. Good collaterals are associated with a higher incidence of angina pectoris and normal...... electrocardiogram and with lower incidence of Q-waves, positive exercise tests, heart failure, previous myocardial infarction, and dyskinesia at ventriculography. Survival rates after 10 years were (1) 51.5% with good and 34.5% with poor collaterals (p less than 0.1), (2) 59.4% with angina pectoris and good...... collaterals and 41.2% with angina pectoris and poor collaterals (p less than 0.05), (3) 64.8% without and 24.4% with heart failure and good collaterals (p less than 0.001), and (4) 58.3% without and 16.1% with heart failure and poor collaterals (p less than 0.01). Good collaterals protect the myocardium...

  1. An attempt of thallium-201 myocardial perfusion imaging during transient coronary arterial occlusion by PTCA

    International Nuclear Information System (INIS)

    Nakagawa, Tatsuya; Sugihara, Hiroki; Katahira, Toshio

    1989-01-01

    To evaluate the myocardial perfusion during transient coronary occlusion, we attempted to obtain the myocardial scintigraphy during percutaneous transluminal coronary angioplasty (PTCA). Tl-201 was injected at the last inflation of angioplastic balloon and occlusion was kept on for 60 sec. Planar images or SPECT were obtained immediately after PTCA. With this protocol, myocardial perfusion defects were observed during PTCA and fully redistributed 3 hours after Tl injection. Extent of ischemic lesions were almost same as that observed during exercise in two cases without collateral vessels. In a case with well visualized collateral vessels, perfusion defect was smaller in PTCA images than that in exercise stressed images. We conclude that intravenous injection of Tl-201 during PTCA is useful to assess the alteration of myocardial perfusion due to transient coronary occlusion without increasing the risk of angioplastic procedure. (author)

  2. Thirty Years Later: Evolution of Treatment for Acute Left Main Coronary Artery Occlusion

    Directory of Open Access Journals (Sweden)

    Moshe Y. Flugelman

    2016-01-01

    Full Text Available Acute occlusion of left main coronary artery is a catastrophic event. We describe two patients with acute occlusion of the left main coronary artery treated thirty years apart. The first patient was treated in 1982 and survived the event without revascularization but developed severe heart failure. His survival was so unusual that it merited a case report at that time. The second patient was treated at the end of 2015. Early revascularization resulted in myocardial reperfusion and near normal left ventricular function. These patients exemplify the progress in therapeutic cardiology over the last 30 years.

  3. Acute Simultaneous Thrombotic Occlusion of Multiple Coronary Arteries in Acute Myocardial Infarction: A Case Report

    Directory of Open Access Journals (Sweden)

    Mohammad Mahdi Daei

    2017-05-01

    Full Text Available Introduction Simultaneous multiple coronary artery thrombosis is a rare finding in ST segment elevation myocardial infarction (STEMI, and has a high mortality rate. Case Presentation We report a case of myocardial infarction with cardiogenic shock, left bundle branch block, and multiple ST segment elevation on the electrocardiogram and thrombotic occlusion of the left circumflex, optus marginal, and left anterior descending arteries on emergency coronary angiography. Thrombus aspiration was performed at left circumflex, optus marginal, and left anterior descending arteries. Conclusions In patients with STEMI, multiple coronary thrombosis is unusual and associated with high patient mortality.

  4. Thallium-201 myocardial perfusion imaging during transient coronary occlusion at the time of PTCA

    International Nuclear Information System (INIS)

    Nakagawa, Tatsuya; Sugihara, Hiroki; Inagaki, Suetsugu

    1989-01-01

    To evaluate myocardial perfusion during transient coronary arterial occlusion, thallium-201 was administered intravenously during percutaneous transluminall coronary angioplasty (PTCA) in 12 patients with effort angina, and the resulting perfusion images were compared with those of exercise stress obtained before PTCA. Thallium-201 was injected at the last inflation of an angioplastic baloon and occlusion was maintained for 60 to 90 sec. Three projections of planar images were obtained immediately after PTCA, using a portable gamma camera in an angiography room. These perfusion images obtained during PTCA and exercise were visually interpreted and compared. Myocardial perfusion defects due to the responsible vessel occlusion were observed at early imaging after PTCA, and were fully redistributed three hrs post injection. In 10 patients without angiographically imaged collateral vessels, there were no significatn differences in perfusion between images during PTCA and during exercise. Two patients whose collaterals were observed during coronary angiography before PTCA had higher perfusion scores during PTCA than during exercise. We concluded that intravenous injection of thallium-201 during PTCA is a useful means for assessing alteration of myocardial perfusion due to transient coronary occlusion without increasing the risk of angioplastic procedures, and that it provides more precise information about the jeopardized myocardium, perfused by antegrade blood flow. (author)

  5. Assessment of collateral artery function and growth in a pig model of stepwise coronary occlusion

    NARCIS (Netherlands)

    de Groot, Daphne; Grundmann, Sebastian; Timmers, Leo; Pasterkamp, Gerard; Hoefer, Imo E.

    de Groot D, Grundmann S, Timmers L, Pasterkamp G, Hoefer IE. Assessment of collateral artery function and growth in a pig model of stepwise coronary occlusion. Am J Physiol Heart Circ Physiol 300: H408-H414, 2011. First published October 15, 2010; doi: 10.1152/ajpheart.00070.2010.-Therapeutic

  6. [Heparin in coronary angioplasty. Randomized study in cases with low risk of acute occlusion].

    Science.gov (United States)

    Tanajura, L F; Sousa, A G; Pinto, I M; Chaves, A J; Centemero, M P; Feres, F; Mattos, L A; Cano, M N; Maldonado, G A; Sousa, J E

    1993-02-01

    To assess the efficacy of heparin in preventing the abrupt closure after coronary angioplasty in low risk patients for this phenomenon. In the last 4 years, 525 patients successfully dilated were randomized to receive intravenous heparin (n = 264) or not (n = 261) after the angioplasty. The excluding criteria were contraindications for heparin and risk for abrupt closure (refractory unstable angina, primary coronary angioplasty in acute myocardial infarction, evidence of intracoronary thrombus, intimal tear after the procedure and cases of chronic total occlusions). Both heparin and non heparin groups were similar in respect to female sex (15% x 17%; p = NS), age over 70 years old (7% x 9%; p = NS), previous myocardial infarction (26% x 24%; p = NS), multi-vessel procedures (4% x 7%; p = NS, stable angina (40% x 46%; p = NS), unstable angina (52% x 48%; p = NS) and angioplasty after thrombolytic therapy (8% x 6%; p = NS). The overall incidence of abrupt closure was 2/525 (0.4%), with one case (0.4%) in each group. The in-hospital mortality was 1/525 (0.2%), which occurred in a non-heparin patient, due to a anterior myocardial infarction. Major complications occurred similarly in heparin and non-heparin groups (0.4%). Bleeding complications were observed more frequently in the heparin group (7% x 2%; p = 0.002). All of them were in the catheterization site and none required blood transfusion. Severe systemic bleeding were not observed. In patients regarded as low risk for abrupt closure, the incidence of this complication was really low (0.4%) and heparin probably do not prevent it.

  7. Tips and tricks for antegrade recanalization of chronic total occlusions using the CrossBoss catheter.

    Science.gov (United States)

    Kwan, Tak W; Diwan, Ravi; Ratcliffe, Justin A; Huang, Yili; Patri, Rahul; James, David; Liou, Michael; Fallahi, Arzhang; Young, Bruce; Nanjundappa, Aravinda; Daggubati, Ramesh

    2015-02-01

    To provide new strategies and techniques for the successful recanalization of chronic total occlusions (CTOs) with the sole use of the CrossBoss catheter. In addition, some common CTO scenarios are illustrated in detail. CTOs are one of the most challenging complex coronary lesion subsets to intervene upon. Even with the innovation of specialized catheters, the success rate of antegrade recanalization remains low. Between June and December 2013, a retrospective analysis of 50 consecutive patients who presented with a planned percutaneous intervention (PCI) of a CTO was performed. In all patients, the CrossBoss catheter was used. No additional reentry devices were necessary. Procedural success was defined as failure. The average fluoroscopy time was 45.9 minutes and the average amount of contrast use was 273.8 mL. No patient suffered a coronary perforation from the CrossBoss catheter. With increased experience using the CrossBoss catheter, the antegrade success rate of CTOs can be improved. Some tips include identifying the likely course of the artery with the aid of retrograde injection, proper guidewire selection and manipulation, and redirecting the CrossBoss catheter if there is substantial deviation from the original path.

  8. Calculation of Coronary Angiographic Total Blush in Patients with Coronary Artery Disease and its Prognostic Implication

    Directory of Open Access Journals (Sweden)

    Jing-Jing Gai

    2015-01-01

    Full Text Available Background: Myocardial perfusion grade (MPG is an accepted method of evaluating myocardial perfusion. However, it does not take into the account, the extent of the perfusion. We hypothesized that myocardial blush area times MPG (total blush would be more accurate than simple MPG, and yield better prognostic information. Methods: About 34 patients were recruited after they had consented to both coronary angiography (CAG and single photon emission computed tomography (SPECT, and divided into two groups. A special dedicated computer was employed to calculate the total blush. The CAG was performed as a conventional way. Scintigraphic technetium 99m methoxyisobutyl-isonitrile rest and stress images were evaluated quantitatively. The comparison was made between stenosis versus chronic total occlusion (CTO, MPG 1, 2 versus MPG 3, percutaneous intervention (PCI successful versus failure. A correlation was made between ejection fraction (EF and myocardial perfusion by MPG, total blush, SPECT, and syntax score. Results: The perfusion indices of total blush, summed difference score (SDS and syntax score were insignificant between the two groups (P > 0.05. However, the left ventricular end diastolic volume was significantly larger in CTO (P < 0.05. The patients with stenosis had better MPG than with CTO (P < 0.05. The increased MPG was associated with increased total blush, higher syntax score, and EF (P < 0.05. Successful PCI resulted in better perfusion indicated by increased total blush, and MPG (P < 0.05 but successful PCI did not change syntax score, EF and SDS significantly. Multivariate linear analysis with EF as the dependent factor and syntax score, SDS, total blush, blush area, and MPG as the independent factors showed a significantly higher degree of correlation (R = 0.87, P < 0.05. Conclusion: After PCI the total blush and EF improved significantly indicating its potential application in the future.

  9. Microcatheter balloon pinning technique to facilitate wiring of a left circumflex chronic total occlusion.

    Science.gov (United States)

    Oguayo, Kevin N; Oguayo, Chris C; Vallabhan, Ravi; Choi, James W

    2017-12-01

    Coronary chronic total occlusions (CTOs) are commonly encountered during diagnostic angiograms. With recent advances, especially in experienced centers, success rates with CTO percutaneous coronary intervention (PCI) have approached 80% or higher. It is important to note that despite these advancements in techniques, CTOs remain difficult to treat. We present a case of a left circumflex artery (LCX) CTO that was successfully revascularized using a microcatheter balloon pinning technique that allowed additional wire support. A 77-year-old woman status post-two-vessel coronary artery bypass graft surgery presented with new onset angina at rest and was found to have a patent graft to the left anterior descending artery, and an unrevascularized proximal LCX CTO. PCI was attempted with a microcatheter using an antegrade approach. This approach was unsuccessful due to the lack of support and the left circumflex angle. As a result, we used a balloon to pin the microcatheter to the wall of the left main to allow for successful wiring of the LCX. A stent was successfully deployed in the LCX, and the patient was discharged from the hospital 2 days later. At follow-up, the patient was asymptomatic and returned to her usual activity. After conducting a thorough literature search, it appears that this is the first case that a microcatheter has been pinned with a balloon. We believe that in LCX CTOs that require support, the microcatheter pinning technique can provide adequate support in wiring CTO's. LCX CTOs can be very difficult to treat, we present a case of a LCX CTO that required the use of the microcatheter balloon pinning technique to allow additional wire support for successful wiring and ultimately treatment. © 2017 John Wiley & Sons Ltd.

  10. Absence of robust ischemic preconditioning by five 1-minute total umbilical cord occlusions in fetal sheep.

    NARCIS (Netherlands)

    Lotgering, F.K.; Bishai, J.M.; Struijk, P.C.; Blood, A.B.; Hunter, C.J.; Oberg, K.C.; Power, G.G.; Longo, L.D.

    2004-01-01

    OBJECTIVE: To determine to what extent a series of five 1-minute total umbilical cord occlusions, intended to induce ischemic preconditioning (IP), affects the physiologic responses to a 10-minute total umbilical cord occlusion (damaging insult [DI]) 1 hour later and provides cardio- and

  11. Long-term clinical outcomes after successful and failed recanalization to native chronic Total occlusion: Insights from the Busan chronic Total occlusion (B-CTO) Registry.

    Science.gov (United States)

    Kim, Moo Hyun; Mitsudo, Kazuaki; Jin, Cai De; Kim, Tae Hyung; Cho, Young-Rak; Park, Jong-Sung; Park, Kyungil; Park, Tae-Ho; Serebruany, Victor

    2016-06-01

    To assess hard major adverse clinical events (HMACE) after successful versus failed percutaneous coronary intervention for chronic total occlusion (PCI-CTO). There are limited data regarding long-term HMACE risks based on PCI-CTO success. First-time PCI was performed in 438 consecutive patients with 473 target CTO lesions. Patients after procedural success (n=355; 378 CTO lesions) and failure (n=83; 95 CTO lesions) were followed for an average 40months (7-77months range). We compared HMACE (composite of cardiac death, non-fatal myocardial infarction (MI), and stroke) dependent on the success of PCI. The incidence of HMACE was low, with a total of 16 events, and did not differ {6% vs.3.1%, HR=0.47; CI [0.16-1.35; p=0.162} dependent on the success of PCI-CTO. There were less cardiac deaths {0.3% vs. 1.2%, RR=0.22; CI [0.01-3.50];p=0.283}, non fatal MI {1.1% vs.3.6%, RR=0.27; CI [0.06-1.22], p=0.089}, but more strokes {1.7% vs.1.2%, RR=1.32; CI [0.16-10.99], p=0.795} after successful PCI-CTO. The risks of HMACE after PCI-CTO over long-term follow-up were minimal, and do not depend on the procedure success. This unexpected finding somewhat challenge the aggressive interventional approach, and should be confirmed in the adequately powered randomized trial. Copyright © 2016 Elsevier Inc. All rights reserved.

  12. Robotically assisted totally endoscopic coronary artery bypass surgery

    OpenAIRE

    Canale, Leonardo Secchin; Mick, Stephanie; Mihaljevic, Tomislav; Nair, Ravi; Bonatti, Johannes

    2013-01-01

    Robotically assisted totally endoscopic coronary artery bypass surgery has emerged as a feasible and efficient alternative to conventional full sternotomy coronary artery bypass graft surgery in selected patients. This minimally invasive approach using the daVinci robotic system allows fine intrathoracic maneuvers and excellent view of the coronary arteries. Both on-pump and off-pump operations can be performed to treat single and multivessel disease. Hybrid approaches have the potential of o...

  13. Initial and Long-Term Results of Endovascular Therapy for Chronic Total Occlusion of the Subclavian Artery

    International Nuclear Information System (INIS)

    Babic, Srdjan; Sagic, Dragan; Radak, Djordje; Antonic, Zelimir; Otasevic, Petar; Kovacevic, Vladimir; Tanaskovic, Slobodan; Ruzicic, Dusan; Aleksic, Nikola; Vucurevic, Goran

    2012-01-01

    Purpose: To study the initial and long-term results of angioplasty and primary stenting for the treatment of chronic total occlusion (CTO) of the subclavian artery (SA). Materials and Methods: From January 1999 to February 2010, 56 patients (25 men with a mean age of 58 ± 8 years) underwent endovascular treatment for CTO of the SA. Duplex scans and arteriograms confirmed occlusion in all cases. Indications for recanalization were subclavian steal syndrome in 33 patients (58.1%), arm claudication in 13 patients (23.2%), and coronary ischemia in 7 patients (12.5%) who had a history of previous coronary artery bypass grafting that included left internal thoracic artery graft. Three patients (5.4%) were treated before the scheduled coronary artery bypass surgery, which included left internal thoracic artery graft. After successful recanalization, all arteries were stented, and all of the patients were followed-up at 1, 3, 6, and 12 months after surgery and annually thereafter. Results: Successful recanalization of the SA was achieved in 46 patients (82.1%), and the complication rate was 7.1%. During follow-up (mean 40 ± 26 months; range 2 to 125), the primary patency rates after 1 and 3 years were 97.9% and 82.7%, respectively. At the end of follow-up, 76% of the arteries showed no evidence of restenosis. Univariate analysis failed to identify any variable predictive of long-term patency of successfully recanalized SA. Conclusion: Percutaneous transluminal angioplasty with stenting of the complete total occlusion of the SA is a safe and effective procedure associated with low risks and good long-term results.

  14. [Occlusion of secondary branches after angioplasty of the left descending coronary artery].

    Science.gov (United States)

    Araújo, E C; Sousa, A G; Nicolela Júnior, E L; Cano, M N; Maldonado, G; Feres, F; Mattos, L A; Pinto, I M; Tanajura, L F; Fontes, V F

    1990-05-01

    To evaluate the incidence and clinical presentation of the occlusion of such secondary branches in patients with single vessel coronary artery disease in the left anterior descending artery, who underwent a first elective and successful PTCA. Two hundred and thirteen side branches of 121 patients considered to be at risk. They were divided into group I (GI-85 side branches, 39.9%), if they originated from the atherosclerotic site; and group II (GII-120 side branches, 61.5%), if their origin would be involved during the balloon inflation. In the GI there were 54 septal branches and 31 diagonal branches, and 36& had angiographic evidence of ostium disease. GII was constituted by 77 septal and 51 diagonal branches, and 7.8% of them had evidence of ostium disease. Seven side branches (3.3%) at risk occluded, 4 from GI (4.7%) and 3 (2.3%) from GII. As for the clinical presentation, 57% of them had angina, where as 28.6% showed minor abnormalities in the ECG. No patient elevated its serum CK-MB, and silent occlusion occurred in 43% of them. Occlusion of side branches is a low incidence phenomenon, which happens more often in septal branches with ostium disease that originates from the atherosclerotic site; that about half of the patient had silent occlusion (43%) or mild ischemic manifestations.

  15. The Effect of PAI-1 4G/5G Polymorphism and Clinical Factors on Coronary Artery Occlusion in Myocardial Infarction.

    Science.gov (United States)

    Parpugga, Tajinder Kumar; Tatarunas, Vacis; Skipskis, Vilius; Kupstyte, Nora; Zaliaduonyte-Peksiene, Diana; Lesauskaite, Vaiva

    2015-01-01

    Data on the impact of PAI-1-675 4G/5G genotype for fibrinolysis during myocardial infarction are inconsistent. The aim of our study was to evaluate the association of clinical and genetic (PAI-1-675 4G/5G polymorphism) factors with coronary artery occlusion in patients with myocardial infarction. PAI-1-675 4G/5G detection was achieved by using Sanger sequencing in a sample of patients hospitalized for stent implantation due to myocardial infarction. We categorized the patients into two groups: patients with coronary artery occlusion and patients without coronary artery occlusion according to angiographic evaluation. We identified n = 122 (32.4%) 4G/4G, n = 186 (49.5%) 4G/5G, and n = 68 (18.1%) 5G/5G PAI-1 genotype carriers. Univariate and multivariate analysis showed that only the 4G/5G genotype was associated with coronary artery occlusion (OR: 1.656 and 95% CI: 1.009-2.718, p = 0.046). Our results showed that carriers of PAI-1 4G/5G genotype with myocardial infarction have increased odds of coronary artery occlusion more than 1.6 times in comparison to the carriers of homozygous genotypes.

  16. Robotically assisted totally endoscopic coronary artery bypass surgery

    Science.gov (United States)

    Canale, Leonardo Secchin; Mick, Stephanie; Mihaljevic, Tomislav; Nair, Ravi

    2013-01-01

    Robotically assisted totally endoscopic coronary artery bypass surgery has emerged as a feasible and efficient alternative to conventional full sternotomy coronary artery bypass graft surgery in selected patients. This minimally invasive approach using the daVinci robotic system allows fine intrathoracic maneuvers and excellent view of the coronary arteries. Both on-pump and off-pump operations can be performed to treat single and multivessel disease. Hybrid approaches have the potential of offering complete revascularization with the “best of both worlds” from surgery (internal mammary artery anastomosis in less invasive fashion) and percutaneous coronary intervention (least invasive approach). In this article we review the indications, techniques, short and long term results, as well as current developments in totally endoscopic robotic coronary artery bypass operations. PMID:24251021

  17. Coronary stent implantation is superior to balloon angioplasty for chronic coronary occlusions: six-year clinical follow-up of the GISSOC trial.

    Science.gov (United States)

    Rubartelli, Paolo; Verna, Edoardo; Niccoli, Luigi; Giachero, Corinna; Zimarino, Marco; Bernardi, Guglielmo; Vassanelli, Corrado; Campolo, Luigi; Martuscelli, Eugenio

    2003-05-07

    We investigated whether the benefits of stent implantation over balloon percutaneous transluminal coronary angioplasty (PTCA) for treatment of chronic total coronary occlusions (CTO) are maintained in the long term. Several randomized trials have shown that in CTO, stent implantation confers clinical and angiographic mid-term outcomes superior to those observed after PTCA. However, limited information on the long-term results of either technique is available. Six-year clinical follow-up of patients enrolled in the Gruppo Italiano di Studio sullo Stent nelle Occlusioni Coronariche (GISSOC) trial was performed by direct visit or telephone interview. Major adverse cardiac events (MACE), defined as cardiac death, myocardial infarction, target lesion revascularization (TLR), and anginal status, were recorded. Freedom from MACE at six years was 76.1% in the stent group, compared with 60.4% in the PTCA group (p = 0.0555). This difference was due mainly to TLR-free survival rates (85.1% vs. 65.5% for the stent and PTCA groups, respectively; p = 0.0165). Eleven patients underwent TLR after the nine-month follow-up visit (stent group: n = 5; PTCA group: n = 6); however, in most cases, restenosis of the study occlusion was evident at nine-month angiography. This study represents the longest reported clinical follow-up of patients after percutaneous recanalization of CTO and demonstrates that the superiority of stent implantation over balloon PTCA is maintained in the long term. Stent and PTCA results appear to remain stable after nine-month angiographic follow-up. Stent implantation in CTO that can be recanalized percutaneously is therefore a valuable long-term therapeutic option.

  18. Balloon Occlusion of the Contralateral Iliac Artery to Assist Recanalization of the Ipsilateral Iliac Artery in Total Aortoiliac Occlusion: A Technical Note

    Directory of Open Access Journals (Sweden)

    Abdel Aziz A. Jaffan

    2013-01-01

    Full Text Available Endovascular recanalization of chronic total aortoiliac occlusion is technically challenging. Inability to reenter the true aortic lumen, following retrograde iliac recanalization, is one of the most common causes of failure. We describe a case of a total aortoiliac occlusion where balloon occlusion of the right common iliac artery, following its recanalization from a brachial approach, was used to facilitate antegrade recanalization of the occluded contralateral left common iliac artery.

  19. Loss of PDZK1 causes coronary artery occlusion and myocardial infarction in Paigen diet-fed apolipoprotein E deficient mice.

    Directory of Open Access Journals (Sweden)

    Ayce Yesilaltay

    2009-12-01

    Full Text Available PDZK1 is a four PDZ-domain containing protein that binds to the carboxy terminus of the HDL receptor, scavenger receptor class B type I (SR-BI, and regulates its expression, localization and function in a tissue-specific manner. PDZK1 knockout (KO mice are characterized by a marked reduction of SR-BI protein expression ( approximately 95% in the liver (lesser or no reduction in other organs with a concomitant 1.7 fold increase in plasma cholesterol. PDZK1 has been shown to be atheroprotective using the high fat/high cholesterol ('Western' diet-fed murine apolipoprotein E (apoE KO model of atherosclerosis, presumably because of its role in promoting reverse cholesterol transport via SR-BI.Here, we have examined the effects of PDZK1 deficiency in apoE KO mice fed with the atherogenic 'Paigen' diet for three months. Relative to apoE KO, PDZK1/apoE double KO (dKO mice showed increased plasma lipids (33% increase in total cholesterol; 49 % increase in unesterified cholesterol; and 36% increase in phospholipids and a 26% increase in aortic root lesions. Compared to apoE KO, dKO mice exhibited substantial occlusive coronary artery disease: 375% increase in severe occlusions. Myocardial infarctions, not observed in apoE KO mice (although occasional minimal fibrosis was noted, were seen in 7 of 8 dKO mice, resulting in 12 times greater area of fibrosis in dKO cardiac muscle.These results show that Paigen-diet fed PDZK1/apoE dKO mice represent a new animal model useful for studying coronary heart disease and suggest that PDZK1 may represent a valuable target for therapeutic intervention.

  20. Adaptation in properties of skeletal muscle to coronary artery occlusion/reperfusion in rats

    Energy Technology Data Exchange (ETDEWEB)

    Ogoh, Shigehiko [Univ. of North Texas, Fort Worth, TX (United States). Health Science Center; Hirai, Taku [Kyoto Univ. (Japan). Graduate School of Medicine; Nohara, Ryuuji [Kitano Hospital, Osaka (Japan); Taguchi, Sadayoshi [Kyoto Univ. (Japan). Graduate School of Human and Environmental Studies

    2002-10-01

    The present study was designed to determine if changes in function and metabolism of heart muscle induce alterations in characteristics of skeletal muscle. We investigated the histochemical and biochemical properties of soleus (SOL) and extensor digitorum longus (EDL) muscles in Wistar rats at the chronic phase after coronary artery occlusion/reperfusion. The size of myocardial infarct region was evaluated using a high resolution pinhole single photo emission computed tomography (SPECT) system. 4wk after left coronary artery occlusion/reperfusion, the SOL and EDL of hindlimb were dissected out and immersed in isopentane cooled with liquid nitrogen for subsequent histochemical and biochemical analysis. From SPECT imaging, the blood circulation was recovered, but the recovery of fatty acid metabolism was not observed in infarct region of heart. Citrate synthase (CS) and 3-hydroxyacyl-CoA dehydrogenase (HAD) activities in infarct region of heart were lower in the myocardial infarction (MI, n=6) group compared with that of age-matched sham-operated (Sham, n=6) group. In addition, heart muscle hypertrophy caused by the dysfunction in MI group was observed. In skeletal muscle, the atrophy and transition of fiber type distribution in MI group, reported in previous studies of heart failure, were not observed. However, the succinate dehydrogenase (SDH) activity in the slow twitch oxidative (SO) from SOL of MI group decreased by 9.8% and in the fast twitch oxidative glycolytic fibers (FOG), 8.0% as compared with sham group. Capillary density of the SO fibers from SOL of MI group also reduced by 18.5% and in the FOG fibers, 18.2% as compared with Sham group. Decreased capillary density in this study related significantly to decreased SDH activity of single muscle fibers in chronic phase of perfusion after surgical infarction. Our results make it clear that there is a difference in the reaction of skeletal muscle to coronary artery occlusion/reperfusion compared with chronic

  1. Adaptation in properties of skeletal muscle to coronary artery occlusion/reperfusion in rats

    International Nuclear Information System (INIS)

    Ogoh, Shigehiko; Taguchi, Sadayoshi

    2002-01-01

    The present study was designed to determine if changes in function and metabolism of heart muscle induce alterations in characteristics of skeletal muscle. We investigated the histochemical and biochemical properties of soleus (SOL) and extensor digitorum longus (EDL) muscles in Wistar rats at the chronic phase after coronary artery occlusion/reperfusion. The size of myocardial infarct region was evaluated using a high resolution pinhole single photo emission computed tomography (SPECT) system. 4wk after left coronary artery occlusion/reperfusion, the SOL and EDL of hindlimb were dissected out and immersed in isopentane cooled with liquid nitrogen for subsequent histochemical and biochemical analysis. From SPECT imaging, the blood circulation was recovered, but the recovery of fatty acid metabolism was not observed in infarct region of heart. Citrate synthase (CS) and 3-hydroxyacyl-CoA dehydrogenase (HAD) activities in infarct region of heart were lower in the myocardial infarction (MI, n=6) group compared with that of age-matched sham-operated (Sham, n=6) group. In addition, heart muscle hypertrophy caused by the dysfunction in MI group was observed. In skeletal muscle, the atrophy and transition of fiber type distribution in MI group, reported in previous studies of heart failure, were not observed. However, the succinate dehydrogenase (SDH) activity in the slow twitch oxidative (SO) from SOL of MI group decreased by 9.8% and in the fast twitch oxidative glycolytic fibers (FOG), 8.0% as compared with sham group. Capillary density of the SO fibers from SOL of MI group also reduced by 18.5% and in the FOG fibers, 18.2% as compared with Sham group. Decreased capillary density in this study related significantly to decreased SDH activity of single muscle fibers in chronic phase of perfusion after surgical infarction. Our results make it clear that there is a difference in the reaction of skeletal muscle to coronary artery occlusion/reperfusion compared with chronic

  2. Total Arterial Off‑pump Coronary Revascularization with a Bilateral ...

    African Journals Online (AJOL)

    Total Arterial Off‑pump Coronary Revascularization with a Bilateral Internal Mammary Artery Y Graft (208 cases). Jun-Feng Yang, Hong-Chao Zhang1, Cheng-Xiong Gu, Hua Wei. INTRODUCTION. AY graft is a graft formed by the left internal mammary artery (LIMA) connected to the left anterior descending (LAD) artery and ...

  3. Role of 2D speckle tracking echocardiography in predicting acute coronary occlusion in patients with non ST-segment elevation myocardial infarction

    Directory of Open Access Journals (Sweden)

    Viola William Keddeas

    2017-06-01

    Conclusion: Both global and regional peak longitudinal systolic strain can offer accurate, feasible, and non-invasive predictor for acute coronary artery occlusion in patients with non ST elevation myocardial infarction who may benefit from early revascularization.

  4. Differentiation of chronic total occlusion and subtotal occlusion of the femoropopliteal artery-role of retrograde flow sign and collateral circulation on CT angiography images.

    Science.gov (United States)

    Zhang, Shujun; Su, Yanfei; Chen, Haisong

    2017-08-01

    To study the value of a retrograde flow sign and the collateral circulation on CT angiography (CTA) for the differential diagnosis of chronic total occlusion from subtotal occlusion of the femoropopliteal artery (FPA). 50 patients with obstruction of the FPA underwent CTA and digital subtraction angiography examinations of the lower limbs. The frequency of a retrograde flow sign and collateral circulation on CTA in chronic total and subtotal occlusion was noted and analyzed, with the results of digital subtraction angiography as a standard to judge total or subtotal occlusion. The decreasing CT value from the distal to proximal direction on CTA suggests the existence of retrograde flow. There were significant differences in the occurrence rates of a retrograde flow sign on CTA in the chronic total and subtotal obstruction groups (X 2 = 13.1, p collateral circulation sign (X 2 = 13.5, p collateral circulation sign to diagnose chronic total obstruction of the FPA had a sensitivity of 92.3% and specificity of 89.8%. The retrograde flow sign combined with a collateral circulation sign is of great clinical value for differentiation of chronic total stenosis from severe stenosis (subtotal occlusion) of the FPA. Advances in knowledge: A retrograde flow sign combined with a collateral circulation sign is of great clinical value to differentiate between chronic total stenosis and severe stenosis (subtotal occlusion) of the FPA.

  5. Endovascular crossing of Chronic Total Occlusions using an impulse : An explorative design study

    NARCIS (Netherlands)

    Sakes, A.; van der Wiel (student), Marleen; Dodou, D.; Breedveld, P.

    2017-01-01

    In this study we investigated whether exerting an impulse on a Chronic Total Occlusion (CTO) improves the success rate of CTO crossing as compared to the currently used method of statically pushing the guidewire against the CTO. A prototype (Ø2 mm) was developed that generates translational

  6. Quantification of myocardial injury produced by temporary coronary artery occlusion and reflow with technetium-99m-pyrophosphate

    International Nuclear Information System (INIS)

    Jansen, D.E.; Corbett, J.R.; Buja, L.M.; Hansen, C.; Ugolini, V.; Parkey, R.W.; Willerson, J.T.

    1987-01-01

    Previously, technetium-99m-stannous pyrophosphate (/sup 99m/Tc-PPi) has been used to localize and estimate the size of myocardial infarcts in animals after permanent coronary artery occlusion. This study tested the hypothesis that /sup 99m/Tc-PPi accurately sizes myocardial infarctions produced by temporary coronary artery occlusion and reflow in dogs. Three groups of dogs were studied: group A underwent 3 hr of occlusion followed by 2 hr of reperfusion, with /sup 99m/Tc-PPi injected 10 min after reflow (n = 10); group B underwent 3 hr of occlusion followed by 2 hr of reperfusion, with /sup 99m/Tc-PPi injected 90 min after reflow (n = 11); and group C underwent 3 hr of occlusion followed by reflow with /sup 99m/Tc-PPi injected at 10 min and again at 48 hr after reflow (n = 5). Myocardial slices from group A and B dogs were imaged in vitro. Group C dogs were imaged with single photon-emission computed tomography (SPECT) in vivo, and myocardial slices were imaged in vitro at the conclusion of the study. The extent of myocardial infarction was defined with triphenyltetrazolium chloride (TTC) staining, and coronary blood flow was estimated with radioactive microspheres. In addition, transmural myocardial tissue samples were taken from the center of the myocardial infarction, the lateral portion of the myocardial infarction, the normal myocardium adjacent to the lateral aspect of the infarcts, and from the normal myocardium and counted for /sup 99m/Tc-PPi activity. A significant correlation was found between infarct size determined by areas of increased /sup 99m/Tc-PPi uptake and that estimated from TTC staining for both group A (r = .89) and group B animals (r = .98)

  7. Patent haemostasis prevents radial artery occlusion in patients with an acute coronary syndrome.

    Science.gov (United States)

    Wilson, Simon J; Mitchell, Andrew; Gray, Timothy J M; Loh, Hoe Jun; Cruden, Nick L

    2017-08-01

    A haemostatic technique that maintains radial artery flow ("patent haemostasis") following transradial catheterization reduces rates of radial artery occlusion (RAO) in patients with stable coronary disease. It is unclear whether this benefit extends to patients with an acute coronary syndrome (ACS). Patients undergoing inpatient transradial catheterization for an ACS were prospectively enrolled in a consecutive cohort study (n=300). Radial haemostasis was obtained using standard radial compression (cohort 1; n=150) or patent haemostasis (cohort 2; n=150). An end-of-case activated clotting time (ACT) was recorded and radial artery patency assessed within 24 hours of sheath removal by reverse Barbeau's test. The incidence of RAO was 16.0% following standard radial compression and 5.3% following patent haemostasis (p=0.003). Univariate predictors of RAO were patent haemostasis (OR 0.30; [0.13-0.68], p=0.004), hyperlipidaemia (OR 0.46; [0.21-0.98], p=0.04), history of current smoking (OR 2.86; [1.3-6.0], p=0.015) and longer procedure times (OR 1.03/additional minute; [1.01-1.05], p=0.003). There was no association between the end-of-case ACT and RAO (OR 1.00; [0.9-1.01] p=1.00). After adjusting for covariates, patent haemostasis reduced the risk of RAO by 70% compared to standard compression (OR 0.30; [0.12-0.77], p=0.12). The c-statistic for model discrimination was 0.79 (95% CI [0.71-0.86], ppatent haemostasis as an independent predictor of reduced RAO (OR 0.38 [0.15-0.95], p=0.039). Patent haemostasis is highly effective in preventing early RAO in patients with ACS. Copyright © 2017 Elsevier B.V. All rights reserved.

  8. A common variant of endothelial nitric oxide synthase (Glu298Asp) is associated with collateral development in patients with chronic coronary occlusions

    International Nuclear Information System (INIS)

    Lamblin, Nicolas; Cuilleret, François J; Helbecque, Nicole; Dallongeville, Jean; Lablanche, Jean-Marc; Amouyel, Philippe; Bauters, Christophe; Van Belle, Eric

    2005-01-01

    Experimental studies support an important role for endothelial nitric oxide synthase (eNOS) in the regulation of angiogenesis. In humans, a common polymorphism exists in the eNOS gene that results in the conversion of glutamate to aspartate for codon 298. In vitro and in vivo studies have suggested a decreased NOS activity in patients with the Asp 298 variant. We hypothesized that a genetic-mediated decreased eNOS activity may limit collateral development in patients with chronic coronary occlusions. We selected 291 consecutive patients who underwent coronary angiography and who had at least one chronic (>15 days) total coronary occlusion. Collateral development was graded angiographically using two different methods: the collateral flow grade and the recipient filling grade. Genomic DNA was extracted from white blood cells and genotyping was performed using previously published techniques. Collateral development was lower in patients carrying the Asp 298 variant than in Glu-Glu homozygotes (collateral flow grade: 2.64 ± 0.08 and 2.89 ± 0.08, respectively, p = 0.04; recipient filling grade: 3.00 ± 0.08 and 3.24 ± 0.07, respectively, p = 0.04). By multivariable analysis, three variables were independently associated with the collateral flow grade: female gender, smoking, and the Asp 298 variant (p = 0.03) while the Asp 298 variant was the sole variable independently associated with the recipient filling grade (p = 0.03). Collateral development is lower in patients with the Asp 298 variant. This may be explained by the decreased NOS activity in patients with the Asp 298 variant. Further studies will have to determine whether increasing eNOS activity in humans is associated with coronary collateral development

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

    NARCIS (Netherlands)

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

    1986-01-01

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

  10. Novel Crossing System for the Recanalization of Complex Chronic Total Occlusions: Ex vivo Proof of Concept of the SoundBite Crossing System.

    Science.gov (United States)

    Bérubé, Simon; Benko, Andrew; Despatis, Marc-Antoine; Riel, Louis-Philippe; Brodmann, Marianne; Therasse, Eric; Brouillette, Martin; Mustapha, Jihad A; Généreux, Philippe

    2017-04-01

    Chronic total occlusion (CTO) lesions are frequent in patients with peripheral and coronary artery disease, and associated with a higher risk of adverse events, including mortality, decreased quality of life, and increased health-care costs. Percutaneous intervention of CTO lesions has been associated with a lower procedural success rate, and current dedicated CTO devices may be of limited use for the non-CTO expert, and associated with increased intraprocedural complication rates. The SoundBite Crossing System (SoundBite Medical Solutions, Inc) is a newly developed device using shockwaves (short-duration, high-amplitude pressure pulses) to facilitate penetration of the proximal cap and crossing of the occlusion. The current report describes the first use of the SoundBite Crossing System in the recanalization of human ex vivo occluded arteries below the knee during a simulated procedure performed under fluoroscopy. Microcomputed tomography and histologic evaluation of the occluded and recanalized segment are provided to support therapeutic mechanism.

  11. Computational fluid dynamics study of the end-side and sequential coronary artery bypass anastomoses in a native coronary occlusion model.

    Science.gov (United States)

    Matsuura, Kaoru; Jin, Wei Wei; Liu, Hao; Matsumiya, Goro

    2018-04-01

    The objective of this study was to evaluate the haemodynamic patterns in each anastomosis fashion using a computational fluid dynamic study in a native coronary occlusion model. Fluid dynamic computations were carried out with ANSYS CFX (ANSYS Inc., Canonsburg, PA, USA) software. The incision lengths for parallel and diamond anastomoses were fixed at 2 mm. Native vessels were set to be totally occluded. The diameter of both the native and graft vessels was set to be 2 mm. The inlet boundary condition was set by a sample of the transient time flow measurement which was measured intraoperatively. The diamond anastomosis was observed to reduce flow to the native outlet and increase flow to the bypass outlet; the opposite was observed in the parallel anastomosis. Total energy efficiency was higher in the diamond anastomosis than the parallel anastomosis. Wall shear stress was higher in the diamond anastomosis than in the parallel anastomosis; it was the highest at the top of the outlet. A high oscillatory shear index was observed at the bypass inlet in the parallel anastomosis and at the native inlet in the diamond anastomosis. The diamond sequential anastomosis would be an effective option for multiple sequential bypasses because of the better flow to the bypass outlet than with the parallel anastomosis. However, flow competition should be kept in mind while using the diamond anastomosis for moderately stenotic vessels because of worsened flow to the native outlet. Care should be taken to ensure that the fluid dynamics patterns are optimal and prevent future native and bypass vessel disease progression.

  12. Treatment of Chronic Total Occlusions Using the Avinger Ocelot Crossing Catheter

    OpenAIRE

    Sewall, Luke E.

    2015-01-01

    Peripheral arterial disease is becoming more prevalent as the population ages. In addition, the severity of the disease seems to be progressing from simple narrowing of vessels to chronic total occlusions (CTOs). Treatment of CTOs of the infrainguinal peripheral arteries remains a challenge even for experienced endovascular specialists. Many crossing techniques have been described ranging from standard guidewire and catheter-based techniques including subintimal recanalization to specialized ...

  13. Kinetics of thallium-201 in reperfused canine myocardium after coronary artery occlusion

    International Nuclear Information System (INIS)

    Okada, R.D.

    1984-01-01

    To study the kinetics of thallium-201 in nonsalvaged acutely infarcted myocardium and salvaged myocardium, the tracer was administered after experimental left anterior descending coronary artery reperfusion 2 hours after occlusion. In 19 dogs, thallium activity was then monitored for 4 hours in the reperfused anterior wall and normal posterior wall using miniature cadmium telluride radiation detectors. After sacrifice, 13 of the dogs were found to have an infarcted anterior wall by triphenyltetrazolium-chloride staining. In these dogs, mean (+/- standard deviation) fractional 4 hour thallium clearance was 0.33 +/- 0.08 for the infarct zone and 0.15 +/- 0.06 for the normal control zone (p less than 0.001). When computer-modeled, the clearance curve from the infarct zone was biexponential. The second exponential clearance curve from the infarct zone began 19.1 +/- 3.2 minutes after tracer administration, and was indistinguishable from the monoexponential clearance curve from the normal control zone. Thallium clearance from the blood pool was triexponential, the final exponential clearance curve being indistinguishable from the normal control zone clearance curve. Six dogs were found to have a salvaged noninfarcted anterior wall by triphenyltetrazolium-chloride staining. In these dogs, mean fractional 4 hour thallium clearance was 0.20 +/- 0.07 for the reperfused zone, and 0.19 +/- 0.08 for the normal control zone (p . NS). When computer-modeled, clearance curves for the reperfused and control zones were monoexponential. The monoexponential clearance curve for the salvaged reperfused zone was indistinguishable from the monoexponential clearance curve for normal myocardium

  14. Functional Significance of Angiographic Collaterals in Patients with Totally Occluded Right Coronary Artery: Intracoronary Thallium-201 Scintigraphy

    International Nuclear Information System (INIS)

    Lee, Do Yun; Lee, Jong Doo; Cho, Seung Yun; Shim, Won Heum; Ha, Jong Won; Kim, Han Soo; Kwon, Hyuk Moon; Jang, Yang Soo; Chung, Nam Sik; Kim, Sung Soon; Park, Chang Yun; Kim, Young Soo

    1993-01-01

    To compare the myocardial viability in patients suffering from total occlusion of the right coronary artery (RCA) with the angiographic collaterals, intracoronary injection of Thallium-201 (T1-201) was done to 14 coronary artery disease (CAD) patients (pts) with total occlusion of RCA and into four normal subjects for control. All 14 CAD pts had Grade 2 or 3 collateral circulations. There were 14 male and 4 females, and their ages ranged from 31 to 70 years. In nine pts, T1-201 was injected into left main coronary artery (LCA) (300 ∼ 350 μ Ci) to evaluate the myocardial viability of RCA territory through collateral circulations. The remaining five pts received T1-201 into RCA (200-250 μ Ci) because two had intraarterial bridging collaterals and three had previous successful PTCA. Planar and SPECT myocardial perfusion images were obtained 30 minutes, and four to five hours after T1-201 reinjection. Intravenous T1-201 reinjection (six pts) or 99m Tc-MIBI (two pts) were also performed in eight CAD pts. Intracoronary myocardial perfusion images were compared with intravenous T1-201(IV T1-201) images, EGG, and ventriculography. Intracoronary TI-201 images proved to be superior to that of IV T1-201 due to better myocardial to background uptake ratio and more effective in the detection of viable tissue. We also found that perfusion defects were smaller on intracoronary T1-201 images than those on the IV T1-201. All of the 14 CAD pts had either mostly viable myocardium (seven pts) or large area of T1-201 perfusion (seven pts) in RCA territory, however ventriculographic wall motion and ECG did not correlate well with intracoronary myocardial perfusion images. In conclusion, total RCA occlusion patients with well developed collateral circulation had large area of viable myocardial in the corresponding territory.

  15. The effect of collateral flow and myocardial viability on the distribution of technetium-99m sestamibi in a closed-chest model of coronary occlusion and reperfusion

    International Nuclear Information System (INIS)

    Chareonthaitawee, P.; O'Connor, M.K.; Gibbons, R.J.; Christian, T.F.; Ritman, E.L.

    2000-01-01

    The objective of this study was to determine the effect of myocardial viability and the degree of collateral blood flow on the uptake and retention of 99m Tc-sestamibi by examining three animal models of coronary occlusion and reperfusion, each reflecting a different state of viability and collateral blood flow. Three closed-chest animal models were studied: canine (high collateral flow, preserved viability), porcine (low collateral flow, absent viability) and porcine with slowly occlusive coronary stents producing infarction and enhanced collateral blood flow (high collateral flow, absent viability). There were seven dogs, seven pigs and six pigs, respectively, in each animal model. Animals from all three models were subjected to a 40-min total left anterior descending artery (LAD) occlusion followed by 2 h of reperfusion. 99m Tc-sestamibi and radiolabelled microspheres were injected during LAD occlusion 10 min prior to reperfusion. Animals were sacrificed after 2 h of reperfusion flow. Ex situ heart slice imaging to determine risk area was followed by viability staining to determine infarct size. Slices were subsequently sectioned into equally sized radial segments and placed in a gamma well counter. Risk area as determined by ex situ 99m Tc-sestamibi imaging was not significantly different by model. Pathological infarct size differed significantly by model [canine = 1%±1% of the left ventricle (LV); porcine = 13%±8% LV; porcine with stent = 14%±7% LV; P=0.002]. Collateral blood flow by microspheres during occlusion tended to differ among models (overall P=0.08), with the canine and porcine with stent models having relatively high flow rates compared with the acute porcine model. 99m Tc-sestamibi activity correlated with microsphere blood flow in all three models, with r values for individual animals (n=20) ranging from 0.86 to 0.96 (all P 99m Tc-sestamibi uptake with myocardial blood flow. 99m Tc-sestamibi uptake overestimated blood flow to a greater extent

  16. Treatment of Chronic Total Occlusions Using the Avinger Ocelot Crossing Catheter.

    Science.gov (United States)

    Sewall, Luke E

    2015-12-01

    Peripheral arterial disease is becoming more prevalent as the population ages. In addition, the severity of the disease seems to be progressing from simple narrowing of vessels to chronic total occlusions (CTOs). Treatment of CTOs of the infrainguinal peripheral arteries remains a challenge even for experienced endovascular specialists. Many crossing techniques have been described ranging from standard guidewire and catheter-based techniques including subintimal recanalization to specialized CTO crossing devices. One of the newest technologies, the Avinger Ocelot catheter (Avinger, Inc., Redwood City, CA), employs optical coherence tomography imaging on the tip of a rotating crossing catheter to allow visual confirmation of luminal passage. This article will review this new technology for crossing CTOs, review the results of the multicenter CONNECT II trial, and discuss the potential benefits of direct visualization while crossing occlusions.

  17. Clinical, angiographic and hemodynamic predictors of recruitable collateral flow assessed during balloon angioplasty coronary occlusion

    NARCIS (Netherlands)

    Piek, J. J.; van Liebergen, R. A.; Koch, K. T.; Peters, R. J.; David, G. K.

    1997-01-01

    We sought to determine the predictive value of factors influencing coronary collateral vascular responses in humans. There is limited information on the factors responsible for coronary collateral vascular development, despite the protective effect of collateral vessels in ischemic syndromes.

  18. Effects of KB-R9032, a new Na+/H+ exchange inhibitor, on canine coronary occlusion/reperfusion-induced ventricular arrhythmias.

    Science.gov (United States)

    Yamada, Chikaomi; Xue, YiXue; Chino, Daisuke; Hashimoto, Keitaro

    2005-08-01

    We investigated the effects of KB-R9032 (N-(4-isopropyl-2,2-dimethyl-3-oxo-3,4-dihydro-2H-benzo[1,4]oxazine-6-carbonyl) guanidine methanesulfonate), a new Na(+)/H(+) exchange inhibitor, on a coronary artery occlusion/reperfusion-induced arrhythmia model in pentobarbital anesthetized dogs. KB-R9032 reduced the number of ventricular premature contractions seen during the coronary occlusion, while it did not alter the heart rate, mean blood pressure, or electrocardiographic parameters (PR, QRS, or QTc interval). KB-R9032 also decreased the incidence of fatal ventricular fibrillation during coronary artery occlusion and/or after reperfusion. These antiarrhythmic effects were observed not only in the pre-ischemic administration group, but also in the group given KB-R9032 at the 15th min of the 30-min occlusion. These findings support the view that Na(+)/H(+) exchanger may play an important role in inducing coronary ischemia/reperfusion arrhythmias. This suggests that the use of Na(+)/H(+) exchange inhibitors, such as KB-R9032, may be an effective clinical approach to suppress sudden cardiac death due to acute myocardial ischemia/reperfusion such as during coronary bypass surgery, cardiac valve surgery, or percutaneous transluminal coronary angioplasty.

  19. Quantification of ischemic stress during repeated coronary artery occlusion in the dog. A method for validation of therapeutic effects. I. Estimation of O2-debt and O2-repayment.

    Science.gov (United States)

    Hoeft, A; Korb, H; Baller, D; Wolpers, H G; Hellige, G; Bretschneider, H J

    1984-01-01

    In 9 open-chest mongrel dogs 4-6 intermittent 3-min occlusions of the LAD artery were performed with time intervals of about 45 min. Using a mu-computer, the following variables were calculated online: energy demand according to the Bretschneider equation (Et) from digitized hemodynamic data; myocardial oxygen consumption (MVO2) from fiberoptically measured coronary sinus oxygen saturation and coronary sinus blood flow. Coronary occlusion led to a decrease in MVO2 in comparison to Et. The integral of the difference between MVO2 and Et over the entire occlusion time yielded a total O2-deficiency (DO2) of 76 (+/- 12%) microliter O2/g ischemic tissue and a correlation coefficient with the weights of the intravitally stained ischemic areas of r = 0.96. Additional O2-uptake in relation to Et during the early perfusion period yielded a correlation to the size of the ischemic area of r = 0.95 and an average O2-repayment (RO2) of 32 (+/- 14%) microliter O2/g ischemic tissue. The determination of total myocardial O2-deficiency during ischemic stress as well as determination of O2-repayment during the early reperfusion period could be used to estimate the extent of ischemic stressed myocardium. Subsequently, the evaluation of pharmacological effects on myocardial ischemia should be possible.

  20. Successful total robotic-assisted aortobifemoral bypass for treatment of complicated aortoiliac occlusive disease.

    Science.gov (United States)

    Lin, Judith C; Kaul, Sanjeev A; Rogers, Craig G

    2011-05-01

    Laparoscopic aortobifemoral bypass (AFB) for aortoiliac occlusive disease (AIOD) is a durable, minimally invasive procedure with comparable long-term outcomes to conventional open AFB. However, laparoscopic AFB requires advance training in laparoscopy with prolong learning curve to accomplish infrarenal aortic dissection and vascular reconstruction to minimize aortic clamp time and leg ischemia time. We describe another minimally invasive technique of total robotic-assisted AFB for extensive, complicated AIOD in 3 patients who are not endovascular candidate or have failed endoluminal approach previously.

  1. Optical coherence tomography findings after chronic total occlusion interventions: Insights from the “AngiographiC evaluation of the everolimus-eluting stent in chronic Total occlusions” (ACE-CTO) study (NCT01012869)

    Energy Technology Data Exchange (ETDEWEB)

    Sherbet, Daniel P.; Christopoulos, Georgios; Karatasakis, Aris; Danek, Barbara Anna; Kotsia, Anna; Navara, Rachita; Michael, Tesfaldet T.; Roesle, Michele; Rangan, Bavana V.; Haagen, Donald [VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, TX (United States); Garcia, Santiago [Minneapolis VA Healthcare System and University of Minnesota, Minneapolis, MN (United States); Maniu, Calin [Bon Secours Health System, Suffolk, VA (United States); Pershad, Ashish [Banner Good Samaritan Medical Center, Phoenix, AZ (United States); Abdullah, Shuaib M.; Hastings, Jeffrey L.; Kumbhani, Dharam J.; Luna, Michael; Addo, Tayo; Banerjee, Subhash [VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, TX (United States); Brilakis, Emmanouil S., E-mail: esbrilakis@gmail.com [VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, TX (United States)

    2016-10-15

    Background: There is limited information on optical coherence tomography (OCT) findings after percutaneous coronary intervention (PCI) of chronic total occlusions (CTOs). OCT allows high resolution imaging that can enhance understanding of the vascular response after stenting of chronically occluded vessels. Methods: The Angiographic Evaluation of the Everolimus-Eluting Stent in Chronic Total Occlusions (ACE-CTO) study collected angiographic and clinical outcomes from 100 patients undergoing CTO PCI with the everolimus-eluting stent (EES). OCT was performed 8-months post stenting in 62 patients. Every third frame was analyzed throughout the course of the stented arterial segment. Lumen contours were semi-automatically traced and stent struts were manually delineated, with automatic measurement of the strut to lumen distance. Struts on the luminal side of the lumen contour were classified as malapposed if the distance to the lumen contour exceeded 0.108 mm. Results: A total of 44,450 struts in 6047 frames were analyzed, of which 4113 9.3%, 95% confidence intervals [CI] 9.0% to 9.5%) were malapposed and 1230 (2.8%, 95% CI 2.6% to 2.9%) were uncovered. Fifty-five of 62 patients (88.7%, 95% CI 78.5% to 98.4%) had at least one malapposed stent strut and 50 patients (80.7%, 95% CI 69.2% to 88.6%) had at least one uncovered stent strut. Mean strut-intimal thickness of the apposed and malapposed struts was 0.126 ± 0.140 mm and − 0.491 ± 0.440 mm, respectively. Conclusion: High rates of stent strut malapposition and incomplete stent strut coverage were observed after CTO PCI using EES, highlighting unique challenges associated with stent implantation in CTOs. - Highlights: • Percutaneous coronary intervention with drug-eluting stents for chronic total occlusion is associated with a 40% rate of binary in-stent restenosis at 8 months • Of patients who receive a drug eluting stent for a chronic total occlusion 88.7% will have stent strut malapposition and 80.7% will

  2. Limitations of the Outback LTD re-entry device in femoropopliteal chronic total occlusions.

    Science.gov (United States)

    Shin, Susanna H; Baril, Donald; Chaer, Rabih; Rhee, Robert; Makaroun, Michel; Marone, Luke

    2011-05-01

    Subintimal recanalization for the treatment of femoropopliteal chronic total occlusions (CTO) occasionally requires re-entry devices to access the true lumen distally, but limited information is available on factors predicting the success or failure of these devices. We evaluated the Outback LTD re-entry device (LuMend, Redwood City, Calif; acquired by Cordis Corp, Miami Lakes, Fla). A retrospective review of patients with femoropopliteal CTO from August 2006 to August 2009 was performed. Age, gender, occlusion length, site of re-entry, and the angle of the aortic bifurcation were recorded. Procedural angiograms were used to assign a calcification score (none, mild, moderate, severe) at the re-entry site. Univariate and multivariate logistic regression analyses were used to identify factors predicting failure of re-entry into the true lumen. Of 249 CTOs treated, the re-entry device was used 52 times (20.9%): 47 superficial femoral artery (SFA) occlusions and 5 combined SFA and popliteal artery occlusions (33 TransAtlantic InterSociety Consensus II type C and 18 type D lesions). Of 48 procedures with available angiograms for review, the target re-entry site was at the adductor canal in 30 (62.5%), the above-knee popliteal artery in 13 (27.1%), behind the knee joint in 4 (8.3%), and the mid-SFA in 2 (4.2%). Patients (54% men) were a mean age of 73.1 years. Re-entry was successful in 34 attempts (64.5%). Causes of failure included inability to re-enter the true lumen in 11 (61.1%), difficulty tracking the device over a wire in 3 (16.7%), acute angle of aortic bifurcation in 2 (11.1%), mechanical failure of the device in 1 (5.6%), and difficulty tracking the device through the lesion in 1 (5.6%). Moderate or severe calcification at the site of re-entry was the only significant predictor of failure (odds ratio, 6.3; 95% confidence interval, 1.45-24.48; P = .01). An aortic bifurcation angle ≥40° did trend toward predicting success (odds ratio, 0.23; 95% confidence

  3. A randomised comparison of Conventional versus Intentional straTegy in patients with high Risk prEdiction of Side branch OccLusion in coronary bifurcation interVEntion: rationale and design of the CIT-RESOLVE trial.

    Science.gov (United States)

    Zhang, Dong; Yin, Dong; Song, Chenxi; Zhu, Chengang; Kirtane, Ajay J; Xu, Bo; Dou, Kefei

    2017-06-12

    The intentional strategy (aggressive side branch (SB) protection strategy: elective two-stent strategy or jailed balloon technique) is thought to be associated with lower SB occlusion rate than conventional strategy (provisional two-stent strategy or jailed wire technique). However, most previous studies showed comparable outcomes between the two strategies, probably due to no risk classification of SB occlusion when enrolling patients. There is still no randomised trial compared the intentional and conventional strategy when treating bifurcation lesions with high risk of SB occlusion. We aim to investigate if intentional strategy is associated with significant reduction of SB occlusion rate compared with conventional strategy in high-risk patients. The Conventional versus Intentional straTegy in patients with high Risk prEdiction of Side branch OccLusion in coronary bifurcation interVEntion (CIT-RESOLVE) is a prospective, randomised, single-blind, multicentre clinical trial comparing the rate of SB occlusion between the intentional strategy group and the conventional strategy group (positive control group) in a consecutive cohort of patients with high risk of side branch occlusion defined by V-RESOLVE score, which is a validated angiographic scoring system to evaluate the risk of SB occlusion in bifurcation intervention and used as one of the inclusion criteria to select patients with high SB occlusion risk (V-RESOLVE score ≥12). A total of 21 hospitals from 10 provinces in China participated in the present study. 566 patients meeting all inclusion/exclusion criteria are randomised to either intentional strategy group or conventional strategy group. The primary endpoint is SB occlusion (defined as any decrease in thrombolysis in myocardial infarction flow grade or absence of flow in SB after main vessel stenting). All patients are followed up for 12-month postdischarge. The protocol has been approved by all local ethics committee. The ethics committee have

  4. Silver-Impregnated Occlusive Dressing Reduces Rates of Acute Periprosthetic Joint Infection After Total Joint Arthroplasty.

    Science.gov (United States)

    Grosso, Matthew J; Berg, Ari; LaRussa, Samuel; Murtaugh, Taylor; Trofa, David P; Geller, Jeffrey A

    2017-03-01

    Commercial silver-impregnated occlusive dressings (such as Aquacel Ag Surgical wound dressing) have been touted as antimicrobial dressings to be used following total joint arthroplasty. Given the increased cost of an Aquacel dressing over a standard dressing for total joint arthroplasty, the objective of this study was to determine whether Aquacel surgical dressing is effective in reducing the rates of acute periprosthetic joint infection (PJI) compared to standard sterile dressing. We retrospectively reviewed the charts of 1173 consecutive patients who underwent a total knee or total hip arthroplasty between 2007 and 2015 by 1 surgeon. The surgeon switched from using a standard xeroform/gauze dressing to an Aquacel dressing in June 2011, with no other major changes in antimicrobial management. Charts were reviewed for evidence of acute PJI (within 3 months of surgery). There were a total of 11 cases of acute PJI in this patient cohort (0.94%). The incidence of acute PJI for patients managed with a sterile xeroform dressing was 1.58% (9 of 568 patients), compared to 0.33% (2 of 605 patients) with the use of Aquacel dressing. Univariate analysis showed this to be statistically significant (P = .03), and a multiple logistic regression model supported Aquacel surgical dressing as a protective factor with an odds ratio of 0.092 (95% confidence interval, 0.017-0.490; P = .005). This 4-fold decrease in acute PJI with the use of Aquacel dressing supports the use of silver-impregnated occlusive dressings for the reduction of acute PJI. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. Efficacy and safety of novel multi-lumen catheter for chronic total occlusions: from preclinical study to first-in-man experience.

    Science.gov (United States)

    Mitsutake, Yoshiaki; Ebner, Adrian; Yeung, Alan C; Taber, Mark D; Davidson, Charles J; Ikeno, Fumiaki

    2015-02-15

    To report our initial animal and human experience with a new multi-lumen catheter called MultiCross™ (Roxwood Medical, Inc.) in a porcine coronary model and patients with a chronic total occlusion (CTO). Preclinical safety study was done in the coronary vasculature of a porcine model. In a clinical setting, patients with a CTO of a coronary artery (n = 5) were enrolled. After an initial unsuccessful attempt using a conventional guidewire, operators could use the MultiCross system. The primary efficacy endpoint was successful recanalization (technical success) and the primary safety endpoint was serious adverse events through 30 days post-procedure. The MultiCross catheter was used for all patients after failure of the initial attempt with a guidewire. Successful recanalization was achieved in all CTOs attempted (100%). No patients reported any adverse events at 30 days post-procedure. In this first-in-man experience, the MultiCross catheter has the potential to enhance crossing of CTOs. © 2014 Wiley Periodicals, Inc.

  6. Association of Stress Test Risk Classification With Health Status After Chronic Total Occlusion Angioplasty (from the Outcomes, Patient Health Status and Efficiency in Chronic Total Occlusion Hybrid Procedures [OPEN-CTO] Study).

    Science.gov (United States)

    Salisbury, Adam C; Sapontis, James; Saxon, John T; Gosch, Kensey L; Lombardi, William L; Karmpaliotis, Dimitri; Moses, Jeffery W; Qintar, Mohammed; Kirtane, Ajay J; Spertus, John A; Cohen, David J; Grantham, J Aaron

    2018-03-01

    Stress testing is endorsed by the American College of Cardiology/American Heart Association Appropriate Use Criteria to identify appropriate candidates for Chronic Total Occlusion (CTO) Percutaneous Coronary Intervention (PCI). However, the relation between stress test risk classification and health status after CTO PCI is not known. We studied 449 patients in the 12-center OPEN CTO registry who underwent stress testing before successful CTO PCI, comparing outcomes of patients with low-risk (LR) versus intermediate to high-risk (IHR) findings. Health status was assessed using the Seattle Angina Questionnaire Angina Frequency (SAQ AF), Quality of Life (SAQ QoL), and Summary Scores (SAQ SS). Stress tests were LR in 40 (8.9%) and IHR in 409 (91.1%) patients. There were greater improvements on the SAQ AF (LR vs IHR 14.2 ± 2.7 vs 23.3 ± 1.3 points, p <0.001) and SAQ SS (LR vs IHR 20.8 ± 2.3 vs 25.4 ± 1.1 points, p = 0.03) in patients with IHR findings, but there was no difference between groups on the SAQ QoL domain (LR vs IHR 24.8 ± 3.4 vs 27.3 ± 1.6 points, p = 0.42). We observed large health status improvements after CTO PCI in both the LR and IHR groups, with the greatest reduction in angina among those with IHR stress tests. Although patients with higher risk studies may experience greater reduction in angina symptoms, on average, patients with LR stress tests also experienced large improvements in symptoms after CTO PCI, suggesting patients with refractory symptoms should be considered appropriate candidates for CTO PCI regardless of stress test findings. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. Ulnar Artery Compression: A Feasible and Effective Approach to Prevent the Radial Artery Occlusion after Coronary Intervention

    Directory of Open Access Journals (Sweden)

    Jun Tian

    2015-01-01

    Full Text Available Background: Radial artery (RA occlusion (RAO is not rare in patients undergoing coronary intervention by transradial approach (TRCI. Predictors of and prevention from RAO have not been systematically studied. This study aimed to analyze the risk factors of the weakness of RA pulsation (RAP and its predictive value for RAO after TRCI, and simultaneously to describe a feasible and effective approach to maintain RA patency. Methods: Between June 2006 and March 2010, all patients who underwent TRCI were classified according to the weakness of RAP after removing compression bandage with confirmation by Doppler ultrasound for the first 30 consecutive patients. Among a total of 2658 patients studied, 187 (7% patients having a weaker RAP were prospectively monitored. At 1 h after bandage removal, the ulnar artery in puncture side of all patients was blocked with manual compression to favor brachial and collateral artery blood flow through the RA until a good RAP was restored. The primary analysis was the occurrence of RAO. Results: Doppler ultrasound demonstrated the significant reduction of both systolic velocity (61.24 ± 3.95 cm/s vs. 72.31 ± 3.57 cm/s and diastolic velocity (1.83 ± 0.32 cm/s vs. 17.77 ± 3.97 cm/s in RA at access side as compared to the contralateral RA (all P < 0.001, but these velocities in ipsilateral ulnar artery (81.2 ± 2.16 cm/s and 13.1 ± 2.86 cm/s, respectively increased profoundly. The average time of ulnar artery compression was 4.1 ± 1.2 h (ranged 2.5-6.5 h. There were two patients experienced persistent RAO with a success rate of 98.9% and RAO in 0.075% of patients after ulnar artery compression was applied. The pulsation of the ulnar artery after compression was removed had not been influenced by the compression. Conclusions: After intervention using TRCI approach, the presence of a weaker RAP is an indicator of imminent RAO. The continuing compression of ipsilateral ulnar artery is an effective approach to

  8. Risk indicators in coronary cardiac disease and occlusive disease of the peripheral arteries

    International Nuclear Information System (INIS)

    Roth, H.

    1982-01-01

    In 160 patients with clinically confirmed coronary heart diseases, angiograms of the coronary vessels, the left ventricle, the abdominal aorta, the pelvic and femoral arteries and the supra-aortic vessels were taken. At the same time the incidence of the risk indicators overweight, hypercholesterinaemia, hypertriglyceridaemia, hyperuricaemia, diabetes mellitus, hypertension and cigarette smoking was established and compared with the angiograms. Hypercholesterinaemia, hypertriglyceridaemia, diabetes mellitus and hypertension are found to be in a clearly positive correlation with the frequency and severity of coronary and peripheral vascular diseases. For hyperuricaemia and overweight a relation to the frequency and severity of peripheral but not coronary vascular stenoses is outlined. Cigarette smoking, again, proves to be a clear risk indicator. (orig./MG) [de

  9. Towards a contemporary, comprehensive scoring system for determining technical outcomes of hybrid percutaneous chronic total occlusion treatment: The RECHARGE score.

    Science.gov (United States)

    Maeremans, Joren; Spratt, James C; Knaapen, Paul; Walsh, Simon; Agostoni, Pierfrancesco; Wilson, William; Avran, Alexandre; Faurie, Benjamin; Bressollette, Erwan; Kayaert, Peter; Bagnall, Alan J; Smith, Dave; McEntegart, Margaret B; Smith, William H T; Kelly, Paul; Irving, John; Smith, Elliot J; Strange, Julian W; Dens, Jo

    2018-02-01

    This study sought to create a contemporary scoring tool to predict technical outcomes of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) from patients treated by hybrid operators with differing experience levels. Current scoring systems need regular updating to cope with the positive evolutions regarding materials, techniques, and outcomes, while at the same time being applicable for a broad range of operators. Clinical and angiographic characteristics from 880 CTO-PCIs included in the REgistry of CrossBoss and Hybrid procedures in FrAnce, the NetheRlands, BelGium and UnitEd Kingdom (RECHARGE) were analyzed by using a derivation and validation set (2:1 ratio). Variables significantly associated with technical failure in the multivariable analysis were incorporated in the score. Subsequently, the discriminatory capacity was assessed and the validation set was used to compare with the J-CTO score and PROGRESS scores. Technical success in the derivation and validation sets was 83% and 85%, respectively. Multivariate analysis identified six parameters associated with technical failure: blunt stump (beta coefficient (b) = 1.014); calcification (b = 0.908); tortuosity ≥45° (b = 0.964); lesion length 20 mm (b = 0.556); diseased distal landing zone (b = 0.794), and previous bypass graft on CTO vessel (b = 0.833). Score variables remained significant after bootstrapping. The RECHARGE score showed better discriminatory capacity in both sets (area-under-the-curve (AUC) = 0.783 and 0.711), compared to the J-CTO (AUC = 0.676) and PROGRESS (AUC = 0.608) scores. The RECHARGE score is a novel, easy-to-use tool for assessing the risk for technical failure in hybrid CTO-PCI and has the potential to perform well for a broad community of operators. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  10. Controlled antegrade intimal tracking with subintimal balloon inflation as a novel bailout technique for chronic total occlusion after failed intravascular ultrasound-guided parallel wire technique.

    Science.gov (United States)

    Imai, Yuta; Yajima, Junji; Hosaka, Fumitaka

    Failure to cross with a guidewire is the most common reason for failure of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). In cases of CTO PCI with no interventional collaterals, an intravascular ultrasound (IVUS)-guided parallel wire technique is usually the last-resort procedure. Failure of this technique sometimes causes enlarged subintimal space, resulting in procedure failure. We present a successful second attempt at left anterior descending artery CTO PCI with no interventional collaterals. After IVUS-guided parallel wire technique failed with an enlarged subintimal space, successful antegrade wire crossing was achieved using controlled antegrade intimal tracking with balloon inflation in the subintimal space to deflect a second wire. This technique may be useful as a bailout strategy in otherwise-failed CTO PCI with an enlarged subintimal space. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. Endovascular recanalization of native chronic total occlusions in patients with failed lower-extremity bypass grafts.

    Science.gov (United States)

    Wrigley, Clinton W; Vance, Ansar; Niesen, Timothy; Grilli, Christopher; Velez, J Daniel; Agriantonis, Demetrios J; Kimbiris, George; Garcia, Mark J; Leung, Daniel A

    2014-09-01

    To investigate the feasibility, safety, and outcome of endovascular recanalization of native chronic total occlusions (CTOs) in patients with failed lower-extremity bypass grafts. Retrospective review of 19 limbs in 18 patients with failed lower-extremity bypass grafts that underwent recanalization of native arterial occlusions between February 2009 and April 2013 was performed. Nine of the limbs presented with acute ischemia and 10 presented with chronic ischemia, including eight with critical limb ischemia and two with disabling claudication. The mean patency of the failed bypass grafts (63% venous) was 27 months. All limbs had Transatlantic Inter-Society Consensus class D lesions involving the native circulation. Technical success of the endovascular recanalization procedure was achieved in all but one limb (95%). The mean ankle brachial indices before and after treatment were 0.34 and 0.73, respectively. There were no major complications or emergency amputations. Mean patient follow-up was 64 weeks, and two patients were lost to follow-up. Primary patency rates at 3, 6, and 12 months were 87%, 48%, and 16%, respectively. Successful secondary procedures were performed in seven patients, with secondary patency rates at 3, 6, and 12 months of 88%, 73%, and 44%, respectively. Limb salvage rates at 12 and 24 months were 94% and 65%, and amputation-free survival rates at 12 and 24 months were 87% and 60%, respectively. Endovascular recanalization of native CTOs in patients with failed lower-extremity bypass grafts is technically feasible and safe and results in acceptable limb salvage. Copyright © 2014 SIR. Published by Elsevier Inc. All rights reserved.

  12. Cardioprotective effect of ornitho-kinin in an anesthetized, open-chest chicken model of acute coronary occlusion

    Directory of Open Access Journals (Sweden)

    B.C. Prezoto

    2009-09-01

    Full Text Available The generation of bradykinin (BK; Arg-Pro-Pro-Gly-Phe-Ser-Pro-Phe-Arg in blood and kallidin (Lys-BK in tissues by the action of the kallikrein-kinin system has received little attention in non-mammalian vertebrates. In mammals, kallidin can be generated by the coronary endothelium and myocytes in response to ischemia, mediating cardioprotective events. The plasma of birds lacks two key components of the kallikrein-kinin system: the low molecular weight kininogen and a prekallikrein activator analogous to mammalian factor XII, but treatment with bovine plasma kallikrein generates ornitho-kinin [Thr6,Leu8]-BK. The possible cardioprotective effect of ornitho-kinin infusion was investigated in an anesthetized, open-chest chicken model of acute coronary occlusion. A branch of the left main coronary artery was reversibly ligated to produce ischemia followed by reperfusion, after which the degree of myocardial necrosis (infarct size as a percent of area at risk was assessed by tetrazolium staining. The iv injection of a low dose of ornitho-kinin (4 µg/kg reduced mean arterial pressure from 88 ± 12 to 42 ± 7 mmHg and increased heart rate from 335 ± 38 to 402 ± 45 bpm (N = 5. The size of the infarct was reduced by pretreatment with ornitho-kinin (500 µg/kg infused over a period of 5 min from 35 ± 3 to 10 ± 2% of the area at risk. These results suggest that the physiological role of the kallikrein-kinin system is preserved in this animal model in spite of the absence of two key components, i.e., low molecular weight kininogen and factor XII.

  13. Impact of lesion morphology on angiographic and clinical outcomes in patients with chronic total occlusion after recanalization with drug-eluting stents: a multislice computed tomography study

    Energy Technology Data Exchange (ETDEWEB)

    Ito, Tsuyoshi [Toyohashi Heart Center, Toyohashi (Japan); Nagoya City University Graduate School of Medical Sciences, Department of Cardio-Renal Medicine and Hypertension, Nagoya (Japan); Tsuchikane, Etsuo; Nasu, Kenya; Kimura, Masashi; Terashima, Mitsuyasu; Kinoshita, Yoshihisa; Habara, Maoto; Suzuki, Takahiko [Toyohashi Heart Center, Toyohashi (Japan); Suzuki, Yoriyasu; Ehara, Mariko [Nagoya Heart Center, Nagoya (Japan); Ohte, Nobuyuki [Nagoya City University Graduate School of Medical Sciences, Department of Cardio-Renal Medicine and Hypertension, Nagoya (Japan)

    2015-10-15

    The aim of this study was to investigate the multislice computed tomography (MSCT) parameters associated with adverse outcomes after chronic total occlusion percutaneous coronary intervention (CTO-PCI) with drug-eluting stents. A total of 285 patients who underwent MSCT before CTO-PCI were analyzed. Lesion morphology was assessed with MSCT. Angiographic restenosis, reocclusion, and MACE (a composite of cardiac death, myocardial infarction, stent thrombosis, and target lesion revascularization) were analyzed. MACE was observed in 36 patients (13.6 %). Occlusion length was greater (39.5 ± 19.9 mm vs. 22.3 ± 13.7 mm, p < 0.01), minimal vessel area smaller (11.2 ± 5.7 mm{sup 2} vs. 14.5 ± 5.6 mm{sup 2}, p < 0.01), and severe calcification more common (36 % vs. 12 %, p < 0.01) in the MACE group compared to the non-MACE group. We defined occluded length >25.4 mm, minimal vessel area <11.9 mm{sup 2}, which were identified by receiver operating characteristic analysis, and severe calcification as CT-derived risk factors. Angiographic restenosis (60 % vs. 12 % vs. 7 %, p < 0.01), reocclusion (29 % vs. 2 % vs. 2 %, p < 0.01), and MACE (43 % vs. 6 % vs. 3 %, p < 0.01) were more common in patients with 2 or more risk factors than in those with 1 or 0. MSCT characteristics associated with adverse outcomes after CTO-PCI were occlusion length, minimal vessel area, and severe calcification. (orig.)

  14. Chronic Total Occlusion Crossing Approach Based on Plaque Cap Morphology: The CTOP Classification.

    Science.gov (United States)

    Saab, Fadi; Jaff, Michael R; Diaz-Sandoval, Larry J; Engen, Gwennan D; McGoff, Theresa N; Adams, George; Al-Dadah, Ashraf; Goodney, Philip P; Khawaja, Farhan; Mustapha, Jihad A

    2018-02-01

    To present the chronic total occlusion (CTO) crossing approach based on plaque cap morphology (CTOP) classification system and assess its ability to predict successful lesion crossing. A retrospective analysis was conducted of imaging and procedure data from 114 consecutive symptomatic patients (mean age 69±11 years; 84 men) with claudication (Rutherford category 3) or critical limb ischemia (Rutherford category 4-6) who underwent endovascular interventions for 142 CTOs. CTO cap morphology was determined from a review pf angiography and duplex ultrasonography and classified into 4 types (I, II, III, or IV) based on the concave or convex shape of the proximal and distal caps. Statistically significant differences among groups were found in patients with rest pain, lesion length, and severe calcification. CTOP type II CTOs were most common and type III lesions the least common. Type I CTOs were most likely to be crossed antegrade and had a lower incidence of severe calcification. Type IV lesions were more likely to be crossed retrograde from a tibiopedal approach. CTOP type IV was least likely to be crossed in an antegrade fashion. Access conversion, or need for an alternate access, was commonly seen in types II, III, and IV lesions. Distinctive predictors of access conversion were CTO types II and III, lesion length, and severe calcification. CTOP type I lesions were easiest to cross in antegrade fashion and type IV the most difficult. Lesion length >10 cm, severe calcification, and CTO types II, III, and IV benefited from the addition of retrograde tibiopedal access.

  15. Myocardial contrast defect associated with thrombotic coronary occlusion: Pre-autopsy diagnosis of a cardiac death with post-mortem CT angiography

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Heon; Cha, Jang Gyu [Dept. of Radiology, Soonchunhyang University Hospital, Bucheon (Korea, Republic of); Park, Hye Jin; Lee, Soo Kyoung; Yang, Kyung Moo [Dept. of Forensic Medicine, National Forensic Service, Wonju (Korea, Republic of)

    2015-10-15

    We report the case of a female who died of suspected acute myocardial infarction. Post-mortem CT angiography (PMCTA) was performed with intravascular contrast infusion before the standard autopsy, and it successfully demonstrated the complete thrombotic occlusion of a coronary artery and also a corresponding perfusion defect on myocardium. We herein describe the PMCTA findings of a cardiac death with special emphasis on the potential benefits of this novel CT technique in forensic practice.

  16. Procedural and Long-Term Outcomes of Bioresorbable Scaffolds Versus Drug-Eluting Stents in Chronic Total Occlusions: The BONITO Registry (Bioresorbable Scaffolds Versus Drug-Eluting Stents in Chronic Total Occlusions).

    Science.gov (United States)

    Azzalini, Lorenzo; Giustino, Gennaro; Ojeda, Soledad; Serra, Antonio; La Manna, Alessio; Ly, Hung Q; Bellini, Barbara; Benincasa, Susanna; Chavarría, Jorge; Gheorghe, Livia L; Longo, Giovanni; Miccichè, Eligio; D'Agosta, Guido; Picard, Fabien; Pan, Manuel; Tamburino, Corrado; Latib, Azeem; Carlino, Mauro; Chieffo, Alaide; Colombo, Antonio

    2016-10-01

    There is little evidence regarding the efficacy and safety of bioresorbable scaffolds (BRS) for the percutaneous treatment of chronic total occlusions. We performed a multicenter registry of consecutive chronic total occlusion patients treated with BRS (Absorb; Abbott Vascular) and second-generation drug-eluting stents (DES) at 5 institutions. Long-term target-vessel failure (a composite of cardiac death, target-vessel myocardial infarction, and ischemia-driven target-lesion revascularization) was the primary end point. Inverse probability of treatment weight-adjusted Cox regression was used to account for pretreatment differences between the 2 groups. A total of 537 patients (n=153 BRS; n=384 DES) were included. BRS patients were younger and had lower prevalence of comorbidities. Overall mean Japan-Chronic Total Occlusion (J-CTO) score was 1.43±1.16, with no differences between groups. Procedural success was achieved in 99.3% and 96.6% of BRS- and DES-treated patients, respectively (P=0.07). At a median follow-up of 703 days, there were no differences in target-vessel failure between BRS and DES (4.6% versus 7.7%; P=0.21). By adjusted Cox regression analysis, there were still no significant differences between BRS and DES (hazard ratio, 1.54; 95% confidence interval, 0.69-3.72; P=0.34). However, secondary analyses suggested a signal toward higher ischemia-driven target-lesion revascularization with BRS. Implantation of BRS versus second-generation DES in chronic total occlusion was associated with similar risk of target-vessel failure at long-term follow-up. However, a signal toward increased ischemia-driven target-lesion revascularization with BRS was observed. Large randomized studies should confirm these findings. © 2016 American Heart Association, Inc.

  17. Twelve months follow-up after retrograde recanalization of superficial femoral artery chronic total occlusion

    Science.gov (United States)

    Wojtasik-Bakalarz, Joanna; Arif, Salech; Chyrchel, Michał; Rakowski, Tomasz; Bartuś, Krzysztof; Dudek, Dariusz

    2017-01-01

    Introduction Fifty percent of cases of peripheral artery disease are caused by chronic total occlusion (CTO) of the superficial femoral artery (SFA). Ten–fifteen percent of percutaneous SFA recanalization procedures are unsuccessful. In those cases the retrograde technique can increase the success rate of the procedure, but the long-term follow-up of such procedures is still unknown. Aim To assess the efficacy and clinical outcomes during long-term follow-up after retrograde recanalization of the SFA. Material and methods We included patients after at least one unsuccessful percutaneous antegrade recanalization of the SFA. Patients were evaluated for the procedural and clinical follow-up of mean time 13.9 months. Results The study included 17 patients (7 females, 10 males) who underwent percutaneous retrograde recanalization of the SFA from June 2011 to June 2015. The mean age of patients was 63 ±7 years. Retrograde puncture of the distal SFA was successful in all cases. A retrograde procedure was performed immediately after antegrade failure in 4 (23.5%) patients and after a previously failed attempt in 13 (76.5%) patients. The procedure was successful in 15 (88.2%) patients, and unsuccessful in 2 (11.8%) patients. Periprocedural complications included 1 peripheral distal embolization (successfully treated with aspiration thrombectomy), 1 bleeding event from the puncture site and 7 puncture site hematomas. During follow-up the all-cause mortality rate was 5.8% (1 patient, non-cardiac death). The primary patency rate at 12 months was 88.2% and secondary patency 100%. Conclusions The retrograde SFA puncture seems to be a safe and successful technique for CTO recanalization and is associated with a low rate of perioperative and long-term follow-up complications. PMID:28344617

  18. Twelve months follow-up after retrograde recanalization of superficial femoral artery chronic total occlusion

    Directory of Open Access Journals (Sweden)

    Joanna Wojtasik-Bakalarz

    2017-03-01

    Full Text Available Introduction : Fifty percent of cases of peripheral artery disease are caused by chronic total occlusion (CTO of the superficial femoral artery (SFA. Ten–fifteen percent of percutaneous SFA recanalization procedures are unsuccessful. In those cases the retrograde technique can increase the success rate of the procedure, but the long-term follow-up of such procedures is still unknown. Aim : To assess the efficacy and clinical outcomes during long-term follow-up after retrograde recanalization of the SFA. Material and methods: We included patients after at least one unsuccessful percutaneous antegrade recanalization of the SFA. Patients were evaluated for the procedural and clinical follow-up of mean time 13.9 months. Results: The study included 17 patients (7 females, 10 males who underwent percutaneous retrograde recanalization of the SFA from June 2011 to June 2015. The mean age of patients was 63 ±7 years. Retrograde puncture of the distal SFA was successful in all cases. A retrograde procedure was performed immediately after antegrade failure in 4 (23.5% patients and after a previously failed attempt in 13 (76.5% patients. The procedure was successful in 15 (88.2% patients, and unsuccessful in 2 (11.8% patients. Periprocedural complications included 1 peripheral distal embolization (successfully treated with aspiration thrombectomy, 1 bleeding event from the puncture site and 7 puncture site hematomas. During follow-up the all-cause mortality rate was 5.8% (1 patient, non-cardiac death. The primary patency rate at 12 months was 88.2% and secondary patency 100%. Conclusions : The retrograde SFA puncture seems to be a safe and successful technique for CTO recanalization and is associated with a low rate of perioperative and long-term follow-up complications.

  19. Impact of subintimal plaque modification procedures on health status after unsuccessful chronic total occlusion angioplasty.

    Science.gov (United States)

    Hirai, Taishi; Grantham, J Aaron; Sapontis, James; Cohen, David J; Marso, Steven P; Lombardi, William; Karmpaliotis, Dimitri; Moses, Jeffrey; Nicholson, William J; Pershad, Ashish; Wyman, R Michael; Spaedy, Anthony; Cook, Stephen; Doshi, Parag; Federici, Robert; Nugent, Karen; Gosch, Kensey L; Spertus, John A; Salisbury, Adam C

    2017-10-25

    We sought to determine the impact of subintimal plaque modification (SPM) on early health status following unsuccessful chronic total occlusion (CTO) PCI. Intentionally dilating the subintimal space during unsuccessful CTO PCI to facilitate flow through dissection planes and improve success of repeat PCI attempts is a technique used by some hybrid operators, and may improve health status by restoring distal vessel flow despite unsuccessful CTO PCI. We studied 138 patients who underwent unsuccessful CTO PCI in a 12-center CTO PCI registry. Safety was assessed by comparing in-hospital outcomes of patients undergoing unsuccessful CTO PCI with and without SPM. The association between SPM and health status was quantified using the Seattle Angina Questionnaire Summary Score (SAQ SS), and the association between SPM and SAQ SS was determined using multivariable regression. SPM was performed in 59 patients (42.8%). Complication rates were similar comparing those with and without SPM. At 1-month, patients treated with SPM had larger increases in SAQ SS compared to patients who were not (28.3 ± 21.7 vs. 16.8 ±20.2, P = 0.012), and SPM was associated with an adjusted mean 10.5 point (95% CI 1.4-19.7, P = 0.02) greater SAQ SS improvement through 30 days. SPM was performed in almost half of unsuccessful CTO PCIs and was not associated with increased procedural complications. SPM was independently associated with better patient-reported health status at 30 days. Further studies are needed to assess the necessity of subsequent PCI in patients with significant health status improvements after SPM. © 2017 Wiley Periodicals, Inc.

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

    Science.gov (United States)

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

    2017-06-06

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

  1. Endovascular treatment for symptomatic stent failures in long-segment chronic total occlusion of femoropopliteal arteries.

    Science.gov (United States)

    Yang, Xinrui; Lu, Xinwu; Li, Weimin; Huang, Ying; Huang, Xintian; Lu, Min; Jiang, Mi'er

    2014-08-01

    The objective of this study was to evaluate the outcomes of the secondary endovascular treatment (SEVT) for symptomatic recurrences in long-segment chronic total occlusion (CTO) of femoropopliteal arteries (FPAs) and to investigate the factors affecting the outcomes. Data of patients undergoing FPA stent implantation for primary, long-segment (>10 cm) CTO lesions and receiving endovascular intervention for symptomatic recurrences more than once in our institution from July 1, 2008, to September 1, 2012, were reviewed. Follow-up results referring to SEVT procedures were analyzed, including primary patency, limb salvage (LS) rate, technical success rate, and prevalence of procedure-related complications. Primary patency and LS were analyzed with Kaplan-Meier curves. Univariate and multivariable analyses were performed to identify factors associated with recurrent restenosis with a Cox proportional hazards model. Ninety-one patients (mean age, 75.1 years) were included. The indications for SEVT were claudication (38.5%) and critical limb ischemia (61.5%). Preprocedural ankle-brachial index was 0.37 ± 0.16. The median time between initial endovascular treatment and SEVT was 6.5 months (range, 1.0-24.4 months). The arteries in 63 limbs were totally occluded. Fractures were found in 30 (18.8%) of the initially placed stents. Successful recanalization was achieved in 82 limbs (90.1%). The mean postprocedural ankle-brachial index was 0.84 ± 0.15 in those limbs that were successfully recanalized. The complication rate was 9.9%. One patient died of cerebral hemorrhage during catheter-directed thrombolysis. Other complications included the development of a groin hematoma (n = 5), distal embolization (n = 1), formation of a femoral pseudoaneurysm (n = 1), and development of acute heart failure (n = 1). The mean follow-up period was 11.0 ± 5.6 months. The cumulative primary patency rate after SEVT was 66.9% and 52.0% at 12 and 24 months. The LS rate since SEVT was 91.2% and

  2. Retrograde Wiring of Collateral Channels of the Heart in Chronic Total Occlusions: A Systematic Review and Meta-Analysis of Safety, Feasibility, and Incremental Value in Achieving Revascularization.

    Science.gov (United States)

    Khand, Aleem; Patel, Bilal; Palmer, Nicholas; Jones, Julia; Andron, Mohammed; Perry, Raph; Mehrotra, Sanjay; Mitsudo, Kazuaki

    2015-11-01

    To conduct a systematic review and meta-analysis on retrograde wiring in chronic total occlusions (CTOs) with focus on its safety and feasibility. We searched publications from 1990 to December 2013 in PubMed, Ovid, EMBASE, and the Cochrane database inserting a number of terms relating to the collateral circulation of the heart in CTOs. A total of 18 case series (n range17-462) with a total of 2280 CTO revascularization attempts fulfilled criteria for a study of retrograde wiring of collateral channels in CTOs. There were no randomized studies comparing a primary antegrade with a primary retrograde approach. Procedural CTO revascularization rates ranged from 67% to 90.6% with a large proportion having previously failed an "antegrade" approach. The septal perforator collaterals and epicardial channels were used in 73.2% (n = 1670) and 21.7% (n = 495) of cases. Although collateral/coronary perforation was not infrequent (n = 90, 5%), serious acute complications were uncommon; in the combined population 18 cases of cardiac tamponade (0.8%) and 3 deaths (0.1%). Septal perforating wiring (79.3%) was significantly more likely to be successful compared to epicardial coronary artery wiring (72.5%) when chosen by the operator as a route of retrograde access to the CTO body (relative risk 1.11 [95% confidence interval: 1.02-1.20; P = .013]). Successful retrograde wiring of collateral channels in selected patients undertaken by "CTO dedicated" operators can significantly enhance the chances of revascularization of complex CTOs with a low risk of acute serious complications. Septal perforator channels are significantly more likely to be successfully retrogradely wired compared to epicardial vessels when either is selected, by reference to their anatomical suitability by the operator, as a route of access. © The Author(s) 2015.

  3. Contribution of quantitative coronary angiography in Palmaz-Schatz optimal stent liberation strategy for subacute occlusion control

    International Nuclear Information System (INIS)

    Sousa, Amanda Guerra de Moraes Rego

    1995-01-01

    This study examines whether a single method, quantitative coronary angiography with automated edge detection, could efficiently guide optimal stent liberation, assuring good clinical results and eliminating the need for anticoagulation therapy. This investigation includes 101 patients with optimal implantation of 104 Palmaz-stents. Their mean age was 58.62 years and 79.2% were male. Most of them presented unstable angina (61.39%) and had single vessel disease (85.15%) The treated vessel was the left anterior descending artery in 39.60%; the right coronary artery in 34.66%; the left circumflex artery in 7.92% and saphenous vein grafts in 17.82%. The mean reference diameter of the target vessel was 3.43 mm. Each implantation comprehended two phases: initial stent liberation and additional high pressure balloon inflation, guided by quantitative coronary angiography. Arterial quantification showed an important increase in the mean luminal diameter (p<0.001), characterized by an immediate gain of 2.37 mm [standard deviation (SD): 0.55 m]. Quantitative angiography permitted to identify a further gain in the luminal diameter following the high pressure balloon inflation, o.49 mm 9 SD:0.53 mm). Therefore, the total mean immediate gain was 2.85 mm (SD:0.64 mm). The mean diameter stenosis changed from 80.21% (SD:14.56%) to 11.81% (SD: 7.59% - p<0.001) after initial stent delivery; and to 0.16% (SD:3.45% - p<,0.001), after high pressure balloon inflation. Quantitative coronary angiography performed detailed measurements of the minimal caliber variations along the entire prosthesis due to the high pressure balloon inflations, similarly to the intracoronary ultrasound. This guided the optimal stent implantation and helped the clinical management of these cases. In this series, even maintained only under antiaggregant agents, no patient presented major ischemic complications and only one (0.99%) had a hemorrhage in the puncture site that required blood transfusion. The mean in

  4. Total venous inflow occlusion and pericardial auto-graft reconstruction for right atrial hemangiosarcoma resection in a dog.

    Science.gov (United States)

    Verbeke, Fei; Binst, Dominique; Stegen, Ludo; Waelbers, Tim; de Rooster, Hilde; Van Goethem, Bart

    2012-10-01

    A sizeable right atrial hemangiosarcoma in a 6-year-old Bordeaux dog, World Health Organization (WHO) stage 2, was excised using total venous inflow occlusion. The defect was restored with a non-vascularized pericardial auto-graft. The dog had a disease-free interval of 7 mo. The dog was euthanized 9 months later, at which time there were distant metastases but no indication of local recurrence.

  5. Wasp sting induced STEMI with complete coronary artery occlusion: a case of Kounis syndrome.

    Science.gov (United States)

    Cross, Benjamin; Choudhury, Tawfiqur Rahman; Hindle, Mark; Galasko, Gavin

    2017-09-07

    A 45-year-old previously healthy man with minimal coronary artery disease on imaging presented with an acute MI after sustaining a wasp sting following previous non-eventful exposures throughout his life. This is the first case of Kounis syndrome with optical coherence tomography imaging and proven IgE wasp venom hypersensitivity. The Hymenoptera venom is composed of allergenic proteins and vasoactive amines which are responsible for venom toxicity. This patient also has a history of atopy giving a predisposition for developing IgE-mediated allergic reactions. Hymenoptera stings can be severe in atopic individuals and anaphylaxis may ensue. However, it is a rare cause of myocardial infarction (MI) (Kounis syndrome). Multiple wasp stings in the past may have contributed to sensitisation. Kounis syndrome is a rare clinical manifestation which should remain in the minds of physicians, especially with younger patients with no history of ischaemic heart disease or few risk factors. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  6. Tracking in Presence of Total Occlusion and Size Variation using Mean Shift and Kalman Filter

    OpenAIRE

    RAMOS PONCE, Oscar Efrain; MIRZAEI, Mohammad Ali; MERIENNE, Frédéric

    2011-01-01

    International audience; The classical mean shift algorithm for tracking in perfectly arranged conditions constitutes a good object tracking method. However, in the real environment it presents some limitations, especially under the presence of noise, objects with varying size, or occlusions. In order to deal with these problems, this paper proposes a reliable object tracking algorithm using mean shift and the Kalman filter, which was added to the traditional algorithm as a predictor when no r...

  7. Chronic Total Occlusion-Angioplasty with Antegrade Approach: A two-Year Experience in “Modarres Hospital”, A Tertiary University Hospital, Tehran, Iran

    Directory of Open Access Journals (Sweden)

    Morteza Safi

    2016-10-01

    Full Text Available Introduction: New techniques for the percutaneous treatment of coronary chronic total occlusions (CTO have had a high success rate since a few years ago, so the interest for this treatment has been increasing these days.Methods: The current observational study was performed in Modarres hospital as a tertiary referral center. All the patients with documented stable angina who had failed to response to full guideline-mediated medical therapy, referred to our hospital, were candidates for coronary angiography. Antegrade strategy was applied for all these patients. The length of the lesion, the fluoroscopy time of the CTO angioplasty, consumed contrast volume, the number of guide wires used, whether a corsair or tornus micro-catheter was used or not, and the success rate of the angioplasty were documented for further analysis.Results: A total of 47 patients with documented stable angina were finally included. The median age was 59 (45-78 and 70.2% were male. The mean length of the lesion was 34.0 ± 1.1 .The mean fluoroscopy time and contrast volume were 57.9 ± 3.2 minutes and 525.9 ± 20.9 mL, respectively. In average, 2.2 guide wires were used. Corsair and tornus micro-catheters were applied in 30 (63.8% and 5 (10.6% of the cases, respectively. Seven complications (all including coronary dissection occurred. In-hospital major adverse cardiac events (MACE rate was 10.6%, all of which were non-Q wave myocardial infarction. The success rate was 85.1%. The higher number of used wires, use of corsair, and tornus micro-catheter were not significantly concordant with success rate (P-value > 0.05; in addition, longer lesion was not concordant with unsuccessfulness rate (P-value > 0.05.Conclusions: Patient selection for CTO-angioplasty should be performed more carefully. Patients’ quality of life and risk of probable procedural complications and future cardiac events should be assessed to decide the best treatment approach. Radiation exposure, contrast

  8. One-year results of total arterial revascularization vs. conventional coronary surgery: CARRPO trial

    DEFF Research Database (Denmark)

    Damgaard, Sune; Wetterslev, Jørn; Lund, Jens T

    2009-01-01

    AIMS: To investigate clinical and angiographic outcomes after coronary surgery using total arterial revascularization (TAR). METHODS AND RESULTS: We randomized 331 patients with multivessel or isolated left main disease to TAR [internal thoracic (ITA) and radial arteries] vs. conventional...... revascularization (CR) using left ITA and vein grafts. The primary angiographic outcome was the patency index: number of patent grafts (

  9. OUTBACK catheter for treatment of superficial femoral and iliac artery chronic total occlusion: Experience from two centers

    Directory of Open Access Journals (Sweden)

    Mohammad Ali Husainy

    2016-01-01

    Full Text Available Purpose: The OUTBACK® catheter is a reentry device that enables reentry into a vessel lumen from the subintimal space during subintimal angioplasty. It is reserved for cases where reentry has not been possible using conventional wire and catheter techniques. We report a two-center experience in recanalization of the chronic total occlusions of the common iliac (CIA and the superficial femoral artery (SFA using the OUTBACK® catheter in cases where other techniques were unsuccessful. Material and Methods: All cases where recanalization was performed using the OUTBACK® reentry catheter between January 2010 to January 2015 were retrospectively identified and included in this study. 21 patients were identified. The indication for intervention in these cases included claudication and critical leg ischemia. In all cases, conventional recanalization could not be successfully achieved. Results: The OUTBACK® catheter was used to recanalize 10 SFA occlusion and 9 CIA occlusions. In 19 patients (90%, reentry into true arterial lumen was successfully achieved. 17 patients had their recanalization through the transfemoral approach whereas 2 patients had a transpopliteal artery approach. In 2 patients, reentry into the true lumen could not be achieved using the OUTBACK® catheter due to patient's intolerability for the procedure and severe atherosclerotic calcified plaques. There was 100% patency of the vessel intervened on Duplex ultrasound at 24 months of follow up. 16 patients (84% remained asymptomatic and 2 patients (10.5% reported worsening of their symptoms due to the development of new lesions within the arterial system. Conclusion: The OUTBACK® catheter is an effective and safe technique for reentry into the vessel lumen when conventional techniques fail.

  10. OUTBACK catheter for treatment of superficial femoral and iliac artery chronic total occlusion: Experience from two centers.

    Science.gov (United States)

    Husainy, Mohammad Ali; Suresh, Balla; Fang, Cheng; Ammar, Thoraya; Botchu, Rajesh; Thava, V

    2016-01-01

    The OUTBACK(®) catheter is a reentry device that enables reentry into a vessel lumen from the subintimal space during subintimal angioplasty. It is reserved for cases where reentry has not been possible using conventional wire and catheter techniques. We report a two-center experience in recanalization of the chronic total occlusions of the common iliac (CIA) and the superficial femoral artery (SFA) using the OUTBACK(®) catheter in cases where other techniques were unsuccessful. All cases where recanalization was performed using the OUTBACK(®) reentry catheter between January 2010 to January 2015 were retrospectively identified and included in this study. 21 patients were identified. The indication for intervention in these cases included claudication and critical leg ischemia. In all cases, conventional recanalization could not be successfully achieved. The OUTBACK(®) catheter was used to recanalize 10 SFA occlusion and 9 CIA occlusions. In 19 patients (90%), reentry into true arterial lumen was successfully achieved. 17 patients had their recanalization through the transfemoral approach whereas 2 patients had a transpopliteal artery approach. In 2 patients, reentry into the true lumen could not be achieved using the OUTBACK(®) catheter due to patient's intolerability for the procedure and severe atherosclerotic calcified plaques. There was 100% patency of the vessel intervened on Duplex ultrasound at 24 months of follow up. 16 patients (84%) remained asymptomatic and 2 patients (10.5%) reported worsening of their symptoms due to the development of new lesions within the arterial system. The OUTBACK(®) catheter is an effective and safe technique for reentry into the vessel lumen when conventional techniques fail.

  11. Routine Use of Surgical Retrograde Transtibial Endovascular Approach for Failed Attempts at Antegrade Recanalization of Chronic Peripheral Artery Total Occlusions

    International Nuclear Information System (INIS)

    Liang, GangZhu; Zhang, FuXian; Luo, XiaoYun; Zhang, ChangMing; Feng, YaPing; Niu, LuYuan; Zhang, Huan; Hu, Lu; Zhao, Hui; Cheng, Long; Zhang, MingYi

    2016-01-01

    PurposeOur aim was to describe the technical aspects and clinical outcomes of an open surgical approach to retrograde transtibial endovascular therapy for recanalization of chronic total occlusions (CTOs) of peripheral arteries because of inability to acquire antegrade intravascular access across the occlusion.Materials and MethodsBetween January 2011 and May 2014, conventional antegrade revascularization failed in 15 limbs of 15 patients (11 males, 4 females) with complex CTOs. The mean age of the patients was 74 years (range 48–83 years). Five patients had severe claudication (Rutherford Category 3), and 10 patients had critical limb-threatening ischemia (Rutherford Categories 4–5). For each of these cases of antegrade failure, an open surgical exposure of the tibial or dorsalis pedis artery was used to allow a safe retrograde transtibial endovascular approach to recanalize the CTO.ResultsSurgical retrograde access from the tibial artery was achieved successfully in 14 of the 15 patients. In the 14 successful retrograde endovascular approaches, surgical retrograde transtibial access was achieved from the dorsalis pedis artery in 8 patients and from the posterior tibial artery in 6. The average time to obtain retrograde access was 5 min (range 2–11 min). No stenosis or occlusion occurred in the tibial or dorsalis pedis arteries used for the retrograde access sites during follow-up.ConclusionsRoutine surgical exposure can be a safe and an effective method for retrograde transtibial access to the more proximal occluded arterial segments in selected patients with CTO.

  12. Routine Use of Surgical Retrograde Transtibial Endovascular Approach for Failed Attempts at Antegrade Recanalization of Chronic Peripheral Artery Total Occlusions

    Energy Technology Data Exchange (ETDEWEB)

    Liang, GangZhu; Zhang, FuXian, E-mail: gangzhuliang@126.com; Luo, XiaoYun; Zhang, ChangMing; Feng, YaPing; Niu, LuYuan; Zhang, Huan; Hu, Lu; Zhao, Hui; Cheng, Long; Zhang, MingYi [Capital Medical University, Department of Vascular Surgery, Beijing Shijitan Hospital (China)

    2016-12-15

    PurposeOur aim was to describe the technical aspects and clinical outcomes of an open surgical approach to retrograde transtibial endovascular therapy for recanalization of chronic total occlusions (CTOs) of peripheral arteries because of inability to acquire antegrade intravascular access across the occlusion.Materials and MethodsBetween January 2011 and May 2014, conventional antegrade revascularization failed in 15 limbs of 15 patients (11 males, 4 females) with complex CTOs. The mean age of the patients was 74 years (range 48–83 years). Five patients had severe claudication (Rutherford Category 3), and 10 patients had critical limb-threatening ischemia (Rutherford Categories 4–5). For each of these cases of antegrade failure, an open surgical exposure of the tibial or dorsalis pedis artery was used to allow a safe retrograde transtibial endovascular approach to recanalize the CTO.ResultsSurgical retrograde access from the tibial artery was achieved successfully in 14 of the 15 patients. In the 14 successful retrograde endovascular approaches, surgical retrograde transtibial access was achieved from the dorsalis pedis artery in 8 patients and from the posterior tibial artery in 6. The average time to obtain retrograde access was 5 min (range 2–11 min). No stenosis or occlusion occurred in the tibial or dorsalis pedis arteries used for the retrograde access sites during follow-up.ConclusionsRoutine surgical exposure can be a safe and an effective method for retrograde transtibial access to the more proximal occluded arterial segments in selected patients with CTO.

  13. Totally implantable port management: impact of positive pressure during needle withdrawal on catheter tip occlusion (an experimental study).

    Science.gov (United States)

    Lapalu, Jordane; Losser, Marie-Reine; Albert, Odile; Levert, Albert; Villiers, Stéphane; Faure, Pierre; Douard, Marie-Cécile

    2010-01-01

    Totally implanted ports (TIP) have become a standard part of patient care, providing long-term central venous access for treatment administration and other procedures. Despite overall the safety and effectiveness of TIP, complications still occur. Negative pressure created during needle withdrawal induces blood reflux and subsequent catheter occlusion. Application of positive pressure during needle withdrawal is thought to largely prevent such reflux, but supporting data are limited. To quantify the role of positive pressure, using a test model designed to simulate physiological conditions. Reflux associated with needle withdrawal with and without applied positive pressure was tested using various TIP models from different manufacturers mounted on a specially designed test bench. In addition to the presence or absence of positive pressure during needle withdrawal, study variables comprised of needle type (safety and standard), needle gauge and port septum diameter. Application of positive pressure during needle withdrawal reduced the incidence of reflux during needle withdrawal by nearly 80% (22% vs. 99%, ppressure. In the absence of positive pressure, mean reflux increased with septum diameter and needle gauge to a statistically significant extent. None of these variables significantly affected reflux in the context of needle withdrawal under positive pressure. The results of this study support the use of positive pressure during needle withdrawal to prevent blood reflux potentially leading to catheter tip occlusion.

  14. Heart ischemia-reperfusion induces local upregulation of vasoconstrictor endothelin receptor type B in rat coronary arteries downstream of occlusion

    DEFF Research Database (Denmark)

    Skovsted, Gry Freja; Kruse, L.S.; Larsen, R

    2014-01-01

    . However, under pathophysiological conditions ETB receptors may also be expressed in vascular smooth muscle cells mediating vasoconstriction. We aimed to investigate whether vasoconstrictor ETB receptors are upregulated in coronary arteries after experimental myocardial ischemia in rats....

  15. Long-term outcomes after re-entry device use for recanalization of common iliac artery chronic total occlusions.

    Science.gov (United States)

    Kokkinidis, Damianos G; Alvandi, Bejan; Cotter, Ryan; Hossain, Prio; Foley, T Raymond; Singh, Gagan D; Waldo, Stephen W; Laird, John R; Armstrong, Ehrin J

    2018-03-09

    To examine the impact of re-entry device (RED) use on 1- and 5-year outcomes after endovascular treatment of common iliac artery (CIA) chronic total Occlusions (CTOs). There are not enough data regarding the long-term safety and efficacy of RED. We performed a two-center retrospective study of 115 patients (140 lesions) undergoing CIA CTO endovascular intervention between 2006 and 2016. Baseline characteristics and long-term outcomes were described. A Cox proportional hazard model was developed to determine if REDs were associated with target lesion revascularization (TLR) or major adverse limb events (MALE) after 1 and 5 years. Among 140 lesions, 43 (31%) required use of a RED. The mean age was 63.9 years and the majority (n = 80) of patients were male. An antegrade crossing approach and treatment of restenotic lesions were less common in the RED group (10% vs. 29%, P < .05 and 0% vs. 21%, P < .05, respectively). There were no significant differences in Rutherford class, pre-procedure ABI, or patient presentation. The procedural complication rates were similar between the two groups. The 1- and 5-year TLR rates for lesions treated with re-entry device vs. standard approaches were 11% vs. 9%; P = 0.8 and 29% vs. 29%; P = 0.9 respectively. The 1 and 5-year MALE rates for lesions treated with re-entry device were 5% vs. 6%; P = 0.8 and 11% vs. 11%; P = 0.9 respectively. This retrospective analysis found that recanalization of CIA occlusions using a RED is safe and is associated with long-term clinical outcomes similar to that of standard crossing techniques. © 2018 Wiley Periodicals, Inc.

  16. Coronary artery rupture during high-pressure post-dilatation of coronary stent in a heavily calcified lesion of an ectatic right coronary artery

    Directory of Open Access Journals (Sweden)

    Sina Ali

    2016-06-01

    Full Text Available Coronary artery perforation (CAP is a rare but feared complication of percutaneous coronary intervention. With the use of novel instruments, including hydrophilic and ultrarigid guidewires, rotablator devices, and cutting balloons, the success rate of intervention for coronary artery chronic total occlusion (CTOs and calcified lesions has increased. Along with these changes, the risk of CAP has also increased. In this case report, we present a tip III CAP due to high-pressure postdilatation of coronary stent in a heavily calcified lesion of an ectatic right coronary artery.

  17. Long-term pretreatment with desethylamiodarone (DEA) or amiodarone (AMIO) protects against coronary artery occlusion induced ventricular arrhythmias in conscious rats.

    Science.gov (United States)

    Morvay, Nikolett; Baczkó, István; Sztojkov-Ivanov, Anita; Falkay, György; Papp, Julius Gy; Varró, András; Leprán, István

    2015-09-01

    The aim of this investigation was to compare the effectiveness of long-term pretreatment with amiodarone (AMIO) and its active metabolite desethylamiodarone (DEA) on arrhythmias induced by acute myocardial infarction in rats. Acute myocardial infarction was induced in conscious, male, Sprague-Dawley rats by pulling a previously inserted loose silk loop around the left main coronary artery. Long-term oral pretreatment with AMIO (30 or 100 mg·(kg body mass)(-1)·day(-1), loading dose 100 or 300 mg·kg(-1) for 3 days) or DEA (15 or 50 mg·kg(-1)·day(-1), loading dose 100 or 300 mg·kg(-1) for 3 days), was applied for 1 month before the coronary artery occlusion. Chronic oral treatment with DEA (50 mg·kg(-1)·day(-1)) resulted in a similar myocardial DEA concentration as chronic AMIO treatment (100 mg·kg(-1)·day(-1)) in rats (7.4 ± 0.7 μg·g(-1) and 8.9 ± 2.2 μg·g(-1)). Both pretreatments in the larger doses significantly improved the survival rate during the acute phase of experimental myocardial infarction (82% and 64% by AMIO and DEA, respectively, vs. 31% in controls). Our results demonstrate that chronic oral treatment with DEA resulted in similar cardiac tissue levels to that of chronic AMIO treatment, and offered an equivalent degree of antiarrhythmic effect against acute coronary artery ligation induced ventricular arrhythmias in conscious rats.

  18. Bioresorbable vascular scaffold (BVS) for in-stent chronic total occlusion: Antegrade recanalization and IVUS-guided BVS implantation by radial access

    Energy Technology Data Exchange (ETDEWEB)

    Medda, Massimo [Interventional Cardiology Unit, Istituto Clinico Sant' Ambrogio, Milano (Italy); Casilli, Francesco, E-mail: frcasill@tin.it [Interventional Cardiology Unit, Istituto Clinico Sant' Ambrogio, Milano (Italy); Bande, Marta [Interventional Cardiology Unit, Istituto Clinico Sant' Ambrogio, Milano (Italy); Latini, Maria Giulia [Cardiologia Interventistica, IRCCS Policlinico San Donato, San Donato Milanese, Milano (Italy); Ghommidh, Mehdi [Interventional Cardiology Unit, Istituto Clinico Sant' Ambrogio, Milano (Italy); Del Furia, Francesca [Unità Operativa di Cardiologia, Azienda Ospedaliera di Melegnano, Milano (Italy); Inglese, Luigi [Interventistica Cardiovascolare, Gruppo Sanitario Policlinico di Monza, Milano (Italy)

    2016-01-15

    The completely absorbable stents represent one of the latest innovations in the field of interventional cardiology, prospecting the possibility of “vascular repair”. In the published trials (ABSORB Cohort A and B, ABSORB EXTEND, and ABSORB II, III and IV) chronic total occlusions (CTOs) were considered an exclusion criteria. More recently the CTO-ABSORB pilot study demonstrated the safety and feasibility of bioresorbable vascular scaffold (BVS) use in case of CTO recanalization. We present the first case, to our knowledge, of in-stent occlusion successfully treated with an everolimus-eluting BVS and discuss its potential advantages in such kind of lesions.

  19. Relationship between collateral circulation and myocardial viability of 18F-FDG PET/CT subtended by chronic total occluded coronary arteries.

    Science.gov (United States)

    Dong, Wei; Li, Jianan; Mi, Hongzhi; Song, Xiantao; Jiao, Jian; Li, Quan

    2018-04-01

    To analyze the relationship between the collateral flow of coronary chronic total occlusion (CTO) and myocardial viability detected by 18 F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) imaging. A prospective analysis of 104 patients diagnosed by coronary angiography. All patients underwent resting myocardial perfusion imaging and PET/CT within 1 week. The collateral circulation was graded with Rentrop classification as no or poor collateral circulation in 16 CTO vessels, moderate collateral circulation in 34 CTO vessels, and good collateral circulation in 69 CTO vessels. Myocardial viability was determined with myocardial perfusion imaging and PET. The patterns were interpreted as mismatch, match and normal perfusion and 18 F-FDG uptake. There was no significant correlation between the severity and extent of perfusion defect, myocardial viability and collateral circulation grade. The myocardial viability was normal in mild and moderate hypokinetic regions and decreased in severe hypokinetic and akinesis-dyskinesis regions. The presence of collateral circulation was a sensitive (89%) but not a specific (31%) sign of myocardial viability. In patients with CTO, collateral circulation does not seem to be an effective way for predicting myocardial viability. Further analysis of PET patterns of viable myocardium is needed to guide further revascularization and predict functional improvement and survival benefit.

  20. Calorie restriction prevents the occlusive coronary vascular disease of autoimmune (NZW x BXSB)F1 mice.

    OpenAIRE

    Mizutani, H; Engelman, R W; Kinjoh, K; Kurata, Y; Ikehara, S; Matsuzawa, Y; Good, R A

    1994-01-01

    Male (NZW x BXSB)F1 (W/BF1) mice develop systemic autoimmunity involving autoantibodies, thrombocytopenia, lupus nephritis, and coronary vascular disease (CVD) with myocardial infarction. To determine whether this murine lupus-associated CVD can be prevented by the reduction of dietary calories, male W/BF1 mice were separated into five experimental groups and fed either ad libitum (designated group A, n = 50), fed 32% fewer calories of an otherwise comparable diet (designated group B6, n = 20...

  1. Veno-occlusive liver disease after infradiaphragmatic total lymphoid irradiation. A rare complication; Die Venenverschlusskrankheit der Leber nach infradiaphragmaler total lymphatischer Bestrahlung. Eine seltene Nebenwirkung

    Energy Technology Data Exchange (ETDEWEB)

    Bischof, M.; Zierhut, D.; Gutwein, S.; Wannenmacher, M. [Heidelberg Univ. (DE.) Abt. fuer Klinische Radiologie - Schwerpunkt Strahlentherapie; Hansmann, J. [Heidelberg Univ. (DE.) Abt. fuer Radiologische Diagnostik; Stremmel, W.; Mueller, M. [Heidelberg Univ. (DE). Abt. Innere Medizin 4 (Schwerpunkt Gastroenterologie)

    2001-06-01

    Background: Radiotherapy is potentially curative in early stages of follicle center lymphoma. Frequent side effects are pancytopenia, nausea and abdominal discomfort. A radiation-induced liver injury with serious clinical symptoms and changes in liver function is a rare complication. Case report: Whole abdomen was irradiated in a 49-year-old-patient with a centrocytic-centroblastic lymphoma, stage IA (localization: Left inguinal region). A total dose of 30 Gy was delivered in a weekly fractionation of five times 1.5 Gy. Kidneys were protected by shielding after a dose of 13.5 Gy, liver blocks were positioned after 25 Gy. During the last 2 days of therapy the patient presented with weight gain, ascites, dyspnoea and elevated liver enzymes. Diagnostics revealed hepatosphlenomegaly, ascites and an increased portosystemic pressure gradient. Liver biopsy specimen showed a veno-occlusive disease. Complete relief of symptomatology was achieved within 7 days following placement of a transjugular intrahepatic portosystemic stent-shunt (TIPSS), heparinization and diuretics. Liver enzymes are in the normal range. Conclusion: Veno-occlusive disease of the liver (VOD) is a very rare side effect of primary abdominal irradiation of follicle center lymphoma. This complication should be taken into consideration if a patient presents with upper right quadrant pain, ascites and elevation of liver enzymes especially within 4 months following radiotherapy. Genesis of veno-occlusive disease, diagnostics, therapy and a review of the literature are presented. (orig.) [German] Hintergrund: Die Strahlentherapie spielt bei der kurativen Behandlung der Fruehstadien follikulaerer Keimzentrumslymphome die entscheidende Rolle. Therapiebegleitende Nebenwirkungen sind haeufig Panzytopenie, Nausea und abdominelle Beschwerden. Eine radiogen induzierte Leberschaedigung mit klinisch manifester Symptomatik und schwerer Leberfunktionsstoerung ist dagegen aeusserst selten. Fallbeschreibung: Bei einem 49

  2. Post-valvular surgery multi-vessel coronary artery spasm - A literature review.

    Science.gov (United States)

    Formica, Francesco; Bamodu, Oluwaseun Adebayo; Mariani, Serena; Paolini, Giovanni

    2016-03-01

    Coronary artery spasm (CAS) refers to the spontaneous or stimuli-induced transient, often localized and intense subtotal or total constriction/occlusion of the epicardial coronary artery, usually concomitant with angina pectoris with associated elevation of the ST segment on electrocardiogram (ECG). In this article, we present a literature review on post-valvular surgery CAS and report the clinical case of a 77 year-old man who experienced severe early post-aortic surgery chest pain and hemodynamic instability. Emergent coronary angiography revealed severe occlusion of multiple branches of both coronary arteries. The CAS was alleviated with intracoronary infusion of nitroglycerin.

  3. Adiponectin has a pivotal role in the cardioprotective effect of CP-3(iv), a selective CD36 azapeptide ligand, after transient coronary artery occlusion in mice.

    Science.gov (United States)

    Huynh, David N; Bessi, Valérie L; Ménard, Liliane; Piquereau, Jérôme; Proulx, Caroline; Febbraio, Maria; Lubell, William D; Carpentier, André C; Burelle, Yan; Ong, Huy; Marleau, Sylvie

    2018-02-01

    CD36 is a multiligand receptor involved in lipid metabolism. We investigated the mechanisms underlying the cardioprotective effect of CP-3(iv), an azapeptide belonging to a new class of selective CD36 ligands. The role of CP-3(iv) in mediating cardioprotection was investigated because CD36 signaling leads to activation of peroxisome proliferator-activated receptor-γ, a transcriptional regulator of adiponectin. CP-3(iv) pretreatment reduced infarct size by 54% and preserved hemodynamics in C57BL/6 mice subjected to 30 min coronary ligation and reperfusion but had no effect in CD36-deficient mice. The effects of CP-3(iv) were associated with an increase in circulating adiponectin levels, epididymal fat adiponectin gene expression, and adiponectin transcriptional regulators ( Pparg, Cebpb, Sirt1) after 6 h of reperfusion. Reduced myocardial oxidative stress and apoptosis were observed along with an increase in expression of myocardial adiponectin target proteins, including cyclooxygenase-2, phospho-AMPK, and phospho-Akt. Moreover, CP-3(iv) increased myocardial performance in isolated hearts, whereas blockade of adiponectin with an anti-adiponectin antibody abrogated it. CP-3(iv) exerts cardioprotection against myocardial ischemia and reperfusion (MI/R) injury and dysfunction, at least in part, by increasing circulating and myocardial adiponectin levels. Hence, both paracrine and endocrine effects of adiponectin may contribute to reduced reactive oxygen species generation and apoptosis after MI/R, in a CD36-dependent manner.-Huynh, D. N., Bessi, V. L., Ménard, L., Piquereau, J., Proulx, C., Febbraio, M., Lubell, W. D., Carpentier, A. C., Burelle, Y., Ong, H., Marleau, S. Adiponectin has a pivotal role in the cardioprotective effect of CP-3(iv), a selective CD36 azapeptide ligand, after transient coronary artery occlusion in mice.

  4. Echocardiographic assessment of global longitudinal right ventricular function in patients with an acute inferior ST elevation myocardial infarction and proximal right coronary artery occlusion.

    Science.gov (United States)

    Hutyra, Martin; Skála, Tomáš; Horák, David; Köcher, Martin; Tüdös, Zbyněk; Zapletalová, Jana; Přeček, Jan; Louis, Albert; Smékal, Aleš; Táborský, Miloš

    2015-03-01

    Right ventricular (RV) myocardial infarction (MI) is a frequent concomitant of an acute inferior MI. We set out to determine the diagnostic value of speckle tracking echocardiography in comparison with cardiac magnetic resonance (CMR) for RV stunning and scar prediction. 55 patients (66 ± 11 years) with an acute inferior ST elevation MI who underwent percutaneous coronary intervention (PCI) of an occlusion in the proximal right coronary artery were prospectively enrolled. An echocardiography was done on the day of presentation and on the 5th day thereafter. A CMR was subsequently performed 1 month after the MI. The CMR was used to differentiate between the group with RV scar (n = 26) and without RV scar (n = 29). RV peak systolic longitudinal strain (RV-LS) at presentation determined RV scar (-21.1 ± 5.1% vs. -9.9 ± 4.6%, p -15.8% had a sensitivity of 92% and a specificity of 83% in RV scar prediction (AUC 0.93). RV-LS was superior to TAPSE and TDI in determining the presence of RV scar. According to RV-LS values at presentation and on the 5th day, 3 subgroups were defined: G1-normal deformation (RV-LS -20%, 5th day RV-LS -20%). In G1, there was neither RV scar nor clinically relevant hypotension. In G2, 58% of patients developed RV scar and 36% had hypotension. In the G3, 83% developed RV scar and 55% had hypotension. The myocardial deformation analysis could provide an early prediction of RV scar. It allowed the patients to be divided into subgroups with normal RV function, stunning and persistent RV dysfunction.

  5. The relationship between total arterial revascularization and blood transfusion following coronary artery bypass grafting.

    Science.gov (United States)

    Djordjevic, Jasmina; Ngaage, Dumbor L

    2015-05-01

    Blood transfusion adversely affects the outcome of coronary artery bypass grafting (CABG), yet blood transfusion after CABG is still common. Total arterial revascularisation (TAR) is increasingly used in current practice but its impact on postoperative blood transfusion is not known. We reviewed the cardiothoracic and blood bank databases and collected data for isolated primary CABG patients from July 2007 to June 2012, excluding patients who had a single graft (n = 148). Perioperative variables of TAR patients (n = 745) were compared with patients who had one or more venous grafts (SVG, n = 1,761) for first-time isolated CABG. The conduits used in TAR patients were predominantly left internal thoracic and radial arteries. Matched group comparison of TAR and SVG patients was performed. The association of TAR with blood transfusion was investigated using multivariate and matched analysis. Of 2,506 patients, the 745 (29.7 %) that had TAR were generally younger, with less complex coronary artery disease and less often diabetic. After correcting for these by 1:1 matching, the mean chest tube drainage and rates of blood transfusion remained significantly lower (p transfused in TAR patients. By multivariate analysis, TAR had an independent effect on reducing blood transfusion after CABG [odds ratio (OR) 0.67, 95 % confidence interval (CI) 0.47-0.97, p = .03]. TAR achieved predominantly with left internal thoracic and radial arteries substantially reduced blood transfusion rates after primary CABG. Further studies are warranted.

  6. Coronary CT angiography in coronary artery disease: Opportunities and challenges

    Directory of Open Access Journals (Sweden)

    Zhonghua Sun

    2016-06-01

    Full Text Available Coronary CT angiography is widely recognised as a reliable imaging modality for the diagnosis of coronary artery disease. Coronary CT angiography not only provides excellent visualisation of anatomical changes in the coronary artery with high diagnostic value in the detection of lumen stenosis or occlusion, but also offers quantitative characterisation of coronary plaque components. Furthermore, coronary CT angiography allows myocardial perfusion imaging with diagnostic value comparable to the reference standard method. Coronary CT angiography-derived haemodynamic analysis has the potential to evaluate functional significance of coronary lesions. This review article aims to provide an overview of clinical applications of coronary CT angiography in coronary artery disease.

  7. Occlusal stability.

    Science.gov (United States)

    Wiens, Jonathan P; Priebe, Jennifer W

    2014-01-01

    Occlusion is the foundation for clinical success in fixed, removable, and implant prosthodontic treatment. Understanding those principles is critical when restoring a patient's occlusion. Many philosophies, devices, and theories of occlusion have evolved based on anecdotal clinical observations and applied geometric perceptions. The literature has reported these classic and contemporary occlusal concepts. As evidence-based dentistry emerged, it championed scrutiny of previously held beliefs, resulting in the abandonment of many pragmatic, yet beneficial occlusal procedures. The impetus toward scientific discovery, whereby factual information might be universally applied in dental education and clinical practice, has renewed interest in occlusal studies. Copyright © 2014 Elsevier Inc. All rights reserved.

  8. Predictors of procedural success and improvement of left ventricular ejection fraction after successful recanalization of coronary chronic total occlusion (CTO

    Directory of Open Access Journals (Sweden)

    Ahmed Magdy

    2017-04-01

    Conclusion: PCI for CTO lesions has achieved a better chance for success especially with modern facilities, but we should revise criteria of success and failure as this success has a considerable effect on LV function and patient outcome.

  9. Comparably improved health-related quality of life after total arterial revascularization versus conventional coronary surgery--Copenhagen arterial revascularization randomized patency and outcome trial

    DEFF Research Database (Denmark)

    Damgaard, Sune; Lund, Jens T; Lilleør, Nikolaj B

    2011-01-01

    OBJECTIVE: We compared health-related quality of life up to 11 months after coronary artery bypass grafting using total arterial revascularization versus conventional coronary surgery. METHODS: In this randomized single-center trial, 161 patients underwent total arterial revascularization using s...

  10. Occlusion revisited.

    Science.gov (United States)

    Taner, Tulin

    2012-03-01

    The evaluation of occlusion is of utmost importance, when planning for dental and orthodontic treatment. The occlusal characteristics of normal occlusion change according to the dentoalveolar maturation stages. In primary dentition, flush terminal plane relationship of the second primary molars is desired for a normal molar relationship. In the early mixed dentition stage, cusp to cusp molar relationship is the normal occlusal feature, when posterior primary teeth are in place and leeway space is preserved.

  11. Coronary artery calcification in Kawasaki disease

    International Nuclear Information System (INIS)

    Ino, T.; Shimazaki, S.; Akimoto, K.; Park, I.; Nishimoto, K.; Yabuta, K.; Tanaka, A.

    1990-01-01

    To evaluate the angiographic features of coronary lesions in Kawasaki disease with coronary artery calcification, cinefluoroscopy and cineangiography were retrospectively reviewed in 116 patients who had undergone coronary angiography between 1982 and 1989. Angiographic abnormalities of coronary arteries were demonstrated in 55 of 116 patients. In 5 (9.1%) of the 55 patients, 9 with calcification were identified by cinefluoroscopy and chest X-ray. Eight of the 9 calcified lesions showed a circular or ring-shape configuration. Coronary angiography revealed a total occlusion of the right coronary artery with collateral circulation from the distal left coronary artery in 2 patients and a severe stenosis of the right coronary artery in 2 patients, in whom anticoagulant therapy had not been continued during the follow-up periods. The remaining patient in whom anticoagulant therapy had been continued had bilateral aneurysms but no significant stenosis. These results indicate that a ring-shape calcification on chest X-ray in 2 patients with a history of Kawasaki disease may suggest an involvement by coronary artery stenosis even when anticoagulant drugs had been given. Therefore, coronary angiography should be performed to evaluate the stenotic lesions if this type of calcification is found by routine radiographic examination. (orig.)

  12. Isolated retinal cotton wool spot after coronary angiography

    OpenAIRE

    Kopsachilis, Nikolaos; Brar, Manpreet; Marinescu, Anca I. C.; Sivaprasad, Sobha

    2013-01-01

    Visual symptoms after coronary angiography are rarely encountered and mostly related to contrast induced transient cortical blindness or retinal artery occlusions. We report an intriguing case of a 50-year-old woman, who presented with vision deterioration in her right eye 12 h after coronary angiography for cardiac palpitation. Fundoscopy and optical coherence tomography scan revealed an isolated parafoveal cotton wool spot in her right eye that has totally resolved 6 weeks after initial pre...

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

    Directory of Open Access Journals (Sweden)

    Hongqi Yang

    2015-07-01

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

  14. Rare associations of tetralogy of Fallot with anomalous left coronary artery from pulmonary artery and totally anomalous pulmonary venous connection.

    Science.gov (United States)

    Sen, Supratim; Rao, Suresh G; Kulkarni, Snehal

    2016-06-01

    We describe the cases of two patients with tetralogy of Fallot, aged 4 years and 8 months, who were incidentally detected to have concomitant anomalous left coronary artery from pulmonary artery and total anomalous pulmonary venous connection, respectively, on preoperative imaging. They underwent surgical correction with good mid-term outcomes. In this study, we discuss the embryological basis, physiological effects, and review the literature of these two unusual associations. Awareness of these rare associations will avoid missed diagnoses and consequent surgical surprises.

  15. Impact of primary PCI on early and long-term outcomes in patients with ST-elevation myocardial infarction combined with chronic total occlusion of non-infarct related artery

    International Nuclear Information System (INIS)

    Ge Zhiru; Qiu Jianping; Lu Jide; Shen Weifeng

    2010-01-01

    Objective: To discuss the clinical characteristics of ST-elevation myocardial infarction (STEMI) combined with chronic total occlusion of non-infarct-related artery (non-IRA), and to assess the therapeutic effect of primary percutaneous coronary intervention (PCI). Methods: This study included 360 consecutive patients with STEMI who underwent primary PCI within the first 12 hours after the onset of symptom. Of them, 47 patients (Group A) had at least one chronic total occlusion (CTO) vessel of non-IRA, while the remaining 313 patients (Group B) showed no CTO vessels of non-IRA. Clinical characteristics, PCI procedural features, outcomes during hospitalization and follow-up results were compared between two groups. Results: Compared with Group B, patients in Group A had more diabetes (25.5% vs 14.1%, P = 0.043) and previous myocardial infarction history (10.6% vs 3.2%, P = 0.017). During PCI procedure, intraaortic balloon pump (IABP) was more often used in group A than in group B (21.3% vs 10.9%, P = 0.042). Similarly, temporary cardiac pacing (38.3% vs 21.1%, P = 0.009) and electrical cardioversion (21.3% vs 6.4%, P = 0.001) were more frequently performed in Group A than in Group B. But technical success rate (93.6% vs 94.6%) and in-hospital mortality rate (6.4% vs 5.4%, P > 0.05) showed no significant difference between two groups. During the follow-up period (average 42 months), occurrence of heart failure was significantly higher (21.3% vs 10.9%, P = 0.042) in Group A than in Group B, however no significant difference in mortality rate existed between two groups (4.3% vs 5.8%, P > 0.05). Conclusion: Despite serious clinical conditions, patients with STEMI and CTO of at least one non-infarct-related artery can obtain a satisfactory short-term and long-term effectiveness if primary PCI procedure can be carried out with the help of circulatory and electrophy-siological support. (authors)

  16. A randomized, controlled, multicenter trial to evaluate the safety and efficacy of Zotarolimus- vs. Paclitaxel-eluting stents in de novo occlusive lesions in coronary arteries

    DEFF Research Database (Denmark)

    Chevalier, Bernard; Dimario, Carlo; Neumann, Franz-Josef

    2013-01-01

    The ZOMAXX I trial tested the noninferiority of a zotarolimus-eluting coronary stent (ZoMaxx(™) ) when compared with a paclitaxel-eluting coronary stent (Taxus(™) Express(2™) ) in a randomized trial of percutaneous intervention for de novo coronary artery stenosis. Angiographic analysis at the pr......The ZOMAXX I trial tested the noninferiority of a zotarolimus-eluting coronary stent (ZoMaxx(™) ) when compared with a paclitaxel-eluting coronary stent (Taxus(™) Express(2™) ) in a randomized trial of percutaneous intervention for de novo coronary artery stenosis. Angiographic analysis...... at the primary endpoint of 9 months has been reported previously. The purpose of this follow-on analysis was to describe the clinical results of the ZoMaxx and Taxus cohorts of the ZOMAXX I trial after 5 years....

  17. Combination of Carbon Dioxide Angiography and Outback® Elite for Revascularization of a Patient with Renal Insufficiency with Bilateral Femoropopliteal Chronic Total Occlusions.

    Science.gov (United States)

    Nojima, Yuhei; Nanto, Shinsuke; Adachi, Hidenori; Ihara, Madoka; Kurimoto, Tetsuya

    2017-01-01

    A new reentry device (Outback Elite) system has been available in Japan since June 2016. This new device enables easier treatment of chronic total occlusion (CTO) in the lower extremities. We report a case of a woman in her 70s who underwent revascularization using this new device twice to treat both of her femoropopliteal CTO lesions. She was referred to our hospital complaining of intermittent claudication in both legs. She had a long history of diabetes mellitus complicated with severe chronic kidney disease. Her estimated glomerular filtration rate was Outback Elite device and carbon dioxide (CO 2 ) angiography made it possible to revascularize both of her legs without iodine contrast medium. At 6 months after the procedures, we did not observe exacerbation of claudication in her legs.

  18. Functional significance of coronary collateral circulation during dynamic exercise evaluated by thallium-201 myocardial scintigraphy

    International Nuclear Information System (INIS)

    Wainwright, R.J.; Maisey, M.N.; Edwards, A.C.; Sowton, E.

    1980-01-01

    Sixty-five patients with angiographically documented coronary artery disease were investigated by thallium-201 ( 201 Tl) scintigraphy to determine the role of the collateral circulation during dynamic exercise. Fifty-three patients had complete proximal occlusion of at least one major coronary artery. One patient had total occlusion of all three major coronary arteries. Sixty-four collateral channels were identified, graded, and compared with corresponding regions of the myocardial scintigram. Tracer uptake was also graded and classified as various degrees of protection from ischaemia. A significant correlation between good collaterals with complete protection and poor or absent collaterals with no protection was noted. Seventeen patients (20 occluded vessels) had total coronary occlusion without myocardial infarction. Collaterals conferred protection in 9/15 occlusions whereas no protection was seen in five occlusions without collaterals. There was no difference in the protective role of homocoronary and heterocoronary collateral vessels. Hypertrophy of the first septal left anterior descending perforator conferred significant protection from ischaemia in contrast to bridging collaterals and ghosting. During exercise the right coronary bed is preferentially protected from ischaemia, in contrast to the left anterior descending territory. This probably reflects the direction of a transmural flow gradient between left and right ventricles during exercise. (author)

  19. The dynamics of the coronary collateral circulation.

    Science.gov (United States)

    Zimarino, Marco; D'Andreamatteo, Mariangela; Waksman, Ron; Epstein, Stephen E; De Caterina, Raffaele

    2014-04-01

    Coronary collaterals are present at birth, with wide interindividual variation in their functional capacity. These vessels protect jeopardized myocardium, and the number of collaterals and the extent of their coverage are associated with improved survival in patients with coronary heart disease. The collateral circulation is not a permanent set of structures, but undergoes dynamic changes with important consequences for cardioprotection. If a severe atherosclerotic lesion develops in an artery supplying tissue downstream of a total occlusion through collateral blood flow, pressure gradients across the collateral bed change. The result is that some of the collateral flow previously supplying the perfusion territory of the totally occluded artery is redirected to the perfusion territory of the donor artery, thus producing a 'collateral steal'. The collateral circulation can regress once antegrade flow in the main dependent artery is re-established, as occurs following the recanalization of a chronic total occlusion. The clinical benefits of coronary revascularization must be cautiously weighed against the risk of reducing the protective support derived from coronary collaterals. Consequently, pharmacological, gene-based, and cell-based therapeutic attempts have been made to enhance collateral function. Although such approaches have so far yielded no, or modest, beneficial results, the rapidly accruing data on coronary collateral circulation will hopefully lead to new effective therapeutic strategies.

  20. Effects of low dose aspirin (50 mg/day), low dose aspirin plus dipyridamole, and oral anticoagulant agents after internal mammary artery bypass grafting: patency and clinical outcome at 1 year. CABADAS Research Group of the Interuniversity Cardiology Institute of The Netherlands. Prevention of Coronary Artery Bypass Graft Occlusion by Aspirin, Dipyridamole and Acenocoumarol/Phenprocoumon Study

    NARCIS (Netherlands)

    van der Meer, J.; Brutel de la Rivière, A.; van Gilst, W. H.; Hillege, H. L.; Pfisterer, M.; Kootstra, G. J.; Dunselman, P. H.; Mulder, B. J.; Lie, K. I.

    1994-01-01

    This study was performed to compare the efficacy and safety of aspirin, aspirin plus dipyridamole, and oral anticoagulant agents in the prevention of internal mammary artery graft occlusion. Antithrombotic drugs increase vein graft patency after coronary artery bypass surgery. Their benefit after

  1. Isolated retinal cotton wool spot after coronary angiography

    Directory of Open Access Journals (Sweden)

    Nikolaos Kopsachilis

    2013-01-01

    Full Text Available Visual symptoms after coronary angiography are rarely encountered and mostly related to contrast induced transient cortical blindness or retinal artery occlusions. We report an intriguing case of a 50-year-old woman, who presented with vision deterioration in her right eye 12 h after coronary angiography for cardiac palpitation. Fundoscopy and optical coherence tomography scan revealed an isolated parafoveal cotton wool spot in her right eye that has totally resolved 6 weeks after initial presentation. This is the first case report of this rare post coronary angiography complication.

  2. Isolated retinal cotton wool spot after coronary angiography.

    Science.gov (United States)

    Kopsachilis, Nikolaos; Brar, Manpreet; Marinescu, Anca I C; Sivaprasad, Sobha

    2013-01-01

    Visual symptoms after coronary angiography are rarely encountered and mostly related to contrast induced transient cortical blindness or retinal artery occlusions. We report an intriguing case of a 50-year-old woman, who presented with vision deterioration in her right eye 12 h after coronary angiography for cardiac palpitation. Fundoscopy and optical coherence tomography scan revealed an isolated parafoveal cotton wool spot in her right eye that has totally resolved 6 weeks after initial presentation. This is the first case report of this rare post coronary angiography complication.

  3. Stent implantation for a totally occluded right coronary artery in a six-year-old boy after Kawasaki disease: a case report

    Directory of Open Access Journals (Sweden)

    Hsu Ya-Chi

    2012-04-01

    Full Text Available Abstract Introduction Coronary stenting has previously been considered to be less feasible in children under 12 years old due to the limitation of vascular access. We report the case of a six-year-old boy who successfully underwent stent implantation for his totally occluded right coronary artery. Case presentation A Taiwanese boy aged six years and nine months old was found to have giant aneurysms after an acute episode of Kawasaki disease. An angiography revealed that his middle right coronary artery was totally occluded. A 0.014-inch guidewire was advanced to cross the totally occluded site. After pre-dilating the middle portion of his right coronary artery with a 1.5 mm balloon, stenting of his right coronary artery was accomplished using a 2.5 × 28 mm and a 2.5 × 18 mm bare metal stent. A final angiography demonstrated no residual stenosis or dissection. Conclusion Coronary stenting could be a therapeutic option for children as young as six years old. Close follow-up is mandatory because the long-term outcome is still unclear, especially in a small child.

  4. String-like lumen in below-the-knee chronic total occlusions on contrast-enhanced magnetic resonance angiography predicts intraluminal recanalization and better blood flow restoration

    Energy Technology Data Exchange (ETDEWEB)

    Zhu, Yue-Qi; Lu, Hai-Tao; Wei, Li-Ming; Cheng, Ying-Sheng; Wang, Jian-Bo; Zhao, Jun-Gong [Shanghai Jiao Tong University Affiliated Sixth People' s Hospital, Department of Diagnostic and Interventional Radiology, Shanghai (China); Liu, Fang [Shanghai Jiao Tong University Affiliated Sixth People' s Hospital, Department of Endocrinology, Shanghai (China)

    2017-07-15

    To determine whether string-like lumina (SLs) on contrast-enhanced magnetic resonance angiography (CE-MRA) predict better outcomes in diabetic patients with below-the-knee (BTK) chronic total occlusions (CTOs). This study involved 317 long-segment (>5 cm) BTK CTOs of 245 patients that were examined using CE-MRA and treated using endovascular angioplasty. An SL with a CTO was slowly filled with blood on conventional CE-MRA. Univariate and multivariate analyses were performed to identify predictors of procedural success, recanalisation method and immediate blood flow restoration. The target-lesion patency and limb-salvage rates were assessed. SL-positive CTOs (n = 60) achieved a higher technique success rate, preferred intraluminal angioplasty and better blood flow restoration than SL-negative CTOs (n = 257, P < 0.05). Multivariate analyses revealed that lesion length was the independent predictor of procedural success (P = 0.028). SL was a predictor of intraluminal angioplasty (P < 0.001) and good blood-flow restoration (P = 0.004). Kaplan-Meier analyses at 12 months revealed a higher target lesion patency rate (P = 0.04) and limb-salvage rate (P = 0.35) in SL-positive CTOs. In patients with BTK CTOs, SL predicted intraluminal angioplasty and good blood-flow restoration for BTK CTOs. (orig.)

  5. Combination of Carbon Dioxide Angiography and Outback® Elite for Revascularization of a Patient with Renal Insufficiency with Bilateral Femoropopliteal Chronic Total Occlusions

    Directory of Open Access Journals (Sweden)

    Yuhei Nojima

    2017-01-01

    Full Text Available A new reentry device (Outback Elite system has been available in Japan since June 2016. This new device enables easier treatment of chronic total occlusion (CTO in the lower extremities. We report a case of a woman in her 70s who underwent revascularization using this new device twice to treat both of her femoropopliteal CTO lesions. She was referred to our hospital complaining of intermittent claudication in both legs. She had a long history of diabetes mellitus complicated with severe chronic kidney disease. Her estimated glomerular filtration rate was <20. She refused surgical revascularization; therefore, we performed our treatment without iodine contrast medium. First, magnetic resonance imaging was performed to confirm that the CTO lesions had caused severe claudication before intervention. Subsequently, the Outback Elite device and carbon dioxide (CO2 angiography made it possible to revascularize both of her legs without iodine contrast medium. At 6 months after the procedures, we did not observe exacerbation of claudication in her legs.

  6. Targeted True Lumen Re-Entry With the Outback Catheter: Accuracy, Success, and Complications in 100 Peripheral Chronic Total Occlusions and Systematic Review of the Literature.

    Science.gov (United States)

    Kitrou, Panagiotis; Parthipun, Aneeta; Diamantopoulos, Athanasios; Paraskevopoulos, Ioannis; Karunanithy, Narayan; Katsanos, Konstantinos

    2015-08-01

    To report a single-center experience with the Outback re-entry device for targeted distal true lumen re-entry during subintimal recanalization of chronic total occlusions (CTOs) and compare the results with a systematic review of the literature. Between February 2011 and July 2013, 104 Outback devices were employed in 91 patients (mean age 64±9 years; 57 men) for subintimal recanalization of 100 vessels with CTOs after initial failure of spontaneous reentry. Fifty-two cases involved a retrograde approach to aortoiliac occlusions and 48 were re-entry attempts in infrainguinal CTOs. Outcome measures included complications and technical success, defined as successful targeted re-entry at the preplanned site of the distal true lumen. To evaluate device accuracy, the re-entry distance (between the point of true vessel reconstitution and the eventual re-entry point) was measured. Outback success was 93% (93/100); only 7 cases failed owing to heavy calcification (5/52 aortoiliac vs 2/48 infrainguinal, p=0.44). Re-entry was highly accurate, with a re-entry distance of ~1 cm in both subgroups (1.2±0.1 cm in aortoiliac vs 1.3±0.1 cm in infrainguinal, p=0.40). There were no major and 17 minor complications (9/52 aortoiliac vs 8/48 infrainguinal, p=0.93). Results are in line with the systematic review that identified 11 studies (only 1 randomized trial) involving mostly the femoropopliteal segment (119 aortoiliac and 464 infrainguinal segments). The pooled Outback success rate was 90% (95% confidence interval 85% to 94%) and the pooled complication rate was 4.3% (95% confidence interval 1.6% to 8.3%). The Outback device is safe and has a very high rate of achieving targeted true lumen re-entry, which minimizes the sacrifice of healthy vessel in the aortoiliac and infrainguinal arteries. © The Author(s) 2015.

  7. Predictors for better blood-flow restoration of long-segmental below-the-knee chronic total occlusions after endovascular therapy in diabetic patients

    Energy Technology Data Exchange (ETDEWEB)

    Song, Xiao Li [Dept. of Radiology, Chonnam National University Medical School, Gwangju (Korea, Republic of); Zhu, Yue Qi; Lu, Hai Tao; Lui, Fang; Wei, Li Ming; Kang, Heoung Keun; Zhao, Jun Gong [Shanghai Jiao Tong University Affiliated Sixth People' s Hospital, Shanghai (China)

    2016-11-15

    To prospectively investigate predictors for good restoration of blood flow of below-the-knee (BTK) chronic total occlusions (CTOs) after endovascular therapy in diabetes mellitus (DM) patients. A total of 120 long-segmental (≥ 5 cm) BTK, CTOs in 81 patients who underwent recanalization were included in this study. After angioplasty, blood-flow restoration was assessed using modified thrombolysis in myocardial ischemia grades and classified as good flow (grade 3) and poor flow (grade 1/2). One hundred and six CTOs with successful recanalization were divided into a good flow group (GFG; n = 68) and poor flow group (PFG; n = 38). Multivariate logistic regression analyses were undertaken to determine independent predictors of blood-flow restoration. Receiver operating characteristic curves were constructed to determine the best cutoff value. The prevalence of target-lesion restenosis during follow-up was compared between two groups. Univariate analyses suggested that CTOs in GFG were characterized by lighter limb ischemia (p = 0.03), shorter course of ischemic symptoms (p < 0.01) and lesion length (p = 0.04), more frequent use of intraluminal angioplasty (p = 0.03), and higher runoff score (p < 0.01) than those in PFG. Multivariate regression analyses suggested that distal runoffs (p = 0.001; odds ratio [OR], 10.32; 95% confidence interval [CI]: 4.082-26.071) and lesion length (p < 0.001; OR, 1.26; 95% CI: 1.091-1.449) were independent predictors for good flow restoration. Kaplan-Meier analyses at 12 months showed a higher prevalence of non-restenosis in GFG (p < 0.01). Distal runoffs and lesion length are independent predictors for good flow restoration for long-segmental BTK, CTOs in DM patients who receive endovascular therapy.

  8. Randomized control study of the outback LTD reentry catheter versus manual reentry for the treatment of chronic total occlusions in the superficial femoral artery.

    Science.gov (United States)

    Gandini, Roberto; Fabiano, Sebastiano; Spano, Sergio; Volpi, Tommaso; Morosetti, Daniele; Chiaravalloti, Antonio; Nano, Giovanni; Simonetti, Giovanni

    2013-09-01

    To assess the efficacy and safety of the Outback device in patients with a chronic total occlusion (CTO) of the superficial femoral artery and evaluate its impact on fluoroscopy and procedural times. From October 2006 to March 2007, 52 patients affected by TASC II-D superficial femoral artery CTO were treated with subintimal recanalization. Clinical indications for endovascular recanalization were: claudication, tissue loss, and at rest leg pain with critical limb ischemia. In 26 patients the manual reentry technique was used and in 26 the OUTBACK(®) LTD Re-Entry Catheter was used. Total procedure time, fluoroscopy time and precision in targeting the expected reentry site have been compared. Technical success was achieved in all cases (100%). In group 2, the planned in-target re-entry was achieved in 11/26 cases (42.3%). The procedure was performed with a traditional antegrade approach in 23/26 (88.4%) cases and in three cases (11.6%) a combined antegrade/retrograde approach was necessary. In group 1, the in-target re-entry was achieved in 26/26 cases (100%). In group 2, the mean procedural time was 55.4 ± 14.2 min with a mean fluoroscopy time 39.6 ± 13.9 min compared to 36.0 ± 9.4 min and 29.8 ± 8.9 min, respectively, of group 1 (P Outback device grants high technical success rates and a significant reduction of procedural and fluoroscopy times. Copyright © 2013 Wiley Periodicals, Inc.

  9. Pleiotrophin levels are associated with improved coronary collateral circulation.

    Science.gov (United States)

    Türker Duyuler, Pinar; Duyuler, Serkan; Gök, Murat; Kundi, Harun; Topçuoğlu, Canan; Güray, Ümit

    2018-01-01

    Elucidation of the underlying mechanisms of angiogenesis and arteriogenesis in coronary collateral formation is necessary for new therapies. Pleiotrophin is a secreted multifunctional cytokine and associated with the formation of functional cardiovascular neovascularization in a series of experimental animal models. We aimed to evaluate the serum levels of pleiotrophin in patients with chronic total coronary artery occlusion and poor or good collateral development. We included 88 consecutive patients (mean age of the entire population: 63.7±12.1 years, 68 male patients) with stable angina pectoris who underwent coronary angiography and had chronic total occlusion in at least one major coronary artery. Collateral grading was performed according to the Rentrop classification. After grading, patients were divided into poor collateral circulation (Rentrop grade 0 and 1) and good collateral circulation (Rentrop grades 2 and 3) groups. Serum pleiotrophin levels were measured using a commercial human ELISA kit. Fifty-eight patients had good and 30 patients had poor coronary collaterals. The good collateral group had higher serum pleiotrophin levels than the poor collateral group (690.1±187.9 vs. 415.3±165.9 ng/ml, Pcollateral development (odds ratio: 1.007; confidence interval: 1.003-1.012; P=0.002). This study showed that increased serum pleiotrophin levels are associated with better developed coronary collateral circulation. Further studies are needed to better understand the relationship.

  10. The correlation between serum total bilirubin and outcomes in patients with different subtypes of coronary artery disease.

    Science.gov (United States)

    Huang, Fang-Yang; Peng, Yong; Huang, Bao-Tao; Yang, Yong; Pu, Xiao-Bo; Chen, Shi-Jian; Gui, Yi-Yue; Xia, Tian-Li; Chen, Fei; Liu, Rui-Shuang; Zhu, Ye; Chen, Mao

    2017-02-01

    The relation between serum total bilirubin (TBi) and mortality in patients with established coronary artery disease (CAD) remains undefined. We try to investigate the role of the subtypes of CAD in the association. A total of 3013 patients with angiographically obstructive CAD were enrolled. A retrospective analysis was conducted. Patients were divided into 3 groups as follows: stable CAD (SCAD), unstable angina pectoris (UAP) and acute myocardial infarction (AMI). The predictive values of TBi for 30-day and long-term mortality were assessed using logistic and Cox regression, respectively. Higher initial serum TBi levels were significantly associated with increased risk of short-term mortality (OR 2.35, 95% CI 1.15-4.77) in AMI group. However, the association was absent among patients with SCAD and UAP. Serum TBi was able to independently predict the long-term mortality in SCAD (HR 0.34, 95% CI 0.16-0.70) and UAP (HR 0.49, 95% CI 0.31-0.78) groups. However, there was no significant relation between TBi and long-term mortality in AMI groups. The different subtypes of CAD affected the relation between serum TBi and clinical prognosis. Initial serum TBi was positively correlated with short-term mortality of AMI patients, and negatively correlated with long-term mortality in SCAD or UAP patients. Copyright © 2016 Elsevier B.V. All rights reserved.

  11. Association between inflammatory factor, lipid peroxidation and total-antioxidant in non-diabetic patients of coronary artery disease

    Directory of Open Access Journals (Sweden)

    fatemeh khaki-khatibi

    2014-02-01

    Full Text Available Introduction: The oxidative stress and inflammation are cooperative events involved in atherosclerosis development. In the present study, we assessed the association ofmalondialdehyde (MDA, antioxidant markers, high sensitive C-reactive protein (HS-CRPand lipid status parameters in non-diabetic patients with coronary artery disease (CAD orvessel heart disease (VHD. Significant risk factors such as diabetes were excluded from thestudy. Methods: Oxidative stress parameters for example MDA, antioxidant markers including:erythrocyte superoxide dismutase (SOD, glutathione peroxidase (GPX, total antioxidant capacity (TAC, inflammation marker and serum lipid status parameters were measured in 120 subjects including 60 CAD patients (non-diabetic with angiographically diagnosed CADand 60 CAD-free subjects as a control group, also diabetic patients with malignancy, renal andliver disease, and other disease were excluded from the study. Results: The serum MDA and HS-CRP levels were increased significantly as compared to thecontrols. However, erythrocyte SOD, GPX activities and TAC level were reduced significantly in patients (non-diabetic (P < 0.05 in all cases. The levels of total cholesterol,triglyceride, and low-density lipoprotein cholesterol (LDL-c were significantly higher andthat of high-density lipoprotein cholesterol (HDL-c was significantly lower than those ofcontrols (P < 0.05 in all cases. Conclusion: The association between oxidative stress parameters, antioxidant markers, theinflammation index and lipid status parameters suggest their involvement in atherosclerosis development that may lead to CAD progression.

  12. Tronco de coronária esquerda ocluso secundário a Lues terciária Tronco de coronaria izquierda ocluido secundario a Lúes terciaria Occlusion of the left coronary trunk secondary to tertiary syphilis

    Directory of Open Access Journals (Sweden)

    Ricardo Wang

    2009-09-01

    Full Text Available Paciente de 27 anos, portador de sífilis terciária, manifestando isquemia miocárdica, com angina instável, secundária à oclusão do tronco da coronária esquerda. O diagnóstico foi confirmado pelos achados da sorologia e da patologia do fragmento da aorta.Paciente de 27 años, portador de sífilis terciaria, manifestando isquemia miocárdica, con angina inestable, secundaria a la oclusión del tronco de la coronaria izquierda. El diagnóstico fue confirmado por los resultados de la serología y de la patología del fragmento de la aorta.A 27-year-old patient with tertiary syphilis, manifested as myocardial ischemia, presenting unstable angina, secondary to left coronary trunk occlusion. The diagnosis was confirmed by the serological findings and the pathological assessment of the aorta fragment.

  13. Total Cardiovascular Events Analysis of the EXAMINE Trial in Patients with Type 2 Diabetes and Recent Acute Coronary Syndrome.

    Science.gov (United States)

    Cavender, Matthew A; White, William B; Liu, Yuyin; Massaro, Joseph M; Bergenstal, Richard M; Mehta, Cyrus R; Zannad, Faiez; Heller, Simon; Cushman, William C; Cannon, Christopher P

    2018-04-13

    Alogliptin, a dipeptidyl-peptidase 4 inhibitor, is approved for the treatment of patients with type 2 diabetes. EXAMINE was a randomized-controlled clinical trial designed to demonstrate the cardiovascular safety of alogliptin. In the trial, 5380 patients with established T2DM who had a recent ACS event (between 15-90 days) were randomized to treatment with either alogliptin or placebo. To better understand and describe the cardiovascular (CV) safety of alogliptin, we analyzed data from the EXAMINE randomized clinical trial to determine whether treatment with alogliptin affected recurrent and total CV events. Poisson regression analysis was performed to compare the total number of occurrences of CV death, MI, stroke, unstable angina, and coronary revascularization between all patients randomized to alogliptin versus placebo groups. Patients with recurrent CV events were older and more likely to have renal disease and history of heart failure. There were 1100 first CV events and an additional 666 recurrent events over a median of 18 months of follow-up. There were no significant differences with regard to the total number of events in patients treated with alogliptin (n=873) or placebo (n=893; p=0.52). Furthermore, there were no differences in the types of events seen in patients treated with alogliptin or placebo. Alogliptin did not increase the risk of either first or recurrent CV events when compared to placebo in patients with type 2 diabetes and recent ACS. These data support the CV safety of alogliptin in patients who are at increased risk of future CV events. This article is protected by copyright. All rights reserved.

  14. Multidetector Computed Tomography (CT) Analysis of 168 Cases in Diabetic Patients with Total Superficial Femoral Artery Occlusion: Is It Safe to Use an Anterolateral Thigh Flap without CT Angiography in Diabetic Patients?

    Science.gov (United States)

    Suh, Hyunsuk Peter; Kim, Youngchul; Suh, Youngchul; Hong, JoonPio

    2018-01-01

     The superficial femoral artery (SFA) is the most common site of lower extremity atherosclerosis, and collateral vessels from the deep femoral artery (DFA) play an important compensatory role between the iliofemoral segment and the popliteal artery. We examined SFA occlusion and collateral vessel developments in patients with diabetes mellitus using computed tomography (CT) angiography. We also compared the collateral systems from the DFA and the descending branch of the lateral circumflex femoral artery (dbLCFA) in the case of SFA occlusion.  We retrospectively reviewed 1,316 sets of CT angiographic data collected from 673 patients with diabetes between 2008 and 2010. The degree of stenosis in each segment of the proximal and distal SFA and the number and size of collateral vessels originating from the DFA and dbLCFA were measured using established scoring systems. In cases where the SFA was occluded, the numbers of collateral vessels originating from the DFA and the dbLCFA vessel were compared.  The mean occlusion rate of the SFA was 15.6%. We noted that collateral vessels from DFA and dbLCFA were the main circulatory route in cases of occlusions of the SFA. More collateral vessels developed from the DFA than from the dbLCFA. Overall, 0.6% of the patients had only collateral systems from the dbLCFA.  When planning to use anterolateral thigh free flaps in diabetic patients with suspected SFA total occlusion, thorough investigations of the peripheral vessels are essential. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  15. Cardiovascular Risk Factors and Total Serum Antioxidant Capacity in Healthy Men and in Men with Coronary Heart Disease

    Directory of Open Access Journals (Sweden)

    Anna Gawron-Skarbek

    2014-01-01

    Full Text Available Whether the incidence of coronary heart disease (CHD is related to a decrease in total antioxidant capacity (TAC has not yet been completely clarified. We assessed TAC of blood serum in a group of 163 men with CHD aged 34.8–77.0 years and in 163 age-matched peers without CHD. Two spectrophotometric methods were applied to assess TAC: ferric reducing ability of serum (TAC-FRAS and 2.2-diphenyl-1-picryl-hydrazyl (TAC-DPPH tests. In the CHD group, multivariate analysis revealed that uric acid (UA, triglycerides, and systolic blood pressure contributed independently to the TAC-FRAS variance. TAC-DPPH was favorably predicted by UA concentration, but negatively so by current smoking and glucose levels. In men without CHD, UA was the only independent determinant of both TAC-FRAS and TAC-DPPH. Presence of CHD was not an independent predictor of TAC—observed between-group differences (higher TAC in CHD patients disappeared after adjustment for other confounders. We conclude that UA is the main determinant of TAC of blood serum in men. TAC is not directly influenced by age or CHD but is related to several indices of overweight/obesity and laboratory measures of metabolic syndrome, especially in patients with CHD.

  16. The use of excimer laser for complex coronary artery lesions.

    Science.gov (United States)

    Ben-Dor, Itsik; Maluenda, Gabriel; Pichard, Augusto D; Satler, Lowell F; Gallino, Robert; Lindsay, Joseph; Waksman, Ron

    2011-01-01

    Excimer laser coronary atherectomy (ELCA) has been used for coronary intervention for more than 20 years. Advances in delivery systems for laser energy using the xenon-chlorine pulsed laser catheter deliver higher energy density with lower heat production. The Spectranetics CVX-300 (Spectranetics, Colorado Springs, CO, USA) excimer laser catheter system has been used for the treatment of complex coronary lesions. We report our experience with the use of this advanced system for stenoses for which were unsuitable for standard percutaneous coronary intervention; for example, balloon-resistant lesions, chronic total occlusions, and for underexpanded stents in calcified lesions. ELCA may also be valuable for thrombus-containing lesion. We find ELCA to be indispensable in the catheterization laboratory for specific complex or calcified lesions. Its role should be explored in a large randomized trial of thrombus containing lesions and saphenous vein grafts. Copyright © 2011. Published by Elsevier Inc.

  17. Statistical coronary motion models for 2D + t/3D registration of X-ray coronary angiography and CTA

    DEFF Research Database (Denmark)

    Baka, N.; Metz, C. T.; Schultz, C.

    2013-01-01

    Accurate alignment of intra-operative X-ray coronary angiography (XA) and pre-operative cardiac CT angiography (CTA) may improve procedural success rates of minimally invasive coronary interventions for patients with chronic total occlusions. It was previously shown that incorporating patient...... motion models to provide constraints for the 2D+t/3D registration. We propose a methodology for building statistical motion models of the coronary arteries from a training population of 4D CTA datasets. We compare the 2D+t/3D registration performance of the proposed statistical models with other motion...... estimates, including the patient specific motion extracted from 4D CTA, the mean motion of a population, the predicted motion based on the cardiac shape. The coronary motion models, constructed on a training set of 150 patients, had a generalization accuracy of 1mm root mean square point-to-point distance...

  18. Contribution of quantitative coronary angiography in Palmaz-Schatz optimal stent liberation strategy for subacute occlusion control; Contribuicao da angiografia coronaria quantitativa na estrategia de liberacao otima da endoprotese de Palmaz-Schatz para o controle da oclusao subaguda

    Energy Technology Data Exchange (ETDEWEB)

    Sousa, Amanda Guerra de Moraes Rego

    1995-07-01

    This study examines whether a single method, quantitative coronary angiography with automated edge detection, could efficiently guide optimal stent liberation, assuring good clinical results and eliminating the need for anticoagulation therapy. This investigation includes 101 patients with optimal implantation of 104 Palmaz-stents. Their mean age was 58.62 years and 79.2% were male. Most of them presented unstable angina (61.39%) and had single vessel disease (85.15%) The treated vessel was the left anterior descending artery in 39.60%; the right coronary artery in 34.66%; the left circumflex artery in 7.92% and saphenous vein grafts in 17.82%. The mean reference diameter of the target vessel was 3.43 mm. Each implantation comprehended two phases: initial stent liberation and additional high pressure balloon inflation, guided by quantitative coronary angiography. Arterial quantification showed an important increase in the mean luminal diameter (p<0.001), characterized by an immediate gain of 2.37 mm [standard deviation (SD): 0.55 m]. Quantitative angiography permitted to identify a further gain in the luminal diameter following the high pressure balloon inflation, o.49 mm 9 SD:0.53 mm). Therefore, the total mean immediate gain was 2.85 mm (SD:0.64 mm). The mean diameter stenosis changed from 80.21% (SD:14.56%) to 11.81% (SD: 7.59% - p<0.001) after initial stent delivery; and to 0.16% (SD:3.45% - p<,0.001), after high pressure balloon inflation. Quantitative coronary angiography performed detailed measurements of the minimal caliber variations along the entire prosthesis due to the high pressure balloon inflations, similarly to the intracoronary ultrasound. This guided the optimal stent implantation and helped the clinical management of these cases. In this series, even maintained only under antiaggregant agents, no patient presented major ischemic complications and only one (0.99%) had a hemorrhage in the puncture site that required blood transfusion. The mean in

  19. Robotic Total Arterial Off-Pump Coronary Artery Bypass Grafting: Seven-Year Single-Center Experience and Long-Term Follow-Up of Graft Patency.

    Science.gov (United States)

    Yang, Ming; Wu, Yang; Wang, Gang; Xiao, Cangsong; Zhang, Huajun; Gao, Changqing

    2015-10-01

    Coronary artery bypass grafting (CABG) is the gold-standard treatment for coronary artery disease, but the long-term benefits of robotic CABG remain unclear. Between January 2007 and November 2014, 240 consecutive patients (187 male and 53 female, average age 59 years) underwent robotic off-pump CABG with the da Vinci Surgical System (Intuitive Surgical, Sunnyvale, CA) in our center. Totally endoscopic coronary artery bypass (TECAB) (n = 100) or mini-thoracotomy coronary artery bypass (MINICAB) (n = 140) grafting was performed with skeletonized internal mammary arteries (IMA). Patients were followed up and graft patency was assessed every 6 months by coronary angiography or 64-multi-slide computed tomographic angiography. All cases were completed without conversion to median sternotomy or cardiopulmonary bypass. A total of 237 single IMA grafts (98.3%) and 4 bilateral IMA grafts (1.7%) were used. No operative mortality was observed. Hybrid revascularization of non-left anterior descending vessels was performed in 24 patients (10%). No death, stroke, or myocardial infarction occurred in the follow-up of 41.1 ± 12.9 months. All grafts were patent before discharge. The IMA graft patency was 97.1% in TECAB and 96.4 % in MINICAB over 3 years (up to 91 months) postoperatively. Robotic off-pump CABG using IMA grafts is a safe and effective procedure in selected patients. The long-term outcome and patency of IMA grafts are excellent. Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  20. CAD-RADS - a new clinical decision support tool for coronary computed tomography angiography.

    Science.gov (United States)

    Foldyna, Borek; Szilveszter, Bálint; Scholtz, Jan-Erik; Banerji, Dahlia; Maurovich-Horvat, Pál; Hoffmann, Udo

    2018-04-01

    Coronary computed tomography angiography (CTA) has been established as an accurate method to non-invasively assess coronary artery disease (CAD). The proposed 'Coronary Artery Disease Reporting and Data System' (CAD-RADS) may enable standardised reporting of the broad spectrum of coronary CTA findings related to the presence, extent and composition of coronary atherosclerosis. The CAD-RADS classification is a comprehensive tool for summarising findings on a per-patient-basis dependent on the highest-grade coronary artery lesion, ranging from CAD-RADS 0 (absence of CAD) to CAD-RADS 5 (total occlusion of a coronary artery). In addition, it provides suggestions for clinical management for each classification, including further testing and therapeutic options. Despite some limitations, CAD-RADS may facilitate improved communication between imagers and patient caregivers. As such, CAD-RADS may enable a more efficient use of coronary CTA leading to more accurate utilisation of invasive coronary angiograms. Furthermore, widespread use of CAD-RADS may facilitate registry-based research of diagnostic and prognostic aspects of CTA. • CAD-RADS is a tool for standardising coronary CTA reports. • CAD-RADS includes clinical treatment recommendations based on CTA findings. • CAD-RADS has the potential to reduce variability of CTA reports.

  1. Bilateral internal carotid artery occlusion

    International Nuclear Information System (INIS)

    Yamamoto, Yasumasa; Tsuda, Harumi; Nabatame, Hidehiko; Akiguchi, Ichiro; Kameyama, Masakuni.

    1987-01-01

    Four cases of bilateral internal carotid occlusion are reported with respect to clinical features, hemodynamics and various image diagnosis. MRI is applied to three cases. The patients comprised 2.08 % of all cerebral occlusive diseases treated during the past five years at our clinic. One case is of abrupt onset and three cases are progressing profiles. In one of these cases, collateral circulation is supplied mainly by leptomeningeal anastomosis of the posterior cerebral artery and posterior pericallosal artery branching from the basilar artery. In two of them, they are supplied through the circle of Willis. Middle cerebral artery occlusion, occlusion supra occlusionem, however, causes decisive ischemic lesion in its teritory. Applying MRI, complicated ischemic lesions, such as lacunar infarction, paraventricular lesion, deep white matter lesion and border zone infarction can clearly be identified. In the case of total aphasia, the lesions responsible are demonstrated clearly by MRI, but only vaguely by X-ray CT. (author)

  2. Coronary artery fistulas

    Directory of Open Access Journals (Sweden)

    V. M. Subbotin

    2015-01-01

    Full Text Available Coronary artery fistulas are classified as abnormalities of termination and referred to as major congenital anomalies. Most coronary artery fistulas are small, unaccompanied by clinical symptoms, and diagnosed by echocardiography or coronarography performed for an unrelated cause. Such fistulas usually do not cause any complications and can spontaneously resolve. However, larger fistulas are usually >3 tones the size of a normal caliber of a coronary artery and may give rise to clinical symptoms in these cases. The clinical symptoms of coronary artery fistulas may mimic those of various heart diseases depending on which chamber a fistula drains into. Most fistulas are congenital. Congenital coronary artery fistulas may occur as an isolated malformation or be concurrent with other cardiac anomalies, more frequently with critical pulmonary stenosis or atresia with an intact interventricular septum and pulmonary stenoses, Fallot's tetralogy, aortic coarctation, and left heart hypoplasia. When choosing a treatment modality, one should take into account the number of fistula communications, the feeding vessel, localization of drainage, degree of myocardial damage, and hemodynamic relevance of the shunt caused by the presence of a fistula. The goal of treatment is to obliterate a fistula by preserving normal coronary blood flow. The risk for persisting fistula should be balanced with the potential risk of complications related to a procedure of coronarography and fistula occlusion. Percutaneous transcatheter coil occlusion of coronary artery fistulas is the modality of choice in children with the suitable anatomy of fistula communications and without concomitant congenital heart diseases.

  3. Performance of laser fluorescence for the detection of enamel caries in non-cavitated occlusal surfaces: clinical study with total validation of the sample.

    Science.gov (United States)

    Abalos, Camilo; Mendoza, Asunción; Jimenez-Planas, Amparo; Guerrero, Elena; Chaparro, Antonio; Garcia-Godoy, Franklin

    2012-02-01

    To evaluate the clinical performance of a laser fluorescence device in detecting enamel caries in non-cavitated occlusal surfaces. The sample included 96 first and second permanent molars, selected according to the criteria of Ekstrand: 44 not suspected of having dentin caries (score: 0-2) and 52 under suspicion (score: 3-4). Once measured by laser fluorescence, all teeth were validated by fissurotomy (gold standard). To avoid ethical questions, the 44 teeth (score: 0-2) used were to serve as abutments for a fixed dental prostheses. Following fissurotomy, the 52 teeth with suspected caries were treated with resin composite restorations. Kruskall-Wallis statistical analysis (PLaser fluorescence showed an area under the Receiver Operating Characteristic (ROC) curve of Az = 0.803 for enamel caries. The cut-off point with the highest sensitivity and specificity was 15, with a sensitivity and specificity of 0.97 and 0.63, respectively. Values under 10 indicated healthy teeth.

  4. Current technical and clinical features of the antegrade and retrograde approaches to percutaneous transluminal coronary intervention for chronic total occlusion – 2013 version

    Directory of Open Access Journals (Sweden)

    Toshiya Muramatsu

    2014-03-01

    Full Text Available PCI for the treatment of CTO has made remarkable progress in recent years, and interventional cardiologists in Japan have made a great contribution to this progress. Innovative techniques, including the retrograde approach, are hot topics in the CTO field. The long-term prognosis after initial success is also attracting considerable attention. Strategies for treating CTO are continually evolving, and the author’s strategy also continues to change over time. The author’s strategy as of 2013 is described here.

  5. Occlusal tooth wear in patients of a dental school's prosthodontic department in Xi'an, China

    NARCIS (Netherlands)

    Meng, M.; Zhang, Q.; Witter, D.J.; Bronkhorst, E.M.; Creugers, N.H.J.; Ma, C.; Zhang, S.

    2014-01-01

    PURPOSE: To assess the relationships between occlusal tooth wear and occlusal conditions, chewing side preference, and occlusal guidance scheme. MATERIALS AND METHODS: A total of 257 Chinese adult dental school patients were categorized according to a hierarchical functional classification system.

  6. Restenosis after coronary angioplasty.

    Science.gov (United States)

    Anderson, H V; Vignale, S J; Benedict, C R; Willerson, J T

    1993-09-01

    Coronary angioplasty is used to treat coronary atherosclerotic disease in many patients. One problem with coronary angioplasty is the phenomenon of restenosis. Restenosis appears to be a universal response to arterial wall injury. The biological events that underlie restenosis are characterized by: platelet adhesion and aggregation at sites of damaged endothelium, and within dissections into the medial layers, release of platelet derived growth-promoting substances, inflammation of the injured medial zone, transformation, migration, and proliferation of smooth muscle cells of the media following their activation by growth-promoting substances, secretion of copious amounts of extracellular matrix material, and finally, termination of the growth process following regrowth of endothelium over the damaged area. More than a decade of research work has helped identify clinical correlates of restenosis after coronary angioplasty. Patient-related correlates include male gender, unstable angina, diabetes, and continued smoking after angioplasty. Lesion-related correlates include multilesion and multivessel procedures, higher post-angioplasty residual stenosis, proximal vessel location, location in the left anterior descending coronary artery, location in a vein graft, long lesions, and total occlusions. However, for the purposes of individual patient care, clinical correlates are not particularly helpful. No group of variables has predicted complete freedom from restenosis, and conversely no group of variables has reliably indicated its presence. All patients undergoing angioplasty will require some form of follow-up evaluation. Symptom status by itself has not been found to be useful for predicting restenosis. However, when symptom status is combined with exercise thallium-201 scintigraphy, performed 4-6 months after angioplasty, it is less than ideal, but has a negative predictive value of over 90%. This means that over 90% of patients who are asymptomatic and have no

  7. Avaliação clínica de cães submetidos à parada circulatória total por diferentes períodos de tempo através da técnica de "Inflow Occlusion" Clinical evaluation of dogs submitted to circulatory arrest for different periods of time by "Inflow Occlusion"

    Directory of Open Access Journals (Sweden)

    Daniel C. Garcia

    2009-02-01

    Full Text Available A técnica de "Inflow Occlusion" pode ser utilizada em cirurgias cardíacas quando se pretende manter o coração aberto apenas por alguns minutos, para realização de pequenos reparos. No entanto, a parada circulatória total (PCT, evento decorrente da técnica em questão, pode acarretar severas alterações metabólicas e neurológicas ao paciente. Neste estudo foram utilizados 12 cães sem raça definida, os quais foram divididos em dois grupos, A e B, sendo os mesmos submetidos a 7 e 8 minutos de PCT, respectivamente, utilizando-se da técnica de "Inflow Occlusion". Tentou-se estabelecer normotermia durante os procedimentos cirúrgicos. Avaliações clínica e comportamental foram realizadas nos dois grupos após os procedimentos cirúrgicos e dados bioquímicos foram coletados para comparação entre os períodos pré e pós-operatórios. Ocorreram dois óbitos transoperatórios no grupo B. Alterações clínicas transitórias foram observadas no grupo A até o momento M7 (48 horas após cirurgia, e no grupo B, as mesmas foram mais intensas e presentes mesmo após M7; e em um animal do grupo B foi observada cegueira permanente por todo o período de acompanhamento. Apesar das alterações observadas, há indícios que seja seguro realizar a técnica de "Inflow Occlusion" por até 7 minutos, sendo contra-indicada, no entanto, para períodos mais prolongados."Inflow Occlusion" technique can be used in heart surgeries when heart is required to be opened just for few minutes, to allow quick repairs. However, circulatory arrest, event occasioned by this technique, may produce serious metabolic and neurological consequences to the patient. In this study, 12 mongrel dogs were used, divided into two groups, A and B, which were submitted to 7 and 8 minutes of total circulatory arrest, respectively, using "Inflow Occlusion" technique. Normothermia was tried during surgical procedures. Clinical and behavior evaluation were performed after surgery to

  8. Diabetes mellitus and female gender are the strongest predictors of poor collateral vessel development in patients with severe coronary artery stenosis.

    Science.gov (United States)

    Yetkin, Ertan; Topal, Ergun; Erguzel, Nuri; Senen, Kubilay; Heper, Gulumser; Waltenberger, Johannes

    2015-04-01

    Coronary collateral vessel development (CVD), i.e., arteriogenesis, is regarded as one of the most important mechanisms—along with angiogenesis—to result in protection of the myocardium. Coronary CVD is associated with a reduction in infarct size, future cardiovascular events and improved survival in patients with occlusive coronary artery disease by enhancing regional perfusion in the chronically ischemic myocardium. In the present study, we aimed to investigate the relation of cardiovascular risk factors and hematological parameters with collateral development in patients with severely stenotic (≥95%) and totally occluded coronary artery disease including at least one major coronary artery. The study population was selected from the patients who underwent coronary angiography between January 2008 and March 2009. Five hundred and two patients who had at least one coronary artery stenosis ≥95% (368 men; mean age 59 ± 10 years) comprised the study population. Of the 502 patients, 228 had total occlusion in at least one major epicardial coronary artery. Collateral artery grading was performed by using Cohen-Rentrop method to the vessel with coronary artery stenosis of ≥95% and patients with chronic total occlusions (CTO). Patients with grade 0-1 collateral development were regarded as the poor collateral group, and patients with grade 2-3 collateral development were regarded as the good collateral group. Two hundred and fifty-eight (51%) of 502 patients had poor collateral development, and 244 (49%) had good collateral development. Logistic regression analysis revealed that DM was independently associated with poor CVD in patients with ≥95% stenosis (p risk factor for poor CVD in addition to DM in patients with CTO.

  9. Analysis of decrease in lung perfusion blood volume with occlusive and non-occlusive pulmonary embolisms

    International Nuclear Information System (INIS)

    Ikeda, Yohei; Yoshimura, Norihiko; Hori, Yoshiro; Horii, Yosuke; Ishikawa, Hiroyuki; Yamazaki, Motohiko; Noto, Yoshiyuki; Aoyama, Hidefumi

    2014-01-01

    Highlights: • The proportion of preserved PE lesions in the non-occlusive group was 76.7% (33/43). • HUs of the iodine map were significantly higher in the non-occlusive group than in the occlusive group. • There was no significant difference in HUs between the non-occlusive and corresponding normal group. - Abstract: Purpose: The aim of this study was to determine if lung perfusion blood volume (lung PBV) with non-occlusive pulmonary embolism (PE) differs quantitatively and visually from that with occlusive PE and to investigate if lung PBV with non-occlusive PE remains the same as that without PE. Materials and methods: Totally, 108 patients suspected of having acute PE underwent pulmonary dual-energy computed tomography angiography (DECTA) between April 2011 and January 2012. Presence of PE on DECTA was evaluated by one radiologist. Two radiologists visually evaluated the PE distribution (segmental or subsegmental) and its nature (occlusive or non-occlusive) on DECTA and classified perfusion in lung PBV as “decreased,” “slightly decreased,” and “preserved”. Two radiologists used a lung PBV application to set a region of interest (ROI) in the center of the lesion and measured HU values of an iodine map. In the same slice as the ROI of the lesion and close to the lesion, another ROI was set in the normal perfusion area without PE, and HUs were measured. The proportion of lesions was compared between the occlusive and non-occlusive groups. HUs were compared among the occlusive, non-occlusive, and corresponding normal groups. Results: Twenty-five patients had 80 segmental or subsegmental lesions. There were 37 and 43 lesions in the occlusive and non-occlusive groups, respectively. The proportion of decreased lesions was 73.0% (27/37) in the occlusive group, while that of preserved lesions in the non-occlusive group was 76.7% (33/43). There was a significant difference in the proportion of lesions (P < 0.001) between the two groups. HUs of the

  10. Coronary sinus flow measured by pulsed Doppler ultrasound is a powerful indicator of coronary blood supply- a pig heart in vitro study.

    Science.gov (United States)

    Zheng, Xiao-Zhi; Wu, Jing; Hua, Jie

    2016-06-01

    To evaluate the correlation between the coronary sinus flow and the infusion volume in the coronaries and assess the performance of coronary sinus flow in predicting coronary artery occlusion in an isolated pig heart. The coronary sinus flow was measured in 16 isolated pig hearts by pulsed Doppler ultrasound. The correlation between the coronary sinus flow and the infusion volume in different coronary artery was analyzed, and the performance of coronary sinus flow in predicting different coronary artery occlusion was deducted. There were no statistically significant differences between the coronary sinus flow and the infusion volume in different coronary artery (p>0.05). The correlations between the coronary sinus flow and the infusion volume in left anterior descending coronary artery (LAD), left circumflex coronary artery (LCX), LAD and LCX, and LAD, LCX and right coronary artery (RCA) were all higher than 0.85 (p85% sensitivity and specificity. Excepting RCA mild occlusion (80% sensitivity and specificity. Conclusions The coronary sinus flow measured by pulsed Doppler ultrasound can effectively and exactly reflect the infusion volume in coronaries, which is a powerful indicator of coronary blood supply.

  11. Effects of chronic oral L-arginine administration on the L-arginine/NO pathway in patients with peripheral arterial occlusive disease or coronary artery disease: L-Arginine prevents renal loss of nitrite, the major NO reservoir.

    Science.gov (United States)

    Schneider, Jessica Y; Rothmann, Sabine; Schröder, Frank; Langen, Jennifer; Lücke, Thomas; Mariotti, François; Huneau, Jean François; Frölich, Jürgen C; Tsikas, Dimitrios

    2015-09-01

    Despite saturation of nitric oxide (NO) synthase (NOS) by its substrate L-arginine (Arg), oral and intravenous supplementation of Arg may enhance NO synthesis, a phenomenon known as "The L-arginine paradox". Yet, Arg is not only a source of NO, but is also a source for guanidine-methylated (N (G)) arginine derivatives which are all inhibitors of NOS activity. Therefore, Arg supplementation may not always result in enhanced NO synthesis. Concomitant synthesis of N (G)-monomethyl arginine (MMA), N (G),N (G)-dimethylarginine (asymmetric dimethylarginine, ADMA) and N (G),N (G´)-dimethylarginine (symmetric dimethylarginine, SDMA) from supplemented Arg may outweigh and even outbalance the positive effects of Arg on NO. Another possible, yet little investigated effect of Arg supplementation may be alteration of renal function, notably the influence on the excretion of nitrite in the urine. Nitrite is the autoxidation product of NO and the major reservoir of NO in the circulation. Nitrite and Arg are reabsorbed in the proximal tubule of the nephron and this reabsorption is coupled, at least in part, to the renal carbonic anhydrase (CA) activity. In the present placebo-controlled studies, we investigated the effect of chronic oral Arg supplementation of 10 g/day for 3 or 6 months in patients suffering from peripheral arterial occlusive disease (PAOD) or coronary artery disease (CAD) on the urinary excretion of nitrite relative to nitrate. We determined the urinary nitrate-to-nitrite molar ratio (UNOxR), which is a measure of nitrite-dependent renal CA activity before and after oral intake of Arg or placebo by the patients. The UNOxR was also determined in 6 children who underwent the Arg test, i.e., intravenous infusion of Arg (0.5 g Arg/kg bodyweight) for 30 min. Arg was well tolerated by the patients of the three studies. Oral Arg supplementation increased Arg (plasma and urine) and ADMA (urine) concentrations. No appreciable changes were seen in NO (in PAOD and CAD) and

  12. Process review of a departmental change from conventional coronary artery bypass grafting to totally arterial coronary artery bypass and its effects on the incidence and severity of postoperative stroke.

    Science.gov (United States)

    Albert, Alexander; Sergeant, Paul; Florath, Ines; Ismael, Mohammed; Rosendahl, Ulrich; Ennker, Jürgen

    2011-04-01

    We evaluated the process of changing from conventional coronary artery bypass grafting (CABG) to totally arterial off-pump coronary artery bypass (TOPCAB) at a single heart center in Germany. We (1) used multivariate statistical methods to assess real-time monitoring of OPCAB effects, (2) conducted a case review to assess preventable deaths and identify areas of improvement, (3) conducted a team survey, and (4) evaluated benchmarking results. All surgeons and assistants (n = 18) at this center were involved and were guided by the department head and one of the consultants, who was trained in this procedure in 2004 at the Leuven OPCAB school. The frequency of OPCAB operations increased abruptly in 2005 from 5% to 43% and then increased gradually to 67% (n = 546) by 2008 (total, 1781 OPCAB cases and 1563 on-pump cases). The in-hospital and 30-day mortality rates for OPCAB surgeries (n = 10 [0.6%] and 21 [1.2%], respectively) were lower than for on-pump surgeries (n = 27 [1.7%] and 26 [1.7%], respectively). Stroke rates were also lower for OPCAB surgeries (7 cases [0.4%] versus 15 cases [1%]). The lower risk of stroke in the OPCAB group was significant (P popularity, and a top national rank). The change from conventional CABG to TOPCAB was effective in decreasing the incidence and severity of stroke, in developing a team routine and a positive team attitude, and in producing excellent benchmarking results. The presence of a training and communication deficiency at the beginning of the study suggested an area for further improvement. After 6 years TOPCAB had largely replaced conventional CABG.

  13. The Impact of Combining a Low-Tube Voltage Acquisition with Iterative Reconstruction on Total Iodine Dose in Coronary CT Angiography

    Directory of Open Access Journals (Sweden)

    Toon Van Cauteren

    2017-01-01

    Full Text Available Objectives. To assess the impact of combining low-tube voltage acquisition with iterative reconstruction (IR techniques on the iodine dose in coronary CTA. Methods. Three minipigs underwent CCTA to compare a standard of care protocol with two alternative study protocols combining low-tube voltage and low iodine dose with IR. Image quality was evaluated objectively by the CT value, signal-to-noise ratio (SNR, and contrast-to-noise ratio (CNR in the main coronary arteries and aorta and subjectively by expert reading. Statistics were performed by Mann–Whitney U test and Chi-square analysis. Results. Despite reduced iodine dose, both study protocols maintained CT values, SNR, and CNR compared to the standard of care protocol. Expert readings confirmed these findings; all scans were perceived to be of at least diagnostically acceptable quality on all evaluated parameters allowing image interpretation. No statistical differences were observed (all p values > 0.11, except for streak artifacts (p=0.02 which were considered to be more severe, although acceptable, with the 80 kVp protocol. Conclusions. Reduced tube voltage in combination with IR allows a total iodine dose reduction between 37 and 50%, by using contrast media with low iodine concentrations of 200 and 160 mg I/mL, while maintaining image quality.

  14. A comparison of total amount of blood needed in patients taking autologous or homologous blood transfusion in coronary artery bypass grafting a clinical randomized case control trial

    International Nuclear Information System (INIS)

    Akhlagh, S.H.; Chohedri, A.H.; Bazojoo, A.; Nemati, M.H.

    2007-01-01

    The aim of this clinical case-control trial was to compare the total amount of blood needed in patients taking autologous or homologous blood transfusion in coronary artery bypass grafting (CABG) surgery. Sixty patients scheduled for CABG were randomly allocated to ANH (Acute Normovulemic Hemodynamic) group (A group) or control group (B group). Hematocrit before operation and 24 hours after the operation were checked. The amount of the total blood needed in each group was measured at the end of the operation. There was no significant difference between the two groups as regards post operational hematocrit. The mean total blood infused to the control and ANH group was 2010 ml and 1815 ml respectively. However there was significant difference between the two groups as regards the total amount of the blood needed during operation. Our randomized, double blinded case control study demonstrated that autologous blood, beside carrying lower risks for hemolytic and nonhemolytic transfusion reactions decrease the total amount of blood needed for CABG. However larger studies with more patients are needed to confirm the results. (author)

  15. Evaluation of early coronary graft patency after coronary artery bypass graft surgery using multislice computed tomography angiography

    Directory of Open Access Journals (Sweden)

    Raissi Kamal

    2009-12-01

    Full Text Available Abstract Background Coronary artery bypass graft (CABG surgery is the standard of care in the treatment of advanced coronary artery disease, and its long-term results are affected by the failure of bypass grafts. The aim of the present study was to evaluate the early patency rate in coronary bypass grafts. Methods A total of 107 consecutive patients who underwent CABG were included in this study. Early graft patency was evaluated via computed tomography (CT angiography in the first week after surgery. Results There were a total of 366 grafts, comprised of 250 venous grafts and 116 arterial grafts. Multi-slice CT detected acute graft occlusions in 32 (8.7% of all the grafts, including 26 (10% of the 250 venous grafts and 6 (5% of the 116 arterial grafts. The patency rates obtained were 97.3% for the left internal mammary (IMA grafts, 50% for the radial artery grafts, and 50% for the right IMA grafts. Additionally, 107 (96.4% grafts to the left anterior descending artery (LAD were classified as patent, whereas 1 (30% of the 3 grafts in the left circumflex (LCX region and 1 (50% of the 2 grafts in the right coronary artery (RCA territory were found to be occluded. In the venous category, 8 (13.7% of the 58 grafts to LAD were found to be occluded. In the LCX region, 9 (8.5% of the 106 grafts were classified as occluded, while the remaining 97 (91.5% grafts were patent. The venous grafts to RCA were occluded in 9 (10.4% of the 86 grafts. Amongst the multiple preoperative, intraoperative, and postoperative factors, pump time was significantly longer in the patients with occluded grafts than in those with patent grafts (P = 0.04. Conclusion The IMA grafts had the highest early patency rate amongst the coronary bypass grafts. However, the other arterial grafts were associated with a high rate of acute occlusions.

  16. The validity of the Finnish Diabetes Risk Score for the prediction of the incidence of coronary heart disease and stroke, and total mortality.

    Science.gov (United States)

    Silventoinen, Karri; Pankow, James; Lindström, Jaana; Jousilahti, Pekka; Hu, Gang; Tuomilehto, Jaakko

    2005-10-01

    Cardiovascular disease shares several risk factors with type 2 diabetes. We tested whether the Finnish Diabetes Risk Score (FINDRISC), recently developed in a Finnish population to estimate the future risk of diabetes, would also identify individuals at high risk of coronary heart disease (CHD) and stroke, and total mortality in this same population. Independent risk factor surveys were conducted in 1987, 1992, and 1997 in Finland, comprising 8268 men and 9457 women aged 25-64 years and free of CHD and stroke at baseline. During the follow-up until the end of 2001, 699 incident acute CHD events, 324 acute stroke events, and 765 deaths occurred. The data were analysed by using receiver operating characteristic (ROC) curves and the Cox-regression model. The areas under the ROC curves (AUC) were 71% for CHD, 73% for stroke, and 68% for total mortality in men and 78, 68, and 72% in women, respectively. The addition of systolic and diastolic blood pressures, total and high-density lipoprotein cholesterol, and smoking increased the AUC values modestly (the change of the absolute values from 2.6 to 6.5%), but the additional use of plasma glucose had only a slight effect on the AUC values for CHD and stroke. The FINDRISC is a reasonably good predictor of CHD, stroke and total mortality.

  17. Egg consumption, serum total cholesterol concentrations and coronary heart disease incidence: Japan Public Health Center-based prospective study.

    Science.gov (United States)

    Nakamura, Yasuyuki; Iso, Hiroyasu; Kita, Yoshikuni; Ueshima, Hirotsugu; Okada, Katsutoshi; Konishi, Masafumi; Inoue, Manami; Tsugane, Shoichiro

    2006-11-01

    Limited egg consumption is often recommended to reduce serum cholesterol concentration for the prevention of CHD. We examined the association of egg consumption and total cholesterol concentration with the risk of CHD. A total of 90 735 subjects (19 856 men and 21 408 women, aged 40-59 years in cohort I; 23 463 men and 26 008 women, aged 40-69 years in cohort II) were followed from 1990-4 to the end of 2001 under the Japan Public Health Center-based prospective study. Total cholesterol was obtained in 36 % of the subjects. Men and women were combined for the analyses. The subjects were categorised into four groups according to egg consumption. Subjects with total cholesterol >or=2200 mg/l were less frequent in frequent egg consumption groups in both cohorts (trend Pegg consumption were more likely to avoid a cholesterol-rich diet. Egg consumption was not associated with the risk of CHD, although total cholesterol was significantly related to the risk of CHD. The multivariate hazard ratio of CHD in subjects with total cholesterol >or=2400 v. eggs more frequently, up to almost daily, was not associated with an increase in CHD incidence for middle-aged Japanese men and women. Subjects with hypercholesterolaemia were less frequently in frequent egg consumption groups, probably because they avoided eating eggs.

  18. Plasma total homocysteine levels in children with type 1 diabetes: relationship with vitamin status, methylene tetrahydrofolate reductase genotype, disease parameters and coronary risk factors.

    Science.gov (United States)

    Dinleyici, E C; Kirel, Birgul; Alatas, Ozkan; Muslumanoglu, Hamza; Kilic, Zubeyir; Dogruel, Nesrin

    2006-08-01

    The objectives of this study were: to determine plasma total homocysteine tHcy levels and the prevalence of hyperhomocysteinemia in children with type 1 diabetes, to determine correlates of plasma tHcy levels with nutritional factor such as serum folic acid and vitamin B12 levels, genetic factors as methylenetetrahydrofolate reductase MTHFR gene polymorphism (C677T and A1298C), to attempt to identify possible dependencies between tHcy and the degree of metabolic control, the duration of the disease and presence of complications, and also to determine the relationship between other coronary risk factors. Plasma tHcy levels and other related parameters performed in 32 children with type 1 diabetes and 23 age-sex matched healthy children. Median tHcy level was higher in the patient group (11.38, 3.28 to 66.01 micromol/l) than the control group (8.78, 1.06 to 13.66 mol/l) (p cholesterol, triglyceride, apolipoprotein B, systolic blood pressure, blood urea nitrogen and creatinine levels and lower folate, apolipoprotein A1 levels and glomerular filtration rate values than the control group. Plasma tHcy levels were higher in diabetic children with poor metabolic control. Because of hyperhomocysteinemia is common in diabetic children and plasma tHcy levels correlated with early onset of the disease and disease duration, we recommend the usage of plasma tHcy levels as a risk indicator parameter with other coronary risk factor for detecting and preventing cardiovascular disease in diabetic children.

  19. Intake of total omega-3 fatty acids, eicosapentaenoic acid and docosahexaenoic acid and risk of coronary heart disease in the Spanish EPIC cohort study.

    Science.gov (United States)

    Amiano, P; Machón, M; Dorronsoro, M; Chirlaque, M Dolores; Barricarte, A; Sánchez, M-J; Navarro, C; Huerta, J M; Molina-Montes, E; Sánchez-Cantalejo, E; Urtizberea, M; Arriola, L; Larrañaga, N; Ardanaz, E; Quirós, J R; Moreno-Iribas, C; González, C A

    2014-03-01

    The evidence about the benefits of omega-3 fatty acid intake on coronary heart disease (CHD) is not consistent. We thus aimed to assess the relation between dietary intake of total omega-3 fatty acids (from plant and marine foods) and marine polyunsaturated fatty acids (PUFAs), eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), on the risk of CHD in the Spanish cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC). The analysis included 41,091 men and women aged 20-69 years, recruited from 1992 to 1996 and followed-up until December 2004. Omega-3 fatty acid intake was estimated from a validated dietary questionnaire. Only participants with definite incident CHD event were considered as cases. Cox regression models were used to assess the association between the intake of total omega-3 fatty acids, EPA or DHA and CHD. A total of 609 participants (79% men) had a definite CHD event. Mean intakes of total omega-3 fatty acids, EPA and DHA were very similar in the cases and in the cohort, both in men and women. In the multivariate adjusted model, omega-3 fatty acids, EPA and DHA were not related to incident CHD in either men or women. The hazard ratios (HR) for omega-3 were 1.23 in men (95% CI 0.94-15.9, p = 0.20); and 0.77 in women (95% CI 0.46-1.30, p = 0.76). In the Spanish EPIC cohort, with a relatively high intake of fish, no association was found between EPA, DHA and total omega-3 fatty acid intake and risk of CHD. Copyright © 2013 Elsevier B.V. All rights reserved.

  20. Occlusion effects, Part I

    DEFF Research Database (Denmark)

    Hansen, Mie Østergaard

    annoyances and the objective measurements were analysed. Persons suffering from tinnitus behaved differently than person without tinnitus. The latter group showed significant relations between the measured occlusion effect, hearing loss and the personal of occlusion. The actual sensation level is also...

  1. [As cardioprotective and angiogenic biomarker, can ghrelin predict coronary collateral development and severity of coronary atherosclerosis?

    Science.gov (United States)

    Akboğa, Mehmet Kadri; Taçoy, Gülten; Yılmaz Demirtaş, Canan; Türkoğlu, Sedat; Boyacı, Bülent; Çengel, Atiye

    2017-06-01

    Ghrelin exerts protective effects on cardiovascular system by inhibiting progression of atherosclerosis, supression of vascular inflammation, and stimulating angiogenesis. Thus, the aim of this study was to investigate the effect of serum ghrelin on coronary collateral development and SYNTAX score in patients with severe coronary artery disease. Total of 91 patients who had ≥90% stenosis in at least one major coronary artery were prospectively included in this cross-sectional, observational study. Collateral degree was graded according to Rentrop-Cohen classification. Patients with grade 2 or 3 collateral degree were allocated to Good Collateral Group and patients with grade 0 or 1 collateral degree were included in Poor Collateral Group. Ghrelin and vascular endothelial growth factor A (VEGF-A) levels were measured using radioimmunoassay and ELISA kits. Serum ghrelin and VEGF-A levels were significantly higher in Good Collateral Group. Furthermore, ghrelin level showed significant inverse correlation with SYNTAX score (r=0.348; p=0.001). In multivariable regression analysis, ghrelin (Odds ratio, 1.013; 95% confidence interval, 1.011-1.017; p=0.013), VEGF-A, fasting plasma glucose and presence of chronic total occlusion were independent predictors of good collateral development. In receiver operating characteristic curve analysis, ghrelin value cut-off point of ≥781 pg/mL predicted good collateral development with sensitivity of 73.1% and specificity of 67.7%. Findings suggested that ghrelin has antioxidant and antiinflammatory properties that protect endothelial functions and also stimulate angiogenesis, which results in development of good coronary collateral and inhibition of progression of coronary atherosclerosis.

  2. Viewpoint-based ambient occlusion.

    Science.gov (United States)

    González, Francisco; Sbert, Mateu; Feixas, Miquel

    2008-01-01

    A new ambient occlusion technique builds a channel between various viewpoints and an object's polygons, providing the information needed to create an occlusion map with multiple application possibilities.

  3. Novel management strategy for coronary steal syndrome: case report of occlusion of a LIMA graft side branch with a combination of drug-eluting and covered-stent deployment.

    LENUS (Irish Health Repository)

    Hynes, Brian G

    2009-11-01

    We report a novel percutaneous therapeutic approach to the management of suspected coronary artery steal syndrome resulting from a large side branch of the left internal mammary artery bypass graft, using a combination of coated and drug-eluting stents. We demonstrate the feasibility and long-term efficacy of this strategy in a case report.

  4. Doença arterial obstrutiva periférica e índice tornozelo-braço em pacientes submetidos à angiografia coronariana Peripheral arterial occlusive disease and ankle-brachial index in patients who had coronary angiography

    Directory of Open Access Journals (Sweden)

    Sthefano Atique Gabriel

    2007-03-01

    Full Text Available OBJETIVO: Avaliar a prevalência de doença arterial obstrutiva periférica (DAOP em coronariopatas. Avaliar a relação entre Índice Tornozelo-Braço (ITB e doença coronariana, e sua correlação com fatores de risco cardiovascular. MÉTODO: ITB investigado com ultra-sonografia Doppler. Características clínicas pesquisadas: idade, sexo, diabetes mellitus, hipertensão arterial sistêmica, etilismo, tabagismo e obesidade. População: 113 pacientes submetidos à angiografia coronariana. Primeira análise: 2 grupos - ausência e presença de coronariopatia. Segunda análise: 3 grupos - Grupo 1 - ausência de lesão coronariana; Grupo 2 - estenose 70%. Terceira análise: 2 grupos - ausência e presença de DAOP. RESULTADOS: 90,76% dos coronariopatas apresentaram DAOP. Houve diferença significante quanto à faixa etária (pOBJECTIVE: To evaluate the prevalence of peripheral arterial disease (PAD in patients with coronary arterial disease. To evaluate the relation between ankle-brachial index (ABI and coronary arterial disease, and its correlation with cardiovascular risk factors. METHOD: ABI investigated with Doppler ultrasonic device. Clinical characteristics researched: age, gender, diabetes, hypertension, alcoholism, smoking and obesity. Population: 113 patients who had coronary angiography. First analyses: 2 groups - absence and presence of coronary arterial disease. Second analyses: 3 groups - Group 1 - absence of coronary lesion; Group 2 - stenosis 70%. Third analyses: 2 groups - absence and presence of PAD. RESULTS: 90.76% of patients with coronary arterial disease presented PAD. There were significant difference including age (p<0.001, hypertension (p<0.001. smoking (p<0.001, body mass index (BMI (p<0.001, systolic blood pressure (SBP (p<0.001, diastolic blood pressure (DBP (p<0.001 and pulse pressure (PP (p<0.001 and ABI (p<0.001 between patients with and without coronary lesion. There were significant difference including age (p<0

  5. Primary percutaneous coronary intervention for coronary thrombosis during cisplatin, etoposide and bleomycin combination therapy under thromboprophylaxis with nadroparin

    Directory of Open Access Journals (Sweden)

    Mehmet Yaman

    2015-06-01

    Full Text Available Testicular cancer is the most common solid tumor among young men. Regimens containing cisplatin and bleomycin in combination with etoposide are used for treatment of non-seminomatous germ cell testicular tumors. Cancer patients are at increased risk of thrombosis. Epidemiological studies have identified chemotherapy as an additional risk factor for a hypercoagulability state and thrombosis. The risk is more pronounced with cisplatin-containing chemotherapy. Thromboprophylaxis with LMWH during chemotherapy has demonstrated to give substantial risk reduction of thromboembolic events. We present a case of acute myocardial infraction during combined chemotherapy with bleomycin, etoposide and cisplatin for testicular cancer under thromboprophylaxis with nadroparin. Emergency coronary angiography revealed total occlusion of the right coronary artery by a thrombus which was successfully removed by aspiration.

  6. Vertebrobasilar Artery Occlusion

    Directory of Open Access Journals (Sweden)

    Schoen, Jessica

    2011-05-01

    Full Text Available The presentation of vertebrobasilar artery occlusion varies with the cause of occlusion and location of ischemia. This often results in delay in diagnosis. Areas of the brain supplied by the posterior circulation are difficult to visualize and usually require angiography or magnetic resonance imaging. Intravenous thrombolysis and local-intra arterial thrombolysis are the most common treatment approaches used. Recanalization of the occluded vessel significantly improves morbidity and mortality. Here we present a review of the literature and a case of a patient with altered mental status caused by vertebrobasilar artery occlusion. [West J Emerg Med. 2011;12(2:233-239.

  7. Familial resemblance on the Thurstone Activity Scale, systolic blood pressure, and total cholesterol among first degree relatives of subjects with and without coronary heart disease.

    Science.gov (United States)

    Carmelli, D; Rosenman, R

    1985-01-01

    An investigation of the pattern of familial resemblance of three different risk factors assessed in families of coronary heart disease (CHD) patients and controls is presented. The fathers of these families participated in the Western Collaborative Group Study that first established the type A/B behavior pattern as an independent risk factor for CHD. A recently developed methodology, the Structured Exploratory Data Analysis (SEDA), was implemented to examine parental interaction, parent-offspring closeness, asymmetries in transmission, and other differences in the pattern of familial similarities among family members of case and control subjects. The analysis performed revealed pronounced parent-child similarity for total serum cholesterol values in both case and control families; spouse closeness and parent-child resemblance for systolic blood pressure measurements only in control families; and sex asymmetries in the parent-child closeness on pace of activity, which also differed between case and control families. The results of this investigation underscore the value of examining the joint pattern of familial resemblance of a number of risk factors as a means for differentiating between cultural and biological factors affecting familial aggregation of CHD.

  8. An alternative treatment of occlusal wear: Cast metal occlusal surface

    OpenAIRE

    Sandeep Kumar; Aman Arora; Reena Yadav

    2012-01-01

    Acrylic resin denture teeth often exhibit rapid occlusal wear, which may lead to decrease in the chewing efficiency, loss of vertical dimension of occlusion, denture instability, temporomandibular joint disturbances, etc. There are various treatment options available like, use of highly cross linked acrylic teeth, amalgam or metal inserts on occlusal surface, use of composite, gold or metal occlusal surface, etc. Several articles have described methods to construct gold and metal occlusal sur...

  9. Occlusive Peripheral Arterial Disease

    Science.gov (United States)

    ... Lower Your Stroke Risk? Ecstasy May Help Some PTSD Sufferers, but Safety Issues Remain First Death Reported ... of these factors contributes not only to the development of occlusive peripheral arterial disease but also to ...

  10. Extent of myocardium at risk for left anterior descending artery, right coronary artery, and left circumflex artery occlusion depicted by contrast-enhanced steady state free precession and T2-weighted short tau inversion recovery magnetic resonance imaging

    DEFF Research Database (Denmark)

    Nordlund, David; Heiberg, Einar; Carlsson, Marcus

    2016-01-01

    Background - Contrast-enhanced steady state free precession (CE-SSFP) and T2-weighted short tau inversion recovery (T2-STIR) have been clinically validated to estimate myocardium at risk (MaR) by cardiovascular magnetic resonance while using myocardial perfusion single-photon emission computed...... tomography as reference standard. Myocardial perfusion single-photon emission computed tomography has been used to describe the coronary perfusion territories during myocardial ischemia. Compared with myocardial perfusion single-photon emission computed tomography, cardiovascular magnetic resonance offers...... superior image quality and practical advantages. Therefore, the aim was to describe the main coronary perfusion territories using CE-SSFP and T2-STIR cardiovascular magnetic resonance data in patients after acute ST-segment-elevation myocardial infarction. Methods and Results - CE-SSFP and T2-STIR data...

  11. Occlusion effects, Part II

    DEFF Research Database (Denmark)

    Hansen, Mie Østergaard

    The present report studies the mechanism of the occlusion effect by means of literature studies, experiments and model estimates. A mathematical model of the occlusion effect is developed. The model includes the mechanical properties of the earmould and the airborne sound as well as the body...... conducted sound from own voice. These aspects are new in the sense that previous studies disregard the earmould mechanics and includes only one sound source placed in the ear canal....

  12. Association of obstructive sleep apnea with homocystein, nitric oxide and total antioxidant capacity levels in patients with or without coronary artery disease.

    Science.gov (United States)

    Ortaç Ersoy, Ebru; Fırat, Hikmet; Akaydın, Sevgi; Özkan, Yeşim; Durusu, Mine; Darılmaz Yüce, Gülbahar; Ergün, Recai; Topeli, Arzu; Ardıç, Sadık

    2014-01-01

    Obstructive sleep apnea (OSA) is associated with cardiovascular morbidity and mortality. Deficiency of nitric oxide (NO) and plasma levels of homocystein have been implicated in the pathogenesis of cardiovascular disease. OSA results in oxygen desaturation and arousal from sleep. Free oxygen radicals can be produced by hypoxia-reoxygenation. To test for the hypothesis that OSA is associated with cardiovascular morbidity, we investigated levels of homocystein, NO and total antioxidant capacity in OSA patients with and without coronary artery disease (CAD) in comparison with normal subjects and patients with CAD without OSA. Polysomnography was performed in 27 patients who had a myocardial infarction and in 25 patients without evidence of CAD. Patients were grouped according their polysomnography results as OSA with CAD (group 1), OSA without CAD (group 2), CAD (group 3), and normal (group 4) . Levels of homocystein, NO and total antioxidant capacity were determined after an overnight fasting. Data were analysed with parametric and non parametric statistical tests. According to apnea-hypopnea index (AHI) 44.4% of CAD patients were OSA. After polysomnographic evaluation, the patients were re-distributed as follows: OSA with CAD (n= 12), OSA without CAD (n= 14), CAD (n= 15), and normal (n= 11). Homocystein levels were higher in 3 groups compared to controls. AHI, MDI and desaturation time was higher in three -vessel disease compared to one and two- vessel diseases (p< 0.05). NO levels were correlated with the period of oxygen desaturation (r: -0.45, p= 0.031). The antioxidant capacity did not differ between OSA and healthy groups. OSA is frequent in CAD. AHI, MDI and desaturation time are higher in patients with severe CAD. It is important to evaluate OSA patients for CAD.

  13. Diagnostic performance of 64-channel multislice computed tomography in assessment of significant coronary artery disease in symptomatic subjects.

    Science.gov (United States)

    Shabestari, Abbas Arjmand; Abdi, Seifollah; Akhlaghpoor, Shahram; Azadi, Mitra; Baharjoo, Hamidreza; Pajouh, Mohammad Danesh; Emami, Zyae; Esfahani, Fatemeh; Firouzi, Iraj; Hashemian, Mahmoud; Kouhi, Morad; Mozafari, Mahmoud; Nazeri, Iraj; Roshani, Mahmoud; Salevatipour, Babak; Tavalla, Hedayatollah; Tehrai, Mahmoud; Zarrabi, Ali

    2007-06-15

    The recent development of 64-channel multislice computed tomography (MSCT) has resulted in noninvasive coronary artery imaging improvement. This study was conducted to determine the accuracy of 64-slice MSCT in a relatively unselected group of 143 patients with presentations suggestive of coronary artery disease, including those with unstable angina pectoris, who underwent both coronary computed tomographic angiography and invasive coronary angiography. No arrhythmia was considered an exclusion criterion except for atrial fibrillation or frequent extrasystoles. In patients with fast heart rates, a beta blocker was administered orally. Data were obtained using electrocardiography gated 64-slice MSCT. Computed tomographic angiography and invasive coronary angiography findings of each coronary segment were compared to determine the sensitivity, specificity, positive predictive value, and negative predictive value of MSCT in the detection of their normalcy or insignificant (or=50% diameter decrease) stenosis or total occlusion. In per-patient assessment, the calculated sensitivity, specificity, positive predictive value, and negative predictive value of MSCT were 96%, 67%, 91%, and 83%, respectively. These values in per-artery evaluation were 94%, 94%, 87%, and 97%, and corresponding values in per-segment analysis were 92%, 97%, 77%, and 99%, respectively. In conclusion, computed tomographic angiography has high diagnostic performance in the assessment of significant coronary artery disease in most patients in a daily routine practice, including those presenting with unstable angina pectoris symptoms.

  14. Angiographically demonstrated coronary collaterals predict residual viable myocardium in patients with chronic myocardial infarction. A regional metabolic study

    International Nuclear Information System (INIS)

    Fukai, Masumi; Ii, Masaaki; Nakakoji, Takahiro

    2000-01-01

    Angiographical demonstration of coronary collateral circulation may suggest the presence of residual viable myocardium. The development of coronary collaterals was judged according to Rentrop's classification in 37 patients with old anteroseptal myocardial infarction and 13 control patients with chest pain syndrome. The subjects with myocardial infarction were divided into 2 groups: 17 patients with the main branch of the left coronary artery clearly identified by collateral blood flow from the contralateral coronary artery [Coll (+) group, male/female 10/7, mean age 56.6 years] and 20 patients with obscure coronary trunk [Coll (-) group, male/female 16/4, mean age 54.9 years]. Thallium-201 myocardial scintigraphy and examination of local myocardial metabolism were carried out by measuring the flux of lactic acid under dipyridamole infusion load. Coronary stenosis of 99% or total occlusion was found in only 5 of 20 patients (25%) in the Coll (-) group but in 16 of 17 patients (94%) in the Coll (+) group (p<0.001). Redistribution of myocardial scintigraphy was found in 11 of 15 patients (73%) in the Coll (+) group, but only 3 of 18 patients (17%) in the Coll (-) group (p<0.01). The myocardial lactic acid extraction rate was -13.2±17.0% in the Coll (+) group, but 9.1±13.2% in the Coll (-) group (p<0.001). These results suggest that coronary collateral may contribute to minimizing the infarct area and to prediction of the presence of viable myocardium. (author)

  15. A new 4-variable formula to differentiate normal variant ST segment elevation in V2-V4 (early repolarization) from subtle left anterior descending coronary occlusion - Adding QRS amplitude of V2 improves the model.

    Science.gov (United States)

    Driver, Brian E; Khalil, Ayesha; Henry, Timothy; Kazmi, Faraz; Adil, Amina; Smith, Stephen W

    Precordial normal variant ST elevation (NV-STE), previously often called "early repolarization," may be difficult to differentiate from subtle ischemic STE due to left anterior descending (LAD) occlusion. We previously derived and validated a logistic regression formula that was far superior to STE alone for differentiating the two entities on the ECG. The tool uses R-wave amplitude in lead V4 (RAV4), ST elevation at 60 ms after the J-point in lead V3 (STE60V3) and the computerized Bazett-corrected QT interval (QTc-B). The 3-variable formula is: 1.196 x STE60V3 + 0.059 × QTc-B - 0.326 × RAV4 with a value ≥23.4 likely to be acute myocardial infarction (AMI). Adding QRS voltage in V2 (QRSV2) would improve the accuracy of the formula. 355 consecutive cases of proven LAD occlusion were reviewed, and those that were obvious ST elevation myocardial infarction were excluded. Exclusion was based on one straight or convex ST segment in V2-V6, 1 millimeter of summed inferior ST depression, any anterior ST depression, Q-waves, "terminal QRS distortion," or any ST elevation >5 mm. The NV-STE group comprised emergency department patients with chest pain who ruled out for AMI by serial troponins, had a cardiologist ECG read of "NV-STE," and had at least 1 mm of STE in V2 and V3. R-wave amplitude in lead V4 (RAV4), ST elevation at 60 ms after the J-point in lead V3 (STE60V3) and the computerized Bazett-corrected QT interval (QTc-B) had previously been measured in all ECGs; physicians blinded to outcome then measured QRSV2 in all ECGs. A 4-variable formula was derived to more accurately classify LAD occlusion vs. NV-STE and optimize area under the curve (AUC) and compared with the previous 3-variable formula. There were 143 subtle LAD occlusions and 171 NV-STE. A low QRSV2 added diagnostic utility. The derived 4-variable formula is: 0.052*QTc-B - 0.151*QRSV2 - 0.268*RV4 + 1.062*STE60V3. The 3-variable formula had an AUC of 0.9538 vs. 0.9686 for the 4-variable formula (p = 0

  16. The human coronary collateral circulation: development and clinical importance.

    Science.gov (United States)

    Seiler, Christian; Stoller, Michael; Pitt, Bertram; Meier, Pascal

    2013-09-01

    Coronary collaterals are an alternative source of blood supply to myocardium jeopardized by ischaemia. In comparison with other species, the human coronary collateral circulation is very well developed. Among individuals without coronary artery disease (CAD), there are preformed collateral arteries preventing myocardial ischaemia during a brief vascular occlusion in 20-25%. Determinants of such anastomoses are low heart rate and the absence of systemic arterial hypertension. In patients with CAD, collateral arteries preventing myocardial ischaemia during a brief occlusion are present in every third individual. Collateral flow sufficient to prevent myocardial ischaemia during coronary occlusion amounts to one-fifth to one-fourth the normal flow through the open vessel. Myocardial infarct size, the most important prognostic determinant after such an event, is the product of coronary artery occlusion time, area at risk for infarction, and the inverse of collateral supply. Well-developed coronary collateral arteries in patients with CAD mitigate myocardial infarcts and improve survival. Approximately one-fifth of patients with CAD cannot be revascularized by percutaneous coronary intervention or coronary artery bypass grafting. Therapeutic promotion of collateral growth is a valuable treatment strategy in those patients. It should aim at growth of large conductive collateral arteries (arteriogenesis). Potential arteriogenic approaches include the treatment with granulocyte colony-stimulating factor, physical exercise training, and external counterpulsation.

  17. Percutaneous transluminal coronary angioplasty

    International Nuclear Information System (INIS)

    Przybojewski, J.Z.; Weich, H.F.H.

    1984-01-01

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

  18. Endovascular Treatment Strategies in Aortoiliac Occlusion

    International Nuclear Information System (INIS)

    Ozkan, Ugur; Oguzkurt, Levent; Tercan, Fahri; Gumus, Burcak

    2009-01-01

    The aim of this study was to report our experience in endovascular treatment of total aortoiliac occlusion. Five patients who underwent endovascular recanalization procedures including manual aspiration thrombectomy, balloon angioplasty, and stent placement for total aortoiliac occlusion in a 4-year period were reviewed retrospectively. The mean age of patients was 51 years (range, 43 to 58 years). All patients had abdominal aorta and bilateral common iliac artery occlusion with or without external iliac artery occlusion. All patients either had a contraindication to surgery or refused it. Initial technical success was obtained in four of five (80%) patients. Endovascular techniques were successful in four patients who had good distal runoff and short-segment aortoiliac occlusion, but failed in a patient who had the worst distal runoff and long-segment aortoiliac occlusion. We observed two major complications, one of which was bilateral rupture of the common iliac arteries treated with covered stent placement. Another patient had extension of intra-aortic thrombus into the iliac stent after primary stenting. This was successfully treated with manual aspiration thrombectomy. Aortic and iliac stents remained patent during the follow-up period (median, 18 months; range, 3 to 26 months) in four patients. Primary patency rates at 6, 12, and 24 months were all 80%. In conclusion, endovascular treatment can be an alternative for aortoiliac occlusion in selected patients. Short- to midterm follow-up so far is satisfactory. Removal of intra-aortic thrombus with manual aspiration thrombectomy before balloon angioplasty and/or stenting is possible and a good alternative to thrombolysis.

  19. [Complete denture occlusion considered from occlusal contacts during mastication].

    Science.gov (United States)

    Suzuki, Tetsuya

    2004-12-01

    Few reports describe the functional superiority of full balanced occlusion to that of lingualized occlusion. Recently, a bilateral balanced scheme has been much more generally applied than a unilateral balanced scheme in lingualized occlusion as well as in full balanced occlusion. Occlusal contacts on the non-chewing side occur earlier than on the chewing side;in the order of second molar, first molar, and then premolars. The contact on the balancing side contributes to the prevention of denture dislocation and guidance from eccentric positions to the centric occlusal position during mastication. Therefore, bilateral balanced occlusion was shown to be effective for denture stability during mastication with complete dentures. Today's typical edentulous patients have greater mean age than in the past, and thus are seen with severe alveolar bone resorption, thin mucosa and sometimes abnormalities of the maxillomandibular relation. Their occlusal positions are often unstable and changeable after insertion of complete dentures. Because lingualized occlusion allows for easier accommodation and correction, lingualized occlusion is more suitable for such cases than full balanced occlusion, which requires a strict occlusal relationship. In light of the standard Japanese diet, there is some doubt about why lingualized occlusion might be suitable for Japanese edentulous patients in terms of the sense of mastication. A method of evaluating the sense of mastication needs to be established.

  20. Coronary CT angiography and MR angiography of Kawasaki disease

    International Nuclear Information System (INIS)

    Goo, Hyun Woo; Park, In-Sook; Ko, Jae Kon; Kim, Young Hwee

    2006-01-01

    Although the incidence of coronary artery aneurysms has diminished in patients with Kawasaki disease, coronary artery involvement is still regarded as a major complication of the disease, significantly affecting morbidity and mortality. Recent technical advances in coronary CT angiography (CTA) and MR angiography (MRA) have led to the possibility of using these two imaging methods as minimally invasive alternatives to the more invasive diagnostic catheter angiography in evaluating coronary artery abnormalities, such as aneurysm, stenosis, and occlusion. In this article, we describe imaging techniques and findings of coronary CTA and MRA in Kawasaki disease. (orig.)

  1. Punctal occlusion with Prolene suture material in the patients with ...

    African Journals Online (AJOL)

    Aim: To analyze the efficacy and outcomes of punctal occlusion with 5-0 Prolene suture material for the treatment of dry eye. Materials and. Methods: A total of 20 patients with moderate and severe dry eyes, recalcitrant to maximal medical therapy, underwent temporary punctal occlusion with 5-0 Prolene suture material.

  2. Cardiogenic shock due to coronary artery disease associated with interrupted aortic arch

    Directory of Open Access Journals (Sweden)

    Luís Alberto Oliveira Dallan

    2013-06-01

    Full Text Available Acute pulmonary edema is a serious event. Its occurrence in association with interrupted aortic arch and coronary heart disease is rare. Recently, an old patient developed cardiogenic shock and acute pulmonary edema due to acute coronary insufficiency, associated with interrupted aortic arch. The coronary angiography revealed occlusion of the right coronary artery and 95% obstruction in the left main coronary artery, associated with interruption of the descending aorta. Coronary artery bypass graft was performed, without extracorporeal circulation, to the anterior descending coronary artery. We discuss the initial management, given the seriousness of the case.

  3. Effect of stenosed and occluded coronary arteries on immediate and late myocardial uptake of thallium-201.

    Science.gov (United States)

    Clitsakis, D; Layton, C A; Battersby, W; Johns, M; Stockley, A V

    1981-01-01

    Exercise and redistribution myocardial scintigraphy using thallium-201 was compared with the left ventricular angiogram and with the presence of stenosis or occlusion of coronary arteries on angiography. Irreversible scintigraphic defects representing areas of myocardial infarction were found in all patients with occlusion of the left anterior descending artery but nearly one-third of patients with stenosis of that artery also showed evidence of infarction. For the right coronary or circumflex arteries the incidence of infarction was 82% with vessel occlusion and 57% with vessel stenosis. Of abnormally contracting segments on the left ventricular angiogram, 95% showed irreversible scintigraphic defects but 33% of normally contracting segments supplied by a diseased artery also showed this. Myocardial infarction is not uncommon in patients with angina even in the absence of coronary occlusion. The incidence is underestimated by the left ventricular angiogram. These findings are of importance in the assessment of patients with coronary disease and their evaluation before coronary artery surgery. PMID:7272129

  4. Atherosclerosis of coronary blood vessels - local or systemic inflamation?

    Science.gov (United States)

    Pejkov, Hristo; Kedev, Sasko; Panov, Saso; Srbinovska-Kostovska, Elizabeta; Lang, Irene

    2013-01-01

    The presence of atherosclerotic lesions in the blood vessels is a predisposition for the development and occurrence of acute ischaemic attacks. Bigger atherosclerotic lesions in the coronary blood vessels cause lumen occlusion, which is a cause of acute myocardial infarction. Endothelial dysfunction is defined as an ability of the endothelium to produce vasorelaxing nitric oxide (NO), or deregulation of the other vasoactive substances, such as angiotensin II and endothelin [13]. This definition describes endothelial dysfunction as an improper vasomotor constriction of the vessel, that leads to lumen occlusion of the already existing atherosclerotic lesions. According to the modern model, the development of atherosclerotic plaque and inappropriate endothelial NO production have a synergistic role in patho-physiological and molecular processes in the blood vessels [14]. Lesions in the coronary arteries are deposits of huge quantities of foamy cells and fibrous plaques. The thin fibrous plaques are 10-20% of the total plaque population and are the cause of 80-90% of clinical cases due to their ability to rupture [48]. According to all the results from published studies by far, it has been pointed out that the plaque stability, not the absolute size influences the rupture potential. Elucidating the risk factors that may modify in the atherogenesis and the consequent atherothrombic effect is the first step to this goal.

  5. The assessment of serum levels of malondialdehyde and total antioxidant capacity after the use of atorvastatin in patients with coronary artery stenosis

    Directory of Open Access Journals (Sweden)

    Gholamreza Shahsavari

    2015-02-01

    significant reduction of plasma MDA levels as well as a significant enhancement of TAC in coronary artery stenosis patients with long time receiving atorvastatin contribute to the lowering oxidative stress in this patients.

  6. Percutaneous occlusion of vascular malformations in pediatric and adult patients: 20-year experience of a single center.

    Science.gov (United States)

    Pereira-da-Silva, Tiago; Martins, José Diogo; de Sousa, Lídia; Fiarresga, António; Trigo Pereira, Conceição; Cruz Ferreira, Rui; Ferreira Pinto, Fátima

    2016-02-01

    A case series on different vascular malformations (VM) treated with percutaneous occlusion in children and adults is presented. Percutaneous occlusion is usually the preferred treatment method for VM. Previous series have mostly focused on single types of devices and/or VM. Retrospective analysis of all patients who underwent percutaneous occlusion of VM in a single center, from 1995 to 2014, excluding patent ductus arteriosus. Clinical and angiographic data, procedural details, implanted devices, and complications were assessed. Procedural success was defined as effective device deployment with none or minimal residual flow. Predictors of procedural failure and complications were determined by multivariate analysis. A total of 123 VM were intervened in 47 patients with median age of 12 years (25 days-76 years). The VM included 55 pulmonary arteriovenous fistulae, 39 aortopulmonary collaterals, 10 systemic venovenous collaterals, 8 peripheral arteriovenous fistulae, 5 Blalock-Taussig shunts, 4 coronary fistulae, and 2 Fontan fenestrations. The 143 devices used included 80 vascular plugs, 38 coils, 22 duct occluders, and 3 foramen ovale or atrial septal defect occluders. Median vessel size was 4.5 (2.0-16.0) mm and device/vessel size ratio was 1.4 (1.1-2.0). Successful occlusion was achieved in 118 (95.9%) VM, including three reinterventions. Four (3.3%) clinically relevant complications occurred, without permanent sequelae. Lower body weight was independently associated with procedural failure and complications. To our knowledge, this is the largest series on different VM occluded percutaneously in children and adults, excluding patent ductus arteriosus. Percutaneous occlusion was effective and safe, using different devices. © 2015 Wiley Periodicals, Inc.

  7. Study on the histopathological modifications of the dental pulp in occlusal trauma.

    Science.gov (United States)

    Popescu, M R; Deva, V; Dragomir, L P; Searpe, Monica; Vătu, Mihaela; Stefârţă, A; Rauten, Anne Marie

    2011-01-01

    The diagnosis of occlusion-generated disorders of the dento-maxillary apparatus represents a sensitive stage within the establishment of the therapeutic means for the functional rehabilitation of dental arches. The laborious effort carried out in order to specify the diagnosis resides in the fact that any trauma arising at the level of any component of the stomatognate system may lead to an occlusal dysfunction. The uncured carious processes, besides the pulp and periapical complications, may lead to an occlusal dysfunction through horizontal migrations of teeth resulting in the derangement of the occlusal curvatures as well as through vertical migrations of the teeth opposing a tooth diagnosed with occlusal caries or which largely reduced the coronary height. The dental iatrogenia, besides the eructation anomalies and neuromuscular dysfunction within the oromaxillofacial area also determines the appearance of occlusal dysfunction. The radiological examination through correlation with the clinical manifestations may provide significant data related to the magnitude of the prejudice caused to dento-paradontal units experiencing occlusal trauma. The histopathological study through correlation with the clinical manifestations provides significant data on the tolerance of dento-paradontal units within the occlusal dysfunction. Also, subsequent to the analysis of the possible actions of aggression generated by the occlusal trauma correlations could be determined between the type of the histological lesion of the pulp-dentine complex and the etiopathogenic factors, as well as correlations depending on the damage degree through occlusal trauma of the dental parts involved.

  8. Occlusal vertical dimension. Review article

    OpenAIRE

    Alvítez Temoche, Daniel Augusto; Facultad de Odontología de la Universidad Nacional Mayor de San Marcos.

    2016-01-01

    Modication of occlusal vertical dimension is a procedure that is often necessary for complex oral reha-bilitation treatments to get a functional occlusal for patients. is literature review was made on databases: Medline (PubMed), Scopus, Scielo, BSV (Bireme), ISI (Web of science) and Lilacs using the keywords “occlusal vertical dimension”,”altered vertical dimension”, “temporomandibular joint”, and “masticatory muscles”. It can be said that the management of occlusal vertical dimension is a s...

  9. [The influence of carbon dioxide baths differing in the total mineralization levels on the functional state of the cardiovascular system of the patients presenting with hypertensive disease associated with coronary heart disease].

    Science.gov (United States)

    L'vova, N V; Tupitsyna, Iu Iu; Badalov, N G; Krasnikov, V E; Lebedeva, O D

    2013-01-01

    The results of the study on the influence of carbon dioxide baths differing in the total mineralization levels on the clinical course of hypertensive disease associated with coronary heart disease and on various functional systems of the body. The data obtained provide an insight into the role of salt concentrations (10 and 20 g/l) in carbon dioxide bath water (1.2 g/l) applied for the traditional treatment of the patients with hypertensive disease associated with concomitant coronary heart disease and musculoskeletal pathology. Highly mineralized bath water has a greater influence on the functional state of the cardiovascular system by causing a more pronounced decrease in peripheral vascular resistance and hypotensive effect. Baths with a salt concentration of 20 g/l markedly reduced pain and had anti-inflammatory effect in the patients with pathology of support and locomotor organs.

  10. 3D/3D registration of coronary CTA and biplane XA reconstructions for improved image guidance

    Energy Technology Data Exchange (ETDEWEB)

    Dibildox, Gerardo, E-mail: g.dibildox@erasmusmc.nl; Baka, Nora; Walsum, Theo van [Biomedical Imaging Group Rotterdam, Departments of Radiology and Medical Informatics, Erasmus Medical Center, 3015 GE Rotterdam (Netherlands); Punt, Mark; Aben, Jean-Paul [Pie Medical Imaging, 6227 AJ Maastricht (Netherlands); Schultz, Carl [Department of Cardiology, Erasmus Medical Center, 3015 GE Rotterdam (Netherlands); Niessen, Wiro [Quantitative Imaging Group, Faculty of Applied Sciences, Delft University of Technology, 2628 CJ Delft, The Netherlands and Biomedical Imaging Group Rotterdam, Departments of Radiology and Medical Informatics, Erasmus Medical Center, 3015 GE Rotterdam (Netherlands)

    2014-09-15

    Purpose: The authors aim to improve image guidance during percutaneous coronary interventions of chronic total occlusions (CTO) by providing information obtained from computed tomography angiography (CTA) to the cardiac interventionist. To this end, the authors investigate a method to register a 3D CTA model to biplane reconstructions. Methods: The authors developed a method for registering preoperative coronary CTA with intraoperative biplane x-ray angiography (XA) images via 3D models of the coronary arteries. The models are extracted from the CTA and biplane XA images, and are temporally aligned based on CTA reconstruction phase and XA ECG signals. Rigid spatial alignment is achieved with a robust probabilistic point set registration approach using Gaussian mixture models (GMMs). This approach is extended by including orientation in the Gaussian mixtures and by weighting bifurcation points. The method is evaluated on retrospectively acquired coronary CTA datasets of 23 CTO patients for which biplane XA images are available. Results: The Gaussian mixture model approach achieved a median registration accuracy of 1.7 mm. The extended GMM approach including orientation was not significantly different (P > 0.1) but did improve robustness with regards to the initialization of the 3D models. Conclusions: The authors demonstrated that the GMM approach can effectively be applied to register CTA to biplane XA images for the purpose of improving image guidance in percutaneous coronary interventions.

  11. Thrombelastographic hypercoagulability and antiplatelet therapy after coronary artery bypass surgery (TEG-CABG trial)

    DEFF Research Database (Denmark)

    Rafiq, Sulman; Johansson, Pär I; Kofoed, Klaus F

    2017-01-01

    , and death compared to aspirin monotherapy in hypercoagulable patients undergoing coronary artery bypass surgery. A total of 1683 patients were screened for eligibility, among which 165 patients were randomized and 133 patients underwent multislice computed tomography scan to evaluate their grafts...... trial to test the hypothesis of intensified antiplatelet therapy in hypercoagulable patients. Due to the low enrollment and high loss to follow up, our results can only be viewed as hypothesis generating. We found a high rate of graft occlusions in this patient population. Our results were...

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

    International Nuclear Information System (INIS)

    Ambrosini, Vittorio; Sorropago, Giovanni; Laurenzano, Eugenio; Golino, Luca; Casafina, Alfredo; Schiano, Vittorio; Gabrielli, Gabriele; Ettori, Federica; Chizzola, Giuliano; Bernardi, Guglielmo; Spedicato, Leonardo; Armigliato, Pietro; Spampanato, Carmine; Furegato, Martina

    2015-01-01

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

  13. Feasibility and safety of 7F sheathless guiding catheter during transradial coronary intervention.

    Science.gov (United States)

    Kwan, Tak W; Cherukuri, Sanjay; Huang, Yili; Pancholy, Samir; Daggubati, Ramesh; Liou, Michael; Coppola, John; Saito, Shigeru

    2012-08-01

    The aim of our study is to assess the feasibility, safety, and rate of radial artery occlusion (RAO) using 7F sheathless guiding catheter in a large population undergoing transradial intervention (TRI). There is a frequent need for large bore guiding catheter to perform complex coronary interventions. Hydrophilic sheathless guiding catheters are not available in the US, therefore, we present the results of a multicenter study using the modified sheathless technique and readily available catheters. Between December 2010 and February 2011, 116 consecutive patients from four tertiary US centers who underwent TRI using 7F sheathless guiding catheter were included in this study. In our study of 116 patients with 123 coronary lesions, 57 stenoses (49%) were complex interventions, which included patients with acute coronary syndromes, chronic total occlusion (CTO), bifurcation stenting, calcified lesions, left main artery, and saphenous venous graft interventions. Overall procedural success rate was 95%. At 7-day, there were six patients (5%) with RAO, of which two of the six had severe radial artery spasm during the procedure. At 30-day, the overall persistent RAO was only detected in three patients (2.5%), as three patients had return of antegrade radial artery flow. In our multicenter study of 116 consecutive patients, using 7F sheathless guiding catheter to perform TRI is associated with a high procedural success (95%) and a low 30-day RAO rate (2.5%). Copyright © 2012 Wiley Periodicals, Inc.

  14. Left atrial appendage occlusion

    Directory of Open Access Journals (Sweden)

    Ahmad Mirdamadi

    2013-01-01

    Full Text Available Left atrial appendage (LAA occlusion is a treatment strategy to prevent blood clot formation in atrial appendage. Although, LAA occlusion usually was done by catheter-based techniques, especially percutaneous trans-luminal mitral commissurotomy (PTMC, it can be done during closed and open mitral valve commissurotomy (CMVC, OMVC and mitral valve replacement (MVR too. Nowadays, PTMC is performed as an optimal management of severe mitral stenosis (MS and many patients currently are treated by PTMC instead of previous surgical methods. One of the most important contraindications of PTMC is presence of clot in LAA. So, each patient who suffers of severe MS is evaluated by Trans-Esophageal Echocardiogram to rule out thrombus in LAA before PTMC. At open heart surgery, replacement of the mitral valve was performed for 49-year-old woman. Also, left atrial appendage occlusion was done during surgery. Immediately after surgery, echocardiography demonstrates an echo imitated the presence of a thrombus in left atrial appendage area, although there was not any evidence of thrombus in pre-pump TEE. We can conclude from this case report that when we suspect of thrombus of left atrial, we should obtain exact history of previous surgery of mitral valve to avoid misdiagnosis clotted LAA, instead of obliterated LAA. Consequently, it can prevent additional evaluations and treatments such as oral anticoagulation and exclusion or postponing surgeries including PTMC.

  15. Coronary collateral vessels in patients with previous myocardial infarction

    International Nuclear Information System (INIS)

    Nakatsuka, M.; Matsuda, Y.; Ozaki, M.

    1987-01-01

    To assess the degree of collateral vessels after myocardial infarction, coronary angiograms, left ventriculograms, and exercise thallium-201 myocardial scintigrams of 36 patients with previous myocardial infarction were reviewed. All 36 patients had total occlusion of infarct-related coronary artery and no more than 70% stenosis in other coronary arteries. In 19 of 36 patients with transient reduction of thallium-201 uptake in the infarcted area during exercise (Group A), good collaterals were observed in 10 patients, intermediate collaterals in 7 patients, and poor collaterals in 2 patients. In 17 of 36 patients without transient reduction of thallium-201 uptake in the infarcted area during exercise (Group B), good collaterals were seen in 2 patients, intermediate collaterals in 7 patients, and poor collaterals in 8 patients (p less than 0.025). Left ventricular contractions in the infarcted area were normal or hypokinetic in 10 patients and akinetic or dyskinetic in 9 patients in Group A. In Group B, 1 patient had hypokinetic contraction and 16 patients had akinetic or dyskinetic contraction (p less than 0.005). Thus, patients with transient reduction of thallium-201 uptake in the infarcted area during exercise had well developed collaterals and preserved left ventricular contraction, compared to those in patients without transient reduction of thallium-201 uptake in the infarcted area during exercise. These results suggest that the presence of viable myocardium in the infarcted area might be related to the degree of collateral vessels

  16. An alternative treatment of occlusal wear: cast metal occlusal surface.

    Science.gov (United States)

    Kumar, Sandeep; Arora, Aman; Yadav, Reena

    2012-01-01

    Acrylic resin denture teeth often exhibit rapid occlusal wear, which may lead to decrease in the chewing efficiency, loss of vertical dimension of occlusion, denture instability, temporomandibular joint disturbances, etc. There are various treatment options available like, use of highly cross linked acrylic teeth, amalgam or metal inserts on occlusal surface, use of composite, gold or metal occlusal surface, etc. Several articles have described methods to construct gold and metal occlusal surfaces, however, these methods are time-consuming, expensive and requires many cumbersome steps. These methods also requires the patient to be without the prosthesis for the time during which the laboratory procedures are performed. This article presents a quick, simple and relatively inexpensive procedure for construction of metal occlusal surfaces on complete dentures.

  17. An alternative treatment of occlusal wear: Cast metal occlusal surface

    Directory of Open Access Journals (Sweden)

    Sandeep Kumar

    2012-01-01

    Full Text Available Acrylic resin denture teeth often exhibit rapid occlusal wear, which may lead to decrease in the chewing efficiency, loss of vertical dimension of occlusion, denture instability, temporomandibular joint disturbances, etc. There are various treatment options available like, use of highly cross linked acrylic teeth, amalgam or metal inserts on occlusal surface, use of composite, gold or metal occlusal surface, etc. Several articles have described methods to construct gold and metal occlusal surfaces, however, these methods are time-consuming, expensive and requires many cumbersome steps. These methods also requires the patient to be without the prosthesis for the time during which the laboratory procedures are performed. This article presents a quick, simple and relatively inexpensive procedure for construction of metal occlusal surfaces on complete dentures.

  18. Mesiodistal tooth angulation to segmental occlusal plane in panoramic radiography

    International Nuclear Information System (INIS)

    Kim, Jae Duk; Kim, Jin Soo; You, Choong Hyun

    2005-01-01

    To evaluate the stability of the segmental occlusal plane and anatomical line as the reference line for measuring the mesiodistal tooth angulation in panoramic radiography and to determine the mean angle and the range of the mesiodistal tooth angulation in Korean population with normal occlusions. Twenty nine subjects (15 men, 14 women) with normal occlusion were selected. A total of 29 panoramic radiograms were taken at normal head position and then 10 images of 5 subjects selected were repeatedly taken with repositioning 2 times at each of the head down (V-shaped occlusion) and up (horizontal occulsion) for evaluation of stability of adopted reference lines by using PM2002CC (Planmeca, Finland). The images were traced with adoption of two test reference lines and the long axes of the teeth. The mesial angles formed by each reference line and the long axes of the teeth were measured and analyzed. With anatomical reference line, the mesiodistal tooth angulations of the molars showed the significant difference by over 5 degree between the normal and each changed head position. With segmented occlusal reference line, deviations of mesiodistal tooth angulations by the two changed head positions were less than 1 degree. The means, standard deviations, and maximum and minimum values of mesiodistal tooth angulations to segmental occlusal reference line on panoramic radiography were determined. It would appear that mesiodistal tooth angulations to segmental occlusal plane as reference line in panograms are predictable as standards of normal occlusion and useful for evaluation of tooth arrangement between adjacent teeth.

  19. Mesiodistal tooth angulation to segmental occlusal plane in panoramic radiography

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jae Duk; Kim, Jin Soo; You, Choong Hyun [Chosun University College of Medicine, Kwangju (Korea, Republic of)

    2005-03-15

    To evaluate the stability of the segmental occlusal plane and anatomical line as the reference line for measuring the mesiodistal tooth angulation in panoramic radiography and to determine the mean angle and the range of the mesiodistal tooth angulation in Korean population with normal occlusions. Twenty nine subjects (15 men, 14 women) with normal occlusion were selected. A total of 29 panoramic radiograms were taken at normal head position and then 10 images of 5 subjects selected were repeatedly taken with repositioning 2 times at each of the head down (V-shaped occlusion) and up (horizontal occulsion) for evaluation of stability of adopted reference lines by using PM2002CC (Planmeca, Finland). The images were traced with adoption of two test reference lines and the long axes of the teeth. The mesial angles formed by each reference line and the long axes of the teeth were measured and analyzed. With anatomical reference line, the mesiodistal tooth angulations of the molars showed the significant difference by over 5 degree between the normal and each changed head position. With segmented occlusal reference line, deviations of mesiodistal tooth angulations by the two changed head positions were less than 1 degree. The means, standard deviations, and maximum and minimum values of mesiodistal tooth angulations to segmental occlusal reference line on panoramic radiography were determined. It would appear that mesiodistal tooth angulations to segmental occlusal plane as reference line in panograms are predictable as standards of normal occlusion and useful for evaluation of tooth arrangement between adjacent teeth.

  20. Acute Right Coronary Ostial Stenosis during Aortic Valve Replacement

    Directory of Open Access Journals (Sweden)

    Sarwar Umran

    2012-01-01

    Full Text Available We report a rare case of acute right coronary artery stenosis developing in a patient undergoing aortic valve replacement. We present a case report with a brief overview of the literature relating to coronary artery occlusion associated with cardiac valve surgery - the theories and treatments are discussed. A 85 year-old female was admitted under the care of the cardiothoracic team with signs and symptoms of heart failure. Investigations, including cardiac echocardiography and coronary angiography, indicated a critical aortic valve stenosis. Intraoperative right ventricular failure ensued post aortic valve replacement. Subsequent investigations revealed an acute occlusion of the proximal right coronary artery with resultant absence of distal flow supplying the right ventricle. An immediate right coronary artery bypass procedure was performed with resolution of the right ventricular failure. Subsequent weaning off cardiopulmonary bypass was uneventful and the patient continued to make excellent recovery in the postoperative phase. To our knowledge this is one of the few documented cases of intraoperative acute coronary artery occlusion developing during valve surgery. However, surgeons should be aware of the potential for acute occlusion so that early recognition and rapid intervention can be instituted.

  1. Effect of Xenon Anesthesia Compared to Sevoflurane and Total Intravenous Anesthesia for Coronary Artery Bypass Graft Surgery on Postoperative Cardiac Troponin Release: An International, Multicenter, Phase 3, Single-blinded, Randomized Noninferiority Trial.

    Science.gov (United States)

    Hofland, Jan; Ouattara, Alexandre; Fellahi, Jean-Luc; Gruenewald, Matthias; Hazebroucq, Jean; Ecoffey, Claude; Joseph, Pierre; Heringlake, Matthias; Steib, Annick; Coburn, Mark; Amour, Julien; Rozec, Bertrand; Liefde, Inge de; Meybohm, Patrick; Preckel, Benedikt; Hanouz, Jean-Luc; Tritapepe, Luigi; Tonner, Peter; Benhaoua, Hamina; Roesner, Jan Patrick; Bein, Berthold; Hanouz, Luc; Tenbrinck, Rob; Bogers, Ad J J C; Mik, Bert G; Coiffic, Alain; Renner, Jochen; Steinfath, Markus; Francksen, Helga; Broch, Ole; Haneya, Assad; Schaller, Manuella; Guinet, Patrick; Daviet, Lauren; Brianchon, Corinne; Rosier, Sebastien; Lehot, Jean-Jacques; Paarmann, Hauke; Schön, Julika; Hanke, Thorsten; Ettel, Joachym; Olsson, Silke; Klotz, Stefan; Samet, Amir; Laurinenas, Giedrius; Thibaud, Adrien; Cristinar, Mircea; Collanges, Olivier; Levy, François; Rossaint, Rolf; Stevanovic, Ana; Schaelte, Gereon; Stoppe, Christian; Hamou, Nora Ait; Hariri, Sarah; Quessard, Astrid; Carillion, Aude; Morin, Hélène; Silleran, Jacqueline; Robert, David; Crouzet, Anne-Sophie; Zacharowski, Kai; Reyher, Christian; Iken, Sonja; Weber, Nina C; Hollmann, Marcus; Eberl, Susanne; Carriero, Giovanni; Collacchi, Daria; Di Persio, Alessandra; Fourcade, Olivier; Bergt, Stefan; Alms, Angela

    2017-12-01

    Ischemic myocardial damage accompanying coronary artery bypass graft surgery remains a clinical challenge. We investigated whether xenon anesthesia could limit myocardial damage in coronary artery bypass graft surgery patients, as has been reported for animal ischemia models. In 17 university hospitals in France, Germany, Italy, and The Netherlands, low-risk elective, on-pump coronary artery bypass graft surgery patients were randomized to receive xenon, sevoflurane, or propofol-based total intravenous anesthesia for anesthesia maintenance. The primary outcome was the cardiac troponin I concentration in the blood 24 h postsurgery. The noninferiority margin for the mean difference in cardiac troponin I release between the xenon and sevoflurane groups was less than 0.15 ng/ml. Secondary outcomes were the safety and feasibility of xenon anesthesia. The first patient included at each center received xenon anesthesia for practical reasons. For all other patients, anesthesia maintenance was randomized (intention-to-treat: n = 492; per-protocol/without major protocol deviation: n = 446). Median 24-h postoperative cardiac troponin I concentrations (ng/ml [interquartile range]) were 1.14 [0.76 to 2.10] with xenon, 1.30 [0.78 to 2.67] with sevoflurane, and 1.48 [0.94 to 2.78] with total intravenous anesthesia [per-protocol]). The mean difference in cardiac troponin I release between xenon and sevoflurane was -0.09 ng/ml (95% CI, -0.30 to 0.11; per-protocol: P = 0.02). Postoperative cardiac troponin I release was significantly less with xenon than with total intravenous anesthesia (intention-to-treat: P = 0.05; per-protocol: P = 0.02). Perioperative variables and postoperative outcomes were comparable across all groups, with no safety concerns. In postoperative cardiac troponin I release, xenon was noninferior to sevoflurane in low-risk, on-pump coronary artery bypass graft surgery patients. Only with xenon was cardiac troponin I release less than with total intravenous

  2. The Role of Coronary Computed Tomography Angiography and Cardiac Magnetic Resonance in STEMI Patients with Normal Coronary Angiography

    Directory of Open Access Journals (Sweden)

    Beganu Elena

    2017-09-01

    Full Text Available Usually, the diagnosis of myocardial infarction based on patient symptoms, electrocardiogram (ECG changes, and cardiac enzymes, is not a challenge for cardiologists. The correlation between coronary anatomy and the ECG territories that present ischemic changes can help the clinician to estimate which coronary artery presents lesions upon performing a coronary angiogram. In certain situations, the diagnosis of myocardial infarction can be difficult due to the lack of correlations between the clinical and paraclinical examinations and the coronary angiogram. In some cases, patients with chest pain and ST-segment elevation on the ECG tracing present with a normal coronary angiography. In other cases, patients without important changes on the ECG can present critical lesions or even occlusions upon angiographic examination. The aim of this article is to highlight the role of noninvasive coronary magnetic resonance and multi-slice computed tomography in patients with ST-segment elevation myocardial infarction and normal coronary angiography.

  3. Coronary artery rupture in blunt thoracic trauma: a case report and review of literature.

    Science.gov (United States)

    Abu-Hmeidan, Jareer Heider; Arrowaili, Arief Ismael; Yousef, Raid Said; Alasmari, Sami; Kassim, Yasser M; Aldakhil Allah, Hamad Hamad; Aljenaidel, Abdullah Mohammed; Alabdulqader, Abdullah Abdulmohsen; Alrashed, Muath Hamad; Alkhinjar, Mulfi Ibrahim; Al-Shammari, Nawwaf Rahi

    2016-08-02

    Blunt thoracic trauma can rarely result in coronary artery injury. Blunt trauma can result in occlusion of any of the coronary arteries or can lead to its rupture and bleeding. Traumatic coronary artery occlusion can lead to myocardial infarction, while its rupture and bleeding can result in hemopericardium and cardiac tamponade, and can be rapidly fatal. Survival after coronary artery rupture in blunt thoracic trauma is exceedingly rare. We present a case of a young male who sustained a blunt thoracic trauma in a motor vehicle collision, that resulted in rupture of the left anterior descending (LAD) coronary artery and subsequent cardiac tamponade. Prompt surgical intervention with pericardiotomy and ligation of the artery has resulted in survival of the patient. In cases of traumatic coronary artery rupture, early surgical intervention is crucial to avoid mortality. Ligation of the injured coronary is a viable option in selected cases, and can be the most expeditious option in patients in extremis.

  4. Class II malocclusion occlusal severity description

    Directory of Open Access Journals (Sweden)

    Guilherme Janson

    2010-08-01

    Full Text Available OBJECTIVES: It is well known that the efficacy and the efficiency of a Class II malocclusion treatment are aspects closely related to the severity of the dental anteroposterior discrepancy. Even though, sample selection based on cephalometric variables without considering the severity of the occlusal anteroposterior discrepancy is still common in current papers. In some of them, when occlusal parameters are chosen, the severity is often neglected. The purpose of this study is to verify the importance given to the classification of Class II malocclusion, based on the criteria used for sample selection in a great number of papers published in the orthodontic journal with the highest impact factor. MATERIAL AND METHODS: A search was performed in PubMed database for full-text research papers referencing Class II malocclusion in the history of the American Journal of Orthodontics and Dentofacial Orthopedics (AJO-DO. RESULTS: A total of 359 papers were retrieved, among which only 72 (20.06% papers described the occlusal severity of the Class II malocclusion sample. In the other 287 (79.94% papers that did not specify the anteroposterior discrepancy severity, description was considered to be crucial in 159 (55.40% of them. CONCLUSIONS: Omission in describing the occlusal severity demands a cautious interpretation of 44.29% of the papers retrieved in this study.

  5. [Relationship between Occlusal Discomfort Syndrome and Occlusal Threshold].

    Science.gov (United States)

    Munakata, Motohiro; Ono, Yumie; Hayama, Rika; Kataoka, Kanako; Ikuta, Ryuhei; Tamaki, Katsushi

    2016-03-01

    Occlusal dysesthesia has been defined as persistent uncomfortable feelings of intercuspal position continuing for more than 6 months without evidence of physical occlusal discrepancy. The problem often occurs after occlusal intervention by dental care. Although various dental treatments (e. g. occlusal adjustment, orthodontic treatment and prosthetic reconstruction) are attempted to solve occlusal dysesthesia, they rarely reach a satisfactory result, neither for patients nor dentists. In Japan, these symptoms are defined by the term "Occlusal discomfort syndrome" (ODS). The aim of this study was to investigate the characteristics of ODS with the simple occlusal sensory perceptive and discriminative test. Twenty-one female dental patients with ODS (mean age 55.8 ± 19.2 years) and 21 age- and gender-matched dental patients without ODS (mean age 53.1 ± 16.8 years) participated in the study. Upon grinding occlusal registration foils that were stacked to different thicknesses, participants reported the thicknesses at which they recognized the foils (recognition threshold) and felt discomfort (discomfort threshold). Although there was no significant difference in occlusal recognition thresholds between the two patient groups, the discomfort threshold was significantly smaller in the patients with ODS than in those without ODS. Moreover, the recognition threshold showed an age-dependent increase in patients without ODS, whereas it remained comparable between the younger (patient subgroups with ODS. These results suggest that occlusal discomfort threshold rather than recognition threshold is an issue in ODS. The foil grinding procedure is a simple and useful method to evaluate occlusal perceptive and discriminative abilities in patients with ODS.

  6. Occlusion et posture

    OpenAIRE

    Le Breton, Alix

    2017-01-01

    L'objectif majeur de l'orthodontie est d'obtenir une occlusion fonctionnelle. Cette fonction occlusale est capitale dans la croissance du complexe maxillo-facial mais aussi dans la croissance et la statique générale du corps. Le champ d'action de l'orthodontiste s'inscrit donc dans une prise en charge globale. Il doit prendre conscience que son traitement risque d'influer sur la posture et modifier le schéma corporel du patient. Ce travail va dans un premier temps définir le système postural ...

  7. Non-atherosclerotic spontaneous coronary artery dissection revascularized by intravascular ultrasonography-guided fenestration with cutting balloon angioplasty.

    Science.gov (United States)

    Ito, Tsuyoshi; Shintani, Yasuhiro; Ichihashi, Taku; Fujita, Hiroshi; Ohte, Nobuyuki

    2017-07-01

    A 46-year-old woman was referred to our hospital due to chest pain. Twelve-lead electrocardiogram revealed ST-segment elevation suggesting acute myocardial infarction. Emergent coronary angiography showed diffuse narrowing and occlusion in the middle to distal left anterior descending artery (LAD). To investigate the cause of occlusion, an intravascular ultrasound (IVUS) examination was performed and we diagnosed spontaneous coronary artery dissection (SCAD) as the cause of occlusion. After a cutting balloon was dilated at the distal LAD, coronary flow recovered. IVUS-guided angioplasty with cutting balloon could be a choice of treatment in SCAD patients who need revascularization.

  8. Analyzing Physiologic occlusion

    Directory of Open Access Journals (Sweden)

    M. Emamie

    1987-08-01

    Full Text Available Generally speaking, when preserving and restoring the gnathostomatic system the dentist controls tooth morphology to insure proper distribution of stress. So, we restore a portion of a tooth or all the teeth in such a manner as to subject the associated parts of the system to the least stress. We evaluate our diagnosis and control it in our treatment. The treatment should be based on the scientific method. We create optimal occlusion or a desirable functional state of the masticatory system.  Many persons with occlusal imperfections will not have symptoms of functional disorders. This is the psychological adaptive capacity of the neuromuscular system, teeth, dental arches, and periodontal tissues.Recent developments in dental material, technology and instruments however, have simplified the taskaf restoring rebuilding and rehabilitating diseased mouths. So, optimum oral health and function should be the prime objective of all treatment procedures. Because the ultimate aim will always be to restore the mouth to health and preserve this status throughout the life of a patient.

  9. A case of spontaneous coronary artery dissection presenting with acute anterior wall myocardial infarction in a young adult male - an increasingly recognized rare disease.

    Science.gov (United States)

    Taha, Mohamed; Latt, Htun; Al-Khafaji, Jaafar; Ali, Mohamed; Seher, Richard

    2018-01-01

    Background : Spontaneous coronary artery dissection (SCAD) is increasingly recognized as an important cause of myocardial infarction and sudden death. Although some correlations have been noted in relation to aetiology, no direct causes have been identified in a large number of patients. Most of the patients are women in peripartum period or of childbearing age, with few if any risk factors for coronary heart disease. In men, however, risk factors for atherosclerosis are more prevalent in cases of SCAD Case report : We report a case of a 43-years-old healthy male, with no known risk factors, who presented with ischemic chest pain and elevated troponin levels. He underwent an emergent percutaneous transluminal coronary angiography which revealed a total occlusion of the left anterior descending artery at its origin with an evidence of spontaneous dissection as the cause of the occlusion, which was subsequently treated with placement of a drug-eluting stent and thrombectomy from the distal occluded portion. This case highlights the importance of including spontaneous coronary artery dissection as a cause of ischemic cardiac insults and illustrates the approach to treatment. Conclusion : Internists should have a low threshold of clinical suspicion for SCAD especially in a young patient with no known risk factors and should know the importance of emergency in management.

  10. Precordial junctional ST-segment depression with tall symmetric T-waves signifying proximal LAD occlusion, case reports of STEMI equivalence

    NARCIS (Netherlands)

    de Winter, Ruben W.; Adams, Rob; Verouden, Niels J. W.; de Winter, Robbert J.

    2016-01-01

    Timely reperfusion therapy by means of primary percutaneous coronary intervention (PCI) is the preferred treatment for patients with ST-segment elevation myocardial infarction. A significant number of patients with large acute myocardial infarction, caused by occlusion of an epicardial coronary

  11. [Temporomandibular joint, occlusion and bruxism].

    Science.gov (United States)

    Orthlieb, J D; Ré, J P; Jeany, M; Giraudeau, A

    2016-09-01

    Temporomandibular joint and dental occlusion are joined for better and worse. TMJ has its own weaknesses, sometimes indicated by bad functional habits and occlusal disorders. Occlusal analysis needs to be addressed simply and clearly. The term "malocclusion" is not reliable to build epidemiological studies, etiologic mechanisms or therapeutic advice on this "diagnosis". Understanding the impact of pathogenic malocclusion is not just about occlusal relationships that are more or less defective, it requires to locate them within the skeletal framework, the articular and behavioural context of the patient, and above all to assess their impact on the functions of the masticatory system. The TMJ-occlusion couple is often symbiotic, developing together in relation to its environment, compensating for its own shortcomings. However, a third partner may alter this relationship, such as bruxism, or more generally oral parafunctions, trauma or an interventionist practitioner. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  12. Thermolabile defect of methylenetetrahydrofolate reductase in coronary artery disease.

    Science.gov (United States)

    Kang, S S; Passen, E L; Ruggie, N; Wong, P W; Sora, H

    1993-10-01

    To determine whether or not a moderate genetic defect of homocysteine metabolism is associated with the development of coronary artery disease, we studied the prevalence of thermolabile methylenetetrahydrofolate reductase, which is probably the most common genetic defect of homocysteine metabolism. Three hundred thirty-nine subjects who underwent coronary angiography were classified into three groups: (1) patients with severe coronary artery stenosis (> or = 70% occlusion in one or more coronary arteries or > or = 50% occlusion in the left main coronary artery), (2) patients with mild to moderate coronary artery stenosis (< 70% occlusion in one or more coronary arteries or < 50% occlusion in the left main coronary artery), and (3) patients with non-coronary heart disease or noncardiac chest pain (nonstenotic coronary arteries). The thermolability of methylenetetrahydrofolate reductase was prospectively determined in all subjects. Plasma homocyst(e)ine levels were then measured in those with thermolabile methylenetetrahydrofolate reductase. The traditional risk factors for coronary artery disease were thereafter ascertained by chart review of all subjects. The prevalence of thermolabile methylenetetrahydrofolate reductase was 18.1% in group 1, 13.4% in group 2, and 7.9% in group 3. There was a significant difference between the prevalence of thermolabile methylenetetrahydrofolate reductase in groups 1 and 3 (P < .04). All individuals with thermolabile methylenetetrahydrofolate reductase irrespective of their clinical grouping had higher plasma homocyst(e)ine levels than normal (group 1, 14.86 +/- 5.85; group 2, 15.36 +/- 5.70; group 3, 13.39 +/- 3.80; normal, 8.50 +/- 2.8 nmol/mL). Nonetheless, there was no statistically significant difference in the plasma homocyst(e)ine concentrations of these patients with or without coronary artery stenosis. Using discriminant function analysis, thermolabile methylenetetrahydrofolate reductase was predictive of angiographically

  13. Modelling total coronary heart disease burden and long-term benefit of cholesterol lowering in middle aged men with and without a history of cardiovascular disease.

    Science.gov (United States)

    Packard, Chris J; Young, Robin; Ross, Kevin; Ford, Ian; Ambegaonkar, Baishali M; Brudi, Philippe; McCowan, Colin

    2017-10-01

    Cumulative coronary heart disease (CHD) events over 20 years were examined in men screened for, and in those randomized to, the West of Scotland Coronary Prevention Study. Record linkage provided CHD-related events and days in hospital for the 80 230 screenees, including the randomized cohort of 6595 men. Risk factors were determined at baseline, and disease burden assessed for groups defined by cholesterol. Effects of cholesterol lowering were modelled from differences between groups, and from the treatment arms of the trial. Over 20 years, those without a history of CHD (n = 61 211) had 23.0 events per 100 subjects in the lowest cholesterol group (mean 4.0 mmol/L) and 65.1 per 100 in the highest (8.8 mmol/L). Corresponding days in hospital were 167.2-435.4 per 100 subjects. Analogous figures for men with a CHD history (n = 8570) were 77.3-141.7 events per 100 and 526.1-936.7 hospital days per 100. Lowering cholesterol by about 1.0 mmol/L in men with average cholesterol and no CHD was predicted to be associated with 8.9 fewer events and a saving of 56.0 hospital days per 100. In those with CHD this difference gave, depending on starting level, 26.8-36.5 fewer events and savings of 158.2-247.3 hospital days per 100 subjects. Comparison of cumulative events in 45-54 vs. 55-64 year olds in the trial revealed greater benefit from intervention in the younger decade. Long-term, longitudinal data reveal the considerable CHD burden in middle-aged men and indicate substantial clinical benefits from both moderate and aggressive cholesterol lowering. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2017. For permissions, please email: journals.permissions@oup.com.

  14. [Treatment of acute coronary dissection by angioplasty during diagnostic catheterization by the Sones' technique].

    Science.gov (United States)

    Maldonado, G A; Cavalcanti, R C; Livera, J R; Mota, F B; de Oliveira, N S; Yaktine, H; Cano, M; Sousa, A G; Sousa, J E

    1991-12-01

    Male, 50 year-old, white, who underwent coronary arteriography and exhibited proximal dissection of the left anterior descending coronary artery induced by the Sones catheter with subsequent acute vessel occlusion. The patient was immediately treated by balloon angioplasty with excellent outcome.

  15. Anterolateral papillary muscle rupture after intervention of the right coronary artery.

    Science.gov (United States)

    Morris, Liam; Desai, Anand; Akkus, Nuri Ilker

    2015-11-01

    Rupture of the anterolateral papillary muscle following a right coronary artery occlusion is extremely rare, and when complicated by a right ventricular infarction, can be fatal. The literature on optimal management of this complication is limited. We present an unusual case of anterolateral papillary muscle rupture following intervention of the right coronary artery. Published by Elsevier España.

  16. Quantitative angiographic follow-up of the coronary wallstent in native vessels and bypass grafts (European experience - March 1986 to March 1990)

    NARCIS (Netherlands)

    B.H. Strauss (Bradley); P.W.J.C. Serruys (Patrick); M.E. Bertrand (Michel); J. Puel (Jacques); B. Meier (Bernard); J-J. Goy (Jean-Jacques); L. Kappenberger (Lukas); A.F. Rickards (Anthony); U. Sigwart (Ulrich); M-A.M. Morel (Marie-Angèle); E.W.J. Montauban van Swijndregt (Eline)

    1992-01-01

    textabstractThe coronary stent has been investigated as an adjunct to percutaneous transluminal coronary angioplasty to obviate the problems of early occlusion and late restenosis. From March 1986 to March 1990, 265 patients (308 lesions) were implanted with the coronary Wallstent in 6 European

  17. Oclusão Completa do Arco Aórtico em Paciente Portadora de Arterite de Takayasu e Espondilite Anquilosante / Total Aortic arch Occlusion in a Patient with Takayasu's Arteritis and Spondylitis Ankylosans

    Directory of Open Access Journals (Sweden)

    Rodolfo Souza Cardoso

    2015-03-01

    stiffness of the spine, headache, dizziness, absence of pulses in the upper limbs and systemic hypertension. The CT angiography revealed occlusion of the aorta of the supra-aortic trunks (SAT and signals of spondylopathy, characterized by syndesmophytes between vertebral bodies and signs of ankylosis of the sacroiliac joint. The digital subtraction angiography confirmed a complete occlusion of the TSA in its origins and extensive collateral circulation. Treatment was started with immunosuppressants and corticosteroids, and treatment of hypertension, with a reduction in blood pressure and improvement of headache, although a maintenance of low back pain and joint stiffness was observed. Conclusion: The simultaneous occurrence of two seemingly distinct diseases such as TA and AS should be interpreted as the manifestation of a systemic inflammatory condition of unknown etiology not yet fully defined.

  18. Impact of mobile intensive care unit use on total ischemic time and clinical outcomes in ST-elevation myocardial infarction patients - real-world data from the Acute Coronary Syndrome Israeli Survey.

    Science.gov (United States)

    Koifman, Edward; Beigel, Roy; Iakobishvili, Zaza; Shlomo, Nir; Biton, Yitschak; Sabbag, Avi; Asher, Elad; Atar, Shaul; Gottlieb, Shmuel; Alcalai, Ronny; Zahger, Doron; Segev, Amit; Goldenberg, Ilan; Strugo, Rafael; Matetzky, Shlomi

    2017-01-01

    Ischemic time has prognostic importance in ST-elevation myocardial infarction patients. Mobile intensive care unit use can reduce components of total ischemic time by appropriate triage of ST-elevation myocardial infarction patients. Data from the Acute Coronary Survey in Israel registry 2000-2010 were analyzed to evaluate factors associated with mobile intensive care unit use and its impact on total ischemic time and patient outcomes. The study comprised 5474 ST-elevation myocardial infarction patients enrolled in the Acute Coronary Survey in Israel registry, of whom 46% ( n=2538) arrived via mobile intensive care units. There was a significant increase in rates of mobile intensive care unit utilization from 36% in 2000 to over 50% in 2010 ( pintensive care unit use were Killip>1 (odds ratio=1.32, pintensive care units benefitted from increased rates of primary reperfusion therapy (odds ratio=1.58, pintensive care unit benefitted from shorter median total ischemic time compared with non-mobile intensive care unit patients (175 (interquartile range 120-262) vs 195 (interquartile range 130-333) min, respectively ( pintensive care unit use was the most important predictor in achieving door-to-balloon time intensive care unit group (odds ratio=0.79, 95% confidence interval (0.66-0.94), p=0.01). Among patients with ST-elevation myocardial infarction, the utilization of mobile intensive care units is associated with increased rates of primary reperfusion, a reduction in the time interval to reperfusion, and a reduction in one-year adjusted mortality.

  19. Image Based Solution to Occlusion Problem for Multiple Robots Navigation

    Directory of Open Access Journals (Sweden)

    Taj Mohammad Khan

    2012-04-01

    Full Text Available In machine vision, occlusions problem is always a challenging issue in image based mapping and navigation tasks. This paper presents a multiple view vision based algorithm for the development of occlusion-free map of the indoor environment. The map is assumed to be utilized by the mobile robots within the workspace. It has wide range of applications, including mobile robot path planning and navigation, access control in restricted areas, and surveillance systems. We used wall mounted fixed camera system. After intensity adjustment and background subtraction of the synchronously captured images, the image registration was performed. We applied our algorithm on the registered images to resolve the occlusion problem. This technique works well even in the existence of total occlusion for a longer period.

  20. The Effect of Occlusal Splint Pretreatment on Mandibular Movements and Vertical Dimension of Occlusion in Long-Term Complete Denture Wearers.

    Science.gov (United States)

    de Almeida, Rita de Cássia Costa Ribeiro; da Rosa, Wellington Luiz de Oliveira; Boscato, Noéli

    2016-01-01

    This study evaluated the pretreatment influence of occlusal splints and relines on mandibular movements (MM) and vertical dimension of occlusion (VDO) in longstanding complete denture wearers. A total of 30 volunteers were randomly assigned to three groups (n = 10): control (C), relining of old denture (RD), and occlusal splints (OS). Individual extent of MM was assessed via intraoral Gothic arch tracings and the VDO using posed frontal images taken at three time points. The OS group showed statistically significant differences when compared with the other groups (P occlusal splints pretreatment.

  1. Coronary Arteries

    Science.gov (United States)

    ... called coronary circulation. The aorta (the main blood supplier to the body) branches off into two main ... Daily Conferences For the Public Heart Information Center Project Heart Women’s Heart Health Clinical Trials 6770 Bertner ...

  2. [Nonsurgical treatment of coronary pulmonary arteriovenous fistula].

    Science.gov (United States)

    Cano, M N; Kambara, A; Maldonado, G; Mattos, L A; Tanajura, L F; Fontes, V F; Pinto, I M; Feres, F; Sousa, A G; Sousa, J E

    1993-03-01

    Fifty eight year old man, with dyspnea, fatigue and progressive angina underwent cinecoronarography, which showed an arterio-venous coronary-pulmonary fistula originating from the circumflex artery to the pulmonary circulation. We decided to occlude it percutaneously, using a detachable balloon technic. The occlusion was accomplished successfully. Clinical evolution was excellent and the follow-up cinecoronarography 6 months later showed the maintainance of the initial results.

  3. Computerized occlusal analysis in bruxism

    Directory of Open Access Journals (Sweden)

    Lazić Vojkan

    2006-01-01

    Full Text Available Introduction. Sleep bruxism as nocturnal parafunction, also known as tooth grinding, is the most common parasomnia (sleep disorder. Most tooth grinding occurs during rapid eye movement - REM sleep. Sleep bruxism is an oral habit characterized by rhythmic activity of the masticatory muscles (m. masseter that causes forced contact between dental surfaces during sleep. Sleep bruxism has been associated with craniomandibular disorders including temporomandibular joint discomfort, pulpalgia, premature loss of teeth due to excessive attrition and mobility, headache, muscle ache, sleep interruption of an individual and problems with removable and fixed denture. Basically, two groups of etiological factors can be distinguished, viz., peripheral (occlusal factors and central (pathophysiological and psychological factors. The role of occlusion (occlusal discrepancies as the causative factor is not enough mentioned in relation to bruxism. Objective. The main objective of this paper was to evaluate the connection between occlusal factors and nocturnal parafunctional activities (occlusal disharmonies and bruxism. Method. Two groups were formed- experimental of 15 persons with signs and symptoms of nocturnal parafunctional activity of mandible (mean age 26.6 years and control of 42 persons with no signs and symptoms of bruxism (mean age 26.3 yrs.. The computerized occlusal analyses were performed using the T-Scan II system (Tekscan, Boston, USA. 2D occlusograms were analyzed showing the occlusal force, the center of the occlusal force with the trajectory and the number of antagonistic tooth contacts. Results. Statistically significant difference of force distribution was found between the left and the right side of the arch (L%-R% (t=2.773; p<0.02 in the group with bruxism. The difference of the centre of occlusal force - COF trajectory between the experimental and control group was not significant, but the trajectory of COF was longer in the group of

  4. Unexpected evolution of a non-stenotic lesion in the left main coronary artery of a patient with non-ST-segment elevation myocardial infarction.

    Science.gov (United States)

    Ispas, Alexandru Florin; Mangin, Lionel; Paziuc, Alexandru; Belle, Loic

    2017-06-01

    A 72-year-old man was referred to our catheterization laboratory 48 hours after a non-ST-segment elevation myocardial infarction. His medical history included coronary artery disease (CAD) (percutaneous coronary intervention of the right coronary artery and chronic total occlusion of the circumflex artery), atrial fibrillation (AF), and chronic kidney disease. An electrocardiogram showed a pre-existent left bundle-branch block and the patient's maximum cardiac troponin concentration was 8.64 µg/L (upper limit of normal: 0.003 µg/L). The coronary angiogram revealed an ulcerated plaque of the left main coronary artery (LMCA) and moderate stenosis of the left anterior descending (LAD) coronary artery. A non-interventional approach to treatment was chosen. One month later, a control angiography showed a giant distal aneurysm complicating the lesion; the fractional flow reserve (FFR) value in the LAD was 0.74. The heart team discussed the case and concluded that the aneurysm was inaccessible via surgery. To protect the LAD from possible covered stent thrombosis or restenosis, coronary artery bypass grafting of the LAD was performed prior to percutaneous coronary intervention (PCI). Five days later, we proceeded with percutaneous exclusion of the aneurysm. We combined coil embolization of three Interlock™ two-dimensional detachable coils with stenting of the LMCA, using a PK Papyrus™ covered stent. Effective angiographic exclusion was achieved. The patient was discharged on warfarin, aspirin, and clopidogrel for 1 month, followed by long-term aspirin and oral anticoagulation. A 6-month follow-up angiography demonstrated a completely sealed aneurysm and optical coherence tomography (OCT) confirmed the successful endothelialization of the covered stent.

  5. Epidemiology of aortic disease - aneurysm, dissection, occlusion

    International Nuclear Information System (INIS)

    Steckmeier, B.

    2001-01-01

    The physiological infrarenal aortic diameter varies between 12.4 mm in women an 27.6 mm in men. As defined, an aneurysmatic dilatation begins with 29 mm. According to that, 9% of all people above the age of 65 are affected by an abdominal aortic aneurysm (AAA). Compared with the female sex, the male sex predominates at a rate of about 5:1. The disease is predominant in men of the white race. In black men, black and white women the incidence of AAA is identical. 38 to 50 percent of the AAA patients (patients) suffer from hypertension, 33 to 60% from coronary, 28% from cerebrovascular and 25% from peripheral occlusive disease. The AAA expansion rate varies between 0.2 and 0.8 cm per year and is exponential from a diameter of 5 cm on. In autopsy studies, the rupture rates with AAA diameters of 7 cm were below 5%, 39% and 65%, respecitvely. 70% of the AAA patients do not die of a rupture, but of a cardiac disease. Serum markers, such as metalloproteinases and procollagen peptides are significantly increased in AAA patients. Thoraco-abdominal aneurysms (TAA) make up only 2 to 5% of all degenerative aneurysms. 20 to 30% of the TAA patients are also affected by an AAA. 80% of the TAA are degenerative, 15 to 20% are a consequence of the chronic dissection - including 5% of Marfan patients -, 2% occur in case of infections and 1 to 2% in case of aortitis. The TAA incidence in 100,000 person-years is 5.9% during a monitoring period of 30 years. In case of TAA, an operation is indicated with a maximum diameter of 5.5 to 6 cm and more and, in case of a Marfan's syndrome (incidence of 1:10,000), with a maximum diameter of 5.5 cm and more. With regard to aorto-iliac occlusive diseases, there are defined 3 types of distribution. Type I refers to the region of the bifurcation itself. Type II defines the diffuse aortoiliac spread of the disease. Type III designates multiple-level occlusions also beyond the inguinal ligament. Type I patients in most cases are female and more

  6. Evaluation and comparison of the Minnesota Code and Novacode for electrocardiographic Q-ST wave abnormalities for the independent prediction of incident coronary heart disease and total mortality (from the Women's Health Initiative).

    Science.gov (United States)

    Zhang, Zhu-ming; Prineas, Ronald J; Eaton, Charles B

    2010-07-01

    Electrocardiographic (ECG) Q- and ST-T-wave abnormalities predict coronary heart disease (CHD) and total mortality. No comparison has been made of the classification of these abnormalities by the 2 most widely used ECG coding systems for epidemiologic studies-the Minnesota Code (MC) and Novacode (NC). We evaluated 12-lead electrocardiograms from 64,597 participants (49 to 79 years old, 82% non-Hispanic white) in the Women's Health Initiative clinical trial in 1993 to 1998, with a maximum of 11 years of follow-up. We used MC and NC criteria to identify Q-wave, ST-segment, and T-wave abnormalities for comparison. In total, 3,322 participants (5.1%) died during an average 8-year follow-up, and 1,314 had incident CHD in the baseline cardiovascular disease-free group. Independently, ECG myocardial infarction criteria by the MC or NC were generally equivalent and were strong predictors for CHD death and total mortality (hazard ratio 1.62, 95% confidence interval 1.05 to 2.51 for CHD death; hazard ratio 1.36, 95% confidence interval 1.09 to 1.71 for total mortality) in a multivariable analytic model. Electrocardiograms with major ST-T abnormalities by the MC or NC coding system were stronger in predicting CHD deaths and total mortality than was the presence of Q waves alone. In conclusion, the ECG classification systems for myocardial infarction/ischemia abnormalities from the MC and NC are valuable and useful in clinical trials and epidemiologic studies. ST-T abnormalities are stronger predictors for CHD events and total mortality than isolated Q-wave abnormalities. Copyright (c) 2010 Elsevier Inc. All rights reserved.

  7. Comparison of the occlusal vertical dimension after processing complete dentures made with lingualized balanced occlusion and conventional balanced occlusion.

    Science.gov (United States)

    Basso, Michael Frederico Manzolli; Nogueira, Sergio Sualdini; Arioli-Filho, Joao Neudenir

    2006-09-01

    An increase in occlusal vertical dimension (OVD) may occur after processing complete dentures. Although many factors that generate this change are known, no information is available in the dental literature regarding the effect that the occlusal scheme may have on the change in OVD. This in vitro study compared the increase in OVD, after processing, between complete dentures with teeth arranged in lingualized balanced occlusion and conventional balanced occlusion. Thirty sets of complete dentures were evaluated as follows: 15 sets of complete dentures were arranged in conventional balanced occlusion (control) and 15 sets of complete dentures were arranged in lingualized balanced occlusion. All dentures were compression molded with a long polymerization cycle. The occlusal vertical dimension was measured with a micrometer (mm) before and after processing each set of dentures. Data were analyzed using an independent t test (alpha=.05). The mean increase in the OVD, after processing, was 0.87 +/- 0.21 mm for the control group and 0.90 +/- 0.27 mm for the experimental group. There was no significant difference between the groups. After processing, dentures set in lingualized balanced occlusion showed an increase in OVD similar to those set in conventional balanced occlusion. Although the 2 occlusal concepts resulted in similar increases in the OVD after processing, the lingualized balanced occlusion may result in easier occlusal adjustments, as the less complicated occlusal scheme uses a smaller number of centric occlusion contact points.

  8. Distribution of occlusal forces during occlusal adjustment of dental implant prostheses: a nonlinear finite element analysis considering the capacity for displacement of opposing teeth and implants.

    Science.gov (United States)

    Kasai, Kayo; Takayama, Yoshiyuki; Yokoyama, Atsuro

    2012-01-01

    The purpose of this study was to investigate the influence of occlusal forces (the contractile forces of the masticatory muscles) during occlusal adjustment on the distribution of forces on combinations of implants and teeth during intercuspal clenching by means of finite element analysis. Three-dimensional finite element models of the mandible, one with two implants in the molar region and the other with four implants in the premolar and molar regions, were constructed. Linearly elastic material properties were defined for all elements except the periodontal ligament, which was defined as nonlinearly elastic. The temporomandibular joints and antagonists were simplified and replaced with nonlinear springs. Antagonists were assumed to be a natural tooth or an implant and had two- or three-stage displaceability (ie, very high displaceability under tension and when the displacement was smaller than the clearance assumed to be made by occlusal adjustment, but displaceability of the antagonists themselves when the displacement was greater than the clearance). The clearance by occlusal adjustment was decided beforehand with a trial-and-error method so that the occlusal forces were distributed symmetrically under a prescribed load. Each model was evaluated under loads of 100 N, 200 N, and 800 N for the distribution of occlusal forces on the teeth and implants. In the case of occlusal adjustment under the total occlusal force of 40 N, the stress was concentrated at the most posteriorly located implant in all models under all loading conditions. This concentration was reduced in the case of occlusal adjustment under the total occlusal force of 200 N, except under a load of 800 N. Hard biting appeared to be better for occlusal adjustment to avoid overloading of the most posterior implant.

  9. Scuba diving, acute left anterior descending artery occlusion and normal ECG

    Science.gov (United States)

    Doll, Sébastien Xavier; Rigamonti, Fabio; Roffi, Marco; Noble, Stéphane

    2013-01-01

    We report the case of an acute proximal occlusion of the left anterior descending coronary (LAD) artery following a scuba diving decompression accident and associated with normal ECG. Following uneventful thromboaspiration and coronary stenting, the patient was discharged on day  4 with secondary preventative therapies. A transthoracic echocardiography performed at this point showed a complete recovery compared with an initial localised akinesia involving the anterior and apical portion of the left ventricle upon admission. This case highlights that significant acute coronary lesions involving the LAD can occur without any ECG anomaly. The presence of acute and persistent angina associated with troponin elevation should prompt physicians to consider coronary angiography without delay, independently of the ECG results. PMID:23376677

  10. Occlusion-Aware View Interpolation

    Directory of Open Access Journals (Sweden)

    Ince Serdar

    2008-01-01

    Full Text Available Abstract View interpolation is an essential step in content preparation for multiview 3D displays, free-viewpoint video, and multiview image/video compression. It is performed by establishing a correspondence among views, followed by interpolation using the corresponding intensities. However, occlusions pose a significant challenge, especially if few input images are available. In this paper, we identify challenges related to disparity estimation and view interpolation in presence of occlusions. We then propose an occlusion-aware intermediate view interpolation algorithm that uses four input images to handle the disappearing areas. The algorithm consists of three steps. First, all pixels in view to be computed are classified in terms of their visibility in the input images. Then, disparity for each pixel is estimated from different image pairs depending on the computed visibility map. Finally, luminance/color of each pixel is adaptively interpolated from an image pair selected by its visibility label. Extensive experimental results show striking improvements in interpolated image quality over occlusion-unaware interpolation from two images and very significant gains over occlusion-aware spline-based reconstruction from four images, both on synthetic and real images. Although improvements are obvious only in the vicinity of object boundaries, this should be useful in high-quality 3D applications, such as digital 3D cinema and ultra-high resolution multiview autostereoscopic displays, where distortions at depth discontinuities are highly objectionable, especially if they vary with viewpoint change.

  11. Enhanced regional washout of technetium-99m-sestamibi in patients with coronary spastic angina

    International Nuclear Information System (INIS)

    Ono, Souichi; Yamaguchi, Hiroyuki; Abe, Shigeru; Tachibana, Hidetada; Sato, Takayuki; Takeishi, Yasuchika; Kubota, Isao

    2003-01-01

    Reverse redistribution and rapid washout of 99m Tc-sestamibi are observed in patients with acute myocardial infarction and may indicate viable myocardium. However, the clinical significance of this phenomenon has not been rigorously examined in other cardiac diseases. Thus, we investigated whether reverse redistribution and washout of 99m Tc-sestamibi could be used in the diagnosis and follow-up of patients with coronary spastic angina. Thirty patients diagnosed as coronary spastic angina were examined. During coronary arteriography, spasm was induced by provocation test with ergonovine, and only total or subtotal occlusion was considered positive. Myocardial perfusion tomography was obtained 45 min (early) and 3 hr (delayed) after 99m Tc-sestamibi injection. Segmental defect score was visually graded from 0 (normal) to 4 (defect), and a total defect score was determined as the sum of defect scores for all segments. Washout rate of 99m Tc-sestamibi from the myocardium was calculated for each segment. After medical treatment with calcium antagonists and nitrates for 3 months, 99m Tc-sestamibi imaging was repeated. Out of 30 patients, on the early images 17 (57%) patients demonstrated decreased 99m Tc-sestamibi uptake in spastic segments; on the other hand, 24 (80%) patients did decreased 99m Tc-sestamibi uptake in spastic segments on delayed images. Total defect scores in delayed images were higher than those in early images (6.9±0.3 vs. 3.6±0.4, p 99m Tc-sestamibi was observed in 17 out of 30 patients (57%) with coronary spastic angina. Washout rate of 99m Tc-sestamibi from spastic segments was higher than that from non-spastic segments (16±2% vs. 11±5%, p 99m Tc-sestamibi was observed in patients with coronary spastic angina and might indicate that the ability of myocyte to retain the tracer was impaired due to repetitive brief ischemia by coronary spasm. The early and delayed 99m Tc-sestamibi imaging provides useful information for the diagnosis and responses

  12. Pig specific vascular anatomy allows acute infrarenal aortic occlusion without hind limb ischemia and stepwise occlusion without clinical signs.

    Science.gov (United States)

    Haacke, N; Unger, J K; Haidenhein, C; Russ, M; Hiebl, B; Niehues, S M

    2011-01-01

    In a porcine, aortic graft model we found 5 animals to develop and survive unnoticed, complete infrarenal aortic occlusion and 2 pigs with an acute occlusion but rather unspecific clinical symptoms. We investigated the pigs' vascular system to classify the anatomic capabilities to compensate for an acute abdominal aortic occlusion. Retrospective analysis of CT scans and clinical data to specify unexpected results in a case series of infrarenal occlusion in a porcine model. Collaborative study of experimental and clinical departments. Fifteen healthy female minipigs. All pigs underwent an infrarenal aortic graft intervention. Anesthesia and perioperative management of the animals were preformed along the standard operating procedures of the local Department of Experimental Medicine. All animals received perioperative antibiotics, ASS, and carprofen for postoperative analgesia. Arterial pressure, heart rate, body temperature, and diuresis were monitored during surgery and therapeutic interventions. Contrast media based computed tomography (CT) with total body scans were performed at 1, 4, 10, 12 weeks after surgery. Comparable scans of cardiovascular healthy subjects (humans and pigs) and patients with a Leriche's syndrome were analyzed. Neither acute (within the first 12 h after surgery) nor stepwise total aortic occlusion show unmistakable clinical signs. In pigs, the epigastric artery (EGA) - which is in connection with suprarenal lumbal arteries, subclavian and external iliac artery - is highly developed associated to the high number of mammary glands of about 7 on one side. In humans, the ratio of aortic to EGA-diameter is 1 : 0.15. In minipigs we found a ratio of 1 : 0.43 which changed during aortic occlusion resulting in a ratio of 1 : 0.58. Pigs with a slowly developing occlusion demonstrated an enlargement of the ureteric artery of about 210% completing a sufficient collateral system. While in the human Leriche's syndrome months are needed to enlarge the

  13. 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.

  14. Positive correlation between occlusion rate and nidus size of proton beam treated brain arteriovenous malformations (AVMs)

    DEFF Research Database (Denmark)

    Blomquist, Erik; Ronne Engström, Elisabeth; Borota, Ljubisa

    2016-01-01

    Background. Proton beam radiotherapy of arteriovenous malformations (AVM) in the brain has been performed in Uppsala since 1991. An earlier study based on the first 26 patients concluded that proton beam can be used for treating large and medium sized AVMs that were considered difficult to treat...... symptoms, clinical course, the size of AVM nidus and rate of occlusion was collected. Outcome parameters were the occlusion of the AVM, clinical outcome and side effects.Results. The rate of total occlusion was overall 68%. For target volume 0-2cm3 it was 77%, for 3-10 cm3 80%, for 11-15 cm3 50% and for 16...... those with and without total occlusion regarding mean age, gender distribution or symptoms at diagnosis. Forty-one patients developed a mild radiation-induced brain edema and this was more common in those that had total occlusion of the AVM. Two patients had brain hemorrhages after treatment. One...

  15. Relationship between aortic valve calcification and the severity of coronary atherosclerotic disease.

    Science.gov (United States)

    Qian, Juying; Chen, Zhangwei; Ge, Junbo; Ma, Jianying; Chang, Shufu; Fan, Bing; Liu, Xuebo; Ge, Lei

    2010-07-01

    Aortic valve calcification (AVC), which has been confirmed to be associated with various risk factors of cardiac disease, is common in the elderly and associated with increased cardiovascular mortality. It has been hypothesized that AVC is associated with coronary atherosclerotic disease, and its severity. Between July 2007 and November 2007, a total of 235 patients with chest pain or chest distress were admitted to the authors' institution for coronary angiography. The severity of coronary atherosclerotic disease (CAD) was evaluated by the Gensini score, the number of stenosed vessels, and the prevalence of total occlusion. All patients underwent transthoracic echocardiography to detect AVC. Patients with CAD had a higher prevalence of AVC than those without CAD (44% versus 26%, p = 0.005). Likewise, the prevalence of AVC was significantly higher in patients with a higher Gensini score than in those with a lower score. Patients with AVC had a higher prevalence of CAD, and higher Gensini scores and numbers of stenosed coronary arteries, even after stratification by age (65 years). On multivariable logistic regression analysis for CAD, the odds ratio (OR) of AVC was 2.315 (95% confidence interval (CI): 1.158-4.629, p = 0.018); this value was higher than that for total cholesterol (OR = 1.637, p = 0.008), lipoprotein-a (OR = 1.003, p = 0.015) and fibrinogen (OR = 1.009, p = 0.006), and marginally less than that for male gender (OR = 2.665, p = 0.005). Patients with AVC had a higher prevalence and greater severity of CAD.

  16. Survival results of postoperative coronary angiogram for treatment of perioperative myocardial ischaemia following coronary artery bypass grafting: a single-centre experience.

    Science.gov (United States)

    Preußer, Maximilian J; Landwehrt, Jan; Mastrobuoni, Stefano; Biancari, Fausto; Dakkak, Abdul R; Alshakaki, Mosab; Martens, Sven; Dell'Aquila, Angelo M

    2018-02-01

    Although perioperative myocardial ischaemia (PMI) is a well-known complication following coronary artery bypass grafting (CABG), standard strategies for its diagnosis and treatment are so far not defined. In this study, we sought to evaluate the impact on survival of postoperative coronary angiogram for management of patients with PMI after CABG. Overall, 4028 patients underwent isolated CABG in a single-centre institution between January 2006 and September 2013. A total of 168 (4.2%) patients received postoperative coronary angiogram because of diagnosis of PMI. These patients were matched on the basis of gender, age at surgery and date of surgery, with 336 (1:2 ratio) CABG patients without PMI to determine the impact of the PMI management. A total of 476 grafts were examined (263 venous grafts, 196 internal mammary artery grafts and 17 radial artery grafts). Almost three-quarters of the 168 PMI (74.4%) patients underwent postoperative coronary angiogram within 24 h of surgery. Normal postoperative coronary angiogram, graft failure and new native vessels occlusion were observed in 23.2%, 52.4% and 24.4% of patients, respectively. A total of 30 (17.9%) patients underwent surgical revision of grafts, whereas 60 (35.7%) patients were treated with percutaneous coronary intervention. Eighteen (10.7%) PMI patients died during the hospital stay compared with 6 (1.8%) patients in the non-PMI group. Survival rates at 7 years were 62.5% in the PMI group and 81.1% in non-PMI group (P PMI (P 24 h after surgery) was an independent predictor of poorer mid-term survival (P = 0.008; hazard ratio 3.62, 95% confidence interval 1.41-9.33). PMI after CABG is associated with a significantly poorer survival. A prompt postoperative management must always be considered. Further prospective studies are required to confirm our results. © The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights

  17. Avaliação hemogasométrica durante a parada circulatória total - Inflow Occlusion - aplicada por diferentes períodos de tempo em cães sadios

    Directory of Open Access Journals (Sweden)

    Karina Lacava Kwasnicka

    2000-01-01

    Full Text Available Apesar de a técnica do "Inflow Stasis" já estar sendo usada há décadas, não existem muitos trabalhos relacionando seus efeitos no pós-operatório. Pacientes que vão sofrer uma cirurgia cardíaca devem receber monitorização adequada, incluindo a dos gases sangüíneos, pH e bicarbonato, uma vez que sofrerão alterações na ventilação e sistema circulatório. O objetivo deste trabalho foi verificar possíveis alterações na ventilação, oxigenação e equilíbrio ácido-básico em cães submetidos a diferentes períodos de parada circulatória. Quinze cães adultos (Canis familiaris e hígidos foram divididos aleatoriamente em três grupos (A, B e C e submetidos a diferentes períodos de parada circulatória total (5, 10 e 15 minutos. No decorrer da cirurgia, foram coletadas amostras de sangue arterial da artéria femoral (previamente cateterizada e imediatamente analisadas por analisador de pH e gases sangüíneos. Os momentos de avaliação foram: M0- antes da indução anestésica; M1- após indução anestésica; M2- antes da parada circulatória; M3- durante a parada circulatória; M4- após restauração da circulação; M5- ao término da cirurgia; M6- 24 horas após o término; e M7- 48 horas após o término da cirurgia. Depois de submeter os resultados a análises estatísticas, verificou-se que a parada circulatória total causou elevado grau de hipóxia tecidual com conseqüente acidose metabólica, que foi leve no grupo A, moderada no B e severa no grupo C.

  18. [Synchronized anterograde perfusion during percutaneous transluminal coronary angioplasty: preliminary clinical study].

    Science.gov (United States)

    Farcot, J C; Berland, J; Derumeaux, G; Letac, B; Bourdarias, J P

    1995-03-01

    A new circulatory system, "physiologic anteroperfusion system", has been developed and tested in 6 patients with significant proximal coronary artery stenosis. Prolonged and safe balloon inflation was possible without any ischemic signs. The system consists of an electronic cardiac synchroperfusor which, by activating a pulsatile unit, permits increased diastolic anteroperfusion of autologous blood under physiologic pressure through low-profile standard angioplasty catheters. This study reports the results obtained in 6 patients during proximal prolonged percutaneous transluminal coronary angioplasty. Four men and two women suffering from severe exertional angina pectoris, with normal resting left ventricular function, no collaterals and excellent apical two-dimensional four-chamber echocardiographic views were studied. After a 90 +/- 10 seconds of control occlusion under continuous monitoring of hemodynamics, electrocardiograms (3 to 4 leads), two-dimensional echo and chest pain grading, a second balloon inflation protected by the physiologic anteroperfusion system at a flow rate of 44 +/- 12 ml/min was performed for fifteen minutes. The ischemic signs present in the myocardium depending on the occluded artery were totally abolished during prolonged inflation protected by physiologic anteroperfusion system. All the patients were successfully dilated and were discharged from hospital the following morning without cardiac enzyme elevation or signs of central or peripheral hemolysis. Conclusion, in 6 patients with severe proximal coronary artery stenosis, safe prolonged proximal angioplasty without signs of ischemia was performed using a new simple physiologic anteroperfusion system, which allows active diastolic flow-pressure controlled autologous arterial blood perfusion, through standard low profile catheters.

  19. The association between Occlusion Time and Temporomandibular Disorders.

    Science.gov (United States)

    Baldini, Alberto; Nota, Alessandro; Cozza, Paola

    2015-02-01

    Recently, some published studies show there is a multifactorial origin for Temporomandibular Disorders, but the dental occlusion's contribution to the development of Temporomandibular Disorders, and how it may influence the adaptive capacity of the Stomatognathic system, it's still unclear. The aim of this study is to evaluate the correlation between the Occlusion Time and Temporomandibular Disorders. A total of 54 patients were enrolled in the study (24 males and 30 females, mean age 27.94 ± 8.21 years). The TMD group (8 males and 10 females) consisted of subjects who presented with at least 1 of the following signs of Temporomandibular Disorders: Temporomandibular Joint sounds (clicking or crepitation), Temporomandibular Joint locking episodes, limited mandibular opening, painful limitation of mandibular movements, pain to palpation of the Temporomandibular Joint or of the masticatory muscles. The control group (16 males and 20 females) presented as free from Temporomandibular Disorders. The T-Scan III computerized occlusal analysis system was to record the subjects' Occlusion. Times during eight mandibular opening-closing movements. The two-ways ANOVA test analyzed the variations for group and sex, showing that the TMD group mean Occlusion Time (0.64 ± 0.21s) was statistically significantly longer than the control group mean Occlusion Time (0.45 ± 0.17s) (p<0.001). Significant differences were also found for gender where the mean OT of female subjects was longer than males one with statistical significance (p-value<0.01). The computerized analysis of the Occlusion Time in patients affected by TMJ problems has to be carefully considered as adjunctive instrumental device. Copyright © 2014 Elsevier Ltd. All rights reserved.

  20. Two Years Survival Rate of Occlusal ART Restorations Placed ...

    African Journals Online (AJOL)

    The aim of this study was to assess the acceptability and effectiveness of ART restorations placed without tooth surface conditioning on occlusal caries in the permanent dentition in a primary oral health care centre in Nigeria. A total of 93 ART restorations were placed without tooth conditioning in children and adolescents ...

  1. Characteristics, Detection Methods and Treatment of Questionable Occlusal Carious Lesions

    DEFF Research Database (Denmark)

    Makhija, S.K.; Gilbert, G.H.; Funkhouser, E.

    2014-01-01

    Questionable occlusal carious lesions (QOC) can be defined as an occlusal tooth surface with no cavitation and no radiographic radiolucencies, but caries is suspected due to roughness, surface opacities or staining. An earlier analysis of data from this study indicates 1/3 of patients have a QOC....... The objective of this report has been to quantify the characteristics of these common lesions, the diagnostic aids used and the treatment of QOC. A total of 82 dentist and hygienist practitioner-investigators from the USA and Denmark in the National Dental Practice-Based Research Network participated. When...

  2. Endovascular Sharp Recanalization for Calcified Femoropopliteal Artery Occlusion

    Directory of Open Access Journals (Sweden)

    Hsuan-Li Huang

    2012-01-01

    Full Text Available Endovascular intervention of peripheral chronic total occlusion (CTO is technically challenging and time consuming. Various techniques and devices are used to facilitate lesion crossing and improve the success rate of the procedure. However, these new devices are quite expensive and not readily available. We report 2 cases of peripheral CTO wherein the occlusions were successfully crossed by using stiff end of Terumo glidewire. This sharp recanalization may be a useful technique for the recanalization of calcified peripheral CTOs when conventional techniques fail and new devices are not readily available, but it is accompanied by the risk of distal atheroembolism.

  3. Endograft Limb Occlusion in EVAR

    DEFF Research Database (Denmark)

    Taudorf, M; Jensen, L P; Vogt, K C

    2014-01-01

    % at 3 years. Logistic regression showed that iliac artery tortuosity (DIS) (p = .001) and body mass index (p = .007) had a significant impact on graft patency. CONCLUSION: A tortuous vessel on the preoperative CTA is associated with an increased risk of limb occlusion after EVAR. Adjunctive stenting...

  4. Occlusion for fixed prosthodontics: a historical perspective of the gnathological influence.

    Science.gov (United States)

    Pokorny, Paul H; Wiens, Jonathan P; Litvak, Harold

    2008-04-01

    This article addresses the historical perspective of the gnathological influence upon the concepts of occlusion for fixed prosthodontics. A critical assessment and subsequent scientific validation of occlusal theories require an understanding of their evolution in the formative years and the subsequent development of effective models for clinical practice. While gnathological concepts offer a structured methodology for prosthodontic procedures, further research is needed to corroborate current occlusal treatment approaches. This review focuses on the "classic" fixed prosthodontic literature and the currently available scientific literature involving fixed prosthodontic dentate occlusion and gnathology. A MEDLINE search was performed to identify English-language peer-reviewed publications spanning the last 56 years, along with an extensive hand search for years prior. Electronic searches of the literature were performed in MEDLINE using the key words: case series, clinical trials, cohort studies, fixed partial denture occlusion, dental occlusion, dental occlusion research, centric relation, incisal guidance, maximal intercuspation, occlusal vertical dimension, and occlusion, in various combinations to obtain potential references for review. A total of 10,382 English-language nonduplicate titles were obtained for 1950-2006 for the key words "dental occlusion." Other key word searches produced smaller numbers of articles, many of which were duplicates due to multiple searches and were subsequently eliminated. Manual hand searching of the MEDLINE reference list and other journals of interest was performed to identify any articles missed in the original search. Articles were included for review if they contained emerging occlusal theories, new technologies, or occlusal studies that included multiple subjects in contrast to case reports.

  5. Temporomandibular Disorders Treatment with Correction of Decreased Occlusal Vertical Dimension

    Directory of Open Access Journals (Sweden)

    Ljuben Guguvcevski

    2017-10-01

    CONCLUSION: Occlusal splint is a part of reversible occlusal therapy in cases with decreased occlusal vertical dimension. After reducing the symptoms related to decreased occlusal vertical dimension definitive prosthetic therapy can be done.

  6. [Cephalometric determination of the occlusion plane: the Broadrick flag technique].

    Science.gov (United States)

    Ousehal, L; Lazrak, L; Marzak, J; Bennani, A

    2012-03-01

    Based on the principle of the sphere of MONSON, the Broadrick flag technique constitutes a relatively simple means to determine the plan of occlusion, by using a radius fixes of 104 mm. The theory of MONSON was debated a long time. Our work consists of a clinical study realized in the CCTD of Casablanca, on 31 completely toothed cases normocclusion. Its objective was triple: to calculate on the profile teleradiographies, the anatomical and geometrical rays used for the construction of SPEE curve, to see if there is concordance between these two rays and finally to compare them with the theoretical value of 104 mm. From the obtained results it would seem that: The 104 mm value, cannot be considered as a standard average to be used to determine the curve of occlusion, also the articulator such as it is designed currently cannot be used in all the patient's about is the values of their rays. In the absence of molars, the anatomical radius cannot be used in place of the geometrical radius to determine the curve of occlusion. The measured gap between the obtained curve and the plan of occlusion remains not insignificant, he can reach 3 mm for the anatomical radius and 3,5 mm for the geometrical radius. In the total edentate, the cephalometric determination of occlusion plane, by basing itself on the anatomical radius or the geometrical radius is not possible.

  7. Selvester QRS score and total perfusion deficit calculated by quantitative gated single-photon emission computed tomography in patients with prior anterior myocardial infarction in the coronary intervention era.

    Science.gov (United States)

    Kurisu, Satoshi; Shimonaga, Takashi; Ikenaga, Hiroki; Watanabe, Noriaki; Higaki, Tadanao; Ishibashi, Ken; Dohi, Yoshihiro; Fukuda, Yukihiro; Kihara, Yasuki

    2017-04-01

    Selvester QRS scoring system has an advantage of being inexpensive and easily accessible for estimating myocardial infarct (MI) size. We assessed the correlation and agreement between QRS score and total perfusion deficit (TPD) calculated by quantitative gated single-photon emission computed tomography (QGS) in patients with prior anterior MI undergoing coronary intervention. Sixty-six patients with prior anterior MI and 66 age- and sex-matched control subjects were enrolled. QRS score was obtained using a 50-criteria and 31-point system. QRS score was significantly higher in patients with prior anterior MI than control subjects (12.8 ± 8.9 vs 1.1 ± 2.7 %, p < 0.001). In overall patients (n = 132), QRS score was correlated well with TPD (r = 0.81, p < 0.001). This good correlation was found even in patients with TPD ≤40 % (n = 126) or in patients with TPD ≤30 % (n = 117). In overall patients, MI size estimated by QRS score was 7.0 ± 8.8 %, which was significantly smaller than TPD, 11.4 ± 14.0 % (p < 0.001). Bland-Altman plot showed that there was an increasing difference between QRS score and TPD with increasing MI size. When Blant-Altman plots were applied to patients with TPD ≤40 % and further in patients with TPD ≤30 %, the difference between QRS score and TPD became smaller, and the agreement became better. In overall patients, QRS score was correlated well with QGS measurements, such as end-diastolic volume (r = 0.62, p < 0.001), end-systolic volume (r = 0.67, p < 0.001), or ejection fraction (r = -0.73, p < 0.001). Our results suggest that QRS score reflects TPD well in patients with prior anterior MI, whose TPD is less than approximately 30 % even in the coronary intervention era.

  8. Vertebral Artery Dissection Complicated by Basilar Artery Occlusion

    Directory of Open Access Journals (Sweden)

    Chia-Yin Kuan

    2014-08-01

    Full Text Available Acute basilar artery occlusion (ABAO is an infrequent but potentially fatal complication that can cause strokes in both adults and children. Traumatic vertebral artery dissection (VAD is one of the most common causes of ABAO in young patients. We present a case of an 11-year-old boy with VAD complicated by basilar artery occlusion 2 days after a fight with classmates that caused severe neurological deficits. He did not have any direct head trauma or concomitant risk factors. Clinical symptoms included nausea, vomiting, and rapid alteration of consciousness. Magnetic resonance imaging showed total occlusion of the basilar artery, and angiography confirmed VAD from the third to the fourth segments. A history of such subtle precipitating events should be noted when diagnosing young patients with brainstem strokes. A delay in the diagnosis of ABAO is frequently due to misleading symptoms and signs and the lack of awareness of this rare condition.

  9. Sealing occlusal caries lesions in adults referred for restorative treatment

    DEFF Research Database (Denmark)

    Bakhshandeh, Azam; Qvist, Vibeke; Ekstrand, Kim R

    2012-01-01

    The aim of this study was to assess the possibility to arrest occlusal caries lesions in adults by sealant as well as to assess the presence of radiographic progression, arrest, and regression of the sealed lesions. Seventy-two occlusal caries lesions in 52 adult patients referred to restorative...... treatment by senior lecturers at School of Dentistry, Copenhagen, Denmark were included. In case the patient had more than one occlusal caries lesion, randomization between sealing and restoration was made; otherwise, the lesion was sealed. In total, 60 resin sealants and 12 composite restorations were made....... All 12 restorations and 39 of the remaining 49 sealants were well functioning, seven (14%) sealants were repaired/replaced due to failure, and three (6%) sealed lesions were restored due to caries progression (p¿>¿0.05). The radiographic assessment showed caries progression beneath five (10%) sealants...

  10. Cephalometric analysis for functional occlusion

    Directory of Open Access Journals (Sweden)

    Ashok Karad

    2016-01-01

    Full Text Available Background: Various elements contributing to good functional occlusion have not been clearly assessed with cephalometrics for the diagnosis of functional problems and their application in clinical practice. The aim of this study, therefore, was to analyze different components of functional occlusion to formulate concise functional cephalometric analysis. Materials and Methods: Eighty-two cases (38 males and 44 females, with class I occlusion and balanced facial profile, were examined based on the selection criteria, and cephalograms were taken in natural head position. All the radiographs were then analyzed using various functional parameters. Results: The mean values of condylar path angle and incisal path angle were 55.83° and 65.67°, respectively, with large deviations. However, both showed positive correlation. The value of the angle of long axis of mandibular incisor with respect to the line joining center of condyle and lower incisor tip was 88.04°. Moreover, the angle between the occlusal plane and horizontal plane was 12.88°. In vertical plane, lower face height (LFH was found to be slightly less than the upper face height. Maxilla contributed around 45% of the LFH while mandible formed about 60%. Furthermore, upper alveolar component (maxillary alveolar height formed more than half of the maxilla (53.79% whereas lower alveolar component (mandibular alveolar height was 74.8% of the mandible. Conclusion: This study has analyzed various components of functional occlusion and formulated a concise functional cephalometric analysis for diagnosis, treatment planning, and assessment of treatment results.

  11. Malignant occlusion of the coeliac axis

    Energy Technology Data Exchange (ETDEWEB)

    Jonsson, K.; Wattsgaard, C.; Genell, S. (Malmoe Allmaenna Sjukhus, Malmoe (Sweden). Dept. of Diagnostic Radiology)

    1982-01-01

    Occlusion or extensive stenosis of the coeliac trunk due to malignant tumor are described in three patients. If, at angiography of a patient with a malignant tumor, occlusion of the coeliac trunk is found, tumor or lymph node metastases causing the occlusion must be considered; this may be of importance when intra-arterial chemotherapy of the tumor is planned.

  12. [The occlusal contact mode during lateral excursion].

    Science.gov (United States)

    Sugawara, N

    2000-09-01

    The purpose of this study is to clarify the occlusal contact mode between the upper and lower molars on the working side of group function occlusion during lateral excursion. After the intercuspal position (IP) and two lateral positions (L1, the middle point between IP and L2; L2, the edge-to-edge occlusal position of the molars) on the Gothic arch were defined, occlusal contact relations in these three occlusal positions were recorded, using black silicone. Digital data of real occlusal contacts and visualized data of close (less than 30 microns) occlusal areas, by computer image processing, were analyzed. The conclusions are as follows: 1. Although the numbers of real occlusal contacts and the visualized occlusal area tend to decrease toward L2 during lateral excursion, the former, in some cases, goes up and down. 2. Functional cusps play an important part in occlusal contact at the intercuspal position. 3. Occlusal contact points are on the functional cusps of the upper and lower molars, which can be clinically regarded as certain points, and these points slide on the inclining non-functional cusps of antagonistic teeth during lateral excursion. 4. Each upper and lower molar has 2 to 6 occlusal contact points near the top functional cusps at the intercuspal position, and some of them contact continuously during lateral excursion.

  13. Hyperhomocysteinemia Presenting with Complete Unilateral Intracranial and Extracranial Carotid Occlusion in a Young Patient.

    Science.gov (United States)

    Niazi, Farheen; Rahman, Abdul; Batool, Uzma

    2017-09-01

    Hyperhomocysteinemia has been associated with premature peripheral vascular, cerebrovascular, and coronary artery disease. It has been associated with vascular diseases including cerebrovascular disease, particularly in subjects with significant carotid stenosis. However, hyperhomocysteinemia causing unilateral complete occlusion of whole of internal carotid, common carotid, and external carotid has been rarely reported. We report a case of an adult patient aged 35-year with complete occlusion of right common carotid, internal carotid, both intracranial and extracranial part, presented with recurrent TIAs and stroke and was found to be having hyperhomocysteinemia as the cause of this complete occlusion and showed marked clinical recovery with appropriate treatment. Prompt identification and treatment of hyperhomocysteinemia, as a vascular risk factor especially in young, is of utmost importance especially when its treatment is cost-effective and can save major disability from stroke.

  14. Branching patterns of left coronary artery among North Indians ...

    African Journals Online (AJOL)

    The left coronary artery displays variations in pattern, number and distribution of its branches. These variations influence the manifestation and extent of the coronary artery disease affecting the left main branch. A total of 100 North Indian cadaveric hearts were dissected to observe the main trunk of the left coronary artery.

  15. Cephalometric indicators of the vertical dimension of occlusion.

    Science.gov (United States)

    Strajnić, Ljiljana; Stanisić-Sinobad, Darinka; Marković, Dubravka; Stojanović, Ljiljana

    2008-06-01

    The aim of this investigation was to establish precise indicators of the vertical dimension of occlusion (VDO) which could be used as objective parameters in prosthodontic treatment providing exact control of the reconstructed vertical dimension of occlusion, early detection of errors and correction of the vertical dimension of occlusion during complete denture manufacturing. A total of 60 lateral cephalometric radiographs of subjects with natural dentition and class I skeletal jaw relationship, of Serbian nationality from the region of Vojvodina, were included in the investigation. Thirty subjects were males, and thirty females, their age range was 20 to 29 years. Cephalometric analysis was performed by using "Dr. Ceph" computer software (FYI Technologies, GA, USA). By evaluation of the craniofacial complex in subjects with natural dentition, horizontal dentofacial developmental growth was established in the examined sample and it was based on the relationship between the posterior and anterior total facial height (S-Go:N-Me, female X=68.96%, male X=72.8%) and statistically significant differences were found between the sexes in almost all linear dimensions and in the relation between the posterior and the anterior total facial height. Highly significant differences (pvertical dimension of occlusion in the treatment of edentulous patients.

  16. 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......-derived collateral flow index (CFI) was determined as (P(w)-P(cvp))/(P(a)-P(cvp)), where P(w) represents coronary wedge pressure, P(cvp) central venous pressure, and P(a) mean aortic blood pressure. Both were measured during transient coronary occlusion by a balloon inflation of 30 s. Pre-interventional FFR (0.......65 +/- 0.20) correlated inversely with the CFI (0.18 +/- 0.11), r =- 0.356, P /=50% diameter stenosis) was seen in 29.1%. Compared to patients with poorly developed collaterals (CFI collaterals (CFI >/= 0...

  17. Effect of Prewarming during Induction of Anesthesia on Microvascular Reactivity in Patients Undergoing Off-Pump Coronary Artery Bypass Surgery: A Randomized Clinical Trial.

    Directory of Open Access Journals (Sweden)

    Youn Joung Cho

    Full Text Available General anesthesia may induce inadvertent hypothermia and this may be related to perioperative cardiovascular complications. Microvascular reactivity, measured by the recovery slope during a vascular occlusion test, is decreased during surgery and is also related to postoperative clinical outcomes. We hypothesized that microvascular changes during surgery may be related to intraoperative hypothermia. To evaluate this, we conducted a randomized study in patients undergoing off-pump coronary artery bypass surgery, in which the effect of prewarming on microvascular reactivity was evaluated.Patients scheduled for off-pump coronary artery bypass surgery were screened. Enrolled patients were randomized to the prewarming group to receive forced-air warming during induction of anesthesia or to the control group. Measurement of core and skin temperatures and vascular occlusion test were conducted before anesthesia induction, 1, 2, and 3 h after induction, and at the end of surgery.In total, 40 patients were enrolled and finished the study (n = 20 in the prewarming group and n = 20 in the control group. During the first 3 h of anesthesia, core temperature was higher in the prewarming group than the control group (p < 0.001. The number of patients developing hypothermia was lower in the prewarming group than the control group (4/20 vs. 13/20, p = 0.004. However, tissue oxygen saturation and changes in recovery slope following a vascular occlusion test at 3 h after anesthesia induction did not differ between the groups. There was no difference in clinical outcome, including perioperative transfusion, wound infection, or hospital stay, between the groups.Prewarming during induction of anesthesia decreased intraoperative hypothermia, but did not reduce the deterioration in microvascular reactivity in patients undergoing off-pump coronary artery bypass surgery.ClinicalTrials.gov NCT02186210.

  18. Autoregulation of coronary blood flow in the isolated beating pig heart.

    Science.gov (United States)

    Schampaert, Stéphanie; van 't Veer, Marcel; Rutten, Marcel C M; van Tuijl, Sjoerd; de Hart, Jurgen; van de Vosse, Frans N; Pijls, Nico H J

    2013-08-01

    The isolated beating pig heart model is an accessible platform to investigate the coronary circulation in its truly morphological and physiological state, whereas its use is beneficial from a time, cost, and ethical perspective. However, whether the coronary autoregulation is still intact is not known. Here, we study the autoregulation of coronary blood flow in the working isolated pig heart in response to brief occlusions of the coronary artery, to step-wise changes in left ventricular loading conditions and contractile states, and to pharmacologic vasodilating stimuli. Six slaughterhouse pig hearts (473 ± 40 g) were isolated, prepared, and connected to an external circulatory system. Through coronary reperfusion and controlled cardiac loading, physiological cardiac performance was achieved. After release of a coronary occlusion, coronary blood flow rose rapidly to an equal (maximum) level as the flow during control beats, independent of the duration of occlusion. Moreover, a linear relation was found between coronary blood flow and coronary driving pressure for a wide variation of preload, afterload, and contractility. In addition, intracoronary administration of papaverine did not yield a transient increase in blood flow indicating the presence of maximum coronary hyperemia. Together, this indicates that the coronary circulation in the isolated beating pig heart is in a permanent state of maximum hyperemia. This makes the model excellently suitable for testing and validating cardiovascular devices (i.e., heart valves, stent grafts, and ventricular assist devices) under well-controlled circumstances, whereas it decreases the necessity of sacrificing large mammalians for performing classical animal experiments. © 2013, Copyright the Authors. Artificial Organs © 2013 Wiley Periodicals, Inc. and International Center for Artificial Organs and Transplantation.

  19. Interventional therapy of atherosclerotic renal artery occlusion

    International Nuclear Information System (INIS)

    Li Jian; Xu Ke; Xiao Liang

    2009-01-01

    Objective: To investigate the effectiveness of interventional therapy for the atherosclerotic renal artery occlusion (ARAO). Methods: During the period of June 2001-Dec. 2007, 16 patients with ARAO (total of 16 occluded arteries) underwent interventional managements, including percutaneous endovascular renal artery revascularization, balloon dilatation angioplasty and stent placement. Follow-up survey was made at regular intervals. The patent condition of the renal artery was evaluated with ultrasonography and digital subtraction angiography. The blood pressure and the renal function were determined and the data were statistically analyzed in order to assess the intermediate and long-term effect of the interventional therapy. Results: Of 16 patients, technical success was achieved in 15 (93.8%) and failure occurred in one. During a follow-up period of 9 - 24 months, 3 patients died. According to the data obtained at each patient's last follow-up survey, the hypertension fell to normal in 3 (25.0%), was improved in 7 (58.3%) and showed no marked change in 2 patients (16.7%), with a clinical efficacy of 83.3% (10 / 12). The renal function was improved in 2 (16.7%), stabilized in 6 (50%) and deteriorated in 4 patients (33.3%), with an effective rate of 66.7% (8 / 12). Conclusion: For the treatment of atherosclerotic renal artery occlusion, the interventional therapy carries high successful rate and can effectively lower the blood pressure level, in addition, it can also protect the renal function in a certain degree. (authors)

  20. The Effect of Sex and Anthropometry on Clinical Outcomes in Patients Undergoing Percutaneous Coronary Intervention for Complex Coronary Lesions.

    Science.gov (United States)

    Lee, Seung Yul; Shin, Dong Ho; Kim, Jung Sun; Kim, Byeong Keuk; Ko, Young Guk; Choi, Donghoon; Jang, Yangsoo; Hong, Myeong Ki

    2017-03-01

    To evaluate the effects of sex and anthropometry on clinical outcomes in patients who underwent percutaneous coronary intervention (PCI). From three randomized trials (REal Safety and Efficacy of 3-month dual antiplatelet Therapy following Endeavor zotarolimus-eluting stent implantation, Impact of intraVascular UltraSound guidance on outcomes of Xience Prime stents in Long lesions, Chronic Total Occlusion InterVention with drUg-eluting Stents), we compared 333 pairs of men and women matched by propensity scores, all of whom underwent intravascular ultrasound (IVUS)-guided PCI for complex lesions. For 12 months, the incidence of adverse cardiac events, defined as the composite of cardiac death, target lesion-related myocardial infarction, and target lesion revascularization, was not different between women and men (2.4% vs. 2.4%, p=0.939). Using multivariable Cox's regression analysis, post-intervention minimum lumen area [MLA; hazard ratio (HR)=0.620, 95% confidence interval (CI)=0.423-0.909, p=0.014] by IVUS was a predictor of adverse cardiac events. Height on anthropometry and lesions with chronic total occlusion were significantly related to post-intervention MLA. However, female sex was not independently associated with post-intervention MLA. In an age and sex-adjusted model, patients in the low tertile of height exhibited a greater risk for adverse cardiac events than those in the high tertile of height (HR=6.391, 95% CI=1.160-35.206, p=0.033). Sex does not affect clinical outcomes after PCI for complex lesions. PCI outcomes, however, may be adversely affected by height.

  1. Occlusal stability in shortened dental arches.

    Science.gov (United States)

    Witter, D J; Creugers, N H; Kreulen, C M; de Haan, A F

    2001-02-01

    Shortened dental arches consisting of anterior and premolar teeth have been shown to meet oral functional demands. However, the occlusal stability may be at risk as a result of tooth migration. The aim of this nine-year study was to investigate occlusal stability in shortened dental arches as a function over time. Occlusal stability indicators were: 'interdental spacing', 'occlusal contacts of anterior teeth in Intercuspal Position', 'overbite', 'occlusal tooth wear', and 'alveolar bone support'. Subjects with shortened dental arches (n = 74) were compared with subjects with complete dental arches (controls, n = 72). Repeated-measurement regression analyses were applied to assess age-dependent variables in the controls and to relate the occlusal changes to the period of time since the treatment that led to the shortened dental arches. Compared with complete dental arches, shortened dental arches had similar overbite and occlusal tooth wear. They showed more interdental spacing in the premolar regions, more anterior teeth in occlusal contact, and lower alveolar bone scores. Since the differences remained constant over time, we conclude that shortened dental arches can provide long-term occlusal stability. Occlusal changes were self-limiting, indicating a new occlusal equilibrium.

  2. Vertex occlusal radiography in localizing unerupted mesiodentes

    Directory of Open Access Journals (Sweden)

    P Chalakkal

    2011-01-01

    Full Text Available The aim was to compare the vertex occlusal projection with the anterior maxillary occlusal projection in localizing the position of mesiodentes. Mesiodentes were observed in an 8-year-old boy with an anterior maxillary occlusal radiograph. A vertex occlusal radiograph was taken to compare it with the former in terms of mesiodentes localization with respect to the maxillary central incisors. The vertex occlusal radiograph provided greater details of the position and proximity of mesiodentes with respect to the long axis of maxillary central incisors in comparison to the anterior maxillary occlusal radiograph. Vertex occlusal radiography is an important diagnostic tool in diagnosing the presence, position, and proximity of mesiodentes with respect to the long axis of normally aligned maxillary central incisors. However, it is not recommended for routine use in a patient as its radiation dose is higher than conventional intraoral radiographic methods.

  3. Retinal vein occlusion: current treatment.

    Science.gov (United States)

    Lattanzio, Rosangela; Torres Gimeno, Ana; Battaglia Parodi, Maurizio; Bandello, Francesco

    2011-01-01

    Retinal vein occlusion (RVO) is a pathology noted for more than 150 years. Although a lot has been written on the matter, it is still a frequent condition with multifactorial etiopathogenesis with many unclear aspects. The RVO pathogenesis has varied systemic and local implications that make it difficult to elaborate treatment guidelines. The management of the patient with RVO is very complex and a multidisciplinary approach is required in order to identify and correct the associated risk factors. Laser therapy remains the gold standard in RVO, but only modest functional improvement has been shown in branch retinal occlusion forms. Multicenter studies of intravitreal drugs present them as an option to combine with laser. Anti-vascular endothelial growth factor, corticosteroids and sustained-release implants are the future weapons to stop disease progression and get a better visual outcome. Consequently, it is useful to clarify some aspects of the pathology that allow a better patient management. Copyright © 2010 S. Karger AG, Basel.

  4. Arterial occlusive disease after radiotherapy

    International Nuclear Information System (INIS)

    Piedbois, P.; Mazeron, J.J.; Le Bourgeois, J.P.; Becquemin, J.P.; Blanc, I.; Lange, F.; Melliere, D.

    1990-01-01

    Fourteen cases of arterial occlusion or severe narrowing following radiotherapy are studied in order to assess the possible etiological role of such therapy in arterial lesion. Surgical results are also discussed in terms of long-term efficacy. The average time of occurrence after radiotherapy was 8 years post-radiotherapy. This series includes 7 supra-aortic trunk stenoses and 7 abdominal aorta trunk stenoses. The doses received in the volumes iradiated ranged from 47 to 70 Gy with standard fractionation. Association of atherosclerotic risk factors was present in 12 patients, but stenoses were usually confined to irradiated areas, and at imes occurred in uncommon sites. Surgical management included 11 by-passes, 2 endarterectomies and one percutaneous transluminal angioplasty. All patients experienced immediate and satisfactory functional improvements. Three patients were re-operated on because of the re-occlusion of the by-pass and graft infection. On the whole, stenoses in previously irradiated areas showed no particular difficulties for surgical treatment. It was concluded that radiotherapy seems to be a definite risk factor for arterial occlusion or narrowing, especially in association in association with atherosclerotic risk factors. (author). 45 refs.; 3 figs.; 2 tabs

  5. Occlusal status among Yemeni children

    Directory of Open Access Journals (Sweden)

    Nabil M Al-Zubair

    2014-01-01

    Full Text Available Objectives: The purpose of this study was to assess the occlusal status in schoolchildren in Yemen, and to compare the results with those of other studies. Materials and Methods: The sample for this epidemiological survey consisted of 3003 primary school students, half of whom were boys and the other half girls, aged 12 years. The subjects were randomly selected, and none had received previous orthodontic treatment. Variables examined included intra-arch irregularities and malalignment (crowding and spacing in the incisal segments of the arch and midline diastema and discrepancies in occlusal contact relationship (maxillary overjet, mandibular overjet, anterior openbite and antero-posterior molar relation. Results: The results showed that about 26.1% of the subjects were still in the late mixed dentition stage and 73.9% presented with a dentition in the early permanent stage. Normal overjet was found in 55% of the sample. Crowding was observed in 31.4% of the subjects and midline diastema in 14.2%. Conclusion: Occlusal status among Yemeni children was characterized by a relatively high frequency of dental crowding, as well as a relatively high frequency of anterior mandibular overjet (Class III malocclusions.

  6. Do breastfeeding and bottle feeding influence occlusal parameters?

    Science.gov (United States)

    Galán-Gónzalez, Antonio F; Aznar-Martín, Teresa; Cabrera-Domínguez, Maria E; Domínguez-Reyes, Antonia

    2014-01-01

    A study was made of the influence of breastfeeding and bottle feeding on development of the dental arches and occlusion in an infant population. In total, 298 infants (163 girls and 135 boys) were selected from a series of 1,643 preschool children in Seville, Spain, evaluating the type of feeding received after birth (breastfeeding only or bottle feeding only), the duration of such feeding, and its influence upon the parameters that define occlusion of the dental arches. The study comprised a full exploration of the stomatognathic system of the infants and a questionnaire for the parents. SPSS Statistical Package software (SPSS, Inc., Chicago, IL) was used to analyze the results. In total, 109 children were exclusively breastfed (36.6%) for an average of 6.8±5.8 months, whereas 189 children were exclusively bottle fed (63.4%) for an average of 17.99±11.5 months. On comparing the occlusal parameters of the two groups, the most beneficial effects (straight terminal plane, canine class I relationship, diastemas, and primate spaces) corresponded to the infants who were breastfed. Breastfed infants show better development of the dental arches and a lesser incidence of dental occlusion disorders than bottle-fed infants.

  7. [Occlusal planes of Angle's class III malocclusion impact by anterior overbite].

    Science.gov (United States)

    He, Ping; Xiao, Danna; Cang, Song; Gao, Hui

    2014-06-01

    To investigate the correlation between Angle's class III patients' occlusion plane and anterior overbite by controlling the changes in occlusion plane during orthodontic treatment. In total, 90 Angle's class III adult orthodontic patients were selected as the experimental group, and 30 normal adults were selected as the control group. According to the overbite, the class III patients were divided into three groups, and 14 indicators were measured. ANOVA and multiple comparison analysis were used to analyze the difference between class III patients, and linear analysis was used to analyze the correlation between anterior overbite and anterior-posterior occlusion plane. In class Ill patients, posterior occlusion plane and anterior overbite size were negatively correlated (r = -0.24, P overbite size were positive correlated (r = 0.23, P overbite patients. During orthodontic treatment in different overbite class III patients, the vertical height of the posterior teeth and the rotation of the occlusion plane should be controlled.

  8. Computerized Angiographic Occlusion Rating for Ruptured Clipped Aneurysms is Superior to Subjective Occlusion Rating.

    Science.gov (United States)

    Al-Schameri, A R; Baltsavias, G; Winkler, P; Lunzer, M; Kral, M; Machegger, L; Weymayr, F; Emich, S; Sherif, C; Richling, B

    2015-09-01

    The computerized occlusion rating to estimate angiographic occlusion of embolized aneurysms is superior to the subjective occlusion rating. In this study, we compared the 2 methods in the analysis of aneurysms clipped after subarachnoid hemorrhage. The pre- and postoperative angiographic images (DSA) of 95 selected patients were analyzed and stratified in 4 grades (grade 0 for 100%, grade I for rating and the computerized (angiographic) occlusion rating. For the subjective occlusion rating, the occlusion rate was estimated; for the computerized occlusion rating, the "occluded" and "nonoccluded" aneurysm areas were automatically calculated in square millimeters after outlining the ideal occlusion line. With the subjective occlusion rating, 75 (78.9%), 12 (12.6%), 7 (7.4%), and 1 (1.1%) and with the computerized occlusion rating 45 (47.4%), 24 (25.3%), 20 (21.0%), and 6 (6.3%) patients had aneurysms stratified to grades 0, I, II and III, respectively. The interobserver variation was significant with the subjective occlusion rating but not with the computerized occlusion rating. The subjective occlusion rating overestimated aneurysm occlusion in 30 (31.6%) patients. Mean values were the following: subjective occlusion rating of 97.5 ± 6.3% and computerized occlusion rating of 93.5 ± 9.7%; P = rating: χ(2), 29.65; P rating: χ(2), 35.57, P rates of clipped aneurysms. The clearly lower interobserver variation of the computerized versus subjective occlusion rating may indicate a superiority of the computerized occlusion rating. © 2015 by American Journal of Neuroradiology.

  9. Early results of coronary artery bypass grafting with coronary endarterectomy for severe coronary artery disease

    Directory of Open Access Journals (Sweden)

    Toischer Karl

    2009-09-01

    Full Text Available Abstract Background Despite the existence of controversial debates on the efficiency of coronary endarterectomy (CE, it is still used as an adjunct to coronary artery bypass grafting (CABG. This is particularly true in patients with endstage coronary artery disease. Given the improvements in cardiac surgery and postoperative care, as well as the rising number of elderly patient with numerous co-morbidities, re-evaluating the pros and cons of this technique is needed. Methods Patient demographic information, operative details and outcome data of 104 patients with diffuse calcified coronary artery disease were retrospectively analyzed with respect to functional capacity (NYHA, angina pectoris (CCS and mortality. Actuarial survival was reported using a Kaplan-Meyer analysis. Results Between August 2001 and March 2005, 104 patients underwent coronary artery bypass grafting (CABG with adjunctive coronary endarterectomy (CE in the Department of Thoracic-, Cardiac- and Vascular Surgery, University of Goettingen. Four patients were lost during follow-up. Data were gained from 88 male and 12 female patients; mean age was 65.5 ± 9 years. A total of 396 vessels were bypassed (4 ± 0.9 vessels per patient. In 98% left internal thoracic artery (LITA was used as arterial bypass graft and a total of 114 vessels were endarterectomized. CE was performed on right coronary artery (RCA (n = 55, on left anterior descending artery (LAD (n = 52 and circumflex artery (RCX (n = 7. Ninety-five patients suffered from 3-vessel-disease, 3 from 2-vessel- and 2 from 1-vessel-disease. Closed technique was used in 18%, open technique in 79% and in 3% a combination of both. The most frequent endarterectomized localization was right coronary artery (RCA = 55%. Despite the severity of endstage atherosclerosis, hospital mortality was only 5% (n = 5. During follow-up (24.5 ± 13.4 months, which is 96% complete (4 patients were lost caused by unknown address 8 patients died (cardiac

  10. Acute myocardial infarction in progressively elderly patients. A comparative analysis of immediate results in patients who underwent primary percutaneous coronary intervention

    Directory of Open Access Journals (Sweden)

    Luiz Alberto Mattos

    2001-01-01

    Full Text Available OBJECTIVE: Analysis of the in-hospital results, in progressively elderly patients who undergo primary percutaneous coronary intervention (PCI in the first 24 hours of AMI. METHODS: The patients were divided into three different age groups (60/69, 70/79, and > or = 80 years and were treated from 7/95 until 12/99. The primary success rate and the occurrence of major clinical events were analyzed at the end of the in-hospital phase. Coronary stent implantation and abciximab use were employed at the intervencionist discretion. RESULTS: We analyzed 201 patients with age ranging from 60 to 93 years, who underwent primary PCI. Patients with ages above 70 were more often female (p=.015. Those with ages above 80 were treated later with PCI (p=.054, and all of them presented with total occlusion of the infarct-related artery. Coronary stents were implanted in 30% of the patients. Procedural success was lower in > or = 80 year old patients (p=.022, and the death rate was higher in > or = 70 years olds (p=.019. Reinfarction and coronary bypass surgery were uncommon events. A trend occurred toward a higher combined incidence of major in-hospital events according to increased age (p=.064. CONCLUSION: Elderly patients ( > or = 70 years presented with adverse clinical and angiographic profiles and patients > or = 80 years of age obtained reduced TIMI 3 flow success rates after primary PTCA, and those > or = 70 years had a higher death rate.

  11. Acute myocardial infarction in progressively elderly patients. A comparative analysis of immediate results in patients who underwent primary percutaneous coronary intervention.

    Science.gov (United States)

    Mattos, L A; Zago, A; Chaves, A; Pinto, I; Tanajura, L; Staico, R; Centemero, M; Feres, F; Maldonado, G; Cano, M; Abizaid, A; Abizaid, A; Sousa, A G; Sousa, J E

    2001-01-01

    Analysis of the in-hospital results, in progressively elderly patients who undergo primary percutaneous coronary intervention (PCI) in the first 24 hours of AMI. The patients were divided into three different age groups (60/69, 70/79, and > or =80 years) and were treated from 7/95 until 12/99. The primary success rate and the occurrence of major clinical events were analyzed at the end of the in-hospital phase. Coronary stent implantation and abciximab use were employed at the interventionist discretion. We analyzed 201 patients with age ranging from 60 to 93 years, who underwent primary PCI. Patients with ages above 70 were more often female (p=.015). Those with ages above 80 were treated later with PCI (p=.054), and all of them presented with total occlusion of the infarct-related artery. Coronary stents were implanted in 30% of the patients. Procedural success was lower in > or =80 year old patients (p=.022), and the death rate was higher in > or =70 years olds (p=.019). Reinfarction and coronary bypass surgery were uncommon events. A trend occurred toward a higher combined incidence of major in-hospital events according to increased age (p=.064). Elderly patients (> or =70 years) presented with adverse clinical and angiographic profiles and patients > or =80 years of age obtained reduced TIMI 3 flow success rates after primary PTCA, and those > or =70 years had a higher death rate.

  12. Angiographic patterns of in-stent restenosis classified by computed tomography in patients with drug-eluting stents: correlation with invasive coronary angiography

    International Nuclear Information System (INIS)

    Pan, Jingwei; Lu, Zhigang; Wei, Meng; Zhang, Jiayin; Li, Minghua

    2013-01-01

    To evaluate the diagnostic accuracy of Mehran's in-stent restenosis (ISR) classification by coronary computed angiography (CCTA), with reference to invasive coronary angiography (ICA). Consecutive symptomatic patients, who had clinically suspected ISR and implanted stent diameter ≥ 3 mm, were prospectively enrolled in our study. Mehran's classification was employed by CCTA and ICA to classify ISR lesions into four subtypes: focal, diffuse intrastent, diffuse proliferative and total occlusion. CCTA and ICA measurement of lesion length was further compared. Sixty-one patients with 101 implanted stents were included in our study. The overall sensitivity, specificity, PPV and NPV of CCTA diagnosis of binary ISR, as shown by patient-based analysis (n = 61), were 100 % (49/49), 75 % (8/12), 92.45 % (49/53) and 100 % (8/8) respectively. Mehran's classification of CCTA correlated well with ICA findings. The diagnostic accuracy of CCTA for class I, class II, class III and class IV lesions was 92.5 %, 91.67 %, 100 % and 100 % respectively. Lesion length was assessed to be significantly longer with CCTA than with ICA (11.03 ± 5.89 mm versus 8.56 ± 4.99 mm, P < 0.001). Angiographic patterns of in-stent restenosis can be accurately classified by coronary computed angiography. The lesion length measured by CCTA is longer than that assessed by invasive coronary angiography. (orig.)

  13. Doppler spectrum of superficial femoral artery in patients with occlusive arterial disease of lower extremity: Comparison with angiography

    International Nuclear Information System (INIS)

    Jae, Hwan Jun; Koh, Young Hwan; Kim, Kyoung Won; Kim, Hyun Boem; Jung, Jin Wook; Park, Jae Hyung

    2000-01-01

    To compare Doppler waveform of superficial femoral artery (SFA) with the angiographic findings according to the location and severity of occlusive arterial disease of lower extremity. We examined 32 lower extremities in 20 patients (M:F=18:2, Age: 37-86, Mean age:62) with the occlusive arterial disease of lower extremity using Doppler sonography and angiography. We classified them into 6 groups according to the location and severity of arterial stenosis or occlusion on angiography; stenosis 50% proximal to SFA (n=5), total occlusion proximal to (n=5), stenosis>50% or occlusion in the distal SFA or popliteal artery (n=8), stenosis>50% or occlusion below trifurcation (n=4), stenosis>50% or occlusion i the proximal to SFA (n=6). The Doppler waveforms SFA were retrospectively analyzed tot he 6 groups classified by the angiographic findings. Normal triphasic pattern (3/4) of SFA was preserved in case with stenosis 50% or occlusion in the distal SFA or popliteal artery. Triphasic (2/4) or biphasic pattern with absent diastolic flow (2/4) was detected in stenosis>50% or occlusion in the lover than trifurcation. The waveform was variable in the cases with stenosis>50% or occlusion in the proximal and distal lesion. The Doppler waveform of SFA in the occlusive arterial disease of the lower extremity was variable. However, it tends to show pulsus tardus et parvus pattern in the total occlusion proximal to SFA and high resistive pattern with absent early diastolic reversal in stenosis>50% or occlusion in the distal SFA or popliteal artery.

  14. Initial and 6-month results of biodegradable poly-l-lactic acid coronary stents in humans.

    Science.gov (United States)

    Tamai, H; Igaki, K; Kyo, E; Kosuga, K; Kawashima, A; Matsui, S; Komori, H; Tsuji, T; Motohara, S; Uehata, H

    2000-07-25

    Although metallic stents are effective in preventing acute occlusion and reducing late restenosis after coronary angioplasty, many concerns still remain. Compared with metallic stents, poly-l-lactic acid (PLLA) stents are biodegradable and can deliver drugs locally. The aim of this study was to evaluate the feasibility, safety, and efficacy of the PLLA stent. Fifteen patients electively underwent PLLA Igaki-Tamai stent implantation for coronary artery stenoses. The Igaki-Tamai stent is made of a PLLA monopolymer, has a thickness of 0.17 mm, and has a zigzag helical coil pattern. A balloon-expandable covered sheath system was used, and the stent expanded by itself to its original size with an adequate temperature. A total of 25 stents were successfully implanted in 19 lesions in 15 patients, and angiographic success was achieved in all procedures. No stent thrombosis and no major cardiac event occurred within 30 days. Coronary angiography and intravascular ultrasound were serially performed 1 day, 3 months, and 6 months after the procedure. Angiographically, both the restenosis rate and target lesion revascularization rate per lesion were 10.5%; the rates per patient were 6.7% at 6 months. Intravascular ultrasound findings revealed no significant stent recoil at 1 day, and they revealed stent expansion at follow-up. No major cardiac event, except for repeat angioplasty, developed within 6 months. Our preliminary experience suggests that coronary PLLA biodegradable stents are feasible, safe, and effective in humans. Long-term follow-up with more patients will be required to validate the long-term efficacy of PLLA stents.

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

    Science.gov (United States)

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

    2015-01-01

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

  16. A New Occlusion Device: Application of the ArtVentive Endoluminal Occlusion System (EOS)—First in Human Clinical Trial

    International Nuclear Information System (INIS)

    Venbrux, Anthony C.; Rudakov, Leon; Plass, Andre; Emmert, Maximilian Y.; Ebner, Adrian

    2014-01-01

    PurposeThe purpose of this study was to determine the safety and efficacy of a new endoluminal occlusion device, ArtVentive endoluminal occlusion system (EOS), to occlude the spermatic vein in symptomatic males with varicoceles.MethodsThe ArtVentive EOS device has been developed for percutaneous, peripheral occlusion of the peripheral arterial and venous vasculature. The system is comprised of an implantable occlusion device and a delivery catheter. At present, there are two device sizes: (a) size 1 for target vessels ranging between 3.5 and 5.5 mm in diameter, and (b) size 2 for target vessels 5.5–8.5 mm in diameter. The treatment group included six adult males, ages 22–34 years. Nine target vessels were occluded. A total of 20 devices were implanted in six subjects.ResultsThe acute occlusion rate at the end of the procedure was 100 % occurring in nine of nine vessels. The spermatic veins of all patients remained occluded on venography at 30 days follow-up. Pain scores related to varicoceles decreased in five of six patients.ConclusionsAlthough we recognize this study is limited, initial experience indicates that the ArtVentive EOS is a safe and effective new device for occlusion of vessels (varicoceles). The device has potential applications in other clinical conditions requiring occlusion of veins or arteries

  17. The impact of occlusal plane cant along with gingival display on smile attractiveness.

    Science.gov (United States)

    Kaya, B; Uyar, R

    2016-05-01

    To evaluate the influence of occlusal plane cant in conjunction with maxillary gingival display on perception of smile attractiveness by orthodontists, dentists, and laypersons. Faculty of Dentistry at Baskent University. A total of 204 raters for smile attractiveness. A frontal intra-oral photograph of aligned teeth was modified using image processing software. Six different occlusal lines representing 0° to 5° cants were obtained by tilting the photographs. Each occlusal cant was adjusted in five manners resulting in five different gingival display amounts. Attractiveness of the 30 different smiles was evaluated by 204 raters divided into three groups (n = 68 in each group). Both occlusal cant (p occlusal cant and gingival display amount, which influenced smile attractiveness. Increase in both occlusal plane cant and gingival display negatively influences smile attractiveness. The influence of occlusal plane cant becomes less when gingival display increases, whereas the influence of gingival display decreases when occlusal cant increases. Dentists are more generous than orthodontists, while laypersons are the most generous regarding smile attractiveness scores. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  18. Determination of the occlusal plane using a custom-made occlusal plane analyzer: a clinical report.

    Science.gov (United States)

    Bedia, Sumit V; Dange, Shankar P; Khalikar, Arun N

    2007-11-01

    In fixed prosthodontic procedures, when it has been determined that restoration of all or most of the posterior teeth is necessary, the use of the Broderick occlusal plane analyzer provides an easy and practical method to determine an occlusal plane that will fulfill esthetic and functional occlusion requirements. However, several manufacturers of semiadjustable articulators offer no such occlusal plane analyzers for use with these instruments. This article demonstrates the use of a custom-made Broderick occlusal plane analyzer with a semiadjustable articulator to determine the correct curve of Spee for the occlusal plane.

  19. Aortitis and aortic occlusion in Crohn disease.

    Science.gov (United States)

    Delay, Charline; Schwein, Adeline; Lejay, Anne; Gaertner, Sébastien; Aleil, Boris; Thaveau, Fabien; Georg, Yannick; Chakfe, Nabil

    2015-02-01

    Patients with Crohn disease (CD) or ulcerative colitis are known to be at increased risk of arterial thromboembolic complications. We report the case of a 33-year-old woman suffering from CD for 19 years who presented lower limb claudication. Computed tomography scan revealed an aortoiliac occlusion extending from the level of the inferior mesenteric artery to both iliac bifurcations. Endovascular recanalization was attempted as a first option but failed. We then performed an aortobi-femoral bypass through a left retroperitoneal approach that allowed a total relief of the symptoms. Histologic study of the aorta demonstrated a nonspecific aortitis with lymphohistiocytic cell infiltration in the media and adventitia tunica. There was no signs of associated vasculitis. At the light of a literature review, we discussed our surgical strategy and the inflammation of the aortic wall as local factor of thrombosis that has never been previously described. Copyright © 2015 Elsevier Inc. All rights reserved.

  20. Randomized Comparison of Ridaforolimus- and Zotarolimus-Eluting Coronary Stents in Patients With Coronary Artery Disease: Primary Results From the BIONICS Trial (BioNIR Ridaforolimus-Eluting Coronary Stent System in Coronary Stenosis).

    Science.gov (United States)

    Kandzari, David E; Smits, Pieter C; Love, Michael P; Ben-Yehuda, Ori; Banai, Shmuel; Robinson, Simon D; Jonas, Michael; Kornowski, Ran; Bagur, Rodrigo; Iniguez, Andres; Danenberg, Haim; Feldman, Robert; Jauhar, Rajiv; Chandna, Harish; Parikh, Manish; Perlman, Gidon Y; Balcells, Mercedes; Markham, Peter; Ozan, Melek Ozgu; Genereux, Philippe; Edelman, Elazer R; Leon, Martin B; Stone, Gregg W

    2017-10-03

    The safety and efficacy of a novel cobalt alloy-based coronary stent with a durable elastomeric polymer eluting the antiproliferative agent ridaforolimus for treatment of patients with coronary artery disease is undetermined. A prospective, international 1:1 randomized trial was conducted to evaluate in a noninferiority design the relative safety and efficacy of ridaforolimus-eluting stents (RESs) and slow-release zotarolimus-eluting stents among 1919 patients undergoing percutaneous coronary intervention at 76 centers. Inclusion criteria allowed enrollment of patients with recent myocardial infarction, total occlusions, bifurcations lesions, and other complex conditions. Baseline clinical and angiographic characteristics were similar between the groups. Overall, mean age was 63.4 years, 32.5% had diabetes mellitus, and 39.7% presented with acute coronary syndromes. At 12 months, the primary end point of target lesion failure (composite of cardiac death, target vessel-related myocardial infarction, and target lesion revascularization) was 5.4% for both devices (upper bound of 1-sided 95% confidence interval 1.8%, P noninferiority =0.001). Definite/probable stent thrombosis rates were low in both groups (0.4% RES versus 0.6% zotarolimus-eluting stent, P =0.75); 13-month angiographic in-stent late lumen loss was 0.22±0.41 mm and 0.23±0.39 mm ( P noninferiority =0.004) for the RES and zotarolimus-eluting stent groups, respectively, and intravascular ultrasound percent neointimal hyperplasia was 8.10±5.81 and 8.85±7.77, respectively ( P noninferiority =0.01). In the present trial, which allowed broad inclusion criteria, the novel RESs met the prespecified criteria for noninferiority compared with zotarolimus-eluting stents for the primary end point of target lesion failure at 12 months and had similar measures of late lumen loss. These findings support the safety and efficacy of RESs in patients who are representative of clinical practice. URL: http

  1. Outcome of coronary endarterectomy with off-pump coronary artery bypass grafting: A retrospective study

    Directory of Open Access Journals (Sweden)

    Redoy Ranjan

    2017-09-01

    Full Text Available In this study, we assessed the outcome of surgical revascularization technique, coronary artery bypass grafting (CABG with or without coronary endarterectomy for patients with diffuse coronary artery disease in a single surgeon’s practice on 2,189 patients from January 2009 and December 2016. The variables like intubation time, ICU stay, postoperative myocardial infarction, arrhythmia, renal impairment, stroke and ICU mortality were compared. Among these patients, 1,000 patients required coronary endarterectomy in addition to off-pump coronary artery bypass grafting (OPCABG. Initially, the mortality and incidence of postoperative blood transfusion were higher in the group of patients who had coronary endarterectomy in addition to CABG. However, postoperative combined use of heparin, warfarin and double anti-platelet agent was associated with decreased mortality significantly in our study. In comparison to other group, the patients in the combined coronary endarterectomy with CABG group had a higher incidence of male sex, past myocardial infarction and poor left ventricular function. Total myocardial revascularization is attainable when coronary endarterectomy is performed in addition to off-pump coronary artery bypass graft surgery in diffuse coronary artery disease.

  2. Combined surface and volumetric occlusion shading

    KAUST Repository

    Schott, Matthias O.

    2012-02-01

    In this paper, a method for interactive direct volume rendering is proposed that computes ambient occlusion effects for visualizations that combine both volumetric and geometric primitives, specifically tube shaped geometric objects representing streamlines, magnetic field lines or DTI fiber tracts. The proposed algorithm extends the recently proposed Directional Occlusion Shading model to allow the rendering of those geometric shapes in combination with a context providing 3D volume, considering mutual occlusion between structures represented by a volume or geometry. © 2012 IEEE.

  3. Integral diagnosis of coronary atherosclerosis by coronary multidetector computed tomography and by invasive coronary angiography

    International Nuclear Information System (INIS)

    Llerena Rojas, Luis Roberto; Llerena Rojas, Lorenzo D; Mendoza Rodriguez, Vladimir

    2013-01-01

    Coronary angiography by multidetector computed tomography (CMDCT) visualizes the wall and lumen of coronary arteries. Invasive coronary angiography (INVCA) only visualizes the arterial lumen but with better resolution

  4. [Form and position of occlusion plane in persons with physiological occlusion].

    Science.gov (United States)

    Lisova, T V; Slabkovskaia, A B; Persin, L S

    2006-01-01

    25 subjects aged 19-25 years with normal occlusion were assessed using radiographic and functional methods. Individual differences in occlusion plane form and position and dentofacial muscles functioning were established.

  5. Occlusal risk factors associated with temporomandibular disorders in young adults with normal occlusions.

    Science.gov (United States)

    Wang, Chen; Yin, Xinmin

    2012-10-01

    The aim of this study was to characterize occlusal stability in young adults with temporomandibular disorder (TMD). Thirty-one patients (aged 19-31 years) with complete natural dentition and Angle class I occlusion who exhibited TMD were compared with 31 age- and sex-matched healthy control subjects. The occlusal registrations were performed using the T-Scan II occlusal imaging and analysis system. Center of occlusal force, asymmetry index of occlusal force, maximal movement of COF, premature contacts, clusion time, and disclusion time were recorded. Compared with control subjects, TMD subjects had a significantly higher frequency of premature contacts (16/32, 50.0%) and greater bilateral asymmetry in the occlusal force. Furthermore, prolonged clusion time and disclusion time also were observed in TMD subjects. These results suggest that a significant association exists between occlusal stability and TMD in young adults. Copyright © 2012 Elsevier Inc. All rights reserved.

  6. Safety of increasing vertical dimension of occlusion: a systematic review.

    Science.gov (United States)

    Abduo, Jaafar

    2012-05-01

    To review all the literature investigating the implications of increasing the vertical dimension of occlusion (VDO). A comprehensive electronic search was conducted through PubMed with the aid of Boolean operators to combine the following key words: "occlusal vertical dimension," "increasing vertical dimension," "bite raising," "occlusal space," "resting vertical dimension," "rest position," "altered vertical dimension," "mandibular posture," "temporomandibular joint," and "masticatory muscles." The search was limited to peer-reviewed articles written in English and published through August 2011. Further, the literature search was endorsed by manual searching through peer-reviewed journals and reference lists of the selected articles. A total of 902 studies were initially retrieved, but only 9 met the specified inclusion criteria for the review. From the selected studies, four variables were identified to be relevant to the topic of VDO increase: magnitude of VDO increase, method of increasing VDO, occlusion scheme, and the adaptation period. Considering the limitations of this review, it could be concluded that whenever indicated, permanent increase of the VDO is a safe and predictable procedure. Intervention with a fixed restoration is more predictable and results in a higher adaptation level. Negative signs and symptoms were identified, but they were self-limiting. Due to the lack of a well-designed study, further controlled and randomized studies are needed to confirm the outcome of this review.

  7. Coronary spasm induced by dipyridamole

    International Nuclear Information System (INIS)

    Wartski, M.; Caussin, C.; Lancelin, B.

    2001-01-01

    A 59 years old man was admitted at hospital for recurrent instable angina 1 month after coronary artery bypass surgery. Coronary artery disease started with a transmural antero-septo-apical myocardial infarction without thrombolysis and a percutaneous angioplasty with endo-prothesis on proximal left anterior descendant artery (LAD) is performed Because of recurrent rest angina and subacute stent thrombosis, a coronary artery bypass surgery (CABG) is performed with anastomosis of the left internal thoracic artery on LAD. The patient is admitted for recurrent rest angina one month after CABG. On ECG performed during chest pain, a ST-T segment elevation occurred on inferior leads. Coronary angiography showed no significant stenosis on endo-prothesis and no bypass graft dysfunction. Dipyridamole scintigraphy was realized. 2 minutes after the beginning of Dipyridamole infusion, a ST-T elevation occurred on inferior leads and two marked antero-septal and inferior defects were noticed on myocardial scintigraphy. Images at rest showed a clear improvement in the anterior wall and the inferior wall became normally perfused Patient was treated with anti-spastic drugs and a new coronarography with methyl-ergotamine test was performed inducing chest pain, ST-T elevation on inferior leads and tri-truncular coronary spasm. Patient's treatment was then modified with introduction of Nifedipine. The patient did not experienced new recurrent chest pain and remained totally asymptomatic few months later. (authors)

  8. Occlusal considerations for dental implant restorations.

    Science.gov (United States)

    Bergmann, Ranier H

    2014-01-01

    When placed, dental implants are put into an ever-changing oral environment in which teeth can continue to migrate. Yet, the implants themselves are ankylosed. This can lead to occlusal instability. Teeth may continue to erupt, leaving the implants in infraocclusion. Teeth may move mesially away from an implant, requiring modification to close an open contact point. Friction in the connection between teeth and implants can lead to intrusion of teeth and damage to the periodontal attachment apparatus. Implant occlusion with shallow incisal guidance minimizes lateral and tipping forces. Cross-arch stabilization allows the best distribution of occlusal forces. The choice of restorative materials influences long-term occlusal stability.

  9. Formation of large coronary arteries by cardiac progenitor cells

    Science.gov (United States)

    Tillmanns, Jochen; Rota, Marcello; Hosoda, Toru; Misao, Yu; Esposito, Grazia; Gonzalez, Arantxa; Vitale, Serena; Parolin, Carola; Yasuzawa-Amano, Saori; Muraski, John; De Angelis, Antonella; LeCapitaine, Nicole; Siggins, Robert W.; Loredo, Maria; Bearzi, Claudia; Bolli, Roberto; Urbanek, Konrad; Leri, Annarosa; Kajstura, Jan; Anversa, Piero

    2008-01-01

    Coronary artery disease is the most common cause of cardiac failure in the Western world, and to date there is no alternative to bypass surgery for severe coronary atherosclerosis. We report that c-kit-positive cardiac progenitor cells (CPCs) activated with insulin-like growth factor 1 and hepatocyte growth factor before their injection in proximity of the site of occlusion of the left coronary artery in rats, engrafted within the host myocardium forming temporary niches. Subsequently, CPCs divided and differentiated into endothelial cells and smooth muscle cells and, to a lesser extent, into cardiomyocytes. The acquisition of vascular lineages appeared to be mediated by the up-regulation of hypoxia-inducible factor 1α, which promoted the synthesis and secretion of stromal-derived factor 1 from hypoxic coronary vessels. Stromal-derived factor 1 was critical in the conversion of CPCs to the vascular fate. CPCs formed conductive and intermediate-sized coronary arteries together with resistance arterioles and capillaries. The new vessels were connected with the primary coronary circulation, and this increase in vascularization more than doubled myocardial blood flow in the infarcted myocardium. This beneficial effect, together with myocardial regeneration attenuated postinfarction dilated myopathy, reduced infarct size and improved function. In conclusion, locally delivered activated CPCs generate de novo coronary vasculature and may be implemented clinically for restoration of blood supply to the ischemic myocardium. PMID:18216245

  10. Assessment of occlusion curriculum in predoctoral dental education: report from ACP Task Force on Occlusion Education.

    Science.gov (United States)

    Lee, Damian J; Wiens, Jonathan P; Ference, John; Donatelli, David; Smith, Rick M; Dye, Bryan D; Obrez, Ales; Lang, Lisa A

    2012-10-01

    The purposes of this report were to (1) assess the current occlusion curriculum in the predoctoral prosthodontic education of US dental institutions and (2) to examine the opinions of faculty, course directors, and program directors on the contents of occlusion curriculum. The Task Force on Occlusion Education from the American College of Prosthodontists (ACP) conducted two surveys using a web-based survey engine: one to assess the current status of occlusion education in predoctoral dental education and another to examine the opinions of faculty and course directors on the content of occlusion curriculum. The sections in the surveys included demographic information, general curriculum information, occlusion curriculum for dentate patients, occlusion curriculum for removable prosthodontics, occlusion curriculum for implant prosthodontics, temporomandibular disorder (TMD) curriculum, teaching philosophy, concepts taught, and methods of assessment. The results from the surveys were compiled and analyzed using descriptive statistics. The results from the two surveys on general concepts taught in occlusion curriculum were sorted and compared for discrepancies. According to the predoctoral occlusion curriculum surveys, canine guidance was preferred for dentate patients, fixed prosthodontics, and fixed implant prosthodontics. Bilateral balanced occlusion was preferred for removable prosthodontics and removable implant prosthodontics. There were minor differences between the two surveys regarding the occlusion concepts being taught and the opinions of faculty members teaching occlusion. Two surveys were conducted regarding the current concepts being taught in occlusion curriculum and the opinions of educators on what should be taught in occlusion curriculum. An updated and clearly defined curriculum guideline addressing occlusion in fixed prosthodontics, removable prosthodontics, implant prosthodontics, and TMD is needed. © 2012 by the American College of Prosthodontists.

  11. Evaluation of functional parameters in the occlusion of complete denture wearers before and after prosthetic treatment.

    Science.gov (United States)

    Joanna, Kuć; Teresa, Sierpińska; Maria, Gołębiewska

    2017-10-01

    The aim of the study was to evaluate functional parameters of the occlusion in complete denture wearers before and after prosthetic treatment. The sample used as the basis for the present study consisted of 50 healthy Caucasian patients (35 women and 15 men), aged from 44 to 86 years (mean=69.18±10), with a total deficiency of teeth. All patients received new complete dentures. Each patient underwent lateral radiograph with the presence of complete dentures, both before (initially existing dentures) and after the prosthetic treatment (new restorations). Cephalometric analysis was based on the Ricketts and McNamara criteria. In order to assess the functional parameters of the occlusion T-scan III analysis was conducted. The following parameters were measured: occlusion - and disclusion time. Statistically significant differences of functional parameters obtained before and 3 months after the treatment were noted in the whole study group. Both before and after therapy occlusion time was longer in women than in men. No statistically significant link was noted between functional parameters in occlusion and age of the patients, denture wearing time, and edentulous period. Some relationships were noted between occlusion time and cephalometric parameters associated with anterior facial height. Reconstruction of the surface of artificial teeth and vertical occlusal dimension affects the sustainability of parameters of occlusion and balance of forces in centric occlusion. The progressive shortening of occlusion time during the period of monitoring may be considered as a sign of progressive adaptation. Copyright © 2017 Japan Prosthodontic Society. Published by Elsevier Ltd. All rights reserved.

  12. Facial height in Japanese-Brazilian descendants with normal occlusion

    Science.gov (United States)

    Vieira, Fabiano Paiva; Pinzan, Arnaldo; Janson, Guilherme; Fernandes, Thais Maria Freire; Sathler, Renata Carvalho; Henriques, Rafael Pinelli

    2014-01-01

    OBJECTIVE: The aim of this study was to determine the standards of facial height in 30 young (14-year-old) Japanese-Brazilian descendants with normal occlusion, and assess whether sexual dimorphism is evident. METHODS: The cephalometric measurements used followed the analyses by Wylie-Johnson, Siriwat-Jarabak, Gebeck, Merrifield and Horn. RESULTS: Results showed dimorphism for total anterior facial height (TAFH), lower anterior facial height (LAFH), anterior facial height (AFH), total posterior facial height (TPFH) and upper posterior facial height (UPFH) measurements. CONCLUSIONS: The standards of facial heights in young Japanese-Brazilian descendants with normal occlusion were observed. Sexual dimorphism was identified in five out of thirteen evaluated variables at this age range. PMID:25715717

  13. Non-Occlusive Mesenteric Ischemia

    International Nuclear Information System (INIS)

    Kraemer, S.C.; Universitaetsklinikum Ulm; Goerich, J.; Oertel, F.; Scheld, H.; Heindel, W.

    2003-01-01

    The so-called non-occlusive disease (NOD) or non-occlusive mesenteric ischemia (NOMI) is a severe and life-threatening pathology. Even under optimal circumstances and standardised diagnostic and therapeutic procedures maximum survival rates do not exceed 50%. The NOD is a pathology of the elder patient and its incidence rises with other comorbidities such as reduced cardiac output, diabetes and renal insufficiency. Induction of the disease with a severe vasoconstriction of the splanchnic vessels may be a simple cardiac decompensation, a frequent trigger however is a previous heart surgery with consecutive cardiac shock. Early diagnosis is difficult to conduct because of unspecific symptoms. Beside abdominal pain in awake patients, ileus or subileus is remaining the single acute symptom which could be also a consequence of a postoperative paralysis. Laboratory parameters such as leucocytosis and elevated lactat levels are often positive, but unspecific and the latter may be a delayed sign of progressive disease. The only sufficient method for diagnosis implicating a possible treatment option seems to be an immediate angiographic examination. Because of the disappointing results of a solitary surgical approach transarterial medication via catheter is indicated. Depending of the course of the disease only a combination of local mesenteric infusion of vasodilatory drugs and surgical resection of already necrotic bowel promises a successful therapeutic approach and better survival rates. (orig.) [de

  14. Transthoracic echocardiography for imaging of the different coronary artery segments: a feasibility study

    Directory of Open Access Journals (Sweden)

    Wiseth Rune

    2009-12-01

    Full Text Available Abstract Background Transthoracic echocardiography (TTE may be used for direct inspection of various parts of the main coronary arteries for detection of coronary stenoses and occlusions. We aimed to assess the feasibility of TTE to visualise the complete segments of the left main (LM, left descending (LAD, circumflex (Cx and right (RCA coronary arteries. Methods One hundred and eleven patients scheduled for diagnostic coronary angiography because of chest pain or acute coronary syndrome had a TTE study to map the passage of the main coronary arteries. LAD, Cx and RCA were each divided into proximal, middle and distal segments. If any part of the individual segment of a coronary artery with antegrade blood flow was not visualised, the segment was labeled as not satisfactorily seen. Results Complete imaging of the LM was achieved in 98% of the patients. With antegrade directed coronary artery flow, the proximal, middle and distal segments of LAD were completely seen in 96%, 95% and 91% of patients, respectively. Adding the completely seen segments with antegrade coronary flow and segments with retrograde coronary flow, the proximal, middle and distal segments of LAD were adequately visualised in 96%, 96% and 93% of patients, respectively. With antegrade directed coronary artery flow, the proximal, middle and distal segments of Cx were completely seen in 88%, 61% and 3% and in RCA in 40%, 28% and 54% of patients. Retrograde coronary artery flow was correctly identified as verified by coronary angiography in seven coronary segments, mainly in the posterior descending artery (labeled as the distal segment of RCA and distal LAD. Conclusions TTE is a feasible method for complete demonstration of coronary flow in the LM, the proximal Cx and the different segments of LAD, but less suitable for the RCA and mid and distal segments of the Cx. (ClinicalTrials.gov number NTC00281346.

  15. Value of the 12-lead electrocardiogram to define the level of obstruction in acute anterior wall myocardial infarction: correlation to coronary angiography and clinical outcome in the DANAMI-2 trial

    DEFF Research Database (Denmark)

    Eskola, Markku J; Nikus, Kjell C; Holmvang, Lene

    2008-01-01

    BACKGROUND: Acute anterior myocardial infarction (MI) caused by proximal occlusion of the left anterior descending coronary artery (LAD), is associated with unfavourable outcome and should be recognized by simple noninvasive methods like the 12-lead electrocardiogram (ECG). METHODS: In a prospect......BACKGROUND: Acute anterior myocardial infarction (MI) caused by proximal occlusion of the left anterior descending coronary artery (LAD), is associated with unfavourable outcome and should be recognized by simple noninvasive methods like the 12-lead electrocardiogram (ECG). METHODS...

  16. Evaluation of noncoronary sources of left ventricular perfusion to intercoronary collateral-dependent myocardium due to chronic major vessel occlusion: absent contribution of luminal and extracardiac channels

    International Nuclear Information System (INIS)

    Crystal, G.J.; Downey, H.F.; Bashour, F.A.

    1981-01-01

    Liminal contribution to perfusion of collateral-dependent left ventricular (LV) myocardium was evaluated in six dogs. A portion of LV free wall was rendered collateral-dependent by gradual occlusion of left circumflex artery with Ameroid constrictor. Eight to 10 weeks after implantation of constrictor, measurements of LV myocardial flow were made by left atrial injections of 9-10 micro radioactive microspheres. To measure total collateral flow, microspheres were injected under control conditions, and to measure luminal contribution to collateral flow, microspheres were injected after ligation of right coronary artery during extracorporeal perfusion of left common coronary artery (LCCA) with microsphere-free arterial blood, and during stoppage of flow through LCCA. Under control conditions, myocardial blood flow in collateral-dependent region, 1.01 +/- 0.31 ml/min/gm, was not significantly different from that in normal region, 1.06 +/- 0.32 ml/min/gm. Flow from luminal collateral vessels was negligible (less than 0.005 ml/min/gm) in both collateral-dependent and normal myocardium, and was not affected by stoppage of flow through LCCA. These results indicate that luminal collateral vessels, as well as collateral vessels originating from other noncoronary sources, do not contribute significantly to perfusion of normal or collateral-dependent LV myocardium

  17. Detection of severe left anterior descending coronary artery stenosis by transthoracic evaluation of resting coronary flow velocity dynamics

    Directory of Open Access Journals (Sweden)

    Edward G. Abinader

    2010-09-01

    Full Text Available In the presence of severe stenosis, coronary artery flow may be reduced at rest. Recent advances in echocardiography have made non-invasive sampling of velocities in the left an­terior descending coronary artery (LAD possible. The aim of our study was to evaluate feasi­bility and capability of transthoracic Doppler to detect severe stenosis of the LAD. The study population consisted of 42 subjects with suspected coronary artery disease scheduled for coronary angiography. All had complete transthoracic echocardiography and Doppler sampling of LAD velocities. Quantitative cor­onary angiography was performed within 24 hours of the echocardiogram. Correlations between LAD velocity profile, measurements and calculations, and the angiographic results were performed. Six subjects had LAD occlusion, 10 had severe (>80% diameter LAD stenosis, and 26 had normal or non-occlusive LAD disease. In all six subjects with LAD occlusion, distal LAD velocities were not detectable, while in the other 36 subjects, LAD velocities were recorded indicating the vessels were patent. In the 10 subjects with severe LAD stenosis, the diastolic/systolic velocity ratio was <1.5, while in those with non-signifi­cant LAD disease, the diastolic/systolic velocity ratio was >1.5 (P<0.005. Diastolic LAD flow was 21.8±13 mL/min in the presence of severe stenosis as compared to 48.5±20 mL/min in subjects without severe stenosis (P<0.0013. LAD velocities had high sensitiv­ity and specificity for the prediction of severe angiographic stenosis. Thus transthoracic Doppler measurement of LAD velocities is feas­ible and can predict the presence of severe LAD stenosis or occlusion.

  18. 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

  19. [Relationship between occlusal plane and masticatory path in youth with individual normal occlusion].

    Science.gov (United States)

    Lin, Xue-feng; Li, Shao-hua; Huang, Zhuo-shan; Wu, Xia-yi

    2010-06-01

    To investigate the characteristics of and relationship between occlusal plane and masticatory path in young adults with individual normal occlusion, and to provide clinical implications on both morphological and functional reference of occlusal plane location. Forty-three young adults with individual normal occlusion were included. Lateral projections of cephalometric radiographs were taken. The parameters of anatomical landmarks were analyzed. The BioEGN mandibular kinesiography analyzer was used to record the path of incisal edge of mandibular central incisor movement during mastication. The Pearson's linear correlation analysis was performed to analyze the relationship of inclination of occlusal plane and data mentioned above with SPSS13.0 software. The inclination of occlusal plane (the angle between occlusal plane and Camper's line OP-CP) was (2.1 ± 3.8)° in youth with normal occlusion. Means of maximal distances of 3-dimensional masticatory mandibular movement paths were as follow: the vertical length was (20.22 ± 4.28) mm, the anterior-posterior width was (11.42 ± 2.45) mm, and the lateral width was (8.62 ± 1.52) mm. The inclination of occlusal plane was negatively correlated to the lateral width of masticatory path in frontal plane (r = -0.39, P Occlusal plane was approximately vertical to the opening and closing path in the vicinity of intercuspal position during mastication. The inclination of occlusal plane was positively related to occlusal plane-closing angles in the upper segments of closing path during mastication (P occlusal plane (P > 0.05). These results suggest that the sagittal inclination of occlusal plane can influence 3-dimensional morphology of masticatory path.The inclination of occlusal plane has a guiding effect on masticatory movement in the upper segments of closing path.

  20. In vivo performance of two devices for occlusal caries detection.

    Science.gov (United States)

    Bozdemir, Esin; Karaarslan, Emine Sirin; Ozsevik, A Semih; Ata Cebe, M; Aktan, Ali Murat

    2013-07-01

    The aim of this in vivo study was to compare the performance of light-emitting diode (LED)- and laser fluorescence (LF)-based devices with that of visual inspection (VI) in the diagnosis of occlusal caries. A total of 156 occlusal surfaces were investigated. Each occlusal surface was assessed with LED- and LF-based devices after a VI was performed. Pit and fissure opening was applied to the occlusal surfaces in which opacity or discoloration was distinctly visible after airdrying. The inter-examiner reliability of caries examination was assessed using the weighted κ statistics. The sensitivity, specificity, and accuracy of occlusal caries diagnosis using these methods were calculated according to the appropriate thresholds. Acceptable inter-examiner agreement was found for the LED- and LF-based devices and VI (κ=0.61, κ=0.76, and κ=0.87, respectively). Higher specificity values were achieved at a T2 threshold for the LF-based device (0.76 and 0.80) and at a T1 threshold for the LED-based readings (0.60 and 0.62) and VI (0.90 and 0.93) for both observers. With regard to VI, higher sensitivity values were found at both thresholds for the two observers in comparing the three caries detection methods (0.98 at T1 and 0.96 at T2). The accuracy values for T1 were higher than those for the T2 values, for all three caries detection methods. Caries lesions may be detected more accurately than clinically sound areas by both caries detection devices.

  1. Occlusal stability in shortened dental arches.

    NARCIS (Netherlands)

    Witter, D.J.; Creugers, N.H.J.; Kreulen, C.M.; Haan, A. de

    2001-01-01

    Shortened dental arches consisting of anterior and premolar teeth have been shown to meet oral functional demands. However, the occlusal stability may be at risk as a result of tooth migration. The aim of this nine-year study was to investigate occlusal stability in shortened dental arches as a

  2. The prevalence of questionable occlusal caries

    DEFF Research Database (Denmark)

    Makhija, Sonia K; Gilbert, Gregg H; Funkhouser, Ellen

    2012-01-01

    Questionable occlusal caries (QOC) can be defined as clinically suspected caries with no cavitation or radiographic evidence of occlusal caries. To the authors' knowledge, no one has quantified the prevalence of QOC, so this quantification was the authors' objective in conducting this study...

  3. Coronary artery dissection and acute myocardial infarction following blunt chest trauma

    Directory of Open Access Journals (Sweden)

    Tønnessen Theis

    2009-04-01

    Full Text Available Abstract Blunt chest trauma might lead to cardiac injury ranging from simple arrhythmias to lethal conditions such as cardiac rupture. We experienced a case of initially overlooked traumatic coronary artery dissection which resulted in acute myocardial infarction (AMI. A high degree of suspicion is needed to diagnose this condition. Based on our case, we will give an overview of relevant literature on this topic. ECG, echocardiography, coronary angiography and cardiac enzymes are valuable tools in diagnosing this rare condition. The time span from coronary artery occlusion to revascularisation must be short if AMI is to be avoided.

  4. Aortoiliac occlusive disease masquerading as cerebrovascular accident

    Directory of Open Access Journals (Sweden)

    Nandeesh B

    2007-01-01

    Full Text Available Acute aortoiliac occlusion is an unusual but potentially catastrophic condition causing acute limb ischemia and associated with early and high rates of mortality and morbidity. It is caused by either embolic occlusion of the infra renal aorta at the bifurcation or beyond or thrombosis of the abdominal aorta and its large terminal branches. Neurological symptoms are rare manifestation of acute aortoiliac occlusion and when neurological symptoms predominate, patients are mistakenly considered to have cerebrovascular event. We present a 60-year-old man with atherosclerotic thrombotic occlusion of the left common iliac artery causing acute painful monoplegia. We mistook the acute monoplegia due to acute limb ischemia for cerebrovascular accident. Pathologic examination revealed a firm thrombus occluding the origin of left common iliac artery and extending along the length of the vessel. Acute aortic iliac occlusion can masquerade as a cerebrovascular stroke and a thorough clinical evaluation and imaging studies allow early diagnosis and instituting life-saving treatment timely.

  5. [Occlusal vertical dimension in removable complete dentures].

    Science.gov (United States)

    den Haan, R; Witter, D J

    2011-12-01

    In removable complete dentures, the occlusal vertical dimension is an important factor for patients' satisfaction with aesthetics. An excessively reduced occlusal vertical dimension is especially likely to lead to complaints about aesthetics, whereas an increased occlusal vertical dimension may lead to discomfort and a decision not to wear the complete dentures. There are various methods for determining the occlusal vertical dimension in complete dentures, based on the vertical dimension in the rest position of the mandible or on phonetics. However, none of the methods have proven to be clearly superior, in terms of reliability, than the others. The assessment of the occlusal vertical dimension will become more reliable if several methods are used simultaneously. Moreover, knowledge of the characteristics of the ageing face is essential.

  6. Effect of occlusal contact stability on the jaw closing point during tapping movements.

    Science.gov (United States)

    Nishigawa, Keisuke; Suzuki, Yoshitake; Ishikawa, Teruaki; Bando, Eiichi

    2012-04-01

    We studied the relationship between tapping point reproducibility and stability of occlusal contacts at maximum intercuspation. Tapping movements of 12 adult volunteers who had dentition with natural teeth were recorded, and distances between the tapping point (TP) and the intercuspal position (ICP) at the incisal point were calculated. Occlusal contacts at the ICP of individual subjects were also evaluated with black-colored silicone impression material. The correlation between TP-ICP distance and occlusal contact stability was studied. TP-ICP distance exhibited negative correlations with the total number of teeth showing occlusal contact at the ICP. Standard deviations of TP-ICP distance also negatively correlated with the extension of occlusal contact area over dentition. This finding indicates that occlusal contacts at the ICP affect the kinematic behavior of tapping movements. The results of this study also suggest that jaw movement data may provide useful clinical information for the evaluation of occlusal contact at ICP. Copyright © 2011 Japan Prosthodontic Society. Published by Elsevier Ltd. All rights reserved.

  7. A novel method to determine perineal artery occlusion among male bicyclists.

    Science.gov (United States)

    Parthiban, Sujeeth; Hotaling, James M; Kathrins, Martin; Baftiri, Amit P; Freels, Sally; Niederberger, Craig S

    2015-01-01

    Background. Perineal pressure due to bicycle riding has been associated with erectile dysfunction. We developed a novel method to measure the occlusive force exerted over the perineal arteries and determined perineal artery occlusion by a variety of seat designs. Methods. Doppler ultrasonography facilitated perineal artery localization and determination of the force required for perineal artery occlusion in 20 healthy men. Flexiforce(®) sensors were affixed over the proximal and distal aspects of the perineal arteries bilaterally. Individuals completed bicycle rides in the road- and stationary-settings with six distinct seat designs, including those with and without an anterior "nose." Results. The occlusion time proportion of the total ride time was calculated for each trial. The overall occlusion time proportion was 0.59 (95% CI [0.45-0.73]) across all seats and settings. The "no-nose" bicycle seat and the stationary-setting demonstrated significantly lower occlusion proportion times than the traditional nose bicycle seat and road-setting, respectively. However, all bicycle seats yielded an occlusion time proportion of 0.41 or greater. Discussion. Our method of real-time, non-invasive force measurement localized to the perineal arteries may be used to validate future bicycle seat design. It also underscores the significant risk of perineal artery insufficiency in men who are avid bicyclists. This risk may be minimized by using newer "no-nose" bicycle seats.

  8. A novel method to determine perineal artery occlusion among male bicyclists

    Directory of Open Access Journals (Sweden)

    Sujeeth Parthiban

    2015-12-01

    Full Text Available Background. Perineal pressure due to bicycle riding has been associated with erectile dysfunction. We developed a novel method to measure the occlusive force exerted over the perineal arteries and determined perineal artery occlusion by a variety of seat designs.Methods. Doppler ultrasonography facilitated perineal artery localization and determination of the force required for perineal artery occlusion in 20 healthy men. Flexiforce® sensors were affixed over the proximal and distal aspects of the perineal arteries bilaterally. Individuals completed bicycle rides in the road- and stationary-settings with six distinct seat designs, including those with and without an anterior “nose.”Results. The occlusion time proportion of the total ride time was calculated for each trial. The overall occlusion time proportion was 0.59 (95% CI [0.45–0.73] across all seats and settings. The “no-nose” bicycle seat and the stationary-setting demonstrated significantly lower occlusion proportion times than the traditional nose bicycle seat and road-setting, respectively. However, all bicycle seats yielded an occlusion time proportion of 0.41 or greater.Discussion. Our method of real-time, non-invasive force measurement localized to the perineal arteries may be used to validate future bicycle seat design. It also underscores the significant risk of perineal artery insufficiency in men who are avid bicyclists. This risk may be minimized by using newer “no-nose” bicycle seats.

  9. Oxidative Stress in Human Aorta of Patients with Advanced Aortoiliac Occlusive Disease.

    Science.gov (United States)

    Lucas, Márcio Luís; Carraro, Cristina Campos; Belló-Klein, Adriane; Kalil, Antonio Nocchi; Aerts, Newton

    2016-01-01

    Oxidative stress seems to be a role in the atherosclerosis process, but research in human beings is scarce. To evaluate the role of oxidative stress on human aortas of patients submitted to surgical treatment for advanced aortoiliac occlusive disease. Twenty-six patients were divided into three groups: control group (n=10) formed by cadaveric organ donors; severe aortoiliac stenosis group (patients with severe aortoiliac stenosis; n=9); and total aortoiliac occlusion group (patients with chronic total aortoiliac occlusion; n=7). We evaluated the reactive oxygen species concentration, nicotinamide adenine dinucleotide phosphate-oxidase, superoxide dismutase and catalase activities as well as nitrite levels in samples of aortas harvested during aortofemoral bypass for treatment of advanced aortoiliac occlusive disease. We observed a higher level of reactive oxygen species in total aortoiliac occlusion group (48.3±9.56 pmol/mg protein) when compared to severe aortoiliac stenosis (33.5±7.4 pmol/mg protein) and control (4.91±0.8 pmol/mg protein) groups (Pcontrol group (3.81±1.7 versus 1.05±0.31 µmol/min.mg protein; Pcontrol cases (Pbe due to a compensative phenomenon to reactive oxygen species production mediated by nicotinamide adenine dinucleotide phosphate oxidase. This preliminary study offers us a more comprehensive knowledge about the role of oxidative stress in advanced aortoiliac occlusive disease in human beings.

  10. Coronary artery disease (image)

    Science.gov (United States)

    ... through these arteries is critical for the heart. Coronary artery disease usually results from the build-up of fatty material and plaque, a condition called atherosclerosis. As the coronary arteries narrow, the flow of blood to the ...

  11. Coronary heart disease

    Science.gov (United States)

    Heart disease, Coronary heart disease, Coronary artery disease; Arteriosclerotic heart disease; CHD; CAD ... more calcium, the higher your chance for CHD. Exercise stress test . Heart CT scan . Nuclear stress test .

  12. Occlusion for stimulus deprivation amblyopia

    Science.gov (United States)

    Antonio-Santos, Aileen; Vedula, Satyanarayana S; Hatt, Sarah R; Powell, Christine

    2014-01-01

    Background Stimulus deprivation amblyopia (SDA) develops due to an obstruction to the passage of light secondary to a condition such as cataract. The obstruction prevents formation of a clear image on the retina. SDA can be resistant to treatment, leading to poor visual prognosis. SDA probably constitutes less than 3% of all amblyopia cases, although precise estimates of prevalence are unknown. In developed countries, most patients present under the age of one year; in less developed parts of the world patients are likely to be older at the time of presentation. The mainstay of treatment is removal of the cataract and then occlusion of the better-seeing eye, but regimens vary, can be difficult to execute, and traditionally are believed to lead to disappointing results. Objectives Our objective was to evaluate the effectiveness of occlusion therapy for SDA in an attempt to establish realistic treatment outcomes. Where data were available, we also planned to examine evidence of any dose response effect and to assess the effect of the duration, severity, and causative factor on the size and direction of the treatment effect. Search methods We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2013, Issue 9), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to October 2013), EMBASE (January 1980 to October 2013), the Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to October 2013), PubMed (January 1946 to October 2013), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 28 October 2013. Selection criteria We planned

  13. Functional Aesthetic Occlusal Plane (FAOP

    Directory of Open Access Journals (Sweden)

    Carlos Alexandre Câmara

    Full Text Available ABSTRACT Introduction: A reasonable exposure of incisors and gingival tissues is generally considered more attractive than excess or lack of exposure. A reasonable gingival exposure is considered to be around 0 to 2 mm when smiling and 2-4 mm exposure of the maxillary incisor edge when the lips are at rest. Objective: The aim of this paper is to present the Functional Aesthetic Occlusal Plane (FAOP, which aims to help in the diagnosis of the relationships established among molars, incisors and the upper lip. Conclusion: FAOP can complement an existing and established orthodontic treatment plan, facilitating the visualization of functional and aesthetic demands by giving a greater focus on the position of incisors in the relationship established among the incisors, molars and the upper lip stomion.

  14. Functional Aesthetic Occlusal Plane (FAOP).

    Science.gov (United States)

    Câmara, Carlos Alexandre; Martins, Renato Parsekian

    2016-01-01

    A reasonable exposure of incisors and gingival tissues is generally considered more attractive than excess or lack of exposure. A reasonable gingival exposure is considered to be around 0 to 2 mm when smiling and 2-4 mm exposure of the maxillary incisor edge when the lips are at rest. The aim of this paper is to present the Functional Aesthetic Occlusal Plane (FAOP), which aims to help in the diagnosis of the relationships established among molars, incisors and the upper lip. FAOP can complement an existing and established orthodontic treatment plan, facilitating the visualization of functional and aesthetic demands by giving a greater focus on the position of incisors in the relationship established among the incisors, molars and the upper lip stomion.

  15. Effects of intracoronary streptokinase and intracoronary nitroglycerin infusion on coronary angiographic patterns and mortality in patients with acute myocardial infarction

    International Nuclear Information System (INIS)

    Rentrop, K.P.; Feit, F.; Blanke, H.

    1984-01-01

    Patients with a clinical diagnosis of acute myocardial infarction were randomly assigned to one of four treatment groups: intracoronary streptokinase, intracoronary nitroglycerin, intracoronary streptokinase and intracoronary nitroglycerin, or conventional therapy without initial angiography. Of 124 patients 122 sustained acute myocardial infarction. Initial angiography revealed total occlusion of the coronary artery responsible for infarction in 67 percent (61 of 91). Acute recanalization occurred in 74 percent (32 of 43) of patients receiving streptokinase but in only 6 percent (1 of 18) of patients treated with nitroglycerin alone. At angiography of all four groups on Day 10 to 14 the vessel responsible for acute myocardial infarction was patent in 77 percent (71 of 92) of patients; there was no difference among groups, indicating gradual, endogenous thrombolysis in patients not treated with streptokinase. Patients with subtotal obstruction initially had significant improvement in left ventricular function, significantly lower peak creatine kinase levels, and a trend toward lower mortality than patients with total occlusion initially. Mortality at six months in patients receiving streptokinase (21 percent, 13 of 62) did not differ significantly from that in patients not treated with streptokinase (10 percent, 6 of 61). Additional studies will be necessary to assess treatment effects in the angiographic subsets identified by this trial

  16. Tooth Abnormalities and Occlusal Disorders in Individuals With Frontonasal Dysplasia.

    Science.gov (United States)

    Dainezi, Vanessa Benetello; Neves, Lucimara Teixeira das; da Silva Dalben, Gisele; Gomide, Marcia Ribeiro

    2017-05-01

      Frontonasal dysplasia is a rare developmental defect of the midface, and little is known about the dental involvement in individuals with this condition. This study investigated tooth abnormalities and occlusal disorders in individuals with frontonasal dysplasia.   Cross-sectional.   Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, Brazil.   Clinical oral examination, analysis of patient records, and panoramic radiographs.   A total of 20 individuals with frontonasal dysplasia aged 7 to 17 years.   Prevalence of the several tooth abnormalities and occlusal disorders analyzed.   A total of 19 individuals presented at least one tooth abnormality, with highly variable findings. In radiographs, 20% of individuals (all presenting oral clefts) presented agenesis of lateral incisors and second premolars. No supernumerary teeth were observed; 65% of individuals exhibited occlusal alterations, especially anterior open bite in the two individuals with median cleft lip.   Variable clinical and radiographic alterations were observed, probably due to the large variety of phenotypic characteristics. No specific dental alteration could be related with frontonasal dysplasia.

  17. The Artery of Percheron Infarction after Coronary Angiography

    Directory of Open Access Journals (Sweden)

    Haitham Mazek

    2016-01-01

    Full Text Available Coronary angiography is the golden choice for coronary artery disease evaluation and management. However, as with any invasive procedures, there is a risk of complications. We are reporting a case of 69-year-old male with past medical history of cardiac bypass surgery, CHF, hypertension, and hyperlipidemia who was admitted to the hospital to evaluate his chest pain. He had treadmill stress test that showed ischemic induced exercise. Patient underwent coronary angiography that showed proximal complete occlusion of the RCA with a patent graft. At the end of the procedure, the patient did not wake up and remained minimally responsive. An urgent brain MRI was ordered and showed infarctions consistent with an artery of Percheron infarction. Later, patient has improved slowly and was discharged home. We briefly here discuss this rare complication including the risk factor, clinical presentation, and the management.

  18. Three-dimensional computed tomography angiography of coronary artery bypass graft with electron beam tomography

    Energy Technology Data Exchange (ETDEWEB)

    Hoshi, Toshiko; Yamauchi, Tatsuo; Kanauchi, Tetsu; Konno, Miyuki; Imai, Kamon; Suwa, Jiro; Onoguchi, Katsuhisa; Hashimoto, Kazuhiro; Horie, Toshinobu [Saitama Cardiovascular and Respiratory Center, Konan (Japan)

    2001-10-01

    Assessment of coronary artery bypass graft patency by three-dimensional reconstructed computed tomography angiography (3D-CTA) derived from electrocardiography-gated contrast-enhanced electron beam tomography (EBT) was evaluated. Thirty-nine patients with 99 grafts (45 arterial grafts and 54 venous grafts) underwent 3D-CTA and selective coronary angiography within a 3-week interval. 3D-CTA images of the coronary bypass grafts were compared with the coronary angiography images used as the control. 3D-CTA defined 42 of 44 arterial grafts as patent (sensitivity: 95%), all 47 venous grafts as patent (sensitivity: 100%) and all 7 venous grafts as occlusive (specificity: 100%). The overall sensitivity and specificity were 98% and 88%, respectively. 3D-CTA is an useful noninvasive technique with adequate sensitivity and specificity to assess coronary artery bypass graft patency. (author)

  19. Ischemia Reperfusion Injury after Gradual versus Rapid Flow Restoration for Middle Cerebral Artery Occlusion Rats.

    Science.gov (United States)

    Xu, Wan-Wan; Zhang, Ying-Ying; Su, Juan; Liu, Ao-Fei; Wang, Kai; Li, Chen; Liu, Yun-E; Zhang, Yi-Qun; Lv, Jin; Jiang, Wei-Jian

    2018-01-26

    Ischemia-reperfusion injury (IRI) is an important cause of adverse prognosis after recanalization in patients with acute occlusion of major intracranial artery (AOMIA). Here, we provided data indicating that gradual flow restoration (GFR) would be superior to rapid flow restoration (RFR) in alleviating cerebral IRIs in middle cerebral artery occlusion (MCAO) rats. A total of 94 MCAO rats with 15, 30 and 60-minute occlusion were randomly assigned to receive either GFR or RFR intervention. There were significant differences between GFR and RFR group in mean neurological severity score (1.02 versus 1.28; p RFR could effectively alleviate cerebral IRIs in MCAO rats, especially in rats with longer occlusion duration, suggesting that GFR may be particularly applicable to AOMIA patients who are presented to neurointerventionalists in the later-time of recanalization therapy window.

  20. Eversion Subclavian Endarterectomy and Transposition for Coronary-Subclavian Steal Syndrome in a Patient with Refractory Angina Pectoris.

    Science.gov (United States)

    Hinojosa, Carlos A; Anaya-Ayala, Javier E; Laparra-Escareno, Hugo; Guerrero-Hernandez, Manuel; Galindo-Uribe, Jaime

    2016-01-01

    Late onset of angina pectoris associated with subclavian artery (SA) atherosclerotic occlusive disease is a rare and recognized cause of myocardial ischemia when the lesion is proximal to a left internal mammary artery (LIMA) to coronary bypass. The symptoms typically exacerbate by increasing the flow demand in the extremity; this phenomenon is known as late coronary-subclavian steal syndrome. We describe the case of a 66-year-old woman who underwent coronary artery bypass grafting from the LIMA to the left anterior descending coronary artery in 2000. Years later, she experienced refractory angina pectoris associated to an occlusive lesion in the proximal left SA. SA endarterectomy with eversion technique and subclavian-carotid transposition restored the antegrade flow with resolution of the symptomatology. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. Coronary artery disease following mediastinal radiation therapy

    International Nuclear Information System (INIS)

    Annest, L.S.; Anderson, R.P.; Li, W.; Hafermann, M.D.

    1983-01-01

    Coronary artery disease occurred in four young men (mean age 41 years) who had received curative irradiation therapy for mediastinal malignancies 12 to 18 (mean 15) years previously. None was at high risk for developing coronary artery disease by Framingham criteria. Angiography demonstrated proximal coronary artery disease with normal distal vessels. Distribution of the lesions correlated with radiation dosimetry in that vessels exposed to higher radiation intensity were more frequently diseased. Three patients had coronary bypass grafting for intractable angina and are asymptomatic at 10 to 43 months. A total of 163 patients underwent mediastinal irradiation for lymphoma or thymoma between 1959 and 1980. Among the 29 who survived 10 or more years, five (18%) developed severe coronary artery disease, implicating thoracic radiotherapy as an important risk factor. Because of the importance of mantle irradiation in the treatment of lymphomas, the prevalence of these neoplasms, and the survival patterns following treatment, many long-term survivors may be at increased risk for the development of coronary artery disease. Recognition of the relationship between radiotherapy and coronary artery disease may lead to earlier diagnosis and more timely intervention. Standard surgical treatment may be particularly beneficial because of the relative youth of most of these patients and because the proximal distribution of typical lesions increases the likelihood of complete revascularization

  2. Prevalence and characteristics of coronary artery anomalies in children with congenital heart disease diagnosed with coronary angiography.

    Science.gov (United States)

    Temel, Münevver Tuğba; Coşkun, Mehmet Enes; Başpınar, Osman; Demiryürek, Abdullah Tuncay

    2017-09-01

    Aim of the present study was to determine the prevalence of coronary artery anomalies in children with congenital heart disease. Data of 1138 consecutive patients who were referred for cardiac catheterization and angiography for assessment of coronary anomaly between January 2005 and December 2009 were retrospectively analyzed. Total of 515 patients whose coronary arteries could be examined through left ventricle and aortic root injection were included in the study. Of 515 angiograms with visible coronaries, 42 patients (20 males, 22 females; mean age: 5.3±2.0 years) were found to have final diagnosis of coronary anomaly. Prevalence of coronary artery anomalies was 8.16% in this study. It was determined that 38 (90.4%) were anomalies of origination, 2 (4.8%) were anomalies of intrinsic coronary arterial anatomy, and 2 (4.8%) were anomalies of coronary termination. Most common coronary artery abnormality was anomalous origin of the right coronary artery from the left aortic sinus (16 patients; 38.1%), and the most common congenital heart disease was tetralogy of Fallot (18 patients; 42.9%). Recognizing variability of coronary artery anomalies is critical when considering surgical or interventional therapies in children with congenital heart disease.

  3. 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.

  4. Myocardial segmentation based on coronary anatomy using coronary computed tomography angiography: Development and validation in a pig model

    Energy Technology Data Exchange (ETDEWEB)

    Chung, Mi Sun [Chung-Ang University College of Medicine, Department of Radiology, Chung-Ang University Hospital, Seoul (Korea, Republic of); Yang, Dong Hyun; Seo, Joon Beom; Kang, Joon-Won; Lim, Tae-Hwan [Asan Medical Center, University of Ulsan College of Medicine, Department of Radiology and Research Institute of Radiology, Seoul (Korea, Republic of); Kim, Young-Hak; Kang, Soo-Jin; Jung, Joonho [Asan Medical Center, University of Ulsan College of Medicine, Heart Institute, Seoul (Korea, Republic of); Kim, Namkug [Asan Medical Center, University of Ulsan College of Medicine, Department of Convergence Medicine, Seoul (Korea, Republic of); Heo, Seung-Ho [Asan Medical Center, University of Ulsan College of Medicine, Asan institute for Life Science, Seoul (Korea, Republic of); Baek, Seunghee [Asan Medical Center, University of Ulsan College of Medicine, Department of Clinical Epidemiology and Biostatistics, Seoul (Korea, Republic of); Choi, Byoung Wook [Yonsei University, Department of Diagnostic Radiology, College of Medicine, Seoul (Korea, Republic of)

    2017-10-15

    To validate a method for performing myocardial segmentation based on coronary anatomy using coronary CT angiography (CCTA). Coronary artery-based myocardial segmentation (CAMS) was developed for use with CCTA. To validate and compare this method with the conventional American Heart Association (AHA) classification, a single coronary occlusion model was prepared and validated using six pigs. The unstained occluded coronary territories of the specimens and corresponding arterial territories from CAMS and AHA segmentations were compared using slice-by-slice matching and 100 virtual myocardial columns. CAMS more precisely predicted ischaemic area than the AHA method, as indicated by 95% versus 76% (p < 0.001) of the percentage of matched columns (defined as percentage of matched columns of segmentation method divided by number of unstained columns in the specimen). According to the subgroup analyses, CAMS demonstrated a higher percentage of matched columns than the AHA method in the left anterior descending artery (100% vs. 77%; p < 0.001) and mid- (99% vs. 83%; p = 0.046) and apical-level territories of the left ventricle (90% vs. 52%; p = 0.011). CAMS is a feasible method for identifying the corresponding myocardial territories of the coronary arteries using CCTA. (orig.)

  5. Trends in the treatment of coronary disease today. Selective use of PTCA and bypass surgery.

    Science.gov (United States)

    Jones, E L; Craver, J M; Guyton, R A; Bone, D K; Hatcher, C R

    1983-01-01

    Selection and treatment of patients with ischemic heart disease is presently undergoing an evolutionary trend. Percutaneous transluminal coronary angioplasty (PTCA) has been recommended as the initial procedure for many patients with coronary artery disease (CAD), thus possibly redefining candidates for coronary bypass surgery (CABS). Between October 1980 and June 1982, 777 patients having PTCA and 2068 patients having CABS were analyzed for differences in clinical presentation, complications, and early outcome. Patients having CABS were significantly older, had a higher incidence of hypertension (46% vs. 32%), more multivessel disease (80% vs. 12%), and poorer left ventricular function (nl. wall motion = 88% vs. 52%). The incidence of myocardial infarction in patients after PTCA was 1.0% (8/777). Emergency CAB was required in 5.3% of patients following PTCA. There were no deaths following the angioplasty procedure and 25 deaths in 2068 patients having CABS (hospital mortality rate = 1.2%). Since 1973, there has been a progressive decline in hospital mortality rate (now, less than 1%), postoperative infarction (now, 3%), requirement for inotropic drugs (now, 5%) and frequency of IABP (less than 1%). Increasing ability to achieve complete revascularization now means improved survival and freedom from angina with CAB surgery. PTCA and CAB are both procedures that may be used effectively for selected patients, depending on clinical presentation, extent of CAD, and left ventricular function (LVF). Careful patient selection affords the opportunity for use of PTCA in patients with single-vessel disease (SVD) and good LVF and CABS in patients with multivessel disease, regardless of LVF. Symptomatic patients with SVD and total vessel occlusion are not candidates for PTCA. Our data demonstrate that both PTCA and CABS may be accomplished with very low perioperative complications and hospital mortality. PMID:6222708

  6. Contrast agent choice for intravenous coronary angiography

    International Nuclear Information System (INIS)

    Zeman, H.D.; Siddons, D.P.

    1989-01-01

    The screening of the general population for coronary artery disease would be practical if a method existed for visualizing the extent of occlusion after an intravenous injection of contrast agent. Measurements performed with monochromatic synchrotron radiation x-rays and an iodine containing contrast agent at the Stanford Synchrotron Radiation Laboratory have shown that such an intravenous angiography procedure would be possible with an adequately intense monochromatic x-ray source. Because of the size and cost of synchrotron radiation facilities it would be desirable to make the most efficient use of the intensity available, while reducing as much as possible the radiation dose experienced by the patient. By choosing contrast agents containing elements with a higher atomic number than iodine, it is possible to both improve the image quality and reduce the patient radiation dose, while using the same synchrotron source. By using Si monochromator crystals with a small mosaic spread, it is possible to increase the x-ray flux available for imaging by over an order of magnitude, without any changes in the storage ring or wiggler magnet. The most critical imaging task for intravenous coronary angiography utilizing synchrotron radiation x-rays is visualizing a coronary artery through the left ventricle or aorta which also contains a contrast agent. Calculations have been made of the signal to noise ratio expected for this imaging task for various contrast agents with atomic numbers between that of iodine and bismuth

  7. A Study on Growth and Development of Dentition and Occlusion in Children : Changes of Occlusion

    OpenAIRE

    Kaihara, Yasutaka; Saiga, Kaori; Nakae, Hisami; Kuramoto, Meiko; Makihira, Mika; Miyamoto, Yoko; Suzuki, Junji; Amano, Hideaki; Miura, Kazuo; Kawabata, Yasushi; Kozai, Katsuyuki

    2005-01-01

    The purpose of this study was to examine the longitudinal change of occlusion in children. The materials were study models obtained annually from 27 patients (17 boys and 10 girls) aged 4 to 12, having no history of significant tooth decay or orthodontic treatment. The interdental spaces in the primary dentition, the anterior occlusal relationship, the terminal plane, the relationship of the permanent first molar, and the change of occlusion from the primary dentition to the permanent dentiti...

  8. Maximizing mandibular prosthesis stability utilizing linear occlusion, occlusal plane selection, and centric recording.

    Science.gov (United States)

    Williamson, Richard A; Williamson, Anne E; Bowley, John; Toothaker, Randy

    2004-03-01

    The stability of mandibular complete dentures may be improved by reducing the transverse forces on the denture base through linear (noninterceptive) occlusion, selecting an occlusal plane that reduces horizontal vectors of force at occlusal contact, and utilizing a central bearing intraoral gothic arch tracing to record jaw relations. This article is intended to acquaint the reader with one technique for providing stable complete denture prostheses using the aforementioned materials, devices, and procedures.

  9. Pulmonary veno-occlusive disease.

    Science.gov (United States)

    Montani, David; Lau, Edmund M; Dorfmüller, Peter; Girerd, Barbara; Jaïs, Xavier; Savale, Laurent; Perros, Frederic; Nossent, Esther; Garcia, Gilles; Parent, Florence; Fadel, Elie; Soubrier, Florent; Sitbon, Olivier; Simonneau, Gérald; Humbert, Marc

    2016-05-01

    Pulmonary veno-occlusive disease (PVOD) is a rare form of pulmonary hypertension (PH) characterised by preferential remodelling of the pulmonary venules. In the current PH classification, PVOD and pulmonary capillary haemangiomatosis (PCH) are considered to be a common entity and represent varied expressions of the same disease. The recent discovery of biallelic mutations in the EIF2AK4 gene as the cause of heritable PVOD/PCH represents a major milestone in our understanding of the molecular pathogenesis of PVOD. Although PVOD and pulmonary arterial hypertension (PAH) share a similar clinical presentation, with features of severe precapillary PH, it is important to differentiate these two conditions as PVOD carries a worse prognosis and life-threatening pulmonary oedema may occur following the initiation of PAH therapy. An accurate diagnosis of PVOD based on noninvasive investigations is possible utilising oxygen parameters, low diffusing capacity for carbon monoxide and characteristic signs on high-resolution computed tomography of the chest. No evidence-based medical therapy exists for PVOD at present and lung transplantation remains the preferred definitive therapy for eligible patients. Copyright ©ERS 2016.

  10. Percutaneous sharp recanalization of a membranous IVC occlusion with an occlusion balloon as a needle target

    Directory of Open Access Journals (Sweden)

    Michael D. Rivers-Bowerman, MD, MSc, FRCPC

    2017-09-01

    Full Text Available A 50-year-old male with right upper quadrant symptoms and hepatic dysfunction was found to have multiple dilated hepatic veins (HVs with intrahepatic collateralization and membranous occlusion of the intrahepatic inferior vena cava (IVC consistent with primary Budd–Chiari syndrome. Venacavograms depicted drainage of the intrahepatic collaterals through a left-sided HV entering the IVC above the level of the occlusion. Sharp recanalization of the membranous IVC occlusion was performed with an occlusion balloon as a needle target under echocardiographic monitoring followed by balloon angioplasty with restoration of IVC patency. Clinical, laboratory, and venographic procedural success has been demonstrated to 9 months with minimal residual stenosis.

  11. Ocular neovascularization in eyes with a central retinal artery occlusion or a branch retinal artery occlusion

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    Mason lll JO

    2015-06-01

    Full Text Available John O Mason III,1,2 Shyam A Patel,1 Richard M Feist,1,2 Michael A Albert Jr,1,2 Carrie Huisingh,1 Gerald McGwin Jr,1,3 Martin L Thomley1,2 1Department of Ophthalmology, University of Alabama School of Medicine, Birmingham, AL, USA; 2Retina Consultants of Alabama, Callahan Eye Foundation Hospital, Birmingham, AL, USA; 3Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA Purpose: To investigate the ocular neovascularization (ONV rate in eyes with a branch retinal artery occlusion (BRAO or a central retinal artery occlusion (CRAO, and to study factors that may influence the ONV rate secondary to CRAO.Methods: This was a retrospective case series of consecutive patients (286 total eyes: 83 CRAOs and 203 BRAOs who were diagnosed with a retinal artery occlusion from 1998 to 2013 at the Retina Consultants of Alabama and University of Alabama at Birmingham, Birmingham, AL, USA. Generalized estimating equations were used to evaluate the association between hypothesized risk factors and ONV development.Results: Twelve (14.5% of the 83 eyes with a CRAO developed ONV. Eleven of 12 eyes (91.7% had iris neovascularization, ten of 12 eyes (83.3% had neovascular glaucoma, and two of 12 eyes (16.7% had neovascularization of the optic disc. The average time for ONV development secondary to CRAO was 30.7 days, ranging from the date of presentation to 137 days. Only two (<1.0% of the 203 eyes with a BRAO developed iris neovascularization. Diabetes mellitus type 2 was a risk factor for ONV development following a CRAO with an adjusted odds ratio of 5.2 (95% confidence interval: 1.4–19.8 (P=0.02.Conclusion: ONV is an important complication of CRAO and is a less-frequent complication of BRAO. Patients with a CRAO, especially those with diabetes mellitus type 2, should be closely monitored for the first 6 months for ONV. Keywords: neovascularization, neovascular glaucoma, retinal artery occlusion, central

  12. Branch retinal artery occlusion in Susac's syndrome

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    Ricardo Evangelista Marrocos de Aragão

    2015-02-01

    Full Text Available Susac's syndrome is a rare disease attribuited to a microangiopathy involving the arterioles of the cochlea, retina and brain. Encefalopathy, hearing loss, and visual deficits are the hallmarks of the disease. Visual loss is due to multiple, recurrent branch arterial retinal occlusions. We report a case of a 20-year-old women with Susac syndrome presented with peripheral vestibular syndrome, hearing loss, ataxia, vertigo, and vision loss due occlusion of the retinal branch artery.

  13. Occlusion Issues in Early Renaissance Art

    OpenAIRE

    Barbara Gillam

    2011-01-01

    Early Renaissance painters innovatively attempted to depict realistic three-dimensional scenes. A major problem was to produce the impression of overlap for surfaces that occlude one another in the scene but are adjoined in the picture plane. Much has been written about perspective in art but little about occlusion. Here I examine some of the strategies for depicting occlusion used by early Renaissance painters in relation to ecological considerations and perceptual research. Perceived surfac...

  14. Current possibilities in occlusal caries management

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    Hrvoje Jurić

    2013-11-01

    Full Text Available Dental caries is a multifactorial disease that affects most populations throughout the world and it is still the primary cause of oral pain and tooth loss. The occlusal surfaces of posterior teeth are the most vulnerable sites for dental caries due to their anatomy. Therefore, the aim of the following article is to summarize current knowledge on occlusal caries development and the possibilities of its prevention. Although the overall caries rate today has fallen for populations in industrialized countries, the rate of occlusal surface caries has not decreased. This may be explained with fact that topically applied fluorides and their mode of action prevent caries better on smooth than on occlusal surfaces. As we know, tooth decay of first permanent molars causes a great deal of different short and long term difficulties for patients. Therefore, there is a continuous need for implementation of programs for caries prevention in permanent teeth. Nowadays, we like to treat our patients by minimally invasive methods. A very important step in our effective preventive treatment is sealing pits and fissures as a cornerstone of occlusal caries management. Reliable assessment of caries activity is also very important for defining treatment needs and plans. A very important decision, which should be made during occlusal caries management, is the selection of restorative material according to the treatment plan. Conclusion. Current possibilities in occlusal caries prevention and management are very effective. Therefore, dentists today do not have any excuse for avoiding the philosophy of Minimally Invasive Dentistry, especially when we talk about caries management of occlusal surfaces in permanent molars.

  15. Thrombolysoangioplasty in chronic, long segmental occlusive arterial disease

    International Nuclear Information System (INIS)

    Chung, Tae Woong; Kim, Jae Kyu; Koh, Byung Kwan; Kim, Jin Yup; Seo, Jeoung Jin; Kang, Hyeoung Keun

    1993-01-01

    From July 1988 to September 1992, we experienced 15 cases of thrombolysoangioplasty (TLA) at Chonnam University Hospital. Among 15 cases, 5 had claudication (Clinical stage II according to Modified Fontaine Classification), pain at rest (III),and gangrene (IV). Duration of symptoms was 1-7 months except patients of clinical stage IV unable to guess occlusion age. The occlusion length was 5-10 cm in 8 cases, 10-20 cm in 4 cases, and above 30 cm in 2 cases. In all cases, thrombolytic therapy was performed with intraarterial urokinase infusion. The total amount of urokinase ranged from 300,000 IU to 2,000,000 IU and infusion time ranged from 2 to 50 hours except three cases infused bolus dose only. Complete successful TLA was defined as technical (less than 50% of residual stenosis) and clinical success. Partial success was defined as technical success but clinical failure. Follow-up angiography could be performed in 8 cases. Overall initial success rate was 86.6% (13/15). Among them, complete success was in 11 cases and partial success was in 2 cases. Recurrence of disease was not noted on all cases(n=8). Severe complications, such as hemorrhage, did not occurred. TLA was considered to be effective and safe way to recanalized chronic long artery occlusion in lower extremity

  16. Influence of occlusal plane inclination and mandibular deviation on esthetics.

    Science.gov (United States)

    Corte, Cristiane Cherobini Dalla; Silveira, Bruno Lopes da; Marquezan, Mariana

    2015-10-01

    The aim of this study was to assess the degree of perception of occlusal plane inclination and mandibular deviation in facial esthetics, assessed by laypeople, dentists and orthodontists. A woman with 5.88° of inclination and 5.54 mm of mandibular deviation was selected and, based on her original photograph, four new images were created correcting the deviations and creating more symmetric faces and smiles. Examiners assessed the images by means of a questionnaire. Their opinions were compared by qualitative and quantitative analyses. A total of 45 laypeople, 27 dentists and 31 orthodontists filled out the questionnaires. All groups were able to perceive the asymmetry; however, orthodontists were more sensitive, identifying asymmetries as from 4.32° of occlusal plane inclination and 4.155 mm of mandibular deviation (pocclusal plane inclination and 5.54 mm of mandibular deviation (pOcclusal plane inclination and mandibular deviation were perceived by all groups, but orthodontists presented higher perception of deviations.

  17. Patency of Saphenous Vein Grafts Using the PAS-Port System During Coronary Artery Bypass Surgery.

    Science.gov (United States)

    Kubota, Hiroshi; Endo, Hidehito; Ishii, Hikaru; Tsuchiya, Hiroshi; Takahashi, Yu; Inaba, Yusuke; Noma, Mio; Yoshimoto, Akihiro; Higuchi, Satoshi; Kohshoh, Hideyasu; Taniai, Seiichi; Ishiguro, Haruhisa; Yoshino, Hideaki; Sudo, Kenichi

    2017-08-01

    Several proximal anastomosis devices have been developed to shorten the time required for a proximal anastomosis and to avoid aortic cross-/side-clamping during coronary artery bypass grafting. This study retrospectively examined the patency of saphenous vein grafts (SVGs) using the PAS-Port System (Cardia Inc, Redwood City, CA). From 2004 to 2014, 451 patients underwent coronary artery bypass graft operations requiring at least 1 proximal anastomosis using a PAS-Port device. A total of 802 PAS-Port devices were used, and 95.0% (762 of 802) were implanted successfully. Among the successfully implanted anastomoses, 76.8% (585 of 762) were evaluated using coronary angiography or multidimensional computed tomography, or both. The evaluations were performed between postoperative days 4 and 3,182 (mean, 319 ± 624 days). The early (1 to 365 days) and the midterm to long-term (more than 366 days) occlusion rates were examined. A complete postoperative clinical course was recorded for 70.7% of the patients. Overall, 93.8% (549 of 585) of the device-dependent SVGs were patent. The patency rates of device-dependent SVGs that were 1, 2, 3, 4, 5, 6, 7, and 8 years old were 90.1% ± 1.8%, 87.1% ± 2.3%, 86.1% ± 2.5%, 82.9% ± 3.3%, 80.6% ± 3.9%, 77.2% ± 5.0%, 77.2% ± 5.0%, and 70.2% ± 8.1%, respectively. The longest follow-up period was 3,182 days (8.7 years). The occlusion rate for device-dependent SVGs tended to decrease as the number of patients accumulated. The PAS-Port system provided acceptable SVG patency and clinical outcome for the early and midterm to long-term. There may be a learning curve for the use of PAS-Port device that affects the device-dependent SVG patency. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  18. Effect of occlusal plane on smile attractiveness.

    Science.gov (United States)

    Batwa, Waeil; Hunt, Nigel P; Petrie, Aviva; Gill, Daljit

    2012-03-01

    To determine the influence of the occlusal plane angle on smile attractiveness as perceived by a group of adult orthodontic patients and dentists. The first stage utilized a laboratory approach to record changes in vertical tooth position at different occlusal plane angles using a maxillary model mounted on an articulator. In the second stage, photographic manipulation was undertaken, using data from stage 1, to produce a computerized prediction of the appearance of the smile at differing occlusal plane angles (0, 5, 10, 15, and 20 degrees). Finally, the five developed photographs were assessed by participants. Alterations in the occlusal plane angle did affect relative smile attractiveness for both patients (n  =  66) and dentists (n  =  66). For patients, the 10 degree smile was rated better than the 0 and 20 degree smiles (P occlusal plane angle does affect relative smile attractiveness. However, patients were more tolerant of these changes than dentists. This suggests that large changes in the occlusal plane angle would affect relative smile attractiveness, and small changes are unlikely to affect smile attractiveness.

  19. Occlusal characteristics of children with hypertrophied adenoids in Nigeria.

    Science.gov (United States)

    Osiatuma, Vivien Ijeoma; Otuyemi, Olayinka Donald; Kolawole, Kikelomo Adebanke; Ogunbanjo, Babatunde Ogunbiyi; Amusa, Yemisi Bola

    2015-03-01

    Nasorespiratory function and its relation to craniofacial growth are of great interest because of the basic biological relationship between form and function, and the accumulating findings of the relationship between mode of breathing, craniofacial growth and orthodontic treatment. The aim of this study was to evaluate the effect of adenoid hypertrophy and sociodemographic variables on the occlusion of children. A total of 180 subjects aged 3-12 years were selected at the Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria. Ninety subjects had hypertrophied adenoids while 90 normal children served as the control group. Orthodontic examinations were carried out and impressions for study models taken. Occlusion was assessed in the anterior-posterior, transverse and vertical planes. Class I relationship was the most prevalent occlusion in both adenoid and control subjects (55.6% and 72.2%, respectively). The occurrence of class II division 1 was significantly higher among adenoid than control subjects (P=0.003). Posterior crossbites occurred significantly more in adenoid subjects in the 9-12 years category. In the vertical plane, the occurrence of deep bite was significantly greater in male than female adenoid subjects. Age had a statistically significant but weak correlation with anterior open bite (r=0.37). Age and BMI also had significant though weak correlations with posterior crossbite in female adenoid subjects (r=0.39 and r=0.36, respectively). Regression analysis also showed that age had a significant effect on the occurrence of anterior open bite, while BMI had a significant effect on the occurrence of class II occlusion in adenoid subjects (Pocclusion in the three planes. Age and BMI have significant effects on the occurrence of anterior open bite and class II division 1 malocclusion respectively in adenoid subjects. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  20. Quantitative evaluation of capillaroscopic microvascular changes in patients with established coronary heart disease.

    Science.gov (United States)

    Sanchez-Garcia, M Esther; Ramirez-Lara, Irene; Gomez-Delgado, Francisco; Yubero-Serrano, Elena M; Leon-Acuña, Ana; Marin, Carmen; Alcala-Diaz, Juan F; Camargo, Antonio; Lopez-Moreno, Javier; Perez-Martinez, Pablo; Tinahones, Francisco José; Ordovas, Jose M; Caballero, Javier; Blanco-Molina, Angeles; Lopez-Miranda, Jose; Delgado-Lista, Javier

    2018-02-23

    Microcirculation disturbances have been associated to most of the cardiovascular risk factors as well as to multiple inflammatory diseases. However, whether these abnormalities are specifically augmented in patients with coronary heart disease is still unknown. We aimed to evaluate if there is a relationship between the presence of coronary heart disease and the existence of functional and structural capillary abnormalities evaluated in the cutaneous microcirculation by videocapillaroscopy. Two matched samples of 30 participants with and without coronary heart disease but with similar clinical and anthropometric characteristics were evaluated by videocapillaroscopy at the dorsal skin of the third finger of the non-dominant hand. We calculated basal capillary density as well as capillary density after a period of arterial and venous occlusion in order to evaluate functionality and maximum capillary density. We also measured capillary recruitment. Microvascular capillary density at rest was significantly lower in patients suffering from coronary heart disease than in controls. This fact was also found after dynamic tests (arterial and venous occlusion), suggesting functional impairments. Capillary recruitment of the samples was not different in our sample. In our study, patients with coronary heart disease exhibit functional and structural microvascular disturbances. Although this is a very preliminary study, these findings open the door for further studying the microvascular functionality in coronary patients and how it relates to the response to treatment and/or the prognosis of the disease. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

  1. Plastia cirúrgica de óstio coronariano esquerdo com estenose não aterosclerótica Surgical ostial angioplasty of non-atherosclerotic left coronary artery stenosis

    Directory of Open Access Journals (Sweden)

    Fábio ARGENTA

    2000-12-01

    Full Text Available Discute-se o caso clínico de um paciente homem, 38 anos, com insuficiência cardíaca classe IV (NYHA e angina de repouso em razão de insuficiência aórtica severa, oclusão de óstio da artéria coronária direita e lesão subtotal do óstio da artéria coronária esquerda, em razão de aortite de origem luética. O tratamento constituiu-se de prótese aórtica mecânica e plastia do óstio coronariano esquerdo com "telhado" de veia safena. A evolução clínica pós-operatória foi excelente, tendo o paciente retornado à vida ativa e sem sintomas.A clinical case of a 38 year old male, with heart failure grade IV (NYHA and angina at rest related to severe aortic regurgitation, right coronary ostial occlusion, and a sub-total occlusion of the left coronary ostium owing to syphilitic infection in the past is reported and discussed. Treatment was established implanting a mechanical aortic prosthesis and a direct left main angioplasty suturing a patch made of safenous vein. Follow up has been excellent and the patient is today having a normal life, free of symptoms.

  2. Oxidative Stress in Human Aorta of Patients with Advanced Aortoiliac Occlusive Disease

    Directory of Open Access Journals (Sweden)

    Márcio Luís Lucas

    Full Text Available Abstract Introduction: Oxidative stress seems to be a role in the atherosclerosis process, but research in human beings is scarce. Objective: To evaluate the role of oxidative stress on human aortas of patients submitted to surgical treatment for advanced aortoiliac occlusive disease. Methods: Twenty-six patients were divided into three groups: control group (n=10 formed by cadaveric organ donors; severe aortoiliac stenosis group (patients with severe aortoiliac stenosis; n=9; and total aortoiliac occlusion group (patients with chronic total aortoiliac occlusion; n=7. We evaluated the reactive oxygen species concentration, nicotinamide adenine dinucleotide phosphate-oxidase, superoxide dismutase and catalase activities as well as nitrite levels in samples of aortas harvested during aortofemoral bypass for treatment of advanced aortoiliac occlusive disease. Results: We observed a higher level of reactive oxygen species in total aortoiliac occlusion group (48.3±9.56 pmol/mg protein when compared to severe aortoiliac stenosis (33.5±7.4 pmol/mg protein and control (4.91±0.8 pmol/mg protein groups (P<0.05. Nicotinamide adenine dinucleotide phosphate oxidase activity was also higher in total aortoiliac occlusion group when compared to the control group (3.81±1.7 versus 1.05±0.31 µmol/min.mg protein; P<0.05. Furthermore, superoxide dismutase and catalase activities were significantly higher in the severe aortoiliac stenosis and total aortoiliac occlusion groups when compared to the control cases (P<0.05. Nitrite concentration was smaller in the severe aortoiliac stenosis group in comparing to the other groups. Conclusion: Our results indicated an increase of reactive oxygen species levels and nicotinamide adenine dinucleotide phosphate-oxidase activity in human aortic samples of patients with advanced aortoiliac occlusive disease. The increase of antioxidant enzymes activities may be due to a compensative phenomenon to reactive oxygen species

  3. Alcohol consumption and blood lipids in elderly coronary patients

    NARCIS (Netherlands)

    Jong, de H.J.I.; Goede, de J.; Oude Griep, L.M.; Geleijnse, J.M.

    2008-01-01

    Alcohol may have a beneficial effect on coronary heart disease (CHD) that could be mediated by elevation of high-density lipoprotein cholesterol (HDLC). Data on alcohol consumption and blood lipids in coronary patients are scarce. We studied whether total ethanol intake and consumption of specific

  4. Prevalence and risk factors of premature coronary artery disease in patients undergoing coronary angiography in Kurdistan, Iraq.

    Science.gov (United States)

    Mohammad, Ameen Mosa; Jehangeer, Hekmat Izzat; Shaikhow, Sabri Khalif

    2015-11-18

    Premature coronary artery disease (PCAD) seems to increase, particularly in developing countries. Given the lack of such studies in the country, this study examines the prevalence, associated cardiovascular risk factors, and coronary angiographic profile of the disease in Iraq. Data was collected from a total of 445 adult patients undergoing coronary angiography at Duhok Heart Center, Kurdistan in a period between March and September 2014. Patients were divided into PCAD (male 70 % compared to lesser obstruction. Premature coronary artery disease is alarming  in the country. Cardiovascular risk factors are clustered among them. But the angiographic profile and therapeutic options of PCAD are close to those reported from previous studies.

  5. Selective Coronary Arteriography

    Science.gov (United States)

    Parker, John O.; Challis, Thomas W.; West, Roxroy O.

    1966-01-01

    The technique of selective coronary arteriography, as described originally by Sones, was employed in 255 patients. Successful catheterization of both coronary arteries was carried out in 88% of these patients, and in the last 100 examinations both coronary arteries were entered in 95 patients. Selective coronary arteriography is a useful diagnostic tool but is a potentially hazardous form of examination as we encountered four episodes of ventricular fibrillation in the present series. ImagesFig. 1Fig. 2Figs. 3A-DFig. 3EFig. 3FFig. 4Fig. 5Fig. 6Fig. 7Fig. 8Fig. 9 PMID:5902704

  6. The effect of peripherally inserted central catheter (PICC) valve technology on catheter occlusion rates--the 'ELeCTRiC' study.

    Science.gov (United States)

    Johnston, Andrew J; Streater, Carmel T; Noorani, Remy; Crofts, Joanne L; Del Mundo, Aldwin B; Parker, Richard A

    2012-01-01

    Peripherally Inserted Central Catheters (PICCs) are increasingly being used to provide short to medium-term central venous access. The current study was designed to test the hypothesis that PICC valve technology does not influence PICC occlusion rates. Intensive care unit (ICU) patients who required a PICC were randomized to one of three types of dual lumen PICC (open ended non-valved, Groshong valve, PASV valve). PICC occlusions were recorded and managed with a protocol that used urokinase. A total of 102 patients were recruited to the study. The overall risk of occlusion per catheter was 35% (95% CI 26% to 44%). The overall rate of occlusion was 76 occlusions per 1000 catheter days (95% CI 61 to 95). Presence or type of valve did not significantly influence this rate (open-ended non-valved PICC 38% of catheters, 79 occlusions per 1000 catheter days; Groshong 38% of catheters, 60 occlusions per 1000 catheter days; PASV 27% of catheters, 99 occlusions per 1000 catheter days). The dose of urokinase required to treat PICC occlusions did not significantly differ between PICC types. Valved PICCs do not appear to influence PICC occlusion rates.

  7. Coronary artery abnormalities in Kawasaki disease - Comparison between CT and MR coronary angiography

    International Nuclear Information System (INIS)

    Kim, Jong Woo; Goo, Hyun Woo

    2013-01-01

    Background: Although CT coronary angiography (CTCA) and MR coronary angiography (MRCA) are increasingly used in patients with Kawasaki disease, comparison of coronary artery assessability and diagnostic performance between the two imaging modalities has been rarely performed. Purpose: To investigate which imaging modality, CTCA or MRCA, is better for evaluating coronary artery abnormalities in patients with Kawasaki disease. Material and Methods: Between 2003 and 2011, 56 patients (38 boys/men; age range, 1-24 years) with Kawasaki disease underwent CTCA or MRCA (group A). Of these, 17 underwent both CTCA and MRCA (group B). Visibility of 11 coronary arterial segments in each patient was graded on a four-point scale. Coronary artery aneurysm, stenosis, and occlusion were evaluated by CTCA and MRCA, based on a reference standard obtained from cardiac catheterization, echocardiography, follow-up CTCA and MRCA, and clinical history. Coronary artery assessability and diagnostic performance were compared between CTCA and MRCA. Results: In per-segment analysis, more segments were assessable on CTCA than on MRCA in both groups. In per-patient analysis of group B, no significant difference in the assessability was found between CTCA (95.0%, 128.3/135 segments) and MRCA (92.4%, 124.8/135 segments) (P > 0.05). Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of CTCA vs. MRCA were 93.1% vs. 77.9% (P < 0.001), 99.2% vs. 99.7% (P = 0.65), 96.8% vs. 98.7% (P = 0.65), 98.2% vs. 94.1% (P < 0.001), and 98.0% vs. 94.9% (P = 0.008), respectively, in group A, and 91.8% vs. 70.4% (P < 0.001), 99.5% vs. 99.5% (P = 1.000), 98.5% vs. 98.0% (P = 1.000), 97.2% vs. 91.1% (P = 0.006), and 97.6% vs. 92.3% (P = 0.004), respectively, in group B. Conclusion: Although CTCA and MRCA show comparable assessability in per-patient analysis, CTCA shows higher diagnostic performance than MRCA for evaluating coronary artery abnormalities in patients with Kawasaki

  8. Round-the-clock performance of coronary CT angiography for suspected acute coronary syndrome: Results from the BEACON trial

    NARCIS (Netherlands)

    M.M. Lubbers (Marisa); A. Dedic (Admir); A. Kurata (Akira); M.L. Dijkshoorn (Marcel); J. Schaap (Jeroen); Lammers, J. (Jeroen); E.J. Lamfers (Evert); B.J.W.M. Rensing (Benno); R.L. Braam (Richard L.); H.M. Nathoe (Hendrik); J.C. Post; P.P.M. Rood (Pleunie); C.J. Schultz (Carl); A. Moelker (Adriaan); M. Ouhlous (Mohamed); B.M. van Dalen (Bas); H. Boersma (Eric); K. Nieman (Koen)

    2017-01-01

    textabstractObjective: To assess the image quality of coronary CT angiography (CCTA) for suspected acute coronary syndrome (ACS) outside office hours. Methods: Patients with symptoms suggestive of an ACS underwent CCTA at the emergency department 24 hours, 7 days a week. A total of 118 patients, of

  9. Coronary Artery Anomalies in Animals.

    Science.gov (United States)

    Scansen, Brian A

    2017-04-12

    Coronary artery anomalies represent a disease spectrum from incidental to life-threatening. Anomalies of coronary artery origin and course are well-recognized in human medicine, but have received limited attention in veterinary medicine. Coronary artery anomalies are best described in the dog, hamster, and cow though reports also exist in the horse and pig. The most well-known anomaly in veterinary medicine is anomalous coronary artery origin with a prepulmonary course in dogs, which limits treatment of pulmonary valve stenosis. A categorization scheme for coronary artery anomalies in animals is suggested, dividing these anomalies into those of major or minor clinical significance. A review of coronary artery development, anatomy, and reported anomalies in domesticated species is provided and four novel canine examples of anomalous coronary artery origin are described: an English bulldog with single left coronary ostium and a retroaortic right coronary artery; an English bulldog with single right coronary ostium and transseptal left coronary artery; an English bulldog with single right coronary ostium and absent left coronary artery with a prepulmonary paraconal interventricular branch and an interarterial circumflex branch; and a mixed-breed dog with tetralogy of Fallot and anomalous origin of all coronary branches from the brachiocephalic trunk. Coronary arterial fistulae are also described including a coronary cameral fistula in a llama cria and an English bulldog with coronary artery aneurysm and anomalous shunting vessels from the right coronary artery to the pulmonary trunk. These examples are provided with the intent to raise awareness and improve understanding of such defects.

  10. The location of obstruction predicts stent occlusion in malignant gastric outlet obstruction

    Science.gov (United States)

    Grunwald, Douglas; Cohen, Jonah; Bartley, Anthony; Sheridan, Jennifer; Chuttani, Ram; Sawhney, Mandeep S.; Pleskow, Douglas K.; Berzin, Tyler M.; Mizrahi, Meir

    2016-01-01

    Background: Gastric outlet obstruction (GOO) can occur with locally invasive or metastatic cancer involving the upper gastrointestinal tract at the pylorus or the duodenum. Endoscopic management with self-expanding metal stents (SEMSs) is often the preferred palliative approach. Stent occlusion is a common reason for failure and reintervention. We set out to determine whether the location of the malignant obstruction is associated with the angulation of the stent and can predict stent occlusion. Methods: We performed a retrospective review of consecutive patients who underwent successful duodenal stenting with SEMS for malignant GOO between 2006 and 2015 at a large advanced endoscopy referral center. We determined the location of obstruction, the stent angle, and the rate of technical and clinical success of stent placement. We then identified cases of subsequent stent occlusion confirmed by endoscopic evaluation. Results: A total of 100 consecutive patients were included in the study; 91 of these patients had enough data to evaluate SEMS occlusion. A total of 21 patients (23%) developed stent occlusion with a median time of 39 days. The risk of occlusion sequentially increased as the obstruction occurred more distally from the antrum to the third or fourth portion of the duodenum (p = 0.006). This relationship was maintained after controlling for stent angle (p = 0.05). Conclusions: A distal location of malignant GOO was strongly predictive of stent occlusion, independent of stent angle. This may be due to longer and more complex distal obstructions, along with foreshortening of the stent during placement and tumor infiltration. If replicated, these results will have implications for endoscopic practice and future device development. PMID:27803736

  11. Ulnar artery: The Ulysses ultimate resort for coronary procedures

    Directory of Open Access Journals (Sweden)

    George Hahalis, MD, PhD

    2016-07-01

    Full Text Available Despite the increasing worldwide adoption of the transradial access site, the ulnar artery (UA only very infrequently serves as a primary option for coronary procedures. In contrast to the uncertainty surrounding previous reports regarding the feasibility and safety, recent data from larger registries and randomized trials provide more conclusive evidence that the transulnar route may be safely selected as an alternative arterial access approach. However, a default transulnar strategy appears time-consuming and is associated with higher crossover rates compared with the radial artery (RA. Once arterial access is obtained, the likelihood of a successful coronary procedure is high and similar between the two forearm arteries. The UA has similar flow-mediating vasodilating properties with and seems at least as vulnerable as the RA with regard to incident occlusion, with UA occlusion (UAO rates being probably higher than previously anticipated. A learning curve effect may not be apparent for crossover rates among experienced radialists, but increasing experience is associated with reduction in the fluoroscopy time, contrast volume and frequency of large hematoma formation. The UA may represents an important alternative access site for coronary procedures, and experienced radial operators should obtain additional skills to perform the transulnar approach. Nevertheless, in view of this method's lower feasibility compared to the RA, an initial ulnar access strategy should be reserved for carefully selected patients to ensure satisfactory cannulation rates.

  12. Ulnar artery: The Ulysses ultimate resort for coronary procedures.

    Science.gov (United States)

    Hahalis, George; Deftereos, Spyridon; Bertrand, Olivier F

    2016-08-20

    Despite the increasing worldwide adoption of the transradial access site, the ulnar artery (UA) only very infrequently serves as a primary option for coronary procedures. In contrast to the uncertainty surrounding previous reports regarding the feasibility and safety, recent data from larger registries and randomized trials provide more conclusive evidence that the transulnar route may be safely selected as an alternative arterial access approach. However, a default transulnar strategy appears time-consuming and is associated with higher crossover rates compared with the radial artery (RA). Once arterial access is obtained, the likelihood of a successful coronary procedure is high and similar between the two forearm arteries. The UA has similar flow-mediating vasodilating properties with and seems at least as vulnerable as the RA with regard to incident occlusion, with UA occlusion (UAO) rates being probably higher than previously anticipated. A learning curve effect may not be apparent for crossover rates among experienced radialists, but increasing experience is associated with reduction in the fluoroscopy time, contrast volume and frequency of large hematoma formation. The UA may represents an important alternative access site for coronary procedures, and experienced radial operators should obtain additional skills to perform the transulnar approach. Nevertheless, in view of this method's lower feasibility compared to the RA, an initial ulnar access strategy should be reserved for carefully selected patients to ensure satisfactory cannulation rates. Copyright © 2016 Hellenic Cardiological Society. Published by Elsevier B.V. All rights reserved.

  13. Progression of Diabetic Capillary Occlusion: A Model.

    Directory of Open Access Journals (Sweden)

    Xiao Fu

    2016-06-01

    Full Text Available An explanatory computational model is developed of the contiguous areas of retinal capillary loss which play a large role in diabetic maculapathy and diabetic retinal neovascularization. Strictly random leukocyte mediated capillary occlusion cannot explain the occurrence of large contiguous areas of retinal ischemia. Therefore occlusion of an individual capillary must increase the probability of occlusion of surrounding capillaries. A retinal perifoveal vascular sector as well as a peripheral retinal capillary network and a deleted hexagonal capillary network are modelled using Compucell3D. The perifoveal modelling produces a pattern of spreading capillary loss with associated macular edema. In the peripheral network, spreading ischemia results from the progressive loss of the ladder capillaries which connect peripheral arterioles and venules. System blood flow was elevated in the macular model before a later reduction in flow in cases with progression of capillary occlusions. Simulations differing only in initial vascular network structures but with identical dynamics for oxygen, growth factors and vascular occlusions, replicate key clinical observations of ischemia and macular edema in the posterior pole and ischemia in the retinal periphery. The simulation results also seem consistent with quantitative data on macular blood flow and qualitative data on venous oxygenation. One computational model applied to distinct capillary networks in different retinal regions yielded results comparable to clinical observations in those regions.

  14. Occlusion issues in early Renaissance art

    Science.gov (United States)

    Gillam, Barbara

    2011-01-01

    Early Renaissance painters innovatively attempted to depict realistic three-dimensional scenes. A major problem was to produce the impression of overlap for surfaces that occlude one another in the scene but are adjoined in the picture plane. Much has been written about perspective in art but little about occlusion. Here I examine some of the strategies for depicting occlusion used by early Renaissance painters in relation to ecological considerations and perceptual research. Perceived surface overlap is often achieved by implementing the principle that an occluding surface occludes anything behind it, so that occlusion perception is enhanced by a lack of relationship of occluding contour to occluded contours. Some well-known figure-ground principles are also commonly used to stratify adjoined figures. Global factors that assist this stratification include the placement of figures on a ground plane, a high viewpoint, and figure grouping. Artists of this period seem to have differed on whether to occlude faces and heads, often carefully avoiding doing so. Halos were either eliminated selectively or placed oddly to avoid such occlusions. Finally, I argue that the marked intransitivity in occlusion by architecture in the paintings of Duccio can be related to the issue of perceptual versus cognitive influences on the visual impact of paintings. PMID:23145262

  15. Depicting Occlusion in Early Renaissance Art

    Science.gov (United States)

    Gillam, Barbara

    2011-01-01

    The artist attempting to give the impression of three-dimensional relationships must convey somehow that one surface is in front of another. There is a large and venerable literature in Psychology on this subject, showing how figure-ground, border ownership and amodal completion and continuation are determined but there is almost no discussion of how artist's have recruited these and other principles to create convincing impressions of occlusion. Even Gombrich (Art & Illusion 1960) only considers the situation in which a figure has to be imagined from very partial cues, not how juxtaposed elements in art are parsed perceptually into occluding and occluded surfaces. In this paper I shall discuss approaches to occlusion present in early Renaissance art and the degree to which the principles now well-known to Psychologists were discovered and used, as artists increasingly depicted naturalistic scenes. Among the preoccupations of these artists, as indicated by their work, were whether and how much to occlude faces (and the related issue of the management of haloes), occlusion of and by architectural features, and the importance or otherwise of transitivity in occlusion relationships within the scene. They also clearly used the ground plane, high viewpoints and arrangements of contour terminations, as well as more conventional figural cues, to disambiguate perceived occlusion or to avoid the confusion of multiple surfaces.

  16. Depicting Occlusion in Early Renaissance Art

    Directory of Open Access Journals (Sweden)

    Barbara Gillam

    2011-05-01

    Full Text Available The artist attempting to give the impression of three-dimensional relationships must convey somehow that one surface is in front of another. There is a large and venerable literature in Psychology on this subject, showing how figure-ground, border ownership and amodal completion and continuation are determined but there is almost no discussion of how artist's have recruited these and other principles to create convincing impressions of occlusion. Even Gombrich (Art & Illusion 1960 only considers the situation in which a figure has to be imagined from very partial cues, not how juxtaposed elements in art are parsed perceptually into occluding and occluded surfaces. In this paper I shall discuss approaches to occlusion present in early Renaissance art and the degree to which the principles now well-known to Psychologists were discovered and used, as artists increasingly depicted naturalistic scenes. Among the preoccupations of these artists, as indicated by their work, were whether and how much to occlude faces (and the related issue of the management of haloes, occlusion of and by architectural features, and the importance or otherwise of transitivity in occlusion relationships within the scene. They also clearly used the ground plane, high viewpoints and arrangements of contour terminations, as well as more conventional figural cues, to disambiguate perceived occlusion or to avoid the confusion of multiple surfaces.

  17. Occlusion Issues in Early Renaissance Art

    Directory of Open Access Journals (Sweden)

    Barbara Gillam

    2011-12-01

    Full Text Available Early Renaissance painters innovatively attempted to depict realistic three-dimensional scenes. A major problem was to produce the impression of overlap for surfaces that occlude one another in the scene but are adjoined in the picture plane. Much has been written about perspective in art but little about occlusion. Here I examine some of the strategies for depicting occlusion used by early Renaissance painters in relation to ecological considerations and perceptual research. Perceived surface overlap is often achieved by implementing the principle that an occluding surface occludes anything behind it, so that occlusion perception is enhanced by a lack of relationship of occluding contour to occluded contours. Some well-known figure-ground principles are also commonly used to stratify adjoined figures. Global factors that assist this stratification include the placement of figures on a ground plane, a high viewpoint, and figure grouping. Artists of this period seem to have differed on whether to occlude faces and heads, often carefully avoiding doing so. Halos were either eliminated selectively or placed oddly to avoid such occlusions. Finally, I argue that the marked intransitivity in occlusion by architecture in the paintings of Duccio can be related to the issue of perceptual versus cognitive influences on the visual impact of paintings.

  18. Temporomandibular Disorders Treatment with Correction of Decreased Occlusal Vertical Dimension.

    Science.gov (United States)

    Guguvcevski, Ljuben; Gigovski, Nikola; Mijoska, Aneta; Zlatanovska, Katerina; Arsova-Gigovska, Ana

    2017-12-15

    The term decreased occlusal vertical dimension refers to the reduced distance between two anatomical points while the teeth are in a state of occlusion. The development of this situation is about some parafunctional activities of the masticatory system. To evaluate the value of decreased occlusal vertical dimension in cases with temporomandibular disorder and to follow up the influence of corrective treatment with occlusal splints and definitive prosthetic construction upon the elimination of clinical symptoms. Eight cases with decreased occlusal vertical dimension accompanied with temporomandibular disorders were treated with an occlusal splint, as part of reversible occlusal treatment. After reducing, or complete elimination of the symptoms related to problems of decreased occlusal vertical dimension, the definitive prosthetic therapy was performed. The mean value of decreased occlusal vertical dimension in our patients is 8.5 mm, and the mean value of therapy time with an occlusal splint in these patients was 3.5 months. Occlusal splint is a part of reversible occlusal therapy in cases with decreased occlusal vertical dimension. After reducing the symptoms related to decreased occlusal vertical dimension definitive prosthetic therapy can be done.

  19. Distribution of extracellular potassium and electrophysiologic changes during two-stage coronary ligation in the isolated, perfused canine heart

    NARCIS (Netherlands)

    Coronel, R.; Fiolet, J. W.; Wilms-Schopman, J. G.; Opthof, T.; Schaapherder, A. F.; Janse, M. J.

    1989-01-01

    We studied the relation between [K+]o and the electrophysiologic changes during a "Harris two-stage ligation," which is an occlusion of a coronary artery, preceded by a 30-minute period of 50% reduction of flow through the artery. This two-stage ligation has been reported to be antiarrhythmic. Local

  20. Coronary stent on coronary CT angiography: Assessment with model-based iterative reconstruction technique

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Eun Chae; Kim, Yeo Koon; Chun, Eun Ju; Choi, Sang IL [Dept. of of Radiology, Seoul National University Bundang Hospital, Seongnam (Korea, Republic of)

    2016-05-15

    To assess the performance of model-based iterative reconstruction (MBIR) technique for evaluation of coronary artery stents on coronary CT angiography (CCTA). Twenty-two patients with coronary stent implantation who underwent CCTA were retrospectively enrolled for comparison of image quality between filtered back projection (FBP), adaptive statistical iterative reconstruction (ASIR) and MBIR. In each data set, image noise was measured as the standard deviation of the measured attenuation units within circular regions of interest in the ascending aorta (AA) and left main coronary artery (LM). To objectively assess the noise and blooming artifacts in coronary stent, we additionally measured the standard deviation of the measured attenuation and intra-luminal stent diameters of total 35 stents with dedicated software. All image noise measured in the AA (all p < 0.001), LM (p < 0.001, p = 0.001) and coronary stent (all p < 0.001) were significantly lower with MBIR in comparison to those with FBP or ASIR. Intraluminal stent diameter was significantly higher with MBIR, as compared with ASIR or FBP (p < 0.001, p = 0.001). MBIR can reduce image noise and blooming artifact from the stent, leading to better in-stent assessment in patients with coronary artery stent.

  1. 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.

  2. Occlusal Caries: Biological Approach for Its Diagnosis and Management

    DEFF Research Database (Denmark)

    Christina Carvalho, Joana; Dige, Irene; Machiulskiene, Vita

    2016-01-01

    The management of occlusal caries still remains a major challenge for researchers as well as for general practitioners. The present paper reviews and discusses the most up-to-date knowledge and evidence of the biological principles guiding diagnosis, risk assessment, and management of the caries...... process on occlusal surfaces. In addition, it considers the whole spectrum of the caries process on occlusal surfaces, ranging from the molecular ecology of occlusal biofilms to the management of deep occlusal caries lesions. Studies using molecular methods with focus on biofilms in relation to occlusal...

  3. Effect of glove occlusion on the skin barrier

    DEFF Research Database (Denmark)

    Tiedemann, Daniel; Clausen, Maja Lisa; John, Swen Malthe

    2016-01-01

    that the negative effect of occlusion in itself is limited, and that only extensive and long-term occlusion will cause barrier impairment. However, studies investigating combined effect of occlusion and exposure to soaps/detergents indicate that occlusion significantly enhances the skin barrier damage caused...... of this study is to review the literature on the effects of glove occlusion on skin barrier function. The PubMed database was searched up to 1 February 2015 for articles on the association between glove occlusion and skin barrier function, including human studies only and in English. Only experimental studies...... by detergents/soaps in a dose-response fashion....

  4. Compliance with occlusion therapy for childhood amblyopia.

    Science.gov (United States)

    Wallace, Michael P; Stewart, Catherine E; Moseley, Merrick J; Stephens, David A; Fielder, Alistair R

    2013-09-17

    Explore compliance with occlusion treatment of amblyopia in the Monitored and Randomized Occlusion Treatment of Amblyopia Studies (MOTAS and ROTAS), using objective monitoring. Both studies had a three-phase protocol: initial assessment, refractive adaptation, and occlusion. In the occlusion phase, participants were instructed to dose for 6 hours/day (MOTAS) or randomized to 6 or 12 hour/day (ROTAS). Dose was monitored continuously using an occlusion dose monitor (ODM). One hundred and fifty-two patients (71 male, 81 female; 122 Caucasian, 30 non-Caucasian) of mean ± SD age 68 ± 18 months participated. Amblyopia was defined as an interocular acuity difference of at least 0.1 logMAR and was associated with anisometropia in 50, strabismus in 44, and both (mixed) in 58. Median duration of occlusion was 99 days (interquartile range 72 days). Mean compliance was 44%, mean proportion of days with no patch worn was 42%. Compliance was lower (39%) on weekends compared with weekdays (46%, P = 0.04), as was the likelihood of dosing at all (52% vs. 60%, P = 0.028). Compliance was lower when attendance was less frequent (P amblyopia type, and severity were not associated with compliance. Mixture modeling suggested three subpopulations of patch day doses: less than 30 minutes; doses that achieve 30% to 80% compliance; and doses that achieve around 100% compliance. This study shows that compliance with patching treatment averages less than 50% and is influenced by several factors. A greater understanding of these influences should improve treatment outcome. (ClinicalTrials.gov number, NCT00274664).

  5. Occlusion and occlusal characteristics of primary dentition in North Indian children of East Lucknow region.

    Science.gov (United States)

    Khan, R; Singh, N; Govil, S; Tandon, S

    2014-10-01

    To determine occlusion and occlusal characteristics of the primary dentition in North Indian school-going children of East Lucknow region. A cross-sectional study was conducted on 453 participants in the age group of 3-6 years. Participants were selected randomly and occlusal relationship was assessed based on Baume's classification. Various other occlusal characteristics were also recorded and assessed based on clinical and photographic evaluation. The data were then subjected to statistical analysis. Out of 453 participants examined, results revealed 62.3% had flush terminal plane; 31.3% mesial step molar relationship and 6.4% distal step molar relationship. It was also observed that 91.6% had Class I canine relationship, 93.4% primate spaces, 69.5% physiologic spaces. Amongst other occlusal characteristics, increased overbite and crowding were prevalent. Association of various occlusal characteristics and oral habits with respect to primary molar relation was also assessed. Chi-square test was performed to carry out statistical analysis. p value plane relationship with spacing and Class I canine relationship predominated. Further prospective studies are required to provide an insight into patterns of occlusal relationship and its changes in Indian children.

  6. Influence of mandibular fixation method on stability of the maxillary occlusal plane after occlusal plane alteration.

    Science.gov (United States)

    Yosano, Akira; Katakura, Akira; Takaki, Takashi; Shibahara, Takahiko

    2009-05-01

    In this study, we investigated how method of mandibular fixation influenced longterm postoperative stability of the maxilla in Class III cases. In particular, we investigated change in the maxillary occlusal plane after Occlusal Plane Alteration. Therefore, we focused on change in the palatal plane to evaluate stability of the maxillary occlusal plane, as the position of the palatal plane affects the maxillary occlusal plane. This study included 16 patients diagnosed with mandibular protrusion. Alteration of the occlusal plane was achieved by clockwise rotation of the maxilla by Le Fort I osteotomy and mandibular setback was performed by bilateral sagittal split ramus osteotomy. We analyzed and examined lateral cephalometric radiographs taken at 1 month, 3 months, 6 months, and 1 year after surgery. Stability achieved by two methods of mandibular fixation was compared. In one group of patients (group S) titanium screws were used, and in the other group (group P) titanium-locking mini-plates were used. No significant displacement was recognized in group S, whereas an approximately 0.7mm upward vertical displacement was recognized in the anterior nasal spine in group P. As a result, not only the angle of the palatal plane and S-N plane, but also occlusal plane angle in group P showed a greater decrease than that in group S. The results suggest that fixing the mandible with screws yielded greater stability of the maxilla and maxillary occlusal plane than fixing the mandible with titanium plates.

  7. Immediate Occlusal versus Non-Occlusal Loading of Implants: A Randomized Clinical Pilot Study.

    Science.gov (United States)

    Vogl, Susanne; Stopper, Marlene; Hof, Markus; Wegscheider, Walther A; Lorenzoni, Martin

    2015-06-01

    Immediate occlusal and non-occlusal loading protocols have been discussed and, despite varying success rates, are considered viable in selected cases. Preoperative implant planning and intraoperative transfer are essential to the success of implant-supported reconstructions in partially or completely edentulous jaws. This study was performed to compare clinical outcomes of immediate occlusal versus non-occlusal loading of posterior implants. Of 19 patients with 52 screw-type implants replacing mandibular molars or premolars, nine patients with 21 implants were randomized to a study group that received immediate restorations with occlusal loading, whereas 10 patients with 31 implants were randomized to a control group that received provisional restorations without occlusal loading. Occlusal loading was defined as full loading in maximum intercuspidation. Single-tooth or splinted multiunit restorations were incorporated by screw retention or cementation. Marginal bone defects (MBD), implant survival, and implant success were evaluated 12 months after insertion. Both groups revealed similar MBD levels consistent with previous reports. No implants were lost (overall survival: 100%) or found to fail (overall success: 100%). No significant intergroup differences were noted for any of the evaluated parameters. Immediate restorations in partially edentulous mandibles demonstrated successful clinical and radiographic 12-month results. Larger long-term prospective studies are needed to confirm the final evidence and predictability of immediate functional loading as a standard treatment concept for partially edentulous jaws. © 2013 Wiley Periodicals, Inc.

  8. THE ROLE OF ECG IN LOCALIZING THE CULPRIT VESSEL OCCLUSION IN ACUTE ST SEGMENT ELEVATION MYOCARDICAL INFARCTION WITH ANGIOGRAPHIC CORRELATION

    Directory of Open Access Journals (Sweden)

    Markandeya Rao

    2015-12-01

    Full Text Available BACKGROUND & OBJECTIVES The Electrocardiogram remains a crucial tool in the identification and management of acute myocardial infarction. A detailed analysis of patterns of ST-segment elevation may influence decisions regarding the perfusion therapy. This study was undertaken to identify the culprit vessel from ECG in patients with acute ST elevation myocardial infarction and correlate with coronary angiogram. MATERIALS & METHODS This is a prospective study, conducted on 126 patients in Osmania General Hospital, Hyderabad. Patients with ST segment elevation from ECG was evaluated to identify culprit vessel and later correlated with coronary angiogram. RESULTS Amongst 126 patients in this study, 70 patients had anterior wall and 56 patients had inferior wall myocardial infarction. ST> 1mm in V4R, ST  V3/ST  LIII Lead II was the most sensitive and ratio of STV3/STLIII >1.2 was the most specific criteria. ST in inferior leads > 1mm had maximum sensitivity in localizing occlusion in proximal D1 occlusion proximal to S1 as well. Absence of ST i in inferior leads is the most sensitive criteria in occlusion distal to S1 as well as in distal D1 in AWMI. CONCLUSION The admission ECG in patients with ST elevation AMI is valuable not only for determining early reperfusion treatment, but also provides important information to guide clinical decision-making.

  9. Management of occlusal canting with miniscrews.

    Science.gov (United States)

    Yáñez-Vico, Rosa Maria; Iglesias-Linares, Alejandro; Cadenas de Llano-Pérula, Maria; Solano-Reina, Alvaro; Solano-Reina, Enrique

    2014-07-01

    A 14-year-old boy with a skeletal Class II malocclusion and open bite whose chief complaint was a posterior crossbite showed a canted occlusal plane with asymmetric gummy smile and mandibular deviation at clinical examination. The treatment with miniscrews focused on the bilateral intrusion of the maxillary posterior teeth and, after resolving the open bite, a new biomechanical technique involving joined miniscrews was applied for an en masse intrusion of the left side. This treatment strategy achieved optimal occlusion with improvements to the sagittal, vertical, and transverse relationships and achieved a harmonious smile.

  10. Occlusal Characteristics of the Primary Dentition Revisited.

    Science.gov (United States)

    Alexander, Stanley A; Askari, Marjan; Lewis, Patricia

    2015-11-01

    The occlusal characteristics of the primary dentition of 130 children 3 to 6 years old were examined. Variables were the terminal plane relationship, primary canine occlusion, spacing, overjet and overbite relationships. The flush terminal plane was the most common finding. A Class I relationship of the primary canine occurred in 85% of the subjects. Spaced dentitions occurred 81% of the time, while the presence of primate spaces occurred in at least one of the four quadrants. The overjet relationship varied from +1 mm to 4 mm in all subjects, and the majority of children were considered to have a normal overbite.

  11. Interventional treatment for the occlusive hepatic veins in Budd-Chiari syndrome

    International Nuclear Information System (INIS)

    Zhang Xitong; Xu Ke; Feng Bo; Su Hongying; Li Hong; Zu Maoheng; Cui Jingguo; Yang Xueliang; Zhao Jinxu; Chen Kai

    2003-01-01

    Objective: To evaluate the interventional methods for occlusive hepatic veins in Budd-Chiari syndrome and its mid and long-term effects. Methods: Forty-two patients (male 17 cases and female 25 cases) aged from 18 to 57 years old (mean 34.5 years) were studied. The liver functions were Child A in 23 cases, Child B in 6 cases, and Child C in 13 cases, respectively. A total of 92 hepatic veins were occluded. Among them, 29 left hepatic veins, 24 middle hepatic veins, 36 right hepatic veins, and 3 accessory hepatic veins were occluded. Thirty-four patients were accompanied with the stenotic or occlusive inferior vena cave (IVC) . The interventional methods included: (1) recanalization of occlusive hepatic veins (by transjugular, transfemoral, and percutaneous transhepatic route, or the combination of above three methods); (2) percutaneous transluminal angioplasty; (3) self-expanding stent implantation. The occlusive IVC in 32 patients also accepted PTA and/or stent implantation. Results: The successful recanalization was carried out in forty hepatic veins in 40 patients. PTA of occlusive veins was followed by stent implantation in 8 patients. The pressure of hepatic veins dropped from 34.5 cm H 2 O (25.0-48.0 cm H 2 O) to 22.0 cm H 2 O (12.0-35.0 cm H 2 O) after intervention (T=11.50, P < 0.01). The symptoms and pathological signs improved obviously in 32 cases and improved partly in 8 cases. During the follow-up period from 1 month to 54 months (mean 27.5 months), one cases died of liver function failure at one month after intervention. The re-intervention of occlusive veins in two cases were performed and the better results were acquired again. Five cases didn't accept re-intervention. Neither recurrence of symptoms nor re-occlusion of hepatic veins was found in the other 32 patients. Conclusion: (1) Multiple and synthetical interventional methods for the occlusive hepatic veins in Budd-Chiari syndrome can be utilized. (2) The intervention of hepatic vein is mini

  12. Strain gauge analysis of occlusal forces on implant prostheses at various occlusal heights.

    Science.gov (United States)

    Cho, Young-Eun; Park, Eun-Jin; Koak, Jai-Young; Kim, Seong-Kyun; Heo, Seong-Joo; Park, Ji-Man

    2014-01-01

    The purpose of this study was to evaluate and compare the strain development at different occlusal heights of an implant prosthesis and adjacent teeth through the use of strain gauges. A test model was constructed using autopolymerizing polyurethane resin, artificial composite resin teeth, and an implant gold crown in the mandibular first molar area. The resin block containing the implant and the gold crown was sectioned, and two expansion screws were attached perpendicular to the bottom of the resin block on the buccal and lingual sides. The expansion screws were turned to create a gap. Four groups were created based on the occlusal height of the implant gold crown. Three strain gauges were attached to the buccal surfaces of the mandibular right second premolar, implant gold crown, and second molar. Beef jerky, carrot, and bread were used as test foods. A universal testing machine was used to apply compressive forces of 300 N (beef jerky), 250 N (carrot), and 50 N (bread), and the occlusal force was measured in each group. With 300 N, occlusal forces were concentrated on the adjacent teeth when the occlusal height of the implant prosthesis decreased. With 250 and 50 N, when the occlusal height of the implant prosthesis increased, the occlusal force applied to the implant prosthesis increased, but alterations in the implant crown height had little effect on the adjacent teeth. Different amounts of strain in the implant prosthesis and adjacent teeth were recorded depending on the occlusal height of the prosthesis. With 250 or 50 N of force, an increased prosthesis height affected the implant itself. With 300 N of force, decreased occlusal height of the prosthesis resulted in increased force on the adjacent teeth.

  13. Comparison of Radiofrequency Ablation with Saturated Saline Preinjection and Renal Artery Occlusion: In Vivo Study in Canine Kidneys Preinjection and Renal Artery Occlusion: In Vivo Study in Canine Kidneys

    Energy Technology Data Exchange (ETDEWEB)

    Shin, Byung Seok; Ahn, Moon Sang [Chungnam National University Hospital, Daejeon (Korea, Republic of); Park, Mi Hyun [Dept. of Radiology, Dankook University Hospital, Cheonan (Korea, Republic of); Jeon, Gyeong Sik [Dept. of Radiology, CHA Bundang Medical Center, CHA University College of Medicine, Seongnam (Korea, Republic of); Lee, Byung Mo [Dept. of Surgery, Paik Hospital, Inje University College of Medicine, Seoul (Korea, Republic of); Lee, Ki Chang [Dept. of Veterinary Radiology, Chonbuk National University College of VeterinaryMedicine, Seoul (Korea, Republic of); Kim, Ho Jun [Dept. of Radiology, Konyang University Hospital, Daejeon (Korea, Republic of); Ohm, Joon Young [Dept. of Radiology, Bucheon St. Mary Hospital, The Catholic University of Korea College of Medicine, Bucheon (Korea, Republic of)

    2012-04-15

    To compare the ablation zone after radiofrequency ablation (RFA) with saturated saline preinjection and renal artery occlusion in canine kidneys. RFA was induced in the kidneys of six mongrel dogs. A total of 24 ablation zones were induced using a 1-cm tip internally cooled needle electrode in three groups: RFA (Control group), RFA with 0.5 mL saturated saline preinjection (SS group), and RFA with renal artery occlusion by atraumatic vascular clamp (Occlusion group). Ablation zone diameters were measured along transverse and longitudinal sections of the needle axis, and volumes were calculated. Temperature, applied voltage, current, and impedance during RFA were recorded automatically. The RFA zone volume was the largest in the SS group (1.33 {+-} 0.34 cm{sup 3}), followed by the Occlusion group (1.07 {+-} 0.38 cm{sup 3}) and then the Control group (0.62 {+-} 0.09 cm{sup 3}). Volumes for the SS and Occlusion groups were significantly larger than those for the Control group (p = 0.001, p = 0.012). There was no significant difference in volumes between the SS and Occlusion groups (p = 0.178). Saturated saline preinjection is as effective as renal arterial occlusion for expanding the ablation zone. RFA with saturated saline preinjection could help to treat large renal tumors.

  14. THE RESULTS OF URGENT CORONARY ANGIOGRAPHY AND STENTING IN THE ACUTE CORONARY SYNDROME

    Directory of Open Access Journals (Sweden)

    Vasiliy Davydkin

    2016-07-01

    Full Text Available The acute coronary syndrome is a major cause of hospitalization and high mortality rates. For many there have been ongoing debates years over the treatment method choice and various diagnostic methods. The purpose of the research is to investigate the diagnostic capabilities of emergency coronary angiography and efficacy of transluminal balloon angioplasty with stenting for acute coronary syndrome with lifting and without ST elevation. Results In patients with ACS with ST-segment elevation myocardial contractility was better after thrombolytic therapy, which is appropriate over the first 2 hours of the onset of anginal pain. However, in the group of the patients with ACS with ST-segment elevation violations of local contractility was more common than in the group of patients with ACS without ST-segment elevation. In both groups of patients with ACS the risk of unfavorable outcome did not depend on the number of affected vessels, but on a variant of the syndrome (elevation or without ST elevation. In patients with ACS with ST-segment elevation was significantly more frequently identified hemodynamically significant stenosis of the arteries. In ACS without ST-segment elevation no statistically significant difference in myocardial contractility and risk of unfavorable outcome on the scale of GRACE in groups with single and biarterial coronary disease not obtained. In the case of significant stenoses diagnosed through emergency coronary angiography, emergency balloon angioplasty with stenting is indicated. When there is technical impossibility of angioplasty (excessive tortuosity, occlusion, stenosis of the left main coronary artery, etc., it is advisable to perform emergency bypass surgery. Discussion and Conclusions The analysis of the treatment results it revealed that timely percutaneous transluminal coronary angioplasty with stenting in combination with thrombolytic therapy has contributed significantly to improving not only contractility, but

  15. An evaluation of occlusal relationship and primate space in deciduous dentition in Kancheepuram District, Tamil Nadu, India

    Directory of Open Access Journals (Sweden)

    Daya Srinivasan

    2017-01-01

    Full Text Available Aim: The objective of the study was to evaluate the occlusal characteristics of primary dentition in 3–5-year-old children in Kancheepuram district. Materials and Methods: A cross-sectional survey was carried out on children aged 3–5 year old in the Kancheepuram district. A total of 603 children were examined. Occlusal relationship was assessed separately on both right and left side and was classified as a flush terminal plane, mesial step, or distal step. Similarly, occlusal relationship of primary canine was examined and classified as Class I, II, or III. Primate space was measured in both the arches using digital Vernier caliper. Results: Pearson Chi-square test was used. Statistical significance was noted on both right and left side primary molar occlusion as well as in the canine occlusion across the three age groups. Primate spaces in both arches have been found to be significant across the three age groups. Mann–Whitney test between gender and occlusal relationship was found to be not significant. Conclusion: Flush terminal plane is the most common primary molar occlusion found in the present study which is statistically significant. Most of the children had primate space present in upper and lower teeth which is statistically significant.

  16. [Effect of 2 methods of occlusion adjustment on occlusal balance and muscles of mastication in patient with implant restoration].

    Science.gov (United States)

    Wang, Rong; Xu, Xin

    2015-12-01

    To compare the effect of 2 methods of occlusion adjustment on occlusal balance and muscles of mastication in patients with dental implant restoration. Twenty patients, each with a single edentulous posterior dentition with no distal dentition were selected, and divided into 2 groups. Patients in group A underwent original occlusion adjustment method and patients in group B underwent occlusal plane reduction technique. Ankylos implants were implanted in the edentulous space in each patient and restored with fixed prosthodontics single unit crown. Occlusion was adjusted in each restoration accordingly. Electromyograms were conducted to determine the effect of adjustment methods on occlusion and muscles of mastication 3 months and 6 months after initial restoration and adjustment. Data was collected and measurements for balanced occlusal measuring standards were obtained, including central occlusion force (COF), asymmetry index of molar occlusal force(AMOF). Balanced muscles of mastication measuring standards were also obtained including measurements from electromyogram for the muscles of mastication and the anterior bundle of the temporalis muscle at the mandibular rest position, average electromyogram measurements of the anterior bundle of the temporalis muscle at the intercuspal position(ICP), Astot, masseter muscle asymmetry index, and anterior temporalis asymmetry index (ASTA). Statistical analysis was performed using Student 's t test with SPSS 18.0 software package. Three months after occlusion adjustment, parameters of the original occlusion adjustment method were significantly different between group A and group B in balanced occlusal measuring standards and balanced muscles of mastication measuring standards. Six months after occlusion adjustment, parameters of the original occlusion adjustment methods were significantly different between group A and group B in balanced muscles of mastication measuring standards, but was no significant difference in balanced

  17. Cost-identification analysis of revascularization procedures on patients with peripheral arterial occlusive disease

    NARCIS (Netherlands)

    Jansen, R.M.G.; de Vries, S.O.; Cullen, K.A.; Donaldson, M.C.; Hunink, M.G.M.

    1998-01-01

    Objective: To determine average total in-hospital costs of various revascularization procedures for peripheral arterial occlusive disease; to examine the effect of procedure-related complications and patient characteristics on these costs; and to examine whether costs have changed over time.

  18. Novel technique using the Outback LTD catheter for a common iliac artery occlusion.

    Science.gov (United States)

    Mixon, Timothy A

    2009-02-15

    We present a case of an unusual arterial--arterial anastamosis that resulted from an unsuccessful attempt at crossing a total occlusion of the common iliac artery. Subsequently, we were able to successful recanalize the artery using a modified technique with the Outback reentry catheter. Copyright 2009 Wiley-Liss, Inc.

  19. Left atrial appendage occlusion versus standard medical care in patients with atrial fibrillation and intracerebral hemorrhage

    DEFF Research Database (Denmark)

    Nielsen-Kudsk, Jens Erik; Johnsen, Søren Paaske; Wester, Per

    2017-01-01

    AIMS: The aim of this study was to investigate the prognosis in patients with atrial fibrillation (AF) and intracerebral haemorrhage (ICH) having a left atrial appendage occlusion (LAAO) versus patients receiving standard medical therapy. METHODS AND RESULTS: A total of 151 patients from the Nord...

  20. Selective coronary scintigraphy

    International Nuclear Information System (INIS)

    Gambini, D.-J.

    1975-01-01

    Isotopic techniques occupy a leading place amongst examinations practicable on coronary patients because of their reliability and the safety and simplicity of their use. The present work reviews the possible applications of selective coronary scintigraphy in pathology. After a brief discussion on scintigraphy, isotopic techniques for myocardium research, coronarography and other methods to study local myocardium perfusion the theoretical bases for the use of the exploration are studied, the techniques and methods employed are reported and the results discussed. Coronary scintigraphy consists of selective injection in the two coronary arteries previously catheterized during a coronarography, of two different populations of microspheres labelled with two physically short-lived indicators: 15μ 99m Tc-labelled serumalbumin microspheres, 10 to 15μ In-labelled siderophiline microspheres. Various studies have shown the complete harmlessness of the exploration when certain precautions are taken regarding the size and number of the spheres. The microspheres disperse into the downstream arterial territory proportionally to the number of capillaries present in the different parts of the irrigated region, and are temporarily stopped in the precapillaries. The preparation of the different images needed to interpret the Face and OAG examination for the left coronary, then for the right coronary, is carried out at the end of the coronarography and lasts about 45 minutes. It is also possible by selective injection in the aorta-coronary bridges to judge their functional condition by observation of the regions they irrigate. 56 patients of the Necker hospital cardiological clinic have been examined [fr

  1. Combined central retinalartery and vein occlusion complicating ...

    African Journals Online (AJOL)

    Orbital Cellulitis is a dreaded ophthalmologic disease. Itmay destroy vision and the eye andmay even become life threatening. Often visual loss is the result of exposure and subsequent destruction of ocular tissue commonly the cornea and the uvea. We report a case of combined central retinal artery and vein occlusion ...

  2. Clinical Aspects of Combination of Ceramic and Acrylic Occlusal Surfaces

    Directory of Open Access Journals (Sweden)

    Z. Ozhohan

    2017-03-01

    Full Text Available The objective of the research was to develop and substantiate the methods of constructing the occlusal surfaces when manufacturing aesthetic fixed restorations through the combination of different materials. Materials and methods. The study included 65 patients with ceramic and acrylic occlusal surfaces of aesthetic fixed dental prostheses. Group I included 21 patients with a combination of ceramic and acrylic occlusal surfaces. Group II included 22 patients with a combination of ceramic occlusal surfaces. Group III included 22 patients with a combination of acrylic occlusal surfaces. The patients were observed 3, 6 and 12 months after prosthetic repair. Results. The greatest increase in the occlusal contact surface area of fixed restorations was observed in Group I, that is, when combining dental prostheses with ceramic and acrylic occlusal surfaces. Considering uneven abrasion of the occlusal surfaces, we do not recommend to combine different materials when veneering the occlusal surface of the antagonistic teeth. Conclusions. This study demonstrated the important role of the correct combination of materials when veneering the occlusal surfaces. Physical and chemical properties of materials, namely the abrasion resistance play a significant role in the long-term denture functioning. The smallest increase in the occlusal contact surface area was observed in Group II when combining ceramic occlusal surfaces. It was due to a good abrasion resistance of ceramics as compared to acrylic resin as well as the presence of the glazed layer which prevents the premature abrasion of the occlusal surfaces of the antagonistic teeth due to lower surface roughness. The combination of acrylic resin and ceramics when constructing the occlusal surfaces of fixed restorations in Group I demonstrated the highest rate of the increase in the occlusal contact surface area – 9.93%. It was due to a low hardness of acrylic resin and its high surface roughness. In

  3. Temporomandibular Disorders Treatment with Correction of Decreased Occlusal Vertical Dimension

    OpenAIRE

    Guguvcevski, Ljuben; Gigovski, Nikola; Mijoska, Aneta; Zlatanovska, Katerina; Arsova-Gigovska, Ana

    2017-01-01

    BACKGROUND: The term decreased occlusal vertical dimension refers to the reduced distance between two anatomical points while the teeth are in a state of occlusion. The development of this situation is about some parafunctional activities of the masticatory system. AIM: To evaluate the value of decreased occlusal vertical dimension in cases with temporomandibular disorder and to follow up the influence of corrective treatment with occlusal splints and definitive prosthetic construction up...

  4. Medial mandibular flexure and maximum occlusal force in dentate adults.

    Science.gov (United States)

    Canabarro, Simone de Andrade; Shinkai, Rosemary Sadami Arai

    2006-01-01

    Medial mandibular flexure (MMF) is the functional narrowing of the mandible during opening and protrusion movements, which may affect conventional or implant-supported prostheses. This study evaluated the association among MMF, maximum occlusal force (MOF), gender, weight, height, body mass index (BMI), and age in 80 dentate adult subjects (40 women, 40 men; age range 20 to 38 years). Bilateral MOF was measured using a cross-arch force transducer placed in the first molar region. For MMF calculation, impressions of the mandibular occlusal surface were made with vinyl polysiloxane putty material in rest (R), maximum opening (O), and maximum protrusion (P). The impressions were scanned, and the images were processed using Adobe Photoshop software. Reference points were selected on the occlusal surface of the contralateral first molars, and the linear intermolar distance was measured using Image Tool software. MMF was calculated by subtracting the intermolar distance during opening or protrusion from the intermolar distance during rest. Mean values of MOF were 698.14 N for women and 1,009.48 N for men; MMF-O was 0.146 mm and MMF-Pwas 0.15 mm for the total sample. No correlation was found between MOF and MMF (r = 0.02 for MMF-O; r = 0.11 for MMF-P; P > .05) or between MMF and weight, height, BMI, or age. MOF was significantly associated (P <.001) with weight (r = 0.509), height (r = 0.459), and BMI (r = 0.423), but not with age (r = 0.009). These results suggest that MMF is not associated with MOF in this sample of dentate adults.

  5. Effect of selective hepatic inflow occlusion during liver cancer resection on liver ischemia-reperfusion injury

    Directory of Open Access Journals (Sweden)

    Yin-Tian Deng

    2016-11-01

    Full Text Available Objective: To study the effect of selective hepatic inflow occlusion during liver cancer resection on liver ischemia-reperfusion injury. Methods: A total of 68 patients with primary liver cancer who underwent left liver resection in our hospital between May 2012 and August 2015 were selected for study and divided into group A (selective hepatic inflow occlusion of left liver and group B (Prignle hepatic inflow occlusion according to different intraoperative blood occlusion methods, serum was collected before and after operation to determine liver enzyme content, the removed liver tissue was collected to determine energy metabolism indexes, inflammation indexes and oxidative stress indexes. Results: 1 d, 3 d and 5 d after operation, GPT, GOT, GGT, LDH and ALP content in serum of both groups were significantly higher than those before operation, and GPT, GOT, GGT, LDH and ALP content in serum of group A 1 d, 3 d and 5 d after operation were significantly lower than those of group B; ATP, ADP, AMP, PI3K, AKT, GSK3β, T-AOC, PrxI and Trx content in liver tissue of group A were significantly higher than those of group B while PTEN, IL-12p40, MDA and MPO content were significantly lower than those of group B. Conclusions: Selective hepatic inflow occlusion during liver cancer resection can reduce the liver ischemia-reperfusion injury, improve the energy metabolism of liver cells and inhibit inflammation and oxidative stress in liver tissue.

  6. Use of poly (amidoamine dendrimer for dentinal tubule occlusion: a preliminary study.

    Directory of Open Access Journals (Sweden)

    Tianda Wang

    Full Text Available The occlusion of dentinal tubules is an effective method to alleviate the symptoms caused by dentin hypersensitivity, a significant health problem in dentistry and daily life. The in situ mineralization within dentinal tubules is a promising treatment for dentin hypersensitivity as it induces the formation of mineral on the sensitive regions and occludes the dentinal tubules. This study was carried out to evaluate the in vitro effect of a whole generation poly(amidoamine (PAMAM dendrimer (G3.0 on dentinal tubule occlusion by inducing mineralization within dentinal tubules. Dentin discs were treated with PAMAM dendrimers using two methods, followed by the in vitro characterization using Attenuated total reflection Fourier-transform infrared spectroscopy (ATR-FTIR, X-ray diffraction (XRD, Field emission scanning electron microscopy (FE-SEM and Energy-Dispersive X-ray Spectroscopy (EDS. These results showed that G3.0 PAMAM dendrimers coated on dentin surface and infiltrated in dentinal tubules could induce hydroxyapatite formation and resulted in effective dentinal tubule occlusion. Moreover, crosslinked PAMAM dendrimers could induce the remineralization of demineralized dentin and thus had the potential in dentinal tubule occlusion. In this in vitro study, dentinal tubules occlusion could be achieved by using PAMAM dendrimers. This could lead to the development of a new therapeutic technique for the treatment of dentin hypersensitivity.

  7. Auxetic coronary stent endoprosthesis

    DEFF Research Database (Denmark)

    Amin, Faisal; Ali, Murtaza Najabat; Ansari, Umar

    2014-01-01

    to determine the effects of fabrication processes on the topography of the auxetic stent. RESULTS AND CONCLUSIONS: The elastic recoil (3.3%) of the in vitro mechanical analysis showed that the auxetic stent design effectively maintained the luminal patency of the coronary artery. Also, the auxetic coronary...... was obtained via laser cutting, and surface treatment was performed with acid pickling and electropolishing, followed by an annealing process. In vitro mechanical analysis was performed to analyze the mechanical performance of the auxetic coronary stent. Scanning electronic microscopy (SEM) was used...

  8. Off-pump Versus On-pump Coronary Artery Bypass Surgery: Graft Patency Assessment With Coronary Computed Tomographic Angiography: A Prospective Multicenter Randomized Controlled Pilot Study.

    Science.gov (United States)

    Noiseux, Nicolas; Stevens, Louis-Mathieu; Chartrand-Lefebvre, Carl; Soulez, Gilles; Prieto, Ignacio; Basile, Fadi; Mansour, Samer; Dyub, Adel M; Kieser, Teresa M; Lamy, André

    2017-11-01

    A large multicenter randomized trial (RCT) is needed to assess off-pump coronary artery bypass graft (CABG) patency when performed by skilled surgeons. This prospective multicenter randomized pilot study compares graft patency after on-pump and off-pump techniques and addresses the feasibility of such an RCT. Consecutive patients were prospectively recruited for ≥64-slice computed tomography angiography graft patency assessment 1 year after randomization to off-pump or on-pump CABG. Blinded assessment of graft patency was performed, and the results were categorized as normal, ≥50% stenosis, or occlusion. A multilevel model with random effects on the patient was used to account for correlation of results in patients with multiple grafts. A total of 157 patients (3 centers, 84 off-pump and 73 on-pump patients, 512 grafts, assessability rate 98.4%) were included. Patency index (% nonoccluded grafts) was 89% for the off-pump technique and 95% for the on-pump technique (P=0.09). Patency was similar for arterial and vein grafts (both 92%; P=0.88), as well as between target territories (89% to 94%; P=0.53). In this pilot study, 1-year graft patency results after off-pump and on-pump surgery were similar. This feasibility trial demonstrates that a large multicenter RCT to compare CABG patency after on-pump with that after off-pump techniques is feasible and can be reliably undertaken using computed tomography angiography.

  9. Occlusal Plane Orientor”: An Innovative and Efficient Device for Occlusal Plane Orientation

    OpenAIRE

    Kuniyal, Harish; Katoch, Nidhi; Rao, P. Laxman

    2011-01-01

    Correct occlusal plane orientation is a prerequisite in Prosthodontic reconstructive treatment therapy as it helps in achieving esthetics and phonetics anteriorly and forms a milling surface posteriorly where tongue and buccinator muscle position the food bolus during mastication. Activity of Muscles during clenching will be least, when the occlusal plane is made parallel to plane of lost natural teeth. Conventionally the ala-tragus line (Camper’s plane) is used as a guide for assessment of t...

  10. Reversal of myopic Anisometropic amblyopia with occlusion therapy ...

    African Journals Online (AJOL)

    Objective: To report a reversal of myopic anisometropic amblyopia with occlusion therapy in a 25 year old. Design: Case report. Setting: Eye clinic of a University Teaching Hospital in a metropolitan city. Participant: an index patient. Intervention: Occlusion therapy. Main Outcome Measure: Post occlusion visual acuity.

  11. Occlusion invariant face recognition using mean based weight ...

    Indian Academy of Sciences (India)

    Features obtained from the corresponding occlusion-free patches of training images are used for face image recognition. The SVM classifier is used for occlusion detection for each patch. In the recognition phase, the MBWM bases of occlusion-free image patches are used for face recognition. Euclidean nearest neighbour ...

  12. Digital assessment of occlusal wear patterns on occlusal stabilization splints: a pilot study.

    Science.gov (United States)

    Korioth, T W; Bohlig, K G; Anderson, G C

    1998-08-01

    If masticatory load distribution is task-dependent, then the pattern of wear on an acrylic resin occlusal splint over time may affect clinical outcome. This pilot study quantitatively assessed posterior wear after 3 months on the occlusal surfaces of maxillary stabilization splints. Subjects with known history of nocturnal bruxism were given heat-cured full-arch acrylic resin occlusal stabilization splints to be worn nocturnally for 3 months. Splint occlusion was adjusted at appliance delivery and was refined at the baseline session 1 to 2 weeks later. No further adjustment of the splint surface was performed during the 3-month study period. Sequential impressions of the splint occlusal surface provided epoxy resin models that were digitized and analyzed through specialized software. Changes in the digitized splint surface from baseline to 3 months allowed comparison of wear facets between splint sides and among tooth locations. Splint wear was asymmetric between sides and uneven between dental locations. For full coverage occlusal splints, the appliance wear phenomenon can be site specific and, if left undisturbed, may yield two extremes of high wear and a zone of low wear in-between.

  13. Avaliação e mensuração da sutura palatina mediana por meio da radiografia oclusal total digitalizada em pacientes submetidos à expansão rápida maxilar Evaluation and measurement of midpalatal suture through the digitalized occlusal radiography in patients submitted to rapid maxillary expansion

    Directory of Open Access Journals (Sweden)

    Sandra Maria Nobre David

    2009-10-01

    Full Text Available OBJETIVOS: avaliar e mensurar a sutura palatina mediana por meio de radiografias oclusais totais de maxila digitalizadas, antes e depois da sua disjunção. MÉTODOS: a amostra constou de 17 pacientes, com idades entre 7 e 22 anos. Radiografias oclusais totais da maxila foram executadas antes e depois da abertura da sutura palatina mediana, e digitalizadas em scanner HP Scanjet 6110 C com adaptador de transparências HPC 6261 6100 C, utilizando-se o programa Deskscan II. Para a avaliação e medição, foi utilizado o programa Radioimp® (Radiomemory, MG/Brasil. Na análise estatística, foram utilizados a média, o desvio-padrão, o coeficiente de variação e os testes "t" e ANOVA. CONCLUSÕES: após os resultados, foi possível concluir que (1 na região dos incisivos, houve uma abertura palatina mediana estatisticamente significativa; (2 houve abertura de diastema entre os incisivos centrais superiores em torno de 69,37% dos casos; (3 houve uma maior abertura da sutura palatina mediana na região a 10mm a partir da crista para posterior, em comparação com a região a 3mm para posterior do parafuso expansor; (4 na região a 3mm para posterior do parafuso expansor houve uma abertura de 35,97%, e na região a 10mm para posterior da crista uma abertura de 69,37%.AIM: to evaluate and to measure the midpalatal suture through digitalized occlusal radiographies before and after its disjunction. METHODS: The sample was comprised by 17 patients, with ages from 7 to 22 years. Occlusal radiographies of these patients were obtained before and after the suture's opening. The occlusal radiographies were digitalized in a HP Scanjet 6100 C scanner with the HPC 6261 6100 C transparencies adaptor and the Deskscan II software. The statistical analysis used average, standard deviation, variation coefficient, "t" test and ANOVA. CONCLUSIONS: After the results, it was possible to conclude that: (1 statistically, there was a significant midpalatal opening in the

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

    DEFF Research Database (Denmark)

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

    2015-01-01

    , and translocation of bacteria from the oral cavity to the coronary arteries may play a role in the development of coronary artery disease. Very few studies have used angioplasty balloons for in vivo sampling from diseased coronary arteries, and with varying results. Therefore, the aim of this study was to assess...... if bacterial DNA from primarily oral bacteria could be detected on coronary angioplasty balloons by use of an optimized sampling process combined with an internally validated sensitive polymerase chain reaction (PCR) assay. Coronary angioplasty balloons and control samples from a total of 45 unselected...... patients with stable angina, unstable angina/non-ST elevation myocardial infarction, and ST-elevation myocardial infarction (n = 15 in each group) were collected and analyzed using a PCR assay with high sensitivity and specificity for 16S rRNA genes of the oral microbiome. Despite elimination of extraction...

  15. THE PLURAL LESION CORONARY AND CYTOKINES DISBALANCE IN PATIENTS WITH CORONARY ATHEROSCLEROSIS

    Directory of Open Access Journals (Sweden)

    Martynov AV

    2012-12-01

    Full Text Available The aim of the study was to examine the levels of the main pro-inflammatory and anti-inflammatory cytokines in patients with ischemic heart disease, and the study of the possible impact of persistent herpes virus infection plural lesion coronary arteries. A total of 57 patients (mean age 49,3 ± 3,7 years IHD s hemodynamically significant stenoses of the coronary vessels. Conducted virological examination, including the definition of hypertension HSV1, HSV2, HHV6, SMV, VZV and VEB immunofluorescent and cytokines ІL-1β, ІL-6 ІL-8, TNF by ELISA in serum. Found increased levels of proinflammatory cytokines ІL-1β, ІL-6 and FNPα of IHD patients who had hemodynamically significant stenoses of coronary vessels. ІL-6 level in patients with 2 or more significant coronary artery lesions exceeded the rate of patients with a damaged coronary artery in 1.67 TNFα, ІL-8 - 1.37 ІL-1β and 1.28 times respectively. In patients with plural coronary vascular damage was the most common combination of CMV, VEB and HHV6. Since CMV was detected in more than 60% of patients with injuries of two spacecraft and nearly 76% from three spacecraft, VEB was detected in 72% and 88%, respectively.

  16. Acute Coronary Syndrome

    Science.gov (United States)

    ... illustration of coronary arteries ). A stent, a wire mesh tube, may be permanently placed in the artery ... Changes Recovery FAQs • Heart Attack Tools & Resources • Support Network Heart Attack Tools & Resources My Cardiac Coach What ...

  17. Coronary Artery Bypass Surgery

    Science.gov (United States)

    ... t help, you may need coronary artery bypass surgery. The surgery creates a new path for blood to flow ... more than one bypass. The results of the surgery usually are excellent. Many people remain symptom-free ...

  18. Coronary Artery Disease

    Science.gov (United States)

    ... in some patients. Calcium channel blockers may cause constipation and leg swelling. Most patients don’t have ... stress test, cardiovascular, Chest Pain, coronary artery disease, elderly, electrocardiogram, older adults, senior, shortness of breath March ...

  19. Layperson's preference regarding orientation of the transverse occlusal plane and commissure line from the frontal perspective.

    Science.gov (United States)

    Silva, Bruno Pereira; Jiménez-Castellanos, Emilio; Finkel, Sivan; Macias, Inmaculada Redondo; Chu, Stephen J

    2017-04-01

    Facial asymmetries in features such as lip commissure and interpupillary plane canting have been described as common conditions affecting smile esthetics. When presented with these asymmetries, the clinician must choose the reference line with which to orient the transverse occlusal plane of the planned dental restorations. The purpose of the online survey described in this study was to determine lay preferences regarding the transverse occlusal plane orientation in faces that display a cant of the commissure line viewed from the frontal perspective. From a digitally created symmetrical facial model with the transverse occlusal plane and commissure line parallel to the interpupillary line (horizontal) and a model constructed in a previous study (control), a new facial model was created with 3 degrees of cant of the commissure line. Three digital tooth mountings were designed with different transverse occlusal plane orientations: parallel to the interpupillary line (A), parallel to the commissure line (B), and the mean angulation plane formed between the interpupillary and commissure line (C), resulting in a total of 4 images. All images, including the control, were organized into 6 pairs and evaluated by 247 selected laypersons through an online Web site survey. Each participant was asked to choose the more attractive face from each of the 6 pairs of images. The control image was preferred by 72.9% to 74.5% of the participants compared with the other 3 images, all of which represented a commissure line cant. Among the 3 pairs which represent a commissure line cant, 59.1% to 61.1% preferred a transverse plane of occlusion cant (B and C) compared with a plane of occlusion parallel to the interpupillary, line and 61.1% preferred a plane of occlusion parallel to the commissure line (B) compared with the mean angulation plane (C). Laypeople prefer faces with a commissure line and transverse occlusal plane parallel to the horizontal plane or horizon. When faces present a

  20. Large coronary intramural hematomas

    DEFF Research Database (Denmark)

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

    2015-01-01

    coronary vessel wall pathology, with poorly understood underlying pathogenic mechanisms. Affected individuals may present with a broad spectrum of symptoms ranging from acute coronary syndromes (ACS) to cardiogenic shock or even sudden cardiac death. The disease entity causes challenges in terms of both......, no randomized, controlled trials exist to guide treatment, and no consensus regarding management is available. Currently, treatment strategies are based on a case-by-case clinical assessment, and experiences described in previous, limited retrospective studies and case reports....

  1. Coronary Fistulas: A Case Series

    Directory of Open Access Journals (Sweden)

    Nada Fennich

    2014-01-01

    Full Text Available Coronary artery fistula is an uncommon finding during angiographic exams. We report a case series of five patients with congenital coronary fistulas. The first patient was 56 years old and had a coronary fistula associated with a partial atrio ventricular defect, the second patient was 54 years old and had two fistulas originating from the right coronary artery with a severe atherosclerotic coronary disease, the third patient was 57 years old with a fistula originating from the circumflex artery associated with a rheumatic mitral stenosis, the fourth patient was 50 years old and had a fistulous communication between the right coronary artery and the right bronchial artery, and the last patient was 12 years old who had bilateral coronary fistulas draining into the right ventricle with an aneurismal dilatation of the coronary arteries. Angiographic aspects of coronary fistulas are various; management is controversial and depends on the presence of symptoms.

  2. Compare Complication of Classic versus Patent Hemostasis in Transradial Coronary Angiography

    OpenAIRE

    Roghani, Farshad; Tajik, Mohammad Nasim; Khosravi, Alireza

    2017-01-01

    Background: Coronary artery disease (CAD) is multifactorial disease, in which thrombotic occlusion and calcification occur usually. New strategies have been made for diagnosis and treatment of CAD, such as transradial catheterization. Hemostasis could be done in two approaches: traditional and patent. Our aim is to find the best approach with lowest complication. Materials and Methods: In a comparative study, 120 patients were recruited and divided randomly into two subgroups, including tradi...

  3. [Case report of occlusal treatment with full mouth reconstruction].

    Science.gov (United States)

    Oizumi, Makoto

    2008-07-01

    A 70-year-old woman presented with a complaint of masticatory pain and disturbance. She had collapse of occlusal support and vertical dimension decrease. This case used provisional restoration for increasing vertical dimension and reconstruction of anterior guidance. After confirming occlusal stability, she was treated with fixed prosthesis and removable partial dentures. This patient was followed for 6 and a half years with no prosthetic complications, because the reconstruction of bilateral occlusal support and anterior guidance were performed. It is important to reconstruct the occlusal support and anterior guidance in cases of prosthetic treatment of occlusal collapse.

  4. The value of exercise radionuclide ventriculography in risk stratification after coronary arterial bypass grafting

    International Nuclear Information System (INIS)

    Iskandrian, A.S.; Hakki, A.H.; Goel, I.P.; Mundth, E.D.; Kane, S.; Schenk, C.

    1985-01-01

    Cardiac events after coronary artery bypass surgery (CABG) may be related to left ventricular (LV) function, residual coronary artery diseases (CAD), graft occlusion, and progression of CAD. This study examined the value of rest and exercise (EX) radionuclide ventriculography (RNV) done 3-6 mos after CABG in risk stratification in 212 pts. There were 185 men and 27 women, aged 57 +- 8 years (mean +- SD). During a followup period of up to 4 years, (15 +- 10 months), there were 23 cardiac events; 13 pts died of cardiac causes and 20 had non-fatal acute myocardial infarctions. The pts with and without events did not differ in: clinical presentation after CABG (most were asymptomatic), medications and ECG findings at rest and EX. The pts with events had lower EX systolic blood pressure (p < 0.01); resting LV ejection fraction (EF) (p = 0.002), and EX EF (40 +- 18% vs 54 +- 16%, p = 0.002). The change in EF (rest to EX) was not significantly different (l.6 +- 8.2%, vs 2.1 +- 9.2%). Survival analysis (Cox model) identified the EX EF as the best predictor of death and total events (X/sup 2/ = 4.3 and 2.4, p = 0.04 and 0.07 respectively). Actuarial life table analysis showed that the risk increased as the EX EF decreased when pts were grouped into EX EF ≥ 50, 30-49, and <30%, (p < 0.001, Mantel-Cox). Thus, EX RNA is useful in risk stratification after CABG. The EX LVEF is an important descriptor that categorizes pts into different risks groups. The pts at high risk probably require more aggressive followup and continued medical therapy

  5. Coronary tortuosity: a long and winding road.

    NARCIS (Netherlands)

    Zegers, E.S.; Meursing, B.T.J.; Oude Ophuis, A.J.M.

    2007-01-01

    Coronary tortuosity is a phenomenon often encountered by cardiologists performing coronary angiography. The aetiology and clinical importance of coronary tortuosity are still unclear. Coronary tortuosity without fixed atherosclerotic stenosis in patients with angina pectoris and an abnormal exercise

  6. Role of intraoperative fibrinolytic therapy in acute arterial occlusion.

    Science.gov (United States)

    Norem, R F; Short, D H; Kerstein, M D

    1988-08-01

    Nineteen patients with acute onset of ischemia affecting the lower extremities were studied from January 1985 to March 1987. Patients with preoperative Doppler and angiographic studies consistent with arterial occlusions subsequently underwent a thromboembolectomy using a Fogarty catheter. All patients were given a bolus injection of 5,000 units of heparin intravenously at the start of the surgical procedure. In all patients studied, a clot was retrieved on the first pass, but after two additional passes, total distal blood flow was not shown to be restored on angiogram. Intraoperative angiograms showed distal emboli. All patients underwent intraoperative fibrinolytic therapy by local bolus infusion. Streptokinase, ranging from 50,000 to 200,000 units, was administered in 50,000 unit injections in ten to 15 minute intervals. Repeat attempts at thromboembolectomy with the Fogarty catheter resulted in an additional clot retrieved in all 19 patients with intraoperative angiographic, Doppler and clinical improvement. No perioperative or postoperative complications were observed, including anaphylactic reactions, uncontrollable bleeding or amputation. Four patients had nonacute femoropopliteal bypass operations within the next six months. Intraoperative fibrinolytic therapy can be a safe and effective adjunct in acute arterial embolic occlusion requiring balloon catheter thromboembolectomy.

  7. Coronary Artery Anomalies in Animals

    Directory of Open Access Journals (Sweden)

    Brian A. Scansen

    2017-04-01

    Full Text Available Coronary artery anomalies represent a disease spectrum from incidental to life-threatening. Anomalies of coronary artery origin and course are well-recognized in human medicine, but have received limited attention in veterinary medicine. Coronary artery anomalies are best described in the dog, hamster, and cow though reports also exist in the horse and pig. The most well-known anomaly in veterinary medicine is anomalous coronary artery origin with a prepulmonary course in dogs, which limits treatment of pulmonary valve stenosis. A categorization scheme for coronary artery anomalies in animals is suggested, dividing these anomalies into those of major or minor clinical significance. A review of coronary artery development, anatomy, and reported anomalies in domesticated species is provided and four novel canine examples of anomalous coronary artery origin are described: an English bulldog with single left coronary ostium and a retroaortic right coronary artery; an English bulldog with single right coronary ostium and transseptal left coronary artery; an English bulldog with single right coronary ostium and absent left coronary artery with a prepulmonary paraconal interventricular branch and an interarterial circumflex branch; and a mixed-breed dog with tetralogy of Fallot and anomalous origin of all coronary branches from the brachiocephalic trunk. Coronary arterial fistulae are also described including a coronary cameral fistula in a llama cria and an English bulldog with coronary artery aneurysm and anomalous shunting vessels from the right coronary artery to the pulmonary trunk. These examples are provided with the intent to raise awareness and improve understanding of such defects.

  8. Congenital anomalies of coronary arteries: Diagnosis with 64 slice multidetector CT

    Energy Technology Data Exchange (ETDEWEB)

    Tariq, Rukhsana, E-mail: drrukhsanatariq@hotmail.com [Consultant Radiologists, Advanced Radiology Clinic, Behind Hamdard University Hospital, Off M.A. Jinnah Road, Karachi (Pakistan); Kureshi, Shahzad Babar [Consultant Radiologists, Advanced Radiology Clinic, Behind Hamdard University Hospital, Off M.A. Jinnah Road, Karachi (Pakistan); Siddiqui, Usman T. [Medical College, Aga Khan University, Karachi (Pakistan); Ahmed, Rashid [Consultant Radiologists, Advanced Radiology Clinic, Behind Hamdard University Hospital, Off M.A. Jinnah Road, Karachi (Pakistan)

    2012-08-15

    Objective: Congenital coronary artery anomalies are generally incidental, uncommon and asymptomatic. Some can cause severe potentially life threatening symptoms. The common mode of studying the coronary arteries is Conventional Coronary Angiogram. ECG-gated-multidetector CT is a non invasive modality. The objective of our study was to identify rare congenital coronary artery anomalies and discuss their clinical significance. Material and methods: A total number of 900 MDCT coronary angiograms were carried out at our institution between the period of April 2006 and October 2010. Patients with coronary artery anomaly constituted the subject of study. Results: The incidence of anomalous anatomical origin and course of the coronary arteries in our study was 1.55%. Hemodynamical significance was seen in five patients. 3 cases of single coronary artery originating from right coronary sinus were seen. 1 case of anomalous left coronary artery arising from main pulmonary artery was seen. 4 cases of anomalous RCA arising from left aortic cusp, 6 cases of absent LMCA with separate origin of LAD and LCX were seen. Conclusion: Multidetector row CT is a noninvasive modality in cardiac imaging. It provides superior resolution of coronary tree and its variant. No projectional vascular overlap is seen. Various postprocessing techniques outclass catheter angiography imaging. Definition of ostia and proximal course of the coronary arteries by Multidetector CT is better than catheter angiography.

  9. Congenital anomalies of coronary arteries: Diagnosis with 64 slice multidetector CT

    International Nuclear Information System (INIS)

    Tariq, Rukhsana; Kureshi, Shahzad Babar; Siddiqui, Usman T.; Ahmed, Rashid

    2012-01-01

    Objective: Congenital coronary artery anomalies are generally incidental, uncommon and asymptomatic. Some can cause severe potentially life threatening symptoms. The common mode of studying the coronary arteries is Conventional Coronary Angiogram. ECG-gated-multidetector CT is a non invasive modality. The objective of our study was to identify rare congenital coronary artery anomalies and discuss their clinical significance. Material and methods: A total number of 900 MDCT coronary angiograms were carried out at our institution between the period of April 2006 and October 2010. Patients with coronary artery anomaly constituted the subject of study. Results: The incidence of anomalous anatomical origin and course of the coronary arteries in our study was 1.55%. Hemodynamical significance was seen in five patients. 3 cases of single coronary artery originating from right coronary sinus were seen. 1 case of anomalous left coronary artery arising from main pulmonary artery was seen. 4 cases of anomalous RCA arising from left aortic cusp, 6 cases of absent LMCA with separate origin of LAD and LCX were seen. Conclusion: Multidetector row CT is a noninvasive modality in cardiac imaging. It provides superior resolution of coronary tree and its variant. No projectional vascular overlap is seen. Various postprocessing techniques outclass catheter angiography imaging. Definition of ostia and proximal course of the coronary arteries by Multidetector CT is better than catheter angiography.

  10. Concepts of occlusion in prosthodontics: A literature review, part I

    Directory of Open Access Journals (Sweden)

    V Rangarajan

    2015-01-01

    Full Text Available Occlusion and its relationship to the function of the stomatognathic system have been widely studied in dentistry since many decades. This series of articles describe about occlusion in the complete denture, fixed partial denture, and implants. Part I and II of this articles series describe concepts and philosophies of occlusion in complete denture. So far, available research has not concluded a superior tooth form or occlusal scheme to satisfy the requirements of completely edentulous patients with respect to comfort, mastication, phonetics, and esthetics. Since then, several balanced and nonbalanced articulation concepts were proposed in the literature. A balanced articulation appears to be most appropriate because of tooth contacts observed during nonfunctional activities of patients. This article discusses about evolution of different concepts of occlusion and occlusal schemes in complete denture occlusion.

  11. [Study on retention and stability of linear occlusal complete dentures].

    Science.gov (United States)

    Zhang, Ping; Xu, Jun

    2003-01-01

    To learn retention and stability of linear occlusal complete dentures by investigating the subjective feelings of patient and the value of retention force. Static retention forces of maxillary and mandibular dentures were measured for 25 patients wearing linear occlusal dentures by using Hz-1 retention dynamometer. The subjective feelings of patients in functional state were gained simultaneously through questionnaire. Linear occlusal dentures demonstrate good retention in static and dynamic state. Among patients with severe resorption of residual ridge (RRR), mandibular linear occlusal dentures (shown good retentive subjective feelings) demonstrate significantly smaller retention force than those with slight or medium degree of RRR. There is no correlation between the subjective feelings and the values of retention forces of mandibular dentures. The subjective feelings of patients wearing new linear occlusal dentures are much better than that of old anatomic occlusal dentures. Linear occlusal dentures improve the performances of dentures by enhancing their stability during mastication movement.

  12. Restoration of posterior teeth using occlusal matrix technique

    Directory of Open Access Journals (Sweden)

    Martos Josue

    2010-01-01

    Full Text Available This article describes a technique for duplicating occlusal surface anatomy using the Biteperf device. Duplication requires an intact occlusal enamel surface and is only indicated when caries lesions are hidden. The occlusal matrix technique allows for preservation of all anatomic details. When the last layer of composite has been placed, the occlusal matrix is forced into the uncured composite to replicate the original occlusal surface, instead of performing manual curing and shaping as in the standard approach. It is technically possible to achieve this effect with any material that is able to copy anatomic details. The main benefits of the occlusal matrix technique, more precisely the Biteperf, are the technical ease of use due to its simplicity and its high accuracy in reconstructing occlusal morphology.

  13. Coronary Anomalies: Left Main Coronary Artery Aneurysm

    OpenAIRE

    Varda, Rajsekhar; Chitimilla, Santosh Kumar; Lalani, Aslam

    2012-01-01

    Coronary artery aneurysm is one of the rarest anomalies that we see in our medical practice and they are mostly associated with obstructive lesions due to atherosclerotic changes. Management of these aneurysm patients (conservative or surgical repair) usually depends on obstructive lesions and associated symptoms. We are presenting a case of left main aneurysm measuring around 1 4 × 2 8  mm with other obstructive leisons. It was treated with surgical repair in view of obstructive lesions and ...

  14. Coronary Anomalies: Left Main Coronary Artery Aneurysm

    Directory of Open Access Journals (Sweden)

    Rajsekhar Varda

    2012-01-01

    Full Text Available Coronary artery aneurysm is one of the rarest anomalies that we see in our medical practice and they are mostly associated with obstructive lesions due to atherosclerotic changes. Management of these aneurysm patients (conservative or surgical repair usually depends on obstructive lesions and associated symptoms. We are presenting a case of left main aneurysm measuring around 14×28 mm with other obstructive leisons. It was treated with surgical repair in view of obstructive lesions and symptoms.

  15. Quantitative relationship between coronary calcium content and coronary flow reserve as assessed by integrated PET/CT imaging

    International Nuclear Information System (INIS)

    Curillova, Zelmira; Yaman, Bettina F.; Sitek, Arkadius; El Fakhri, Georges; Dorbala, Sharmila; Kwong, Raymond Y.; Anagnostopoulos, Constantinos; Di Carli, Marcelo F.

    2009-01-01

    To evaluate the relationship between coronary artery calcium (CAC) and coronary vasodilator function. We evaluated 136 patients without known coronary artery disease (CAD) undergoing vasodilator stress 82 Rb PET/CT and CAC scoring who showed normal myocardial perfusion. The CAC score, resting and hyperemic myocardial blood flow (MBF), coronary flow reserve (CFR) and coronary vascular resistance were analyzed. Global and regional CAC scores showed significant but weak inverse correlations with hyperemic MBF (r=-0.31 and r=-0.26, p≤0.0002 respectively) and CFR (r=-0.28 and r=-0.2, p≤0.001 respectively). With increasing CAC score, there was a modest stepwise decline in CFR on a per-patient basis (1.8±0.5 vs 1.7±0.5 vs 1.5±0.4, p=0.048, with total CAC=0, 1-400 and >400, respectively) and on a per-vessel basis. In multivariable modeling only body mass index and CAC score were predictive of CFR. In patients with an intermediate likelihood of, but without overt, CAD, there is a statistically significant but weak inverse correlation between CAC content and coronary vasodilator function. The strength of this association weakens after adjusting CAC scores for age, gender and coronary risk factors. This suggests that CAC and coronary vasodilator function provide biologically different information regarding atherosclerosis. (orig.)

  16. RTSAH Traversal Order for Occlusion Rays

    KAUST Repository

    Ize, Thiago

    2011-04-01

    We accelerate the finding of occluders in tree based acceleration structures, such as a packetized BVH and a single ray kd-tree, by deriving the ray termination surface area heuristic (RTSAH) cost model for traversing an occlusion ray through a tree and then using the RTSAH to determine which child node a ray should traverse first instead of the traditional choice of traversing the near node before the far node. We further extend RTSAH to handle materials that attenuate light instead of fully occluding it, so that we can avoid superfluous intersections with partially transparent objects. For scenes with high occlusion, we substantially lower the number of traversal steps and intersection tests and achieve up to 2× speedups. © 2010 The Author(s).

  17. Handling Occlusions for Robust Augmented Reality Systems

    Directory of Open Access Journals (Sweden)

    Maidi Madjid

    2010-01-01

    Full Text Available Abstract In Augmented Reality applications, the human perception is enhanced with computer-generated graphics. These graphics must be exactly registered to real objects in the scene and this requires an effective Augmented Reality system to track the user's viewpoint. In this paper, a robust tracking algorithm based on coded fiducials is presented. Square targets are identified and pose parameters are computed using a hybrid approach based on a direct method combined with the Kalman filter. An important factor for providing a robust Augmented Reality system is the correct handling of targets occlusions by real scene elements. To overcome tracking failure due to occlusions, we extend our method using an optical flow approach to track visible points and maintain virtual graphics overlaying when targets are not identified. Our proposed real-time algorithm is tested with different camera viewpoints under various image conditions and shows to be accurate and robust.

  18. Nontraumatic vascular emergencies: imaging and intervention in acute venous occlusion

    International Nuclear Information System (INIS)

    Haage, Patrick; Schmitz-Rode, Thomas; Krings, Timo

    2002-01-01

    Risk factors for acute venous occlusion range from prolonged immobilization to hypercoagulability syndromes, trauma, and malignancy. The aim of this review article is to illustrate the different imaging options for the diagnosis of acute venous occlusion and to assess the value of interventional strategies for venous thrombosis treatment in an emergency setting. First, diagnosis and treatment of the most common form of venous occlusion, at the level of the lower extremities, is presented, followed by pelvic vein and inferior vena cava occlusion, mesenteric venous thrombosis, upper extremity occlusion, acute cerebral vein thrombosis, and finally acute venous occlusion of hemodialysis access. In acute venous occlusion of the lower extremity phlebography is still the reference gold standard. Presently, duplex ultrasound with manual compression is the most sensitive and specific noninvasive test. Limitations of ultrasonography include isolated distal calf vein occlusion, obesity, and patients with lower extremity edema. If sonography is nondiagnostic, venography should be considered. Magnetic resonance venography can differentiate an acute occlusion from chronic thrombus, but because of its high cost and limited availability, it is not yet used for the routine diagnosis of lower extremity venous occlusion only. Regarding interventional treatment, catheter-directed thrombolysis can be applied to dissolve thrombus in charily selected patients with symptomatic occlusion and no contraindications to therapy. Acute occlusion of the pelvic veins and the inferior vena cava, often due to extension from the femoropopliteal system, represents a major risk for pulmonary embolism. Color flow Doppler imaging is often limited owing to obesity and bowel gas. Venography has long been considered the gold standard for identifying proximal venous occlusion. Both CT scanning and MR imaging, however, can even more accurately diagnose acute pelvis vein or inferior vena cava occlusion. MRI is

  19. Nontraumatic vascular emergencies: imaging and intervention in acute venous occlusion

    Energy Technology Data Exchange (ETDEWEB)

    Haage, Patrick; Schmitz-Rode, Thomas [Department of Diagnostic Radiology, University of Technology Aachen, Pauwelsstrasse 30, 52057 Aachen (Germany); Krings, Timo [Department of Neuroradiology, University of Technology Aachen, Pauwelsstrasse 30, 52057 Aachen (Germany)

    2002-11-01

    Risk factors for acute venous occlusion range from prolonged immobilization to hypercoagulability syndromes, trauma, and malignancy. The aim of this review article is to illustrate the different imaging options for the diagnosis of acute venous occlusion and to assess the value of interventional strategies for venous thrombosis treatment in an emergency setting. First, diagnosis and treatment of the most common form of venous occlusion, at the level of the lower extremities, is presented, followed by pelvic vein and inferior vena cava occlusion, mesenteric venous thrombosis, upper extremity occlusion, acute cerebral vein thrombosis, and finally acute venous occlusion of hemodialysis access. In acute venous occlusion of the lower extremity phlebography is still the reference gold standard. Presently, duplex ultrasound with manual compression is the most sensitive and specific noninvasive test. Limitations of ultrasonography include isolated distal calf vein occlusion, obesity, and patients with lower extremity edema. If sonography is nondiagnostic, venography should be considered. Magnetic resonance venography can differentiate an acute occlusion from chronic thrombus, but because of its high cost and limited availability, it is not yet used for the routine diagnosis of lower extremity venous occlusion only. Regarding interventional treatment, catheter-directed thrombolysis can be applied to dissolve thrombus in charily selected patients with symptomatic occlusion and no contraindications to therapy. Acute occlusion of the pelvic veins and the inferior vena cava, often due to extension from the femoropopliteal system, represents a major risk for pulmonary embolism. Color flow Doppler imaging is often limited owing to obesity and bowel gas. Venography has long been considered the gold standard for identifying proximal venous occlusion. Both CT scanning and MR imaging, however, can even more accurately diagnose acute pelvis vein or inferior vena cava occlusion. MRI is

  20. ACUTE CORONARY SYNDROME DUE TO CORONARY VASOSPASM – CASE REPORT

    Directory of Open Access Journals (Sweden)

    S. D. Klimovskiy

    2017-01-01

    Full Text Available Spasm of the coronary arteries is a dynamic narrowing of one or more coronary arteries, leading to significant restriction of the lumen. The leading role in coronary  artery spasm diagnostic belongs to coronary  angiography and its accompanying provocative tests. Mechanisms of coronary  artery spasm development remain incompletely clarified and it's considered as a multifactorial disease with its own specific risk factors.  Though pathophysiology is no longer a matter of dispute, further  efforts should be aimed at the practical application of the recommendations. Diagnosis of the coronary  artery spasm  has important practical significance, due to the prevailing benefit of calcium antagonists in the treatment and absence of benefit from percutaneous coronary  interventions in most cases. A clinical case of the patient with multivessel, multifocal coronary  artery spasm is presented.

  1. Depicting Occlusion in Early Renaissance Art

    OpenAIRE

    Gillam, Barbara

    2011-01-01

    The artist attempting to give the impression of three-dimensional relationships must convey somehow that one surface is in front of another. There is a large and venerable literature in Psychology on this subject, showing how figure-ground, border ownership and amodal completion and continuation are determined but there is almost no discussion of how artist's have recruited these and other principles to create convincing impressions of occlusion. Even Gombrich (Art & Illusion 1960) only consi...

  2. [Renal insufficiency and clinical outcomes in patients with acute coronary syndrome undergoing percutaneous coronary intervention: a multi-centre study].

    Science.gov (United States)

    Huo, Yong; Ho, Wa

    2007-12-18

    To investigate the association of renal insufficiency and clinical outcomes in patients with acute coronary syndrome(ACS). The study was a multi-centre register study including 3,589 ACS patients coming from 39 centers across China who had received percutaneous coronary intervention(PCI) prior to 1st February, 2007. Estimated glomerular filtration rate (eGFR) was calculated for all patients using the 4-variable MDRD equation with the serum creatinine obtained before angiography. The association between renal insufficiency and clinical outcomes and the presence of in-hospital death and bleeding was studied by Fisher's exact test. Multi-variable analysis on the risk factors of in-hospital bleeding was done by logistic regression test. The mean age of the study population was (61.74+/-11.37) years (ranging from 23 years to 92 years)and 76.5% (2,746/3,589) of the population was male. Only 90 patients (2.51%) were known to have chronic kidney disease at the time of admission and 144 patients(4.01%) had serum creatinine levels above 133 micromol/L. However, after the evaluation of renal status by the MDRD equation, 2,250 patients (63.1%)showed a reduction in eGFR of less than 90 mL/min, of whom, 472 (13.1%) even reached the level of moderate renal insufficiency (eGFRchronic total occlusion lesions(CTO) and eight (0.22%) needed shift to coronary artery bypass grafting (CABG) after angiography. Both the presence of CTO lesions and CABG were proved to be associated with decrease of renal function through Fisher's exact test (P= 0.005 8 and 0.041, respectively). The in-hospital mortality rate was 0.47%(17/3 589) which was associated with the degree of renal insufficiency (P=0.001 3). A total of 75 patients(2.09%) of in-hospital bleeding were recorded with 26 patients(0.72%) diagnosed as major bleeding events. 92% (69/75) of the bleeding events occurred after PCI. Bleeding was found to be associated with the degree of renal insufficiency in every type of antithrombotic

  3. Feasibility and safety of transradial coronary interventions using a 6.5-F sheathless guiding catheter in patients with small radial arteries.

    Science.gov (United States)

    Cheaito, Radi; Benamer, Hakim; Hovasse, Thomas; Tritar, Amine; Hage, Fouad; Garot, Philippe; Lefèvre, Thierry; Unterseeh, Thierry; Chevalier, Bernard; Morice, Marie-Claude; Louvard, Yves

    2015-07-01

    This study investigated the feasibility and the safety of using a 6.5-French sheathless guide catheter in patients with small radial arteries. The small size of radial arteries is a limitation of transradial coronary intervention. A new sheathless guiding catheter with a diameter almost 2-Fr smaller than conventional sheaths and a full-length hydrophilic coating has been introduced. A total of 148 patients from three French hospitals were consecutively enrolled from March 2009 to February 2012. They underwent transradial approach (TRA) for percutaneous coronary interventions (PCI) using the 6.5-F ASAHI sheathless Eaucath guiding catheter system. Among the 148 patients enrolled, 95 were females (64%), and 183 lesions were treated. Procedural success rate was 100%. Thirteen patients (9%) underwent same-procedure multivessel interventions for the right and left coronary artery. Among the group of 46 patients undergoing bifurcation PCI, 35 (76%) bifurcated lesions were treated with a kissing balloon technique, one patient had a saphenous vein bypass graft lesion requiring filter wire placement prior to intervention, nine (6.1%) patients required rotational atherectomy, thrombus-aspiration catheters were used in 19 (12.8%) patients, fractional flow reserve (FFR)-guided PCI in 10 (6.7%) patients, alcohol septal ablation in three (2%) patients. Ten (6.7%) cases of chronic total occlusion were successfully treated in nine (6.1%) patients using the hydrophilic catheter. No radial artery site complications was noted. The use of sheathless guiding catheters is a safe, effective method for PCI via TRA in small radial arteries without catheter-related complications. © 2015 Wiley Periodicals, Inc.

  4. Clinical study of internal carotid artery occlusion

    International Nuclear Information System (INIS)

    Okada, Kyoko

    1989-01-01

    Fourteen patients with internal carotid artery (ICA) occlusion identified by cerebral angiography were studied for clinical features, computed tomographic findings, collateral circulation and risk factors. Eleven patients were males, and at age distribution it occurred more frequently in patients over 50 years to 60 years of age rather than other ages. As for the risk factors of cerebral infarction, smoking was more frequent in patients with thrombosis, and heart disease was more common in those with embolism. Stroke occurred progressively in patients with thrombosis whereas it occurred suddenly in those with embolism. The consciousness was more severely disturbed in patients with embolism than in those with thrombosis. On neuro-radiological findings, in the patients with thrombosis, the infarcted area on CT were small and emerged as deep or watershed types, and on the angiograms, occlusion at carotid bifurcation were found more frequently and the collateral circulation were well developed. In those with embolism, the infarcted areas were large and emerged as cortical types, and on the angiograms, occlusions were observed more frequently in the intracranial portion and collateral circulation were poorly developed. In many patients with thrombosis, platelet aggregation, hematocrit and blood viscosity increased, but in those with embolism did not. (author)

  5. Distal outflow occlusion with bypass revascularization: last resort measure in managing complex MCA and PICA aneurysms.

    Science.gov (United States)

    Esposito, Giuseppe; Fierstra, Jorn; Regli, Luca

    2016-08-01

    Partial trapping with or without bypass revascularization is a well-established strategy in the surgical management of complex aneurysms. Distal outflow occlusion is performed by occluding the efferent artery downstream of the aneurysm and represents an alternative to proximal inflow occlusion in partial trapping treatment. With this article we report a case series employing distal outflow occlusion for managing posterior-inferior cerebellar artery (PICA) and middle cerebral artery (MCA) complex aneurysms and discuss the rationale of this treatment strategy. A case series of eight patients who underwent surgery for complex PICA (n = 3) and MCA (n = 5) aneurysms by means of distal outflow occlusion and flow-replacement bypass is presented. Two out of the eight patients presented with subarachnoid hemorrhage (SAH) (1 PICA and 1 MCA aneurysm). In seven out of eight patients (87.5 %), total aneurysmal thrombosis was obtained; in one patient, postoperative neuroimaging showed a partial aneurysmal thrombosis. Aneurysm growth or delayed rupture was not observed. All the bypasses were patent at the end of the procedure and all but one at follow-up (asymptomatic occlusion). One patient had postoperative worsening, unrelated to bypass patency. All other patients improved. Three patients maintained an mRS score of 1, four patients had improved mRS scores by ≥1, and 1 patient had a worsened mRS score compared to preoperatively. We believe that partial trapping with distal outflow occlusion for treating complex intracranial aneurysms represents a useful strategy as a last resort measure. To avoid cerebral ischemia, flow-replacement bypass is key to success.

  6. Outcomes of coronary artery bypass grafting versus percutaneous coronary intervention with second-generation drug-eluting stents for patients with multivessel and unprotected left main coronary artery disease

    Directory of Open Access Journals (Sweden)

    Kyriacos Papadopoulos

    2017-01-01

    Full Text Available Objectives: To compare the efficacy and safety of percutaneous coronary intervention using second-generation drug-eluting stents with those of coronary artery bypass grafting among patients with multivessel disease and/or unprotected left main coronary artery disease in terms of mortality, myocardial infarction, repeat revascularization, and angina. Background: Although coronary artery disease is a leading cause of death in the Western world and in many developing countries, its optimal treatment is still a matter of controversy. Several studies have examined the clinical safety and efficacy of percutaneous coronary intervention using first-generation drug-eluting stents over coronary artery bypass grafting in patients with multivessel disease and/or unprotected left main coronary artery disease. However, this study compared the efficacy of percutaneous coronary intervention using second-generation drug-eluting stents to that of coronary artery bypass grafting for multivessel disease and/or unprotected left main coronary artery disease. Methods: This was a prospective single-center cohort study conducted from September 2012 to November 2014 at the Nicosia General Hospital. In total, 140 patients (94% men and 6% women with chronic coronary artery disease undergoing revascularization with either percutaneous coronary intervention using second-generation drug-eluting stents or coronary artery bypass grafting were evaluated. We examined the differences in clinical outcomes between coronary artery bypass grafting and percutaneous coronary intervention at 1-year follow-up. Results: Percutaneous coronary intervention with second-generation drug-eluting stents as opposed to coronary artery bypass grafting resulted in similar rates of mortality (5.7% vs 11.4%, respectively; p = 0.135, myocardial infarction (0% vs 4.3%, respectively, repeat revascularization (4.3% vs 8.6%, respectively; p = 0.115 and angina (10% vs 18.6%, respectively; p = 0

  7. Total protein

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/article/003483.htm Total protein To use the sharing features on this page, please enable JavaScript. The total protein test measures the total amount of two classes ...

  8. Coronary embolism causing acute inferior wall and ventricular myocardial infarction in a patient with rheumatic valvular heart disease: treatment with thrombus aspiration.

    Science.gov (United States)

    Du, Xiao-Yu; Hui, Peng; Zheng, Yang

    2015-06-26

    An elderly man with rheumatic valvular heart disease and atrial fibrillation presented with acute myocardial infarction. A coronary angiogram revealed complete occlusion of the right coronary artery (RCA), and we therefore considered that a thrombus might have obstructed the ostium of the RCA. We used a guiding catheter and the syringe of an aspiration device to remove two large dark red thrombi. A subsequent angiogram revealed that blood flow through the RCA had recovered, and the endomembrane of the RCA was smooth, with no evidence of stenosis or residual thrombus. In this case, thrombus aspiration via a guiding catheter was efficacious for treating this type of coronary embolism.

  9. Combining carotid endarterectomy with off-pump coronary artery bypass graft surgery is safe and effective

    Directory of Open Access Journals (Sweden)

    Arun Garg

    2015-01-01

    Full Text Available Background: We, as neurologists, are frequently consulted to give neurological clearance for surgery in patients who are undergoing coronary artery bypass graft (CABG surgery and have suffered from stroke or transient ischemic attack (TIA in past. Similarly clearance is also sought in another group of patients who, though have not suffered from stroke or TIA, but found to have significant carotid stenosis on routine screening prior to surgery. Cardiac surgeons and anesthetists want to know the risk of perioperative stroke in such patients and should carotid endarterectomy (CEA be done along with CABG. In absence of any clear-cut guideline, neurologists often fail to give any specific recommendation. Aim: To find out safety and efficacy of synchronous CEA in patients undergoing CABG. Design: Retrospective study. Materials and Methods: Out of 3,700 patients who underwent CABG, 150 were found to have severe carotid stenosis of >70%. Out of this, 46 patients with >80% stenosis (three symptomatic and 43 asymptomatic and one patient with >70% symptomatic carotid stenosis (TIA within last 2 weeks were taken for simultaneous CEA along with CABG. These three symptomatic carotid patients had suffered from stroke within last 6 months. Results: One patient with asymptomatic near total occlusion of carotid artery suffered from hyperperfusion syndrome. None suffered from ischemic stroke, myocardial infarction (MI, or death during perioperative period. Conclusion: Combining CEA along with CABG is a safe and effective procedure.

  10. High burden of coronary atherosclerosis in patients with cirrhosis

    DEFF Research Database (Denmark)

    Kazankov, Konstantin; Munk, Kim; Ovrehus, Kristian Altern

    2017-01-01

    ) score than controls (120 [interquartile range, 0-345] vs. 5 [interquartile range, 0-86] HU, P=0.001). Likewise, patients with cirrhosis had a higher prevalence of extensive (>= 5 coronary segments involved; 45% vs. 18 P=0.01) and multivessel coronary disease (>= 2 vessels involved; 75% vs. 53 P=0.......02). Furthermore, the total plaque volume whether noncalcified or calcified was higher in cirrhosis (117 [interquartile range, 0-310] vs. 36 [interquartile range, 0-148] mm(3), P=0.02). Conclusion Coronary artery disease is equally prevalent in patients with cirrhosis and subjects with new-onset chest pain...

  11. Effect of various antithrombotic regimens (aspirin, aspirin plus dipyridamole, anticoagulants) on the functional status of patients and grafts one year after coronary artery bypass grafting

    NARCIS (Netherlands)

    Mulder, B. J.; van der Doef, R. M.; van der Wall, E. E.; Tijssen, J. G.; Piek, J. J.; van der Meer, J.; Dunning, A. J.

    1994-01-01

    From 1987 until 1991 a large prospective randomized multicentre study was performed in The Netherlands, Germany and Switzerland entitled CABADAS (Prevention of Coronary Artery Bypass graft occlusion by Aspirin, Dipyridamole, and Acenocoumarol/Phenprocoumon Study). The aim of CABADAS was to evaluate

  12. Postural stability and occlusal status among Japanese elderly.

    Science.gov (United States)

    Song-Yu, Xuan; Rodis, Omar M M; Ogata, Sagiri; Can-Hu, Jin; Nishimura, Michiko; Matsumura, Seishi

    2012-06-01

    There are still no data available on the relationship between postural stability and occlusal status among the elderly. To examine relationships between postural stability and occlusal status through a cohort study among elderly Japanese. Oral examination, occlusal status, postural stability and a questionnaire were conducted and given to 87 community-dwelling Japanese at enrolment. The average occlusal pressure of the female group was statistically higher than the male group while average occlusal pressure and postural stability length were lesser in the group with more remaining teeth. Postural stability area and number of remaining teeth showed statistically significant correlations. Postural stability length was lesser in the group with strong occlusal force. Furthermore, the number of decayed teeth was fewer in the good hygiene group. This study identified a close relationship between occlusal status and postural stability of Japanese older individuals. Occlusal hypofunction was observed more in those with occlusal problems, and a decrease in their occlusal functions resulted in postural instability. © 2011 The Gerodontology Society and John Wiley & Sons A/S.

  13. A study on occlusal stability in shortened dental arches.

    Science.gov (United States)

    Sarita, Paulo T N; Kreulen, Cees M; Witter, Dick J; van't Hof, Martin; Creugers, Nico H J

    2003-01-01

    The aim of this study was to verify the hypothesis that shortened dental arches constitute a risk to occlusal stability. Using cluster samples, 725 subjects with shortened dental arches comprising intact anterior regions and zero to eight occluding pairs of posterior teeth and 125 subjects with complete dental arches were selected. Subjects with shortened dental arches were classified into eight categories according to arch length and symmetry. Parameters for occlusal stability were interdental spacing, occlusal tooth wear, occlusal contact of incisors in intercuspal position, and vertical and horizontal overlap. Additionally, tooth mobility and overeruption of unopposed teeth were assessed. Influence of independent variables (dental arch category, age, gender, and residence) on the parameters for occlusal stability was assessed by one-way ANOVA and Tukey's multiple range tests. Extreme shortened dental arches (zero to two pairs of occluding premolars) had significantly more interdental spacing, occlusal contact of incisors, and vertical overlap compared to complete dental arches. Occlusal wear and prevalence of mobile teeth were highest in these categories. The category with three to four occluding premolars had significantly more interdental spacing and, for the older age group, more anterior teeth in occlusal contact compared to complete dental arches. Age was consistently associated with increased changes in occlusal integrity. Signs of increased risk to occlusal stability seemed to occur in extreme shortened dental arches, whereas no such evidence was found for intermediate categories of shortened dental arches.