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Current status of robotically assisted coronary revascularization  

Microsoft Academic Search

This article reviews the current status of totally endoscopic coronary revascularization using telemanipulation systems for robotic assistance. Current challenges in implementing a robotic surgical program are discussed, and application of the technology in both arrested and beating heart procedures is considered.

Gerhard Wimmer-Greinecker; Heinz Deschka; Tayfun Aybek; Stefan Mierdl; Anton Moritz; Selami Dogan



Revascularization therapy for coronary artery disease. Coronary artery bypass grafting versus percutaneous transluminal coronary angioplasty.  

PubMed Central

Coronary artery bypass surgery relieves the symptoms of myocardial ischemia and prolongs survival of patients with more severe coronary artery disease. Randomized trials of surgical therapy have consistently shown that the benefits of surgical revascularization are proportional to the amount of myocardium affected by, or at risk for, ischemic injury. This risk is inferred from angiographically delineated coronary anatomy, estimates of left ventricular function, and physiologic testing. The population that may see a survival benefit from surgical revascularization has probably been expanded beyond that reported in the VA, CASS, and ECSS trials, due to improved perioperative care, longer graft survival, and the use of internal mammary artery grafts. Percutaneous transluminal coronary angioplasty revascularizes myocardium by dilating a stenotic segment of coronary artery. While successful in relieving the symptoms of myocardial ischemia, PTCA is hindered by the occurrence of abrupt vessel closure and the frequent development of restenosis. Furthermore, firm proof of a survival benefit, outside of emergency therapy for acute myocardial infarction, is not yet available. However, because the risk of procedure-related death or serious complication is lower than that seen with bypass surgery, PTCA provides a useful alternative revascularization method for patients with less extensive disease, in whom the risk of surgery may equal or exceed any beneficial effect. New technology and growing experience are widening the scope of percutaneous revascularization by extending the hope of symptomatic relief and survival benefit even to patients with extensive, severe coronary artery disease. Comparisons between surgical therapy and PTCA in select populations with single- and multivessel coronary artery disease have shown that PTCA is not as effective as surgery for long-term symptomatic control, and that it often requires repeat PTCA or cross-over to bypass surgery; however, long-term outcomes (i.e., death and myocardial infarction) are similar. The cost of treatment beginning with PTCA may be lower than that of initial surgery, even when the increased need for repeat revascularization is taken into account. Despite this, surgical bypass remains the mainstay of therapy for patients with severe coronary artery disease and a poor prognosis for survival, and will remain the fallback procedure for patients who repeatedly undergo failed PTCA. At the present time, revascularization should be offered on the basis of symptom severity (in the presence of medical therapy) and in accordance with the prognosis for survival as judged by the extent and severity of disease (Table VI). Percutaneous transluminal coronary angioplasty is preferred in patients who require revascularization but can obtain no proven benefit from bypass surgery. Coronary artery bypass surgery, using the internal mammary artery when possible, remains the revascularization method of choice for patients with more severe disease or whose disease is not amenable to treatment using percutaneous methods (Table VII).

Wilson, J M; Ferguson, J J



[Integrative medical intervention strategies for recurrent angina after coronary revascularization].  


Coronary revascularization (CRV), mainly by means of percutaneous coronary intervention or coronary artery bypass graft surgery, has been developed nowadays to rescue patients with myocardial ischemia. Nevertheless, the recurrent angina after coronary revascularization (RACR) remains a concernful problem in clinical practice, its management is still a real challenge to physicians. Therefore, the prevention and treatment of RACR become vital for keeping the benefits of CRV. The common causes of RACR and the adoptable integrative medical approaches for its diagnosis and treatment were discussed in this paper. PMID:21302480

Chen, Peng; Wang, Lei; Zhang, Jian



Robotic total endoscopic coronary artery bypass hybrid revascularization procedure in a patient with a preoperative tracheostoma.  


Preoperative tracheostoma presents a significant risk of sternal wound complications, mediastinitis, stoma necrosis and tracheal injury in patients requiring cardiac surgery. Several approaches have been described to limit these risks. Robotic totally endoscopic coronary artery bypass grafting in patients with a tracheostoma has not been reported. We describe a case of completely endoscopic coronary surgery using the daVinci(®) Si™ system in a patient with a tracheostoma. Single left internal mammary artery grafting to the left coronary artery system was carried out successfully as the first stage of a hybrid revascularization and followed by percutaneous coronary intervention to the circumflex coronary artery. We regard this technique as the most minimally-invasive method of surgical coronary revascularization with a significant potential to reduce the risk of mediastinitis in patients with a tracheostoma. PMID:21297145

Lehr, Eric J; van Wagenberg, Frans S; Haque, Reyaz; Bonatti, Johannes



Multivessel coronary revascularization and outcomes in kidney transplant recipients.  


Coronary artery disease is a major cause of morbidity and mortality in the kidney transplant population. We compared the long-term outcomes of coronary artery bypass graft (CABG) surgery with percutaneous coronary intervention (PCI) for multivessel coronary disease in a contemporary cohort of US kidney transplant recipients. From the U.S. Renal Data System, we identified all adult kidney transplant patients with ?6 months of Medicare A+B undergoing first recorded multivessel coronary revascularization from 1997 to 2009. The associations of CABG versus PCI with death and the composite of death or myocardial infarction (MI) were compared using proportional hazards regression. Of the 2272 patients included in the study, 1594 underwent CABG and 678 underwent PCI. The estimated 5-year survival rate was 55% [95% confidence interval (CI) 53% to 57%] following coronary revascularization, with no significant association between revascularization type and death [adjusted hazard ratio (aHR) = 1.08; CI 0.94-1.23] or the composite of death or MI (aHR = 1.07; CI 0.96-1.18). Separate propensity score-matched analyses yielded similar results. In this analysis of kidney transplant recipients undergoing multivessel coronary revascularization, we found no difference between CABG and PCI in terms of survival or the composite of death and MI. PMID:23957580

Lenihan, Colin R; Montez-Rath, Maria E; Winkelmayer, Wolfgang C; Chang, Tara I



Robotic-enhanced arterial revascularization for multivessel coronary artery disease  

Microsoft Academic Search

Background. A tendency to reduce operative trauma is determining the evolution of cardiac surgical techniques lately. The introduction of robotic-enhanced endoscopic systems enables surgeons to perform arterial revascularization for multivessel disease without sternotomy.Methods. From May 1999, 17 (4 women, 13 men; median age 63 ± 7.4 years) patients with multivessel coronary artery disease were treated surgically using arterial revascularization by

Romuald Cichon; Utz Kappert; Jens Schneider; Ina Schramm; Vassilios Gulielmos; Sems M Tugtekin; Stephan Schüler



Underuse of Coronary Revascularization Procedures: Application of a Clinical Method  

Microsoft Academic Search

Objectives. Our main objective was to apply a new method to determine whether coronary revascularization procedures are underused, especially among African-Americans and uninsured patients.Background. Although overuse of revascularization procedures has been studied, underuse as defined clinically has not been examined before.Methods. The study was conducted at four public and two academically affiliated private hospitals in Los Angeles; 671 patients who

Marianne Laouri; Richard L Kravitz; William J French; Irene Yang; Jeffrey C Milliken; Lee Hilborne; Robin Wachsner; Robert H Brook



Detection of myocardial viability in the prediction of improvement in left ventricular function after successful coronary revascularization by using the dobutamine stress echocardiography and quantitative SPECT rest-redistribution-reinjection 201TI imaging after dipyridamole infusion.  


The aim of this study was to assess the feasibility, safety, and respective diagnostic accuracy of low-dose dobutamine infusion and rest-redistribution-reinjection thallium 201 single photon emission computed tomography (SPECT) after dipyridamole infusion (Th-DIP), in the prediction of functional improvement of asynergic infarcted zones, after successful revascularization in patients with chronic ischemic heart disease. Thirty-one patients with a previous myocardial infarction and left ventricular dysfunction (mean ejection fraction: 41 +/- 5.8%) were studied. The regional wall motion of the left ventricle was evaluated by basic echocardiography before and 14 +/- 1.7 weeks after successful revascularization (19 by percutaneous transluminal coronary angioplasty and 12 by coronary artery bypass grafting). Dobutamine stress echocardiography (DSE) was performed in all patients with dobutamine infusion of 5 and 10 micrograms/kg/minute over five minutes. Within three days after DSE and prior to revascularization, all patients underwent Th-DIP for myocardial viability assessment. A 16-ventricular-segment model was used for basic, DSE, and Th-DIP images. Viability was assessed by applying the standard criteria for each technique. In the 31 patients, 496 segments were analyzed. By basic echocardiography, 164 (33%) of them were classified as asynergic. The DSE detected viable tissue in 69/496 (14%) segments, whereas Th-DIP identified viability in 95/496 (19%) segments. When the postrevascularization basic echocardiographic study was used as the gold standard in identifying myocardial viability, the sensitivity and specificity for the DSE and Th-DIP were 86.5%, 94.4% and 90.5%, 69%, respectively. No major side effects were observed with both techniques. In conclusion, DSE seems to be an accurate method for identifying viable but asynergic myocardium in patients with chronic ischemic heart disease, whereas Th-DIP overestimates the postrevascularization recovery. Detection of hibernating myocardium can be obtained by these two noninvasive methods. However, DSE seems to be more useful in determining the prospective selection of patients who are going to benefit from revascularization. PMID:8921752

Kostopoulos, K G; Kranidis, A I; Bouki, K P; Antonellis, J P; Kappos, K G; Rodogianni, F E; Zamanis, N J; Tavernarakis, A G; Lolas, C T; Anthopoulos, L P



Intravascular ultrasound predictors of restenosis after percutaneous transcatheter coronary revascularization  

Microsoft Academic Search

Objectives. This study sought to evaluate preintervention and postintervention intravascular ultrasound studies for potential predictors of angiographic restenosis and to use ultrasound predictors of restenosis to enhance our understanding of the pathophysiology of the restenosis disease process.Background. Restenosis remains the major limitation of percutaneous transcatheter coronary revascularization. Although its mechanisms remain incompletely understood, numerous studies have identified some of the

Gary S. Mintz; Jeffrey J. Popma; Augusto D. Pichard; Kenneth M. Kent; Lowell F. Satler; Ya Chien Chuang; Jennifer Griffin; Martin B. Leon



Clinical evidence versus patients' perception of coronary revascularization.  


Coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) have been developed as revascularization techniques for coronary artery disease. CABG offers a survival advantage over medical therapy, especially for high-risk coronary patients, whereas PCI is the most frequent initial procedure to treat multi-vessel coronary artery disease, because it is less invasive. However, PCI has been found to confer no additional benefit with respect to myocardial infarction (MI) or death. The SYNTAX trial compared the outcomes of patients with left main and/or three-vessel coronary artery disease treated with CABG versus PCI using drug-eluting stents. The 4-year results showed that all-cause mortality and cardiac death were both significantly higher in the PCI group than in the CABG group. Despite extensive evidence of the advantages of CABG over PCI with respect to death or MI, PCI is recommended more often and CABG less often than indicated in the guidelines. Patients with coronary artery disease should receive unbiased information about the risks and benefits of each procedure and the alternatives. A multidisciplinary approach, referred to as "the Heart Team", could help to improve the informed consent process when recommending revascularization treatment for coronary artery disease. PMID:23283351

Kawasuji, Michio



Percutaneous coronary revascularization in patients with formerly \\  

Microsoft Academic Search

BACKGROUND: Patients with refractory angina pectoris in end-stage coronary artery disease represent a severe condition with a higher reduction of life-expectancy and quality of life as compared to patients with stable coronary artery disease. It was the purpose of this study to invasively re-evaluate highly symptomatic patients with formerly diagnosed refractory angina pectoris in end-stage coronary artery disease for feasible

Thomas W Jax; Ansgar J Peters; Ahmed A Khattab; Matthias P Heintzen; Frank-Chris Schoebel



Total arterial coronary revascularization-patient selection, stenoses, conduits, targets.  


Graft patency determines prognosis in coronary artery bypass grafting (CABG). Numerous reports over the past 20 years have documented superior patencies and prognosis when multiple arterial grafts are used, yet less than 10% of CABG have multiple arterial grafts. Several conduits have been proposed, with varying degrees of success. Saphenous vein grafts (SVG) begin to fail with intimal hypertrophy and then atheroma after 5 years, with patency rates of 50% to 60% at 10 years, and <30% at 15 years. In contrast, left internal thoracic artery (LITA) patency is >95% at 10 years and >90% at 20 years. The radial artery is extremely versatile and can reach all territories, but is muscular and vulnerable to spasm and competitive flow. Similarly, the right gastroepiploic artery is also muscular, and is best suited to the posterior descending coronary artery, especially in reoperations and is also affected by competitive flow. In addition, bilateral internal thoracic artery grafting (BITA) grafts and total arterial revascularization (TACR) can be performed with identical perioperative mortality (1%) and perioperative morbidity to LITA + SVG. Importantly, survival is superior-85% to 90% at 10 years versus 75% to 80% respectively. BITA/TACR patients also suffer fewer late cardiac events and reoperations, with superior results for older patients, those requiring urgent surgery, diabetics, patients with renal dysfunction and in reoperations. Contraindications to BITA include obesity, insulin dependent diabetics, and severe chronic obstructive airways disease. As such, arterial grafts have better patencies and clinical results. BITA/TACR is often underutilized, but can be achieved in the majority of patients. Opportunities exist to enhance BITA/TACR use in CABG to the potential benefit of our patients. PMID:23977629

Tatoulis, James



Simultaneous hybrid revascularization by bilateral carotid stenting and coronary artery bypass grafting.  


Management of patient with concomitant severe coronary and carotid artery disease is challenging. The combined or staged surgical revascularization is burdened by an high risk of morbidity and mortality. Carotid artery stenting (CAS) has been recently introduced as an alternative revascularization approach. We describe a case of simultaneous hybrid revascularization by CAS followed by immediate coronary artery bypass graft (CABG) in a patient with a severe coronary artery disease and bilateral carotid artery stenosis. © 2010 Wiley-Liss, Inc. PMID:21207421

Visconti, Gabriella; Marino, Luigi; Briguori, Carlo



[Coronary revascularization during cardiopulmonary resuscitation. The bridge code].  


Cardiac arrest is one of the major current challenges, due to both its high incidence and mortality and the fact that it leads to severe brain dysfunction in over half of the survivors. The so-called coronary origin Bridge Code is presented, based on the international resuscitation recommendations (2005, 2010). In accordance with a series of strict predictive criteria, this code makes it possible to: (1) select refractory CPR patients with a high or very high presumption of underlying coronary cause; (2) evacuate the patient using mechanical chest compressors [LucasTM, Autopulse®], maintaining coronary and brain perfusion pressures; (3) allow coronary revascularization access during resuscitation maneuvering (PTCA during ongoing CPR); (4) induce early hypothermia; and (5) facilitate post-cardiac arrest intensive care. In the case of treatment failure, the quality of hemodynamic support makes it possible to establish a second bridge to non-heart beating organ donation. PMID:22402193

Serrano Moraza, A; Del Nogal Sáez, F; Alfonso Manterola, F



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

Microsoft Academic Search

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 single or bilateral internal thoracic artery (ITA) and radial artery grafts versus 170 patients conventionally revascularized using left ITA and saphenous vein grafts.

Sune Damgaard; Jens T. Lund; Nikolaj B. Lilleør; Mario J. Perko; Jan K. Madsen; Daniel A. Steinbrüchel



[Peculiarities of endovascular myocardial revascularization in patients with coronary heart disease and multivascular lesions in the coronary bed].  


This study included 171 patients with multivascular lesions in the coronary bed treated endovascularly for myocardial revascularization. The patients divided into 3 groups underwent complete, functionally adequate, and incomplete revascularization respectively. Analysis of clinical, anamnestic and angiographic characteristics of the patients revealed possible risk factors hampering the necessary extent of revascularization in case of multivascular lesions in the coronary bed such as chronic coronary occlusion, occlusion of more than 20 mm of the coronary artery, high risk of percutaneous coronary intervention based on the SYNTAX Score scale, and calcinosis of the effected segment. PMID:23019969

Kha?rutdinov, E R; Shugushev, Z Kh; Maksimkin, D A; Arablinski?, A B; Tarichko, Iu B



Stress imaging use and repeat revascularization among medicare patients with high-risk coronary artery disease.  


The optimal use of stress testing after coronary revascularization remains unclear, and overuse of stress testing might increase the rates of repeat revascularization. We analyzed the association at both the patient and regional level between the use of stress testing and repeat revascularization for a cohort of Medicare beneficiaries receiving revascularization within 30 days of an admission for symptomatic coronary artery disease. The sample consisted of 219,748 Medicare beneficiaries aged >65 years who received percutaneous coronary intervention or cardiac bypass artery grafting after hospital admission for symptomatic coronary artery disease in 2003 to 2004. Medicare claims data through 2008 identified the use of stress testing and repeat revascularization. The associations between the cumulative incidence of stress testing and repeat revascularization were analyzed using linear regression analysis. Within 6 years of the initial revascularization, the cumulative incidence of events was 0.61 for stress testing and 0.23 for repeat revascularization. Most (53.1%) repeat revascularizations were preceded by a stress test. Only 10.3% of repeat revascularization procedures were preceded by myocardial infarction. The 4-year cumulative incidence of repeat revascularization and stress testing varied between the Hospital Referral Regions represented by the sample, and the positive correlation between the rates by the health referral region accounted for only a small portion of the total health referral region variation in revascularization rates. In conclusion, stress testing is commonly performed among Medicare patients after the initial revascularization, and most repeat procedures are performed for stable coronary artery disease. The variation in stress testing patterns only explained a modest fraction of the regional variation in the repeat revascularization rates. PMID:22819426

Rossi, Joseph S; Federspiel, Jerome J; Crespin, Daniel J; Carey, Timothy S; Sheridan, Brett C; Stearns, Sally C



Beneficial effects of cardiac rehabilitation in patients with incomplete revascularization after primary coronary angioplasty.  


Background: There are no reliable data concerning the safety and benefits of physical rehabilitation in patients with a two-vessel disease before the second stage of angioplasty. The aim of this study was to evaluate the efficiency of early cardiac rehabilitation in patients with acute coronary syndromes and with angiographically significant residual coronary artery stenosis after a successful percutaneous coronary intervention (PCI) into the culprit lesion. Design: Retrospective analysis of the results of coronary angiograms and exercise tests of patients who underwent stationary rehabilitation after their first ACS and first PCI. Setting: Cardiac Rehabilitation Department. Population: One hundred ninety patients divided into 2 groups according to the completeness of myocardial revascularization; 49 with significant (?70%) coronary artery stenosis in a non-culprit vessel, the mean diameter reduction 80±9%; and 141 without any residual stenosis. The prevalence of classical risk factors was comparable in both groups. Rehabilitation was conducted as a stationary 3-week program. Methods. Comparison of the initial and final exercise test workload in both groups, as well as the frequency of adverse effects during the program. Results: Physical training in patients with incomplete revascularization (IR) was safe and well tolerated. Significant increase of workload capacity after the rehabilitation program was observed in both groups: in the IR group from 7.3±3.0 to 8.8±2.9 MET (P<0.0001) and in the complete revascularization (CR) group - from 7.6±2.8 to 9.2±2.9 MET (P<0.0001). No significant difference was observed in initial workload capacities (P=0.9813) nor in final workload capacities (P=0.8571) between the two groups. Two patients in the group with residual lesion (4%) and one in the group without residual lesion (0.7%) required urgent PCI during the rehabilitation program, P=0.1637. Conclusion: Early postinfarction physical training is safe and efficient for patients after complete revascularization and for those with untreated non-culprit coronary artery stenosis. Gradual increase in physical training intensity under cardiologist supervision is essential in identifying those rare patients for whom the second stage of angioplasty should not be delayed. Clinical rehabilitation impact. Our study shows that patients with incomplete revascularization may be qualified for cardiac rehabilitation programs. PMID:23558697

Rechci?ski, T; Ka?owski, M; Kasprzak, J D; Trzos, E; Kurpesa, M



Incident Coronary Revascularization and Subsequent Mortality in Chronic Heart Failure: A Propensity-Matched Study  

PubMed Central

Introduction Ischemic heart disease (IHD) is common in heart failure (HF), yet the association between incident coronary revascularization and mortality in these patients has not been examined in a propensity-matched study. Methods In the Digitalis Investigation Group trial, 2853 patients without coronary revascularization and 120 patients with coronary revascularization during the first three years were alive at the end of three years. We used propensity scores to match 119 and 357 patients with and without coronary revascularization. Matched Cox regression models were used to estimate hazard ratio (HR) and 95% confidence interval (CI) for mortality during the fourth year of follow-up, for all patients and by the mean left ventricular ejection fraction (LVEF) of 35%. Results Coronary revascularization was associated with higher mean LVEF (36 % versus 32 %; p<0.0001) and prevalence of angina pectoris (48% versus 32%; p<0.0001) but fewer prior myocardial infarction (80% versus 87%; p=0.023), all of which were balanced post-match. All-cause mortality occurred in 5.9% and 6.2% patients respectively with and without coronary revascularization (HR for coronary revascularization, 0.95; 95% CI, 0.39–2.32; p=0.910). HR for mortality associated with coronary revascularization for patients with LVEF ?35% and >35% were respectively 1.34 (95% CI, 0.48–3.71; p=0.578) and 0.61 (95% CI, 0.13–2.87; p=0.532). Conclusion Chronic HF patients with IHD receiving coronary revascularization were more likely to have angina and higher LVEF. However, in a balanced propensity-matched cohort, there was no association between coronary revascularization and mortality. The LVEF-associated variation in mortality needs to be prospectively studied.

Giamouzis, Grigorios; Agha, Syed Abbas; Ekundayo, O. James; Aban, Inmaculada; Love, Thomas E.; Daniel, Casey; Butler, Javed; Ahmed, Ali



Statin wars following coronary revascularization -Evidence-based clinical practice?  

PubMed Central

BACKGROUND Randomized clinical trials (RCTs) have shown that statins provide substantial heath benefits. Pharmaceutical companies spend enormous amounts of money on both clinical trials and marketing. The relative influence of information from clinical trials on physician prescription patterns for statins is unknown. OBJECTIVE To examine the correlation between statin prescription patterns and the quality of evidence from RCTs. METHODS Using the computerized administrative databases of the Quebec Health Insurance Board, the choice of statin for elderly patients (older than 65 years of age) following a coronary revascularization procedure (percutaneous coronary intervention or coronary artery bypass graft surgery) performed between January 1, 1994, and June 30, 2003, was examined. Prescriptions for each statin were compared with their evidence base obtained from a cumulative systematic literature review of RCTs that recorded mortality as an outcome and were published before December 31, 2002. RESULTS The study cohort comprised 27,979 elderly revascularized patients who received at least one statin prescription. In 1996, the year atorvastatin was introduced, simvastatin and pravastatin had 38.3% and 37.1% of the market share, respectively. By 2003, atorvastatin had 44% of the market share, compared with 29.9% and 24.1% for simvastatin and pravastatin, respectively. In contrast, RCTs published up to the end of 2002 had culminated in 133,341 and 140,565 patient-years of follow-up for simvastatin and pravastatin, respectively, and only 1459 patient-years for atorvastatin. CONCLUSIONS Prescription patterns regarding the choice of statin do not appear to be determined uniquely from high-quality RCTs. Further research into the other possible determinants of physician prescription patterns is necessary.

Brophy, James M; Costa, Vania



Safety and efficacy of off-pump coronary revascularization in severe left ventricular dysfunction  

Microsoft Academic Search

Background  Myocardial revascularization in presence of severe Left Ventricular Dysfunction (LVD) presents a challenging surgical scenario.\\u000a To improve the results of this high risk procedure, off-pump revascularization is being increasingly used; yet without conclusive\\u000a evidence of definite benefit. Present study aims to assess the early outcome of coronary revascularization in presence of\\u000a severe Left Ventricle (LV) dysfunction by off pump method

Himanshu Pratap; Saket Agarwal; Sanjeev Singh; Nikhil Patil; Nilanjan Dutta; Deepak Kumar Satsangi



Revascularization for coronary artery disease in diabetes mellitus: Angioplasty, stents and coronary artery bypass grafting  

Microsoft Academic Search

Patients with diabetes mellitus (DM) are prone to a diffuse and rapidly progressive form of atherosclerosis, which increases\\u000a their likelihood of requiring revascularization. However, the unique pathophysiology of atherosclerosis in patients with DM\\u000a modifies the response to arterial injury, with profound clinical consequences for patients undergoing percutaneous coronary\\u000a intervention (PCI). Multiple studies have shown that DM is a strong risk

Doron Aronson; Elazer R. Edelman



Utilizing Risk Scores in Determining the Optimal Revascularization Strategy for Complex Coronary Artery Disease  

Microsoft Academic Search

Percutaneous coronary intervention (PCI) of multivessel and\\/or left main stem disease have been shown to be potentially legitimate\\u000a revascularization alternatives in appropriately selected patients. Risk stratification is an important component in guiding\\u000a patients to identify the most appropriate revascularization modality (PCI or coronary artery bypass grafting [CABG]) in conjunction\\u000a with the Heart Team. The aim of this paper is to

Vasim Farooq; Salvatore Brugaletta; Patrick W. Serruys


Coronary revascularization in lung transplant recipients with concomitant coronary artery disease.  


Coronary artery disease (CAD) is not uncommon among lung transplant candidates. Several small, single-center series have suggested that short-term outcomes are acceptable in selected patients who undergo coronary revascularization prior to, or concomitant with, lung transplantation. Our objective was to evaluate perioperative and intermediate-term outcomes in this patient population at our institution. We performed a retrospective, observational cohort analysis of 898 lung transplant recipients between 1997 and 2010. Pediatric, multivisceral, lobar or repeat transplantations were excluded, resulting in 791 patients for comparative analysis, of which 49 (median age 62, 79.6% bilateral transplant) underwent concurrent coronary artery bypass and 38 (median age 64, 63.2% bilateral transplant) received preoperative percutaneous coronary intervention (PCI). Perioperative mortality, overall unadjusted survival and adjusted hazard ratio for cumulative risk of death were similar among both revascularization groups as well as controls. The rate of postoperative major adverse cardiac events was also similar among groups; however, concurrent coronary artery bypass was associated with longer postoperative length of stay, more time in the intensive care unit and more postoperative days requiring ventilator support. These results suggest that patients with CAD need not be excluded from lung transplantation. Preferential consideration should be given to preoperative PCI when feasible. PMID:24102830

Castleberry, A W; Martin, J T; Osho, A A; Hartwig, M G; Hashmi, Z A; Zanotti, G; Shaw, L K; Williams, J B; Lin, S S; Davis, R D



One-stage hybrid procedure: association between awake minimally invasive surgical revascularization and percutaneous coronary intervention.  


Hybrid revascularization provides minimally invasive options for high-risk patients with multivessel coronary artery disease. We used a hybrid approach in two patients. The surgical revascularization with the left internal mammary artery (LIMA) on the left descending coronary artery was performed through an inferior j-shaped mini-sternotomy keeping the patients awake with high-epidural thoracic anesthesia. At the end of the operations the patients were moved to the angiography laboratory to complete the revascularization with angioplasty. No complications were reported. PMID:19531536

Del Giglio, Mauro; Dell'Amore, Andrea; Zuffi, Andrea; Sokoli, Arvit



Impact of an aggressive coronary stenting strategy on the incidence of target lesion revascularization.  


Coronary stenting has been shown to reduce the incidence of target lesion revascularization (TLR) compared with balloon angioplasty in highly selected patients. However, the impact of an aggressive coronary stenting strategy in unselected patients on the overall incidence of TLR is unclear. We assessed the effect of increased stenting by comparing long-term results in consecutive patients who underwent successful percutaneous revascularization (with or without stents) during June to December 1995 (n=347) with those in June to December 1996 (n=401). Stents were used in 22.5% of patients in 1995 versus 66.1% in 1996 (p <0.0001). Mean age of the patients was 62+/-11 years (71% men) in 1995 versus 63+/-10 in 1996 (76% men) (p=NS). The 2 groups were well matched with the exception that the 1996 cohort included more patients with unstable coronary syndromes (25% in 1995 vs 34% in 1996 (p=0.003). There was no significant difference in the incidence of in-hospital adverse events. After 12 months of follow-up (complete in 95% of patients in each group), the incidence of TLR was significantly lower in the 1996 cohort than in the 1995 cohort (8.5% vs 14.7%, p=0.0075). This was mainly due to reduced requirement for repeat angioplasty in 1996 patients compared with 1995 (6.5% vs 11.8%, p=0.011). It is concluded that in an unselected patient population, an aggressive coronary stenting strategy was associated with a marked overall reduction in requirement for TLR over a 12-month period. PMID:9874044

Farshid, A; Allan, R M; Giles, R W; McCredie, R M; Pitney, M R; Walsh, W F



Employability--a new indication for aneurysmectomy and coronary revascularization.  


Increasing governmental concern with containment of medical costs prompted us to evaluate the efficacy and cost effectiveness of ventricular aneurysmectomy and coronary revascularization. Sixty-six patients underwent ventricular aneurysmectomy between August 1973 and June 1978. Their classification according to the New York Heart Association criteria, their employment status (fully employed, working part time or totally disabled) and their salaries and disability payments for the 11-month periods before and after surgery were compared. There were five hospital deaths (7.6%) with a 40-month actuarial survival of 74%. Ninety-five percent percent of the survivors were class I or class II 20 months (average) postoperatively, full employment increased form 33% preoperatively to 63% postoperatively and total disability decreased from 60% preoperatively to 29% postoperatively. The efficacy of surgery in this group of patients in terms of financial implact on the community was analysed: the cost of surgery averaged $10,537.00 per patient. Computing the income actually earned by the entire group of patients, the disability payments to the individual patients and the lost tax revenues through disability shows that the cost of surgery for the whole group could be paid by 1.68 years of improved postoperative productivity. PMID:7398001

Crosby, I K; Wellons, H A; Martin, R P; Schuch, D; Muller, W H



Catheter-based percutaneous myocardial laser revascularization in patients with end-stage coronary artery disease  

Microsoft Academic Search

OBJECTIVESThis study evaluates the feasibility and safety of a catheter-based laser system for percutaneous myocardial revascularization and analyses the first clinical acute and long-term results in patients with end-stage coronary artery disease (CAD) and severe angina pectoris.BACKGROUNDIn patients with CAD and intractable angina who are not candidates for either coronary artery bypass grafting (CABG) or percutaneous transluminal coronary angioplasty (PTCA),

Bernward Lauer; Ulrike Junghans; Fabian Stahl; Regina Kluge; Stephen N. Oesterle; Gerhard Schuler



Evaluation of Revascularization Subtypes in Octogenarians Undergoing Coronary Artery Bypass Grafting  

PubMed Central

Background Recent data suggest that octogenarians’ long-term survival after complete CABG revascularization is superior to incomplete revascularization. Discriminating between variable definitions of “complete” complicates interpretation of survival data. We aimed to clarify octogenarian long-term survival rates by stratifying revascularization subtypes. Methods and Results From 1986 to 2007, 580 patients 80 to 94 years of age underwent CABG. Functional complete revascularization was defined as at least one graft to all diseased coronary vessels with greater than 50% stenosis. Traditional complete revascularization was defined as one graft to each major arterial system with at least 50% stenosis. Incomplete revascularization was defined as leaving diseased, ungrafted regions. Revascularization was functional in 279 (48%), traditional in 181 (31%), and incomplete in 120 (21%). Long-term survival was evaluated by Kaplan-Meier analysis. Of 537 operative survivors, there were 402 late deaths. Cumulative long-term survival totaled 2,890 patient-years. Late survival (Kaplan-Meier) was similar between functional (6.8 years, mean) and traditional (6.7 years) groups (p=0.51), but diminished with incomplete (4.2 years) revascularization (p=0.007). Survival by group at 5 years was: 59±3% functional, 57±4% traditional, and 45±5% incomplete. Survival at 8 years was: 40±3% functional, 37±4% traditional, and 26±5% incomplete. To minimize selection bias in patients with limited life expectancy, Kaplan-Meier analysis was repeated including only patients with survival greater than 12 months. Survival was again impaired with incomplete revascularization (p=0.04), and there was no difference between functional and traditional complete revascularization (p=0.73). Conclusions Bypassing all diseased arterial vessels after revascularization does not afford significant long-term survival advantage compared to a traditional approach. Incomplete revascularization, related to more extensive disease, is associated with an 18% decline in survival. These data suggest that it is important to avoid incomplete revascularization in octogenarians, but the supplementary endeavor required to perform functional complete revascularization does not improve survival.

Aziz, Abdulhameed; Lee, Anson M.; Pasque, Michael K.; Lawton, Jennifer S.; Moazami, Nader; Damiano, Ralph J.; Moon, Marc R.



Transmyocardial laser revascularization: Results of a multicenter trial with transmyocardial laser revascularization used as sole therapy for end-stage coronary artery disease  

Microsoft Academic Search

Background: Transmyocardial laser revascularization was used as the sole therapy for patients with ischemic heart disease not amenable to percutaneous transluminal coronary angioplasty or coronary artery bypass grafting. This technique uses a carbon dioxide laser to create transmyocardial channels for direct perfusion of the ischemic heart.Methods: Since 1992, 200 patients, at eight hospitals in the United States, have undergone transmyocardial

Keith A. Horvath; Lawrence H. Cohn; Denton A. Cooley; John R. Crew; O. Howard Frazier; Bartley P. Griffith; Kamuran Kadipasaoglu; Allan Lansing; Finn Mannting; Robert March; Mahmood R. Mirhoseini; Craig Smith



Detection of restenosis after successful coronary angioplasty: Improved clinical decision making with use of a logistic model combining procedural and follow-up variables  

Microsoft Academic Search

A prospective study of 111 patients who underwent repeat coronary angiography and exercise thallium-201 scintigraphy 6 +\\/- 2 months after complete revascularization by percutaneous transluminal coronary angioplasty was performed to assess whether clinical, procedure-related and postangioplasty exercise variables yield independent information for the prediction of angiographic restenosis after angioplasty. Complete revascularization was defined as successful angioplasty of one or more

Jean Renkin; Jacques Melin; Annie Robert; Fabienne Richelle; Jean-Louis Bachy; Col Jacques; Jean-Marie R. Detry; William Wijns



17?-estradiol effects on human coronaries and grafts employed in myocardial revascularization: a preliminary study  

PubMed Central

Background This study was undertaken to compare the in vitro effects of 17?-estradiol on human epicardial coronary arteries, resistance coronary arteries and on arterial vessels usually employed as grafts in surgical myocardial revascularization. Methods Coronary artery rings (descending coronary artery, right coronary artery, circumflex coronary artery, first septal branch) and arterial graft rings (internal thoracic artery, gastro-epiploic artery) obtained from human heart donors with heart not suitable to cardiac transplantation were connected to force transducer for isometric force recording. Precontracted specimens with and without endothelium were exposed to increasing concentration of 17?-estradiol (3–30–300–3000 nmol/l) and to vehicle (0.1% v/v ethanol). We also evaluated the effects of 17?-estradiol on vessels before and 20 minutes after exposure to L-monomethyl-arginine and indomethacin. Results 17?-estradiol induced a significant relaxation in all precontracted vessels (mean maximum effect: 78,6% ± 8,5). This effect was not different among the different rings and was not related to the presence of endothelium. N-monomethyl-L-arginine and indomethacin did not modify 17?-estradiol relaxant effect. Conclusion The vasodilator action of the 17?-estradiol is similar on coronary arteries, resistance coronary arteries and arterial vessels usually employed as grafts in myocardial revascularization.

Polvani, Gianluca; Barili, Fabio; Rossoni, Giuseppe; Dainese, Luca; Ossola, Manuela Wally; Topkara, Veli K; Grillo, Francesco; Penza, Eleonora; Tremoli, Elena; Biglioli, Paolo



Incomplete revascularization in multivessel percutaneous transluminal coronary angioplasty: the role for stress thallium-201 imaging  

SciTech Connect

Evaluation of patients with multivessel coronary disease for percutaneous transluminal coronary angioplasty raises the question: Is incomplete revascularization an acceptable procedure in these patients, or does complete revascularization need to be performed, as in coronary artery bypass grafting. To provide an answer the present study utilized exercise thallium imaging as a guide to the performance of angioplasty in 85 patients with multivessel coronary disease. Preangioplasty exercise thallium imaging helped to identify the primary stenosis (culprit lesion) in 93% of patients. Two weeks to 1 month after dilation of this lesion, repeat thallium imaging identified two patient groups: Group 1, 47 patients with no evidence of ischemia in a second vascular distribution and Group 2, 38 patients with evidence of further angioplasty. In Group 2 47% of patients had angioplasty of a second vessel and 79% required multivessel angioplasty at 1 year follow-up. In contrast, only six Group 1 patients (13%) required angioplasty of a second vessel at 1 year. Thus, incomplete revascularization may be an acceptable approach in many patients with multivessel coronary disease. Stress thallium-201 imaging may be a useful technique in the evaluation and management of these patients.

Breisblatt, W.M.; Barnes, J.V.; Weiland, F.; Spaccavento, L.J.



Health Risk Reduction and Functional Restoration Following Coronary Revascularization: A Prospective Investigation Using Dynamic Stage Typology Clustering  

Microsoft Academic Search

We identified patterns of coronary-prone behavior modification in a prospective cohort investigation of health risk reduction following coronary artery bypass graft (CABG) revascularization surgery. Fifty coronary heart disease (CHD) patients scheduled for bypass answered questions about Transtheoretical Model (TTM) change strategy (process) use, mood, and quality of life at 1 month prior to CABG and again at 1-month and 8-month

Terence E. Fitzgerald; James O. Prochaska; Glenn S. Pransky



Effect of Obesity on Repeat Revascularization in Patients Undergoing Percutaneous Coronary Intervention With Drug-Eluting Stents  

Microsoft Academic Search

Obesity is a major risk factor for developing coronary artery disease. The impact of obesity on prognosis among those with established coronary disease is less clear. The objective of this study was to evaluate the effect of obesity on repeat revascularization in patients undergoing percutaneous coronary intervention (PCI) with drug-eluting stents (DES). We examined 6,083 patients who were divided into

Zhi Jian Wang; Yu Jie Zhou; Ying Xin Zhao; Yu Yang Liu; Dong Mei Shi; Xiao Li Liu; Miao Yu; Fei Gao



Revascularization of unprotected left main coronary artery disease: strategy selection and systematic risk assessment.  


Refinement of interventional techniques, adjunctive pharmacological therapy, and the introduction of drug eluting stents have fostered new interest for the percutaneous treatment of unprotected left main coronary artery (ULMCA) stenosis. Several observational registries, some randomized controlled trials and several meta-analyses have consistently shown no difference in mortality and myocardial infarction between percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) surgery in patients with ULMCA stenosis, but a higher rate of target vessel revascularization in patients treated with PCI. As a consequence, PCI of ULMCA stenosis has been upgraded to class IIa or IIb indication in the current European or American College of Cardiology/American Heart Association practice guidelines. Although these results are promising, they do not still represent enough evidence for extending PCI of ULMCA stenosis to current clinical practice. The EXCEL trial will address the value of PCI in relation to CABG for the treatment of ULMCA stenosis in more than 2000 patients. A major breakthrough of the SYNTAX trial has been the demonstration of an interaction between the coronary complexity and the revascularization strategy, suggesting that optimal risk stratification is a key element when deciding the best strategy of revascularization in this high-risk group of patients. Multidisciplinary team approach remains essential to provide a balanced information to the patient and to offer the beast treatment option. PMID:22511269

Palmerini, Tullio; Alessi, Laura; Dangas, George



Abciximab Suppresses the Rise in Levels of Circulating Inflammatory Markers After Percutaneous Coronary Revascularization  

Microsoft Academic Search

Background—Previous investigators have shown that systemic markers of inflammation may be increased in patients with acute ischemic syndromes or after percutaneous coronary revascularization and that persistent elevation in these markers is predictive of excess risk of subsequent adverse cardiac events. By virtue of its cross-reactivity with the glycoprotein IIb\\/IIIa, avb3, and aMb2 receptors, abciximab may reduce inflammatory processes. Methods and

A. Michael Lincoff; Dean J. Kereiakes; Mary A. Mascelli; Lawrence I. Deckelbaum; Elliot S. Barnathan; Kamlesh K. Patel; Bart Frederick; Marian T. Nakada; Eric J. Topol



A randomized comparison of a sirolimus eluting stent with a standard stent for coronary revascularization  

Microsoft Academic Search

BACKGROUND: The need for repeated treatment of restenosis of a treated vessel remains the main limitation of percutaneous coronary revascularization. Because sirolimus (rapamycin) inhibits the proliferation of lymphocytes and smooth-muscle cells, we compared a sirolimus-eluting stent with a standard uncoated stent in patients with angina pectoris. METHODS: We performed a randomized, double-blind trial to compare the two types of stents

M. C. Morice; P. W. Serruys; E. J. Sousa; F. Molnar; J. E. Sousa; J. Fajadet; E. Ban Hayashi; M. A. Perin; A. Colombo; G. Schuler; P. Barragan



Coronary Artery Revascularization Evaluation--A Multicenter Registry With Seven Years of Follow-Up  

PubMed Central

Background Data from randomized clinical trials comparing coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) may not accurately reflect current clinical practice, in which there is off?label usage of drug?eluting stents (DES). We undertook a prospective registry of coronary revascularization by CABG on? and off?pump and PCI with bare?metal stents (BMSs), DESs, or percutaneous transluminal coronary angioplasty (PTCA) to determine clinical outcomes. Methods and Results All patients undergoing isolated coronary revascularization in 8 community?based hospitals were enrolled. Final follow?up was obtained after 5 years by patient and/or physician contact and the Social Security Death Index. ST?elevation myocardial infarction and salvage patients were excluded. Five or more years of follow?up was obtained on 81.5% (3156) of the eligible patients—968 CABG patients (82.0%) and 2188 PCI patients (81.3%). Overall follow?up was 63.5±27.9 months (median, 79.7 months). The incidence of initial major adverse cardiac events (MACEs) at follow?up for CABG versus PCI was 29.2% versus 41.8% (P<0.001). Analysis of stent subgroups showed more events with BMSs (equivalent to PTCA alone) compared with DESs. All stents had more events than on? or off?pump CABG groups. Using propensity score–matched groups, the odds ratio for CABG to PCI was 0.69 (95% confidence interval [CI], 0.56 to 0.85; P<0.001) for mortality and 0.58 (95% CI, 0.45 to 0.75; P<0.001) for any MACE. Conclusions In the current era of DES and off?pump surgery, in a community hospital setting, comparable patients undergoing coronary revascularization appear to benefit from improved long?term survival and reduced MACE with CABG versus PCI.

Kurlansky, Paul; Herbert, Morley; Prince, Syma; Mack, Michael J.



Inflammatory response after coronary revascularization with or without cardiopulmonary bypass  

Microsoft Academic Search

Background. We sought to investigate the effect of multiple coronary artery bypass grafting (CABG) with or without cardiopulmonary bypass (CPB) on the perioperative inflammatory response.Methods. Sixty patients undergoing CABG were randomly assigned to one of two groups: (A) on pump with conventional CPB and cardioplegic arrest, and (B) off pump on the beating heart. Serum samples were collected for estimation

Raimondo Ascione; Clinton T Lloyd; Malcolm J Underwood; Attilio A Lotto; Antonis A Pitsis; Gianni D Angelini



Coronary Revascularization at Specialty Cardiac Hospitals and Peer General Hospitals in Black Medicare Beneficiaries  

PubMed Central

Background Critics have raised concerns that specialty cardiac hospitals exacerbate racial disparities in cardiovascular care, but empirical data are limited. Methods and Results We used administrative data from the Medicare Provider and Analysis Review (MEDPAR) Part A and Provider-of-Service (POS) files from 2002 to 2005. Multivariable logistic regression models were constructed to examine the likelihood of black Medicare patients being admitted to a cardiac hospital for coronary revascularization when compared with white patients within the same healthcare referral region (HRR) after accounting for geographic proximity to the nearest hospitals, procedural acuity and co-morbidities. We identified 35,309 patients who underwent coronary artery bypass grafting (CABG) in 18 HRRs and 94,525 patients who underwent percutaneous coronary intervention (PCI) in 20 HRRs with cardiac hospitals performing these procedures. Patients at cardiac hospitals were more likely to be men and white, and to have less co-morbidity than those at general hospitals. The likelihood of black patients undergoing coronary revascularization at a cardiac hospital was significantly lower for CABG (adjusted odds ratio [OR], 0.67; P=0.01) and PCI (adjusted OR, 0.63; P<0.0001). However, this relationship was substantially attenuated in black patients living in close proximity (i.e., within 10 miles) to cardiac hospitals (adjusted OR for CABG, 0.95; p=0.75; adjusted OR for PCI, 0.78; P=0.01). Conclusions Black patients were significantly less likely to be admitted at cardiac hospitals for coronary revascularization. Precise reasons for these findings are unclear, but suggest complex associations between race and geography in decisions about where to receive care.

Nallamothu, Brahmajee K.; Lu, Xin; Vaughan-Sarrazin, Mary S.; Cram, Peter



Improved angina threshold and coronary reserve following direct myocardial revascularization.  


Angina threshold, coronary reserve, and global myocardial lactate metabolism were studied by atrial pacing in 18 patients with obstructive coronary artery disease before and after aortocoronary artery bypass (ACB) surgery. In 3 of these 18 patients, regional (anterior wall) metabolism was also studied. Following ACB, 16 of the 18 patients did not develop angina at the maximum pacing rate (MPR). One patient developed angina postoperatively at a similar rate as before surgery. In the other patient, postoperative angina threshold was much higher. In the group as a whole, postoperative MPR (159 +/- 3.5 beats/min) was much higher than the preoperative angina rate (124.9 +/- 4.9 beats/min; P less than 0.001). Rate-pressure product (RP) at MPR postoperatively (21.5 +/- 0.89 mm Hg/min X 10(-3)) was also higher than RP at angina rate preoperatively (18.8 +/- 0.92 mm Hg/min X 10(-3); P less than 0.01). Although coronary sinus blood flow (CSBF) both at rest (152 +/- 16.2 ml/min) and at MRP (266 +/- 27.5 ml/min) postoperatively was higher than preoperative CSBF at rest (111 +/- 10.7 ml/min; P less than 0.05) and at angina rate (202 +/- 19.9 ml/min; P less than 0.05), arterial-coronary sinus O2 content (Art.-CSO2) difference was significantly lower postoperatively both at rest (8.9 +/- 0.37 ml/min) and at MPR (9.1 +/- 0.44 ml/min) compared with the preoperative Art.-CSO2 at the rest (12.7 +/- 0.40 ml/min; P less than 0.01) and at angina rate (12.4 +/- 3.8 ml/min; P less than 0.01)... PMID:1080446

Chatterjee, K; Matloff, J M; Swan, H J; Ganz, W; Sustaita, H; Magnusson, P; Buchbinder, N; Henis, M; Forrester, J S



Effect of revascularization on mortality associated with an elevated white blood cell count in acute coronary syndromes  

Microsoft Academic Search

Inflammation is increasingly recognized as having an important role in patients with acute coronary syndromes. We sought to determine whether an elevated white blood cell (WBC) count would predict subsequent mortality and whether revascularization would have a protective effect. We analyzed data from 10,480 patients with acute coronary syndromes enrolled in the PURSUIT trial who had a WBC count measured

Deepak L Bhatt; Derek P Chew; A. Michael Lincoff; Maarten L Simoons; Robert A Harrington; Steve R Ommen; Gang Jia; Eric J Topol



Changing outcomes of coronary revascularization in British Columbia, 1995-2001  

PubMed Central

OBJECTIVES To examine outcomes following all first coronary revascularization procedures, isolated coronary artery bypass graft surgery (CABG) and percutaneous coronary intervention (PCI) on British Columbia (BC) resident adults from 1995 to 2001. METHODS CABG and PCI data were obtained from the BC Cardiac Registry, and mortality data were obtained from the BC Vital Statistics Agency. Analysis was performed by annual cohorts, and the rates reported are unadjusted. RESULTS An increasing percentage of revascularization procedures was performed with PCI (62% in 1995 to 73% in 2001; P<0.001) due to the increased use of PCI procedures. Except in emergent cases, 30-day mortality improved after PCI (1.8% to 1.1%; P=0.02) and CABG (1.8% to 1.2%; P=0.01). Emergent cases accounted for 9.0% of PCIs and 2.7% of CABGs, the percentage treated by CABG decreasing from 14.5% in 1995 to 7.5% by 2001 (P<0.001). Mortality rates among emergent cases was higher at 30 days, with no trend in PCI mortality (12%) but a substantial reduction in 30-day mortality after CABG (28% to 10%; P=0.003). One-year survival free from repeat revascularization following PCI increased from 73% in 1995 to 83% in 2001 (P<0.001) and from 94% to 95% (P<0.005) following CABG. CONCLUSIONS Improvements in procedure-related mortality observed in trials have extended to clinical practice. With respect to emergent cases, an increasing proportion were treated by PCI with no change in PCI mortality but associated with a drop in surgical mortality. There has been a consistent and substantial drop in the need for repeat procedures within one year for patients selected for PCI.

Pate, Gordon E; Gao, Min; Ding, Lillian; Carere, Ronald G; Tyers, Frank O; Hayden, Robert I



Cost considerations in selecting coronary artery revascularization therapy in the elderly.  


This article presents some of the cost factors involved in selecting coronary artery revascularization therapy in an elderly patient. With the percentage of gross national product allocated to healthcare continuing to rise in the US, resource allocation has become an issue. Percutaneous coronary intervention continues to be a viable option for many patients, with lower initial costs. However, long-term angina-free results often require further interventions or eventual surgery. Once coronary artery revascularization therapy is selected, it is worthwhile to evaluate the cost considerations inherent to various techniques. Off-pump coronary artery bypass graft surgery has seen a resurgence, with improved technology and lower hospital costs than on-pump bypass surgery. Numerous factors contributing to cost in coronary surgery have been studied and several are documented here, including the potential benefits of early extubation and the use of standardized optimal care pathways. A wide range of hospital-level cost variation has been noted, and standardization issues remain. With the advent of advanced computer-assisted robotic techniques, a push toward totally endoscopic bypass surgery has begun, with the eventual hope of reducing hospital stays to a minimum while maximizing outcomes, thus reducing intensive care unit and stepdown care times, which contribute a great deal toward overall cost. At the present time, these techniques add a significant premium to hospital charges, outweighing any potential length-of-stay benefits from a cost standpoint. As our elderly population continues to grow, use of healthcare resource dollars will continue to be heavily scrutinized. Although the clinical outcome remains the ultimate benchmark, cost containment and optimization of resources will take on a larger role in the future. PMID:15285697

Maziarz, David M; Koutlas, Theodore C



Neighborhood Socioeconomic and Racial Disparities in Angiography and Coronary Revascularization: The ARIC Surveillance Study  

PubMed Central

Purpose Disparities in the receipt of angiography and subsequent coronary revascularization have not been well-studied. Methods We estimated prevalence ratios and 95% confidence intervals (PR, 95% CI) for the association between neighborhood-level income (nINC) and receipt of angiography; and among those undergoing angiography, receipt of revascularization procedures, among 9,941 hospitalized myocardial infarction patients under epidemiologic surveillance by the Atherosclerosis Risk in Communities (ARIC) Study (1993–2002). Results In analyses by tertile of nINC controlling for age, study community, gender, and year, compared to whites from high nINC areas, blacks from low nINC (0.60, 0.54–0.66) and medium nINC (0.70, 0.60–0.78) areas, as well as whites from low nINC areas (0.83, 0.75–0.91) were less likely to receive angiography, while blacks from high nINC and whites from medium nINC areas were not. Associations were attenuated, but persisted, after controlling for event severity, medical history, receipt of Medicaid, and hospital type. Compared to high nINC whites, blacks were less likely, and whites were as likely, to undergo cardiac revascularization, given receipt of an angiogram. Conclusions Black and lower nINC patients were less likely to undergo angiography than were whites and those from higher nINC areas. Among those receiving angiography, race, but not nINC, gradients persisted.

Rose, Kathryn M.; Foraker, Randi E.; Heiss, Gerardo; Rosamond, Wayne D.; Suchindran, Chirayath M.; Whitsel, Eric A.



Improved regional ventricular function after successful surgical revascularization  

SciTech Connect

Left ventricular segments with reversible asynergy at rest demonstrate reversible myocardial perfusion defects on exercise thallium-201 scintigrams. To determine if improved perfusion eliminates asynergy at rest, 23 patients with angina (stable in 21, unstable in 2) were studied before and after coronary artery bypass surgery. All patients underwent exercise myocardial perfusion scintigraphy, contrast ventriculography and coronary arteriography before and after surgery. Selective graft angiography was performed during the postoperative catheterization to determine graft patency. Segmental ventricular function was quantitated by a regional fraction method. The scintigrams were divided into five regions and compared with the corresponding regions of the ventriculogram. Seventy-one of a possible 142 ventricular segments exhibited exercise-induced perfusion deficits. Preoperative regional ejection fraction was normal in 42 of these segments and abnormal in 29. Postoperatively, in 19 of the abnormal segments, function improved or normalized. All these segments had improved perfusion during exercise after surgery and were supplied by a patent bypass graft. Nine of the 10 segments in which abnormal wall motion persisted postoperatively continued to have exercise-induced perfusion deficits, and 9 of the 10 segments were supplied by an occluded or stenotic graft or one with poor run off. Of the 42 segments with normal wall motion preoperatively, 30 had improved perfusion after surgery and 35 maintained normal function. This study indicates that asynergy at rest is permanently reversed after coronary bypass surgery if improved myocardial perfusion can be documented. These findings are consistent with but do not prove the concept that reversible rest asynergy may reflect chronic ischemia or a prolonged effect from previous ischemic episodes.

Brundage, B.H.; Massie, B.M.; Botvinick, E.H.



Coronary revascularization strategy and outcomes according to blood pressure (from the International Verapamil SR-Trandolapril Study [INVEST]).  


The optimal blood pressure (BP) to prevent major adverse outcomes (death, myocardial infarction, and stroke) for patients with hypertension and coronary artery disease who have undergone previous revascularization is unknown but might be influenced by the type of revascularization procedure. We analyzed data from the INternational VErapamil SR-Trandolapril STudy, focusing on the relation between BP and the outcomes of 6,166 previously revascularized patients, using the 16,410 nonrevascularized patients as a reference group. The previous revascularization strategy consisted of coronary artery bypass grafting (CABG, 45.2%), percutaneous coronary intervention (PCI, 42.1%), or both (CABG+PCI, 12.8%). Patients who had undergone both CABG+PCI and CABG-only had a greater adverse outcome risk (adjusted hazard ratio 1.27% and 1.20%, 95% confidence interval 1.06 to 1.53 and 1.07 to 1.35, respectively). The risk was similar for PCI-only patients (adjusted hazard ratio 1.04, 95% confidence interval 0.92 to 1.19). The relations between the adjusted hazard ratio and on-treatment BP appeared J-shaped for each revascularization strategy, accentuated for PCI and diastolic BP (DBP), but excepting CABG only and DBP for which the relation was linear and positive. In conclusion, major adverse outcomes were more frequent in patients with coronary artery disease who had undergone previous CABG, with or without PCI, compared to those with previous PCI only. This likely reflected more severe vascular disease. The relation to systolic BP was J-shaped for each strategy. Among those patients with previous CABG only, the linear relation with DBP suggested that more complete revascularization might attenuate hypoperfusion at a low DBP. The management of BP might, therefore, require modification of targets according to the revascularization strategy to improve outcomes. PMID:20691307

Denardo, Scott J; Messerli, Franz H; Gaxiola, Efrain; Aranda, Juan M; Cooper-Dehoff, Rhonda M; Handberg, Eileen M; Gong, Yan; Champion, Annette; Zhou, Qian; Pepine, Carl J



Occurrence and predictors of obstructive sleep apnea in a revascularized coronary artery disease cohort.  


Background: Knowledge about the prevalence of obstructive sleep apnea (OSA) in coronary artery disease (CAD) is insufficient. The aim of the current report was to evaluate the occurrence and predictors of OSA among revascularized patients with CAD within the framework of a randomized controlled trial (Randomized Intervention with CPAP in Coronary Artery Disease and Sleep Apnea [RICCADSA]), evaluating the impact of continuous positive airway pressure on cardiovascular outcomes in CAD patients with OSA. Material and Methods: All patients undergoing percutaneous coronary intervention or coronary artery bypass grafting between September 2005 and November 2010 (n = 1,291) were invited to participate. Anthropometrics and medical history were obtained, ambulatory sleep recording was performed, and all subjects completed the Epworth Sleepiness Scale (ESS) questionnaire. Results: In total, 662 patients participated in the sleep study. OSA, defined as an apnea-hypopnea index equal to or greater than 15/hour, was found among 422 (63.7%). The prevalence of hypertension was 55.9%; obesity (body mass index ? 30 kg/m(2)), 25.2%; diabetes mellitus, 22.1%; and current smoking, 18.9%. The patients with CAD who did not participate in the study demonstrated an almost similar anthropometric and clinical profile compared with the studied group. The majority (61.8%) of the patients with OSA were nonsleepy (ESS score < 10). Patients with OSA had a higher prevalence of obesity, hypertension, diabetes mellitus, and history of atrial fibrillation, whereas current smoking was more common in the non-OSA group. Age, male sex, body mass index, and ESS score, but not comorbidities, were independent predictors of OSA. Conclusions: The occurrence of unrecognized OSA in this revascularized CAD cohort was higher than previously reported. We suggest that OSA should be considered in the secondary prevention protocols in CAD. PMID:23952854

Glantz, Helena; Thunström, Erik; Herlitz, Johan; Cederin, Björn; Nasic, Salmir; Ejdebäck, Jan; Peker, Yüksel



Anatomic versus physiologic assessment of coronary artery disease: role of coronary flow reserve, fractional flow reserve, and positron emission tomography imaging in revascularization decision-making.  


Angiographic severity of coronary artery stenosis has historically been the primary guide to revascularization or medical management of coronary artery disease. However, physiologic severity defined by coronary pressure and/or flow has resurged into clinical prominence as a potential, fundamental change from anatomically to physiologically guided management. This review addresses clinical coronary physiology-pressure and flow-as clinical tools for treating patients. We clarify the basic concepts that hold true for whatever technology measures coronary physiology directly and reliably, here focusing on positron emission tomography and its interplay with intracoronary measurements. PMID:23954338

Gould, K Lance; Johnson, Nils P; Bateman, Timothy M; Beanlands, Rob S; Bengel, Frank M; Bober, Robert; Camici, Paolo G; Cerqueira, Manuel D; Chow, Benjamin J W; Di Carli, Marcelo F; Dorbala, Sharmila; Gewirtz, Henry; Gropler, Robert J; Kaufmann, Philipp A; Knaapen, Paul; Knuuti, Juhani; Merhige, Michael E; Rentrop, K Peter; Ruddy, Terrence D; Schelbert, Heinrich R; Schindler, Thomas H; Schwaiger, Markus; Sdringola, Stefano; Vitarello, John; Williams, Kim A; Gordon, Donald; Dilsizian, Vasken; Narula, Jagat



Revascularization for Unprotected Left Main Coronary Artery Disease: An Evolution in Clinical Decision Making  

Microsoft Academic Search

Coronary artery bypass grafting (CABG) has been considered the standard therapy for unprotected (nonrevascularized) left main\\u000a coronary disease (ULM). However, increasing experience with ULM percutaneous coronary intervention (PCI) has resulted in high\\u000a procedural success and favorable early and late clinical outcomes. In particular, reduction in clinical restenosis with drug-eluting\\u000a stents, evolution of procedural technique, and demonstration of favorable outcomes from

David E. Kandzari; John A. Ormiston


Precision incision: robotic coronary revascularization via 3.9-cm minithoracotomy.  


Coronary artery bypass grafting remains the treatment choice for coronary artery disease; but sternotomy, the most commonly used approach, compromises its benefits with postoperative morbidity, higher complication rates, and prolonged length of hospital stay. Despite this, minimally invasive and robotic-assisted technology has not been adopted or widely embraced because supporting literature on robotic-assisted coronary artery bypass grafting is extremely limited. Since 2005, the cardiothoracic surgical team at our institution has been developing and maturing an effective method using robotic harvesting of the left internal mammary artery (LIMA) and beating heart surgery through a minithoracotomy for coronary revascularization. This surgical technique involves precisely placing the robotic endoscopic port immediately over the left anterior descending (LAD) artery target site. The robotically harvested LIMA is secured to the epicardium at the LAD target, the robotic instruments are removed, and the endoscopic port site is enlarged slightly greater than 1 cm to become the minithoracotomy and allow for LIMA-to-LAD anastomosis. The other two robotic ports are used to complete the procedure without a need for additional incisions. This standardized method has been used in more than 750 patients, and since 2009, the last 377 consecutive non-rib-spreading minithoracotomy incisions measured a median of 3.9 cm (mean [SD], 4.16 [1.2748] cm; range, 2.3-12.0 cm). This "How I Do It" article describes our methods in detail and associated robotic nuances. PMID:22885467

Sutter, Francis P; Berry, Tami; Wertan, Maryann C


Impact of Incomplete Revascularization on Long-Term Mortality Following Coronary Stenting  

PubMed Central

Background The impact of incomplete revascularization (IR) on adverse outcomes following percutaneous coronary intervention (PCI) remains inconclusive; and few studies have examined mortality during follow-ups longer than 5 years. The objective of this study is to test the hypothesis that IR is associated with higher risk of long-term (8-year) mortality following stenting for multivessel coronary disease. Methods and Results A total of 13,016 patients with multivessel disease who had undergone stenting procedures with bare-metal stents (BMS) in 1999–2000 were identified in the New York State’s Percutaneous Coronary Intervention Reporting System. A logistic regression model was fit to predict the probability of achieving complete revascularization (CR) in these patients using baseline risk factors; then, the CR patients were matched to the IR patients with similar likelihoods of achieving CR. Each patient’s vital status was followed through 2007 using the National Death Index, and the difference in long-term mortality between IR and CR was compared. It was found that CR was achieved in 29.2% (3,803) of the patients. For the 3,803 pair-matched patients, the respective 8-year survival rates were 80.8% and 78.5% for CR and IR (P=0.04). The risk of death was marginally significantly higher for IR (hazard ratio = 1.12, 95% confidence interval (CI): 1.01–1.26, P=0.04). The 95% bootstrap CI for the hazard ratio was 0.98–1.32. Conclusions IR may be associated with higher risk of long-term mortality following stenting with BMS in patients with multivessel disease. More prospective studies are needed to further test this association.

Wu, Chuntao; Dyer, Anne-Marie; King, Spencer B.; Walford, Gary; Holmes, David R.; Stamato, Nicholas J.; Venditti, Ferdinand J.; Sharma, Samin; Fergus, Icilma; Jacobs, Alice K.; Hannan, Edward L.



The Effect of Revascularization of Atherosclerotic Renal Artery Stenosis on Coronary Flow Reserve and Peripheral Endothelial Function  

Microsoft Academic Search

Background: Patients with atherosclerotic renovascular disease (ARVD) are at increased risk of heart disease because of associated hypertension, coronary artery disease, cardiac failure and chronic kidney disease. Although suggested to be beneficial, the cardiac effects of renal artery revascularization have not been well characterized. Our aim was to analyze the effects of percutaneous dilatation of renal artery stenosis (RAS) in

N. Koivuviita; R. Tertti; M. Luotolahti; O. Raitakari; T. Vahlberg; P. Nuutila; J. Knuuti; K. Metsärinne



The effect of temperature management during cardiopulmonary bypass on neurologic and neuropsychologic outcomes in patients undergoing coronary revascularization  

Microsoft Academic Search

Several studies suggest that normothermic (“warm”) bypass techniques may improve myocardial outcomes for patients undergoing cardiac operations. Normothermic temperatures during cardiopulmonary bypass may, however, decrease the brain's tolerance to the ischemic insults that accompany all cardiac procedures. To assess the effect of bypass temperature management strategy on central nervous system outcomes in patients undergoing coronary revascularization, 138 patients were randomly

Christina T. Mora; Martha B. Henson; William S. Weintraub; John M. Murkin; Tomas D. Martin; Joseph M. Craver; John Parker Gott; Robert A. Guyton



Hyperhomocysteinemia, antithrombin consumption, and early venous graft closure in surgical coronary revascularization.  


Hyperhomocysteinemia is a pathological condition that increases cardiovascular risk due to prothrombotic behaviour in the patient. This case report concerns a 61-year-old man undergoing surgical coronary revascularization for early thrombosis of the venous graft. The postoperative antithrombin activity was extremely low (33%), despite normal preoperative values (79%) and a short cardiopulmonary bypass. At a subsequent screening, the patient was diagnosed with hyperhomocysteinemia (18.4 mmol/L) due to a heterozygous C677T mutation of the enzyme methylenetetrahydrofolate reductase associated with a folate deficiency. Hyperhomocysteinemia and cardiac operation are both factors that induce increased thrombin formation, which may induce antithrombin consumption and a consequent thrombotic event. Further studies are needed to define hyperhomocysteinemia as an independent risk factor for thrombotic events after cardiac surgery. PMID:18612269

Ranucci, M; Romitti, F; Costa, E


A case study of hospital closure and centralization of coronary revascularization procedures  

PubMed Central

Background Despite nation-wide efforts to reduce health care costs through hospital closures and centralization of services, little is known about the impact of such actions. We conducted this study to determine the effect of a hospital closure in Calgary and the resultant centralization of coronary revascularization procedures from 2 facilities to a single location. Methods Administrative data were used to identify patients who underwent coronary artery bypass grafting (CABG), including those who had combined CABG and valve procedures, and patients who underwent percutaneous transluminal angioplasty (PTCA) in the Calgary Regional Health Authority from July 1994 to March 1998. This period represents the 21 months preceding and the 24 months following the March 1996 hospital closure. Measures, including mean number of discharges, length of hospital stay, burden of comorbidity and in-hospital death rates, were compared before and after the hospital closure for CABG and PTCA patients. Multivariate analyses were used to derive risk-adjustment models to control for sociodemographic variables and comorbidity. Results The number of patients undergoing CABG was higher in the year following than in the year preceding the hospital closure (51.6 per 100 000 before v. 67.3 per 100 000 after the closure); the same was true for the number of patients undergoing PTCA (129.8 v. 143.6 per 100 000). The burden of comorbidity was significantly higher after than before the closure, both for CABG patients (comorbidity index 1.3 before v. 1.5 after closure, p < 0.001) and for PTCA patients (comorbidity index 1.0 before v. 1.1 after, p = 0.04). After adjustment for comorbidity, the mean length of hospital stay was significantly lower after than before the closure for CABG patients (by 1.3 days) and for PTCA patients (by 1.0 days). The adjusted rates of death were slightly lower after than before the closure in the CABG group. The adjusted rates of death or CABG in the PTCA group did not differ significantly between the 2 periods. Interpretation Hospital closure and the centralization of coronary revascularization procedures in Calgary was associated with increased population rates of procedures being performed, on sicker patients, with shorter hospital stays, and, for CABG patients, a trend toward more favourable short-term outcomes. Our findings indicate that controversial changes to the structure of the health care system can occur without loss of efficiency and reduction in quality of care.

Hemmelgarn, Brenda R.; Ghali, William A.; Quan, Hude



Complete arterial coronary bypass revascularization with single aorto-ostial anastomosis and long-term outcome.  


Coronary reoperations continue to play an important role in the practice of coronary artery bypass grafting (CABG). Apart from having a sicker patient subgroup, reoperation poses an increasingly more complex and technically demanding surgery to perform. The superior patency of the left internal mammary artery (LIMA) has prompted increased interest in using arterial conduits for coronary bypass. However in situations where LIMA to left anterior descending (LAD) graft can not be done successfully, it remains a problem. We present a case of repeat three vessel coronary bypass surgery where three free arterial grafts were used with single anastomosis to ascending aorta as an alternative because of compromised length of LIMA and radial grafts. PMID:20337168

Prayaga, Sastry; Marashdeh, Mohammad M; Sachdeva, Rajesh



Risk Stratification in Elderly Coronary Artery Disease Patients: Can We Predict Which Seniors Benefit Most from Revascularization Options?  

Microsoft Academic Search

With the increased global burden of an aging population manifesting cardiovascular disease, the decision process for use of\\u000a coronary revascularization options in older adults has gained attention. Assessment of physiologic status has greater bearing\\u000a than chronologic age; items that have proven of particular merit in evaluating comorbidities as they relate to treatment prognosis\\u000a for both PCI and CABG in older

James B. McClurken; Raphael Rosenhek; T. Sloane Guy; Daniel E. Forman


Endovascular management of aortic arch vessel occlusion: successful revascularization of innominate and left subclavian arteries.  


A 56-year-old female presented with pain in her bilateral upper extremities. Angiogram demonstrated occlusion of her left subclavian and innominate arteries (IAs). The patient's left subclavian occlusion was successfully treated with percutaneous mechanical thrombectomy, angioplasty, and stenting. One month later, endovascular revascularization of the IA was performed. Initially the lesion could not be directly transversed from neither an antegrade nor a retrograde approach. Wires were passed from the brachial and femoral arteries into the right common carotid artery where the femoral wire was snared and brought out through the right brachial access. Over this through-and-through wire access, angioplasty and stenting of the IA was performed with an excellent angiographic result. In follow-up, the patient remained free of upper extremity symptoms. Occlusive lesions of the aortic arch vessels can be successfully managed with antegrade and retrograde endovascular techniques. PMID:22504511

Dayama, Anand; Riesenman, Paul J; Cheek, Rick A; Kasirajan, Karthikeshwar



The heart team approach to coronary revascularization-have we crossed the lines of evidence-based medicine?  


Evidence-based medicine demands considerable time and decision-making skills to navigate through the proliferating data. A hierarchical "pyramid of evidence" has been formulated to help categorize data quality. The hierarchical data are processed into recommendations in Practice Guideline statements. Recently, both American College of Cardiology/American Heart Association/Society for Cardiac Angiography and Interventions and European Society of Cardiology guidelines for percutaneous coronary intervention embraced a new "heart team approach" as the preferred method to optimize revascularization decision making in cases of complex coronary anatomy. This extrapolation of a research method to the broad clinical practice has potential limitations. We suggest that both the need for a new method to optimize patient triage for the various revascularization strategies and the method to optimize decision making should be discussed. Published data suggest only minor deviations from guideline-based indications. Furthermore, traditional clinical judgment may result in a better patient outcome than arbitrary treatment assignment by rigid set of criteria. In conclusion, the need for a new decision-making process in the choice of revascularization strategy should be further explored and supported by scientific evidence. PMID:23993117

Rosenschein, Uri; Nagler, Rafael M; Rofe, Amnon



Are Patients With Renal Failure Good Candidates for Percutaneous Coronary Revascularization in the New Device Era?  

Microsoft Academic Search

Background—Patients with end-stage renal disease undergoing conventional balloon angioplasty have reduced procedural success and increased complication rates. This study was designed to determine the immediate and long-term outcomes of patients with varying degrees of renal failure undergoing percutaneous coronary intervention in the current device era. Methods and Results—We compared the immediate and long-term outcomes of 362 renal failure patients (creatinine

Mark H. Rubenstein; Lari C. Harrell; Boris V. Sheynberg; Heribert Schunkert; Hasan Bazari; Igor F. Palacios


New-Onset Diabetes in Elderly Subjects: Association between HbA1c levels, mortality, and coronary revascularization.  


OBJECTIVE New-onset diabetes mellitus (DM) in elderly patients is associated with increased risk of diabetes complications and mortality. It is unknown whether glycemic control in this population influences the mortality risk. RESEARCH DESIGN AND METHODS The current study was conducted using the computerized database of the Sharon-Shomron District of Clalit Health Services in Israel. Included in the study were subjects 65 years of age and above with new-onset DM. The primary outcome measures were all-cause mortality and coronary revascularization procedures with either percutaneous coronary intervention or coronary artery bypass grafting. RESULTS Participants (n = 2,994) were stratified into four groups according to their mean HbA1c levels during the follow-up period (<6.5% [48 mmol/mol], 6.5-6.99% [48-52 mmol/mol], 7-7.49% [53-57 mmol/mol], and ?7.5% [58 mmol/mol]). During a mean follow-up of 5.54 ± 2.1 years, 1,173 (39.17%) participants died and 285 (9.51%) underwent coronary revascularization. An HbA1c level >7.5% (58 mmol/mol) was associated with a significantly increased all-cause mortality rate (hazard ratio [HR] 1.74 [95% CI 1.2-1.8], P < 0.0001). This difference remained statistically significant after a multivariate model adjusted for the conventional cardiovascular risk factors and for the use of hypoglycemic agents and statins. Kaplan-Meier survival plots revealed lower survival rates in this group of patients. Coronary revascularization rates were highest among subjects with HbA1c 6.5-6.99% (48-52 mmol/mol) (HR 1.6 [1.01-2.4], P < 0.05) and lowest in patients with HbA1c ?7.5% (58 mmol/mol). CONCLUSIONS An HbA1c level >7.5% (58 mmol/mol) is associated with increased risk for all-cause mortality and with a lower revascularization rate in elderly patients with new-onset DM. PMID:23877985

Twito, Orit; Ahron, Ella; Jaffe, Anat; Afek, Shani; Cohen, Efrat; Granek-Catarivas, Martine; Klein, Pinchas; Hermoni, Doron



Assessing Depression in the Cardiac PatientWhen Is the Appropriate Time to Assess Depression in the Patient Undergoing Coronary Revascularization?  

Microsoft Academic Search

Depression is a well-established risk factor for cardiovascular disease-related morbidity and mortality. It is common to screen for depression in patients undergoing coronary revascularization prior to revascularization; however, the validity of this assessment is unclear as some patients may experience transient, reactive depression rather than persistent depression. The authors evaluated whether an initial or 1-month postprocedure screen was optimal for

Walker S. Carlos Poston; C. Keith Haddock; Mark W. Conard; Phillip Jones; John Spertus



Off-pump coronary artery bypass grafting provides complete revascularization with reduced myocardial injury, transfusion requirements, and length of stay: A prospective randomized comparison of two hundred unselected patients undergoing off-pump versus conventional coronary artery bypass grafting  

Microsoft Academic Search

Objective: Retrospective comparisons of selected patients undergoing off-pump versus conventional on-pump coronary artery bypass grafting have yielded inconsistent results and raised concerns about completeness of revascularization in off-pump coronary artery bypass grafting.Methods: Two hundred unselected patients referred for elective primary coronary artery bypass grafting were randomly assigned to undergo off-pump coronary artery bypass grafting with an Octopus tissue stabilizer (Medtronic,

J. D. Puskas; W. H. Williams; P. G. Duke; J. R. Staples; K. E. Glas; J. J. Marshall; M. Leimbach; P. Huber; S. Garas; B. H. Sammons; S. A. McCall; R. J. Petersen; D. E. Bailey; H. Chu; E. M. Mahoney; W. S. Weintraub; R. A. Guyton



Induced ischemia detected by dobutamine stress echocardiography in coronary heart disease patients after myocardial re-vascularization. Experience in a District General Hospital.  


Most episodes of myocardial ischemia in patients with known coronary artery disease (CHD) are asymptomatic. Silent myocardial ischemia (SMI) is an important predictor of adverse outcome in patients with proven coronary artery disease. beta-blockers are effective in suppressing ischemia, and improve clinical outcome in patients with coronary artery disease. At present, it is common practice to stop treatment with beta-blockers in clinically asymptomatic patients after coronary artery bypass graft (CABG) and/or myocardial re-vascularization (PTCA/Stent), although the possible presence of SMI/inducible ischemia after myocardial re-vascularization is not known. We examined 56 asymptomatic CHD patients after coronary artery bypass graft (n=36), percutaneous coronary angioplasty PTCA/stent (n=15), or both (n=5); therapy with beta-blockers was stopped in all of them after myocardial revascularization. All these patients underwent a dobutamine stress echocardiography test (DSE test). The DSE test was proposed to these asymptomatic CHD patients to investigate the possible presence of SMI/inducible ischemia after myocardial re-vascularization. All patients had history of myocardial infarction or evidence of mildly impaired left ventricular function at rest as assessed by cardiac catheterization. Abnormal DSE studies occurred in eight of the 56 patients (14%; 95% C.I.: 6-26%). Therapeutic approaches specifically targeted at reducing total ischaemic burden include pharmacologic therapy and myocardial revascularization. On the basis of these data, it can be concluded that asymptomatic CHD patients after myocardial re-vascularization must be re-evaluated to rule out SMI/inducible ischemia that can be treated (e.g. with beta-blockers) reducing cardiovascular morbidity and mortality. PMID:12007683

De Lorenzo, Ferruccio; Saba, Neelam; Dancy, Mark; Kakkar, Vijay Vir; Kadziola, Zbigniew; Xiao, Han B



Sex differences in coronary catheterization and revascularization following acute myocardial infarction: Time trends from 1994 to 2003 in British Columbia  

PubMed Central

BACKGROUND: Studies before the turn of the century reported sex differences in procedure rates. It is unknown whether these differences persist. OBJECTIVES: To examine time trends and sex differences in coronary catheterization and revascularization following acute myocardial infarction (AMI). METHODS: A retrospective analysis was performed of all patients 20 years of age or older who were admitted to hospital in British Columbia with an AMI between April 1, 1994, and March 31, 2003. Segmented regression analysis was used to examine the inflection point of the time trend in 90-day catheterization rates post-AMI. Multivariable Cox regression modelling was used to evaluate sex differences in receiving catheterization and revascularization following AMI. RESULTS: Ninety-day coronary catheterization rates increased significantly over the study period for both men and women (P<0.0001 for trend), with a steeper increase beginning in September 2000. Women were less likely to undergo catheterization than men, even after adjustment for baseline differences; this sex effect was modified by age and care in the intensive care unit or cardiac care unit (ICU/CCU). Specifically, ICU/CCU admission eliminated the sex difference among patients who were younger than 65 years of age. Conditional on receiving cardiac catheterization post-AMI, female sex was not associated with a lower likelihood of receiving revascularization within one year (HR 0.96; 95% CI 0.91 to 1.02). CONCLUSIONS: Despite recent increases in catheterization rates post-AMI, women were less likely to undergo catheterization than men. Interestingly, access to ICU/CCU care removed the sex difference in catheterization access in patients younger than 65 years of age.

Sedlak, Tara L; Pu, Aihua; Aymong, Eve; Gao, Min; Khan, Nadia; Quan, Hude; Humphries, Karin H



How to revascularize patients with diabetes mellitus—  

Microsoft Academic Search

Summary  The diabetic patient is at high risk for coronary artery disease. Incidence as well as severity of the disease is highly increased\\u000a in comparison to non–diabetic patients. The revascularization of the diabetic patient is a great challenge, since the longterm\\u000a results are disappointing when compared to non–diabetic patients. The success of coronary artery bypass grafting is limited\\u000a by increased perioperative

Albrecht Elsässer; Helge Möllmann; Holger M. Nef; Christian W. Hamm



PreDischarge Exercise Test for Evaluation of Patients with Complete or Incomplete Revascularization following Primary Percutaneous Coronary Intervention: A DANAMI-2 Sub-Study  

Microsoft Academic Search

Objectives: It is unclear whether the completeness of revascularization impacts on the prognostic value of an exercise test after primary percutaneous coronary intervention (PCI). Methods: The DANAMI-2 trial included patients with ST elevation acute myocardial infarction randomized to primary PCI or fibrinolysis. Of the 790 patients randomized to primary PCI, 572 performed an exercise test. Prospectively, 310 patients were classified

Nana Valeur; Peter Clemmensen; Peer Grande; Kristian Wachtell; Kari Saunamäki



Recurrence of left ventricular outflow tract obstruction after left anterior descending coronary artery revascularization in a patient with hypertrophic obstructive cardiomyopathy.  


A patient with known hypertrophic obstructive cardiomyopathy presented with an anteroseptal myocardial infarction which resulted in the disappearance of his subaortic pressure gradient. Surgical revascularization of his left anterior descending coronary artery after the viability of his myocardium had been documented led to the recurrence of his left ventricular outflow tract obstruction and subaortic pressure gradient. PMID:11848096

Jaoudé, Simon J Abou; Achouh, Paul E; Ashoush, Ramzi A; Jebara, Victor A



Coronary artery steal via large coronary artery to bronchial artery anastomosis successfully treated by operation.  

PubMed Central

We report a patient with a large coronary artery to bronchial artery anastomosis causing angina by coronary steal. Angina was refractory to medical treatment, but successfully relieved by surgical ligation of the anastomosis. Images

St John Sutton, M G; Miller, G A; Kerr, I H; Traill, T A



Coronary revascularization in "high" versus "low-risk" patients: The role of myocardial protection.  

PubMed Central

Postoperative mortality, infarction, and need for inotropic support are reportedly increased following myocardial revascularization in "high-risk" patients. We believe these complications result from inadequate protection of the compromised myocardium and should not occur with greater frequency in "high-risk" than "Low-risk" patients if the heart is optimally protected during the entire course of the operative procedure. Results following revascularization in 50 consecutive "low-risk" and 50 consecutive "high-risk" patients were analyzed. One or more of the followin factors were present in the "high-risk" group: ventricular dysfunction--ejection fraction less than 0.4, preinfarction angina, evolving infarction, recent infarction (less than 2 weeks), and refractory ventricular tachyarrhythmia. The following principles were used in all patients to minimize ischemic injury: 1) avoidance of pre-bypass hypo- or hypertension, 2) limitation of ischemic arrest to less than 12 minutes, 3) avoidance of ventricular fibrillation, and 4) prolongation of total bypass as necessary to repay the myocardial oxygen debt. Postoperative inotropic support was required in 10% of "high" and 10% of "low-risk" patients, new postoperative infarction developed in 10% of "high" vs. 10% "low-risk" patients; death occurred in 2% of "high" vs. 4% "low-risk" patients. These results are comparable and indicate that optimum myocardial protection allows safe revascularization in the "high-risk" patient.

Olinger, G N; Po, J; Maloney, J V; Mulder, D G; Buckberg, G D



Impact of multivessel coronary artery disease and noninfarct-related artery revascularization on outcome of patients with ST-elevation myocardial infarction transferred for primary percutaneous coronary intervention (from the EUROTRANSFER Registry).  


The aim of the study was to assess the impact of multivessel coronary artery disease (MVD) and noninfarct-related artery (non-IRA) revascularization during index percutaneous coronary intervention (PCI) on outcomes of patients with ST-segment elevation myocardial infarction (STEMI). Data on 1,598 of 1,650 patients with complete angiographic data, with >or=1 significantly stenosed epicardial coronary artery, and without previous coronary artery bypass grafting were retrieved from the EUROTRANSFER Registry database. Patients with 1-, 2-, and 3-vessel disease made up 48.5%, 32.0%, and 19.5% of the registry population, respectively. Patients with MVD were less likely to achieve final Thrombolysis In Myocardial Infarction grade 3 flow (1- vs 2- vs 3-vessel disease, 93.6% vs 89.3% vs 87.9%, respectively, p = 0.003) and ST-segment resolution >50% within 60 minutes after PCI (1- vs 2- vs 3-vessel disease, 80.9% vs 77.5% vs 69.3%, respectively, p <0.001). They were also at higher risk of death during 1-year follow-up (1- vs 2- vs 3-vessel disease, 4.9% vs 7.4% vs 13.5%, respectively, p <0.001), and MVD was identified as an independent predictor of 1-year death. In 70 patients (9%) non-IRA PCI was performed during index PCI. These patients were at higher risk of 30-day and 1-year death compared to patients without non-IRA PCI, but this difference in mortality was no longer significant after adjustment for covariates. In conclusion, patients with MVD have decreased epicardial and myocardial reperfusion success and had worse prognosis after primary PCI for STEMI compared to patients with 1-vessel disease. In this large multicenter registry, non-IRA PCI during the index procedure was performed in 9% of patients with MVD and it was associated with increased 1-year mortality. PMID:20643243

Dziewierz, Artur; Siudak, Zbigniew; Rakowski, Tomasz; Zasada, Wojciech; Dubiel, Jacek S; Dudek, Dariusz



[Coronary-subclavian steal syndrome, a complication following surgical revascularization of myocardium].  


Coronary-subclavian steal syndrome (CSS) is defined as a reversal of flow in a previously constructed internal mammary artery coronary conduit, producing myocardial ischemia. The most often cause is a proximal subclavian artery stenosis or closure. For the first time was CSS described in 1974 and initially was believed to be rare. However, today is the internal mammary artery to the left anterior descending coronary artery used in cardiosurgery as a standard and we can see increasing documentation of this phenomenon. A case report is presented and possibilities of management are discussed in the article. PMID:23256834

Gloger, V



Successful Coronary Stent Retrieval From a Pedal Artery  

SciTech Connect

The purpose of this article is to report complications from a coronary drug-eluting stent lost in the peripheral circulation. We report the case of successful retrieval of a sirolimus coronary stent from a pedal artery in a young patient who underwent coronary angiography for previous anterior myocardial infarction. Recognition of stent embolization requires adequate removal of the device to avoid unwelcome clinical sequelae.

Mariano, Enrica, E-mail:; Versaci, Francesco [Tor Vergata University, Department of Cardiology (Italy); Gandini, Roberto; Simonetti, Giovanni; Di Vito, Livio [Tor Vergata University, Department of Radiology (Italy); Romeo, Francesco [Tor Vergata University, Department of Cardiology (Italy)



Revascularization in multivessel disease: Comparison between two-year outcomes of coronary bypass surgery and stenting  

Microsoft Academic Search

Objective: The recent appreciation that stenting has improved the short- and long-term outcomes of patients treated with coronary angioplasty has made it imperative to reconsider the comparison between surgery and percutaneous interventions in patients with multivessel disease.Methods: One thousand two hundred five patients were randomly assigned to undergo bypass surgery or angioplasty with stent implantation when there was consensus between

Felix Unger; Patrick W. Serruys; Magdi H. Yacoub; Charles Ilsley; Peter Kildeberg Paulsen; Torsten Toftegaard Nielsen; Leon Eysmann; Ferdinand Kiemeneij



[Changes in cerebral circulation in patients with coronary heart disease during myocardial revascularizing operations under combined xenon anesthesia].  


Twenty-five patients with coronary heart disease were examined in the preperfusion stage of myocardial revascularing operations under extracorporeal circulation. All the patients received combined anesthesia with xenon (Xe) as minimum flow anesthesia with flow of gases: oxygen, 0.4 l/min; Xe, 0.9 to 0.4 l/min. Cerebral circulation was investigated by transcranial Doppler study. The following parameters of the circulation: maximum systolic and diastolic blood flow velocities and pulsatile index were bilaterally estimated, by insonating the middle cerebral artery (MCA). When the concentration of Xe was as high as 50-60%, systolic and diastolic blood flow velocities along the MCA increase and the pulsatile index decreased. Opposite results were obtained 8 minutes after Xe feed was stopped. The findings provide evidence that Xe increases cerebral circulation and has a significant hypnotic effect. The increased systolic and diastolic blood flow velocities with the decreased peripheral resistance index in the MCA suggest that Xe diminishes peripheral vascular resistance in the pial arteries of the brain. PMID:17184056

Kozhevnikov, V A; Sandrikov, V A; Fedulova, S V; Guleshov, V A; Morozov, Iu A; Burov, N E; Buniatian, A A


A meta-analysis of randomized trials for repeat revascularization following off-pump versus on-pump coronary artery bypass grafting.  


To determine whether repeat revascularization rates are increased following off-pump coronary artery bypass grafting (CABG), we performed a meta-analysis of randomized controlled trials of off-pump vs on-pump CABG. Databases including MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials were searched through March 2013 using web-based search engines (PubMed, OVID). Studies considered for inclusion met the following criteria: the design was a prospective randomized controlled clinical trial; the study population was patients undergoing CABG; patients were randomly assigned to off-pump vs on-pump CABG and outcomes included repeat revascularization rates at ?1 year. Our exhaustive search identified 12 prospective randomized controlled trials of off-pump vs on-pump CABG. Pooled analysis demonstrated a statistically significant 38% increase in repeat revascularization rates with off-pump relative to on-pump CABG in the fixed-effects model (odds ratio, 1.38; 95% confidence interval, 1.09-1.76; P = 0.008). In general, exclusion of any single trial from the analysis did not substantively alter the overall result of our analysis. There was no evidence of significant publication bias. The results of our analysis suggest that off-pump CABG may increase repeat revascularization rates by 38% over on-pump CABG. PMID:23876842

Takagi, Hisato; Mizuno, Yusuke; Niwa, Masao; Goto, Shin-Nosuke; Umemoto, Takuya



Consideration of a New Definition of Clinically Relevant Myocardial Infarction After Coronary Revascularization: An Expert Consensus Document From the Society for Cardiovascular Angiography and Interventions (SCAI).  


Numerous definitions have been proposed for the diagnosis of myocardial infarction (MI) after coronary revascularization. The universal definition for MI designates post procedural biomarker thresholds for defining percutaneous coronary intervention (PCI)-related MI (type 4a) and coronary artery bypass grafting (CABG)-related MI (type 5), which are of uncertain prognostic importance. In addition, for both the MI types, cTn is recommended as the biomarker of choice, the prognostic significance of which is less well validated than CK-MB. Widespread adoption of a MI definition not clearly linked to subsequent adverse events such as mortality or heart failure may have serious consequences for the appropriate assessment of devices and therapies, may affect clinical care pathways, and may result in misinterpretation of physician competence. Rather than using an MI definition sensitive for small degrees of myonecrosis (the occurrence of which, based on contemporary large-scale studies, are unlikely to have important clinical consequences), it is instead recommended that a threshold level of biomarker elevation which has been strongly linked to subsequent adverse events in clinical studies be used to define a "clinically relevant MI." The present document introduces a new definition for "clinically relevant MI" after coronary revascularization (PCI or CABG), which is applicable for use in clinical trials, patient care, and quality outcomes assessment. PMID:24135581

Moussa, Issam D; Klein, Lloyd W; Shah, Binita; Mehran, Roxana; Mack, Michael J; Brilakis, Emmanouil S; Reilly, John P; Zoghbi, Gilbert; Holper, Elizabeth; Stone, Gregg W



Prevention of restenosis by lovastatin after successful coronary angioplasty  

Microsoft Academic Search

Prevention of restenosis after successful percutaneous transluminal coronary angioplasty (PTCA) remains a major challenge. To determine whether lovastatin could prevent restenosis, between December 1987 and July 1988, a total of 157 patients undergoing successful PTCA were randomly and prospectively assigned to the lovastatin group or a control group. Seventy-nine patients received lovastatin (20 mg daily if the serum cholesterol level

R. Sahni; A. R. Maniet; G. Voci; V. S. Banka



[Double antiaggregant therapy in patients with acute coronary syndrome undergoing coronary angioplasty revascularization. Pending clinical problems and effects of therapy non-compliance].  


Acute coronary syndromes (ACS) are the most frequent cause of hospitalization in intensive cardiac care units and are associated with a high risk of early complications. As a consequence, medical attention and healthcare are mainly directed towards the treatment of the acute phase of ACS, when the risk is higher. However, the risk associated with ACS is not simply confined to the hospitalization period, but may persist for months or years because of the frequent recurrence of ischemic events and related outcomes. Although more aggressive invasive strategies and powerful therapies with anticoagulants and antiplatelet agents have strongly improved the acute prognosis of ACS, the prognosis still remains unfavorable. Notwithstanding this, cardiologists mostly focus on the acute phase of ACS, while adopting a less aggressive approach after patient discharge and during outpatient follow-up. However, secondary prevention measures are as important as acute therapy and should be largely applied, including accurate estimation of the residual risk for the individual patient, appropriate implementation of secondary prevention, and close monitoring of adherence to suggested treatments, such as dual antiplatelet therapy. In conclusion, adherence to therapy is a clinically relevant factor, and efforts towards its improvement should be actively pursued. Moreover, appropriate prescriptions may stimulate therapy adherence with favorable effects, resulting in better clinical outcomes and healthcare cost containment. This holds particularly true for patients with ACS undergoing percutaneous revascularization. PMID:21563433

Casella, Gianni; De Servi, Stefano; Tubaro, Marco; Cavallini, Claudio; Andreotti, Felicita; Olivari, Zoran; Bolognese, Leonardo; Di Pasquale, Giuseppe



Prediction of functional recovery of the left ventricle after coronary revascularization in patients with prior anterior myocardial infarction: a myocardial integrated backscatter study.  


Cyclic variation (CV) of myocardial integrated backscatter (IBS), which reflects intrinsic contractile performance, can predict myocardial viability in patients with a reperfused acute myocardial infarction (MI), but the use of this method has not been validated for chronic left ventricular (LV) dysfunction. The aim of this study was to examine whether myocardial IBS was useful for predicting LV functional recovery after coronary revascularization in 17 patients with prior anterior MI and LV dysfunction (ejection fraction <50%). Within 24 h of the revascularization procedure (percutaneous transluminal coronary angioplasty or coronary stenting), IBS curves were obtained by placing the region of interest on the anterior wall on the short-axis IBS image. The patients had repeat left heart catheterization at 3 or 6 months after the revascularization procedure, and were grouped according to the patterns of the IBS curve within the anterior wall. In 8 patients (group A), the IBS curve had a synchronized pattern with the magnitude of CV > or = 3.5, and in the remaining 9 patients (group B), the curve had either an asynchronized pattern or the magnitude of CV was less than 3.5 dB even in the case of synchronized pattern, or both. At baseline, there were no significant differences in LV functional indices between the 2 groups. After the follow-up period, the LV end-systolic volume decreased (75 +/- 21 ml to 56 +/- 20ml, p = 0.05), LV ejection fraction increased (35 +/- 12% to 50 +/- 14%, p = 0.014), and LV end-diastolic pressure decreased (19 +/- 10 mmHg to 13 +/- 6 mmHg, p = 0.02) in group A, whereas only the LV ejection fraction increased (34 +/- 9% to 40 +/- 11%, p = 0.03) in group B; LV end-systolic volume (72 +/- 19 ml to 66 +/- 16 ml, p = 0.126) and LV end-diastolic pressure (18 +/- 12 mmHg to 14 +/- 8 mmHg, p = 0.184) showed no significant changes. In conclusion, IBS is valuable for predicting LV functional recovery after coronary revascularization in patients with LV dysfunction caused by a remote anterior MI. A large-scale study is be needed to establish these data. PMID:12381081

Ito, Takahide; Suwa, Michihiro; Suzuki, Shuji; Tanimura, Mitsuhiro; Suzuki, George; Kobashi, Ayaka; Nakamura, Tomomi; Miyazaki, Sadae; Kitaura, Yasushi



Complete versus culprit-only revascularization during primary percutaneous coronary intervention in ST-elevation myocardial infarction patients with multivessel disease: a meta-analysis.  


Complete versus culprit-only revascularization in acute ST-elevation myocardial infarction (STEMI) patients with multivessel disease is controversial. Current guidelines recommend treatment of the culprit artery alone during the primary procedure. However, with improvements in stent technique and with the use of new antiplatelet drugs (GP IIb/IIIa inhibitors), complete revascularization (CR) at an early stage is attracting increasing attention. We conducted an English language search on Medline (PubMed database), Embase, and the Cochrane databases between January 1966 and January 2011, as well as a search on the China National Knowledge Internet (1979-January 2011), and the Chinese Biomedical Literature Database (1978-January 2011). Randomized controlled trials (RCTs) or non-RCTs that compared the two strategies in patients with STEMI and multivessel disease (MVD) during primary percutaneous coronary intervention (PCI) were included. Thirteen articles were selected, 8240 patients in the CR group and 51,998 in the culprit-only revascularization group. CR was associated with an increased short-term mortality [odds ratio (OR) = 1.39, 95% confidence interval (CI) = (1.26, 1.53)], a long-term mortality [OR = 1.35, 95% CI = (1.09, 1.67)], and an increased risk of renal failure [OR (95% CI) = 1.24 (1.11, 1.38)] in patients with STEMI and MVD at the primary procedure. In addition, CR did not reduce the rate of short-term major adverse cardiac events [OR (95% CI) = 1.52 (0.88, 2.61)] and remyocardial infarction [OR = 0.57, 95% CI = (0.25, 1.29)]. However, CR was associated with a marked reduction in the rate of revascularization [OR = 0.45, 95% CI = (0.27, 0.74)]. This analysis of current available data demonstrates that CR during primary PCI can put those patients with STEMI and MVD at risk. To clarify this issue, large RCTs are needed. PMID:23465417

Lu, Cong; Huang, Hao; Li, Jing; Zhao, Jianxun; Zhang, Qing; Zeng, Zhi; Chen, Yucheng



Total arterial myocardial revascularization.  


The superiority of the internal thoracic artery (ITA) compared with venous conduits in terms of late graft patency is nowadays well documented. The inferior epigastric artery (IEA) was recently proposed as an alternative conduit for coronary artery surgery with good early clinical and angiographic results. To improve the benefits from myocardial revascularization, we expanded the use of these arterial conduits. From June 1988 to December 1991, 615 patients underwent coronary surgery in our institute. In 138 of them (22.4%) we performed total arterial myocardial revascularization placing 2 or more coronary anastomoses. An average of 2.37 anastomoses per patient were placed with the maximum number of 6 in one case. Only one patient died of cardiac related causes (0.72%). Perioperative morbidity included myocardial infarction and sternal dehiscence in 5 patients each (3.6%). No stroke or reoperation for bleeding occurred. No rectus muscle necrosis was recorded. Accurate preoperative planning of graft placement allows for the performance of as many as 6 distal anastomoses using bilateral ITA and single IEA grafts only, thus completely revascularizing most of the hearts with three-vessel disease. In our series this procedure was not reflected in an increase in the perioperative morbidity. We choose an elective total arterial revascularization in younger (under 65 years) patients who, while showing a lower incidence of complications in our study, are likely to derive the highest benefits from the good durability of ITA and hopefully IEA grafts. PMID:8442986

Paolini, G; Mariani, M A; Benussi, S; Zuccari, M; Di Credico, G; Gallorini, C; Grossi, A



Acute Thrombotic Occlusion of Right Coronary and Left Circumflex Coronary Arteries in a Patient with Antiphospholipid Syndrome: Successful Stent Implantation  

PubMed Central

Antiphospholipid syndrome is a rare disorder. Acute myocardial infarction is uncommon among these patients. Here we report a case of a 44-year-old man with antiphospholipid syndrome admitted for acute inferior myocardial infarction. Performed coronary angiography revealed that both the right coronary and the left circumflex coronary arteries were occluded by thrombi. We successfully performed primary angioplasty and stent implantation for both of the occluded coronary arteries. In the literature, this is the first case with antiphospholipid syndrome in which primary coronary angioplasty with stent implantation was successfully performed for two coronary arteries with acute thrombotic occlusion.

Biceroglu, Serdar; Ildizli Demirbas, Muge; Karaca, Mustafa; Yalcin, Murat; Yilmaz, Hasan



Successful coronary sinus lead replacement despite total venous occlusion using femoral pull through, two operator counter-traction and subclavian venoplasty.  


The majority of patients presenting for lead extraction have indications for a replacement lead. Venous stenosis is common in recipients of pacing leads and can impede ipsilateral lead replacement. Recanalization through an existing tract after lead extraction allows successful lead placement but may require complex hybrid lead extraction and revascularization techniques. We present a case in which a combination of femoral lead extraction with complete guidewire pull-through, two operator external counter-traction and subclavian venoplasty was used to successfully replace a coronary sinus lead in a patient with total subclavian venous occlusion. PMID:17605092

Rogers, Dominic P S; Lambiase, Pier D; Chow, Anthony W C



Screening asymptomatic patients with diabetes for unknown coronary artery disease: Does it reduce risk? An open-label randomized trial comparing a strategy based on exercise testing aimed at revascularization with management based on pharmacological\\/behavioural treatment of traditional risk factors. DADDY-D Trial (Does coronary Atherosclerosis Deserve to be Diagnosed and treated early in Diabetics?)  

Microsoft Academic Search

BACKGROUND: Coronary artery disease is the leading cause of morbidity and mortality in patients with type 2 diabetes. Screening for asymptomatic coronary artery disease with treatment by means of revascularization seems to be an appealing option for prevention. The utility of such a strategy has never been challenged in a randomized trial. METHODS\\/DESIGN: In the present study a cohort of

Fabrizio Turrini; Roberto Messora; Paolo Giovanardi; Stefano Tondi; Paolo Magnavacchi; Rita Cavani; Giandomenico Tosoni; Carlo Cappelli; Elisa Pellegrini; Stefania Romano; Augusto Baldini; Romeo Giulietto Zennaro; Marco Bondi



Less invasive coronary artery revascularization with a minimized extracorporeal circulation system: preliminary results of a comparative study with off-pump-procedures  

PubMed Central

Background Coronary-artery-bypass-grafting (CABG) with conventional extracorporeal circulation (CECC) is associated with adverse effects such as systemic inflammatory response leading to a decrease in systemic vascular resistance and hemodynamic instability. Modern "less invasive" procedures have been established recently which potentially avoid negative side effects of CECC. The aim of this study was to compare perioperative outcome following coronary revascularization using either a minimized extracorporeal circuit (Mini-HLM) or off-pump technique (OPCAB). Methods In this prospective ethics-approved trial, 120 patients referred for CABG were randomly assigned either to off-pump coronary artery bypass (OPCAB) or to a Mini-HLM procedure. Patient demographics, preoperative characteristics and extensive postoperative outcome were analyzed for both groups. Hemodynamic data were measured at seven time points perioperatively. Results Operation-time was longer in the Mini-HLM group (178,3?±?32,9 min) compared to OPCAB (133,2?±?32,7 min, p?Coronary revascularisation with Mini-HLM represents a suitable and "less invasive" procedure which achieves all benefits of OPCAB but may allow for less demanding revascularisation than OPCAB in special patients with complex coronary anatomy and can therefore be used both on a routine basis and in all "conversion" cases of OPCAB.



Racial Differences in Cardiac Revascularization Rates: Does \\  

Microsoft Academic Search

Background: Coronary artery bypass graft (CABG) surgery and percutaneous transluminal coronary angioplasty (PTCA) are well- established treatments for symptomatic coronary artery disease. Previous studies have documented racial differences in rates of use of these cardiac revascularization procedures. Other studies suggest that these procedures are overused: that is, they are done for patients with clinically inappropriate indications. Objective: To test the

Eric C. Schneider; Lucian L. Leape; Joel S. Weissman; Robert N. Piana; Constantine Gatsonis; Arnold M. Epstein



A study on the cost-effectiveness of coronary revascularization: introducing the simultaneous mimic health status model.  


An econometric model is presented to compare the cost-effectiveness of two alternative procedures, percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass surgery (CABG), for the treatment of multivessel coronary artery disease. This study utilizes the MIMIC (multiple indicator multiple cause) health model in a simultaneous equation system to analyse Emory Angioplasty Surgery Trial (EAST) data. This method eliminates the possibility of endogeneity bias, which may have affected the results of previous cost-effectiveness analyses on this topic. The empirical results indicate that neither procedure proves more cost-effective at 3 year follow-up. PMID:9466143

Lee, J S; Bailey, M J; Jeong, J; Mauldin, P D; Weintraub, W S


Cardiac Troponin After Revascularization Procedures  

Microsoft Academic Search

\\u000a A significant proportion (?20%) of patients undergoing percutaneous coronary intervention (PCI) or coronary artery bypass\\u000a graft (CABG) surgery develop elevated levels of creatine kinase MB isoform (CK-MB) afterward. Large increases in the concentration\\u000a of CK-MB after PCI are associated with the risk of death, myocardial infarction, and repeat revascularization. However, the\\u000a prognostic significance of modest elevations (less than five times

Warren J. Cantor; L. Kristin Newby


Two Different Successful Angioplasty Methods in Patients with Stenotic Coronary Artery Ectasia  

PubMed Central

There is no current guideline for percutaneous coronary angioplasty in stenotic ectatic coronary arteries because of the heterogeneity of the coronary artery morphology. We report two successful angioplasty cases in coronary artery ectasia with different clinical scenarios. One case showed atherosclerotic stenosis in the ectatic portion of the right coronary artery that was aggravated after a coronary artery bypass graft. In this case, balloon angioplasty alone without stenting showed acceptable results at the 6-month follow-up coronary angiography. In the other case, we used a peripheral artery balloon and stent for stenosis in the ectatic portion of a large coronary artery. Six-month follow-up coronary angiography showed excellent patency of the previously implanted peripheral stent.

Oh, Suk-Kyu; Kook, Hyungdon; Kim, Dong Hyeok; Ho, Seo Young; Kim, Sun Hwa; Choi, Cheol Ung; Oh, Dong Joo



Revascularization strategies in patients with Type 2 diabetes mellitus.  


This review aims to describe new developments in coronary revascularization strategies for patients with pre-existing Type 2 diabetes mellitus (DM). Recommended strategies for revascularization have been an active area of study with recent important developments. In patients with Type 2 DM and multivessel coronary artery disease (CAD), coronary artery bypass graft (CABG) surgery is the preferred method for revascularization. Patients with DM are at increased risk for diffuse cardiovascular disease due to the proinflammatory, prothrombotic effects of chronic hyperglycemia. In patients undergoing percutaneous coronary intervention, drug-eluting stents and more potent antiplatelet agents especially in those presenting with acute coronary syndromes should be employed. PMID:24138521

Choi, Sharon S; Mehran, Roxana



Prevention of restenosis by lovastatin after successful coronary angioplasty  

SciTech Connect

Prevention of restenosis after successful percutaneous transluminal coronary angioplasty (PTCA) remains a major challenge. To determine whether lovastatin could prevent restenosis, between December 1987 and July 1988, a total of 157 patients undergoing successful PTCA were randomly and prospectively assigned to the lovastatin group or a control group. Seventy-nine patients received lovastatin (20 mg daily if the serum cholesterol level was less than 300 mg/dl and 40 mg daily if the serum cholesterol level was greater than or equal to 300 mg/dl) in addition to conventional therapy (lovastatin group). Seventy-eight patients received conventional therapy alone (control group). Fifty patients in the lovastatin group and 29 in the control group were evaluated with coronary angiography at an interval of 2 to 10 months (mean 4 months). The restenosis rate was evaluated according to the number of patients showing restenosis, the number of vessels restenosed, and the number of PTCA sites restenosed. Restenosis was defined as the presence of greater than 50% stenosis of the PTCA site. In the lovastatin group 6 of 50 patients (12%) had restenosis compared with 13 of 29 patients (44.4%) in the control group (p less than 0.001). When the number of vessels restenosed was considered, only 9 of 72 vessels (12.5%) restenosed in the lovastatin group compared with 13 of 34 vessels (38.2%) in the control group (p less than 0.002). Similarly, 10 of 80 (12.5%) PTCA sites restenosed in the lovastatin group compared with 15 of 36 (41.7%) in the control group (p less than 0.001).

Sahni, R.; Maniet, A.R.; Voci, G.; Banka, V.S. (Episcopal Hospital, Philadelphia, PA (USA))



Percutaneous Transluminal Revascularization following an Angiotensin Receptor Blocker: Successful Treatment for Flash Pulmonary Edema and Hyponatremic Hypertensive Syndrome  

PubMed Central

Either flash pulmonary edema or hyponatremic hypertensive syndrome has been described in renal artery stenosis. However, coexistence of these two disorders has never been previously reported. We describe a patient who presented with flash pulmonary edema and hyponatremic hypertensive syndrome associated with bilateral renal artery disease (one complete occlusion, one highly critical renal artery stenosis, the equivalent of unilateral stenosis of a solitary functioning kidney). His blood pressure, hyponatremia, and symptoms of acute heart failure were much improved by an angiotensin receptor blocker. After the procedure of percutaneous transluminal revascularization, his stenotic kidney function and serum sodium levels were completely restored.

Shao, Leping; Gao, Yanxia; Xu, Yan; Lang, Yanhua



Multicenter experience in revascularization of very elderly patients  

Microsoft Academic Search

BackgroundVery elderly patients are increasingly referred for revascularization yet have been underrepresented in both prior percutaneous coronary intervention (PCI) and coronary bypass surgery (CABG) clinical trials. We pooled the largest PCI and CABG clinical registries in the United States to better understand revascularization procedure use, risks and outcomes in patients aged ?75 years.

Eric D. Peterson; Karen P. Alexander; David J. Malenka; Edward L. Hannan; Gerald T. O'Conner; Ben D. McCallister; William S. Weintraub; Fred L. Grover



[Revascularization measures after acute myocardial infarct].  


Thrombolytic therapy in acute myocardial infarction reduces mortality significantly. This acute effect seems to be counterbalanced by the increased mortality during follow-up whether or not the patient has been treated with thrombolytic therapy. Thrombolysis seems to be a first step in the treatment of acute myocardial infarction. Revascularization procedures are able to improve patient prognosis. Long-term follow-up demonstrated this fact whether or not PTCA was performed in the acute setting or on an elective basis. The 6-year survival was 80%. This survival rate was higher for patients who underwent PTCA than for those who were not undergoing PTCA and those who had no reperfusion of the coronary artery. The best prognosis was found for patients with coronary bypass surgery, indicating that revascularization should be the aim of treatment. The 6-year survival rate was found to be 92% and is thus in the range of patients with coronary artery disease. Acute infarct PTCA is limited to patients with cardiogenic shock and is particularly useful for patients with occlusion of the main stem of the left coronary artery. Acute infarct PTCA is also recommended in patients with contraindications for thrombolytic therapy, when interventions can be performed rapidly, when a large infarct size is present and infarct time is less than 4 hours. Whether or not RESCUE-PTCA should be recommended is under investigation. Patients with an open coronary artery have a better prognosis than patients with occluded coronary arteries, but during the acute stage, spontaneous recanalization is present in many patients. The RESCUE study will address this question. Elective PTCA is recommended as well as coronary bypass surgery, when successful reperfusion is achieved and one-or two-vessel disease is present or there is a two- or three-vessel disease or main stem involvement, respectively. In patients with coronary lesions less than 70% conservative treatment is useful. The guidelines of the American College of Cardiology and the American Heart Association are strongly recommended. PMID:8328196

Erbel, R; Spiecker, M; Rupprecht, H J; Darius, H; Görge, G; Haude, M; Dietz, U; Meyer, J



Thallium201 myocardial imaging before and after coronary revascularization: assessment of regional myocardial blood flow and graft patency  

Microsoft Academic Search

Twenty patients underwent myocardial imaging with thallium-201 (²°¹Tl) before and subsequent to coronary artery bypass grafting. All patients had rest and maximal treadmill exercise imaging postoperatively. Eleven of the 20 patients had rest and exercise ²°¹Tl images preoperatively; 9\\/20 only had rest imaging preoperatively. Postoperative regional exercise perfusion was improved in seven of the 11 patients who had preoperative exercise

J. L. Ritchie; K. A. Narahara; G. B. Trobaugh; D. L. Williams; G. W. Hamilton



Successful endovascular treatment of rupture of mycotic left main coronary artery aneurysm.  


Mycotic coronary aneurysm formation is a rare complication in patients with infective endocarditis. Furthermore, rupture of coronary artery aneurysm, also rare, is life threatening. Sudden rupture of left main mycotic coronary aneurysm occurred in a patient, aged 68 years, 1 month after root replacement for aortic regurgitation caused by infectious endocarditis. A polytetrafluoroethylene-covered stent was implanted covering the entire aneurysmal portion crossing over the left circumflex coronary artery in this emergent situation. After a successful hemostatic procedure, the patient recovered from cardiogenic shock. We confirmed the sustained patency of the stent segment by coronary angiography 6 months after the procedure. PMID:23395219

Torii, Sho; Ohta, Hiroshi; Morino, Yoshihiro; Nakashima, Makoto; Suzuki, Yoshitaka; Murata, Seiichiro; Sakuma, Yoshihiro; Ikari, Yuji; Tamura, Tsutomu



Cerebral Revascularization  

Microsoft Academic Search

\\u000a During the last 10 years, there has been a revival of interest in cerebral revascularization procedures. Not only have significant\\u000a progressions in surgical techniques been published, the use of more advanced diagnostic methods has led to a widening of the\\u000a indications for cerebral bypass surgery. The purpose of this review is to outline the current techniques for extracranial-to-intracranial\\u000a (EC\\/IC) and

H. J. N. Streefkerk; A. Zwan; R. M. Verdaasdonk; H. J. Mansvelt Beck; C. A. F. Tulleken


Spontaneous left main dissection treated by percutaneous coronary intervention.  


Spontaneous coronary artery dissection is a rare cause of acute coronary events or sudden cardiac death. The clinical presentation is highly variable and prognosis varies widely, depending mainly on how rapidly it is diagnosed. Prompt treatment is also essential, and includes medical management, percutaneous coronary intervention and surgical revascularization. We describe the case of a young woman presenting with spontaneous coronary artery dissection of the left main coronary artery, first diagnosed as coronary thrombus, who underwent successful percutaneous coronary stenting. This report highlights the need to include spontaneous coronary artery dissection in differential diagnosis of chest pain in young women and that distinguishing between coronary thrombus and coronary artery dissection is not always straightforward. To our knowledge this is the fourth case of left main stenting in a patient with spontaneous coronary artery dissection described in the literature. PMID:23809628

Sousa, Alexandra; Lopes, Ricardo; Silva, João Carlos; Maciel, M Júlia



ACCF/SCAI/STS/AATS/AHA/ASNC/HFSA/SCCT 2012 Appropriate use criteria for coronary revascularization focused update: a report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, American Association for Thoracic Surgery, American Heart Association, American Society of Nuclear Cardiology, and the Society of Cardiovascular Computed Tomography.  


The American College of Cardiology Foundation (ACCF), Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, and the American Association for Thoracic Surgery, along with key specialty and subspecialty societies, conducted an update of the appropriate use criteria (AUC) for coronary revascularization frequently considered. In the initial document, 180 clinical scenarios were developed to mimic patient presentations encountered in everyday practice and included information on symptom status, extent of medical therapy, risk level as assessed by noninvasive testing, and coronary anatomy. This update provides a reassessment of clinical scenarios the writing group felt to be affected by significant changes in the medical literature or gaps from prior criteria. The methodology used in this update is similar to the initial document, and the definition of appropriateness was unchanged. The technical panel scored the clinical scenarios on a scale of 1 to 9. Scores of 7 to 9 indicate that revascularization is considered appropriate and likely to improve patients' health outcomes or survival. Scores of 1 to 3 indicate revascularization is considered inappropriate and unlikely to improve health outcomes or survival. Scores in the mid-range (4 to 6) indicate a clinical scenario for which the likelihood that coronary revascularization will improve health outcomes or survival is uncertain. In general, as seen with the prior AUC, the use of coronary revascularization for patients with acute coronary syndromes and combinations of significant symptoms and/or ischemia is appropriate. In contrast, revascularization of asymptomatic patients or patients with low-risk findings on noninvasive testing and minimal medical therapy are viewed less favorably. The technical panel felt that based on recent studies, coronary artery bypass grafting remains an appropriate method of revascularization for patients with high burden of coronary artery disease (CAD). Additionally,percutaneous coronary intervention may have a role in revascularization of patients with high burden of CAD. The primary objective of the appropriate use criteria is to improve physician decision making and patient education regarding expected benefits from revascularization and to guide future research. PMID:22296741

Patel, Manesh R; Dehmer, Gregory J; Hirshfeld, John W; Smith, Peter K; Spertus, John A



ACCF/SCAI/STS/AATS/AHA/ASNC/HFSA/SCCT 2012 appropriate use criteria for coronary revascularization focused update: a report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, American Association for Thoracic Surgery, American Heart Association, American Society of Nuclear Cardiology, and the Society of Cardiovascular Computed Tomography.  


The American College of Cardiology Foundation (ACCF), Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, and the American Association for Thoracic Surgery, along with key specialty and subspecialty societies, conducted an update of the appropriate use criteria (AUC) for coronary revascularization frequently considered. In the initial document, 180 clinical scenarios were developed to mimic patient presentations encountered in everyday practice and included information on symptom status, extent of medical therapy, risk level as assessed by noninvasive testing, and coronary anatomy. This update provides a reassessment of clinical scenarios the writing group felt to be affected by significant changes in the medical literature or gaps from prior criteria. The methodology used in this update is similar to the initial document, and the definition of appropriateness was unchanged. The technical panel scored the clinical scenarios on a scale of 1 to 9. Scores of 7 to 9 indicate that revascularization is considered appropriate and likely to improve patients' health outcomes or survival. Scores of 1 to 3 indicate revascularization is considered inappropriate and unlikely to improve health outcomes or survival. Scores in the mid-range (4 to 6) indicate a clinical scenario for which the likelihood that coronary revascularization will improve health outcomes or survival is uncertain. In general, as seen with the prior AUC, the use of coronary revascularization for patients with acute coronary syndromes and combinations of significant symptoms and/or ischemia is appropriate. In contrast, revascularization of asymptomatic patients or patients with low-risk findings on noninvasive testing and minimal medical therapy are viewed less favorably. The technical panel felt that based on recent studies, coronary artery bypass grafting remains an appropriate method of revascularization for patients with high burden of coronary artery disease (CAD). Additionally, percutaneous coronary intervention may have a role in revascularization of patients with high burden of CAD. The primary objective of the appropriate use criteria is to improve physician decision making and patient education regarding expected benefits from revascularization and to guide future research. PMID:22424518

Patel, Manesh R; Dehmer, Gregory J; Hirshfeld, John W; Smith, Peter K; Spertus, John A; Masoudi, Frederick A; Dehmer, Gregory J; Patel, Manesh R; Smith, Peter K; Chambers, Charles E; Ferguson, T Bruce; Garcia, Mario J; Grover, Frederick L; Holmes, David R; Klein, Lloyd W; Limacher, Marian C; Mack, Michael J; Malenka, David J; Park, Myung H; Ragosta, Michael; Ritchie, James L; Rose, Geoffrey A; Rosenberg, Alan B; Russo, Andrea M; Shemin, Richard J; Weintraub, William S; Wolk, Michael J; Bailey, Steven R; Douglas, Pamela S; Hendel, Robert C; Kramer, Christopher M; Min, James K; Patel, Manesh R; Shaw, Leslee; Stainback, Raymond F; Allen, Joseph M



Coronary-to-Bronchial Artery Communication: Report of Two Patients Successfully Treated by Embolization  

SciTech Connect

We report two cases of coronary-to-bronchial artery communication responsible for coronary steal. In both cases the anastomosis originated from the proximal circumflex artery and developed because of bronchiectasis. In both cases closure of the anastomosis was achieved successfully by embolization. To date, the patients remained free from symptoms.

Jarry, Genevieve [Department of Cardiology, University of Amiens, Rene Laennec Avenue, F-80054 Amiens (France); Bruaire, Jean-Pierre [Department of Cardiology, Coutances Hospital, Rue de la Gare, F-50200 Coutances (France); Commeau, Philippe [Department of Cardiology, Centre Hospitalier Prive St. Martin, 18 rue des Roqueronts, F-14050 Caen (France); Hermida, Jean-Sylvain; Leborgne, Laurent [Department of Cardiology, University of Amiens, Rene Laennec Avenue, F-80054 Amiens (France); Auquier, Marie-Anne [Department of Radiology, University of Amiens, Rene Laennec Avenue, F-80054 Amiens (France); Delonca, Jean; Quiret, Jean-Claude [Department of Cardiology, University of Amiens, Rene Laennec Avenue, F-80054 Amiens (France); Remond, Alexandre [Department of Radiology, University of Amiens, Rene Laennec Avenue, F-80054 Amiens (France)



Robert H. Goetz: the surgeon who performed the first successful clinical coronary artery bypass operation  

Microsoft Academic Search

Robert H. Goetz performed the first successful clinical coronary artery bypass operation on May 2, 1960. He used a nonsuture technique to connect the right internal thoracic artery to the coronary artery by means of a modified Payr’s cannula made of tantalum. The patency of the anastomosis was demonstrated angiographically and the patient remained free of angina pectoris for 1

Igor E Konstantinov



Psychological factors influence the success of coronary artery surgery.  

PubMed Central

Thirty-six patients with angina were investigated by treadmill exercise testing and coronary angiography prior to coronary artery surgery. Severity of angina was judged by interview and self-assessment visual analogue scale and all patients were psychiatrically assessed. Further physical and psychiatric assessments were made at 3 and 6 months postoperatively. Eleven patients (31%) had significant psychiatric morbidity preoperatively and these had worse symptom scores and exercise tolerance compared with non-psychiatric cases, despite equivalent coronary angiographic findings and left ventricular function. Post-operatively, exercise tolerance improved equally in both groups but psychiatric cases remained significantly more symptomatic. Psychiatric morbidity remained unchanged throughout the study. We conclude that almost one third of patients with severe angina have psychiatric morbidity which is associated with a poor symptomatic response to coronary artery surgery, despite objective improvement in exercise tolerance. Ways of improving the symptomatic response to surgery in patients with coexisting psychiatric morbidity should be studied.

Channer, K S; O'Connor, S; Britton, S; Walbridge, D; Rees, J R



Successful percutaneous transluminal coronary angioplasty for acute myocardial infarction in von Willebrand's disease.  


An elderly woman with mild von Willebrand's disease presented with acute myocardial infarction. Percutaneous transluminal coronary angioplasty, to mechanically disrupt the thrombus without anticoagulation, was successfully undertaken. Haemostatic cover was also avoided. PMID:12410656

James, P R; de Belder, A J; Kenny, M W



Improvement of left ventricular ejection fraction, heart failure symptoms and prognosis after revascularization in patients with chronic coronary artery disease and viable myocardium detected by dobutamine stress echocardiography  

Microsoft Academic Search

OBJECTIVESThis study was designed to address, in patients with severe ischemic left ventricular dysfunction, whether dobutamine stress echocardiography (DSE) can predict improvement of left ventricular ejection fraction (LVEF), functional status and long-term prognosis after revascularization.BACKGROUNDDobutamine stress echocardiography can predict improvement of wall motion after revascularization. The relation between viability, improvement of function, improvement of heart failure symptoms and long-term prognosis

Jeroen J. Bax; Don Poldermans; Abdou Elhendy; Jan H. Cornel; Eric Boersma; Riccardo Rambaldi; Jos R. T. C. Roelandt; Paolo M. Fioretti



[Decreased plasma soluble P-selectin level in coronary sinus after successful coronary angioplasty in patients with unstable angina].  


P-selectin, an adhesion molecule, is involved in the alpha-granules of platelets with several factors such as platelet factor 4 (PF-4) and in Weibel-Parade bodies of endothelial cells with von Willebrand factor. The levels of the soluble form of P-selectin increase after angina episodes in patients with unstable angina, indicating that soluble P-selectin is associated with platelet activation and thrombogenesis in the coronary circulation. To evaluate the effect of successful coronary angioplasty on platelet activation or thrombogenesis in the coronary circulation, plasma soluble P-selectin, PF-4 and von Willebrand factor antigen levels were measured in blood obtained from the coronary sinus before and after successful coronary angioplasty in 15 patients with unstable angina. Fifteen patients with normal coronary angiograms served as controls. Plasma P-selectin, PF-4 and von Willebrand factor antigen levels were determined by sandwich enzyme-linked immunosorbent assays. Increased plasma soluble P-selectin (159.7 +/- 74.5 vs 78.7 +/- 26.4 ng/ml, p < 0.01) and PF-4 (456.5 +/- 87.0 vs 118.7 +/- 62.3 IU/ml, p < 0.01) levels were found in patients with unstable angina compared with those in controls, and were significantly decreased after angioplasty (147.8 +/- 69.6 ng/ml, p < 0.05; 401.6 +/- 108.5 IU/ml, p < 0.05), whereas von Willebrand factor antigen was unchanged. The ratio of plasma soluble P-selectin levels after and before angioplasty correlated with the corresponding ratio of plasma PF-4 levels (r = 0.53, p < 0.05), but not with the ratio of plasma von Willebrand factor antigen levels. The plasma levels of soluble P-selectin, which increase in the coronary circulation in patients with unstable angina, decrease after successful coronary angioplasty. Such data indicate that soluble P-selectin is associated with platelet activation and the therapeutical procedure improves the thrombogenic state in the coronary circulation. PMID:10354952

Doi, N; Nishio, K; Nakatani, H; Hayashi, T; Miyamoto, S; Hashimoto, T; Dohi, K



A case with successful retrograde stent delivery via AC branch for tortuous right coronary artery.  


The retrograde approach is a novel technique of percutaneous coronary intervention for chronic total occlusion. This technique has improved the success rate of guidewire passage through the occlusion. In the retrograde approach, a microcatheter and balloon are delivered through a retrograde channel. However, it is difficult for a stent to pass through collateral arteries. We report a case of coronary artery stenosis in a markedly tortuous right coronary artery for which a drug-eluting stent was delivered retrogradely via the atrial circumflex branch. PMID:23388238

Uehara, Yoshiki; Shimizu, Mitsuyuki; Yoshimura, Michihiro



Early detection of restenosis after successful percutaneous transluminal coronary angioplasty by exercise-redistribution Thallium scintigraphy  

Microsoft Academic Search

The value of exercise testing and thallium scintigraphy in predicting recurrence of angina pectoris and restenosis after a primary successful transluminal coronary angioplasty (PTCA) was prospectively evaluated. In 89 patients, a symptom-limited exercise electrocardiogram (ECG) and thallium scintigraphy were performed 4 weeks after they had undergone successful PTCA. Thereafter, the patients were followed for 6.4 +\\/- 2.5 months (mean +\\/-

William Wijns; Patrick W. Serruys; Johan H. C. Reiber; Feyter de P. J; Marcel van den Brand; Maarten L. Simoons; Paul G. Hugenholtz



Sequential thallium-201 myocardial perfusion studies after successful percutaneous transluminal coronary artery angioplasty: delayed resolution of exercise-induced scintigraphic abnormalities  

Microsoft Academic Search

To characterize the sequential changes of myocardial perfusion scintigraphy in patients with coronary artery disease (CAD) after complete revascularization, 43 patients underwent exercise thallium-201 (²°¹Tl) myocardial perfusion scintigraphy before and at 9 +\\/- 5 days, 3.3 +\\/- 0.6, and 6.8 +\\/- 1.2 months after percutaneous transluminal coronary angioplasty (PTCA). Only patients with single-vessel CAD, without previous myocardial infarction, and without

D. E. Manyari; M. Knudtson; R. Kloiber; D. Roth



Cardiac troponin T, creatine kinase, and its isoform release after successful percutaneous transluminal coronary angioplasty with or without stenting  

Microsoft Academic Search

Background Cardiac troponin T is a sensitive and specific marker for the detection of minor myocardial injury. However, it has been rarely used to monitor myocardial injury after coronary stenting. The purpose of the study was to measure troponin T after apparently successful percutaneous transluminal coronary angioplasty (PTCA) with or without coronary stenting and to compare its result with serum

Kou-Gi Shyu; Pei-Liang Kuan; Jun-Jack Cheng; Chi-Ren Hung



Successful sealing of a coronary artery perforation with a mesh-covered stent.  


Coronary artery perforation is a rare, but particularly feared and sometimes life-threatening, complication of percutaneous coronary interventions. The incidence of coronary perforation has increased with newer, more invasive interventional devices and techniques like rotablation, excimer laser coronary angioplasty, routine high-pressure balloon dilatation, or chronic total occlusion interventions. Here we describe a case of Ellis grade 2 perforation following a balloon dilatation performed in an in-stent restenotic total occlusion. The perforation was successfully sealed with a recently introduced device, a mesh covered stent (MGuard stent, Inspire MD). This new stent is much more flexible than the polytetrafluoroethylene-covered stent, which is often implanted in Ellis 2 or 3 grade perforations. PMID:22477764

Fogarassy, György; Apró, Dezs?; Veress, Gábor



Successful treatment of distal coronary guidewire-induced perforation with balloon catheter delivery of intracoronary thrombin.  


Distal coronary artery perforation with a coronary guidewire is a relatively rare but potentially fatal complication during PTCA. Historically, these types of perforations have been easy to control with reversal of heparin anticoagulation combined with prolonged distal balloon inflation. In the modern era, with widespread use of potent glycoprotein IIb/IIIa inhibitors, this type of distal wire perforation has become more difficult to manage and potentially lethal. In this article, we report two cases of guidewire-related distal coronary artery perforation, successfully treated using a new technique using localized, distal intracoronary thrombin injection. During prolonged low-pressure balloon inflation, a small dose of thrombin was injected just proximal to the wire perforation site via the lumen of a coronary balloon catheter. This approach appears to be a relatively rapid and effective way to control this troublesome complication. PMID:12594705

Fischell, Tim A; Korban, Elie H; Lauer, Michael A



Activation of coagulation and fibrinolysis despite heparinization during successful elective coronary angioplasty  

Microsoft Academic Search

Our aim was to assess whether the vessel wall trauma induced by balloon inflation during successful elective PTCA results in activation of coagulation and fibrinolysis detectable in circulating blood. In the pilot group (10 patients), when blood was collected under heparinization with adequate anti-Factor Xa activity, catheter-induced thrombin generation was not detected and results obtained from local coronary arterial versus

Seija Peltonen; Riitta Lassila; Juhani Heikkilä



Percutaneous coronary intervention in the Occluded Artery Trial: Procedural success, hazard, and outcomes over 5 years  

PubMed Central

Background The Occluded Artery Trial (OAT) was a 2,201-patient randomized clinical trial comparing routine stent-based percutaneous coronary intervention (PCI) versus optimal medical therapy alone in stable myocardial infarction (MI) survivors with persistent infarct-related artery occlusion identified day 3 to 28 post MI. Intent-to-treat analysis showed no difference between strategies with respect to the incidence of new class IV congestive heart failure, MI, or death. The influence of PCI failure, procedural hazard, and crossover on trial results has not been reported. Methods Study angiograms were analyzed and adjudicated centrally. Factors associated with PCI failure were examined. Time-to-event analysis using the OAT primary outcome was performed by PCI success status. Landmark analysis (up to and beyond 30 days) partitioned early hazard versus late outcome according to treatment received. Results Percutaneous coronary intervention was adjudicated successful in >87%. Percutaneous coronary intervention failure rates were similar in US and non-US sites, and did not significantly influence outcome at 60 months (hazard ratio for success vs fail 0.79, 99% CI 0.45–1.40, P = .29). Partitioning of early procedural hazard revealed no late benefit for PCI (hazard ratio for PCI success vs medical therapy alone 1.06, 99% CI 0.75–1.50, P = .66). Conclusions Percutaneous coronary intervention failure and complication rates in the OAT were low. Neither PCI failure nor early procedural hazard substantively influenced the primary trial results.

Buller, Christopher E.; Rankin, Jamie M.; Carere, Ronald G.; Buszman, Pawel E.; Pfisterer, Matthias E.; Dzavik, Vladimir; Thomas, Boban; Forman, Sandra; Ruzyllo, Witold; Mancini, G.B. John; Michalis, Lampros K.; Abreu, Pedro F.; Lamas, Gervasio A.; Hochman, Judith S.



[Significance of coronary perfusion for therapeutic success in myocardial infarct].  


Survival in acute myocardial infarction is dependent on several parameters. Some of them act by limiting the infarct size, others improve the prognosis independent of the final infarct size. Determinants of infarct size are time of vessel occlusion, degree of collaterals and area at risk. The latter two determinants do not offer a therapeutic approach in acute myocardial infarction. The most important therapeutic intervention remains the restoration of blood flow in the area at risk by either thrombolysis or PTCA. Reperfusion within 60 to 120 minutes significantly reduces mortality and infarct size. Within this time frame, changes in left ventricular function correlate with the survival rate. If reperfusion occurs later, the correlation between changes in left ventricular function and survival is poor or absent in some studies, despite a persistent survival benefit. After 4 bis 6 hours reperfusion is no longer able to limit infarct size significantly. However, this time frame is variable since there are wide variations in the degree of collaterals. With increasing occlusion time of the infarct related coronary artery, mechanisms independent of the limitation of infarct size will determine the prognosis. Late reperfusion has a beneficial effect on survival and on left ventricular function in certain cases. Left ventricular re-modeling and the incidence of severe ventricular arrhythmias can be reduced by delayed reperfusion. Reactivation of hibernating myocardium following reperfusion therapy may improve global left ventricular function. We analysed the importance of the infarct artery perfusion grade (TIMI flow) in 156 consecutive patients treated with infarct-PTCA. The most frequent indications for infarct-PTCA were failed thrombolysis and cardiogenic shock (Table 1).(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7843691

Spiecker, M; Erbel, R; Janssen, H; Meyer, J



Predictive value of low dose dobutamine transesophageal echocardiography and fluorine-18 fluorodeoxyglucose positron emission tomography for recovery of regional left ventricular function after successful revascularization  

Microsoft Academic Search

Objectives. This study was designed to assess the predictive value of myocardial viability diagnosed by dobutamine transesophageal echocardiography and fluorine (F)-18 fluorodeoxyglucose positron emission tomography for left ventricular functional recovery after revascularization in patients with chronic left ventricular dysfunction.Background. The identification of akinetic but viable myocardium is of particular importance for the selection of patients with a compromised left ventricle

Frank M. Baer; Eberhard Voth; Hans J. Deutsch; Christian A. Schneider; Michael Horst; Ernst R. de Vivie; Harald Schicha; Erland Erdmann; Udo Sechtem



Left main coronary artery bidirectional dissection caused by ejection of guideliner catheter from the guiding catheter.  


The "Guideliner," a child catheter, aims to deliver stents in tortuous coronary lesions by deep engagement and providing better support. Coronary artery spiral dissection, which may be caused by deep-seated coronary catheters or noncoaxial engagement is one of the most seen percutaneous coronary intervention-related complications. In this case, Guideliner-related left main dissection occurred after successful revascularization of a chronic total occlusion at the left anterior descending artery and the left circumflex, which has not been previously reported. The Guideliner catheter is efficient in treating complex coronary lesions, but one should be aware of its related complications. PMID:23413132

Chang, Yi-Chih; Fang, Hsiu-Yu; Chen, Tien-Hsing; Wu, Chiung-Jen



Clinical effectiveness of coronary computed tomographic angiography in the triage of patients to cardiac catheterization and revascularization after inconclusive stress testing: results of a 2-year prospective trial  

Microsoft Academic Search

Background  Management of patients with suspected coronary artery disease (CAD) and inconclusive stress imaging test findings may result\\u000a in invasive coronary angiography (ICA). Coronary computed tomographic angiography (CCTA) may be useful in defining the risk\\u000a of CAD and adverse outcomes in this patient population, as well as in reducing the need for ICA.\\u000a \\u000a \\u000a \\u000a Methods  We prospectively enrolled 199 sequential patients referred by

Aiden Abidov; Michael J. Gallagher; Kavitha M. Chinnaiyan; Laxmi S. Mehta; James H. Wegner; Gilbert L. Raff



Myocardial Perfusion Scintigraphy in the Assessment of Post-Revascularization – Current Status and Limitations  

Microsoft Academic Search

Myocardial perfusion imaging (MPI) is widely utilized in the non-invasive diagnosis and management of coronary artery disease\\u000a (CAD). Radionuclide MPI has been well studied in the evaluation, risk stratification and identification of patients with CAD\\u000a who will benefit from revascularization. Myocardial revascularization using percutaneous coronary interventions (PCI) and\\u000a coronary artery bypass graft (CABG) has become a mainstay in the treatment

Jaffar Ali Raza; Assad Movahed


Temporal evolution and functional outcome of no reflow: sustained and spontaneously reversible patterns following successful coronary recanalisation  

Microsoft Academic Search

Objective: To identify in humans the temporal patterns of no reflow and their functional implications.Methods: 24 patients with first acute myocardial infarction and successful coronary recanalisation by recombinant tissue-type plasminogen activator (n = 15) or primary percutaneous transluminal coronary angioplasty (n = 9) were studied by myocardial contrast echocardiography within 24 hours of recanalisation and at one month’s follow up.

L Galiuto; A Lombardo; A Maseri; L Santoro; I Porto; D Cianflone; A G Rebuzzi; F Crea



Left main coronary artery atresia and associated cardiac defects: report on concomitant surgical treatment.  


A 9-year-old boy with congenital atresia of the left main coronary artery underwent myocardial revascularization. Coarctation of the aorta and ventricular septal defect were diagnosed at the age of 1 year. At age 7 years, the child presented with syncope while exercising. Preoperative evaluation included cardiac catheterization which revealed the unexpected finding of congenital atresia of the left main coronary artery with origin of the circumflex artery from the right coronary artery. Surgical correction included myocardial revascularization by means of left internal mammary artery graft to the anterior descending coronary artery, coarctation resection, and ventricular septal defect repair. The patient recovered uneventfully. We report the details of this extremely rare case with successful concomitant surgical management of the congenital coronary artery anomaly and the associated structural heart disease. PMID:23804483

Jatene, Marcelo; Juaneda, Ignacio; Miranda, Rogerio Dos Anjos; Gato, Rafaella; Marcial, Miguel Lorenzo Barbero



Reoperation for myocardial revascularization  

Microsoft Academic Search

At The Cleveland Clinic Foundation, reoperations for myocardial revascularization make up 2.7% of all cardiac operations. Major indications for reoperation include: (a) graft failure, (b) progressive atherosclerosis in grafted or ungrafted vessels, (c) previous incomplete revascularization, and (d) combinations of the other 3. Almost one-half of the candidates satisfy more than 1 of the first 3 indications. Although few in

Floyd D. Loop; Robert L. Thurer; Bruce W. Lytle; Delos M. Cosgrove



Multicenter review of preoperative risk factors for stroke after coronary artery bypass grafting  

Microsoft Academic Search

Background. Stroke complicates the postoperative course in 1% to 6% of patients undergoing coronary revascularization. There has been no large scale mandatory database reporting on the incidence of stroke after coronary revascularization.Methods. A multicenter regional database from the Bureau of Health Care Research Information Services, New York State Department of Health, on 19,224 patients who underwent coronary revascularization in 31

Ranjit John; Asim F. Choudhri; Alan D. Weinberg; Windsor Ting; Eric A. Rose; Craig R. Smith; Mehmet C. Oz



Predictors of success in percutaneous transluminal coronary angioplasty of chronic total occlusions.  


Earlier studies have indicated that percutaneous transluminal coronary angioplasty (PTCA) of chronic total occlusions has a low success rate. To determine success rate and assess clinical and angiographic variables associated with success and complications, 57 total occlusions in 56 patients undergoing PTCA were analyzed. The clinical duration of occlusion was 51 +/- 86 days. Success (less than 50% residual stenosis) was achieved at 40 of 57 (70%) dilatation sites. Of these 57 total occlusions, 5 were attempted within 24 hours of acute myocardial infarction, 35 between 1 day and 8 weeks of clinical occlusion, 13 greater than 8 weeks and 4 were of unknown duration. Success rates were 4 of 5, 25 of 35, 9 of 13 and 2 of 4, respectively, in each group (difference not significant, comparison of all time groups). Of the 9 narrowings with a successful PTCA for an occlusion greater than 8 weeks, the mean duration of occlusion was 93 +/- 41 days (range 60 to 180). None of the attempted dilatations of occlusions with a clinical duration of greater than 180 days (n = 3) was successful. None of the clinical or angiographic variables (including tortuosity, length of occlusion gap, distance of the occlusion from the vessel origin, thrombus, lesion calcium, collaterals, prior myocardial infarction, vessel dilated or diffuse disease) impacted on success rate (difference not significant for all). No patient died, had a Q-wave infarction, required emergency coronary artery bypass grafting or underwent repeat PTCA within 7 days of the procedure. Non-Q-wave infarction occurred in 2 of 56 patients (4%).(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2589190

LaVeau, P J; Remetz, M S; Cabin, H S; Hennecken, J F; McConnell, S H; Rosen, R E; Cleman, M W



Value of a new post-procedural intravascular ultrasound score in predicting target vessel revascularization after coronary drug-eluting stents implantation*  

PubMed Central

Objective: There is no simple or feasible post-procedural intravascular ultrasound (IVUS) score to predict major adverse cardiac events (MACE) in patients undergoing drug-eluting stents (DES) implantation. The aim of this study is to validate a new IVUS score for predicting MACE. Methods: A total of 295 patients (with 322 lesions) were enrolled. IVUS score was calculated in each lesion based on five IVUS morphological characteristics: inflow/outflow disease, malapposition, underexpansion, tissue protrusion, and edge dissection (iMUTE score). We assigned two points to an underexpansion and one point for each presence of other factors. Patients were divided into low score (iMUTE score<2, n=137) and high score (iMUTE score?2, n=158) groups. Results: At one year follow-up, a trend was seen in favor of the low iMUTE score group in MACE (3.65% vs. 10.10%; P=0.052), and there was more target vessel revascularization (TVR) in the high iMUTE score group compared with low score group (6.96% vs. 1.46%; P=0.044). Low iMUTE score was an independent predictor of freedom from TVR at one year (adjusted hazard ratio (HR) 0.5, 95% confidence interval (CI) 0.1–0.8; P=0.02). Conclusions: Post-procedural IVUS iMUTE scoring was simple and feasible in clinical practice, and can provide independent prognostic value for TVR in patients undergoing DES implantation.

Xu, Kai; Han, Ya-ling; Jing, Quan-min; Wang, Shou-li; Ma, Ying-yan; Wang, Xiao-zeng; Wang, Geng; Wang, Zu-lu



Early detection of restenosis after successful percutaneous transluminal coronary angioplasty by exercise-redistribution thallium scintigraphy  

SciTech Connect

The value of exercise testing and thallium scintigraphy in predicting recurrence of angina pectoris and restenosis after a primary successful transluminal coronary angioplasty (PTCA) was prospectively evaluated. In 89 patients, a symptom-limited exercise electrocardiogram (ECG) and thallium scintigraphy were performed 4 weeks after they had undergone successful PTCA. Thereafter, the patients were followed for 6.4 +/- 2.5 months (mean +/- standard deviation) or until recurrence of angina. They all underwent a repeat coronary angiography at 6 months or earlier if symptoms recurred. PTCA was considered successful if the patients had no symptoms and if the stenosis was reduced to less than 50% of the luminal diameter. Restenosis was defined as an increase of the stenosis to more than 50% luminal diameter. The ability of the thallium scintigram (presence of a reversible defect) to predict recurrence of angina was 66%, vs 38% for the exercise ECG (ST-segment depression or angina at peak workload). Restenosis was predicted in 74% of patients by thallium scintigraphy, but only in 50% of patients by the exercise ECG. Thus, thallium scintigraphy was highly predictive but the exercise ECG was not (p less than 0.005). These results suggest that restenosis had occurred to some extent already at 4 weeks after the PTCA in most patients in whom it was going to occur.

Wijns, W.; Serruys, P.W.; Reiber, J.H.; de Feyter, P.J.; van den Brand, M.; Simoons, M.L.; Hugenholtz, P.G.



Outcome of Coronary Bypass Surgery Versus Coronary Angioplasty in Diabetic Patients With Multivessel Coronary Artery Disease  

Microsoft Academic Search

Objectives. This study sought to compare the outcome of percutaneous transluminal coronary angioplasty (PTCA) (n = 834) and coronary artery bypass graft surgery (CABG) (n = 1805) in diabetic patients with multivessel coronary disease from an observational database.Background. There is concern about selection of revascularization in diabetic patients with multivessel coronary artery disease.Methods. Data were collected prospectively and entered into

William S Weintraub; Bernardo Stein; Andrzej Kosinski; John S Douglas; Ziyad M. B Ghazzal; Ellis L Jones; Douglas C Morris; Robert A Guyton; Joseph M Craver; Spencer B King



Value and limitations of exercise stress testing to predict the functional results of coronary artery bypass grafting  

Microsoft Academic Search

To assess the value of exercise stress testing to predict the functional result of revascularization, 90 patients were evaluated by coronary angiography and exercise testing pre and postoperatively. Patients were classified on the basis of the postoperative angiogram in a group with successful surgery and a group with usuccessful surgery. The predictive accuracy positive of ST segmet depression to detect

Frans C. Visser; Linda van Campen; Pim J. de Feyter



Improved late survival with arterial revascularization  

PubMed Central

New coronary artery revascularization strategies are developing: improved quantification of coronary artery disease by the SYNTAX score, new-generation drug-eluting stents and increased use of stents for multivessel disease, ongoing evaluation of stents for left main disease, new strategies for minimally invasive coronary artery bypass grafting (CABG) including the use of robotic-assisted CABG, hybrid procedures, and off pump CABG. In comparisons of all these strategies, the impact on survival is arguably the most important parameter. It has long been accepted that using the left internal mammary artery (LIMA) to bypass the left anterior descending coronary artery (LAD) is the gold standard and may confer the survival advantage reported for CABG compared with percutaneous coronary intervention in the literature. The survival advantage of using additional arterial conduits as compared to the conventional use of LIMA with saphenous veins only has long been debated. Our study, which involved a large cohort of 8,622 patients with multivessel disease, followed over a long period of time, has shown that in primary isolated CABG surgery performed more than 15 years ago with the use of LIMA to the LAD, bypassing the non-LAD targets with at least 1 additional arterial graft, either the right internal mammary artery and/or the radial artery, was an independent predictor of increased survival during the following 15 years. The results were confirmed with both a propensity-matched analysis that included 1,153 patients in each group and a multivariate analysis that was able to control for all differences between the groups because of the power of the large cohort in this series. The significant survival advantage of coronary artery bypass surgery with the use of multiple arterial grafting cannot be ignored in patients with multivessel coronary artery disease as various revascularization strategies are considered.

Schaff, Hartzell V.; Dearani, Joseph A.; Daly, Richard C.



Long-term clinical events following creatine kinase–myocardial band isoenzyme elevation after successful coronary stenting  

Microsoft Academic Search

OBJECTIVEWe sought to evaluate the impact of intermediate creatine kinase–myocardial band isoenzyme (CK-MB) elevation on late clinical outcomes in patients undergoing successful stent implantation in native coronary arteries.BACKGROUNDElevations of CK-MB after percutaneous coronary interventions are frequent. An association between high level of CK-MB elevation (>5 times normal) and late mortality after balloon and new device angioplasty has been reported previously.

Jorge F Saucedo; Roxana Mehran; George Dangas; Mun K Hong; Alexandra Lansky; Kenneth M Kent; Lowell F Satler; Augusto D Pichard; Gregg W Stone; Martin B Leon



Renal artery perforation related with hydrophilic guide wire during coronary intervention: successful treatment with polyvinyl alcohol injection.  


Hydrophilic guide wire-related renal artery perforation (RAP) and subsequent retroperitoneal hemorrhage (RPH) during coronary angiography (CAG) is very rare. We present the case of a 68-year-old woman who suffered accidental hydrophilic 0.035-inch guide wire piercing-related RAP and RPH during CAG and coronary intervention. This RAP was diagnosed by bedside ultrasonography and selective renal angiography, and was successfully treated by transcatheter polyvinyl alcohol injection. PMID:22575577

Lee, Sang Yeub; Kim, Sang Min; Bae, Jang-Whan; Hwang, Kyung-Kuk; Bae, Il Hun; Kim, Dong-Woon; Cho, Myeong-Chan



Preoperative duplex scanning prior to infrainguinal revascularization.  


Arterial occlusive disease has been successfully evaluated with ultrasonography prior to infrainguinal revascularization; this technique contributes to design of operation and, in the case of a bypass, to the selection of a venous conduit. Techniques of black-and-white and color sonoangiography of the peripheral arteries and veins comprise imaging and blood velocimetry. Velocity and flow measurements and other data in the literature that compare ultrasound and radiologic techniques indicate that sonoangiography is already the "practical standard" for vein selection and will have a growing role in preparation for infrainguinal revascularization. PMID:2406973

Salles-Cunha, S X; Andros, G



Percutaneous coronary intervention and the use of glycoprotein IIb/IIIa inhibitors in patients with chronic kidney disease on dialysis: a single center experience.  


Patients on dialysis constitute a major healthcare burden with high prevalence of coronary artery disease frequently requiring coronary revascularization. Prior studies have reported high complications rates with revascularization in patients on dialysis. However, information on the use glycoprotein and direct thrombin inhibitors in this patient population undergoing percutaneous revascularization is limited. We retrospectively analyzed the procedural success and in-hospital outcomes of percutaneous coronary revascularization in 56 consecutive patients on dialysis compared with 524 patients without renal failure, between January 2001 and August 2007 at our facility. Additionally, we also analyzed the off-label use of glycoprotein IIb/IIIa (GP IIb/IIIa) inhibitors during revascularization in this high-risk group of patients to evaluate for possible increased bleeding complications. In the study group, 7 interventions were performed on peritoneal dialysis and 49 on hemodialysis patients. Sixty-one percent of these patients had diabetes mellitus. A total of 72 lesions were intervened upon; 12 underwent angioplasty and 60 underwent stenting. Four of 72 interventions were not successful, giving a procedural success rate of 94%. There were 6 immediate complications (10.7%), but no deaths. Thirty-two patients (57%) received GP IIb/IIIa inhibitors while direct thrombin inhibitors were used during percutaneous coronary intervention in 11(20%) patients. There were no bleeding complications with use of either GP IIb/IIIa inhibitors or direct thrombin inhibitors. In our experience, percutaneous coronary intervention has high procedural success in dialysis patients and concomitant use of GP IIb/IIIa inhibitors is not associated with any major bleeding complications, making this a feasible, safe and effective revascularization option for patients on dialysis; however, this merits further study in a randomized prospective trial. PMID:18837764

Khaja, Azam; Garg, Rajeev; Govindarajan, Gurushanker; Madsen, Richard; Aggarwal, Kul



Early changes in left ventricular subendocardial function after successful coronary angioplasty.  

PubMed Central

OBJECTIVE--To study the early effects of coronary angioplasty on resting left ventricular long axis function, reflecting that of the subendocardium. DESIGN--Prospective echocardiographic and Doppler examination of patients with coronary artery disease, before and after single vessel coronary angioplasty. SETTING--A tertiary referral centre for cardiac diseases with facilities for invasive and non-invasive investigation. PATIENTS--23 patients with significant left coronary disease being considered for coronary angioplasty. RESULTS--Before angioplasty the mean (SD) isovolumic relaxation time was longer than normal (75(19) ms v 55 (10), p < 0.001) with a significant increase in transverse dimension change before mitral valve opening, and peak rate of early diastolic thinning (8(3) v 10.4 (2.6) cm/s (p < 0.001)) was reduced. Long axis motion was frequently abnormal. The interval from the onset of the Q wave to the onset of shortening was prolonged (118 (30) ms v 90 (19) at the left site and 115 (26) ms v 81 (9) at the septal site, p < 0.001) and the onset of early diastolic rapid lengthening delayed with respect to the aortic valve closure sound (A2) by 85 (34) ms v 58 (11) at the left site and 88 (33) ms v 60 (9) at the septal site (p < 0.001). Although overall amplitude was reduced at the septal site only (1.23 (0.3) cm v 1.5 (0.4), p < 0.05), the extent (0.8 (0.2) cm v 1.04 (0.3) at the left site and 0.66 (0.2) cm v 0.9 (0.3) at the septal site, p < 0.001) and peak rate (6.2 (2) cm/s v 10 (2.5) at the left site and 5.4 (2.3) cm/s v 8.5 (2) at the septal site, p < 001) of early diastolic lengthening were both much lower than normal. The E/A ratio on transmitral Doppler was modestly reduced (1.0 (0.7) v 1.4 (0.4), p < 0.05). After angioplasty: isovolumic relaxation time shortened to 64 (18) ms (p < 0.001) and left ventricular incoordination regressed. Long axis shortening with respect to Q (98 (32) ms v 118 (30) at the left site and 94 (23) ms v 115 (26) at the septal site, p < 0.01) and that of lengthening with respect to A2 both normalised. Early diastolic peak lengthening rate increased (7.5 (2.1) cm/s v 6.2 (2) at the left site, and 6.3 (2.4) cm/s v 5.4 (2.3) at the septal site, p < 0.001). The early diastolic peak thinning rate of the posterior wall significantly increased (10 (3.5) cm/s v 8 (3), p < 0.005) as did mitral E/A ratio 1.2 (0.7) v 1.0 (0.7), p < 0.05). CONCLUSION--Long axis motion, representing the function of longitudinally arranged subendocardial fibres, is consistently abnormal in the resting state in coronary artery disease. These systolic and diastolic abnormalities return towards normal after successful angioplasty, suggesting that they are the direct effect of coronary artery stenosis.

Henein, M Y; Priestley, K; Davarashvili, T; Buller, N; Gibson, D G



Frequency of slow coronary flow following successful stent implantation and effect of Nitroprusside.  


Nitroprusside (NTP) is used for the treatment of slow coronary flow (SCF) after coronary interventions. The wide variation in dosage, route, and timing of its administration in the reported studies prevents an objective assessment of its efficacy. We report the incidence and response to a standardized NTP protocol of SCF after successful stent implantation. Selective intracoronary administration of incremental doses (initial bolus of 80 microg incremented by 40 microg) of NPT was assessed in 21 patients who developed SCF in a series of 2,212 consecutive patients who underwent successful stent placement from January to October 2005. SCF was observed only in patients treated for acute myocardial infarction (AMI; 11.5%, 12 of 105) or saphenous vein graft (SVG) stenosis (8.2%, 9 of 109). An intracoronary bolus of nitroglycerin did not restore normal Thrombolysis In Myocardial Infarction (TIMI) flow in any patient. The first 80-microg dose of NTP restored normal TIMI flow in 58% of patients (7 of 12) with AMI and in 44% of patients (4 of 9)with SVG stenosis. The maximal dose (120/160 microg) restored normal TIMI flow in all remaining patients with AMI but in only 1 additional patient with SVG stenosis. At the end of the procedure, the percent decrease in corrected TIMI frame count was significantly larger in patients with AMI (-44+/-10%) than in those with SVG stenosis (-24+/-16%, p=0.02). In a large consecutive series of successful stent procedures, SCF was found only in patients with ST-elevation AMI (11.5%) or with a stenosed SVG (8.2%). In conclusion, the standardized protocol of intracoronary NTP administration succeeded in normalizing SCF in all patients with AMI but in only 5 of 9 patients with SVG stenosis. This latter subgroup requires other therapeutic strategies. PMID:17398183

Airoldi, Flavio; Briguori, Carlo; Cianflone, Domenico; Cosgrave, John; Stankovic, Goran; Godino, Cosmo; Carlino, Mauro; Chieffo, Alaide; Montorfano, Matteo; Mussardo, Marco; Michev, Iassen; Colombo, Antonio; Maseri, Attilio



Characteristics and outcomes of revascularized patients with hypertension: an international verapamil SR-trandolapril substudy.  


Our understanding of the growing population of revascularized patients with hypertension is limited. We retrospectively analyzed the International Verapamil SR-Trandolapril Study, which randomized coronary artery disease patients with hypertension to either verapamil SR- or atenolol-based treatment strategies, focusing on characteristics and outcomes of 6166 previously revascularized patients compared with 16 410 nonrevascularized patients. Revascularized patients had a history of coronary artery bypass grafting (45.2%), percutaneous coronary intervention (42.1%), or both (12.8%). Compared with nonrevascularized patients, revascularized patients at baseline demonstrated a higher prevalence of coronary artery disease risk factors and risk conditions (P<0.001). This higher prevalence was the principal cause of a higher incidence of primary outcome (death, nonfatal myocardial infarction, or nonfatal stroke) among revascularized patients (14.2% versus 8.5% for nonrevascularized patients; P<0.001). However, both patient groups demonstrated a relatively low incidence of subsequent revascularization (5.1% versus 1.5% respectively; P<0.0001). Associations between adjusted hazard ratio for primary outcome and follow-up blood pressure appeared "J shaped" for both patient groups. Because, as a group, revascularized patients with hypertension had worse outcomes compared with nonrevascularized patients, management of blood pressure to a specific target in future studies could result in improved outcomes. PMID:19237684

Denardo, Scott J; Messerli, Franz H; Gaxiola, Efrain; Aranda, Juan M; Cooper-Dehoff, Rhonda M; Handberg, Eileen M; Gong, Yan; Champion, Annette; Zhou, Qian; Pepine, Carl J



Myonecrosis After Revascularization Procedures  

Microsoft Academic Search

The detection of elevated cardiac enzyme levels and the occurrence of electrocardiographic (ECG) abnormalities after revascularization procedures have been the subject of recent controversy. This report represents an effort to achieve a consensus among a group of researchers with data on this subject. Creatine kinase (CK) or CK-MB isoenzyme (CK-MB) elevations occur in 5% to 30% of patients after a

Robert M. Califf; Alaa E. Abdelmeguid; Richard E. Kuntz; Jeffrey J. Popma; Charles J. Davidson; Eric A. Cohen; Neal S. Kleiman; Kenneth W. Mahaffey; Eric J. Topol; Carl J. Pepine; Ray J. Lipicky; Christopher B. Granger; Robert A. Harrington; Barbara E. Tardiff; Brian S. Crenshaw; Robert P. Bauman; Bram D. Zuckerman; Bernard R. Chaitman; John A. Bittl; E. Magnus Ohman



Predictors of the successful outcome of one-year survivors of coronary artery bypass surgery.  


This study was conducted on a South African cohort to establish the actors that may predict the successful outcome of coronary artery bypass surgery when assessed in terms of improved quality of life one year after the surgery. Information was sought on the socio-economic status of patients, their risk-factor profiles and clinical history. From the patient files, information was recorded on left ventricular ejection fraction, number of vessels bypassed, bypass time, and aortic cross-clamp time. The characteristics that were predictive of a successful outcome one year after surgery were identified. Patients in this study represented a high-risk population with multiple risk factors (obese, heavy smokers, hypertensive, hypercholesterolaemic, inactive, family history of heart disease, diabetes, and regular intake of alcohol). Measured medical parameters could not distinguish between the group with an improved quality of life and the group who did not have improved quality of life. One year after CABG all patients with an improved quality of life were men. The additional identified predictor variables for a successful outcome were: being married, patients' height, the knowledge that smoking affects the cardiovascular system, number of years that sporting activities were stopped prior to CABG surgery, a better quality sex life after the operation, acceptance of self-responsibility for rehabilitation, and the spouse knowing the diet the patient should follow. The predictors of a successful outcome at the time of the operation were: being married (OR = 22.6; p = 0.02); taller than 170 cm (OR = 15.5; p = 0.01); stopped all sporting activities for a period less than 20 years prior to their surgery (OR 11.4; p = 0.01). We concluded that the outcome of coronary artery bypass surgery could not be predicted on the basis of a medical model that considers exclusively the extent of the patient's disease and associated co-morbidities. Patients should be carefully selected and an intensive post-operative educational intervention should be provided to patients and their spouses/caregivers. PMID:15778772

Eales, C J; Noakes, T D; Stewart, A V; Becker, P


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

PubMed Central

After percutaneous transluminal coronary angioplasty (PTCA), stress-echocardiography and gated single photon emission computerized tomography (g-SPECT) are usually performed but both tools have technical limitations. The present study evaluated results of PTCA of left anterior descending artery (LAD) six months after PTCA, by combining transthoracic Doppler coronary flow reserve (CFR) and color Tissue Doppler (C-TD) dobutamine stress. Six months after PTCA of LAD, 24 men, free of angiographic evidence of restenosis, underwent standard Doppler-echocardiography, transthoracic CFR of distal LAD (hyperemic to basal diastolic coronary flow ratio) and C-TD at rest and during dobutamine stress to quantify myocardial systolic (Sm) and diastolic (Em and Am, Em/Am ratio) peak velocities in middle posterior septum. Patients with myocardial infarction, coronary stenosis of non-LAD territory and heart failure were excluded. According to dipyridamole g-SPECT, 13 patients had normal perfusion and 11 with perfusion defects. The 2 groups were comparable for age, wall motion score index (WMSI) and C-TD at rest. However, patients with perfusion defects had lower CFR (2.11 ± 0.4 versus 2.87 ± 0.6, p < 0.002) and septal Sm at high-dose dobutamine (p < 0.01), with higher WMSI (p < 0.05) and stress-echo positivity of LAD territory in 5/11 patients. In the overall population, CFR was related negatively to high-dobutamine WMSI (r = -0.50, p < 0.01) and positively to high-dobutamine Sm of middle septum (r = 0.55, p < 0.005). In conclusion, even in absence of epicardial coronary restenosis, stress perfusion imaging reflects a physiologic impairment in coronary microcirculation function whose magnitude is associated with the degree of regional functional impairment detectable by C-TD.

Cicala, Silvana; Galderisi, Maurizio; Guarini, Pasquale; D'Errico, Arcangelo; Innelli, Pasquale; Pardo, Moira; Scognamiglio, Giancarlo; de Divitiis, Oreste



Functional and structural correlates of persistent ST elevation after acute myocardial infarction successfully treated by percutaneous coronary intervention  

Microsoft Academic Search

Background:In the thrombolytic era, persistence of ST-segment elevation was considered a marker of left ventricular (LV) aneurysm. ST-segment elevation may still be found persistently raised after successful primary percutaneous coronary intervention (PCI). Echocardiographic correlates of this finding, however, are still poorly known.Methods and results:82 consecutive patients with first ST-segment elevation myocardial infarction and successful PCI were divided into patients with

Leonarda Galiuto; Sabrina Barchetta; Serena Paladini; Gaetano Lanza; Antonio G Rebuzzi; Mario Marzilli; Filippo Crea



Partial sternotomy coronary surgery with triple-vessel disease in dextrocardia and situs inversus totalis.  


Dextrocardia associated with situs inversus totalis is a rare congenital condition. A small number of cases with these conditions have been reported who underwent myocardial revascularization via the on-pump or off-pump techniques. Among them, only 1 patient with dextrocardia and situs inversus totalis was reported to have the procedure performed with minimally invasive coronary surgery via a right anterior small thoracotomy. However, the case was a single-vessel disease and only one graft was achieved. We describe the case of a 65-year old female patient with triple-vessel obstructive coronary diseases who was successfully revascularized with three grafts using a minimally invasive technique. This was achieved via partial sternotomy and employing off-pump coronary artery bypass grafting. PMID:23559364

Su, Pi Xiong; Gu, Song; Liu, Yan; Gao, Jie



A successful emergency management of spontaneous coronary artery dissection and review of the literature.  


Spontaneous coronary artery dissection (SCAD) is a rare and lethal myocardial ischemic event, which usually causes acute coronary syndrome and sudden death. Emergency management of SCAD includes medical treatment, percutaneous coronary interventions, and coronary artery bypass grafting. Here, we report 1 case of 37-year-old young woman who was found to have a mid-distal SCAD of the left anterior descending artery, taking conservative management decision. In another case of a 50-year-old woman who was found to have a proximal-middle spiral SCAD of the right coronary artery, she underwent coronary angioplasty. After 6 months later at follow-up, 2 patients remained stable without symptom and in recovery of the left ventricular function; angiogram showed the SCAD healed. PMID:23688562

Xin-He, Ye; Cheng-Jian, Yang; Yan, Jin; Xin, Xu; Jia-Ning, Cao; Zhen-Jie, Yang; Feng, Dong



Unprotected Left Main Coronary Artery Intervention for Acute Myocardial Infarction and Cardiogenic Shock  

PubMed Central

Medical therapy alone often insufficiently alters the clinical course of patients who have experienced acute myocardial infarction and concomitant cardiogenic shock, and in whom the left main coronary artery is the culprit vessel. Emergency coronary artery bypass grafting is an effective yet time-consuming approach that entails the risk of extensive, irreversible myocardial damage. Percutaneous coronary intervention in the unprotected left main coronary artery can enable initial revascularization and rapid stabilization even in high-risk patients, but outcomes from the procedure since the recent advent of drug-eluting stents are still being determined. Herein, we report the successful deployment of a sirolimus-eluting stent in a 65-year-old man who had experienced acute myocardial infarction and cardiogenic shock consequent to an occluded left main coronary artery. The patient recovered rapidly and completely. We review the medical literature and compare percutaneous coronary intervention with other methods of treatment.

Abuzahra, Mohammed M.; Mesa, Andres; Treistman, Bernardo



Transmyocardial laser revascularization  

NASA Astrophysics Data System (ADS)

Transmyocardial laser revascularization (TMR) for the treatment of medically unresponsive angina pectoris has been shown to be clinically effective. The mechanism of its action, however, is not quite understood. Over the last five years my collaborators and I have conducted a variety of in vivo and in vitro studies using different animal models, lasers and experimental protocols. The results seem to indicate that the mechanism of action of TMR is related to neovascularization rather than chronically patent channels, as originally proposed.

Aretz, H. T.



Argentine randomized study: coronary angioplasty with stenting versus coronary bypass surgery in patients with multiple-vessel disease (ERACI II): 30-day and one-year follow-up results  

Microsoft Academic Search

OBJECTIVESThe purpose of this study was to compare percutaneous transluminal coronary revascularization (PTCR) employing stent implantation to conventional coronary artery bypass graft surgery (CABG) in symptomatic patients with multivessel coronary artery disease.BACKGROUNDPrevious randomized studies comparing balloon angioplasty versus CABG have demonstrated equivalent safety results. However, CABG was associated with significantly fewer repeat revascularization procedures.METHODSA total of 2759 patients with coronary

Alfredo Rodriguez; Victor Bernardi; Jose Navia; Julio Baldi; Liliana Grinfeld; Jorge Martinez; Daniel Vogel; Roberto Grinfeld; Alejandro Delacasa; Marcelo Garrido; Raul Oliveri; Eduardo Mele; Igor Palacios; William O’Neill



Prolonged Myocardial Hibernation Exacerbates Cardiomyocyte Degeneration and Impairs Recovery of Function After Revascularization  

Microsoft Academic Search

Objectives. We sought to define the effects of time on contractile function, morphology and functional recovery after coronary revascularization in patients with dysfunctional but viable (hibernating) myocardium.Background. Functional recovery after coronary artery bypass graft surgery in patients with chronic myocardial hibernation is incomplete or delayed. The proposed cause is a progressive temporal degeneration of cardiomyocytes.Methods. In 32 patients with multivessel

Ernst R Schwarz; Friedrich A Schoendube; Sawa Kostin; Nicole Schmiedtke; Gernot Schulz; Udalrich Buell; Bruno J Messmer; John Morrison; Peter Hanrath; Juergen vom Dahl



Long-term clinical outcomes after coronary angioplasty using long stents in small coronary vessels.  


The role of coronary stenting in challenging situations, such as small vessels and long lesions, remains controversial. The aim of this study was to examine the procedural, in-hospital, and long-term clinical outcomes of patients undergoing angioplasty with long stents in small coronary vessels. We evaluated the procedural success rate and clinical outcomes in 252 consecutive subjects treated by means of the implantation of a single coronary stent in vessels with a mean reference diameter of < 2.5 mm; 128 patients received a short stent (< or = 16 mm) and 124 a long stent (> or = 18 mm). Lesion morphology was more complex in patients treated with long stents (P < 0.05). The mean stent length was 14 +/- 2 mm in the short-stent group and 25 +/- 3 mm in the long-stent group (P < 0.001). The overall procedural success rate (98.4% vs. 97.6%; P = NS) and the rate of major in-hospital adverse events (death, acute myocardial infarction, or target vessel revascularization; 1.6% vs. 2.4%; P = NS) was similar in the two groups. After 11.7 +/- 7 months of follow-up, there was no difference in the incidence of mortality and myocardial infarction (5% vs. 6.6%; P = NS), but revascularization tended to occur more frequently in the patients treated with long stents (21.7% vs. 13.9%; P = NS). In conclusion, the procedural success rate of single short or long stents in small coronary vessels was similar. Although the incidence of target vessel revascularization tended to be higher in the patients treated with longer stents, 2-year event-free survival was equivalent in the two groups (65% vs. 70%; P = NS). PMID:12112880

Danzi, Gian Battista; Sesana, Marco; Capuano, Cinzia; Di Blasi, Alberto; Baviera, Luisa; Baglini, Roberto



Successful coronary sinus lead replacement despite total venous occlusion using femoral pull through, two operator counter-traction and subclavian venoplasty  

Microsoft Academic Search

The majority of patients presenting for lead extraction have indications for a replacement lead. Venous stenosis is common\\u000a in recipients of pacing leads and can impede ipsilateral lead replacement. Recanalization through an existing tract after\\u000a lead extraction allows successful lead placement but may require complex hybrid lead extraction and revascularization techniques.\\u000a We present a case in which a combination of

Dominic P. S. Rogers; Pier D. Lambiase; Anthony W. C. Chow



A randomized trial of aspirin versus cilostazol therapy after successful coronary stent implantation  

Microsoft Academic Search

Percutaneous transluminal coronary angioplasty (PTCA) is widely used to treat patients with ischemic heart disease, but the procedure involves a number of problems, including acute coronary occlusion and restenosis. Although stents have proved useful for preventing post-PTCA restenosis, especially elastic recoil during the acute phase, no method has yet been established to prevent restenosis caused by vascular smooth muscle cell

Tomoyuki Kunishima; Haruki Musha; Fumihiko Eto; Tatsuya Iwasaki; Junzo Nagashima; Yoshihiro Masui; Takehiko So; Toshika Nakamura; Nagatoshi Oohama; Masahiro Murayama



Survival after coronary revascularization in the elderly  

Microsoft Academic Search

95.0%, 93.8%, and 90.5%, respectively. In 5198 patients 70 to 79 years of age, survival rates were 87.3%, 83.9%, and 79.1%, respectively. In 983 patients 80 years of age, survival was 77.4% for CABG, 71.6% for PCI, and 60.3% for medical therapy. Absolute risk differences in comparison to medical therapy for CABG (17.0%) and PCI (11.3%) were greater for patients

Michelle M. Graham; William A. Ghali; Peter D. Faris



Successful primary percutaneous coronary intervention in the first trimester of pregnancy.  


A 28-year-old patient, medical nurse, in 10th week of her second pregnancy suffered ventricular fibrillation just after entering the waiting room of the emergency department. After she was successfully defibrillated, electrocardiography revealed a large acute anteroseptolateral ST elevation myocardial infarction. Urgent coronarography was done (premedication with 300 mg of aspirin and 600 mg of clopidogrel) with 90 min door-to-balloon time. Proximal left anterior descending occlusion was found, primary percutaneous coronary intervention was done using Amazonia CroCo 3.0/12 bare-metal stent, and Thrombolysis in Myocardial Infarction III flow was achieved. During the procedure, the patient was wrapped in lead apron. Because of postresuscitational agitation, procedure was done in intravenous anesthesia. The revealed risk factors were smoking and hypercholesterolemia. PAI-1 gene 4G/4G genotype and Apo E gene E2/E4 genotype were also found. Estimated X-ray dosage that fetus received during the procedure was 0.45 mSv, which is less than the upper safe limit in pregnancy. All drugs given to our patient (clopidogrel, aspirin, ivabradine, bisoprolol, anesthetics, low-molecular-weight heparin, and unfractionated heparin) have B or C Food and Drug Administration Pregnancy Category. Fetal ultrasonography showed normal fetal growth, and, after consultation with our team, the patient decided to maintain the pregnancy. Before discharge echocardiography showed left ventricle of normal size with anteroseptolateral hypokinesia, small apical aneurysm, left ventricular ejection fraction of 40-45%, and diastolic dysfunction grade II, without pulmonary hypertension. At the 36th week of pregnancy, the patient was hospitalized and closely monitored; clopidogrel and aspirin were discontinued, and low-molecular-weight heparin was administered. She gave birth to a normal boy by vaginal delivery with epidural anesthesia and without any complication. PMID:21351227

Babic, Zdravko; Gabric, Ivo Darko; Pintaric, Hrvoje



Recovery and viability of an acute myocardial infarct after transmyocardial laser revascularization  

Microsoft Academic Search

Objectives. The short- and long-term effectiveness of transmyocardial laser revascularization was evaluated in the setting of an acute myocardial infarction.Background. Theoretically, transmyocardial laser revascularization allows direct perfusion of the ischemic area as ventricular blood flows through the channels to the myocardium.Methods. Infarcts were created by coronary occlusion in 30 sheep. Eighteen of these sheep were studied to assess short-term efficacy.

Keith A Horvath; Wendell J Smith; Rita G Laurence; Frederick J Schoen; Robert F Appleyard; Lawrence H Cohn



A case of complete revascularization with nine sirolimus eluting stents.  


Patients with multivessel disease and LV dysfunction are conventionally treated with coronary artery bypass surgery. With the advent of drug eluting stents, complex lesions are now being tackled percutaneously. The ARTS II registry demonstrated the efficacy and safety of sirolimus-eluting stents (SES) in patients with multivessel disease. We report a case of "complete revascularization" with 9 sirolimus-eluting stents in a patient with multivessel disease and LV dysfunction with an angiographic evaluation at 6 months and 1 year. PMID:19218726

Bardhan, A K; Khan, Aftab


Successful Reduced-Intensity Hematopoietic Stem Cell Transplantation in Myelodysplastic Syndrome with Severe Coronary Artery Disease  

Microsoft Academic Search

A 60-year-old Japanese man with myelodysplastic syndrome (MDS) and effort angina was referred to our clinic for treatment\\u000a of MDS.The patient was transfusion-dependent and displayed coronary artery disease (CAD) with 99% obstruction of the left\\u000a anterior descending coronary artery. Treatment comprised reduced-intensity hematopoietic stem cell transplantation with administration\\u000a of fludarabine phosphate (180 mg\\/m2) and busulfan (8 mg\\/kg), followed by allogeneic

Shigeki Kosugi; Makoto Hirokawa; Yoshinari Kawabata; Hitoshi Hasegawa; Tomoko Yoshioka; Ikuo Miura; Ken-ichi Sawada



The history of arterial revascularization: from Kolesov to Tector and beyond  

PubMed Central

Coronary artery bypass grafting (CABG) is the one of the most effective revascularization strategies for patients with obstructive coronary artery disease. Total arterial revascularization using one or both internal thoracic and radial arteries has been shown to improve early outcomes and reduce long-term cardiovascular morbidity. Although CABG has evolved from an experimental procedure in the early 1900’s to become one of the most commonly performed surgical procedures, there is still significant variation in grafting strategies amongst surgeons. We review the history and development of CABG with a particular emphasis on the early pioneers and the evolution of arterial grafting.

Galvin, Sean D.



Successful Retrieval of a Coronary Stent Dislodged in the Brachial Artery by Means of Improvised Snare and Guiding Catheter  

PubMed Central

This is a case report regarding the retrieval, by means of an improvised snare and guiding catheter, of a stent dislodged in the brachial artery during a transradial coronary intervention. A full-length guiding catheter could not be used to approach the lost stent, which was a mere 30 to 35 cm away from the sheath insertion site at the radial artery, and a commercial snare was not available at the time. Thus, we had to improvise a shortened guiding catheter and a snare, which was formed by folding an angioplasty Whisper guide wire (Abbott Laboratories, Abbott Park, IL) and was used successfully to snare the stent and retrieve it.

Deftereos, Spyridon; Raisakis, Konstantinos; Giannopoulos, Georgios; Kossyvakis, Charalampos; Pappas, Loukas; Kaoukis, Andreas



Current status and future directions in computer-enhanced video- and robotic-assisted coronary bypass surgery.  


Since 1997, both the Cleveland Clinic and London Health Sciences Centre groups have embraced robotic assistance and more recently demonstrated the efficacy of this technology in totally closed-chest, beating heart myocardial revascularization. This endeavor involved an orderly progression and the learning of new surgical skill sets. We review the evolution of robot-enhanced coronary surgery and forecast the future of endoscopic and computer-enhanced, robotic-enabling technology for coronary revascularization. This report describes a computer-assisted totally closed-chest coronary bypass operation, and preliminary results are discussed. The internal thoracic artery (ITA) was harvested through three 5-mm access ports and prepared and controlled endoscopically. A prototype sternal elevator was used to increase intrathoracic working space. A 10-mm endoscopic stabilizer was placed through the second intercostal space, and the left anterior descending coronary artery was controlled with silastic snares. Telerobotic anastomoses were completed end-to-side using custom-made, double-armed 8-0 polytetrafluroethylene sutures. To date, 84 patients have undergone successful myocardial revascularization with robotic assistance with a 0% surgical mortality rate. ITA harvest, anastomotic, and operating times for the entire group have been longer than for conventional surgery at 61.3 +/- 17.9 minutes, 28.5 +/- 28.2 minutes, and 368 +/- 129 minutes, respectively. Bleeding, ventilatory times, arrhythmias, hospital lengths of stay, and return to normal activity have been reduced. Recently, we have developed a new robotic revascularization strategy called Atraumatic Coronary Artery Bypass that is a promising mid-term step on the pathway to totally endoscopic, beating-heart coronary artery bypass. We conclude that computer-enhanced robotic techniques are safe, and further clinical studies are required to define the full potential of this evolving technology. PMID:11977023

Boyd, W Douglas; Kodera, Kojiro; Stahl, Kenneth D; Rayman, Reiza



Sequential thallium-201 myocardial perfusion studies after successful percutaneous transluminal coronary artery angioplasty: delayed resolution of exercise-induced scintigraphic abnormalities  

SciTech Connect

To characterize the sequential changes of myocardial perfusion scintigraphy in patients with coronary artery disease (CAD) after complete revascularization, 43 patients underwent exercise thallium-201 (/sup 201/Tl) myocardial perfusion scintigraphy before and at 9 +/- 5 days, 3.3 +/- 0.6, and 6.8 +/- 1.2 months after percutaneous transluminal coronary angioplasty (PTCA). Only patients with single-vessel CAD, without previous myocardial infarction, and without evidence of restenosis at 6 to 9 months after PTCA were included. Perfusion scans were analyzed blindly with the use of a new quantitative method to define regional myocardial perfusion in the topographic distribution of each coronary artery, which was shown to be reproducible (r = .94 or higher and SEE of 7% or less, between repeated measures by one and two operators). At 4 to 18 days after PTCA, the mean treadmill walking time increased by 123 +/- 42 sec, mean exercise-induced ST segment depression decreased by 0.6 +/- 0.3 mm, group maximal heart rate increased by 20 +/- 9 beats/min, and group systolic blood pressure at peak exercise increased by 24 +/- 10 mm Hg, compared with pre-PTCA values (p less than .001). However, no group differences were noted in these variables between the three post-PTCA stages. Myocardial perfusion in the distribution of the affected (dilated) coronary artery, on the other hand, improved progressively. In the 45 degree left anterior oblique view for instance, myocardial perfusion increased at 9 days after PTCA (from 68 +/- 24% before PTCA to 91 +/- 9%, p less than .001) and at 3.3 months after PTCA (101 +/- 8%, p less than .05 vs 9 days after PTCA), but no further significant changes were seen at 6.8 months after PTCA (102 +/- 8%). Similar changes were noted in the other two views. No relationship between minor complications during PTCA and delayed improvement on the /sup 201/Tl was observed.

Manyari, D.E.; Knudtson, M.; Kloiber, R.; Roth, D.



Reappraisal of coronary endarterectomy for the treatment of diffuse coronary artery disease  

Microsoft Academic Search

Background. The development of new technologies such as transmyocardial laser revascularization and, more recently, local delivery of angiogenic growth factors has refocused attention on the surgical management of diffuse coronary artery disease. In some cases, coronary endarterectomy is also technically feasible. To facilitate decision-making among these options, we reviewed our experience with coronary endarterectomy to determine the results to be

Thoralf M Sundt; Cynthia J Camillo; Eric N Mendeloff; Hendrick B Barner; William A Gay



Determinants of success of coronary angioplasty in patients with a chronic total occlusion: a multiple logistic regression model to improve selection of patients  

Microsoft Academic Search

OBJECTIVE--To study the determinants of success of coronary angioplasty in patients with chronic total occlusions, and to formulate a multiple logistic regression model to improve selection of patients. DESIGN--A retrospective analysis of clinical and angiographic data on a consecutive series of patients. PATIENTS--312 patients (mean age 55, range 31 to 79 years, 86% men) who underwent coronary angioplasty procedure for

K H Tan; N Sulke; N A Taub; E Watts; S Karani; E Sowton



Successful late coronary angioplasty of infarct-related artery suppresses ST-segment elevation on exercise, without improvement of left ventricular function  

Microsoft Academic Search

It is not clear whether the ST-segment elevation in the infarct zone during an exercise stress test is caused by expansion of the necrotic area or by ischemia. The purpose of this study was to evaluate the effects of restoring blood flow of the infarct-related coronary artery by successful coronary angioplasty in patients with silent exercise-induced ST-segment elevation in the

Corrado Vassanelli; Giuliana Menegatti; Guido Canali; Gabriele Zanotto; Isabella Loschiavo; J. Molinari; E. Carbonieri; L. Rossi; P. Zardini



Complex coronary lesions and rotational atherectomy: one hospital's experience*  

PubMed Central

Objective: To evaluate the safety and effectiveness of rotational atherectomy followed by drug eluting stent (DES) implantation in patients with complex coronary lesions. Methods: From August 2006 to August 2012, 253 consecutive patients with 289 lesions and who underwent rotational atherectomy in our center were enrolled in this study. Results: The overall procedure success rate was 98% with the cost of two (0.8%) coronary perforations, three (1.2%) dissections, five (2.0%) slow flows or no flows, three (1.2%) peri-procedure myocardial infarctions, and two (0.8%) in hospital deaths. During follow-up (mean three years), one (0.4%) patient died, two (0.8%) patients had acute myocardial infarction, 14 (5.5%) had restenosis, and target lesion revascularization occurred in eight patients (3.2%). Conclusions: Rotational atherectomy followed by DES implantation is a safe and effective technique for patients with complex coronary lesions, especially calcified and non-dilatable lesions.

Jiang, Jun; Sun, Yong; Xiang, Mei-xiang; Dong, Liang; Liu, Xian-bao; Hu, Xin-yang; Feng, Yan; Wang, Jian-an



Successful percutaneous coronary intervention in a case of acute aortic dissection complicated with malperfusion of the left main coronary artery after replacement of the ascending aorta.  


A 75-year-old female was admitted to our hospital with sudden back pain and right leg ischemia. Computed tomography showed acute type A aortic dissection with the occlusion of the right common iliac artery. The patient was treated with ascending aorta replacement and femoro-femoral bypass. Three hours after the operation, the patient went into a sudden shock. Electrocardiogram showed ventricular tachycardia and ventricular fibrillation. Percutaneous cardio-pulmonary support was administered and coronary arteriogram (CAG) was proceeded for evaluation of the coronary arteries. Although CAG revealed normal coronary arteries, intravascular ultrasound showed mobile intimal flap at left main coronary artery trunk, suggesting dissection of the coronary artery. Percutaneous coronary intervention of the left main coronary artery trunk was performed. The patient recovered from shock and was discharged from the hospital without any major complication. PMID:22566246

Hori, Daijiro; Noguchi, Kenichiro; Yamaguchi, Atsushi; Adachi, Hideo



Successful Transfection of Genes Using AAV-2/9 Vector in Swine Coronary and Peripheral Arteries  

PubMed Central

Background Gene therapy has attracted attention for its potential to treat several cardiovascular diseases. The use of adeno-associated viral (AAV) vectors to facilitate therapeutic gene transfer to suppress intimal hyperplasia is a promising concept. The objective of this study was to analyze the in vivo transduction of a novel recombinant AAV-2/9 vector with SM22? promoter, containing ?-galactosidase gene (Lac Z) or green fluorescent protein (GFP) as reporter genes, to the medial layer smooth muscle cells (SMCs) of swine coronary and peripheral arteries. Methods The AAV2/9 vector containing SM22? (1×1013 pfu) were administered into carotid/femoral/coronary arteries of domestic swine using irrigating balloon catheter-based gene delivery. Following gene transfer, cryosections of arteries were processed for X-Gal and GFP analysis. Fluorescence microscopy and Western blotting were done to analyze the GFP expression in the SMCs. Results LacZ mRNA expression was visualized in the medial layer 7 days after vector administration. The GFP expression was detected at 7th day and lasted for at least 2 months showing the longer-lasting expression of the AAV2/9-vector. Control arteries did not show any expression of GFP or LacZ. There was no significant effect of AAV2/9 viral transduction on serum amylase, fibrinogen and serum CRP levels. Conclusion These finding support the use of AAV2/9 as a vector to effectively transduce a gene in SMCs of coronary and peripheral arteries without causing inflammation.

Pankajakshan, Divya; Makinde, Toluwalope O.; Gaurav, Rohit; Del Core, Michael; Hatzoudis, George; Pipinos, Iraklis; Agrawal, Devendra K.



Separate revascularization of the visceral arteries in thoracoabdominal aneurysm repair  

Microsoft Academic Search

We successfully repaired a ruptured aortic patch containing the visceral arteries after thoracoabdominal aneurysm repair in a young patient with Marfan syndrome. This unexpected and tricky situation was treated by separate revascularization of each visceral artery using small-caliber prosthetic grafts as interposition between the aortic prosthesis and the ostia of the visceral arteries.

Thierry P Carrel; Christoph Signer



Multislice spiral computed tomography coronary angiography in patients with stable angina pectoris  

Microsoft Academic Search

ObjectivesThis study was designed to prospectively evaluate the diagnostic performance of multislice spiral computed tomography (MSCT) coronary angiography for the detection of significant lesions in all segments of the coronary tree potentially suitable for revascularization.

Nico R Mollet; Filippo Cademartiri; Koen Nieman; Francesco Saia; Pedro A Lemos; Eugene P McFadden; Peter M. T Pattynama; Patrick W Serruys; Gabriel P Krestin; Pim J de Feyter



Very Long-Term (15 to 23 Years) Outcomes of Successful Balloon Angioplasty Compared With Bare Metal Coronary Stenting  

PubMed Central

Background Target lesion revascularization (TLR) continues to occur beyond 4 years after bare metal stent (BMS) implantation. However, long-term outcomes after balloon angioplasty (BA) compared with BMS are currently unknown. Methods and Results From 1989 to 1990, 659 patients (748 lesions) underwent successful BA with final balloon ?3.0 mm excluding patients with acute myocardial infarction and were compared with 405 patients (424 lesions) with BMS implantation from June 1990 to 1993. Cumulative incidences of death and target lesion thrombosis (>1 year) were similar between the BA group and the BMS group (44.4% versus 45.4%, P=0.60; and 1.5% versus 0.7%, P=0.99; respectively). Cumulative incidence of TLR during overall follow-up was significantly higher after BA than after BMS implantation (44.6% versus 36.0%, P<0.001), whereas cumulative incidence of late TLR (>4 years) tended to be lower in the BA group than in the BMS group (16.3% versus 21.4%, P=0.16). Cumulative incidence of late TLR after BA was significantly lower in patients with small percent diameter stenosis (%DS) at early follow-up angiography compared with large %DS (14.5% versus 28.0%, P=0.02). In lesions with serial angiography, late lumen loss from early (6 to 14 months) to long-term (4 to 10 years) follow-up angiography was significantly smaller in the BA group (n=42) than in the BMS group (n=55) (?0.08±0.45 mm versus 0.11±0.46 mm, P=0.047). Conclusions Compared with BMS implantation, BA was associated with a trend for less late TLR beyond 4 years and with significantly smaller late lumen loss from early to long-term follow-up angiography.

Yamaji, Kyohei; Kimura, Takeshi; Morimoto, Takeshi; Nakagawa, Yoshihisa; Inoue, Katsumi; Kuramitsu, Shoichi; Soga, Yoshimitsu; Arita, Takeshi; Shirai, Shinichi; Ando, Kenji; Kondo, Katsuhiro; Sakai, Koyu; Iwabuchi, Masashi; Yokoi, Hiroyoshi; Nosaka, Hideyuki; Nobuyoshi, Masakiyo



Hyperbaric oxygen: a new drug in myocardial revascularization and protection?  


Ischemia-reperfusion injury (IRI) occurs following coronary artery revascularization. Reactive oxygen species (ROS) were initially thought to play a role in the pathogenesis of this injury. However, the evidence for this is inconclusive. Recent studies involving ischemic preconditioning have identified ROS as potential mediators for the cardioprotective effects observed following this technique. Furthermore, cardiac studies involving IRI and the use of hyperbaric oxygen (HBO) have demonstrated the ability of HBO to induce cardioprotection and to attenuate IRI. This review suggests the possible role for HBO as a new drug in the arena of myocardial revascularization and cellular protection. While there is mounting clinical evidence for this, a methodological understanding of HBO's cellular mechanisms of actions appears to be lacking. As such, this article attempts to draw the similarity between HBO and other protective oxidative stress mechanisms and then to speculate in an evidence-based manner its possible cellular mechanistic role as a drug via the generation of ROS. PMID:16945821

Yogaratnam, Jeysen Zivan; Laden, Gerard; Madden, Leigh Anthony; Seymour, Ann-Marie; Guvendik, Levant; Cowen, Mike; Greenman, John; Cale, Alex; Griffin, Steve


Echocardiographic Predictors of Survival and Response to Early Revascularization in Cardiogenic Shock  

Microsoft Academic Search

Background—Although echocardiography is used in diagnosis and management of myocardial infarction, it has not been established whether specific features of cardiac structure or function early in the course of cardiogenic shock provide prognostic value. The purposes of this substudy of the SHould we emergently revascularize Occluded Coronaries for cardiogenic shocK (SHOCK) trial were to describe the echocardiographic features of cardiogenic

Michael H. Picard; Ravin Davidoff; Lynn A. Sleeper; Lisa A. Mendes; Christopher R. Thompson; Vladimir Dzavik; Richard Steingart; Ken Gin; Harvey D. White; Judith S. Hochman



Identification and revascularization of hibernating myocardium in angina-free patients with left ventricular dysfunction.  


We examined 17 angina-free patients with left ventricular dysfunction, referred for surgical decision-making, who presented with no or few signs and symptoms of myocardial ischemia according to treadmill stress test. On cardiac catheterization they were affected by severe multi-vessel coronary artery disease; the mean left end-diastolic pressure of this population was 26.3 +/- 5.5 mm Hg (mean +/- SD) and their mean ejection fraction was 27.6 +/- 4.9% (mean +/- SD). They all were investigated for the presence of viable myocardium by the combined assessment of cardiac perfusion and metabolism using single photon emission tomography with [99mTc] labelled hexakis-2-methoxy-isobutyl-isonitrile [99mTc]MIBI/SPET) and positron emission tomography with [18F]-2-fluoro-2-deoxy-D-glucose ([18F]FDG/PET), respectively. Patients were considered for coronary surgery when [18F]FDG was detectable in at least two cardiac segments with wall motion abnormalities and perfusion defects. Nine patients were operated on, six were medically treated and two were scheduled for heart transplantation. We recorded no in-hospital mortality. At a mean follow-up of 28.4 +/- 9.8 (mean +/- SD) months all surgical patients were alive and their NYHA functional classes have improved, except in one case. Among the patients refused for bypass surgery, three are in stable conditions, three have worsened clinical statuses and two died while waiting for heart transplantation. In conclusion, for patients with bypassable coronaries, left ventricular dysfunction and lack of angina, successful coronary revascularization may be predicted by the presence of viable myocardium demonstrated with positron emission tomography. PMID:8011347

Paolini, G; Lucignani, G; Zuccari, M; Landoni, C; Vanoli, G; Di Credico, G; Rossetti, C; Mariani, M A; Fazio, F; Grossi, A



Intraoperative evaluation of revascularization effect on ischemic muscle hemodynamics using near-infrared diffuse optical spectroscopies  

NASA Astrophysics Data System (ADS)

Arterial revascularization in patients with peripheral arterial disease (PAD) reestablishes large arterial blood supply to the ischemic muscles in lower extremities via bypass grafts or percutaneous transluminal angioplasty (PTA). Currently no gold standard is available for assessment of revascularization effects in lower extremity muscles. This study tests a novel near-infrared diffuse correlation spectroscopy flow-oximeter for monitoring of blood flow and oxygenation changes in medial gastrocnemius (calf) muscles during arterial revascularization. Twelve limbs with PAD undergoing revascularization were measured using a sterilized fiber-optic probe taped on top of the calf muscle. The optical measurement demonstrated sensitivity to dynamic physiological events, such as arterial clamping/releasing during bypass graft and balloon inflation/deflation during PTA. Significant elevations in calf muscle blood flow were observed after revascularization in patients with bypass graft (+48.1 +/- 17.5%) and patients with PTA (+43.2 +/- 11.0%), whereas acute post-revascularization effects in muscle oxygenation were not evident. The decoupling of flow and oxygenation after revascularization emphasizes the need for simultaneous measurement of both parameters. The acute elevations/improvements in calf muscle blood flow were associated with significant improvements in symptoms and functions. In total, the investigation corroborates potential of the optical methods for objectively assessing the success of arterial revascularization.

Yu, Guoqiang; Shang, Yu; Zhao, Youquan; Cheng, Ran; Dong, Lixin; Saha, Sibu P.



Therapeutic neovascularization for coronary disease: current state and future prospects  

Microsoft Academic Search

Despite advances in surgical and percutaneous revascularization techniques, nearly one-third of patients with ischemic coronary\\u000a artery disease are not candidates for revascularization due to suboptimal anatomy or receive suboptimal revascularization\\u000a from these standard procedures. Neovascularization of the myocardium is not only a physiologic response to ischemia, but also\\u000a potentially the target of new therapeutic strategies. Induced angiogenesis via protein, gene,

Antonio D. Lassaletta; Louis M. Chu; Frank W. Sellke


Success, safety, and efficacy of implantation of diamond-like carbon-coated stents.  


The aim of this study was to evaluate safety and clinically defined efficacy of the implantation of a new stent coated with diamond-like carbon (DLC stent), in a group of patients who underwent percutaneous transluminal coronary revascularization procedures in two hemodynamic centers. This study was an observational prospective nonrandomized study that included 196 patients with a total of 236 significant de novo atheromatous coronary lesions, in which 245 DLC stents were implanted. The primary end point of this study was a composite of major cardiovascular events (death or acute myocardial infarction with or without Q) and need for target lesion revascularization (TLR) or target vessel revascularization (TVR) procedure during the first 48 hours and at 6 months after the DLC stent implantation. All patients had a myocardial perfusion imaging study with Tl(201) at 6 months after DLC stent implantation. Only patients with a myocardial perfusion imaging study indicative of myocardial ischemia were then submitted for a new coronary angiogram. No major cardiovascular event or emergency TVR occurred during hospitalization. At 6-month follow-up no major cardiovascular event occurred either, whereas the rate for TLR was 5.6% and that for TVR was 7.65%. This preliminary study provides enough clinical evidence that implantation of intracoronary bare metal stents coated with diamond-like carbon is associated with high success rates, safety, and efficacy, both in the hospital and at the 6-month follow-up after the interventional procedure. PMID:17495270

Salahas, Anastasios; Vrahatis, Antonios; Karabinos, Ilias; Antonellis, Ioannis; Ifantis, Georgios; Gavaliatsis, Isidoros; Anthopoulos, Prodromos; Tavernarakis, Antonios


On-Pump Versus Off-Pump Coronary Artery Bypass Grafting in Diabetic Patients: A Propensity Score Analysis  

Microsoft Academic Search

BackgroundDiabetic patients are recognized as being at high risk for adverse outcomes after coronary artery bypass grafting. We evaluated our outcomes in diabetic patients to compare the effect of off-pump with on-pump coronary revascularization.

Arun K. Srinivasan; Antony D. Grayson; Brian M. Fabri



Role of radionuclide cardiac imaging in coronary artery bypass surgery  

SciTech Connect

The main applications of cardiac nuclear imaging in coronary artery bypass surgery include: patient selection, prediction of improvement in resting LV function after revascularization, diagnosis of perioperative myocardial infarction, assessment of the results of revascularization, evaluation of new or recurrent symptoms, and in risk stratification. Proper understanding of which test to be used, when, and why may be important to optimize patient management.

Iskandrian, A.S.; Heo, J.; Mostel, E.



Successful IVUS-guided reentry from iatrogenic coronary arteriovenous fistula related to wire perforation following wiring of a totally occluded vessel.  


We experienced a rare case in which a guidewire was advanced into a coronary vein through an arteriovenous fistula caused by wire perforation. The patient, who had chronic total occlusion (CTO) of the left circumflex coronary artery, was treated successfully with a procedure guided by intravascular ultrasound (IVUS). The IVUS-guided parallel-wire technique allowed recrossing of the guidewire into the distal true lumen of the CTO by identifying the anatomy of the occluded segment and the appropriate re-entry point. Angiography demonstrated that the fistula was completely sealed after stent deployment, and there was no extravasation. PMID:23813071

Ohya, Hidefumi; Kyo, Eisho; Katoh, Osamu



Stenting in chronic coronary occlusion (SICCO): A randomized, controlled trial of adding stent implantation after successful angioplasty  

Microsoft Academic Search

Objectives. This study investigated whether stenting improves long-term results after recanalization of chronic coronary occlusions.Background. Restenosis is common after percutaneous transluminal coronary angioplasty (PTCA) of chronic coronary occlusions. Stenting has been suggested as a means of improving results, but its use has not previously been investigated in a randomized trial.Methods. We randomly assigned 119 patients with a satisfactory result after

Per Anton Sirnes; Svein Gold; Yngvar Myreng; Per Mølstad; Håkean Emanuelsson; Per Albertsson; Magne Brekke; Arild Mangschau; Knut Endresen; John Kjekshus



Penile revascularization--contemporary update  

PubMed Central

Contemporary therapies for erectile dysfunction are generally targeted towards older men and universally engage pharmacological and/or device related treatment options. Penile revascularization, using microvascular arterial bypass surgical techniques, is a non-pharmacological, non-device-related, and reconstructive surgical strategy for men with erectile dysfunction that was first described by Dr Vaclav Michal in 1973. Contemporary penile revascularization attempts to ‘cure' pure arteriogenic erectile dysfunction in young men with arterial occlusive pathology in the distal internal pudendal, common penile or proximal cavernosal artery secondary to focal endothelial injury from blunt pelvic, perineal or penile trauma. A microvascular anastomosis is fashioned between the donor inferior epigastric and recipient dorsal penile artery. Increased perfusion pressure is theoretically communicated to the cavernosal artery via perforating branches from the dorsal artery. This article will review the history, indications and pathophysiology of blunt trauma-induced focal arterial occlusive disease in young men with erectile dysfunction, current surgical techniques utilized and results of surgery. Contemporary use of penile revascularization is a logical and wanted therapeutic option to attempt to reverse erectile dysfunction in young men who have sustained blunt pelvic, perineal or penile trauma.

Dicks, Brian; Bastuba, Martin; Goldstein, Irwin



Cardiac rehabilitation in older coronary patients.  


The majority of patients presenting with acute coronary disease or undergoing coronary revascularization procedures are older than age 65. Disability rates are very high in these patient populations, particularly in women, the older-old, and patients with clinical manifestations of angina pectoris or chronic heart failure. The presence of mental depression is also an important determinant of poor physical functioning. Cardiac rehabilitation has been demonstrated to safely increase aerobic capacity, muscular strength, and endurance in older coronary populations. PMID:9920237

Ades, P A



[Role of percutaneous coronary intervention in diabetic patients].  


Clinical outcomes after revascularization, both for surgery and percutaneous coronary intervention (PCI), is significantly worse in diabetic patients compared with non-diabetic patients. While in acute coronary syndrome, PCI is favored because of the increased risk of surgery performed during ongoing infarction, in stable patients assessment of clinical factors, such as coronary anatomy and comorbidities should guide decision of the revascularization modality (e.g., surgical, PCI, or conservative). Surgery should be favored in patients with multivessel coronary disease and acceptable surgical risk. Overall, the threshold for surgery compared to PCI should be lower in diabetic patients compared with non-diabetic ones. PMID:23789182

Gencer, B; Noble, S; Bonvini, R F; Mach, F; Roffi, M



Five-year outcomes of surgical or percutaneous myocardial revascularization in diabetic patients.  


BACKGROUND: The study compares five-year clinical outcomes of CABG vs PCI in a real world population of diabetic patients with multivessel coronary disease since it is not clear whether to prefer surgical or percutaneous revascularization. METHODS: Between July 2002 and December 2008, 2885 multivessel coronary diabetic patients underwent revascularization (1466 CABG and 1419 PCI) at hospitals in Emilia-Romagna Region, Italy and were followed for 1827±617days by record linkage of two clinical registries with the regional administrative database of hospital admissions and the mortality registry. Five-year incidences of MACCE (mortality, acute myocardial infarction [AMI], stroke, and repeat revascularization [TVR]) were assessed with Kaplan-Meier estimates, Cox proportional hazards regression and cumulative incidence functions of death and TVR, to evaluate the competing risk of AMI on death and TVR. The same analyses were applied to the propensity score matched subgroup of patients undergoing CABG or PCI with DES and with complete revascularization. RESULTS: PCI had higher mortality for all causes (HR: 1.8, 95% CI 1.4-2.2 p<0.0001), AMI (HR: 3.3, 95% CI 2.4-4.6 p<0.0001) and TVR (HR: 4.5, 95% CI 3.4-6.1 p<0.0001). No significant differences emerged for stroke (HR: 0.8, 95% CI 0.5-1.2 p=0.26). The higher incidence of AMI caused higher mortality in PCI group. Results did not change comparing CABG with PCI patients receiving complete revascularization or DES only. CONCLUSIONS: Diabetics show a higher incidence of MACCE with PCI than with CABG: thus diabetes and its degree of control should be considered when choosing the type of revascularization. PMID:23164591

Contini, Giovanni Andrea; Nicolini, Francesco; Fortuna, Daniela; Pacini, Davide; Gabbieri, Davide; Vignali, Luigi; Valgimigli, Marco; Manari, Antonio; Zussa, Claudio; Guastaroba, Paolo; De Palma, Rossana; Grilli, Roberto; Gherli, Tiziano



Arterial myocardial revascularization with right internal thoracic artery and epigastric artery in a patient with Leriche's syndrome  

PubMed Central

Concomitant coronary artery disease (CAD) and Leriche’s syndrome is clinical scenario which poses a challenge to cardiovascular surgeons. This report describes a case of arterial myocardial revascularization in a patient with CAD and Leriche’s syndrome by means of right internal thoracic artery harvested with right epigastric artery in situ fashion, performed in addition to simultaneous aorto-bifemoral bypass.



Patient outcomes after peripheral revascularization surgery  

Microsoft Academic Search

Acquired peripheral vascular disease (PVD) is a significant problem in the United States, resulting in both morbidity and mortality. The purpose of the pilot study was to determine patient outcomes after peripheral revascularization surgery. The specific aims of the pilot study were to examine peripheral revascularization surgical patient outcomes (PVD-related clinical symptoms, functioning, atherosclerotic disease risk factor reduction, and patient

Doris Rasmussen; Susan Barnason; Julie Smith; Mike Epp; Monica Hay; Christine Gable; Cindy Abbott; Dawn Klein



Best way to revascularize patients with main stem and three vessel lesions: patients should undergo PCI!  

Microsoft Academic Search

The optimal revascularization strategy for multivessel disease is under controversial discussion for long time. Until now,\\u000a technical innovations have been faster than performance of clinical trials, making results of randomized studies outdated\\u000a at the time of appearance. Recently, the SYNTAX trial has been published, which compared drug elutings stents (DES) implantation\\u000a with Coronary artery bypass graft (CABG) patients with multivessel

Volker Schächinger; Christian Herdeg; Bruno Scheller



Functional measurement of coronary stenosis.  


Fractional flow reserve (FFR) is considered nowadays as the gold standard for invasive assessment of physiologic stenosis significance and an indispensable tool for decision making in coronary revascularization. Use of FFR in the catheterization laboratory accurately identifies which lesions should be stented and improves the outcome in most elective clinical and angiographic conditions. Recently, FFR has been upgraded to a class IA classification in multivessel percutaneous coronary intervention in the guidelines on coronary revascularization of the European Society of Cardiology. In this state-of-the-art paper, the basic concept of FFR and its application, characteristics, and use in several subsets of patients are discussed from a practical point of view. PMID:22421298

Pijls, Nico H J; Sels, Jan-Willem E M



Coronary steal and ST elevation during dipyridamole stress testing leading to coronary artery bypass grafting  

Microsoft Academic Search

Conclusion  Although our patient had a very rare manifestation of vasodilatory-induced coronary steal, it is important to be aware of\\u000a this type of event during routine stress testing. This case reinforces the potential for acute myocardial infarction (1\\/10.000)13 as a life-threatening adverse event during dipyridamole infusion. This type of event appears to warrant expeditious coronary\\u000a angiography and appropriate coronary revascularization.

Halil Mutlu; Jeffrey Leppo



Determinants of success of coronary angioplasty in patients with a chronic total occlusion: a multiple logistic regression model to improve selection of patients.  

PubMed Central

OBJECTIVE--To study the determinants of success of coronary angioplasty in patients with chronic total occlusions, and to formulate a multiple logistic regression model to improve selection of patients. DESIGN--A retrospective analysis of clinical and angiographic data on a consecutive series of patients. PATIENTS--312 patients (mean age 55, range 31 to 79 years, 86% men) who underwent coronary angioplasty procedure for a chronic total occlusion between 1981 and 1992. RESULTS--Procedural success was achieved in 191 lesions (61.2%). A major complication occurred in six patients (1.9%). Multiple stepwise logistic regression analysis identified the presence of bridging collaterals (p < 0.001), the absence of a tapered entry configuration (p < 0.001), estimated duration of occlusion of greater than three months (p = 0.001), and a vessel diameter of less than 3 mm (p = 0.003) as independent predictors of procedural failure. The logistic regression model was used to classify patients into groups of high, intermediate, and low probability of procedural success with cut off points of 70% and 30%. The predictive value for procedural success (probability > or = 70%) was 91% (95% confidence intervals (95% CI) 83% to 96%) and predictive value for procedural failure (probability < 30%) was 81% (95% CI 64% to 92%). CONCLUSIONS--Percutaneous transluminal coronary angioplasty of chronic total occlusions is associated with a low risk of acute complication. Procedural success is influenced by easily identifiable clinical and angiographic features and the multiple regression model described may help to improve selection of patients.

Tan, K H; Sulke, N; Taub, N A; Watts, E; Karani, S; Sowton, E



Coronary angiography is the gold standard for patients with significant left ventricular dysfunction.  


Left ventricular (LV) dysfunction has been shown to be significantly related to ongoing myocardial ischemia, hibernation, and thus, coronary artery disease. Current treatments for patients with LV dysfunction and concomitant coronary artery disease center around the potential benefit of coronary revascularization, in the form of either coronary artery bypass grafting surgery (CABG) or percutaneous coronary intervention (PCI). Given the great diversity in the patient population making up those with LV dysfunction and coronary artery disease, intense interest has been directed in determining which patients benefit the most from revascularization. Multiple noninvasive evaluations have been utilized in order to select or stratify these patients. However, the gold standard by which clinicians make revascularization determinations is invasive coronary angiography. Within this review, we compare and contrast the noninvasive modalities available to the present day clinician with invasive angiography. Furthermore, we outline the ways in which invasive angiography has been utilized in patients with LV dysfunction and summarize the present guidelines regarding its usefulness. PMID:23518380

Lim, Michael J; White, Christopher J


Pharmacotherapy before and after revascularization: anticoagulation, antiplatelet agents, and statins.  


Proper medical management may enhance perioperative and long-term outcomes for patients with peripheral arterial disease (PAD). For patients with PAD, aspirin and statin drugs remain the mainstay of medical management, based on results from multiple randomized clinical trials that have demonstrated improvements in long-term survival and a decrease in cardiovascular events with these agents. There may additional, unintended positive consequences of treatment with statin drugs, including potential improvements in symptoms of claudication and enhanced graft patency after infrainguinal bypass. For patients undergoing surgical or endovascular revascularization, aspirin remains the standard of care for antithrombotic therapy. Beyond this, use of warfarin should be reserved for patients with high-risk surgical bypass grafts to prolong graft patency, because it carries a significant risk of bleeding complications. The utility of clopidogrel after surgical and endovascular infrainguinal revascularization remains undefined but warrants additional study. At this time the only clear indication for clopidogrel in patients with infrainguinal arterial occlusive disease is for PAD patients who are intolerant of aspirin or have a history of coronary artery stenting within the past 6 months. Proper adjunctive pharmacotherapy for the patient with PAD has the potential to improve symptoms, graft patency, and survival in this challenging subset of patients. PMID:17386359

Dagher, Nabil N; Modrall, J Gregory



Transaortic Modification of the Viabahn Open Revascularization Technique (VORTEC) to Facilitate Renal Artery Revascularization in a Hybrid EVAR Procedure.  


Purpose : To present a modification of the Viabahn open revascularization technique (VORTEC) to facilitate right renal artery (RRA) revascularization via a limited thoracotomy and transaortic sheath during endovascular aneurysm repair (EVAR). Case Report : A 51-year-old man with uncontrolled hypertension and limited respiratory reserve presented with a pararenal abdominal aortic aneurysm (AAA) measuring ?15×8.5×8 cm extending into the iliac arteries. Via a limited low thoracoabdominal incision and retroperitoneal approach, 3 of the renovisceral branches were exposed, but there was difficulty in approaching the RRA. A handmade 4-branched polytetrafluoroethylene graft (PTFE) was anastomosed to the descending thoracic aorta, and the 3 exposed renovisceral branches were bypassed sequentially. A modification of the VORTEC with a transaortic approach to revascularize the RRA was successful; a 7-mm×10-cm Viabahn stent-graft was advanced into the RRA and deployed into the RRA limb of the PTFE graft. The Viabahn-PTFE graft junction was fixed with interrupted suture, and its transaortic portion was dilated with a 7-mm balloon. EVAR was then accomplished with a 28.5-mm Excluder stent-graft. The final angiogram documented patent bypass grafts and no endoleak. Follow-up imaging showed a satisfactory stent-graft and patent PTFE graft without undue kinking of the Viabahn or stenosis within its transaortic portion. The patient remained well after 1-year follow-up. Conclusion : This transaortic modification may be a useful option for hybrid EVAR and application of a sutureless telescoping anastomosis technique. PMID:24093316

Tsai, Meng-Ta; Tseng, Cheng-Che; Kan, Chung-Dann



Incidence and Treatment of Elastic Recoil Occurring in the 15 Minutes Following Successful Percutaneous Transluminal Coronary Angioplasty * * This study was supported by a Training in Cardiovascular Research Grant, NIH 5-T32 HL07360-17, a Texas Affiliate Grant-In-Aid from the American Heart Association, NIH Grant R01HL53225-01 from the National Heart, Lung, and Blood Institute, NIH Ischemic SCOR Grant HL17669, and the Harry S. Moss Heart Fund  

Microsoft Academic Search

This study was performed (1) to assess the incidence and magnitude of elastic recoil occurring within 15 minutes of successful coronary angioplasty, and (2) to determine the effect of subsequent additional balloon inflations on coronary luminal diameter in patients displaying substantial recoil. The coronary angiograms of 50 consecutive patients who underwent a successful percutaneous transluminal coronary angioplasty were analyzed using

William C. Daniel; Mark J. Pirwitz; John E. Willard; Richard A. Lange; L. David Hillis; Charles Landau



A case of postpartum spontaneous coronary artery dissection.  


Spontaneous coronary artery dissection is rare and usually affects younger women in the peripartum period. Here, we report an interesting case of a 34-year-old woman with spontaneous coronary artery dissection that occurred 1 month after childbirth. Emergency coronary angiography showed stenosis of the left anterior descending artery, but immediately afterwards, a new occlusion of the right coronary artery occurred. Intravascular ultrasound was used to image both right and left coronary arteries. The new occlusion of the right coronary artery was probably iatrogenic, but the left coronary artery occlusion was spontaneous. The patient underwent percutaneous coronary intervention in the right coronary artery because of her unstable hemodynamic condition. Revascularization of the left coronary artery was performed by bypass grafting. The patient was discharged on postoperative day 30. As the optimal treatment for spontaneous coronary artery dissection has not yet been established, treatments should be based on the patient's clinical presentation. PMID:23775233

Okamoto, Minoru; Tanaka, Mutsuo; Ishii, Masanobu; Honda, Tsuyoshi; Koga, Hidenobu; Miyao, Yuji; Fujimoto, Kazuteru; Murayama, Toshihiko



Combined cerebral and lower-limb revascularization.  


Brachiocephalic atherosclerosis and aortoiliac occlusive disease are often encountered concomitantly, The authors report a technique of combined brachiocephalic and femoral revascularization in which a single transthoracic approach is used. PMID:11678252

Jebara, V A; Kassabian, E; Badaoui, G; Abdel-Massih, T; Karam, B; Slaba, S; Khalil, A



Combined Cerebral and Lower-Limb Revascularization  

PubMed Central

Brachiocephalic atherosclerosis and aortoiliac occlusive disease are often encountered concomitantly. The authors report a technique of combined brachiocephalic and femoral revascularization in which a single transthoracic approach is used.

Jebara, Victor A.; Kassabian, Elie; Badaoui, Georges; Abdel-Massih, Tony; Karam, Boutros; Slaba, Sami; Khalil, Antoine



Early assessment of percutaneous coronary interventions for chronic total occlusions analyzed by novel echocardiographic techniques  

PubMed Central

OBJECTIVE: Successful revascularization of chronic total occlusions has been associated with improved left ventricular systolic function, reduced anginal symptoms, increased exercise capacity, and increased survival. This study was conducted to determine the impact of revascularization in chronic total occlusion on left ventricular function using novel echocardiographic techniques. METHODS: A total of 129 patients with chronic total occlusion who underwent revascularization between April 2011 and November 2012 were included in this study. Echocardiographic assessments with two-dimensional speckle tracking echocardiography and real-time three-dimensional echocardiography were performed before the procedure and one month after the procedure. The left ventricular ejection fraction, left ventricular volumes, and three-dimensional systolic dyssynchrony index were quantified. RESULTS: An immediate procedural success was obtained in 118 patients (91.5%). There were no acute or subacute stent thromboses during follow-up. The mean left ventricular ejection fraction significantly increased (p<0.001), while the left ventricular end-diastolic and end-systolic volumes significantly decreased (p?=?0.001 and p<0.001, respectively). The three-dimensional systolic dyssynchrony index also decreased significantly (p<0.001). The global longitudinal strain showed a significant increase after successful revascularization (p<0.001). An increase in the global longitudinal strain was correlated with an increase in the left ventricular ejection fraction (r?=?0.27, p?=?0.02). The patients with a left ventricular ejection fraction ?50% displayed a greater improvement in the global longitudinal strain, and the patients with diabetes showed less improvement. CONCLUSIONS: Using novel echocardiographic techniques, our results showed that restoring the coronary blood flow in chronic total occlusion patients reduces the left ventricular volumes and improves the left ventricular ejection fraction and the global longitudinal strain of hibernating myocardium.

Erdogan, Ercan; Akkaya, Mehmet; Bacaksiz, Ahmet; Tasal, Abdurrrahman; Sonmez, Osman; Elbey, Mehmet Ali; Kul, Seref; Vatankulu, Mehmet Akif; Turfan, Murat; Goktekin, Omer



Extracranial revascularization therapy: Angioplasty and stenting  

Microsoft Academic Search

Opinion statement  Beginning with simple balloon angioplasty, minimally invasive revascularization techniques have progressed to the use of metallic\\u000a stents for improved immediate and long-term results. Stent-supported angioplasty now offers a therapeutic option for those\\u000a individuals ineligible for surgical revascularization of stenotic atherosclerotic lesions and who have failed maximal medical\\u000a therapy. However, the clinical equivalence, or possibly even superiority, of angioplasty of

Alexander V. Khaw; H. Christian Schumacher; Philip M. Meyers; Rishi Gupta; Randall T. Higashida



Ablation velocity and thermal damage of myocardial tissue using a CO2 laser for transmyocardial laser revascularization  

NASA Astrophysics Data System (ADS)

Transmyocardial Laser Revascularization (TMLR) is a new experimental method for relief of angina pectoris in patients with severe coronary artery disease. TMLR aims at revascularizing chronic hibernating myocardium by creating transmural channels. One of the working mechanism hypotheses is that the endocardial side of the channels remains open, enabling perfusion of the hibernating myocardium directly from the left ventricle. Although the working mechanism of TMLR is still unknown (perfusion through patent channels, induction of angiogenesis, relief of angina through destruction of sympatic innervation, others?), first clinical studies are successful. Currently, the Heart LaserTM and other CO2 lasers, XeCl Excimer laser and Ho:YAG laser are under investigation for TMLR. The initial attempts of TMR with needles were soon replaced by laser induced channels. Efforts were focused on developing a CO2 laser that could penetrate a beating heart during its relaxation phase. Later, the position of the beam could be fixed in the myocardial wall using lasers with fiber delivery systems and perforation was achieved within multiple cycles. Various researchers reported on both patent and non-patent channels after TMLR. Our belief is that the extent of laser induced thermal damage is one of the factors that determine the clinical outcome and the extent of angiogenesis (and, possibly, the patency of the channel). The purpose of this study is to present a simple theoretical model to predict the extent of thermal damage around a transmyocardial channel. In vitro experiments were performed on myocardial bovine tissue and damage was assessed. The results were used to determine the final parameters of the approximating theoretical equation. To evaluate our results, we compared our results to in vitro data using the Heart LaserTM from the literature. Ablation velocities were also measured and the results were compared to ablation velocity calculations using a model described by Ostegar et al.

Sachinopoulou, Anna; Beek, Johan F.; van Leeuwen, Ton G.; Beek, W. J.



Physiological impact of CTO recanalization assessed by coronary pressure measurement: A case report.  


In this case report, physiological changes of myocardial perfusion in the collateral recipient right coronary artery (RCA) and the collateral donor left anterior descending artery (LAD) with an intermediate lesion were assessed using intracoronary pressure measurement, before and after revascularization of chronic total occlusion (CTO). A 44-year-old male was referred for a catheter examination due to silent myocardial ischemia. An invasive coronary angiogram revealed diffuse narrowing of the RCA with focal occlusive segments in addition to intermediate stenosis in the LAD. A well developed collateral channel from the LAD to the RCA was also confirmed. Fractional flow reserve (FFRmyo) of the LAD before opening the RCA was 0.81. After successful revascularization of the RCA, FFRmyo of the LAD and the RCA were measured with and without an RCA balloon occlusion. Because collateral fractional flow reserve (FFRcoll) of the RCA could be regarded as FFRmyo before revascularization, FFRmyo of the RCA increased from 0.67 to 0.90, meaning a 23% increase of maximum flow by intervention. Interestingly, improvement of FFRmyo of the LAD from 0.81 to 0.93 was also observed, which means a 12% increase of maximum flow. Coronary steal in the LAD was reconfirmed by dramatic worsening of FFRmyo from 0.93 to 0.77 by an RCA balloon occlusion. This phenomenon may be explained by an immediate recruitment of collateral channels. This case clearly demonstrated that CTO opening improves perfusion in not only myocardium supplied by the CTO vessel, but also in that which is supplied by a contralateral collateral donor artery. © 2013 Wiley Periodicals, Inc. PMID:23359324

Matsuo, Hitoshi; Kawase, Yoshiaki



Transmyocardial laser revascularization. Anatomic evidence of long-term channel patency.  

PubMed Central

Transmyocardial laser revascularization, a new surgical technique, is being tested in patients with chronic obstructive coronary artery disease that is refractory to conventional revascularization techniques and to maximal medical therapy. During the operation, which is performed on the beating heart through a left thoracotomy, a high-energy CO2 laser is used to bore transmural channels (1 mm in diameter) into the left ventricle. Each high-energy laser pulse is delivered during end diastole and transects the heart within 10 to 60 msec. The operation is based on the theory that blood will flow directly from the left ventricle into the channels and then into the myocardial vascular plexus. Restoring perfusion should alleviate ischemia in potentially viable myocardium and improve ventricular function. Recently, one of our patients died 3 months after transmyocardial laser revascularization of causes unrelated to the operation. Histologic analysis enabled us to obtain, for the 1st time, anatomic evidence of patent laser channels. Routine staining of cardiac tissue with hematoxylin and eosin revealed multiple patent channels, running perpendicular to and interconnecting with the native vasculature. Although reactive fibrous scar tissue had caused narrowing of the original laser tract, the channels had endothelialized and they contained red blood cells. These findings suggest that the laser channels were functional. We report this interesting case and briefly discuss the anatomic and physiologic phenomena involved in establishing camerosinusoidal blood flow by use of transmyocardial laser revascularization. Images

Cooley, D A; Frazier, O H; Kadipasaoglu, K A; Pehlivanoglu, S; Shannon, R L; Angelini, P



Successful Ablation of Antero-septal Accessory Pathway in the Non-Coronary Cusp in a Child.  


A 15-year-old boy with Wolff-Parkinson-White syndrome underwent an electrophysiology study for symptoms of palpitations and persistence of pre-excitation during peak exercise. He was detected to have right antero-septal accessory pathway with relatively long effective refractory period and no inducible tachycardia. He had only transient normalization with cryoablation. Eight months later, he presented again with two episodes of seizures with preceding palpitations. Neurology evaluation was unremarkable with a normal electroencephalogram. In view of his symptoms in association with evidence of pre-excitation, he underwent a second electrophysiology study with ablation. Cryoablation in the anterior septum again achieved only transient normalization. Mapping in the non-coronary cusp identified an earliest accessory pathway potential. RF ablation was performed in the non-coronary cusp with immediate normalization of his electrocardiogram. At 6 month follow-up, he continues to have no pre-excitation on his EKG. Ablation of the anteroseptal accessory pathway in the non-coronary cusp can be safely performed in patients' refractory to conventional ablation sites and techniques. PMID:22665961

Kobayashi, Daisuke; Arya, Swati O; Singh, Harinder R



Endovascular revascularization of bald aortic arch for severe cerebral ischemia.  


Takayasu arteritis is a rare form of chronic, inflammatory arteriopathy affecting the aorta and its major branches. Obstructive lesions of all arch vessels lead to ischemic brain symptoms. There is very limited experience of endovascular revascularization in this situation. We report case of a female patient with potentially life threatening cerebral ischemic symptoms due to extra-cranial occlusion of all arch arteries. Stent supported angioplasty of brachiocephalic, right common carotid and right subclavian artery was successfully performed. This improved her cerebral blood flow and relieved her severe, disabling neurologic symptoms. PMID:23436624

Tyagi, Sanjay; Girish, M P; Gupta, Mohit D



Coronary angioplasty in pregnancy.  

PubMed Central

Myocardial infarction is rare in pregnancy. A 30 year old white primigravida had an anterior infarct at 20 weeks' gestation, which was followed by troublesome angina. Coronary angiography showed a tight stenosis of the left anterior descending coronary artery. This was treated successfully by percutaneous transluminal coronary angioplasty. Images Fig 1 Fig 2

Cowan, N C; de Belder, M A; Rothman, M T



Successful percutaneous coronary intervention in a patient with combined deficiency of FV and FVIII due to novel compound heterozygous mutations in LMAN1.  


Percutaneous coronary intervention (PCI) in patients with congenital coagulation factor deficiencies presents a unique challenge. They are not only at increased risk of perioperative bleeding but can also suffer thrombosis of the stent as preventive anticoagulation and antiplatelet therapy is difficult. Several cases of successful PCI have been described in patients with haemophilia A and B, but there are no reports in patients with combined coagulation factor deficiencies. We used PCI to treat the coronary artery disease in a patient with the combined deficiency of factor V and factor VIII (F5F8D) and analysed the molecular basis of the disorder for this patient. A 68-year-old patient was admitted for urgent PCI with bare metal stent placement after the diagnosis of the F5F8D. Peripheral blood DNA was extracted for the sequence analysis of LMAN1 and MCFD2 genes. Mutations in LMAN1 was confirmed by molecular cloning of the PCR product and resequencing of the resulting clones. The patient underwent successful PCI with good long-term outcome. Our patient tolerated anticoagulation therapy well, with unfractionated heparin, and double antiplatelet therapy while he was initially supported with fresh frozen plasma and recombinant FVIII. Molecular analysis revealed that the patient carries unusual compound heterozygous frameshift mutations on the same microsatellite repeat region in exon 8 of LMAN1, one of which is a novel mutation (c.912delA). Our results suggest that patients with F5F8D can safely undergo PCI for coronary artery disease, with the treatment individualized to the specific patient. PMID:23557496

Patel, A J; Liu, H-H; Lager, R A; Malkovska, V; Zhang, B



Prognostic significance of serum creatinine concentration for in-hospital mortality in patients with acute myocardial infarction who underwent successful primary percutaneous coronary intervention (from the Heart Institute of Japan Acute Myocardial Infarction [HIJAMI] Registry)  

Microsoft Academic Search

This study evaluated the impact of serum creatinine levels on in-hospital mortality in 1,359 consecutive patients with acute myocardial infarction (from a Japanese prospective multicenter registry) who underwent successful primary percutaneous coronary intervention (PCI). Even in the patients who underwent successful primary PCI, the in-hospital mortality of patients with mild (1.2 ? creatinine

Jun-ichi Yamaguchi; Hiroshi Kasanuki; Yasuhiro Ishii; Masahiro Yagi; Hiroshi Ogawa; Shin-ya Fujii; Hiroshi Koganei; Hisayuki Okada; Hirotaka Kimura; Toshinobu Horie; Kazuo Haze; Tetsuya Sumiyoshi; Takashi Honda



Current management of left main coronary artery disease.  


Coronary artery bypass surgery is considered as the gold standard treatment of unprotected left main coronary artery (ULMCA) disease. Over the last 20 years, improvement in stent technology and operators experience explained the increased number of reports on the results of percutaneous coronary interventions (PCIs) for the treatment of left main (LM) coronary artery lesion. The recent data comparing efficacy and safety of PCIs using drug-eluting stent and coronary artery bypass surgery showed comparable results in terms of safety and a lower need for repeat revascularization for coronary artery bypass surgery. Patient selection for both techniques is fundamental and directly impacts the clinical outcome. Further randomized trials must be conducted to precise the indications of both techniques of revascularization in the treatment of LM disease. PMID:22210689

Fajadet, Jean; Chieffo, Alaide



Transbrachial Intra-Aortic Balloon Pumping for High-Risk Percutaneous Coronary Intervention  

PubMed Central

The beneficial effect of placement of intra-aortic balloon (IAB) pump before revascularization in patients with high-risk coronary anatomy and impaired left ventricular systolic function is documented. However, the conventional insertion of IAB pump via the common femoral artery may be contraindicated or may be even impossible in patients with severe vascular disease. Recently, the percutaneous insertion of IAB via the brachial artery has been shown to be effective and safe in small series of patients with vascular disease undergoing coronary artery bypass surgery. The authors report their experience with a patient with aortobifemoral bypass grafts who underwent successful stenting of a trifurcating distal left main stenosis after placement of a 7.5-Fr IAB pump via the left brachial artery.

Aznaouridis, Konstantinos; Kacharava, Andro G.; Consolini, Michelle; Zafari, A. Maziar; Mavromatis, Kreton



The significance of subclavian artery injection prior to surgical myocardial revascularization.  


Successful arterial revascularization using the internal thoracic artery is dependent on unobstructed inflow through the subclavian artery. Systematic physical examination should discover subclavian stenosis; however, simple routine injection into the orifice of the subclavian artery during the diagnostic catheterization may avoid a catastrophic outcome. PMID:12745864

Elami, Amir; Ad, Niv; Merin, Gideon



Awake coronary artery bypass grafting: utopia or reality?  

Microsoft Academic Search

BackgroundOff-pump coronary artery bypass grafting (OPCAB) was implemented to reduce trauma during surgical coronary revascularization. High thoracic epidural anesthesia further reduced intraoperative stress and postoperative pain. This technique also supports awake coronary artery bypass (ACAB), completely avoiding the drawbacks of mechanical ventilation and general anesthesia in high-risk patients. We compared our first results of the ACAB procedure with the conventional

Tayfun Aybek; Paul Kessler; Selami Dogan; Gerd Neidhart; Mohammad Fawad Khan; Gerhard Wimmer-Greinecker; Anton Moritz



Revascularization of Transplanted Pancreatic Islets and Role of the Transplantation Site  

PubMed Central

Since the initial reporting of the successful reversal of hyperglycemia through the transplantation of pancreatic islets, significant research efforts have been conducted in elucidating the process of revascularization and the influence of engraftment site on graft function and survival. During the isolation process the intrinsic islet vascular networks are destroyed, leading to impaired revascularization after transplant. As a result, in some cases a significant quantity of the beta cell mass transplanted dies acutely following the infusion into the portal vein, the most clinically used site of engraftment. Subsequently, despite the majority of patients achieving insulin independence after transplant, a proportion of them recommence small, supplemental exogenous insulin over time. Herein, this review considers the process of islet revascularization after transplant, its limiting factors, and potential strategies to improve this critical step. Furthermore, we provide a characterization of alternative transplant sites, analyzing the historical evolution and their role towards advancing transplant outcomes in both the experimental and clinical settings.

Pepper, Andrew R.; Ziff, Oliver; Shapiro, A. M. James



Ipsilateral heterodigital artery transfer for finger revascularization.  


We report a case of digital revascularization in a child's small finger by using a digital artery from the adjacent uninjured digit. Reconstruction of a defect in the digital artery with a vein graft is technically challenging in a child and has a higher risk of failure due to anastomoses at 2 levels and possible size mismatch. We detail the technique of heterodigital artery transfer from the ring finger to revascularize the small finger with segmental loss of both digital arteries. This technique has not been reported previously and offers a simpler alternative to vein grafting in select situations. PMID:18776781

LeBlanc, Robby; Bindra, Randip



Quantitative Rest Technetium99m Tetrofosmin Imaging in Predicting Functional Recovery After Revascularization: Comparison With Rest–Redistribution Thallium201  

Microsoft Academic Search

Objectives. This study was undertaken to 1) compare the regional myocardial tracer distributions between rest technetium (Tc)-99m tetrofosmin and rest–redistribution thallium (Tl)-201 images in patients with coronary artery disease and left ventricular dysfunction; and 2) assess the comparative values of these agents for predicting functional recovery after revascularization.Background. Tc-99m tetrofosmin is a new myocardial perfusion imaging agent, but its role

Ichiro Matsunari; Susumu Fujino; Junichi Taki; Junji Senma; Takahiko Aoyama; Takanobu Wakasugi; Jun-ichi Hirai; Takashi Saga; Shinichiro Yamamoto; Norihisa Tonami



The effect of percutaneous transmyocardial laser revascularization on left ventricular function in a porcine model of hibernating myocardium  

Microsoft Academic Search

BackgroundHibernating myocardium is defined as a state of persistently impaired myocardial function at rest due to reduced coronary blood flow that can partially or completely be restored to normal if the myocardial oxygen supply\\/demand relationship is favorably altered. Percutaneous laser revascularization (PMR) is an emerging catheter-based technique that involves creating channels in the myocardium, directly through a percutaneous approach with

Francis Q. Almeda; Dana Glock; Joanne Sandelski; Osama Ibrahim; James E. Macioch; Trisha Allen; John R. Dainauskas; Joseph E. Parrillo; R. Jeffrey Snell; Gary L. Schaer



Myocardial Revascularization by CO2 Laser  

Microsoft Academic Search

An original method of myocardial revascularization using CO2 laser has been studied in a pig model with acute myocardial infarction. Transparietal channels were created by myocardial vaporization, using a CO2 laser beam. A comparative evaluation was made against a control group using as parameters survival rate, ECG changes, anatomopathologic findings, and angiographic studies. With the exception of favorable changes in

T. Goda; Z. Wierzbicki; A. Gaston; J. Leandri; J. Vouron; D. Loisance



Evaluation of penile revascularization for erectile dysfunction: a 10-year follow-up  

Microsoft Academic Search

The objective of this study was to report long-term success rates for penile revascularization (PR) and investigate factors responsible for failures. During the past 10 y, data were obtained on 52 patients who underwent PR. Surgical technique was selected according to preoperative arteriographic findings. The mean age was 28.5 y and the mean follow-up was 70.8 months. Success was defined

Y Vardi; I Gruenwald; U Gedalia; S Nassar; A Engel; Y Har-Shai



Persistent Socioeconomic Differences in Revascularization After Acute Myocardial Infarction Despite a Universal Health Care System—A Danish Study  

Microsoft Academic Search

Background  Use of invasive revascularization [percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG)] after\\u000a acute myocardial infarction (AMI) in Denmark increased between 1996 and 2004. We investigated how this affected socioeconomic\\u000a differences in their use.\\u000a \\u000a \\u000a \\u000a Materials and methods  All patients aged 30–74 years in hospital for a first AMI in Denmark between 1996 and 2004 were included. Cox proportional\\u000a hazard models

Jeppe N. Rasmussen; Søren Rasmussen; Gunnar H. Gislason; Steen Z. Abildstrom; Tina K. Schramm; Christian Torp-Pedersen; Lars Køber; Finn Diderichsen; Merete Osler; Mette Madsen



Minimally invasive coronary artery bypass grafting decreases hospital stay and cost.  

PubMed Central

OBJECTIVE: The authors performed a retrospective cost analysis for patients undergoing revascularization of their left anterior descending (LAD) coronary artery either by standard coronary artery bypass grafting (CABG), percutaneous transluminal coronary angioplasty (PTCA), or minimally invasive coronary artery bypass grafting (MICABG). SUMMARY BACKGROUND DATA: Minimally invasive CABG has become a safe and effective alternative treatment for single-vessel coronary artery disease. However, the acceptance of this procedure as a routine alternative for the treatment of coronary artery disease will depend on both long-term graft patency rates as well as a competitive market cost. METHODS: The authors conducted a retrospective analysis of three patient groups undergoing LAD coronary revascularization from January 1995 to July 1996. Ten patients were selected randomly from this period after PTCA of an LAD lesion with or without stenting. Nine patients underwent standard CABG on cardiopulmonary bypass with a left internal mammary artery. Nine patients received MICABG via a limited left anterior thoracotomy and left internal mammary artery to LAD grafting without the use of cardiopulmonary bypass. RESULTS: Percutaneous transluminal coronary angioplasty (n = 10) was unsuccessful in two patients. One patient in the MICABG group (n = 9) was converted successfully to conventional CABG because of an intramyocardial LAD and dilated left ventricle. There was no operative morbidity or mortality in any group. Average length of stay postprocedure was decreased significantly for both the MICABG and PTCA groups when compared with that of conventional CABG (n = 9) (2.7 + 0.26, p = 0.009, and 2.6 + 0.54, p = 0.006, vs. 4.8 + 0.46, respectively). Total hospital costs for the MICABG and PTCA groups were significantly less when compared with those of standard CABG ($10,129 + 1104, p = 0.0028, and $9113 + 3,039, p = 0.0001, vs. $17,816 + 1043, respectively). There were no statistically significant differences between the MICABG and PTCA groups. CONCLUSIONS: The final role of minimally invasive CABG is unclear. This procedure is clearly cost effective when compared with that of PTCA and conventional CABG. The long-term patency rates for MICABG will determine its overall efficacy.

King, R C; Reece, T B; Hurst, J L; Shockey, K S; Tribble, C G; Spotnitz, W D; Kron, I L



The influence of diabetes mellitus on acute and late clinical outcomes following coronary stent implantation.  


OBJECTIVES: We compared the clinical outcomes following coronary stent implantation in insulin-treated diabetes mellitus (IDDM), non-IDDM patients, and nondiabetic patients. BACKGROUND: Diabetic patients have increased restenosis and late morbidity following balloon angioplasty. The impact of diabetes mellitus (DM), especially IDDM, on in-stent restenosis is not known. METHODS: We studied 954 consecutive patients with native coronary artery lesions treated with elective Palmaz-Schatz stents implantation using conventional coronary angiographic and intravascular ultrasound methodology. Procedural success, major in-hospital complications, and 1-year clinical outcome were compared according to the diabetic status. RESULTS. In-hospital mortality was 2% in IDDM, significantly higher (p <0.02) compared with non-IDDM (0%) and nondiabetics (0.3%). Stent thrombosis did not differ among groups (0.9% in IDDM vs. 0% in non-IDDM and 0% in nondiabetics, p >0.1). During follow-up, target lesion revascularization (TLR) was 28% in IDDM, significantly higher (p <0.05) compared with non-IDDM (17.6%) and nondiabetics (16.3%). Late cardiac event-free survival (including death, myocardial infarction [MI], and any coronary revascularization procedure) was significantly lower (p=0.0004) in IDDM (60%) compared with non-IDDM (70%) and nondiabetic patients (76%). By multivariate analysis, IDDM was an independent predictor for any late cardiac event (OR=2.05, p=0.0002) in general and TLR (odds ratio=2.51, p=0.0001) in particular. CONCLUSIONS. In a large consecutive series of patients treated by elective stent implantation, IDDM patients were at higher risk for in-hospital mortality and subsequent TLR and, as a result, had a significantly lower cardiac event-free survival rate. On the other hand, acute and long-term procedural outcome was found to be similar for non-IDDM compared with nondiabetic patients. PMID:9741497

Abizaid, A; Kornowski, R; Mintz, G S; Hong, M K; Abizaid, A S; Mehran, R; Pichard, A D; Kent, K M; Satler, L F; Wu, H; Popma, J J; Leon, M B



[Surgical myocardial revascularization in a female patient with bilateral occlusion of the common carotid arteries].  


Concurrent stenosis of the coronary and carotid circulation is one of the most serious disease. The authors describe the case of a 74-year old female patient with ischaemic heart disease with concurrent bilateral occlusion of the common carotid arteries. Surgical revascularization of the myocardium was made using extracorporeal circulation under general normothermia with protection of the heart muscle from ischaemia by the method of warm blood cardioplegia. In the discussion the authors analyze contemporary possibilities of surgical treatment of ischaemic disease (MIDCAB, OPCAB, operations with extracorporeal circulation) and emphasize the advantages and risks of different procedures. PMID:12197172

Mand'ák, J; Lonský, V; Dominik, J; Brtko, M; Kubícek, J



Coronary endarterectomy during off-pump coronary artery bypass surgery.  


Coronary endarterectomy (CEA) is often combined with coronary artery bypass grafting (CABG), which is performed on cardiopulmonary bypass (CPB). Recent advances in off-pump surgical technique and cardioanesthesiology, along with the increasing number of patients with high risk of CPB complications made it possible and desirable to execute CEA on a beating heart. Russian scientific literature lacks reports on these interventions. The study was aimed at evaluation of off-pump CEA feasibility and early outcomes. From 59 patients with ischemic heart disease (IHD), who underwent combined CABG and CEA, off-pump technique was used for 16 (27.1%) patients, including 12 men and 4 women, mean age 55.3 +/- 6.4. All of them had long-lasting history of IHD; 2 patients had angina CCS class II, 12--class III and 2 patents--class IV. Total number of anastomoses was 51 for 16 patients or 3.18 per patient. Open endarterectomy was used in 7 (9%) CEAs, semi-closed--in 9 (11.5%) CEAs. The technique of atherosclerotic plaque extraction, coronary artery reconstruction and bypass was similar in both groups. Complete revascularization was achieved for all patients. At discharge clinical improvement was evident in patients with functional classes 0-1. Diffuse involvement of coronary arteries is not considered to be contraindication for CABG. Simultaneous CEA with off-pump technique helps to achieve complete myocardial revascularization and good early outcomes, comparable with the results of conventional CPB-assisted procedures. PMID:19791437

Shne?der, Iu A; Lesbekov, T D; Kuznetsov, K V; Aleshkin, N G; Tso?, M D; Rogacheva, N M; Iuferov, A P



[Coronary artery disease in patients with diabetes].  


Diabetes in patients with coronary artery disease multiplies the risk of a cardiovascular event by a factor of 2 to 3. The risk is still higher for patients with heart or kidney failure. The detection of silent ischemia makes it possible to identify patients with revascularizable stenosis of the coronary artery or three-vessel atheroma. The choice between angioplasty and coronary bypass for diabetes patients with multiple-vessel disease requires multidisciplinary discussion. The onset of acute coronary syndrome in a patient with diabetes justifies coronary angiography to attempt any possible revascularization. Coronary angioplasty with a drug-eluting stent reduces the risk of need for revascularization due to restenosis, without modifying the risk of death/infarction compared with a bare-metal stent. Prognosis is improved only if appropriate comprehensive management follows, including intensive correction of risk factors. The management of a patient with coronary artery disease and diabetes must be multidisciplinary, in a network of care coordinated by the general practitioner. PMID:19362802

Le Feuvre, Claude



[Myocardial revascularization before abdominal aortic surgery in patients with ischemic heart disease].  


We retrospectively analyzed 2 cohorts of patients treated in two clinics implementing different strategies of preoperative examination and lowering of perioperative cardiac risk. Patients in clinic 1 (group I, n=86, mean age 59.4+/-7.7 years) were subjected to coronary angiography (CAG) and if indicated - to preventive myocardial revascularization. In patients of clinic 2 (group II, n=95, mean age 54.3+/-6.5 years) only medical therapy was used. In group I CAG was performed in 90%, and myocardial revascularization - in 28% of patients. Total number of complications and hospital mortality were significantly higher in group II compared with group I (20 vs. 8%, p=0.023; 10.5 vs. 2.3%, =0.026). Myocardial infarction was the cause of 6 deaths (6.3%) in group II, while in group I there were no cardiac complications. Thus compared to control group strategy with routine CAG and preventive myocardial revascularization before abdominal aortic surgery was associated with less perioperative complications, myocardial infarctions, and lower mortality. PMID:23952955

Sumin, A N; Korok, E V; Panfilov, S D; Evdokimov, D O; Bezdenezhnykh, A V; Kislov, E E; Ivanov, S V; Barbarash, L S



Outcomes in patients with abnormal myocardial perfusion imaging and normal coronary angiogram.  


A subset of subjects undergoing myocardial perfusion imaging has perfusion abnormalities that are subsequently labeled false positive based on coronary angiography. We evaluated the long-term prevalence of cardiovascular events in these patients. We retrospectively identified 48 patients who had reversible perfusion abnormalities with myocardial perfusion imaging and normal coronary angiography. Patients with known coronary artery disease, left ventricular dysfunction, valvular disease, and cardiomyopathy were excluded. Patient follow-up, conducted for at least 3 (mean interval, 7.4) years from the index myocardial perfusion imaging, was accomplished by a review of medical records and telephone interviews. Study endpoints were cardiovascular events defined as sudden cardiac death, myocardial infarction, percutaneous coronary revascularization, coronary artery bypass grafting, and cerebrovascular or peripheral revascularization. Thirty-one percent (15 of 48) of the patients had cardiovascular events. Six of the 48 patients had coronary events. These patients had abnormal myocardial perfusion imaging and normal coronary angiogram. The time between myocardial perfusion imaging and coronary event was 0.5 to 8.67 years. There was a strong correlation between the regions of original perfusion abnormality and the ultimate coronary ischemia or revascularization. Abnormal findings on myocardial perfusion imaging may predict a higher prevalence of coronary and peripheral vascular events than suggested by a normal coronary angiogram. PMID:18796451

Delcour, Kimberly S; Khaja, Azamuddin; Chockalingam, Anand; Kuppuswamy, Saravanan; Dresser, Thomas



Survival benefit of coronary-artery bypass grafting accounted for deaths in those who remained untreated  

Microsoft Academic Search

BACKGROUND: Currently there are no direct estimates of mortality reduction afforded by coronary-artery bypass grafting (CABG) that take into account the deaths among patients for whom coronary revascularization was indicated but who did not undergo the treatment. The objective of this analysis was to compare survival after the treatment decision between patients who underwent CABG and those who remained untreated.

Boris G Sobolev; Guy Fradet; Robert Hayden; Lisa Kuramoto; Adrian R Levy; Mark J FitzGerald



Factors excercising an influence on recovery of hibernating myocardium after coronary artery bypass grafting  

Microsoft Academic Search

Objective: Coronary artery bypass grafting (CABG) in patients with endstage coronary disease (CAD) significantly improves symptoms and prolongs life expectancy. Left ventricular function is also improved in some patients, but not in others. Factors which influence functional recovery of hibernating myocardium after revascularization are at present under investigation. Methods: From 3\\/2000 to 8\\/2002, we analyzed 41 patients with an ejection

Harald Hausmann; Rudolf Meyer; Henryk Siniawski; Reinhard Pregla; Matthias Gutberlet; Holger Amthauer; Roland Felix; Roland Hetzer



Factors excercising an influence on recovery of hibernating myocardium after coronary artery bypass graftingq  

Microsoft Academic Search

Objective: Coronary artery bypass grafting (CABG) in patients with endstage coronary disease (CAD) significantly improves symptoms and prolongs life expectancy. Left ventricular function is also improved in some patients, but not in others. Factors which influence functional recovery of hibernating myocardium after revascularization are at present under investigation. Methods: From 3\\/2000 to 8\\/2002, we analyzed 41 patients with an ejection

Harald Hausmann; Rudolf Meyer; Henryk Siniawski; Reinhard Pregla; Matthias Gutberlet; Holger Amthauer; Roland Felix; Roland Hetzer


Myocardial revascularization with bilateral internal thoracic artery in patients with left main disease: an incremental risk?  


Although the long-term patency of the internal thoracic artery (ITA) has been well proved, there is still some concern about its preoperative performance. We considered 80 patients with left main disease (mean age 60.2 years) who underwent coronary artery bypass grafting in our institute from March 1988 to September 1992. Patients with left main disease were divided into 2 groups: group I-38 patients receiving only ITA grafts on the left coronary system and group II-42 patients having a single ITA graft together with saphenous vein grafts on the left coronary system. No patients in group I received a saphenous graft on the left coronary system and three patients with right coronary artery involvement received total arterial myocardial revascularization with the use of the inferior epigastric artery. Perioperative complications in group I and group II patients were, respectively: myocardial necrosis in 2 (6.9%) and 3 (8.8%), use of intraaortic balloon pump in 2 (6.9%) and 2 (5.9%). No death occurred in either group. In our experience, the use of bilateral ITA grafts in patients with left main stenosis was not related to an incremental risk. We conclude that left main disease should not be considered as counterindication to the extensive use of arterial conduits. PMID:7893495

Paolini, G; Zuccari, M; Di Credico, G; Gallorini, C; Stefano, P L; Castiglioni, A; Pala, M G; Grossi, A



Chronic response to direct myocardial revascularization: a preliminary study  

NASA Astrophysics Data System (ADS)

Anecdotal evidence suggests that laser revascularization has long-term benefits on tissue perfusion, perhaps by stimulating angiogenesis. To test this hypothesis, we made 6 transmural channels in rat hearts randomized to either; (1) laser: channels made using a 500 micrometers diameter optic fiber coupled to a holmium:YAG laser, (2) needle: channels made using a 500 micrometers diameter needle, or (3) control: no channels made. Two months later, the rats underwent 90 minutes of coronary artery occlusion followed by 41/2 hours of reperfusion. Prior to the end of the experiment, the artery was reoccluded and the heart perfused with blue dye to detect collateral perfusion within the risk region. Microscopic analysis revealed more dye-containing vessels in needle-treated hearts than in laser or control groups (12 +/- 6*, 3 +/- 1, 2 +/- 1 vessels per field of view, * p < 0.05). Needle channels also appeared to limit necrosis: infarct size was 41 +/- 6* (needle), 61 +/- 6 (laser), 70 +/- 5 (control) % of the risk region in the three groups (*p < 0.05 versus control). Thus, needle- treatment may be capable of reducing infarct size by supplying blood via a collateral circulation apparently stimulated by the channels making process.

Whittaker, Peter; Zheng, Shi-Ming; Kloner, Robert A.



Culprit-Lesion-Only Versus Multivessel Revascularization Using Drug-Eluting Stents in Patients With ST-Segment Elevation Myocardial Infarction: A Korean Acute Myocardial Infarction Registry-Based Analysis  

PubMed Central

Background and Objectives In patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease, complete revascularization (CR) for non-culprit lesions is not routinely recommended. The aim of this study was to compare the clinical outcomes of multivessel compared with infarct-related artery (IRA)-only revascularization in patients undergoing primary percutaneous coronary intervention (PCI) for STEMI. Subjects and Methods From the Korean Acute Myocardial Infarction Registry (KAMIR) database, 1,094 STEMI patients with multivessel disease who underwent primary PCI with drug-eluting stents were enrolled in this study. The patients were divided into two groups: culprit-vessel-only revascularization (COR, n=827) group; multivessel revascularization, including non-IRA (MVR, n=267) group. The primary endpoint of this study included major adverse cardiac events (MACEs), such as death, myocardial infarction, or target or nontarget lesion revascularization at one year. Results There was no difference in clinical characteristics between the two groups. During the one-year follow-up, 102 (15.2%) patients in the COR group and 32 (14.2%) in the MVR group experienced at least one MACE (p=0.330). There were no differences between the two groups in terms of rates of death, myocardial infarction, or revascularization (2.1% vs. 2.0%, 0.7% vs. 0.8%, and 11.7% vs. 10.1%, respectively; p=0.822, 0.910, and 0.301, respectively). The MACE rate was higher in the incompletely revascularized patients than in the completely revascularized patients (15% vs. 9.5%, p=0.039), and the difference was attributable to a higher rate of nontarget vessel revascularization (8.6% vs. 1.8%, p=0.002). Conclusion Although multivessel angioplasty during primary PCI for STEMI did not reduce the MACE rate compared with culprit-vessel-only PCI, CR was associated with a lower rate of repeat revascularization after multivessel PCI.

Jo, Hyun Su; Sohn, Jang Won; Yoon, Joon Cheol; Sohn, Chang Woo; Lee, Sang Hee; Hong, Geu Ru; Shin, Dong Gu; Kim, Young Jo; Jeong, Myung Ho; Chae, Shung Chull; Hur, Seung Ho; Hong, Taek Jong; Seong, In Whan; Chae, Jei Keon; Rhew, Jay Young; Chae, In Ho; Cho, Myeong Chan; Bae, Jang Ho; Rha, Seung Woon; Kim, Chong Jin; Choi, Dong Hoon; Jang, Yang Soo; Yoon, Jung Han; Chung, Wook Sung; Seung, Ki Bae; Park, Seung Jung



Spontaneous coronary artery dissection.  


Spontaneous coronary artery dissection (SCAD) is an infrequent condition that is underdiagnosed. There is a predilection for young women without traditional cardiovascular risk factors, and it is increasingly diagnosed in women who are not peripartum. We discovered an association between SCAD and fibromuscular dysplasia (FMD), in which most women with nonatherosclerotic SCAD were found to have FMD in another vascular territory. We suspect that these seemingly healthy patients have underlying coronary FMD that predisposed them to coronary dissection. Medical treatment of SCAD includes antiplatelet therapy and ?-blockade. Revascularization of SCAD patients might be challenging, and the recommendation for stenting or surgery depends on their clinical status and the dissected coronary anatomy. The long-term outcome of patients who survived their SCAD event is generally good, however, they are at risk for recurrent dissection and major cardiovascular events, and thus should be closely monitored by cardiovascular specialists. This review summarizes the epidemiology, associated etiology, diagnosis, management, and outcome of patients with SCAD. PMID:23498840

Saw, Jacqueline



New technologies in coronary artery surgery.  


Coronary artery disease remains the leading cause of death in developed countries. Major recent studies such as SYNTAX and FREEDOM have confirmed that coronary artery bypass grafting (CABG) remains the gold standard treatment in terms of survival and freedom from myocardial infarction and the need for repeat revascularization. The current review explores the use of new technologies and future directions in coronary artery surgery, through 1) stressing the importance of multiple arterial conduits and especially the use of bilateral mammary artery; 2) discussing the advantages and disadvantages of off-pump coronary artery bypass; 3) presenting additional techniques, e.g. minimally invasive direct coronary artery bypass grafting, hybrid, and robotic-assisted CABG; and, finally, 4) debating a novel external stenting technique for saphenous vein grafts. PMID:23908868

Taggart, David; Nir, Rony-Reuven; Bolotin, Gil



Single Coronary Artery with Aortic Regurgitation  

SciTech Connect

An isolated single coronary artery can be associated with normal life expectancy; however, patients are at an increased risk of sudden death. A case is reported of a 54-year-old man with several months of chest pressure with activity. On exercise Sestamibi stress testing, the patient developed a hypotensive response with no symptoms and minimal electrocardiographic changes. Nuclear scanning demonstrated reversible septal and lateral perfusion defects consistent with severe ischemia. Coronary angiography revealed a single coronary artery with the right coronary artery arising from the left main. There were high-grade stenotic lesions in the left anterior descending and circumflex arteries with only moderate atherosclerotic disease in the right coronary artery. An aortogram showed 2-3+ aortic regurgitation, with an ejection fraction of 45% on ventriculography. The patient underwent four-vessel revascularization and aortic valve replacement and did well postoperatively.

Katsetos, Manny C. [St. Francis Hospital and Medical Center, University of Connecticut, Hartford, Connecticut, Cardiovascular Disease Fellowship Program (United States)], E-mail:; Toce, Dale T. [St. Francis Hospital and Medical Center, University of Connecticut, Hartford, Connecticut, Department of Cardiovascular Disease (United States)



Establishing a successful coronary CT angiography program in the emergency department: official writing of the Fellow and Resident Leaders of the Society of Cardiovascular Computed Tomography (FiRST).  


Coronary CT angiography is an effective, evidence-based strategy for evaluating acute chest pain in the emergency department for patients at low-to-intermediate risk of acute coronary syndrome. Recent multicenter trials have reported that coronary CT angiography is safe, reduces time to diagnosis, facilitates discharge, and may lower overall cost compared with routine care. Herein, we provide a 10-step approach for establishing a successful coronary CT angiography program in the emergency department. The importance of strategic planning and multidisciplinary collaboration is emphasized. Patient selection and preparation guidelines for coronary CT angiography are reviewed with straightforward protocols that can be adapted and modified to clinical sites, depending on available cardiac imaging capabilities. Technical parameters and patient-specific modifications are also highlighted to maximize the likelihood of diagnostic quality examinations. Practical suggestions for quality control, process monitoring, and standardized reporting are reviewed. Finally, the role of a "triple rule-out" protocol is featured in the context of acute chest pain evaluation in the emergency department. PMID:23809428

Maroules, Christopher D; Blaha, Michael J; El-Haddad, Mohamed A; Ferencik, Maros; Cury, Ricardo C



Doppler resistivity index: a predictive tool for clinical outcome after revascularization of renal artery stenosis?  

Microsoft Academic Search

In this study we evaluated the role of resistivity index (RI) in predicting the outcome (6–12-month follow up) of blood pressure (BP) and renal function (RF) in 104 hypertensive patients(HP)(50 females) with renovascular disease (78 atherosclerotic and 41 fibrodysplasic) submitted to successful percutaneous renal artery stenosis revascularization.HP underwent trans-lumbar duplex Ultrasound. RI was derived from the interlobular arteries and a

Stefania Pinto; Vinicio Napoli; Elena Daghini; Francesca Boresi; Carlo Bartolozzi; Antonio Salvetti



Transmyocardial laser revascularization with a high-power (800 W) CO2 laser: clinical report with 50 cases  

NASA Astrophysics Data System (ADS)

This paper reports the clinical experience in transmyocardial laser revascularization (TMLR) with high power CO2 laser and evaluates the preliminary results of TMLR. TMLR may improve angina pectoris and myocardial perfusion significantly. To switch on the laser in proper order may be helpful to shorten duration of surgery. A gentle removal of fat on the apex may increase the successful transmyocardial penetration.

Qu, Zheng; Zhang, Zhaoguang; Ye, Jianguang; Yu, Jianbo



Seven-year follow-up of coronary artery bypasses performed with and without cardiopulmonary bypass  

Microsoft Academic Search

Background: There has been resurgent interest in coronary revascularization performed on the beating heart. Heretofore, there has been no long-term comparison of this technique to traditional coronary artery bypass with cardioplegia. Objective: The purpose of this study was to provide a comparison of long-term survival and intervention-free outcome between patient groups subjected to coronary bypass accomplished with or without the

Steven R. Gundry; Matthew A. Romano; O. Howard Shattuck; Anees J. Razzouk; Leonard L. Bailey



Drug-eluting stents versus bypass surgery for multivessel coronary disease  

Microsoft Academic Search

Since the advent of coronary artery bypass graft (CABG) surgery and the development of percutaneous coronary intervention\\u000a (PCI), there has been debate as to which is the most optimal revascularization strategy for patients with multivessel coronary\\u000a artery disease. Over the past decade, this controversy has been heightened with the introduction into the PCI armamentarium\\u000a of drug-eluting stents (DES) and their

Michael A. Kutcher



Therapeutic angiogenesis for coronary artery disease  

Microsoft Academic Search

Opinion statement  Angiogenesis is a promising new therapy for the treatment of patients with coronary artery disease who are not candidates\\u000a for standard revascularization techniques. The concept of therapeutic angiogenesis is based upon improving myocardial function\\u000a by increasing blood flow to ischemic areas of the heart. Angiogenic growth factors, including fibroblast growth factor and\\u000a vascular endothelial growth factor, have been shown

Tanveer A. Khan; Frank W. Sellke; Roger J. Laham



Echocardiographically measured epicardial fat predicts restenosis after coronary stenting.  


Abstract Objective. Epicardial adipose tissue (EAT), deposited around subepicardial coronary vessels, may contribute directly to perivascular inflammation and smooth muscle cell proliferation. This study assessed the relationship between EAT and in-stent restenosis. Methods. Four hundred and seven patients had received successful coronary intervention. EAT thickness was measured by echocardiography. Angiographic follow-up was obtained between 6 months and 2 years. Restenosis was defined as target lesion revascularization (TLR). EAT thickness of patients was compared by TLR controlling for additional well-known predictors of restenosis. The TLR-free survival analysis according to EAT thickness was estimated using the Kaplan-Meier method and the differences between groups were assessed by the log-rank test. Results. Median EAT thickness was significantly increased in patients undergoing TLR compared with those without restenosis (3.7 vs. 3.0 mm, p = 0.001). EAT thickness was one of the independent factors associated with restenosis (Odds ratio = 1.19, 95% confidence interval = 1.01-1.33, p = 0.007). The TLR-free survival of patients with thick EAT was significantly worse than patients with thin EAT (log-rank p = 0.001). Conclusions. EAT thickness is related with restenosis and may provide additional information for future restenosis. PMID:23937273

Park, Jin-Sun; Choi, Byoung-Joo; Choi, So-Yeon; Yoon, Myeong-Ho; Hwang, Gyo-Seung; Tahk, Seung-Jea; Shin, Joon-Han



Evaluation of outcome and cost-effectiveness using an FDG PET-guided approach to management of patients with coronary disease and severe left ventricular dysfunction (PARR2): rationale, design, and methods  

Microsoft Academic Search

Patients with severe ventricular dysfunction and coronary disease have high morbidity and mortality. They may benefit from revascularization but have significant perioperative morbidity and mortality. Positron emission tomography (PET) imaging with F-18-fluorodeoxyglucose (FDG) can detect viable myocardium that may recover from revascularization in such patients. It is unclear whether use of FDG PET in this population improves outcome or is

Rob Beanlands; Graham Nichol; Terrence D. Ruddy; Robert A. deKemp; Paul Hendry; Dennis Humen; Normand Racine; Heather Ross; Francois Benard; Geoffrey Coates; Robert M. Iwanochko; Ernest Fallen; George Wells



Rotablation in the treatment of high-risk patients with heavily calcified left-main coronary lesions  

PubMed Central

Objective Heavily calcified left-main coronary diseases (LMCA) remain a formidable challenge for percutaneous interventions (PCI). This study was to investigate the safety and efficacy of using rotational atherectomy (RA) in treating such lesions in actual practice. Methods From February 2004 to March 2012, all consecutive patients who received RA for heavily-calcified LMCA lesions in our cath lab were enrolled. The relevant clinical and angiographic characteristics at the time of index PCI, as well as the clinical follow-up outcomes, were retrieved and analyzed. Results A total of 34 consecutive patients were recruited with a mean age 77.2 ± 10.2 years. There were 82.4% presented with acute coronary syndrome and 11.8% with cardiogenic shock. Chronic renal disease and diabetes were seen in 64.7% and 52.9%, respectively. Triple-vessel coronary disease was found in 76.5% of them. The mean SYNTAX score was 50 ± 15 and EuroSCORE II scale 5.6 ± 4.8. The angiographic success rate was 100% with a procedural success rate of 91.2%. The mean number of burrs per patient was 1.7 ± 0.5. Crossing-over stenting was used in 64.7%. Most stents were drug-eluting (67.6%). Intra-aortic ballon pump was used in 20.6% of the procedures. Three patients died during hospitalization, all due to presenting cardiogenic shock. No major complication occurred. Among 31 hospital survivors, the major adverse cardiac events (MACE) rate was 16.1%, all due to target lesion revascularization or target vessel revascularization. Conclusions In high-surgical-risk elderly patients, plaque modification with RA in PCI of heavily-calcified LMCA could be safely accomplished with a minimal complication rate and low out-of-hospital MACE.

Chiang, Meng-Hsiu; Yi, Hung-Tao; Tsao, Cheng-Rong; Chang, Wei-Chun; Su, Chieh-Shou; Liu, Tsun-Jui; Liang, Kae-Woei; Ting, Chih-Tai; Lee, Wen-Lieng



Angiogenesis Is Enhanced in Ischemic Canine Myocardium by Transmyocardial Laser Revascularization 1 1 This study was supported in part by a research grant from CardioGenesis Corporation, Sunnyvale, California  

Microsoft Academic Search

Objectives. This study sought to test whether transmyocardial laser revascularization (TMLR) stimulates angiogenesis in an animal model of chronic ischemia.Background. TMLR relieves angina and may also improve blood flow in patients who are not candidates for traditional therapies. The mechanisms of these benefits are not fully defined.Methods. Ischemia was created in 14 dogs by proximal left anterior descending coronary ameroid

Noriyoshi Yamamoto; Takushi Kohmoto; Anguo Gu; Carolyn DeRosa; Craig R. Smith; Daniel Burkhoff



Neurobehavioral and Life-Quality Changes after Cerebral Revascularization.  

ERIC Educational Resources Information Center

|Studied neuropsychological and life-quality changes six months after carotid endarterectomy, superficial temporal artery to middle cerebral artery bypass, multiple revascularization, and vertebrobasilar revascularization procedures. Compared changes with those in patients with recent severe spinal complaints and in patients for whom…

Baird, Anne Dull; And Others



Reversal of ischaemic systolic and diastolic left ventricular dysfunction by successful coronary angioplasty in patients with non-Q wave anterior myocardial infarction.  


The effect of PTCA on global and regional left ventricular systolic function, isovolumic relaxation, chamber and muscle stiffness were studied in 30 patients with angina pectoris, previous non-Q wave anterior myocardial infarction (AMI) and significant stenosis of the left anterior descending coronary artery (LAD). In 11 of the 30 patients the condition was stable, but it was unstable in 19. Left ventricular angiograms were obtained before and 4.85 +/- 3.67 months after PTCA. The RAO was in the 30 degree projection, with the silhouette of the left ventricle sliced into 90 regions; changes in left ventricular volume, pressure and anterior wall thickness during the full cardiac cycle, together with dp/dt were demonstrated. After PTCA, global ejection fraction increased from 68.77 +/- 5.96% to 76.57 +/- 3.18%, P < 0.001. Impaired contractility was found in 29/90 (32.2%) regions before PTCA and in 5/90 (5.6%) after PTCA, P < 0.001. The time constant of the isovolumic pressure fall decreased after PTCA (52.56 +/- 17.40 ms vs 39.61 +/- 11.26 ms, P < 0.01). Elastic chamber stiffness coefficient decreased (0.022 +/- 0.003 vs 0.008 +/- 0.004, P < 0.001) and peak rate of left ventricular filling increased (319.0 +/- 107.9 ml.min-1 vs 396.8 +/- 201.4 ml.min-1, P < 0.05) after PTCA. The muscle stiffness coefficient was within normal values before and did not change after PTCA. The study findings show that in patients with persistent angina pectoris after non-Q wave AMI, complex systolic and diastolic ischaemic dysfunction occurs. This dysfunction can be reversed after successful PTCA of LAD. PMID:7988603

Witkowski, A; Ruzy??o, W; Górecka, B; Chmielak, Z; Jodkowski, J; Dabrowski, M; Woroszylska, M; Debski, A; Demkow, M; Ciszewski, A



[Cardiogenic shock following mantlefield radiotherapy for Hodgkin's lymphoma: emergency treatment with coronary stent and follow-up at 6 months. Report of a case and review of the literature].  


Radiation therapy is an effective and common treatment modality for Hodgkin's lymphoma, with proven long-term high survival rates and freedom from recurrences. However, the development of radiation-induced coronary artery disease, characterized by severe and widespread coronary involvement and by a high mortality secondary to acute ischemic events, is one of the most feared complications of this treatment modality. Furthermore, in such patients the optimal approach to revascularization remains to be determined, owing to some specific technical surgical difficulties and, as reported in the literature, to the limited experience available to date with percutaneous intervention, especially in case of acute ischemic syndromes. We report on a case of acute anterior myocardial infarction with cardiogenic shock in a 29-year-old male who had undergone radiation therapy to the chest for Hodgkin's lymphoma 10 years previously. He was immediately transferred to the catheterization laboratory: intra-aortic balloon counterpulsation was followed by coronary angiography which revealed severe, widespread triple-vessel disease and an acutely suboccluded very large left anterior descending coronary artery providing collaterals to large segments of the right and circumflex coronary territories. Primary angioplasty and stenting of the left anterior descending coronary artery was performed successfully, with a gradual amelioration of the hemodynamic and clinical parameters. Angiographic follow-up at 6 months demonstrated a widely patent stent, with minimal neointimal hyperplasia but no evidence of restenosis. The patient remained asymptomatic. We discuss our therapeutic strategy and review the relevant literature on the subject. PMID:12611214

Agnelli, Davide; Falcone, Camillo; Belli, Guido; Bedogni, Francesco; Bonini, Walter



Pregnancy-associated spontaneous coronary artery dissection.  


Spontaneous coronary artery dissection is a rare cause of acute myocardial infarction that occurs particularly in women during the pregnancy and in the postpartum period. We describe a dramatic case of pregnancy-related spontaneous left main coronary artery dissection that resulted in acute myocardial infarction with severe left ventricular dysfunction and was complicated by acute heart failure and cardiogenic shock. Urgent revascularization and restoration of myocardial perfusion that were performed in this case resulted in marked left ventricular function recovery and clinical improvement. PMID:18060935

Goland, Sorel; Schwarz, Ernst R; Siegel, Robert J; Czer, Lawrence S C



Successful Use of Sirolimus-Eluting Stents for Treatment of ST-Elevation Acute Myocardial Infarction Caused by Left Main Coronary Artery Occlusion  

PubMed Central

We describe an ST-elevation acute myocardial infarction involving the left main coronary artery in a middle-aged man who was treated by primary angioplasty with the use of sirolimus-eluting stents. To our knowledge, this is the 1st report of survival after sirolimus-eluting stent implantation in a patient with acute occlusion of the left main coronary artery. We discuss the case and review the literature.

Bush, Howard S.; Strong, David E.; Novaro, Gian M.



Revascularization of an ischemic replanted thumb using a lateral arm free fascial flap.  


Digital ischemia and cold sensitivity after replantation are common. Occasionally they are severe enough to warrant intervention, including amputation of an otherwise functional digit. We present a patient with pregangrenous ischemia in a replanted thumb 10 years after multiple digit replantation. Angiography revealed vascular occlusion in the distal radial artery with no patent vessel in the thumb. The option of transposition of a spare neurovascular bundle from the adjacent radial digits was limited by their single-vessel supply resulting from previous replantation. We describe a method of revascularization by introduction of an arteriovenous pedicle, using a free fascial flap harvested from the lateral arm and based on terminal ramifications of the profunda brachii vessels. The flap was buried between the pulp and flexor tendon sheath and anastomosed to the radial artery and a wrist vein. This resulted in successful revascularization of the digit, clinically and radiologically, and 20 months later, the patient remains symptom free. PMID:8285535

Morrison, W A; Cavallo, A V



Apexogenesis and revascularization treatment procedures for two traumatized immature permanent maxillary incisors: a case report  

PubMed Central

Traumatic injuries to an immature permanent tooth may result in cessation of dentin deposition and root maturation. Endodontic treatment is often complicated in premature tooth with an uncertain prognosis. This article describes successful treatment of two traumatized maxillary central incisors with complicated crown fracture three months after trauma. The radiographic examination showed immature roots in maxillary central incisors of a 9-year-old boy with a radiolucent lesion adjacent to the right central incisor. Apexogenesis was performed for the left central incisor and revascularization treatment was considered for the right one. In 18-month clinical and radiographic follow-up both teeth were asymptomatic, roots continued to develop, and periapical radiolucency of the right central incisor healed. Considering the root development of these contralateral teeth it can be concluded that revascularization is an appropriate treatment method in immature necrotic teeth.

Forghani, Maryam; Maghsoudlou, Amir



Results of percutaneous coronary intervention for chronic total occlusions of coronary arteries: a single center report.  


Objectives: Percutaneous coronary intervention (PCI) for chronic total occlusions (CTOs) is associated with lower rates of procedural success and higher complication rates compared with PCIs in non-CTO lesions. The purpose of this study was to analyze the relationship between lesion characteristics and procedural success rates and in-hospital outcomes after PCI for CTO with novel equipment. Study design: We evaluated the prospectively entered data of 63 consecutive patients undergoing PCI for CTO at our institute between August 2009 and June 2012. Results: A total of 63 patients (mean age: 64±11, 71% male) with one CTO lesion each underwent PCI. There were 46 patients (mean age: 63±10, 70% male) in the CTO success group and 17 patients (mean age: 65±13, 76.5% male) in the CTO failure group. Successful revascularization was achieved in 73% of patients. We used antegrade approach in 61 cases and retrograde approach in 2 cases. Our predominant strategy was single-wire technique, which was used in 54 cases (85.7%), followed by parallel-wire technique in 7 cases (11.1%). Moderate-to-severe tortuosity (odds ratio [OR]: 9.732, 95% confidence interval [CI]: 1.783-53.115, p=0.009) and occlusion duration (OR: 1.536, 95% CI: 1.178-2.001, p=0.002) were independent predictors of procedural failure in the multivariate analysis. No in-hospital major cardiac events occurred. Conclusion: We have reported a study with a relatively high success rate of PCI with very low procedural and in-hospital complications. Moderate-to-severe tortuosity was observed as the most challenging problem despite the utilisation of novel equipment and techniques for CTO recanalization. PMID:24104975

Cetin, Mustafa; Karaman, Kay?han; Zencir, Cemil; Oztürk, Unal; Y?ld?z, Emrah; Ozgül, Sami



Percutaneous coronary intervention for unprotected left main coronary artery stenosis  

PubMed Central

Hemodynamically significant left main coronary artery stenosis (LMCA) is found in around 4% of diagnostic coronary angiograms and is known as unprotected LMCA stenosis if the left coronary artery and left circumflex artery has no previous patent grafts. Previous randomized studies have demonstrated a significant reduction in mortality when revascularization by coronary artery bypass graft (CABG) surgery was undertaken compared with medical treatment. Therefore, current practice guidelines do not recommend percutaneous coronary intervention (PCI) for such a lesion because of the proven benefit of surgery and high rates of restenosis with the use of bare metal stents. However, with the advent of drug-eluting stents (DES), the long term outcomes of PCI with DES to treat unprotected LMCA stenoses have been acceptable. Therefore, apart from the current guidelines, PCI for treatment of unprotected LMCA stenosis is often undertaken in individuals who are at a very high risk of CABG or refuse to undergo a sternotomy. Future randomized studies comparing CABG vs PCI using DES for treatment of unprotected LMCA stenosis would be a great advance in clinical knowledge for the adoption of appropriate treatment.

Park, Seung-Jung; Kim, Young-Hak



Cost-Effectiveness of New Cardiac and Vascular Rehabilitation Strategies for Patients with Coronary Artery Disease  

PubMed Central

Objective Peripheral arterial disease (PAD) often hinders the cardiac rehabilitation program. The aim of this study was evaluating the relative cost-effectiveness of new rehabilitation strategies which include the diagnosis and treatment of PAD in patients with coronary artery disease (CAD) undergoing cardiac rehabilitation. Data Sources Best-available evidence was retrieved from literature and combined with primary data from 231 patients. Methods We developed a Markov decision model to compare the following treatment strategies: 1. cardiac rehabilitation only; 2. ankle-brachial index (ABI) if cardiac rehabilitation fails followed by diagnostic work-up and revascularization for PAD if needed; 3. ABI prior to cardiac rehabilitation followed by diagnostic work-up and revascularization for PAD if needed. Quality-adjusted-life years (QALYs), life-time costs (US $), incremental cost-effectiveness ratios (ICER), and gain in net health benefits (NHB) in QALY equivalents were calculated. A threshold willingness-to-pay of $75 000 was used. Results ABI if cardiac rehabilitation fails was the most favorable strategy with an ICER of $44 251 per QALY gained and an incremental NHB compared to cardiac rehabilitation only of 0.03 QALYs (95% CI: ?0.17, 0.29) at a threshold willingness-to-pay of $75 000/QALY. After sensitivity analysis, a combined cardiac and vascular rehabilitation program increased the success rate and would dominate the other two strategies with total lifetime costs of $30 246 a quality-adjusted life expectancy of 3.84 years, and an incremental NHB of 0.06 QALYs (95%CI:?0.24, 0.46) compared to current practice. The results were robust for other different input parameters. Conclusion ABI measurement if cardiac rehabilitation fails followed by a diagnostic work-up and revascularization for PAD if needed are potentially cost-effective compared to cardiac rehabilitation only.

Spronk, Sandra; Bosch, Johanna L.; Ryjewski, Constance; Rosenblum, Judith; Kaandorp, Guido C.; White, John V.; Hunink, M. G. Myriam



Beating-heart totally endoscopic coronary artery bypass grafting: report of a case.  


This case report presents beating-heart totally endoscopic coronary artery bypass grafting (TECAB) for single-vessel coronary artery disease. A 72-year-old man with isolated left anterior descending (LAD) coronary artery disease was considered eligible for TECAB. Left internal thoracic artery (LITA) mobilization and subsequent off-pump revascularization applying the LITA to the LAD in a closed chest environment was performed using the da Vinci surgical system (Intuitive Surgical, Mountain View, CA, USA). The LITA was first harvested completely in a totally skeletonized fashion through three incisions 1-2 cm long in the left thoracic wall. The LAD was immobilized with the aid of a heart stabilizer. The LITA was then anastomosed to the LAD with 10 interrupted sutures of a Nitinol self-closing S15 U-clip device (Medtronic, Minneapolis, MN, USA) on the beating heart without the use of cardiopulmonary bypass. The time acquired to perform anastomosis was 20 min, and the total operative time was 5 h 34 min. The postoperative course was uneventful and the patient was discharged 5 days after the operation. Beating-heart TECAB was successfully performed for this patient with single-vessel LAD disease. This approach may be an evolutionary step toward beating-heart multivessel TECAB. PMID:20037841

Nishida, Satoru; Watanabe, Go; Ishikawa, Norihiko; Kikuchi, Yujiro; Takata, Munehisa; Ushijima, Teruaki



Computed Fractional Flow Reserve (FFTCT) Derived from Coronary CT Angiography.  


Recent advances in image-based modeling and computational fluid dynamics permit the calculation of coronary artery pressure and flow from typically acquired coronary computed tomography (CT) scans. Computed fractional flow reserve is the ratio of mean coronary artery pressure divided by mean aortic pressure under conditions of simulated maximal coronary hyperemia, thus providing a noninvasive estimate of fractional flow reserve (FFRCT) at every point in the coronary tree. Prospective multicenter clinical trials have shown that computed FFRCT improves diagnostic accuracy and discrimination compared to CT stenosis alone for the diagnosis of hemodynamically significant coronary artery disease (CAD), when compared to invasive FFR as the reference gold standard. This promising new technology provides a combined anatomic and physiologic assessment of CAD in a single noninvasive test that can help select patients for invasive angiography and revascularization or best medical therapy. Further evaluation of the clinical effectiveness and economic implications of noninvasive FFRCT are now being explored. PMID:23934536

Zarins, Christopher K; Taylor, Charles A; Min, James K



Endovascular Revascularization for Patients with Critical Limb Ischemia: Impact on Wound Healing and Long Term Clinical Results in 189 Limbs  

PubMed Central

Objective To evaluate the impact on wound healing and long-term clinical outcomes of endovascular revascularization in patients with critical limb ischemia (CLI). Materials and Methods This is a retrospective study on 189 limbs with CLI treated with endovascular revascularization between 2008 and 2010 and followed for a mean 21 months. Angiographic outcome was graded to technical success (TS), partial failure (PF) and complete technical failure. The impact on wound healing of revascularization was assessed with univariate analysis and multivariate logistic regression models. Analysis of long-term event-free limb survival, and limb salvage rate (LSR) was performed by Kaplan-Meier method. Results TS was achieved in 89% of treated limbs, whereas PF and CF were achieved in 9% and 2% of the limbs, respectively. Major complications occurred in 6% of treated limbs. The 30-day mortality was 2%. Wound healing was successful in 85% and failed in 15%. Impact of angiographic outcome on wound healing was statistically significant. The event-free limb survival was 79.3% and 69.5% at 1- and 3-years, respectively. The LSR was 94.8% and 92.0% at 1- and 3-years, respectively. Conclusion Endovascular revascularization improve wound healing rate and provide good long-term LSRs in CLI.

Bae, Jae-Ik; Han, Seung Hwan; Lim, Sang Hyun; Hong, You Sun; Kim, Jae-Young; Kim, Ji Dae; Kim, Jun-Su



Spontaneous coronary artery dissection presenting as cardiac tamponade.  


Spontaneous dissection of the left main coronary artery is the least common of all dissections involving the coronary arteries. It usually occurs in young women, especially in the peripartum or early postpartum period. We describe the case of a 59-year-old man with no previous history of atherosclerotic heart disease who presented in cardiac tamponade and was found to have a spontaneous left main stem coronary artery dissection at cardiac catheterization. Emergency revascularization was carried out with the patient remaining symptom-free 4 months after surgery. PMID:11996290

Badmanaban, Balaji; McCarty, David; Mole, Damian J; McKeown, Pascal P; Sarsam, Mazin A I



Cerebral revascularization: extracranial-intracranial bypass.  


Extracranial-intracranial (EC-IC) bypass remains an important revascularization technique for management of complex cerebrovascular disease. Despite evolving endovascular techniques, the role of bypass for the purpose of flow replacement prior to planned vessel sacrifice remains relevant for treatment of complex and fusiform aneurysms. The role of bypass for purposes of flow augmentation in the setting of cerebral ischemia is limited based on current data, but remains an important option for selected cases of athero-occlusive disease, in addition to a primary treatment for symptomatic moyamoya disease. An objective flow-based approach to EC-IC bypass can enhance decision-making in preoperative patient selection, intraoperative graft assessment, and postoperative follow-up. PMID:21623323

Amin-Hanjani, S



Successful operation in an old survivor of anomalous origin of the left coronary artery from the pulmonary trunk (Bland-White-Garland syndrome)  

Microsoft Academic Search

A case of anomalous origin of the left coronary artery from the pulmonary trunk is reported. The patient, a 64-year-old woman, presented with a history of angina and cardiac failure. She was known to have had a mitral systolic murmur since school age. Echocardiography showed clinically significant mitral regurgitation and highly unusual extensive calcification of the mitral valve chordae, papillary

B. T. Saeed; M. D. Rosin; R. G. Murray



Aortocoronary bypass graft fistula after surgical treatment of circumflex coronary artery fistula: a unique variation of a rare condition successfully treated with percutaneous embolization.  


Multiple coronary artery fistulae are rare, complications can be life-threatening, and with large or symptomatic fistulae, intervention is mandatory. Both surgical and percutaneous interventions are well-described. We believe this is the first report of the embolization of an acquired fistula following initial surgical treatment of multiple congenital fistulae. PMID:19903688

White, Ralph W; Sivananthan, Mohan U; Kay, Philip H



Exercise-induced ST-segment changes permit prediction of improvement in left ventricular ischemic dysfunction after revascularization: Evaluation with positron emission tomographic measurements of regional myocardial blood flow and cardiac output  

Microsoft Academic Search

Background  Prediction of the recovery of left ventricular (LV) ischemic dysfunction after revascularization is important in patients\\u000a with coronary artery disease (CAD). We investigated whether the improvement in LV ischemic dysfunction after revascularization\\u000a could be predicted preoperatively by exercise-induced ST-segment changes.\\u000a \\u000a \\u000a \\u000a Methods and Results  Regional myocardial blood flow (RMBF) and cardiac output were measured with nitrogen 13-ammonia positron emission tomography\\u000a at rest

Takuya Watanabe; Kenichi Harumi; Tetsuo Michihatas; Osamu Okazaki; Hideyuki Yamanaka; Yasushi Akutsu; Takashi Katagiri



Left ventricular function after coronary artery reperfusion.  


Left ventricular dysfunction and dilation after reperfusion relate to the amount of infarcted and dysfunctional myocardium and will continue to be important determinants of morbidity and mortality. There is marked heterogeneity in the anatomic and pathophysiologic presentation of patients with acute myocardial infarction prior to thrombolysis, and many of these individual settings resemble those in animal species with various degrees of collateral formation. Three major determinants of infarct size are responsible for this heterogeneity and include the risk area, the duration of the coronary occlusion, and the level of the residual coronary blood flow via collaterals or a partially patent artery. All 3 of these determinants will influence the initial and late results of reperfusion therapy on infarct size and ventricular function. However, in addition to late or unsuccessful thrombolysis, there are other important factors determining outcome: inadequate reflow, residual coronary stenosis, and coronary reocclusion, factors that can be associated with late progressive left ventricular dilation and dysfunction. The risk factors for left ventricular dysfunction and dilation after reperfusion can now be identified, and such patients should undergo coronary angiography prior to hospital discharge and, if appropriate, revascularization of the infarct-related artery (and perhaps other vessels). In other patients, if serial studies reveal progressive left ventricular failure and dilation late after reperfusion, despite therapy with an angiotensin-converting enzyme (ACE) inhibitor, and if repeat coronary angiography identifies significant coronary stenoses and areas of hibernating or stunned myocardium, revascularization may limit progression of dilation and improve left ventricular function.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8279367

Ross, J



Developing practice recommendations for endovascular revascularization for acute ischemic stroke.  


Guidelines have been established for the management of acute ischemic stroke; however, specific recommendations for endovascular revascularization therapy are lacking. Burgeoning investigation of endovascular revascularization therapies for acute ischemic stroke, rapid device development, and a diverse training background of the providers performing the procedures underscore the need for practice recommendations. This review provides a concise summary of the Society of Vascular and Interventional Neurology endovascular acute ischemic stroke roundtable meeting. This document was developed to review current clinical efficacy of pharmacologic and mechanical revascularization therapy, selection criteria, periprocedure management, and endovascular time metrics and to highlight current practice patterns. It therefore provides an outline for the future development of multisociety guidelines and recommendations to improve patient selection, procedural management, and organizational strategies for revascularization therapies in acute ischemic stroke. PMID:23008406

Lazzaro, Marc A; Novakovic, Roberta L; Alexandrov, Andrei V; Darkhabani, Ziad; Edgell, Randall C; English, Joey; Frei, Donald; Jamieson, Dara G; Janardhan, Vallabh; Janjua, Nazli; Janjua, Rashid M; Katzan, Irene; Khatri, Pooja; Kirmani, Jawad F; Liebeskind, David S; Linfante, Italo; Nguyen, Thanh N; Saver, Jeffrey L; Shutter, Lori; Xavier, Andrew; Yavagal, Dileep; Zaidat, Osama O



Biomarkers in acute coronary artery disease.  


Death from coronary artery disease is by far the leading cause of death worldwide. There is no doubt that a better understanding of atherothrombosis has guided development of improved diagnostic facilities as well as revascularization technologies in combination with current antithrombotic strategies that have altogether impressively reduced acute thromboembolic complications and death from cardiovascular causes within the last decades. However, the rate of ischemic complications even after optimal revascularization and medical therapy remains high. Similarly, morbidity and death associated with chronic ischemic heart disease and ischemic cardiomyopathy respectively are constantly rising. Therefore, there is still a strong need for effective primary prevention strategies, fast and accurate diagnostic procedures as well as for new and smart antithrombotic drugs. The review focuses on cardiac troponins, as relevant markers of myocardial necrosis, currently used in the diagnostic process of acute coronary syndrome. Furthermore, we will discuss the potential role of copeptin, a new marker of acute endogenous stress in acute coronary syndrome patients, as faster diagnosis might lead to faster treatment as well as improved short- and long-term outcome following acute coronary syndrome. Finally, platelets are an old, yet rediscovered biomarker for ischemic cardiovascular outcomes that might be used to estimate the individual bleeding or thrombotic risk and to tailor antiplatelet therapy. PMID:23143510

Freynhofer, Matthias K; Tajsi?, Miloš; Wojta, Johann; Huber, Kurt



The Dresden approach for complete multivessel revascularization  

Microsoft Academic Search

Background. In a prospective clinical trial, a group of patients receiving less invasive surgical procedure, including minithoracotomy in combination with cardiopulmonary bypass (group 1), was compared to a group of patients receiving conventional bypass surgery (group 2) for the treatment of coronary artery disease.Methods. Group 1 included 85 patients (71 men, 14 women, aged 39 to 82 years, median 61.1

Vassilios Gulielmos; Michael Brandt; Michael Knaut; Romuald Cichon; Florian M Wagner; Utz Kappert; Stephan Schüler



Review of Recent US Cost Estimates of Revascularization  

Microsoft Academic Search

Objective: To review recent US cost estimates of revascularization and discuss their implications for third-party payers. Study Design and Methods: A literature review was performed using MEDLINE. The review was lim- ited to English-language articles published between January 2000 and September 2003. The most recent- ly published articles that included US-derived clini- cal outcomes and costs of revascularization were selected

Paul C. Nagle; Abigail W. Smith


Gender differences and temporal trends in clinical characteristics, stress test results and use of invasive procedures in patients undergoing evaluation for coronary artery disease  

Microsoft Academic Search

OBJECTIVESThis study examined gender differences and temporal changes in the clinical characteristics of patients referred for nuclear stress imaging, their imaging results and subsequent utilization of coronary angiography and revascularization.BACKGROUNDGender bias may influence resource utilization in patients with coronary artery disease (CAD). No study has analyzed gender differences and time trends in patients referred for noninvasive testing and subsequent use

Todd D Miller; Veronique L Roger; David O Hodge; Mona R Hopfenspirger; Kent R Bailey; Raymond J Gibbons



Percutaneous coronary intervention versus coronary artery bypass graft surgery for patients with medically refractory myocardial ischemia and risk factors for adverse outcomes with bypass: a multicenter, randomized trial  

Microsoft Academic Search

BACKGROUNDPercutaneous coronary intervention (PCI) and coronary artery bypass graft surgery (CABG) are being applied to high-risk populations, but previous randomized trials comparing revascularization methods have excluded a number of important high-risk groups.OBJECTIVESThis five-year, multicenter, randomized clinical trial was designed to compare long-term survival among patients with medically refractory myocardial ischemia and a high risk of adverse outcomes assigned to either

Douglass A Morrison; Gulshan Sethi; Jerome Sacks; William Henderson; Frederick Grover; Steven Sedlis; Rick Esposito; Kodangudi Ramanathan; Darryl Weiman; Jorge Saucedo; Tamim Antakli; Venki Paramesh; Stuart Pett; Sarah Vernon; Vladimir Birjiniuk; Frederick Welt; Mitchell Krucoff; Walter Wolfe; John C Lucke; Sundeep Mediratta; David Booth; Charles Barbiere; Daniel Lewis



Donor Islet Endothelial Cells in Pancreatic Islet Revascularization  

PubMed Central

OBJECTIVE Freshly isolated pancreatic islets contain, in contrast to cultured islets, intraislet endothelial cells (ECs), which can contribute to the formation of functional blood vessels after transplantation. We have characterized how donor islet endothelial cells (DIECs) may contribute to the revascularization rate, vascular density, and endocrine graft function after transplantation of freshly isolated and cultured islets. RESEARCH DESIGN AND METHODS Freshly isolated and cultured islets were transplanted under the kidney capsule and into the anterior chamber of the eye. Intravital laser scanning microscopy was used to monitor the revascularization process and DIECs in intact grafts. The grafts’ metabolic function was examined by reversal of diabetes, and the ultrastructural morphology by transmission electron microscopy. RESULTS DIECs significantly contributed to the vasculature of fresh islet grafts, assessed up to 5 months after transplantation, but were hardly detected in cultured islet grafts. Early participation of DIECs in the revascularization process correlated with a higher revascularization rate of freshly isolated islets compared with cultured islets. However, after complete revascularization, the vascular density was similar in the two groups, and host ECs gained morphological features resembling the endogenous islet vasculature. Surprisingly, grafts originating from cultured islets reversed diabetes more rapidly than those originating from fresh islets. CONCLUSIONS In summary, DIECs contributed to the revascularization of fresh, but not cultured, islets by participating in early processes of vessel formation and persisting in the vasculature over long periods of time. However, the DIECs did not increase the vascular density or improve the endocrine function of the grafts.

Nyqvist, Daniel; Speier, Stephan; Rodriguez-Diaz, Rayner; Molano, R. Damaris; Lipovsek, Sasa; Rupnik, Marjan; Dicker, Andrea; Ilegems, Erwin; Zahr-Akrawi, Elsie; Molina, Judith; Lopez-Cabeza, Maite; Villate, Susana; Abdulreda, Midhat H.; Ricordi, Camillo; Caicedo, Alejandro; Pileggi, Antonello; Berggren, Per-Olof



Long-term outcomes of optimized medical management of outpatients with stable coronary artery disease.  


The objective of this study was to assess long-term clinical outcomes and their correlates in medically managed outpatients with stable angina pectoris, healed myocardial infarction (MI), or documented asymptomatic coronary artery disease (CAD). Management strategy emphasized maximally tolerated medical therapy and modification of coronary risk factors. Referral to invasive coronary interventions followed stricter criteria than standard published guidelines. Primary study outcomes were all-cause mortality or nonfatal myocardial infarction. Secondary study outcomes included cardiac death, unstable angina, or coronary revascularization. A total of 693 men and women with proved CAD (mean age 67 years at entry, 85% men, 41% with history of MI) were enrolled. The annual incidence of nonfatal MI, cardiac mortality, and total mortality was 2.2%, 0.8%, and 1.4%, respectively, during an average follow-up of 4.6 years. Coronary revascularization was performed in 24% of subjects; unstable or progressive anginal symptoms were the most common reasons for revascularization. In patients with documented stable CAD, a management strategy based on intensive medical therapy and modification of established coronary risk factors was associated with excellent long-term outcomes. Thus, coronary interventions can be safely delayed until clinical instability ensues, without increased risk of MI or death. This treatment approach represents a viable alternative to invasive strategies. PMID:14759377

Jabbour, Samer; Young-Xu, Yinong; Graboys, Thomas B; Blatt, Charles M; Goldberg, Robert J; Bedell, Susanna E; Bilchik, Brian Z; Lown, Bernard; Ravid, Shmuel



Coronary artery disease following mediastinal radiation therapy  

SciTech Connect

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.

Annest, L.S.; Anderson, R.P.; Li, W.; Hafermann, M.D.



Clinical significance of no-reflow phenomenon observed on angiography after successful treatment of acute myocardial infarction with percutaneous transluminal coronary angioplasty  

Microsoft Academic Search

The clinical significance of the angiographic no-reflow phenomenon was evaluated in 93 patients with acute myocardial infarction treated by percutaneous transluminal coronary angioplasty (PTCA). On the basis of the post-PTCA angiograms, patients were divided into three groups: normal angiogram (group 1, n=65), slight no-reflow (group 2, n = 13), and severe no-reflow (group 3, n = 15). Regional wall motion

Itsuro Morishima; Takahito Sone; Shinji Mokuno; Shin Taga; Akemi Shimauchi; Yoshitaka Oki; Junichiro Kondo; Hideyuki Tsuboi; Hiromi Sassa



[Gastric perforation as an early complication of surgical myocardial revascularization using extracorporeal circulation].  


The authors describe the case of a man with ischaemic heart disease after revascularization of the myocardium by an aortocoronary bypass using extracorporeal circulation. The early postoperative course was complicated by perforation of a gastric ulcer. The condition was successfully resolved by an urgent operation, suture of the perforated stomach with toilet of the abdominal cavity. In the discussion the authors analyze the causes of the possible development of gastrointestinal complications after cardiac surgery, in particular the influence of extracorporeal circulation and other specific effects during cardiac surgery and during the immediate postoperative period. PMID:11688246

Mand'ák, J; Lonský, V; Hajzman, Z



Multicenter registry to evaluate the efficacy of the NIROYAL stent in de novo or restenotic coronary stenosis.  


The purpose of this registry was to document the safety and efficacy of elective deployment of the NIROYAL stent (Boston Scientific SCIMED, Maple Grove, Minnesota) in coronary arteries. This was a prospective, multi-center international registry. NIROYAL stents (9, 16, 25 and 32 mm-long) were manually crimped onto coronary balloons and deployed in de novo or restenotic lesions in 165 male and female patients with angina pectoris and a reference vessel diameter of 2.0-4.5 mm. Stent deployment was successful in 98.8% of the lesions. Mean percent diameter stenosis decreased from 83.5+/-10.8% to 2.7+/- 6.2% after intervention. The interventional procedure of the treatment site was successful in 97.6% of patients. At six-month clinical follow-up, 88.5% had event-free survival [i.e., did not experience a major adverse cardiac event (MACE)] and 95.2% had no anginal symptoms. Furthermore, 87.3% of the patients were free of target vessel failure (defined as a composite of acute procedural failure, target vessel revascularization, myocardial infarction or death at six months). Only three MACE were observed within the first 30 days after stent implantation. A low left ventricular ejection fraction and the percentage stenosis pre-procedure were identified as statistically significant (p<0.05) predictive factors for MACE. The incidences of MACE and target vessel failure after six months follow-up were lower than that seen in other studies, and target lesion revascularization rates were low. PMID:10825762

Cremonesi, A; Benit, E; Carlier, M; Colombo, A; Piva, R; Probst, P; Wirtzfeld, A; Pico-Bourdonnec, C; Corcos, T



Spontaneous left main coronary artery dissection complicated by pseudoaneurysm formation in pregnancy: role of CT coronary angiography  

PubMed Central

We report a case of a 26-year-old female, who presented at 34 weeks of an uncomplicated pregnancy with an acute ST elevation anterior wall myocardial infarction. Cardiac catheterization suggested a left main coronary artery dissection with pseudoaneurysm formation. The patient's course was complicated by congestive heart failure. She was initially managed conservatively by a multidisciplinary team including heart failure specialists, obstetricians, and cardiovascular surgeons. 4 days after admission, her LMC was imaged by dual-source 64 slice Cardiac computed tomography, coronary dissection was identified extending to the lumen, and the presence of pseudoaneurysm was confirmed. She underwent subsequently a staged procedure, which included placement of an intra-aortic balloon pump, cesarean section, and coronary artery bypass grafting. This case illustrates the utility of coronary artery CT imaging to assess the complexity and stability of coronary artery dissections, thereby helping to determine the need for, and timing of revascularization procedures.

Rahman, Shahid; Abdul-Waheed, Mohammed; Helmy, Tarek; Huffman, Lynn C; Koshal, Vipin; Guitron, Julian; Merrill, Walter H; Lewis, David F; Dunlap, Stephanie; Shizukuda, Yukitaka; Weintraub, Neal L; Meyer, Cristopher; Cilingiroglu, Mehmet



Spontaneous left main coronary artery dissection complicated by pseudoaneurysm formation in pregnancy: role of CT coronary angiography.  


We report a case of a 26-year-old female, who presented at 34 weeks of an uncomplicated pregnancy with an acute ST elevation anterior wall myocardial infarction. Cardiac catheterization suggested a left main coronary artery dissection with pseudoaneurysm formation. The patient's course was complicated by congestive heart failure. She was initially managed conservatively by a multidisciplinary team including heart failure specialists, obstetricians, and cardiovascular surgeons. 4 days after admission, her LMC was imaged by dual-source 64 slice Cardiac computed tomography, coronary dissection was identified extending to the lumen, and the presence of pseudoaneurysm was confirmed. She underwent subsequently a staged procedure, which included placement of an intra-aortic balloon pump, cesarean section, and coronary artery bypass grafting. This case illustrates the utility of coronary artery CT imaging to assess the complexity and stability of coronary artery dissections, thereby helping to determine the need for, and timing of revascularization procedures. PMID:19338659

Rahman, Shahid; Abdul-Waheed, Mohammed; Helmy, Tarek; Huffman, Lynn C; Koshal, Vipin; Guitron, Julian; Merrill, Walter H; Lewis, David F; Dunlap, Stephanie; Shizukuda, Yukitaka; Weintraub, Neal L; Meyer, Christopher; Cilingiroglu, Mehmet



Angiotensin type I receptor blockade in conjunction with enhanced Akt activation restores coronary collateral growth in the metabolic syndrome  

PubMed Central

We have previously demonstrated that Akt was required for repetitive ischemia (RI)-induced coronary collateral growth (CCG) in healthy rats but was not activated by RI in the metabolic syndrome (JCR:LA-cp rats) where CCG was impaired. Here we hypothesized that failure of angiotensin type I receptor (AT1R) blockers to restore Akt activation is a key determinant of their inability to completely restore CCG in the metabolic syndrome. Therefore, we investigated whether adenovirus-mediated delivery of constitutively active Akt (MyrAkt-Adv) in conjunction with AT1R blockade (candesartan) was able to restore RI-induced CCG in JCR:LA-cp rats. Successful myocardial MyrAkt-Adv delivery was confirmed by a >80% transduction efficiency and an approximately fourfold increase in Akt expression and activation. CCG was assessed by myocardial blood flow measurements in the normal and collateral-dependent zones. MyrAkt-Adv alone significantly increased RI-induced CCG in JCR:LA-cp rats (?30%), but it completely restored CCG in conjunction with administration of candesartan. In contrast, dominant negative Akt (DN-Akt-Adv) reversed the beneficial effect of candesartan on CCG in JCR:LA-cp rats. We conclude that optimal restoration of coronary collateral growth in JCR:LA-cp rats requires a combination of AT1R blockade with constitutive Akt activation. These findings may carry implications for metabolic syndrome patients in need of coronary revascularization.

Jadhav, Rashmi; Dodd, Tracy; Smith, Erika; Bailey, Erin; DeLucia, Angelo L.; Russell, James C.; Madison, Rowan; Potter, Barry; Walsh, Kenneth; Jo, Hanjoong



Antithrombotic therapy in acute coronary syndromes: guidelines translated for the clinician  

Microsoft Academic Search

The use of anticoagulant and antiplatelet therapy during the management of acute coronary syndromes (ACS) has been associated\\u000a with improvements in short- and long-term clinical outcomes, regardless of whether patients are managed conservatively or\\u000a with acute coronary revascularization. Translating the existing evidence for selection of the most appropriate antithrombotic\\u000a strategy has been summarized in available guideline recommendations. Given the breadth

S. Michael Gharacholou; Renato D. Lopes; Jeffrey B. Washam; L. Kristin Newby; Stefan K. James; John H. Alexander



Intervention of stenosed right coronary artery and anomalous left main coronary artery: single main coronary trunk.  


We present the case of an 86-year-old female with stenosis of the anomalous left main trunk originating from a stenosed ostial right coronary artery. She underwent successful percutaneous coronary intervention using simultaneous sirolimus-eluting kissing stents (SKS) for anomalous bifurcating lesions. PMID:18316835

Stevens, Gerin R; Kini, Annapoorna S; Sharma, Samin K



Early postoperative angiographic assessment of radial artery grafts used for coronary artery bypass grafting  

Microsoft Academic Search

Despite a revival of interest in using the radial artery as an alternative conduit for myocardial revascularization, little angiographic documentation of early postoperative results has been presented, particularly in North America. Accordingly, 60 of 150 patients who underwent coronary artery bypass with radial arteries from November 1993 to July 1995 have had postoperative cardiac catheterization at our institution. The patency

Alan H. Chen; Tatsuya Nakao; Richard F. Brodman; Mark Greenberg; Richard Charney; Mark Menegus; Michael Johnson; Richard Grose; Rosemary Frame; Eric C. Hu; Hong-Keun Choi; Steven Safyer



Pitfalls Assessing the Role of Drug-Eluting Stents in Multivessel Coronary Disease  

Microsoft Academic Search

revascularization in patients with multivessel coronary disease. A third major clinical trial, the Surgery or Stent trial on bare metal stents trial, showed a 1-year and 5-year survival benefit for CABG versus PCI, although this result has largely been overlooked (6, 7). As elaborated by Taggart (8) in the 2006 Thomas B. Ferguson lecture to The Society of Thoracic Surgeons,

Nimesh D. Desai


Minimally Invasive Surgery for Coronary Artery Disease with Associated Lung Cancer  

Microsoft Academic Search

Simultaneous surgical management of patients with co-existing ischemic heart disease and lung carcinoma remains controversial. Traditionally, these operations have been staged, with coronary artery revascularization first, followed by pulmonary resection at a later date. Under this procedure, tumor resection is delayed, and these staged procedures may increase morbidity and cost. Our experience with minimally invasive surgery in the cardiac and

Hung-I Lu; Yi-Cheng Wu; Ming-Ju Hsieh; Hui-Ping Liu; Pyng Jing Lin


A review of 1,582 consecutive Octopus off-pump coronary bypass patients  

Microsoft Academic Search

Background. Off-pump coronary bypass may provide a safer form of surgical revascularization by avoiding the unwanted complications of cardiopulmonary bypass, particularly in the increasingly complex patients being referred for operation. This study reviews the entire experience of the Medtronic Octopus System (Medtronic, Minneapolis, MN) for beating heart bypass from 7 surgeons. Demographics, operative procedures, early outcomes, and trends in usage

James C Hart; Ted H Spooner; John Pym; Thomas F Flavin; James R Edgerton; Michael J Mack; Erik W. L Jansen



Should we screen for coronary artery disease in asymptomatic chronic dialysis patients?  

Microsoft Academic Search

The hemodialysis population is characterized by a high prevalence of ‘asymptomatic’ coronary artery disease (CAD), which should be interpreted differently from asymptomatic disease in the general population. A hemodynamically significant stenosis may not become clinically apparent owing to impaired exercise tolerance and autonomic neuropathy. The continuous presence of silent ischemia may cause heart failure, arrhythmias, and sudden death. Whether revascularization

An S De Vriese; Stefaan J Vandecasteele; Barbara Van den Bergh; Frank W De Geeter



A comparative study of rotational atherectomy in acute and stable coronary syndromes in the modern era.  


Percutaneous rotational coronary atherectomy (PRCA) is commonly used in the percutaneous treatment of diffuse, calcified coronary lesions in stable coronary syndromes (SCSs) and facilitates successful delivery and deployment of balloons and stents. Early experience with PRCA cautioned its use in acute coronary syndromes (ACSs). However, the evolution of the PRCA technique and improved antiplatelet pharmacotherapy has broadened its use in ACSs also. A total of 1,112 consecutive patients with an ACS (n=269) or SCS (n=843) who underwent PRCA of 1,483 lesions were examined retrospectively to evaluate the angiographic and short-term clinical outcomes. Troponin-I was elevated in 33.3% of the ACS group and in 0.6% of the SCS group at baseline (p<0.001). Angiographic complications occurred more frequently in the ACS group (18.6% vs 13.1%, p=0.02). There was no difference in major complications between the groups (ACS 1.1% vs SCS 0.8%; p=0.44). The incidence of any periprocedural creatinine kinase-MB elevation was 17.1% versus 18.9% (p=NS) and 30-day major adverse cardiac events (death, disabling stroke, creatine kinase-MB >3 times the upper limit of normal, urgent revascularization) was 5.9% versus 4.6% (p=NS) when comparing the ACS and SCS groups, respectively. With current techniques and antiplatelet therapy, PRCA can be safely performed in ACSs when lesion morphology dictates, with outcomes comparable to that achieved in SCSs. Although angiographic complications occurred more frequently in the ACS group, this did not result in a significantly higher incidence of postprocedural myonecrosis or 30-day major adverse cardiac events. PMID:14675574

Doshi, Sagar N; Kini, Annapoorna; Kim, Michael C; Payne, Nicola; Kamran, Mazullah; Sherman, Warren; Marmur, Jonathan D; Sharma, Samin K



Coronary microembolization  

Microsoft Academic Search

Atherosclerotic plaque rupture is the key event in the pathogenesis of acute coronary syndromes\\u000a and it also occurs during coronary interventions. Atherosclerotic plaque rupture does not always result in complete thrombotic\\u000a occlusion of the epicardial coronary artery with subsequent impending myocardial infarction, but may in milder forms result\\u000a in the embolization of atherosclerotic and thrombotic debris into the coronary microcirculation.

Andreas Skyschally; Kirsten Leineweber; Petra Gres; Michael Haude; Raimund Erbel; Gerd Heusch



Coil embolization of a giant atherosclerotic coronary artery aneurysm.  


The incidence of the coronary artery aneurysm varies from 1.5-5%. Atherosclerosis is the most common cause of coronary artery aneurysm in adults. A discrete, giant, saccular atherosclerotic coronary artery aneurysm in an artery without significant proximal stenosis is rare. We report the first such case of a giant atherosclerotic coronary artery aneurysm successfully treated with coil embolization. PMID:10745597

Rath, P C; Panigrahi, N K; Agarwala, M K; Das, N K; Venkatesvaralu, R



Percutaneous Transluminal Coronary Angioplasty for Culprit Lesions in Patients with Post Myocardial Infarction Angina Based on Dextrocardia and Anomalous Coronary ArteriesCase Reports and Methods  

Microsoft Academic Search

Four cases of successful coronary angioplasty for anomalous coronary arteries, including dextrocardia associated with three-vessel disease, single left coronary artery with proximal left anterior descending lesion, anomalous right coronary artery (RCA) from adjacent left coronary sinus of Valsalva associated with proximal RCA lesion, and anomalous left circumflex angulated lesion bifurcated from the RCA, were encountered. Four cases with 8 target

Yoshimasa Yabe; Reiko Tsukahara



Chronic kidney disease in acute coronary syndromes  

PubMed Central

Chronic kidney disease (CKD) is associated with a high burden of coronary artery disease. In patients with acute coronary syndromes (ACS), CKD is highly prevalent and associated with poor short- and long-term outcomes. Management of patients with CKD presenting with ACS is more complex than in the general population because of the lack of well-designed randomized trials assessing therapeutic strategies in such patients. The almost uniform exclusion of patients with CKD from randomized studies evaluating new targeted therapies for ACS, coupled with concerns about further deterioration of renal function and therapy-related toxic effects, may explain the less frequent use of proven medical therapies in this subgroup of high-risk patients. However, these patients potentially have much to gain from conventional revascularization strategies used in the general population. The objective of this review is to summarize the current evidence regarding the epidemiology and the clinical and prognostic relevance of CKD in ACS patients, in particular with respect to unresolved issues and uncertainties regarding recommended medical therapies and coronary revascularization strategies.

Marenzi, Giancarlo; Cabiati, Angelo; Assanelli, Emilio



Rationale, Design, and Baseline Characteristics of a Trial Comparing Aggressive Lipid Lowering With Atorvastatin Versus Revascularization Treatments (AVERT) fn1 fn1 This work is supported by a grant from Parke-Davis Pharmaceutical Research, a Division of Warner-Lambert Company, Ann Arbor, Michigan  

Microsoft Academic Search

This study describes the design, methodologic features, and baseline characteristics of an open-label randomized trial to determine whether aggressive lipid-lowering therapy with atorvastatin is an alternative to angioplasty or other catheter-based revascularization procedures in patients with significant coronary artery disease. Three-hundred forty-one patients with low-density lipoprotein (LDL) cholesterol ?115 mg\\/dl and ?1 defined narrowing of a major coronary artery were

Lisa S. McCormick; Donald M. Black; David Waters; W. Virgil Brown; Bertram Pitt



Spontaneous coronary dissection during postpartum: etiology and controversies in management.  


A 31-year-old female with a history of toxic oil syndrome in childhood, presented with spontaneous left main coronary dissection 4 weeks after an uncomplicated delivery. She had an extensive myocardial infarction, severe left ventricular dysfunction and cardiogenic shock which did not resolve following urgent surgical revascularization. Temporary left ventricular support and heart transplantation were necessary. We analyze the etiology and treatment sequence in what to our knowledge is the first case with these characteristics to be reported. PMID:15487278

Hinojal, Yolanda Carrascal; Di Stefano, Salvatore; Florez, Santiago; Martínez, Gerardo; de la Fuente, Luis; Casquero, Elena; Gualis, Javier



Stress magnetic resonance imaging in coronary artery disease  

Microsoft Academic Search

\\u000a The management of patients with chest pain requires answers to two principal questions. Firstly, is myocardial ischemia the\\u000a cause of the pain and, if so, where is it and how extensive is it? Secondly, what form of treatment is most likely to abolish\\u000a symptoms and improve prognosis, in particular, is coronary arteriography required prior to a revascularization procedure?

D. J. Pennell; S. R. Underwood


Coronary calcium does not accurately predict near-term future coronary events in high-risk adults  

Microsoft Academic Search

Background—Prognostic risk models have had limited success in predicting coronary events in subjects with multiple risk factors. We and others have proposed an alternative approach using radiographically detectable coronary calcium. We evaluated and compared the predictive value of these 2 approaches for determining coronary event risk in asymptomatic adults with multiple coronary risk factors. In addition, we assessed the predictive

Robert C. Detrano; Nathan D. Wong; Terence M. Doherty; Robert M. Shavelle; Weiyi Tang; Leonard E. Ginzton; Matthew J. Budoff; Kenneth A. Narahara



Vascular Endothelial Growth Factor Gene Delivery for Revascularization in Transplanted Human Islets  

Microsoft Academic Search

Purpose. Islet transplantation is limited by islet graft failure because of poor revascularization, host immune rejection, and nonspecific inflammatory response. Human vascular endothelial growth factor (hVEGF) gene delivery is likely to promote islet revascularization and survival.

Ajit S. Narang; Kun Cheng; James Henry; Chunxiang Zhang; Omaima Sabek; Daniel Fraga; Malak Kotb; A. Osama Gaber; Ram I. Mahato



Percutaneous Transluminal Coronary Angioplasty: Efficacy, Cost and Effects of Prospective Payment.  

National Technical Information Service (NTIS)

Percutaneous transluminal coronary angioplasty (PTCA) is a safe and effective technology for treating selected patients with coronary artery disease, and when performed successfully it is a cost-saving technology compared to coronary bypass surgery. Succe...

N. R. Powe



Revascularization of autogenous skin grafts placed on irradiated tissue  

SciTech Connect

Vascular changes in rat skin after irradiation were examined microangiographically. Revascularization of the skin transplanted during the chronic stage after irradiation was also studied. The results obtained through these examinations revealed higher vascular densities at the acute and the subacute stages, and low values at the chronic stages compared with those of the control. Furthermore, when the skin grafts were transplanted to the irradiated beds in the chronic stage, primary revascularization was scant, and the inhibited capillary proliferation in the recipient sites prevented new vessel penetration. This explains why grafts transplanted to previously irradiated beds fail to survive.

Ueda, M.; Torii, S.; Kaneda, T.; Oka, T.



[Assessment of fractional coronary blood flow reserve].  


Coronary angiography despite all its advantages has a number of limitations. In some cases some supplementary means (methods of visualization such as intravascular ultrasound, optical coherent tomography, as well as determination of functional significance of atherosclerotisc lesions by means of measurement of fractional flow reserve) can help contemporary interventional cardiologist in deciding the problem of necessity of revascularization. We present in this review theoretical aspects of estimation of fractional flow reserve, method of its measurement, and drugs used for achievement of maximal hyperemia. PMID:23098402

Mironov, V M; Merkulov, E V; Samko, A N



Creating accountable care for carotid angioplasty and stenting: A multidisciplinary carotid revascularization board  

PubMed Central

Background: We tested the feasibility of a mandated multidisciplinary carotid revascularization board (MDCB) to review, approve and monitor all carotid artery and stenting (CAS) procedures and outcomes at our institution. Methods: The board was composed of vascular surgeons, cardiologists, interventional neuroradiologists, neurosurgeons, and neurologists, who met weekly to facilitate an evidence-based, consensus recommendation to ensure appropriate CAS referral. Results: The board successfully reviewed and continues to review and approve all CAS procedures at our center. Of the 69 patients considered high risk for standard surgical treatment, 42 patients were symptomatic and 27 patients were asymptomatic. Their mean age was 70.5-year-old and the median degree of stenosis was 79%. In the 74 procedures, periprocedural complications occurred at the following rates: 2.7% death, 2.7% major stroke, 2.7% minor stroke, and 2.7% myocardial infarction (MI) within 30 days of the procedure. At 1 year the primary endpoints of ipsilateral stroke and neurovascular-related death were observed in 8.1% and 2.7% of the patients, respectively. At mean follow-up of 21 months, 18.8% of the patients (13/69) had died (including all causes), and 14.5% (10/69) experienced stroke (including nontarget strokes). Target vessel revascularization was needed in 2.9% patients. Conclusions: A mandated multidisciplinary carotid revascularization board MDCB is feasible and potentially advantageous in real clinical practice. It establishes a model for accountable care by providing a mechanism for institutional oversight, credentialing operators, quality review, standardizing care, cost containment and eliminating the “subspecialty silo mentality.”

Kole, Maximilian K.; Khan, Muhib; Marin, Horia; Sanders, William; Shepard, Alexander; Katramados, Angelos M.; Russman, Andrew N.; Gellman, Steven; Nypaver, Timothy; Malik, Ghaus; Mitsias, Panayiotis D.



Renal Athersosclerotic reVascularization Evaluation (RAVE Study): Study protocol of a randomized trial [NCT00127738  

Microsoft Academic Search

BACKGROUND: It is uncertain whether patients with renal vascular disease will have renal or mortality benefit from re-establishing renal blood flow with renal revascularization procedures. The RAVE study will compare renal revascularization to medical management for people with atherosclerotic renal vascular disease (ARVD) and the indication for revascularization. Patients will be assessed for the standard nephrology research outcomes of progression

Sheldon W Tobe; M Atri; N Perkins; R Pugash; Chaim M Bell



In vivo optical imaging of revascularization after brain trauma in mice  

Microsoft Academic Search

Revascularization following brain trauma is crucial to the repair process. We used optical micro-angiography (OMAG) to study endogenous revascularization in living mice following brain injury. OMAG is a volumetric optical imaging method capable of in vivo mapping of localized blood perfusion within the scanned tissue beds down to capillary level imaging resolution. We demonstrated that OMAG can differentiate revascularization progression

Yali Jia; Marjorie R. Grafe; Andras Gruber; Nabil J. Alkayed; Ruikang K. Wang



Off-pump revascularization of the circumflex artery: technical aspect and short-term results  

Microsoft Academic Search

Background. Beating heart surgery is a technique currently used for revascularization of the anterior and inferior territory. However, revascularization of the circumflex artery is more problematic. With a specific apparatus and surgical technique, we have extended the use of beating heart surgery to more than 90% of patients with multivessel disease, including those necessitating circumflex artery revascularization.Methods. Between October 1996

Raymond Cartier; Robert Blain



Comparison of a Two-Lead, Computerized, Resting ECG Signal Analysis De vice, the MultiFunction-CardioGramsm or MCG (a.k.a. 3DMP), to Quantitative Coronary Angiography for the Detection of Relevant Coronary Artery Stenosis (>70%) - A Meta-Analysis of all Published Trials Performed and Analyzed in the US  

Microsoft Academic Search

Background: Accurate, non-invasive diagnosis of, and screening for, coronary artery disease (CAD) and restenosis after coronary revascularization has been a challenge due to either low sensitivity\\/specificity or relevant morbidity associated with current diagnostic modalities. Methods: To assess sensitivity and specificity of a new computerized, multiphase, resting electrocardiogram analysis device (MultiFunction-CardioGramsm or MCG a.k.a. 3DMP) for the detection of relevant coronary

John E. Strobeck; Joseph T. Shen; Binoy Singh; Kotaro Obunai; Charles Miceli; Howard Sacher; Franz Ritucci; Michael Imhoff


Current role of laser angioplasty of restenotic coronary stents.  


Treatment of in-stent restenosis (ISR) with conventional percutaneous transluminal coronary angioplasty (PTCA) causes significant recurrent neointimal tissue growth in 30-85%. Therefore, laser ablation of intrastent neointimal hyperplasia before balloon dilation can be an attractive alternative. However, the long-term outcomes of such treatment have not been studied thoroughly enough. This prospective case-control study evaluated angiographic and clinical outcomes of PTCA alone and a combination of excimer laser coronary angioplasty (ELCA) and adjunct PTCA in 125 patients with ISR. ELCA was performed before balloon dilation in 67 patients, PTCA alone was performed in 58 patients. Basic demographic and clinical data were comparable in both groups. Lesions included in ELCA group were longer (17.1+/-9.9 vs 13.6+/-9.1 mm; p = 0.034), more complex (36.5% type C stenoses vs 14.3%; p = 0.006), and more frequently had reduced distal blood flow (TIMI <3: 18.9% vs 4.8%; p = 0.025) compared to lesions in the PTCA group. Immediate angiographic results of PTCA and ELCA + PTCA appeared to be comparable. PTCA alone was successful in 57 patients (98.3%), ELCA + PTCA, in 66 patients (98.5%). The rates of hospital complications were comparable (3.0% in ELCA group vs 8.6% in PTCA group). The 1-year follow-up showed that the rates of major adverse cardiac events (MACE) were comparable in the 2 groups (37.3% in ELCA group vs 46.6% in PTCA group). The rates of target vessel revascularization (TVR) within 1 year after the intervention were also similar in the 2 groups (32.8% vs 34.5%). The data mean that ELCA in patients with complex ISR is efficient and safe. Despite a higher complexity of lesions in the ELCA group, no increase in the rate of complications was registered. PMID:16444453

Batyraliev, Talantbek A; Pershukov, Igor V; Niyazova-Karben, Zarema A; Karaus, Alexandru; Calenici, Oleg; Guler, Niyazi; Eryonucu, Beyhan; Temamogullari, Alivahit; Ozgul, Sami; Akgul, Ferit; Sengul, Hakan; Dogru, Orhan; Demirbas, Onder; Timoshin, Ivan S; Gaigukov, Alexei V; Petrakova, Larisa N; Peresypko, Marina K; Sidorenko, Boris A


Downstream testing and subsequent procedures after coronary computed tomographic angiography following coronary stenting in patients ?65 years of age.  


Limited data are available on the use of coronary computed tomographic angiography (CCTA) in patients who have received percutaneous coronary intervention (PCI). To evaluate patterns of cardiac testing including CCTA after PCI, we created a retrospective observational dataset linking National Cardiovascular Data Registry CathPCI Registry baseline data with longitudinal inpatient and outpatient Medicare claims data for patients who received coronary stenting from November 1, 2005 through December 31, 2007. In 192,009 patients with PCI (median age 74 years), the first test after coronary stenting was CCTA for 553 (0.3%), stress testing for 89,900 (46.8%), and coronary angiography for 22,308 (11.6%); 79,248 (41.3%) had no further testing. Patients referred to CCTA first generally had similar or lower baseline risk than those referred for stress testing or catheterization first. Compared to patients with stress testing first after PCI, patients who underwent CCTA first had higher unadjusted rates of subsequent noninvasive testing (10% vs 3%), catheterization (26% vs 15%), and revascularization (13% vs 8%) within 90 days of initial testing after PCI (p <0.0001 for all comparisons). In conclusion, despite similar or lesser-risk profiles, patients initially evaluated with CCTA after PCI had more downstream testing and revascularization than patients initially evaluated with stress testing. It is unclear whether these differences derive from patient selection, performance of CCTA compared to other testing strategies, or the association of early adoption of CCTA with distinct patterns of care. PMID:22651883

Mudrick, Daniel; Kaltenbach, Lisa A; Shah, Bimal; Lytle, Barbara; Masoudi, Frederick A; Mark, Daniel B; Federspiel, Jerome J; Cowper, Patricia A; Green, Cynthia; Douglas, Pamela S



Pulp Revascularization of Immature Dog Teeth With Apical Periodontitis  

Microsoft Academic Search

This study examined the ability of a collagen solution to aid revascularization of necrotic-infected root canals in immature dog teeth. Sixty immature teeth from 6 dogs were infected, disinfected, and randomized into experimental groups: 1: no further treatment; 2: blood in canal; 3: collagen solution in canal, 4: collagen solution + blood, and 5: negative controls (left for natural development).

Blayne Thibodeau; Fabricio Teixeira; Mitsuo Yamauchi; Daniel J. Caplan; Martin Trope



Experimental comparison of bone revascularization by musculocutaneous and cutaneous flaps  

SciTech Connect

Revascularization, one of the major components of bone healing, was examined in an experimental model. The radioactive microsphere technique demonstrated that after 4 weeks beneath a musculocutaneous flap, isolated bone segments had significant blood flow, whereas bone beneath a cutaneous flap did not. The muscle flap bone had a blood flow approximately half that of normal control bone. The muscle of the musculocutaneous flap had a blood flow three times that of the skin of the cutaneous flap. The bipedicle cutaneous flap used was designed to have a healthy blood supply, and at 4 weeks it had a blood flow twice that of control skin. Despite this, there was essentially no demonstrable blood flow in the cutaneous flap bone segments at 4 weeks. Only 3 of 17 bone segments underneath cutaneous flaps showed medullary vascularization, whereas 10 of 11 muscle flap bones did. All bone segments underneath muscle flaps showed osteoblasts and osteoclasts at 4 weeks; neither were seen in the cutaneous bone segments. The process of revascularization occurred through an intact cortex and penetrated into the cancellous bone. Because the bone segments were surrounded by an impervious barrier except for one cortical surface, the cellular activity seen is attributed to revascularization by the overlying flap. In this model, a muscle flap was superior to a cutaneous flap in revascularizing isolated bone segments at 4 weeks. This was documented by blood flow measured by the radioactive microsphere technique and by bone histology.

Fisher, J.; Wood, M.B.



Iatrogenic Arteriovenous Fistula After Revascularization of the Hand  

Microsoft Academic Search

This is the first report of an iatrogenic arteriovenous fistula complicating revascularization of an incomplete amputation of the hand, due to inadvertent anastomosis of the proximal radial artery to the distal cephalic vein. This resulted in a severely painful, massively swollen hand, which was initially diagnosed as an infection or poor venous outflow and eventually required a below-elbow amputation. This

Neil F. Jones; Erin E. Brown; Kayvan T. Khiabani



Femoral artery percutaneous revascularization for patients with critical limb ischemia: outcomes compared to patients with claudication over 2.5 years.  


Patients with critical limb ischemia have higher rates of death and amputation after revascularization compared to patients with intermittent claudication. However, the differences in patency after percutaneous revascularization of the superficial femoral artery are uncertain and impact the long-term risk of amputation and function in critical limb ischemia. We identified 171 limbs from 136 consecutive patients who had angioplasty and/or stenting for super?cial femoral artery stenoses or occlusions from July 2003 through June 2007. Patients were followed for primary and secondary patency, death and amputation up to 2.5 years, and 111 claudicants were retrospectively compared to the 25 patients with critical limb ischemia. Successful percutaneous revascularization occurred in 128 of 142 limbs (90%) with claudication versus 25 of 29 limbs (86%) with critical limb ischemia (p = 0.51). Overall secondary patency at 2.5 years was 91% for claudication and 88% for critical limb ischemia. In Cox proportional hazards models, percutaneous revascularization for critical limb ischemia had similar long-term primary patency (adjusted hazard ratio = 1.1, 95% CI = 0.4, 2.6; p = 0.89) and secondary patency (adjusted hazard ratio = 1.1, 95% CI = 0.2, 6.0; p = 0.95) to revascularization for claudication. Patients with critical limb ischemia had higher mortality and death rates compared to claudicants, with prior statin use associated with less death (p = 0.034) and amputation (p = 0.010), and prior clopidogrel use associated with less amputation (p = 0.034). In conclusion, percutaneous superficial femoral artery revascularization is associated with similar long-term durability in both groups. Intensive treatment of atherosclerosis risk factors and surveillance for restenosis likely contribute to improving the long-term outcomes of both manifestations of peripheral artery disease. PMID:22496125

Todoran, Thomas M; Connors, Gerard; Engelson, Brian A; Sobieszczyk, Piotr S; Eisenhauer, Andrew C; Kinlay, Scott



Long-term results of urgent revascularization for hepatic artery thrombosis after pediatric liver transplantation.  


Hepatic artery thrombosis (HAT) after pediatric orthotopic liver transplantation (OLT) is a serious complication resulting in bile duct necrosis and often requiring retransplantation. Immediate surgical thrombectomy/thrombolysis has been reported to be a potentially successful treatment for restoring blood flow and avoiding urgent retransplantation. The long-term results of this strategy remain to be determined. In 232 pediatric liver transplants, we analyzed long-term outcomes after urgent revascularization for early HAT. HAT developed in 32 patients (13.7%). In 16 children (50%), immediate surgical thrombectomy was performed in an attempt to salvage the graft. Fourteen patients (44%) underwent urgent retransplantation, and 2 (6%) died before further intervention. Immediate thrombectomy resulted in long-term restoration of the hepatic artery flow in 6 of 16 patients (38%) and in 1- and 5-year graft and patient survival rates of 83% and 67%, respectively. In 10 patients, revascularization was unsuccessful, and retransplantation was inevitable. The 1- and 5-year patient survival rates in this group decreased to 50% and 40%, respectively. After immediate retransplantation, the 5-year patient survival rate was 71%. In conclusion, immediate surgical thrombectomy for HAT after pediatric OLT results in long-term graft salvage in about one-third of patients. However, when thrombectomy is unsuccessful, long-term patient survival is lower than the survival of patients who underwent immediate retransplantation. PMID:20583091

Warnaar, Nienke; Polak, Wojciech G; de Jong, Koert P; de Boer, Marieke T; Verkade, Henkjan J; Sieders, Egbert; Peeters, Paul M J G; Porte, Robert J



Tacrolimus Inhibits the Revascularization of Isolated Pancreatic Islets  

PubMed Central

Aims Immunosuppressive drugs could be crucial factors for a poor outcome after islet allotransplantation. Unlike rapamycin, the effects of tacrolimus, the current standard immunosuppressant used in islet transplantation, on graft revascularization remain unclear. We examined the effects of tacrolimus on islet revascularization using a highly sensitive imaging system, and analyzed the gene expression in transplanted islets by introducing laser microdissection techniques. Methods Islets isolated from C57BL/6-Tg (CAG-EGFP) mice were transplanted into the nonmetallic dorsal skinfold chamber on the recipients. Balb/c athymic mice were used as recipients and were divided into two groups: including a control group (n?=?9) and tacrolimus-treated group (n?=?7). The changes in the newly-formed vessels surrounding the islet grafts were imaged and semi-quantified using multi-photon laser-scanning microscopy and a Volocity system. Gene expression in transplanted islets was analyzed by the BioMark dynamic system. Results The revascularization process was completed within 14 days after pancreatic islet transplantation at subcutaneous sites. The newly-formed vascular volume surrounding the transplanted islets in the tacrolimus-treated group was significantly less than that in the control group (p<0.05). Although the expression of Vegfa (p<0.05) and Ccnd1 (p<0.05) was significantly upregulated in the tacrolimus-treated group compared with that of the control group, no differences were observed between the groups in terms of other types of gene expression. Conclusions The present study demonstrates that tacrolimus inhibits the revascularization of isolated pancreatic islets without affecting the characteristics of the transplanted grafts. Further refinements of this immunosuppressive regimen, especially regarding the revascularization of islet grafts, could improve the outcome of islet allotransplantation.

Nishimura, Ryuichi; Nishioka, Sho; Fujisawa, Ikuma; Shiku, Hitoshi; Shimada, Miki; Sekiguchi, Satoshi; Fujimori, Keisei; Ushiyama, Akira; Matsue, Tomokazu; Ohuchi, Noriaki; Satomi, Susumu; Goto, Masafumi



Myocardial revascularization for situs inversus totalis and dextrocardia  

Microsoft Academic Search

Situs inversus totalis with dextrocardia is rare and presentation with coronary artery disease in the ninth decade of life is even rarer. Here we describe a case where a patient underwent coronary stenting and subsequently coronary bypass surgery for the same.

Pramod Bonde; G. F. Campalani



Angiotensin-Converting-Enzyme Inhibition in Stable Coronary Artery Disease  

PubMed Central

BACKGROUND Angiotensin-converting-enzyme (ACE) inhibitors are effective in reducing the risk of heart failure, myocardial infarction, and death from cardiovascular causes in patients with left ventricular systolic dysfunction or heart failure. ACE inhibitors have also been shown to reduce atherosclerotic complications in patients who have vascular disease without heart failure. METHODS In the Prevention of Events with Angiotensin Converting Enzyme Inhibition (PEACE) Trial, we tested the hypothesis that patients with stable coronary artery disease and normal or slightly reduced left ventricular function derive therapeutic benefit from the addition of ACE inhibitors to modern conventional therapy. The trial was a double-blind, placebo-controlled study in which 8290 patients were randomly assigned to receive either trandolapril at a target dose of 4 mg per day (4158 patients) or matching placebo (4132 patients). RESULTS The mean (±SD) age of the patients was 64±8 years, the mean blood pressure 133±17/78±10 mm Hg, and the mean left ventricular ejection fraction 58±9 percent. The patients received intensive treatment, with 72 percent having previously undergone coronary revascularization and 70 percent receiving lipid-lowering drugs. The incidence of the primary end point — death from cardiovascular causes, myocardial infarction, or coronary revascularization — was 21.9 percent in the trandolapril group, as compared with 22.5 percent in the placebo group (hazard ratio in the trandolapril group, 0.96; 95 percent confidence interval, 0.88 to 1.06; P=0.43) over a median follow-up period of 4.8 years. CONCLUSIONS In patients with stable coronary heart disease and preserved left ventricular function who are receiving “current standard” therapy and in whom the rate of cardiovascular events is lower than in previous trials of ACE inhibitors in patients with vascular disease, there is no evidence that the addition of an ACE inhibitor provides further benefit in terms of death from cardiovascular causes, myocardial infarction, or coronary revascularization.



[Surgical treatment of diffuse coronary disease].  


In order to obtain an idea on contemporary opportunities of surgical treatment of diffuse coronary disease the authors compared the results of surgery in 103 patients whose finding called for endarterectomy and bridging of at least one coronary artery (KEA) with the results in 220 patients where it was possible to overcome all significant changes by coronary bypasses only (KBP). Patients in group KEA had more infarctions before operation than patients in group KBP. Diffuse changes of the coronary arteries were found only in patients in group KEA. All patients were operated with extracorporeal circulation and local cooling of the myocardium. Surgery took longer in patients of group KEA than in group KBP. Early mortality was higher in group KEA--4.8% than in group KBP--0.9%. This difference was not statistically significant. Early morbidity in group KEA did not differ, from the morbidity in group KBP. Using effective peroperative protection of the myocardium by local cooling, the risk of KEA is only insignificantly higher than the risk of KBP. KEA makes safe and effective revascularization of the heart muscle in patients with diffuse coronary disease possible. PMID:1794141

Huskic, R; Fabián, J; Nezic, D; Peric, M; Pejcic, P; Trifunovic, I; Vucinic, M



Unraveling the EXCEL: promises and challenges of the next trial of left main percutaneous coronary intervention.  


The Evaluation of Xience Prime or Xience V versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization (EXCEL) trial is a multicenter, ongoing trial conducted in patients with left main disease and SYNTAX score ? 32 to establish the presumptive advantage of percutaneous coronary intervention (PCI) versus bypass surgery in patients with less complex coronary artery disease than those enrolled in the Synergy between PCI with Taxus and Cardiac Surgery (SYNTAX) trial. In this article, we aimed at critically discussing key features and issues relevant to design and clinical interpretation of this new contemporary trial of left main PCI. PMID:22075415

Capodanno, Davide; Tamburino, Corrado



Anger Proneness Predicts Coronary Heart Disease Risk Prospective Analysis From the Atherosclerosis Risk In Communities (ARIC) Study  

Microsoft Academic Search

Background—Increased research attention is being paid to the negative impact of anger on coronary heart disease (CHD). Methods and Results—This study examined prospectively the association between trait anger and the risk of combined CHD (acute myocardial infarction (MI)\\/fatal CHD, silent MI, or cardiac revascularization procedures) and of \\

Janice E. Williams; Catherine C. Paton; Ilene C. Siegler; Marsha L. Eigenbrodt; F. Javier Nieto; Herman A. Tyroler


Current status and future directions in computer-enhanced video- and robotic-assisted coronary bypass surgery  

Microsoft Academic Search

Since 1997, both the Cleveland Clinic and London Health Sciences Centre groups have embraced robotic assistance and more recently demonstrated the efficacy of this technology in totally closed-chest, beating heart myocardial revascularization. This endeavor involved an orderly progression and the learning of new surgical skill sets. We review the evolution of robot-enhanced coronary surgery and forecast the future of endoscopic

W. Douglas Boyd; Kojiro Kodera; Kenneth D. Stahl; Reiza Rayman




Microsoft Academic Search

A b s t r a c t: The aim of the study was to identify incremental values of carotid ultrasound measurements (carotid plaques and stenosis) on the prediction of future coronary revascularization among type 2 diabetic patients. The second objective was to determine the predictive value of the assessment of blood lipids, BMI, abdominal obesity and the ankle-brachial index

Georgievska-Ismail Lj


Treatment of unprotected left main coronary artery disease with drug-eluting stents: is it time for a randomized trial?  

Microsoft Academic Search

The treatment of unprotected left main coronary artery disease by percutaneous intervention represents a considerable challenge for interventional cardiologists. The American College of Cardiology\\/ American Heart Association guidelines currently recommend surgical revascularization for this disorder and percutaneous interventions have thus far been performed only in exceptional cases, albeit with positive results in some patients. Technical limitations, however, including stent restenosis,

Alaide Chieffo; Antonio Colombo



Off-pump versus on-pump coronary surgery: final results from a prospective randomized study Prague4  

Microsoft Academic Search

BackgroundOff-pump coronary artery bypass surgery is becoming increasingly popular despite the lack of sufficient evidence from randomized trials. The aim of our prospective, randomized, single-center study was to examine the role of off-pump revascularization among nonselected patients.

Zbynek Straka; Petr Widimsky; Karel Jirasek; Petr Stros; Jan Votava; Tomas Vanek; Petr Brucek; Miroslav Kolesar; Rudolf Spacek



Clinical and economic outcomes of multivessel coronary stenting compared with bypass surgery: A single-center US experience  

Microsoft Academic Search

Background Randomized trials comparing multivessel stenting with coronary artery bypass surgery (CABG) have demonstrated similar rates of death and myocardial infarction but higher rates of repeat revascularization after stenting. The impact of these alternative strategies on overall medical care costs is uncertain, particularly within the US health care system. Methods We performed a retrospective, matched cohort study to compare the

Matthew R. Reynolds; Nancy Neil; Kalon K. L. Ho; Ronna Berezin; Roberta S. Cosgrove; Robert A. Lager; Cheryl Sirois; Robert G. Johnson; David J. Cohen



The human coronary collateral circulation: development and clinical importance.  


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. PMID:23739241

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



Coronary CTA  

Microsoft Academic Search

This article will first compare the various cardiac imaging studies commonly prescribed and will discuss basic technical aspects of coronary computed tomography angiography (CCTA). CCTA represents one of the most valuable diagnostic studies available in the fight against coronary artery disease (CAD) because early diagnosis is imperative for early intervention. Advances in temporal and spatial resolution enable identification of CAD

Jody W. Baker



Myocardial expression of the vascular endothelial growth factor (VEGF) after endocardial laser revascularization (ELR)  

NASA Astrophysics Data System (ADS)

Background. Endocardial laser revascularization (ELR) is a new technique to treat patients with severe coronary artery disease (CAD) in a percutaneous approach. The results show a significant improvement of symptoms, but the mechanism of action is still unknown. One main theory is the angiogenesis for which Vascular Endothelial Growth Factor (VEGF) is the keypromotor. We investigated immunohistochemically the VEGF-expression after ELR in porcine hearts over a timeperiod of four weeks. Methods. ELR was performed with a single-pulse Thulium:YAG laser. 15 pigs were treated with ELR and the hearts were harvested at five timeperiods: directly (group I), 3 days (group II), 1 week (group III), 2 weeks (group IV) and 4 weeks (group V) after ELR. Each group consisted of three pigs. Immunohistochemically the VEGF-expression was assessed by staining with a polyclonal antibody against VEGF and cellcounting using an expression index (VEGF-EI) Results. A maximum of VEGF-expression was found three days (group II) after ELR with a VEGF-EI of 97%. At 1 week (group III) the VEGF-EI was similar high with 93%. Along the timecourse the index decreased to 22% at 4 weeks (groupV). Conclusions. Our findings show that ELR leads to an local upregulation of VEGF around the channels. The resulting angiogenesis could be the mechanism for the relief of angina.

Rommerscheid, Jan; Theisen, Dirk; Schmuecker, G.; Brinkmann, Ralf; Broll, R.




PubMed Central

Thirteen patients were submitted to direct myocardial revascularization (saphenous vein graft) without the use of an artificial oxygenator. The perfusion was done by a left ventricle-to-aorta bypass and autogenous oxygenation. Most patients had three grafts implanted plus endarterectomy of the distal right coronary artery. There was one hospital death that was apparently not related to the method used. Perfusion time ranged from 45 minutes to 4 hours. Body temperature during perfusion was kept between 25 and 30° C. Perfusion flow was maintained between 25 to 50 ml per kg of body weight per minute. Ischemic, hypothermic cardiac arrest was employed. We demonstrated for the first time that perfusion for this kind of heart surgery could be done with no artificial oxygenators and, apparently, is safer for the patients. There were no bleeding problems even in perfusions as long as 4 hours. There was no respiratory dysfunction, and artificial respiration was used for only 6 to 12 hours. The patients awoke at the end of surgery with no signs or symptoms of central nervous system damage, and vasopressor drugs were rarely used after surgery. Although the experience is very small, it suggests that many postoperative problems, especially those related to bleeding and respiratory dysfunction may be reduced or eliminated by this new method.

De Moraes, Domingos Junqueira; Abilio, Fued Michel; Cunha, Marcos; Feitosa, Lionicio A.; Aragao, Esmeraldino; Cysne, Eumenes; Vieira, Roberto; Glavam, Haroldo C. C.; Zaniolo, Waldomiro; Netto, Mario Salles; Villela, Ronaldo De A.; Labrunie, Pierre



Implications of the atorvastatin versus revascularization treatment (AVERT) study for the clinician.  


The underlying disorder in the vast majority of cases of cardiovascular disease is atherosclerosis, for which low-density lipoprotein cholesterol is recognized as a major risk factor. Data from epidemiologic studies have suggested that lower cholesterol levels are associated with a lower overall risk of morbidity and mortality due to coronary heart disease. Numerous clinical trials with lipid-lowering agents support these epidemiologic data. Of these, studies with the HMG-CoA (3-hydroxy 3-methylglutaryl coenzyme A) reductase inhibitors, or statins, have shown the greatest lipid-lowering effects. Data from recent trials such as the Atorvastatin Versus Revascularization Treatment contribute to a growing body of evidence that suggests that aggressive reduction of cholesterol can yield additional clinical benefits above and beyond that observed with less robust treatment regimens. Aggressive cholesterol-lowering strategies have the potential therefore to have a significant impact on levels of atherosclerotic disease throughout the westernized world. Such effects argue in favor of renaming the entire class of drugs as anti- atherosclerotic rather than lipid-lowering agents. PMID:10980911

Eisenberg, D



Target Lesion Revascularization After Wingspan Assessment of Safety and Durability  

Microsoft Academic Search

Background and Purpose—In-stent restenosis (ISR) occurs in approximately one-third of patients after the percutaneous transluminal angioplasty and stenting of intracranial atherosclerotic lesions with the Wingspan system. We review our experience with target lesion revascularization (TLR) for ISR after Wingspan treatment. Methods—Clinical and angiographic follow-up results were recorded for all patients from 5 participating institutions in our US Wingspan Registry. ISR

David J. Fiorella; Elad I. Levy; Aquilla S. Turk; Felipe C. Albuquerque; G. Lee; Henry H. Woo; Babu G. Welch; David B. Niemann; Phillip D. Purdy; Beverly Aagaard-Kienitz; Peter A. Rasmussen; L. Nelson Hopkins; Thomas J. Masaryk; Cameron G. McDougall


The ELANA technique: high flow revascularization of the brain  

Microsoft Academic Search

High flow revascularization of the brain is hampered by the fact that temporary occusion of a major cerebral artery is necessary to create the distal anastomosis, which may result in brain ischemia. The excimer laser-assisted non-occlusive anastomosis (ELANA) technique circumvents this problem. In this paper we elucidate the development of a non-occlusive way to make anastomoses to the major cerebral

H. J. Streefkerk; J. P. Bremmer; C. A. Tulleken


The ELANA technique: high flow revascularization of the brain.  


High flow revascularization of the brain is hampered by the fact that temporary occusion of a major cerebral artery is necessary to create the distal anastomosis, which may result in brain ischemia. The excimer laser-assisted non-occlusive anastomosis (ELANA) technique circumvents this problem. In this paper we elucidate the development of a non-occlusive way to make anastomoses to the major cerebral arteries. PMID:16060255

Streefkerk, H J; Bremmer, J P; Tulleken, C A



Coronary bifurcation lesions.  


Treatment of coronary bifurcation lesions represents a challenging area in interventional cardiology, but recent advances in percutaneous coronary interventions have led to a dramatic increase in the number of patients successfully treated percutaneously. When compared with nonbifurcation interventions, bifurcation interventions have a lower rate of procedural success, higher procedural costs, longer hospitalization, and a higher rate of clinical and angiographic restenosis. The recent introduction of drug-eluting stents has resulted in a lower event rate and reduction of main vessel restenosis compared with historical controls. Side branch ostial residual stenosis and long-term restenosis remain a problem, however. Although stenting the main vessel with provisional side branch stenting seems to be the prevailing approach, in the era of drug-eluting stents, various two stent techniques have emerged to allow stenting of the large side branch also. PMID:16781940

Sharma, Samin K; Kini, Annapoorna S



Emergency Stenting of Unprotected Left Main Coronary Artery after Acute Catheter-Induced Occlusive Dissection  

PubMed Central

Left main coronary artery dissection occurs very rarely during selective coronary angiography, but it generally progresses to complete coronary occlusion. The traditional treatment of occlusive dissection of the unprotected left main coronary artery has been surgical. Percutaneous treatment has been sporadic and controversial. We report a case of iatrogenic occlusive dissection of the unprotected left main coronary artery during diagnostic coronary angiography, followed by successful stenting of the lesion.

Akgul, Ferit; Batyraliev, Talantbek; Besnili, Fikret; Karben, Zarema



Holmium:YAG laser coronary angioplasty in acute myocardial infarction  

NASA Astrophysics Data System (ADS)

Patients who sustain complicated acute myocardial infarction in whom thrombolytic agents either fail or are contraindicated often need mechanical revascularization other than PTCA. In 24 patients with acute infarction complicated by continuous chest pain and ischemia who either received lytics or with contraindication to lytics, a holmium:YAG laser (Eclipse Surgical Technologies, Palo Alto, CA) was utilized for thrombolysis and plaque ablation. Clinical success was achieved in 23/24 patients, with 23 patients (94%) surviving the acute infarction. Holmium:YAG laser is very effective and safe in thrombolysis and revascularization in this complicated clinical setting.

Topaz, On; Luxenberg, Michael; Schumacher, Audrey



Salvage antegrade visceral revascularization and antegrade aortic stenting for type I and III endoleaks after fenestrated juxtarenal aneurysm repair.  


A 73-year-old man developed type I and III endoleaks from a fractured right renal stent with downward migration of a fenestrated endograft, 6 years after endovascular repair of a juxtarenal aneurysm. Endovascular treatment attempts were unsuccessful. He underwent aortic debranching and antegrade visceral artery revascularization via a left thoracolaparotomy incision and an extraperitoneal approach to the visceral aorta. An antegrade aortic stent covered the endoleak, with technical and clinical success at 9 months. Failure of complex endografts presents particular problems, potentially not amenable to totally endovascular repair. Continued surveillance is mandated as late, asymptomatic sac expansion can occur. PMID:23089303

Gohel, Manjit S; Clark, Martin; Kashef, Elika; Gibbs, Richard G J



Indirect revascularization surgery for moyamoya disease in children and its special considerations  

PubMed Central

Moyamoya disease (MMD) is the most common pediatric cerebrovascular disease in Far Eastern countries. In children, MMD frequently manifests as ischemic symptomatology. Cerebral perfusion gradually decreases as the disease progresses, which often leads to cerebral infarction. The benefits of revascularization surgery, whether direct or indirect, have been well established in MMD patients with ischemic symptoms. In adults, the increase in cerebral blood flow achieved with indirect revascularization is often unsatisfactory, and direct revascularization is usually feasible. In children, however, direct revascularization is frequently technically not feasible, whereas the response to indirect revascularization is excellent, although 1 or 2 weeks are required for stabilization of symptoms. The authors describe surgical procedures and perioperative care in indirect revascularization for MMD. In addition, special considerations with regard to very young patients, patients with recent cerebral infarction, and patients with hyperthyroidism are discussed.

Phi, Ji Hoon; Lee, Ji Yeoun; Kim, Seung-Ki; Cho, Byung-Kyu



Robotically-Assisted Coronary Artery Bypass Grafting  

PubMed Central

Objectives. Robotic surgery enables to perform coronary surgery totally endoscopically. This report describes our experience using the da Vinci system for coronary artery bypass surgery. Methods. Patients requiring single-or-double vessel revascularization were eligible. The procedure was performed without cardiopulmonary bypass on a beating heart. Results. From April 2004 to May 2008, fifty-six patients were enrolled in the study. Twenty-four patients underwent robotic harvesting of the mammary conduit followed by minimal invasive direct coronary artery bypass (MIDCAB), and twenty-three patients had a totally endoscopic coronary artery bypass (TECAB) grafting. Nine patients (16%) were converted to open techniques. The mean total operating time for TECAB was 372 ± 104 minutes and for MIDCAB was 220 ± 69 minutes. Followup was complete for all patients up to one year. There was one hospital death following MIDCAB and two deaths at follow up. Forty-eight patients had an angiogram or CT scan revealing occlusion or anastomotic stenoses (>50%) in 6 patients. Overall permeability was 92%. Conclusions. Robotic surgery can be performed with promising results.

Folliguet, Thierry A.; Dibie, Alain; Philippe, Francois; Larrazet, Fabrice; Slama, Michel S.; Laborde, Francois



Robotically-assisted coronary artery bypass grafting.  


Objectives. Robotic surgery enables to perform coronary surgery totally endoscopically. This report describes our experience using the da Vinci system for coronary artery bypass surgery. Methods. Patients requiring single-or-double vessel revascularization were eligible. The procedure was performed without cardiopulmonary bypass on a beating heart. Results. From April 2004 to May 2008, fifty-six patients were enrolled in the study. Twenty-four patients underwent robotic harvesting of the mammary conduit followed by minimal invasive direct coronary artery bypass (MIDCAB), and twenty-three patients had a totally endoscopic coronary artery bypass (TECAB) grafting. Nine patients (16%) were converted to open techniques. The mean total operating time for TECAB was 372 +/- 104 minutes and for MIDCAB was 220 +/- 69 minutes. Followup was complete for all patients up to one year. There was one hospital death following MIDCAB and two deaths at follow up. Forty-eight patients had an angiogram or CT scan revealing occlusion or anastomotic stenoses (>50%) in 6 patients. Overall permeability was 92%. Conclusions. Robotic surgery can be performed with promising results. PMID:20339505

Folliguet, Thierry A; Dibie, Alain; Philippe, François; Larrazet, Fabrice; Slama, Michel S; Laborde, François



Transmyocardial revascularization with CO 2 laser in patients with refractory angina pectoris  

Microsoft Academic Search

OBJECTIVESThe purpose of the study was to evaluate clinical effects, exercise performance and effect on maximal oxygen consumption (MVO2) of transmyocardial revascularization with CO2-laser (TMR) in patients with refractory angina pectoris.BACKGROUNDTransmyocardial laser revascularization is a new method to treat patients with refractory angina pectoris not eligible for conventional revascularization. Few randomized studies comparing TMR with conventional treatment have been published.METHODSOne

Lars Aaberge; Kenneth Nordstrand; Morten Dragsund; Kjell Saatvedt; Knut Endresen; Svein Golf; Odd Geiran; Michel Abdelnoor; Kolbjorn Forfang



Outcome of extensive coronary artery dissection during coronary angioplasty.  

PubMed Central

A total of 32 (3.6%) patients of 880 undergoing coronary angioplasty during a nine year period at one hospital had extensive dissection (defined as a dissection extending beyond the limits of the dilated angioplasty balloon) in the coronary artery in which the angioplasty procedure was performed. Two (6.25%) of the 32 patients (both of whom were undergoing angioplasty because of unstable angina that was refractory to medical treatment) died as a consequence of the coronary artery dissection. Twelve (38%) needed immediate coronary artery bypass surgery and 11 (34%) had a myocardial infarction, which in four was minor in extent. During follow up, 20 of the 32 patients were successfully managed by medical treatment; only two needed further angioplasty procedures. There were no late deaths. Extensive coronary artery dissection is a serious complication of coronary angioplasty, with a high early mortality and a high incidence of infarction and requirement for bypass surgery. None the less, patients with extensive dissection who are free from the manifestations of acute ischaemia at the end of the procedure can be managed conservatively and have a good immediate and medium term outlook. Attempts should be made to stabilise extensive dissection during coronary angioplasty so that surgical intervention can be delayed or avoided altogether if possible. Images

Cripps, T R; Morgan, J M; Rickards, A F



Coronary Calcium Scan  


... the NHLBI on Twitter. What Is a Coronary Calcium Scan? A coronary calcium scan is a test ... you have calcifications in your coronary arteries. Coronary Calcium Scan Figure A shows the position of the ...


Coronary arteries  

Microsoft Academic Search

.   Coronary angiography (CA) is presently considered the gold standard for the assessment of the coronary arteries. However,\\u000a the presence of ionizing radiation, its invasiveness and the small associated risk of morbidity prompted long ago the development\\u000a of more patient-friendly imaging modalities. A promising technique, magnetic resonance imaging (MRI), has been regarded as\\u000a the major modality in the coming decade.

P. A. Wielopolski; R. J. M. van Geuns; P. J. de Feyter; M. Oudkerk



Small coronary vessel angioplasty: outcomes and technical considerations  

PubMed Central

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

Rathore, Sudhir



Modified aortic root remodeling for annuloaortic ectasia with abnormal coronary take-off.  


The abnormality of coronary arterial take-off is a limiting factor for a successful aortic valve sparing procedure. We present a 13-year-old boy, with Marfan syndrome and annuloaortic ectasia, whose coronary take-off was found to be abnormal during surgery. Two adjacent coronary orifices were located in the left coronary sinus and very close to the right-left commissure. A modified aortic remodeling procedure was successfully performed without translocation of the coronary artery. PMID:12440632

Matsuda, Hikaru; Ichikawa, Hajime; Iwai, Shigemitsu; Takahashi, Toshiki



Coronary aneurysms.  


Coronary aneurysms represent anomalies identified in 0.15-4.9% of patients undergoing coronary angiography. At present there is no uniform definition of this pathology. According to current definitions, the term "aneurysm" refers to both diffuse over 150% dilation of the largest diameter of a coronary artery, and limited spherical or saccular dilation. Aneurysms are observed most commonly in the right coronary artery, and least frequently in the left main coronary artery. It has been demonstrated that atherosclerosis is the main cause of these anomalies in adults, and Kawasaki disease in children and adolescents. However, regardless of the pathogenesis of the aneurysm, pathology of the media of the blood vessel plays a major role in its formation. The most prevalent consequence of aneurysms in the coronary arteries is formation of a thrombus with distal embolization, vasospasm or vessel disruption at the site of wall injury. Therefore, therapeutic management in this anomaly involves both the prevention of thromboembolic complications and percutaneous or surgical closure of the aneurysm entry. PMID:19202953

Gziut, Aneta I; Gil, Robert J



Towards sutureless non-occlusive cerebral revascularization.  


Sutureless vascular anastomoses have been the subject of extensive research for decades. In neurosurgery the need for a safe and fast technique is high, because temporary occlusion of cerebral arteries may rapidly lead to brain ischemia. Conventional sutured anastomoses have always been the golden standard. Limited working space and difficult suturing techniques were reasons to find alternatives. Many artificial devices to create anastomoses have been engineered over the years like tissue sealants, clips and automated suturing sets with variable success. For all previous options, temporary occlusion of the recipient artery was necessary. The Excimer Laser Assisted Non-Occlusive Anastomosis (ELANA) technique™ facilitates the construction of an end-to-side anastomosis without temporary occlusion of the recipient artery using a platinum ring and a laser. However, the technical challenge of intracranial micro-sutures remained. Experiments using less sutures eventually resulted in a sutureless ELANA (SELANA) anastomosis. After in vitro and in vivo experiments, the SELANA slide was considered feasible for intracranial use although some concrete improvements, like the inclusion of a clip at the back of the device, were needed. Therefore, the development of an ideal sutureless anastomosis is still ongoing. This process is an evolution rather than a revolution. PMID:21623324

De Boer, B; Van Doormaal, T P; Van Der Zwan, A; Tulleken, C A; Regli, L



The neglected coronary atherosclerosis.  


A study of the natural history of coronary heart disease by means of gross inspection and light microscopy, carried out on 640 subjects aged 1-50 years who had died of violent accidents, revealed a grossly neglected coronary atherosclerosis. It included fibromuscular plaques, intimal necrotic areas and incorporated microthrombi present in the longitudinally opened main coronary arteries but not visible to the naked eye, and some atherosclerotic lesions visible to the naked eye but present in branch vessels unopened or not removed during routine autopsy. There were approximately 500 grossly neglected intimal necrotic areas and approximately 120 grossly neglected incorporated microthrombi; from a total of 809 atherosclerotic plaques 261 (32%) were grossly neglected. The topographic distribution and the number of neglected and non-neglected atherosclerotic plaques, in successive age groups, were analyzed. A small subsample, including 32 patients 52-79 years old, dead of coronary heart disease, was used to demonstrate the importance of the detection of obstructive atherosclerotic lesions in some usually unopened or not removed branch vessels for a realistic anatomo-clinic-cardioangiographic and ECG correlation. PMID:6882496

Velican, C; Velican, D



Modifications of Coronary Risk Factors  

PubMed Central

In addition to the revascularization and glycemic management interventions assigned at random, the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) design includes the uniform control of major coronary artery disease risk factors, including dyslipidemia, hypertension, smoking, central obesity, and sedentary lifestyle. Target levels for risk factors were adjusted throughout the trial to comply with changes in recommended clinical practice guidelines. At present, the goals are low-density lipoprotein cholesterol <2.59 mmol/L (<100 mg/dL) with an optional goal of <1.81 mmol/L (<70 mg/dL); plasma triglyceride level <1.70 mmol/L (<150 mg/dL); blood pressure level <130 mm Hg systolic and <80 mm Hg diastolic; and smoking cessation treatment for all active smokers. Algorithms were developed for the pharmacologic management of dyslipidemia and hypertension. Dietary prescriptions for the management of glycemia, plasma lipid profiles, and blood pressure levels were adapted from existing clinical practice guidelines. Patients with a body mass index >25 were prescribed moderate caloric restriction; after the trial was under way, a lifestyle weight-management program was instituted. All patients were formally prescribed both endurance and resistance/flexibility exercises, individually adapted to their level of disability and fitness. Pedometers were distributed as a biofeedback strategy. Strategies to achieve the goals for risk factors were designed by BARI 2D working groups (lipid, cardiovascular and hypertension, and nonpharmacologic intervention) and the ongoing implementation of the strategies is monitored by lipid, hypertension, and lifestyle intervention management centers.

Albu, Jeanine; Gottlieb, Sheldon H.; August, Phyllis; Nesto, Richard W.; Orchard, Trevor J.



Meta-analysis of percutaneous coronary intervention versus coronary artery bypass graft surgery in patients with diabetes and left main and/or multivessel coronary artery disease.  


The optimal coronary revascularization strategy for patients with diabetes and left main and/or multivessel disease is undetermined. The aim of our study was to evaluate percutaneous coronary intervention (PCI) versus coronary artery bypass graft (CABG) in those patients. We identified 13 articles, published before October 2011, enrolling 6992 patients, whose follow-up period ranged from 1 to 5 years. Patients with PCI had a significant reduction in cerebral vascular attack (CVA) (OR, 0.29; 95 % CI, 0.16-0.51; p < 0.0001, I (2) = 0 %) as compared with CABG, whereas there was a fourfold increased risk of repeat revascularization associated with PCI even using drug-eluting stent (OR, 4.44; 95 % CI, 3.42-5.78; ?(2) = 4.92, p < 0.00001, I (2) = 0 %). The overall mortality (OR, 0.97; 95 % CI, 0.81-1.15; p = 0.70, I (2) = 0 %) was comparable between the PCI and CABG. However, in subgroup analysis, the composite outcome (death/myocardial infarction/CVA) was significantly reduced in favor of DES implantation (OR, 0.79; 95 % CI, 0.63-0.99; ?(2) = 1.07, p = 0.04, I (2) = 0 %). Our study confirmed the cerebral vascular benefits of PCI by significantly reducing CVA risks, and the composite outcome was better in patients undergoing PCI with drug-eluting stent, despite a higher repeat revascularization rate. It poses imperative demands for future prospective randomized studies to define the optimal strategy in patients with diabetes and left main and/or multivessel disease. PMID:22907763

Gao, Fei; Zhou, Yu Jie; Shen, Hua; Wang, Zhi Jian; Yang, Shi Wei; Liu, Xiao Li



Long-term follow up of percutaneous coronary intervention of coronary artery disease in women ?45 years of age.  


The aim of the present study was to report the short- and long-term clinical outcomes of percutaneous coronary intervention in young women with premature coronary artery disease. From February 2003 to December 2011, 168 consecutive women aged ?45 years who underwent percutaneous coronary intervention with stent implantation were retrospectively analyzed. The primary end point was the incidence of major adverse cardiac events (MACEs) at short- and long-term follow-up. The mean age was 40.3 ± 2.0 years. Conventional coronary artery disease risk factors were common. Autoimmune or connective tissue diseases were present in 6.5% of the population, 4% had gynecologic diseases, 4 were postpartum, and 9 were taking contraceptives. The left anterior descending coronary artery was the most commonly affected vessel (83.3%) and the most common target vessel for stenting (76.8%). A total of 268 stents were implanted, 95.3% of which were drug-eluting stents. During the hospital stay, 1 patient died, and the incidence of MACEs was 1.2%. No additional events had occurred at 30-day follow-up. After a median follow-up duration of 36 months (interquartile range 12 to 60), cumulate MACE-free survival was 80.5%, the rate of target vessel revascularization was 16.5%, and the rate of stent thrombosis was 3.6%. Cox regression showed that hypertension, smoking, a left ventricular ejection fraction <50%, anterior myocardial infarction, and autoimmune disease were independent predictors of MACEs. In conclusion, percutaneous coronary intervention in young women tends to result in an increased rate of target vessel revascularization during long-term follow-up, which may be influenced by conventional and nonconventional risk factors. PMID:23791012

Liu, Wei; Mukku, Venkata Kishore; Liu, Yu-Yang; Shi, Dong-Mei; Zhao, Ying-Xin; Zhou, Yu-Jie



Coronary Perforation and Covered Stents: An Update and Review  

PubMed Central

Coronary perforation is a rare complication of percutaneous coronary intervention. We present two different types of coronary intervention, but both ending with coronary perforation. However, these perforations were tackled successfully by covered stents. This article reviews the incidence, causes, presentation, and management of coronary perforation in the present era of aggressive interventional cardiology. Coronary perforations are classified as type I (extraluminal crater), II (myocardial or pericardial blushing), and III (contrast streaming or cavity spilling). Types I and II coronary perforations are caused by stiff or hydrophilic guidewires. Type I has a benign prognosis, whereas type II coronary perforations have the potential to progress to tamponade. Type III coronary perforations are caused by balloons, stents, or other intracoronary devices and commonly lead to cardiac tamponade necessitating pericardial drainage. However, type III perforations can be managed with covered stents without need for surgical intervention.

Al-Mukhaini, Mohammed; Panduranga, Prashanth; Sulaiman, Kadhim; Riyami, Abdulla Amour; Deeb, Mohammed; Riyami, Mohamed Barkat



Coronary bifurcation lesions: a current update.  


Coronary bifurcations are prone to develop atherosclerotic plaque because of turbulent blood flow and high shear stress. When compared with nonbifurcation coronary interventions, bifurcation interventions have historically reported a lower rate of procedural success, higher procedural costs, longer hospitalization, and higher clinical and angiographic restenosis. Treating bifurcation lesions is challenging, but a simple algorithm based on the side branch size, stenosis, and angulation can be used. The ongoing development of novel drug-eluting stent devices designed specifically for coronary bifurcations and the large randomized clinical trials being conducted to address their utility will add to the already present literature regarding treatment of coronary bifurcation lesions. PMID:19962049

Sharma, Samin K; Sweeny, Joseph; Kini, Annapoorna S



Usefulness of multislice computed tomographic coronary angiography to identify patients with abnormal myocardial perfusion stress in whom diagnostic catheterization may be safely avoided.  


Computed tomographic angiography (CTA) has been validated for noninvasive assessment of coronary anatomy. The aim was to establish whether CTA could guide the use of invasive coronary angiography (ICA) in symptomatic patients with intermediate risk after myocardial perfusion stress imaging (MPSI). From April 2005 to February 2006, patients referred for CTA to a cardiology practice were entered into a database. Inclusion required symptoms suggestive of coronary artery disease and intermediate-risk MPSI. Subjects with intermediate risk after MPSI underwent CTA, and if severe stenosis or moderate stenosis matching a perfusion defect was found, ICA was performed. If appropriate, patients were then sent for revascularization. Clinical follow-up was completed until December 2006. Main outcome measures were number of patients sent for ICA, immediate revascularization after ICA, and adverse outcomes (death, myocardial infarction, and late revascularization). Four hundred twenty-one patients were included. Adequate diagnostic-quality images were obtained in 99%. After MPSI-CTA assessment, 78 patients (18.5%) were sent for ICA and 343 (81.5%) were medically managed. Follow-up was 15+/-3 months. In the group referred for ICA, there were 50 cases of immediate revascularization, 1 non-ST-segment elevation myocardial infarction, 1 death, and 5 patients requiring repeat ICA, 3 of whom underwent late revascularization. In the medically managed group, 6 patients required late ICA, 1 of whom underwent revascularization. In conclusion, in symptomatic patients with suspected coronary artery disease and intermediate-risk MPSI results, CTA can identify up to 80% of patients at low risk of events in whom ICA may be safely avoided. Additional studies assessing new technologies combining MPSI-CTA are needed to refine imaging strategies in these patients. PMID:18036355

Danciu, Sorin C; Herrera, Cesar J; Stecy, Peter J; Carell, Edgar; Saltiel, Frank; Hines, Jerome L



Do women spend longer on wait lists for coronary bypass surgery? Analysis of a population-based registry in British Columbia, Canada  

Microsoft Academic Search

BACKGROUND: Studies have shown patients who are delayed for surgical cardiac revascularization are faced with increased risks of symptom deterioration and death. This could explain the observation that operative mortality among persons undergoing coronary artery bypass surgery (CABG) is higher among women than men. However, in jurisdictions that employ priority wait lists to manage access to elective cardiac surgery, there

Adrian R Levy; Boris G Sobolev; Lisa Kuramoto; Robert Hayden; Stuart M MacLeod



Economic Impact of Angioplasty Salvage Techniques, With an Emphasis on Coronary Stents: A Method Incorporating Costs, Revenues, Clinical Effectiveness and Payer Mix  

Microsoft Academic Search

Objectives. We sought to broaden assessment of the economic impact of percutaneous transluminal coronary angioplasty (PTCA) revascularization salvage strategies by taking into account costs, revenues, the off-setting effects of prevented clinical complications and the effects of payer mix.Background. Previous economic analyses of PTCA have focused on the direct costs of treatment but have not accounted either for associated revenues or

Paul T. Vaitkus; William T. Witmer; Richard G. Brandenburg; Susannah K. Wells; Jonathan B. Zehnacker



Atherosclerotic involvement of the radial artery in patients with coronary artery disease and its relation with midterm radial artery graft patency and endothelial function  

Microsoft Academic Search

BackgroundThe radial artery has recently been proposed as an alternative arterial conduit for surgical myocardial revascularization. This study was conceived to evaluate the degree of atherosclerotic involvement of the radial artery in patients with coronary artery disease and the eventual influence of a subtle degree of preoperative atherosclerosis on the midterm results of radial artery grafts.

Mario Gaudino; Paolo Tondi; Michele Serricchio; Paola Spatuzza; Angelo Santoliquido; Roberto Flora; Fabiana Girola; Giuseppe Nasso; Paolo Pola; Gianfederico Possati



The relationship between Elder Risk Assessment (ERA) scores and cardiac revascularization: a cohort study in Olmsted County, Minnesota, USA  

PubMed Central

Purpose The aging population is predisposed to cardiovascular disease. Our goal was to determine the relationship between a higher Elder Risk Assessment (ERA) score and coronary artery bypass graft (CABG) or percutaneous coronary intervention (PCI), in adults over 60 years. Methods This was a retrospective cohort study in a primary care internal medicine practice. Patients included community-dwelling individuals aged 60 years or older on January 1, 2005. The primary outcome was a combined outcome of CABG and PCI in 2 years. The secondary outcome was mortality 5 years after CABG or PCI. The primary predictor variable was the score on the ERA Index, an instrument that predicts emergency room visits and hospitalization. The outcomes were obtained using administrative data from electronic medical records. The analysis included logistic regression, with odds ratios for the primary outcome and time-to-event analysis for mortality. Results The records of 12,650 patients were studied. A total of 902 patients (7.1%) had either CABG or PCI, with an average age of 74.5 years (±8.3 years). There were 205 patients (23%) who experienced CABG or PCI in the highest-score group (top 10%) compared with 29 patients (3%) in the lowest score group, for an odds ratio of 15.4; 95% confidence interval, 10.1–23.5. There was a greater association of revascularization events by increasing score group. We noted increased mortality by increasing ERA score, in patients undergoing CABG or PCI. The patients in the highest-scoring group had a 50% 5-year survival rate compared with a 97% 5-year survival rate in the lowest-scoring group (P < 0.001). Conclusion Older adults in the highest-ERA-scoring group had the highest utilization of CABG or PCI. Patients with high ERA scores undergoing coronary revascularization were also at the highest risk of mortality. Providers should be aware that higher ERA scores can potentially predict outcomes in high-risk patients.

Sharma, Saurabh; Datta, Shruti; Gharacholou, Shahyar; Siddique, Shahzad K; Cha, Stephen s; Takahashi, Paul Y



Recurrent cardiac tamponade following unusual micro leak after successful closure of the primary leak.  


Although uncommon, coronary artery perforation is one of the most dreadful complications of percutaneous coronary intervention, which requires prompt, aggressive, and effective management. Perforations induced by coronary guidewires are usually located in the distal part of a coronary artery and commonly managed with embolization. This is an unusual case report of guidewire-induced coronary perforation with recurrent cardiac tamponade, which was managed successfully by coil embolization of both ipsilateral and contralateral coronary arteries via transradial approach. PMID:22388314

Baruah, Dibya Kumar; Lakshmi, Adi; Chandrashekaran, Vidya



Absent Right Superior Vena Cava with Persistent Left Superior Vena Cava Which Drains to Unroofed Coronary Sinus in a Child with Atrioventricular Septal Defect and Cor Triatriatum Sinister: Preop Correct Diagnosis and Successful Surgery in a Single Session.  


We report a unique case of a 4-year-old boy with intermediate-type atrioventricular septal defect, cor triatriatum sinister, persistent left superior vena cava, unroofed coronary sinus, and absent right superior vena cava. Persistent left vena cava draining into the unroofed coronary sinus was demonstrated easily using the agitated saline-contrast echocardiography. After conformation with angiographic evaluation, surgery was performed at a single session. Roofing of the coronary sinus with polytetrafluoroethylene patch, mitral cleft repair, tricuspid annuloplasty, atrioventricular defect repair with pericardial patch, and resection of the membrane in the left atrium was succeeded without complication. PMID:23602062

Doksöz, Onder; Güven, Bar??; Yozgat, Y?lmaz; Ozdemir, Rahmi; Me?e, Timur; Tavl?, Vedide; Alayunt, Emin Alp



Coronary Revascularization at Specialty Cardiac Hospitals and Peer General Hospitals in Black Medicare Beneficiaries  

Microsoft Academic Search

Background—Critics have raised concerns that specialty cardiac hospitals exacerbate racial disparities in cardiovascular care, but empirical data are limited. Methods and Results—We used administrative data from the Medicare Provider and Analysis Review Part A and Provider-of-Service files from 2002 to 2005. Multivariable logistic regression models were constructed to examine the likelihood of black Medicare patients being admitted to a cardiac

Brahmajee K. Nallamothu; Xin Lu; Mary S. Vaughan-Sarrazin; Peter Cram



The Effect of Dexamethasone on Side Effects After Coronary Revascularization Procedures  

Microsoft Academic Search

Corticosteroids decrease side effects after noncardiac elec- tive surgery. We designed this randomized, double- blinded, placebo-controlled study to test the hypothesis that standard doses of dexamethasone (4 mg 2) would reduce postoperative nausea, vomiting, and pain, de- crease the incidence of atrial fibrillation (AF), and improve appetite after cardiac surgery, thereby facilitating the re- covery process. A total of 300

Per Halvorsen; Johan R??der; Sven M. Almdahl; Kenneth Nordstrand; Kjell Saatvedt; Terje Veel



Risks associated with renal dysfunction in patients in the coronary care unit  

Microsoft Academic Search

OBJECTIVESThe purpose of this study was to quantify the impact of baseline renal dysfunction on morbidity and mortality in patients in the coronary care unit (CCU).BACKGROUNDThe presence of renal dysfunction is an established independent predictor of survival after acute myocardial infarction and revascularization procedures.METHODSWe analyzed a prospective CCU registry of 12,648 admissions by 9,557 patients over eight years at a

Peter A McCullough; Sandeep S Soman; Shalin S Shah; Stephen T Smith; Keisha R Marks; Jerry Yee; Steven Borzak



Myocardial perfusion imaging to evaluate the efficacy of medical therapy in patients with coronary artery disease  

Microsoft Academic Search

Myocardial perfusion imaging is commonly used to risk-stratify patients based on the presence and extent of stress-induced\\u000a myocardial ischemia. Recent studies have shown that both positron and single photon emission tomography techniques can be\\u000a used to assess the effectiveness of coronary revascularization procedures as well as various anti-ischemic medical therapies\\u000a on myocardial perfusion. In this regard, perfusion imaging may be

John J. Mahmarian



Differential benefits and outcomes of tirofiban vs abciximab for acute coronary syndromes in current clinical practice.  


Little comparative data exist for glycoprotein IIb/IIIa inhibitors in acute coronary syndromes (ACS). Two hundred twenty-eight patients were studied: 114 received tirofiban (TI) and 114 received abciximab (AB) for either unstable angina (UA) or myocardial infarction (MI). All patients received aspirin, heparin, and ticlopidine or clopidogrel. Baseline characteristics were similar between the 2 groups for admitting diagnosis (UA vs MI), age, gender, ejection fraction, diabetes mellitus, prior coronary artery disease, prior myocardial infarction (MI), prior bypass surgery, hypertension, congestive heart failure, hyperlipidemia, MI type (Q vs non-Q), or location. Drug administration time (mean) was 13 hours (AB) and 24 hours (TI). All AB was administered in the catheterization laboratory as compared to TI (34% in laboratory and 66% before laboratory). More AB patients received angioplasty or stent (92% vs 80%, p = 0.008) while more TI patients had CABG (10% vs 3%, p = 0.027). In-hospital complications including death, MI, urgent revascularization, cerebrovascular accidents or transient ischemic attacks, and access site bleeding were similar (p = NS). Multivariate predictors of events (odds ratios) were prior coronary artery bypass graft (2.3), diabetes (1.7), and prior percutaneous transluminal coronary angioplasty (1.7), but not the agent used. Over a mean follow-up of 13 months, the individual endpoints of death, MI, revascularization, or hospitalization were similar for both groups. The AB patients had improved freedom from revascularization (100% vs 81%, p = 0.015) in an emergent setting and TI patients had improved freedom from revascularization (93% vs 77%, p = 0.038) with elective procedures. Tirofiban and abciximab appear effective and safe when used for ACS when recommended dosing and precautions are followed. Major adverse outcomes are rare and bleeding complications uncommon. PMID:12678197

Gowda, Manohar S; Vacek, James L; Lakkireddy, D J; Brosnahan, Kathleen; Beauchamp, Gary D


Vascular endothelial growth factor (VEGF) gene transfer enhances surgical revascularization of necrotic bone  

Microsoft Academic Search

Avascular necrosis of bone is a relatively common clinical condition caused by inflammatory conditions, steroid or other drug use, and trauma that affect many different sites in man. Revascularization of the necrotic bone is slow to occur, often resulting in bone resorption and eventual collapse of the involved bone. Rapid revascularization and subsequent bone remodeling may lead to improved outcomes.Surgical

Kosuke Katsube; Allen T. Bishop; Robert D. Simari; Seppo Ylä-Herttuala; Patricia F. Friedrich



Transmyocardial laser revascularization: Operative techniques and clinical results at two years  

Microsoft Academic Search

Objectives: A new technique, transmyocardial laser revascularization, provides direct perfusion of ischemic myocardium via laser-created transmural channels. From 1993 to 1995, we have treated 20 patients (mean age 61 years, four women and 16 men) with transmyocardial laser revascularization. Preoperatively, the average angina class was 3.7. The patients were screened before the operation by a technetium sestamibi perfusion scan to

Keith A. Horvath; Finn Mannting; Nancy Cummings; Stanton K. Shernan; Lawrence H. Cohn



Implantation of blood vessels into a free bone graft to promote its revascularization  

Microsoft Academic Search

Experiments on rats were used to study the revascularization of a free autogenous bone graft following implantation of blood vessels. The free grafts consisted of tail vertebrae, with a vascular bundle or an artery introduced into the marrow cavity. It was found that proliferation of capillaries promoting revascularization of the graft originated from the adventitia of the implanted artery. It

J. Valka; J. Šmahel; V. E. Meyer



Bone scintigraphy in evaluating the viability of composite bone grafts revascularized by microvascular anastomoses, conventional autogenous bone grafts, and free non-revascularized periosteal grafts  

Microsoft Academic Search

Researchers studied the value of bone scintigraphy in the assessment of anastomotic patency and bone-cell viability in free bone grafts revascularized by microvascular anastomoses in twenty-seven dogs. The dogs were divided into three different groups, and scintigraphy was carried out using technetium-labeled methylene diphosphonate in composite bone grafts revascularized by microvascular anastomoses, conventional autogenous bone grafts, and periosteal grafts placed

A. Berggren; A. J. Weiland; L. T. Ostrup



Gene therapy to stimulate angiogenesis to treat diffuse coronary artery disease.  


Abstract Cardiac gene therapy offers a strategy to treat diffuse coronary artery disease (CAD), a disorder with no therapeutic options. The use of genes to revascularize the ischemic myocardium has been the focus of two decades of preclinical research with a variety of angiogenic mediators, including vascular endothelial growth factor, fibroblast growth factor, hepatocyte growth factor, and others encoded by DNA plasmids or adenovirus vectors. The multifaceted challenge for developing efficient induction of collateral vessels in the ischemic heart requires a choice for route of delivery, dosing level, a relevant animal model, duration of treatment, and assessment of phenotype for efficacy. Overall, studies of gene therapy for ischemia in experimental models are very encouraging, with clear evidence of safety and efficacy, strongly supporting the concept that gene therapy to induce angiogenesis is a viable therapeutic approach for CAD. Clinical studies of cardiac gene therapy with angiogenic factors have added substantially to the evidence for efficacy, but definitive studies have not yet led to commercial approval. This review provides the general concepts for angiogenesis-based therapeutic approaches for diffuse CAD and summarizes the results from key studies in the field with recommendations for refinement to a successful product design and evaluation. PMID:24164242

Kaminsky, Stephen M; Rosengart, Todd K; Rosenberg, Jonathan; Chiuchiolo, Maria J; Van de Graaf, Benjamin; Sondhi, Dolan; Crystal, Ronald G



Wire-guided excimer laser coronary angioplasty: instrument selection, lesion characterization, and operator technique.  


Laser angioplasty has now been successfully performed on over 2,000 patients worldwide. Two systems (Advanced Interventional Systems, and Spectranetics, Corp.) have now received initial approval from the Food and Drug Administration. As with all new interventional techniques designed as an alternative to balloon angioplasty, there are a variety of instrument related issues that merit consideration in terms of patient selection as well as operator technique. While the ultimate role of laser angioplasty in the percutaneous revascularization of coronary artery disease remains to be established with certainty, laser angioplasty is, in fact, being currently used on a widespread basis as an alternative or an adjunct to balloon angioplasty in a large number of centers worldwide. Industry projections suggest that the use of this technique will increase further over the next decade. Accordingly, the purpose of this article is to discuss specific issues regarding instrumentation, native anatomical considerations, operator technique, and complications that relate specifically to the applied use of this technology as it is currently being used. PMID:10150967

Bittl, J A; Sanborn, T A; Abela, G S; Isner, J M



Revascularization of immature permanent incisors after severe extrusive luxation injury.  


Pulp necrosis is an uncommon sequel to extrusive luxation in immature teeth with incomplete apical closure. In this report, we describe the management of severely extruded immature maxillary incisors and the outcome of revascularization to treat subsequent pulp necrosis. An 8.5-Year-old boy with severe dentoalveolar trauma to the anterior maxillary region as a result of a fall was provided emergency treatment consisting of reduction of the dislodged labial cortical bone and repositioning of the central incisors, which had suffered extrusive luxation. When he presented with spontaneous pain involving the traumatized incisors a week later, the teeth were treated via a revascularization protocol using sodium hypochlorite irrigation followed by 3 weeks of intracanal calcium hydroxide, then a coronal seal of mineral trioxide aggregate and resin composite. Complete periradicular healing was observed after 3 Months, followed by progressive thickening of the root walls and apical closure. Follow-up observations confirmed the efficacy of the regenerative treatment as a viable alternative to conventional apexification in endodontically involved, traumatized immature teeth. PMID:22322021

Cehreli, Zafer C; Sara, Sezgi; Aksoy, Burak



Revascularization of immature permanent incisors after severe extrusive luxation injury.  


Pulp necrosis is an uncommon sequel to extrusive luxation in immature teeth with incomplete apical closure. In this report, we describe the management of severely extruded immature maxillary incisors and the outcome of revascularization to treat subsequent pulp necrosis. An 8.5-year-old boy with severe dentoalveolar trauma to the anterior maxillary region as a result of a fall was provided emergency treatment consisting of reduction of the dislodged labial cortical bone and repositioning of the central incisors, which had suffered extrusive luxation. When he presented with spontaneous pain involving the traumatized incisors a week later, the teeth were treated via a revascularization protocol using sodium hypochlorite irrigation followed by 3 weeks of intracanal calcium hydroxide, then a coronal seal of mineral trioxide aggregate and resin composite. Complete periradicular healing was observed after 3 months, followed by progressive thickening of the root walls and apical closure. Follow-up observations confirmed the efficacy of the regenerative treatment as a viable alternative to conventional apexification in endodontically involved, traumatized immature teeth. PMID:22916525

Cehreli, Zafer C; Sara, Sezgi; Aksoy, Burak



The treatment of cerebral ischemia by external carotid artery revascularization.  


Thirteen patients with internal carotid artery occlusion and symptomatic external carotid artery stenosis underwent external carotid artery revascularization by means of endarterectomy (n = 10) or subclavian artery--external carotid artery bypass (n = 3). All patients but one were followed up, for five to 46 months (mean, 20 months). There were no operative deaths or complications and no late strokes. One patient (7.7%) required early extracranial-intracranial (EC-IC) bypass for failure of the external carotid artery endarterectomy to relieve the initial symptoms. All remaining patients were completely (n = 9) or partially (n = 2) relieved of symptoms, and EC-IC bypass was not required. There were no criteria identified by either oculopneumoplethysmography or angiography that could reliably predict the need for subsequent EC-IC bypass. Ninety-two percent of the patients were adequately treated with external carotid artery revascularization alone, suggesting that subsequent EC-IC bypass is seldom required in patients with ipsilateral internal carotid artery occlusion and external carotid artery stenosis. PMID:6838360

Schuler, J J; Flanigan, D P; DeBord, J R; Ryan, T J; Castronuovo, J J; Lim, L T



Impact of preoperative positron emission tomography in patients with severely impaired LV-function undergoing surgical revascularization  

PubMed Central

In patients with ischemic cardiomyopathy, coronary artery bypass grafting (CABG) offers an important therapeutic option but is still associated with high perioperative mortality. Although previous studies suggest a benefit from revascularization for patients with defined viability by a non-invasive technique, the role of viability assessment to determine suitability for revascularization in patients with ischemic cardiomyopathy has not yet been defined. This study evaluates the hypothesis that the use of PET imaging in the decision-making process for CABG will improve postoperative patient survival. We reviewed 476 patients with ischemic cardiomyopathy (LV ejection fraction ?0.35) who were considered candidates for CABG between 1994 and 2004 on the basis of clinical presentation and angiographic data. In a Standard Care Group, 298 patients underwent CABG. In a second PET-assisted management group of 178 patients, 152 patients underwent CABG (PET-CABG) and 26 patients were excluded from CABG because of lack of viability (PET-Alternatives). Primary endpoint was postoperative survival. There were two in hospital deaths in the PET-CABG (1.3%) and 30 (10.1%) in the Standard Care Group (P = 0.018). The survival rate after 1, 5 and 9.3 years was 92.0, 73.3 and 54.2% in the PET-CABG and 88.9, 62.2 and 35.5% in the Standard Care Group, respectively (P = 0.005). Cox-regression analysis revealed a significant influence on long-term survival of patient selection by viability assessment via PET (P = 0.008), of LV-function (P = 0.017), and age >70 (P = 0.016). Preoperative assessment of myocardial viability via PET identifies patients, who will benefit most from CABG.

Haas, Felix; Bauernschmitt, Robert; Wagenpfeil, Stefan; Voss, Bernhard; Schwaiger, Markus; Lange, Rudiger



Coronary Angioplasty  


... or blocked coronary (heart) arteries. The procedure restores blood flow to the heart muscle. Overview As you age, a waxy substance called ... the plaque against the artery wall. This restores blood flow through the ... heart muscle damage caused by a heart attack. Outlook Serious ...


Coronary arteriography and angioplasty  

SciTech Connect

This book explores biomedical radiography of the heart. Topics considered include six bench marks in the history of cardiac catheterization; normal coronary anatomy; anomalies of the coronary arteries; pathoanotomy of the coronary arteries and complications; indications, limitations, and risks of coronary arteriography and left ventriculography; catheterization techniques in coronary arteriography and left ventriculography: the Sones technique; catheterization techniques in coronary arteriography and left ventriculography: the Judkins technique; modification of Judkins catheters; catheterization techniques in coronary arteriography and left ventriculography multipurpose technique; new views in coronary arteriography; quantitative evaluation of left ventricular function; complications of coronary arteriography: management during and following the procedure; interpretation of coronary arteriograms and left ventriculograms; prevalence and distribution of disease in patients catheterized for suspected coronary disease at Emory University Hospital; the Cardiac Catheterization Laboratory; selection for surgery or percutaneous transluminal coronary angioplasty; intracoronary thrombolysis; and percutaneous transluminal coronary angioplasty.

King, S.B.; Douglas, J.S.



New Treatment Applying Low Level Laser Therapy for Acute Dehiscence Saphenectomy in Post Myocardial Revascularization.  

NASA Astrophysics Data System (ADS)

Introduction: In Brazil, the main cause of death is the coronary heart disease and the surgical treatment applied in such cases is the Myocardial Revascularization (MR). Patients undergoing to MR through saphenous vein bypass development dehiscence in 10% of the cases. Dehiscence of surgical incision through Biomodulation treatment with Low Level Laser Therapy (LLLT) in patients who underwent to MR seems to be an unprecedented new therapy and a less invasive technique, which can benefit patients and Institutions, reducing costs. Methodology: It was analyzed 7 diabetic patients, mean age 51, 8 years old that post MR surgery presented dehiscence of the saphenectomy incision on lower limb with erithema, edema and pain. The wounds area varies from 2,2 until 34,8 cm and deep from 0,1 until 1,1 cm. It was used only Diode Laser C.W. (655 nm wavelength), Power = 25 mW, Time = 30 s, Fluence = 4 J/cm2 applied punctually around surgical wound's sore, by 2 cm distance. Results: It was observed granulated tissue all around the incision, as well as decreased inflammatory process, reduction fibrin and wound's size, besides analgesic effect since the first application. It was required in superficial wounds only 3 applications, while in the extensive wounds 8-10 applications were necessary. The LLLT has shown a remarkable role as a wound healing facilitated agent, reflecting the reduction of inflammatory process and improving analgesia. Conclusion: LLLT assisted dehiscence post saphenectomy showed a substantial improvement to the patient's quality of life, with a cost-effectiveness treatment that can benefit both patients and Institutions as an effective and less invasive therapy.

Pinto, Nathali Cordeiro; Shoji, Nara; Junior, Mauro Favoretto; Muramatso, Mikiya; Chavantes, Maria Cristina; Stolf, Noedir A. G.



BMI and Health Status in the Bypass Angioplasty Revascularization Investigation 2 Diabetes Trial (BARI 2D)  

PubMed Central

BACKGROUND The longitudinal association between obesity, weight variability and health status outcomes is important for patients with coronary disease and diabetes. METHODS The Bypass Angioplasty Revascularization Investigation 2 Diabetes trial (BARI 2D) was a multi-center randomized clinical trial to evaluate the best treatment strategy for patients with both documented stable ischemic heart disease and type 2 diabetes. We examined BARI 2D participants for four years to study how BMI was associated with health status outcomes. Health status was evaluated by the Duke Activity Status Index (DASI), RAND Energy/fatigue, Health Distress, and Self-rated health. BMI was measured quarterly throughout follow-up years, and health status was assessed at each annual follow-up visit. Variation in BMI measures was separated into between-person and within-person change in longitudinal analysis. RESULTS Higher mean BMI over follow-up years (the between-person BMI) was associated with poorer health status outcomes. Decreasing BMI (the within-person BMI change) was associated with better Self-rated health. The relationships between BMI variability and DASI or Energy appeared to be curvilinear, and differed by baseline obesity status. Decreasing BMI was associated with better outcomes if patients were obese at baseline, but was associated with poorer DASI and Energy outcomes if patients were non-obese at baseline. CONCLUSIONS For patients with stable ischemic heart disease and diabetes, weight gain was associated with poorer health status outcomes, independent of obesity-related comobidities. Weight reduction is associated with better functional capacity and perceived energy for obese patients but not for non-obese patients at baseline.

Chung, Sheng-Chia; Hlatky, Mark A.; Stone, Roslyn A.; Rana, Jamal S.; Escobedo, Jorge; Rogers, William J.; Bromberger, Joyce T.; Kelsey, Sheryl F.; Brooks, Maria Mori



Heart rate recovery as a predictor of mortality with or without revascularization.  


Increased heart rate during graded exercise is related to increased sympathetic activity and withdrawal of vagal tone. Return of heart rate towards baseline immediately after exercise is usually due to resurgence of vagal tone. As it is an established fact that cardiovascular morbidity and mortality in part has direct relation with parasympathetic dysfunction, it is natural that reduced heart rate recovery (HRR) after exercise, a parameter of parasympathetic dysfunction, could be a predictor of morbidity and mortality. Accordingly 390 TMT positive patients were analysed for HRR as per standard guidelines and followed up for 5 years. While 244(62.6%) showed a normal HRR, 146(37.4%) showed an abnormal HRR. Abnormal HRR was more common in the elderly, in patients with higher resting heart rate, hypertension, diabetes mellitus, current smoking and prior established coronary artery disease (CAD). There were a total of 36 deaths (9.23%) during the 5 year follow-up period. There was mortality advantage in patients who were subjected to revascularization procedure in general (7.5% deaths in revascularised arm vs 10.4% in conservative arm). Analysis reveals persistence of such benefit in patients having normal HRR (2.85% deaths in revascularised arm vs 7.25% in conservative arm). However, mortality benefit was not observed among both groups of patients with abnormal HRR(16.6% deaths in revascularised vs 15.2% in conservatively managed7rpar;. Secondary end points like recurrent angina, arrhythmia, acute myocardial infarction, hospitalization for cardiovascular cause and heart failure were observed in significantly more number of cases with abnormal HRR in comparison to normal. We therefore conclude the abnormal HRR after TMT is an adverse prognostic indicator in patients with symptomatic CAD on long term follow-up. PMID:19729694

Mishra, Archana; Mishra, Chandrakanta; Mohanty, Rama Raman; Behera, Mrutyunjay; Mishra, Kaushik


Management of chronic coronary disease: is the pendulum returning to equipoise?  


Over the last 3 decades, our ability to mechanically dilate obstructive coronary arterial stenoses has fundamentally altered our approach to managing patients with coronary artery disease (CAD). The result has been a swing from an initial pharmacologic approach to anatomically driven revascularization. An accumulation of clinical evidence provides strong support for such intervention in acute coronary syndromes (ACS). In stable CAD, dilative therapy was believed to be superior based on the assumption that high-risk coronary anatomy or myocardial ischemia increases the risk of future death and myocardial infarction. However, there have been major advances in our understanding of the pathophysiology of ACS and the recognition of the significance of predisposing non-flow-limiting coronary stenoses prone to rupture, as well as increasing insight into plaque and patient vulnerability. This improved understanding of the disease has led to the more aggressive use of appropriately targeted pharmacologic agents and an evolution in what constitutes optimal medical therapy (OMT). Data from recent studies, such as the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial, support the concept that in patients with stable CAD, OMT alone in this day and age compares favorably with a therapeutic strategy combining OMT with mechanical intervention. Thus, the treatment pendulum may be swinging back to the understanding that "best practice" today requires the judicious use of interventional and medical therapies in the appropriate patient population. PMID:18474277

Boden, William E



Is Age of 80 Years a Threshold for Carotid Revascularization?  

PubMed Central

Background and purpose: Carotid Angioplasty and Stenting (CAS) has emerged as an alternative to Carotid Endarterectomy (CEA) in treatment of carotid stenotic disease. With increasing life expectancy clinicians are more often confronted with patients of higher age. Octogenarians were often excluded from randomized trials comparing CAS to CEA because they were considered high-risk for revascularization. Conflicting results on the peri-procedural outcome of carotid revascularization in these patients have been reported. In order to objectively evaluate whether age above 80 years should be an upper limit for indicating carotid revascularization we systematically reviewed the currently available literature. Methods: Literature was systematically reviewed between January 2000 and June 2010 using Pubmed and Embase, to identify all relevant studies concerning CAS and CEA in octogenarians. Inclusion criteria were 1) reporting outcome on either CEA or CAS; and 2) data subanalysis on treatment outcome by age. The 30-day Major Adverse Event (MAE) rate (disabling stroke, myocardial infarction or death) was extracted as well as demographic features of included patients. Results: After exclusion of 23 articles, 46 studies were included in this review, 18 involving CAS and 28 involving CEA. A total of 2.963 CAS patients and 14.365 CEA patients with an age >80 years were reviewed. The MAE rate was 6.9% (range 1.6 - 24.0%) following CAS and 4.2% (range 0 – 8.8%) following CEA. A separate analysis in this review included the results of one major registry 140.376 patients) analyzing CEA in octogenarians only reporting on 30-day mortality and not on neurological or cardiac adverse events. When these data were included the MAE following CEA is 2.4% (range 0 – 8.8%) Conclusions: MAE rates after CEA in octogenarians are comparable with the results of large randomized trials in younger patients. Higher complication rates are described for CAS in octogenarians. In general, age > 80 years is not an absolute cut off point to exclude patients from carotid surgery. In our opinion, CEA should remain the golden standard in the treatment of significant carotid artery stenoses, even in the very elderly.

Reichmann, Boudewijn L; van Lammeren, Guus W.; Moll, Frans L; de Borst, Gert J.



Axillary artery to left anterior descending coronary artery bypass with an externally stented graft: a technical report  

PubMed Central

With the proliferation of minimally invasive cardiac surgery a number of alternative inflow sites for coronary artery bypass grafting have been utilized, especially in higher risk patients. The use of axillary-coronary artery bypass is a safe and effective alternative especially in the case of patients requiring redo coronary revascularization. However, the length and convoluted course of the axillary-coronary vein graft makes is susceptible to twisting, trauma and neointimal hyperplasia. We therefore report a case of an axillary-coronary artery bypass in a high risk patient in which a Dacron conduit was used to externally support and protect the vein graft to the left anterior descending artery. Surgical technique and considerations are presented and discussed.

Athanasiou, Thanos; Kapetanakis, Emmanouil I; Rao, Christopher; Salvador, Loris; Darzi, Ara



Coronary artery disease  

MedlinePLUS Videos and Cool Tools

The coronary arteries supply blood to the heart muscle itself. Damage to or blockage of a coronary artery can result in injury to the heart. Normally, blood flows through a coronary artery unimpeded. However, if the ...


In Vivo Optical Imaging of Revascularization after Brain Trauma in Mice  

PubMed Central

Revascularization following brain trauma is crucial to the repair process. We used optical micro-angiography (OMAG) to study endogenous revascularization in living mice following brain injury. OMAG is a volumetric optical imaging method capable of in vivo mapping of localized blood perfusion within the scanned tissue beds down to capillary level imaging resolution. We demonstrated that OMAG can differentiate revascularization progression between traumatized mice with and without soluble epoxide hydrolase (sEH) gene deletion. The time course of revascularization was determined from serial imaging of the traumatic region in the same mice over a one-month period of rehabilitation. Restoration of blood volume at the lesion site was more pronounced in sEH knockout mice than in wild-type mice as determined by OMAG. These OMAG measurements were confirmed by histology and showed that the sEH knockout effect may be involved in enhancing revascularization. The correlation of OMAG with histology also suggests that OMAG is a useful imaging tool for real-time in vivo monitoring of post-traumatic revascularization and for evaluating agents that inhibit or promote endogenous revascularization during the recovery process in small rodents.

Jia, Yali; Grafe, Marjorie R.; Gruber, Andras; Alkayed, Nabil J.; Wang, Ruikang K.



In vivo optical imaging of revascularization after brain trauma in mice.  


Revascularization following brain trauma is crucial to the repair process. We used optical micro-angiography (OMAG) to study endogenous revascularization in living mice following brain injury. OMAG is a volumetric optical imaging method capable of in vivo mapping of localized blood perfusion within the scanned tissue beds down to capillary level imaging resolution. We demonstrated that OMAG can differentiate revascularization progression between traumatized mice with and without soluble epoxide hydrolase (sEH) gene deletion. The time course of revascularization was determined from serial imaging of the traumatic region in the same mice over a one-month period of rehabilitation. Restoration of blood volume at the lesion site was more pronounced in sEH knockout mice than in wild-type mice as determined by OMAG. These OMAG measurements were confirmed by histology and showed that the sEH knockout effect may be involved in enhancing revascularization. The correlation of OMAG with histology also suggests that OMAG is a useful imaging tool for real-time in vivo monitoring of post-traumatic revascularization and for evaluating agents that inhibit or promote endogenous revascularization during the recovery process in small rodents. PMID:21075124

Jia, Yali; Grafe, Marjorie R; Gruber, Andras; Alkayed, Nabil J; Wang, Ruikang K



Results with a Selective Revascularization Strategy for Left Subclavian Artery Coverage During Thoracic Endovascular Aortic Repair  

PubMed Central

Background The need for routine left subclavian artery (LSCA) revascularization when this vessel is covered during thoracic endovascular aortic repair (TEVAR) remains controversial. Here, we report our results with a selective LSCA revascularization strategy during TEVAR. Methods Between 5/2002 and 3/2010, 287 TEVAR procedures were performed at our institution. Of these, 145 (51%) had coverage of the LSCA and form the basis of this report. Results LSCA revascularization was performed in 32 patients (22%) via left common carotid-LSCA bypass. Indications for selective LSCA revascularization included: spinal cord protection (n = 10), patent pedicled left internal mammary artery graft (n = 9), left arm ischemia following LSCA coverage (n = 5), origin of the left vertebral artery from the arch (n = 4), dialysis access in the left upper extremity (n = 2), and vertebrobasilar insufficiency (n = 2). There were no instances of dominant left vertebral artery. There was no difference in the rate of death (6.3% vs 1.8%; p = 0.21), stroke (3.1% vs 3.5%; p = 1.00), permanent paraplegia/paraparesis (3.1% vs 0%; p = 0.22), or type II endoleak (4.3% vs 6.5%; p = 1.00) between the revascularized and non-revascularized groups, respectively. There were no instances of ischemic stroke related to left posterior circulation hypoperfusion. Four complications of carotid-subclavian bypass occurred in three patients (9.4%). Conclusions Selective LSCA revascularization is safe and does not appear to increase the risk of neurologic events. Further, subclavian revascularization is not without complications, which should be considered with regards to a non-selective revascularization strategy.

Lee, Teng C.; Andersen, Nicholas D.; Williams, Judson B.; Bhattacharya, Syamal D.; McCann, Richard L.; Hughes, G. Chad



Syphilitic Coronary Artery Ostial Stenosis Resulting in Acute Myocardial Infarction Treated by Percutaneous Coronary Intervention  

PubMed Central

Cardiovascular abnormalities are well-known manifestations of tertiary syphilis infections which although not frequent, are still causes of morbidity and mortality. A less common manifestation of syphilitic aortitis is coronary artery ostial narrowing related to aortic wall thickening. We report a case of a 46-year-old male admitted due to acute anterior ST elevation myocardial infarction submitted to primary percutaneous coronary intervention successfully. Coronary angiography showed a suboccluded ostial lesion of left main coronary artery. VDRL was titrated to 1/512. The patient was discharged with treatment including benzathine penicillin. Previous case reports of acute myocardial infarction in association with syphilitic coronary artery ostial stenosis have been reported, but the fact that the patient was treated by percutaneous coronary intervention is unique in this case.

Nakazone, Marcelo A.; Machado, Mauricio N.; Barbosa, Raphael B.; Santos, Marcio A.; Maia, Lilia N.



Comparison by meta-analysis of percutaneous coronary intervention versus coronary artery bypass grafting in patients with a mean age of ?70 years.  


A paucity of published data evaluating the outcomes of older patients (age ?70 years) undergoing revascularization for unprotected left main coronary artery disease is available. We performed aggregate data meta-analyses of the clinical outcomes (all-cause mortality, nonfatal myocardial infarction, stroke, repeat revascularization, and major adverse cardiac and cerebrovascular events at 30 days and 12 and 22 months) in studies comparing percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in patients with a mean age of ?70 years and unprotected left main coronary artery disease. A comprehensive, time-unlimited literature search to January 31, 2013 identified 10 studies with a total of 2,386 patients (PCI, n = 909; CABG, n = 1,477). Summary odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using the random-effects model. The patients in the PCI group were more likely than those in the CABG group to present with acute coronary syndrome (59.6% vs 44.8%, p <0.001). PCI was associated with a shorter hospital stay (4.2 ± 0.8 vs 8.3 ± 0.01 days, p <0.001). No significant differences were found between PCI and CABG for all cause-mortality, nonfatal myocardial infarction, and major adverse cardiac and cerebrovascular events at 30 days and 12 and 22 months. However, PCI was associated with lower rates of stroke at 30 days (OR 0.14, 95% CI 0.02 to 0.76) and 12 months (OR 0.14, 95% CI 0.03 to 0.60) and higher rates of repeat revascularization at 22 months (OR 4.34, 95% CI 2.69 to 7.01). These findings were consistent with the findings from a subgroup analysis of patients aged ?75 years. In conclusion, older patients (age ?70 years) with unprotected left main coronary artery disease had comparable rates of all-cause mortality, nonfatal myocardial infarction, and major adverse cardiac and cerebrovascular events after PCI or CABG. The patients undergoing PCI had a shorter hospital stay and lower rates of early stroke; however, they experienced higher repeat revascularization rates at longer term follow-up. PMID:23726179

Alam, Mahboob; Virani, Salim S; Shahzad, Saima A; Siddiqui, Sahar; Siddiqui, Khaleeq H; Mumtaz, Shahzad A; Kleiman, Neal S; Coselli, Joseph S; Lakkis, Nasser M; Jneid, Hani



Platelet glycoprotein IIb/IIIa receptor blockade in coronary artery disease.  


New strategies for profound inhibition of platelet activity at the injured coronary plaque focus on blockade of the platelet surface membrane glycoprotein IIb/IIIa receptor, which binds circulating fibrinogen or von Willebrand factor and crosslinks platelets as the final common pathway to platelet aggregation. Intravenous agents directed against this receptor include the chimeric monoclonal antibody fragment abciximab, the peptide inhibitor eptifibatide and nonpeptide mimetics tirofiban and lamifiban. Over 33,000 patients have been evaluated in 11 large-scale, placebo-controlled trials of these agents. During percutaneous coronary intervention, an absolute reduction of 1.5% to 6.5% in the 30-day risk of death, myocardial infarction or repeat urgent revascularization has been observed, with some variability in treatment effect among the agents tested (abciximab, eptifibatide and tirofiban). Treatment effect is achieved early with every modality of revascularization and is maintained over the long-term (up to three years). Increased bleeding risk may be minimized by reduction and weight-adjustment of concomitant heparin dosing. In the acute coronary syndromes without ST segment elevation, absolute 1.5% to 3.2% reductions in 30-day rates of death or myocardial (re-) infarction have been achieved with two to four day courses of eptifibatide or tirofiban. Clinical benefit accrues during the period of drug infusion and is durable. Treatment effect may be enhanced among patients undergoing early coronary revascularization, with evidence of stabilization before intervention and suppression of postprocedural ischemic events. Thus, blockade of the platelet glycoprotein IIb/IIIa receptor reduces ischemic complications when used as an adjunct to percutaneous coronary intervention or the management of acute ischemic syndromes. PMID:10758948

Lincoff, A M; Califf, R M; Topol, E J



Cryoablation of ventricular tachycardia arising from the left-coronary sinus cusp.  


Ventricular tachycardia (VT) arising from the coronary sinus cusps and mimicking right-ventricular morphology is a rare entity. In this report, we report the successful cryoablation of left-coronary sinus cusp VT. PMID:22562775

Uppu, Santosh C; Tuzcu, Volkan



The life and hard times of a coronary surgeon  

PubMed Central

Coronary artery bypass is arguably the most extensively studied operation in surgical history. The technical advances and beneficial effects on symptoms and prognosis have been well documented over four decades. Percutaneous coronary interventions (PCIs) have also evolved through numerous modifications, and symptom relief has been substantiated; both modalities have been challenged by many randomized controlled trials. The rapid growth of PCIs has decreased coronary artery bypass volumes, and resulted in concerns about training, teaching, research, jobs and income. The most important concern, however, is the increasing ‘off-label’ application of PCIs with drug-eluting stents to a variety of untested coronary lesions. The randomized controlled trials studied a small fraction of those registered and excluded patients who are known to benefit from surgery and, thus, these studies were inherently biased. The results were then extrapolated to ‘real-world’ patients, who had been misinformed and misled about the performance and prognosis of coronary stents, as was later revealed in various registries. Hospitals should develop a collaborative revascularization strategy to provide patients and families with realistic alternatives.

Goldman, Bernard S



Left main coronary stenting in a non surgical octogenarian population: a possible approach.  


Coronary artery bypass grafting is conventionally considered the standard treatment for significant left main coronary artery (LMCA) disease. The management of LMCA disease in octogenarians is however still debated. The aim of this study was to appreciate the safety and effectiveness of percutaneous coronary intervention (PCI) for LMCA disease in octogenarians who were denied for surgical revascularization. The study included 70 consecutive patients ?80 years of age who had undergone PCI for the treatment of LMCA and who were primary denied by our center's heart team for surgical revascularization. Mean age was 83.4±2.6 years. Mean Euroscore was 21.1±16.7 and mean Syntax score was 28.6±8.7. Overall in-hospital mortality was 11%. Mean follow-up time was 30.5±24.2 months. Overall mortality at the end of follow-up was 28%. Cardiac death was found in 18 patients and 2 patients died from terminal renal insufficiency. One patient (2%) presented with a new STEMI, 7 (11.3%) with a new non-STEMI, 13 (21%) with heart failure, and 2 (3.2%) had minor hemorrhage. There was a percutaneous target vessel revascularization in 6 (10%) patients. During follow-up, the total major adverse cerebral and cardiovascular event (MACCE including death, non-fatal acute myocardial infarction (AMI), target lesion revascularization (TLR), or stroke) was 27.4%. Stent implantation was relatively safely applied for the treatment of LMCA disease in octogenarians who were refused for surgery and who represented a high risk population. Despite a non-negligible rate of MACCE, the clinical long term outcome seems correct for this specific population with heavy basal status. PMID:22406303

Dahdouh, Ziad; Roule, Vincent; Sabatier, Rémi; Lognoné, Thérèse; Manrique, Alain; Bignon, Mathieu; Malcor, Guillaume; Massetti, Massimo; Grollier, Gilles



Percutaneous coronary intervention of an obstructive left anterior descending artery with anomalous origin of right coronary artery  

PubMed Central

Coronary artery anomalies are a rare type of congenital anomalies with an incidence of 1.3% during routine cardiac catheterization. Anomalous origin of the coronary arteries is considered an incidental finding without clinical significance. This case describes a patient in whom evaluation of chest pain revealed an obstructive left anterior descending artery as well as an anomalous right coronary artery arising from the left coronary sinus. The patient underwent successful percutaneous coronary intervention of the left anterior descending artery and was discharged home free of angina 3 days later.

Dubey, Laxman



Results of interventional treatment of stress positive coronary artery disease.  


The aim of this study was to define the impact of percutaneous coronary intervention (PCI) including stenting in patients with stress-positive stable coronary artery disease on long-term prognosis and symptoms. A group of 1,018 patients were identified from the angiographic and single-photon emission computed tomographic (SPECT) databases (technetium-99m sestamibi or tetrofosmin at rest and during stress) January 1, 2000, to December 31, 2003, to have significant coronary artery disease (>50% diameter stenosis on quantitative coronary angiography) and positive SPECT findings. Two hundred sixty-six patients were medically treated. Seven hundred fifty-two patients with positive SPECT findings who underwent PCI were matched to 266 patients of similar age, gender, number and location of stenotic arteries, left ventricular function, and size of SPECT perfusion defect who underwent medical treatment. Clinical events (death, nonfatal myocardial infarction, and revascularization) as well as clinical symptoms (angina or dyspnea, Canadian Cardiovascular Society class II to IV) were determined after a follow-up period of 6.4 +/- 1.2 years. In 524 of the 532 patients (98%), clinical follow-up was obtained. There were no differences between the PCI and medical groups in the frequencies of death (13.5% vs 10.9%) and myocardial infarction (5.3% vs 5.6%) during follow-up. PCI patients had more revascularization procedures <1 year after choice of treatment modality (14.7% vs 6.0%, p <0.002). During the subsequent follow-up period (>1 year), the 2 groups did not differ in the frequency of revascularization procedures. At the end of follow-up, patients in the PCI group complained less frequently of angina pectoris (38% vs 49%, p = 0.014). In conclusion, in patients with stress-positive stable coronary artery disease, PCI including stenting did not reduce mortality or rate of nonfatal myocardial infarction. The PCI group complained less frequently of angina pectoris at long-term follow-up. PMID:20494657

Adamu, Umar; Knollmann, Daniela; Alrawashdeh, Wael; Almutairi, Bader; Deserno, Verena; Kleinhans, Eduard; Schäfer, Wolfgang; Hoffmann, Rainer



Effect of Glycoprotein IIb\\/IIIa Receptor Blockade on Recovery of Coronary Flow and Left Ventricular Function After the Placement of Coronary-Artery Stents in Acute Myocardial Infarction  

Microsoft Academic Search

Background—Apart from its established effects on vessel patency after percutaneous coronary revascularization, glycoprotein IIb\\/IIIa receptor blockade by abciximab may improve myocardial perfusion by inhibition of the interaction of platelets and platelet aggregates with the microvasculature. We investigated the effect of abciximab with stent placement in acute myocardial infarction. Methods and Results—In a prospective randomized trial, patients undergoing stenting in acute

Franz-Josef Neumann; Rudolf Blasini; Claus Schmitt; Eckhard Alt; Josef Dirschinger; Meinrad Gawaz; Adnan Kastrati; Albert Schomig


Temporary Intraluminal Vascular Shunts for Limb Revascularization in Traumatic Injury of the Extremities.  

National Technical Information Service (NTIS)

Vascular injury with extremity ischemia continues to result in high amputation rates when it is associated with extensive soft tissue loss, skeletal injuries, or life-threatening injuries. The time between injury and revascularization is the most readily ...

D. L. Dawson R. I. Labbe R. W. Feldtman



Lateral plantar artery bypass grafting: defining the limits of foot revascularization.  


We placed 20 bypass grafts to the lateral plantar artery in 18 extremities to salvage feet with wet (12) or dry (six) gangrene; 15 grafts were implanted in men (75%), and five were implanted in women (25%). The median age was 65 years. All except two patients had diabetes; eight were treated with insulin. One patient had Buerger's disease, and another had vasculitis with chronic lymphocytic leukemia. History of smoking (65%), hypertension (53%), heart disease (71%), and osteomyelitis in the foot (35%), were noted. Cultures were positive in 15 gangrenous feet, 11 with gram-negative bacilli. Four long femoroplantar bypasses were placed. Ten short grafts were placed from the popliteal artery, and six jump grafts were placed distal to a femoropopliteal or tibial bypass. Hospital stay ranged from 8 to 38 days (median 16 days), and there were two in-hospital deaths. Transmetatarsal or button toe amputations were performed in nine feet. There were two below-knee amputations, one with a patent graft, for a foot salvage rate of 89% at 2 months. In four instances the gangrenous ulcers took longer than 6 months to heal; all other wounds healed within 6 months. The primary and secondary patency rates were 85% at 1 month, and 73% at 3 months and thereafter. Four of five graft failures occurred in the two legs with repeat bypass graftings. All patients with successful revascularization are able to walk, and seven returned to work full time. PMID:2810537

Andros, G; Harris, R W; Salles-Cunha, S X; Dulawa, L B; Oblath, R W



Acute Coronary Syndromes: Diagnosis and Management, Part I  

PubMed Central

The term acute coronary syndrome (ACS) refers to any group of clinical symptoms compatible with acute myocardial ischemia and includes unstable angina (UA), non—ST-segment elevation myocardial infarction (NSTEMI), and ST-segment elevation myocardial infarction (STEMI). These high-risk manifestations of coronary atherosclerosis are important causes of the use of emergency medical care and hospitalization in the United States. A quick but thorough assessment of the patient's history and findings on physical examination, electrocardiography, radiologic studies, and cardiac biomarker tests permit accurate diagnosis and aid in early risk stratification, which is essential for guiding treatment. High-risk patients with UA/NSTEMI are often treated with an early invasive strategy involving cardiac catheterization and prompt revascularization of viable myocardium at risk. Clinical outcomes can be optimized by revascularization coupled with aggressive medical therapy that includes anti-ischemic, antiplatelet, anticoagulant, and lipid-lowering drugs. Evidence-based guidelines provide recommendations for the management of ACS; however, therapeutic approaches to the management of ACS continue to evolve at a rapid pace driven by a multitude of large-scale randomized controlled trials. Thus, clinicians are frequently faced with the problem of determining which drug or therapeutic strategy will achieve the best results. This article summarizes the evidence and provides the clinician with the latest information about the pathophysiology, clinical presentation, and risk stratification of ACS and the management of UA/NSTEMI.

Kumar, Amit; Cannon, Christopher P.



Bailout coronary stenting without anticoagulation or intravascular ultrasound guidance: acute and six-month angiographic results in a series of 120 consecutive patients.  


The purpose of this study was to evaluate the feasibility, safety, and efficacy of bailout coronary stenting without anticoagulation or intravascular ultrasound guidance in patients with acute or unequivocal threatened closure after conventional angioplasty. One hundred twenty consecutive patients were prospectively enrolled according to the following criteria: 1) acute or threatened closure after balloon angioplasty; 2) reference vessel diameter > or = 2.5 mm. All patients after stent implantation were on antiplatelet treatment with aspirin and ticlopidine. Four types of stents were used: Palmaz-Schatz (J&J), Gianturco-Roubin (Cook), Freedom (Global Therapeutics), and Microstent (AVE). Procedural results: a total of 206 stents were implanted in 134 target lesions with a stent deployment success rate of 100%; 44 target lesions were treated with multiple stent implantation; the mean luminal diameter after stenting was 3.14 +/- 0.34 mm, and the mean final percent diameter stenosis was -2 +/- 10%; the mean balloon to vessel ratio was 1.11 +/- 0.15; the mean final pressure inflation was 13.9 +/- 2.4 atm; an optimal angiographic result was achieved in 128 lesions (96%). In-hospital results: in-hospital recurrent ischemia occurred in 4 patients (3%); recurrent ischemia resulted directly in death in 1 patient, in nonfatal Q-waves infarction in 2 patients, and in emergency coronary artery surgery in 1 patient. Six-month clinical follow-up results: event free survival rate was 77%; 1 patient had non fatal infarction; the incidence of repeat revascularization procedures was 19%; there were no cardiac deaths. Angiographic follow-up results (follow-up rate 93%): the restenosis or reocclusion rate was 28%. Bailout coronary stenting without chronic anticoagulation treatment or intravascular ultrasound guidance may be considered a highly feasible and safe treatment for acute or threatened closure after failed angioplasty. PMID:9143760

Antoniucci, D; Valenti, R; Santoro, G M; Bolognese, L; Taddeucci, E; Trapani, M; Santini, A; Fazzini, P F



Bivalirudin versus heparin during coronary angioplasty for unstable or postinfarction angina: Final report reanalysis of the Bivalirudin Angioplasty Study  

Microsoft Academic Search

Background This study was a reanalysis of the Bivalirudin Angioplasty Study, which compared bivalirudin with high-dose heparin during coronary angioplasty for unstable angina. Methods Differences in rates of death, myocardial infarction, or repeat revascularization were compared at 7, 90, and 180 days after angioplasty with intention-to-treat analysis. Results The combined end point occurred in 135 of 2161 patients (6.2%) in

John A. Bittl; Bernard R. Chaitman; Frederick Feit; William Kimball; Eric J. Topol



The Impact of General Usage of Stents on Short and Long-Term Health Care Costs following Percutaneous Coronary Intervention  

Microsoft Academic Search

Background: The general usage of stents during percutaneous coronary intervention (PCI) reduces the need for subsequent repeated revascularizations when compared with balloon dilatation. The aim was to evaluate the impact of stenting on short- and long-term in-hospital care costs after PCI. Method and Results: Patients who underwent PCI from July 1992 to June 1993 (group A, n = 166; 4.2%

Annika Odell; Per Landelius; Karin Åström-Olsson; Lars Grip



Laparoscopic mobilization of the inferior epigastric artery for penile revascularization in vasculogenic impotence.  


A laparoscopic approach was used for penile revascularization in a patient with vasculogenic impotence to avoid the long abdominal incision which was traditionally required to harvest the inferior epigastric artery as a neoarterial source. Despite the time-consuming nature of laparoscopy, this procedure was as efficacious but less morbid and required less convalescence than open revascularization. Whether more patients may benefit from this procedure must be evaluated in further studies. PMID:9250921

Moon, Y T; Kim, S C



Should we screen for coronary artery disease in asymptomatic chronic dialysis patients?  


The hemodialysis population is characterized by a high prevalence of 'asymptomatic' coronary artery disease (CAD), which should be interpreted differently from asymptomatic disease in the general population. A hemodynamically significant stenosis may not become clinically apparent owing to impaired exercise tolerance and autonomic neuropathy. The continuous presence of silent ischemia may cause heart failure, arrhythmias, and sudden death. Whether revascularization of an asymptomatic dialysis patient improves outcome remains a moot point, although several observational studies and one small RCT suggest a benefit. It can therefore be defended to screen asymptomatic dialysis patients for CAD. A number of noninvasive screening tests are available, but none has proved equally practical and reliable in the dialysis population as in the general population. Myocardial perfusion scintigraphy (MPS) before and after a pharmacological stress such as dipyridamole can reveal both ischemia and myocardial scarring. When compared with coronary angiography, low sensitivities were reported and attributed to impaired vasodilation to dipyridamole in dialysis patients. A more likely explanation is that not every anatomical stenosis will lead to impaired coronary blood flow on MPS. Numerous studies have shown an incremental prognostic value of dipyridamole-MPS over clinical data for prediction of adverse cardiac events, in some studies even over coronary angiography. Pending the availability of high-quality evidence, in our opinion asymptomatic dialysis patients could undergo dipyridamole-MPS, followed by coronary angiography in case of an abnormal scan. This combined physiological and anatomical evaluation of the coronary circulation allows us to determine which coronary stenosis is clinically relevant and therefore should be revascularized. PMID:21956188

De Vriese, An S; Vandecasteele, Stefaan J; Van den Bergh, Barbara; De Geeter, Frank W



Coronary artery bypass grafts and MDCT imaging: what to know and what to look for.  


Multi-detector row CT (MDCT) scanners with high spatial and temporal resolutions are now available and are increasingly used for non-invasive assessment of vascular disease, including coronary arteries and coronary artery bypass grafts (CABG). Follow-up of patients who have previously undergone surgical revascularization for coronary artery disease is nowadays one of the main applications of MDCT. Thanks to the continuous technical evolution of the CT scanners, it is now possible to scan the heart and the full anatomic extent of grafts with sub-millimeter slice-thickness within a single breath-hold. In the evaluation of these patients, it is important for the radiologist to be familiar with the different types of grafts and surgical techniques to know the main characteristics of each graft type and what to look for in the assessment of a patient who has undergone coronary artery surgical revascularization. This review summarizes some surgical aspects, the biological characteristics of conduits, and the main technical MDCT features, and describes the CABG anatomy together with some typical CT findings. PMID:17874112

Marano, Riccardo; Liguori, Carlo; Rinaldi, Pierluigi; Storto, Maria Luigia; Politi, Marco Angelo; Savino, Giancarlo; Bonomo, Lorenzo



Coronary stenting in cardiac allograft vasculopathy  

Microsoft Academic Search

Objective. The purpose of this study was to evaluate acute angiographic success, in-hospital complications and long-term outcome after intracoronary stenting in patients with cardiac allograft vasculopathy.Background. The application of conventional interventional modalities to treat discrete lesions in patients with cardiac allograft vasculopathy is associated with higher procedural morbidity, mortality and higher restenosis compared to atherosclerotic coronary artery disease. Elective coronary

Suresh P Jain; Stephen R Ramee; Christopher J White; Mandeep R Mehra; Hector O Ventura; Shuyang Zhang; J. Stephen Jenkins; Tyrone J Collins



A new device to seal large coronary aneurysms: a case report  

PubMed Central

Introduction Coronary artery aneurysm is an uncommon disease. It is defined as a coronary artery dilatation, exceeding the diameter of the normal adjacent segment or the diameter of the patient's largest coronary vessel by 1.5 to 2 times. Coronary artery aneurysms are typically diagnosed by coronary angiography. The prognosis of coronary artery aneurysm is not well known and the management is challenging. Case presentation A 68-year-old Italian-Caucasian man presented to our hospital with angina. Coronary angiography revealed a large coronary aneurysm of the right coronary artery, which was successfully treated by the percutaneous implantation of an MGuard™stent. Conclusion This case report provides evidence that coronary artery aneurysms, even if very large, can be safely treated by MGuard™stent implantation. We strongly emphasize the high flexibility and good deliverability of this device, which leads to the complete exclusion of the aneurysm mediated by the process of endothelization of its thin mesh sleeves.



Effects of tirofiban and statins on high-sensitivity C-reactive protein, interleukin-6, and soluble CD40 ligand following percutaneous coronary interventions in patients with stable coronary artery disease.  


This study assessed the effects of tirofiban and statins on high-sensitivity C-reactive protein, interleukin-6, and soluble CD40 ligand after percutaneous coronary intervention in patients who had stable coronary artery disease. Tirofiban insignificantly limited the increase of soluble CD40 ligand after revascularization, especially in patients who had high levels of this marker at baseline (p = 0.06), whereas statins significantly inhibited increases in interleukin-6 and, to a lesser extent, high-sensitivity C-reactive protein without affecting the soluble CD40 ligand. PMID:15642557

Azar, Rabih R; Badaoui, Georges; Sarkis, Antoine; Kassab, Roland; Salamé, Elie; Klaymé, Samira; Naman, Roger; Germanos, Mirna



Acute coronary syndrome in the patient with diabetes: is the management different?  


Diabetic patients who present with an acute coronary syndrome (ACS) have a particularly adverse prognosis, largely contributed by increased platelet reactivity and higher burden of disease severity. Diabetic patients with ACS derive a greater benefit from established therapies, particularly platelet-inhibiting therapies, including clopidogrel pretreatment, and glycoprotein IIb/IIIa inhibitor use. Recent data show intense ADP-P2Y12 platelet receptor inhibition with prasugrel is of particular clinical value in the diabetic patient with ACS, without excessive bleeding. Diabetic patients with ACS also benefit more from aggressive revascularization strategies. Recent data show the benefit of drug-eluting stents in the setting of primary percutaneous coronary intervention for ST-segment elevation myocardial infarction in decreasing target vessel revascularization up to 2 years, particularly in patients at highest risk for restenosis with bare metal stents (likely diabetic patients). This review summarizes the data supporting the key pharmacologic and revascularization management strategies to guide the clinician in taking care of diabetic patients who present with an ACS event. PMID:20446120

Amin, Amit P; Marso, Steven P



Early experience with a helical coronary thrombectomy device in patients with acute coronary thrombosis.  

PubMed Central

Objective: To report our experience with a new thrombectomy device (X-SIZERTM) in patients with angiographically visible thrombus or total coronary occlusion in the setting of acute coronary syndromes. Design: A safety and feasibility study in the use of the X-SIZER during intervention in patients with acute coronary syndromes. Patients: 35 patients, age range 31 to 83 years (mean 60). Setting: University Hospitals of Coventry and Warwickshire NHS Trust (tertiary referral centre). Interventions: The indication for intervention was primary or salvage percutaneous coronary intervention for acute myocardial infarction in 17 of the 35 patients; unstable angina or non-ST-elevation myocardial infarction in 10; and unstable postinfarct angina in eight. Abciximab was given in 11 patients. Main outcome measures: Device success (successful deployment of the device at the site of the lesion with resultant improvement in TIMI flow); clinical success (no residual stenosis at the end of the procedure with no in-hospital major adverse coronary events). Results: Successful use of the device was achieved in 26 of the 35 cases. It failed to cross the lesion in five and failed to improve TIMI flow despite crossing the lesion in four. Clinical success was achieved in 30 of the 35 cases. Device related complications occurred in two cases (vessel perforation) and there was one intraprocedural death (acute myocardial infarction with cardiogenic shock). Conclusions: Thrombectomy with the X-SIZER catheter system appears promising in percutaneous coronary intervention where thrombus extraction is considered necessary before stent implantation.

Constantinides, S; Lo, T S N; Been, M; Shiu, M F



"Keyhole" coronary artery bypass surgery.  

PubMed Central

OBJECTIVE: The objective of this study was to identify the utility of "keyhole" thoracotomy approaches to single vessel coronary artery bypass surgery. SUMMARY BACKGROUND DATA: Although minimally invasive surgery is efficacious in a wide variety of surgical disciplines, it has been slow to emerge in cardiac surgery. Among 49 selected patients, the authors have used a left anterior keyhole thoracotomy (6 cm in length) combined with complete dissection of the eternal mammary artery (IMA) pedicle under thoracoscopic guidance or directly through the keyhole incision to accomplish IMA coronary artery bypass grafting (CABG) to the left anterior descending (LAD) coronary artery circulation or to the right coronary artery (RCA). METHODS: Keyhole CABG was accomplished in 46 of 49 patients in which this approach was attempted. All patients had significant (> 70%) obstruction of a dominant coronary artery that had failed or that was inappropriate for endovascular catheter treatment (percutaneous transluminal coronary angioplasty or stenting). Forty-four of the 49 patients had proximal LAD and 5 had proximal RCA stenoses. The mean age of the patients (35 men and 14 women) was 61 years, and their median New York Heart Association anginal class was III. The mean left ventricular ejection fraction was 42%. Femoral cardiopulmonary bypass support was used in 9 (19%) of 46 patients successfully managed with the keyhole procedure. Short-acting beta-blockade was used in the majority of patients (38 of 46) to reduce heart rate and the vigor of cardiac contraction. RESULTS: As 49 patients have survived operation, which averaged 248 minutes in duration. Median, postoperative endotracheal intubation time for keyhole patients was 6 hours with 25 of 46 patients being extubated before leaving the operating room. The median hospital stay was 4.3 days. Conversion to sternotomy was required in three patients to accomplish bypass because of inadequate internal mammary conduits or acute cardiovascular decompensation during an attempted off-bypass keyhole procedure Postoperative complications were limited to respiratory difficulty in three patients and the development of a deep wound infection in one patient. Nine (19%) of 46 patients received postoperative transfusion. There have been no intraoperative or postoperative infarctions, and angina has been controlled in all but one patient who subsequently had an IMA-RCA anastomotic stenosis managed successfully with percutaneous transluminal coronary angioplasty. CONCLUSIONS: These early results with keyhole CABG are encouraging. As experience broadens, keyhole CABG may become a reasonable alternative to repeated endovascular interventions or sternotomy approaches to recalcitrant single-vessel coronary arterial disease involving the proximal LAD or RCA.

Landreneau, R J; Mack, M J; Magovern, J A; Acuff, T A; Benckart, D H; Sakert, T A; Fetterman, L S; Griffith, B P



Pulmonary function aspects after myocardial revascularization related to preoperative risk  

Microsoft Academic Search

Objective: To compare the postoperative dynamic and static compliance, airway resistance (DynC, StaC and AWR) and gas exchange index (PaO2\\/FiO2) after Coronary Artery Bypass Grafting (CABG) with normal parameters and to compare groups that demonstrated preoperative risk factors or not in respect to these variables. Method: The patients were questioned about previous pulmonary disease, respiratory symptoms, smoking and comorbidities. After

Alexandre Ricardo; Pepe AMBROZIN



Direct coronary stenting in reducing radiation and radiocontrast consumption  

PubMed Central

Introduction Coronary stenting is the primary means of coronary revascularization. There are two basic techniques of stent implantation: stenting with balloon predilatation of stenosis and stenting without predilatation (direct stenting). Limiting the time that a fluoroscope is activated and by appropriately managing the intensity of the applied radiation, the operator limits radiation in the environment, and this saves the exposure to the patient and all personnel in the room. Nephrotoxicity is one of the most important properties of radiocontrast. The smaller amount of radiocontrast used also provides multiple positive effects, primarily regarding the periprocedural risk for the patients with the reduced renal function. The goal of the study was to compare fluoroscopy time, the amount of radiocontrast, and expenses of material used in direct stenting and in stenting with predilatation. Patients and methods In a prospective study, 70 patients with coronary disease were randomized to direct stenting, or stenting with predilatation. Results Fluoroscopy time and radiocontrast use were significantly reduced in the directly stented patients in comparison to the patients stented with balloon-predilatation. The study showed a significant reduction of expenses when using a direct stenting method in comparison to stenting with predilatation. Conslusions If the operator predicts that the procedure can be performed using direct stenting, he is encouraged to do so. Direct stenting is recommended for all percutaneous coronary interventions when appropriate conditions have been met. If direct stenting has been unsuccessful, the procedure can be converted to predilatation.

Caluk, Jasmin; Osmanovic, Enes; Barakovic, Fahir; Kusljugic, Zumreta; Terzic, Ibrahim; Caluk, Selma; Sofic, Amela



Impact of SYNTAX score on 1-year clinical outcomes in patients undergoing percutaneous coronary intervention for unprotected left main coronary artery.  


SYNTAX score is an angiographic scoring system that was developed to quantify the number, complexity, and location of lesions in patients undergoing coronary revascularization. Up to now, the impact of SYNTAX score on clinical outcomes in patients undergoing percutaneous coronary intervention (PCI) for unprotected left main coronary artery (LMCA) lesions has not been fully examined. Therefore, we evaluate the usefulness of the SYNTAX score and identify the cutoff value of this score to predict 1-year clinical outcomes in patients undergoing PCI for unprotected LMCA lesions. This was a single-center retrospective study that included 49 consecutive patients undergoing elective PCI for unprotected LMCA lesions. We calculated the SYNTAX score and examined the correlations between this score and 1-year clinical outcomes. Major adverse cardiac events (MACE) occurred in 12 patients (24%): target lesion revascularization in 9 patients (18%), myocardial infarction in 2 (4%), and cardiac death in 1 (2%). The frequency of MACE was significantly higher in the intermediate (47%) or high score group (50%) than in the low score group (4%). Furthermore, the SYNTAX score was significantly higher in the MACE group than in the non-MACE group (31 vs. 22, p = 0.008). Receiver-operating characteristic curve showed that the SYNTAX score exhibited 83% sensitivity and 76% specificity for predicting the development of MACE at a cutoff value 26. These results demonstrate that the SYNTAX score could be a useful tool to predict 1-year clinical outcomes in patients undergoing elective PCI for unprotected LMCA lesions. PMID:22937491