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1

Successful revascularization to right coronary artery by percutaneous coronary intervention after endovascular therapy for leriche syndrome.  

PubMed

A 69-year-old man with effort angina was admitted to our institution. Echocardiography showed poor left ventricular systolic function with akinesis of the anterior wall and severe hypokinesis of the inferior wall. We performed coronary angiography, which revealed two diseased vessels including chronic total occlusion in the left anterior descending artery and severe stenosis in the right coronary artery (RCA). In addition, aortography revealed aortoiliac occlusive disease known as Leriche syndrome. As the patient's symptom was stable, we first planned to perform endovascular therapy (EVT) for Leriche syndrome to make a route for intra-aortic balloon pumping. We prepared a bi-directional approach from bi-femoral arteries and a left brachial artery. The guidewire was passed through the occlusive area using the retrograde approach. The self-expanding stents were deployed by a kissing technique. At one week after EVT, a 6Fr sheath was inserted from the right radial artery and an intra-aortic balloon pump was successfully inserted through the right femoral artery for percutaneous coronary intervention (PCI) to the RCA. Two drug-eluting stents were successfully deployed to RCA after using an atherectomy device (rotablator). We reported the case as a successfully performed PCI to the RCA after EVT for Leriche syndrome. PMID:24678244

Niizeki, Takeshi; Kaneko, Kazuyoshi; Sugawara, Shigeo; Sasaki, Toshiki; Tsunoda, Yuichi; Takeishi, Yasuchika; Kubota, Isao

2014-01-01

2

Successful Revascularization to Right Coronary Artery by Percutaneous Coronary Intervention after Endovascular Therapy for Leriche Syndrome  

PubMed Central

A 69-year-old man with effort angina was admitted to our institution. Echocardiography showed poor left ventricular systolic function with akinesis of the anterior wall and severe hypokinesis of the inferior wall. We performed coronary angiography, which revealed two diseased vessels including chronic total occlusion in the left anterior descending artery and severe stenosis in the right coronary artery (RCA). In addition, aortography revealed aortoiliac occlusive disease known as Leriche syndrome. As the patient’s symptom was stable, we first planned to perform endovascular therapy (EVT) for Leriche syndrome to make a route for intra-aortic balloon pumping. We prepared a bi-directional approach from bi-femoral arteries and a left brachial artery. The guidewire was passed through the occlusive area using the retrograde approach. The self-expanding stents were deployed by a kissing technique. At one week after EVT, a 6Fr sheath was inserted from the right radial artery and an intra-aortic balloon pump was successfully inserted through the right femoral artery for percutaneous coronary intervention (PCI) to the RCA. Two drug-eluting stents were successfully deployed to RCA after using an atherectomy device (rotablator). We reported the case as a successfully performed PCI to the RCA after EVT for Leriche syndrome.

Niizeki, Takeshi; Kaneko, Kazuyoshi; Sugawara, Shigeo; Sasaki, Toshiki; Tsunoda, Yuichi; Takeishi, Yasuchika; Kubota, Isao

2014-01-01

3

Diabetes mellitus and coronary revascularization procedures.  

PubMed

Revascularization strategy for coronary artery disease in diabetic patients remains a field of controversy. Percutaneous coronary intervention has a less favourable outcome in these patients, though drug eluting stents have significantly improved the outcome. Although in most series, the outcome with coronary artery bypass grafting is worse in diabetic populations, surgery seems to be superior to angioplasty, particularly in diabetics with multivessel disease. Results from randomized trials such as the ongoing FREEDOM, CARDia and SYNTAX may define the role of each procedure in the treatment of diabetic patients with coronary artery disease. PMID:17156868

Anastasiadis, Kyriakos; Moschos, Georgios

2007-06-25

4

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

1995-01-01

5

Coronary revascularization directed by results of coronary Doppler flow measurements.  

PubMed

We present a case where Doppler coronary flow velocity and Doppler reserve measurement directed the decision to proceed with coronary artery revascularization. Measurement of coronary Doppler flow velocity and flow reserve can be useful to help evaluate angiographic "intermediate lesions." The following case involves an indeterminate lesion. A patient was felt likely to have a high-grade stenosis which could not be adequately visualized angiographically because of overlapping vessels. Largely based on the flow velocity and reserve data, the patient was referred for coronary artery bypass grafting. PMID:8149431

Nicholas, J; Kipperman, R

1994-02-01

6

Simulation of coronary artery revascularization.  

PubMed

Simulation of the commonly constructed geometries of aorto-coronary bypass anastomoses was carried out using especially fabricated distensible tubes and a pulsatile pump. The system pressure was maintained between 80 and 120 mmHg. The total mean flow was set at 250 ml min-1 (Reynolds number of 200) and the pulsatile frequency was varied from 0 to 2 Hz. A water-glycerine mixture having a density and viscosity similar to that of blood was used throughout. A 16 mm film of the front of black dye injected proximal to the anastomosis was made as the dye approached and passed through the anastomosis. Anastomotic geometries consisted of: end to side, parallel, 45 degree angle, and 90 degree angle. Stenoses, located in the tube representing the coronary artery, were simulated using a bevelled insert which represented an 80-85% area reduction. Flow visualization revealed that distensible tubes gave more realistic flow patterns than rigid tubes, a result particularly evident when a stenosis was present. Pulsatile flow demonstrated considerably more mixing than steady flow. The use of pulsatile flow in distensible tubing with a partial stenosis showed retrograde flow through the stenosis which was not evident for either steady flow or for flow in rigid tubing. The flow at the anastomatic site of the graft having an angle of 0 degrees showed a jetting action with a zone of recirculating fluid being present whereas for a 90 degree graft a distinct helical flow was formed distal to the anastomosis. PMID:3488994

Watts, K C; Marble, A E; Sarwal, S N; Kinley, C E; Watton, J; Mason, M A

1986-01-01

7

Optimal revascularization for complex coronary artery disease.  

PubMed

Patients with major or symptomatic coronary artery disease (CAD) commonly undergo revascularization--either with CABG surgery, which has been the mainstay of revascularization for more than half a century, or with percutaneous coronary intervention (PCI), which has become the more-commonly used strategy in the past decade. PCI has been tested in more randomized clinical trials than any other procedure in contemporary practice. In general, PCI is the preferred option for treating patients with simple coronary artery lesions and CABG surgery remains the standard of care for patients with complex CAD. Technical advancements in PCI and CABG surgery make comparisons of historical data for these strategies difficult. In this Review, we evaluate the evidence-based use of PCI and CABG surgery in treating patients with multivessel and unprotected left main stem disease and for specific patient groups, including those with diabetes mellitus, chronic heart failure, or chronic kidney disease. Finally, we highlight the available tools to aid decision-making, including clinical guidelines, risk scoring systems, and the role of the 'heart team'. PMID:24042217

Iqbal, Javaid; Serruys, Patrick W; Taggart, David P

2013-11-01

8

Determinants of variations in coronary revascularization practices  

PubMed Central

Background: The ratio of percutaneous coronary interventions to coronary artery bypass graft surgeries (PCI:CABG ratio) varies considerably across hospitals. We conducted a comprehensive study to identify clinical and nonclinical factors associated with variations in the ratio across 17 cardiac centres in the province of Ontario. Methods: In this retrospective cohort study, we selected a population-based sample of 8972 patients who underwent an index cardiac catheterization between April 2006 and March 2007 at any of 17 hospitals that perform invasive cardiac procedures in the province. We classified the hospitals into four groups by PCI:CABG ratio (low [< 2.0], low–medium [2.0–2.7], medium–high [2.8–3.2] and high [> 3.2]). We explored the relative contribution of patient, physician and hospital factors to variations in the likelihood of patients receiving PCI or CABG surgery within 90 days after the index catheterization. Results: The mean PCI:CABG ratio was 2.7 overall. We observed a threefold variation in the ratios across the four hospital ratio groups, from a mean of 1.6 in the lowest ratio group to a mean of 4.6 in the highest ratio group. Patients with single-vessel disease usually received PCI (88.4%–99.0%) and those with left main artery disease usually underwent CABG (80.8%–94.2%), regardless of the hospital’s procedure ratio. Variation in the management of patients with non-emergent multivessel disease accounted for most of the variation in the ratios across hospitals. The mode of revascularization largely reflected the recommendation of the physician performing the diagnostic catheterization and was also influenced by the revascularization “culture” at the treating hospital. Interpretation: The physician performing the diagnostic catheterization and the treating hospital were strong independent predictors of the mode of revascularization. Opportunities exist to improve transparency and consistency around the decision-making process for coronary revascularization, most notably among patients with non-emergent multivessel disease.

Tu, Jack V.; Ko, Dennis T.; Guo, Helen; Richards, Janice A.; Walton, Nancy; Natarajan, Madhu K.; Wijeysundera, Harindra C.; So, Derek; Latter, David A.; Feindel, Christopher M.; Kingsbury, Kori; Cohen, Eric A.

2012-01-01

9

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

PubMed Central

Patients with diabetes mellitus (DM) are prone to a diffuse and rapidly progressive form of atherosclerosis, which increases their likelihood of requiring revascularization. However, the unique pathophysiology of atherosclerosis in patients with DM modifies the response to arterial injury, with profound clinical consequences for patients undergoing percutaneous coronary intervention (PCI). Multiple studies have shown that DM is a strong risk factor for restenosis following successful balloon angioplasty or coronary stenting, with greater need for repeat revascularization and inferior clinical outcomes. Early data suggest that drug eluting stents reduce restenosis rates and the need for repeat revascularization irrespective of the diabetic state and with no significant reduction in hard clinical endpoints such as myocardial infarction and mortality. For many patients with 1- or 2-vessel coronary artery disease, there is little prognostic benefit from any intervention over optimal medical therapy. PCI with drug-eluting or bare metal stents is appropriate for patients who remain symptomatic with medical therapy. However, selection of the optimal myocardial revascularization strategy for patients with DM and multivessel coronary artery disease is crucial. Randomized trials comparing multivessel PCI with balloon angioplasty or bare metal stents to coronary artery bypass grafting (CABG) consistently demonstrated the superiority of CABG in patients with treated DM. In the setting of diabetes CABG had greater survival, fewer recurrent infarctions or need for re-intervention. Limited data suggests that CABG is superior to multivessel PCI even when drug-eluting stents are used. Several ongoing randomized trials are evaluating the long-term comparative efficacy of PCI with drug-eluting stents and CABG in patients with DM. Only further study will continue to unravel the mechanisms at play and optimal therapy in the face of the profoundly virulent atherosclerotic potential that accompanies diabetes mellitus.

Aronson, Doron

2010-01-01

10

Survival After Coronary Revascularization Among Patients With Kidney Disease  

Microsoft Academic Search

Background—The optimal approach to revascularization in patients with kidney disease has not been determined. We studied survival by treatment group (CABG, percutaneous coronary intervention (PCI), or no revascularization) for patients with 3 categories of kidney function: dialysis-dependent kidney disease, non- dialysis-dependent kidney disease, and a reference group (serum creatinine 2.3 mg\\/dL). Methods and Results—Data were derived from the Alberta Provincial

Brenda R. Hemmelgarn; Bruce F. Culleton; L. Brent Mitchell; Merril L. Knudtson; William A. Ghali

2010-01-01

11

[Coronary revascularization (Examples from the world and Turkey)].  

PubMed

Objectives: In this article, our aims were to analyze and assess the data related to coronary revascularization rates, particularly in recent years. Study design: For this purpose, results of important studies, statistics of the Organisation for Economic Co-operation and Development (OECD) countries and data from Turkey's Social Security Agency (SSA) were analyzed for the first time. Until recently, there has been no healthy digital database regarding revascularization rates in Turkey. In the years following the establishment of SSA, it became possible to collect and analyze data obtained from the Medulla database of the Agency. Using the data from the Agency for the period 2009-2011, revascularization rates and cost analyses were performed. Results: Between 2000 and 2010 in European countries as well as in other OECD countries, the percutaneous coronary intervention (PCI) rate was on average 75% of the total revascularization rate and neared 80%. In some countries, the rate has exceeded 85%. In our country, in 2009, 2010 and 2011, the number of coronary angiography procedures and as a result PCI has steadily increased. The rate for PCI was 66.8% in 2009, but it increased to 74% in 2011. At the same time, PCI accounted for 2/3-4/5 of all revascularization procedures. In the cost analysis, however, PCI constituted only 1/5-1/4 of the costs of all revascularization procedures. Conclusion: This report is the first analysis in this area and it gives an initial idea about the current situation of the numerical and financial aspects. This analysis has provided the opportunity to obtain more accurate information about coronary revascularization rates in Turkey and to compare the data to that of other countries. PMID:24769816

Balbay, Yücel; Bener, Selim; Kaygusuz, Taner; Cay, Serkan; Ilkay, Erdo?an

2014-04-01

12

Coronary revascularization--2009: state of the art.  

PubMed

Despite advances in percutaneous coronary intervention, coronary artery bypass grafting remains the most effective intervention for complex coronary artery disease in survival, freedom from reintervention, and cost-effectiveness. To ensure that patients have access to this "gold-standard" treatment, a multidisciplinary team approach, rather than an individual cardiologist acting as a "gatekeeper," should be the standard of care when intervention is necessary, to ensure transparency, real patient choice, and genuine informed consent. PMID:19942116

Taggart, David P

2009-01-01

13

Hybrid Coronary Revascularization in the Era of Drug-Eluting Stents  

Microsoft Academic Search

Left internal mammary artery to left anterior descending coronary artery bypass grafting integrated with percuta- neous coronary angioplasty (hybrid procedure) offers multivessel revascularization with minimal morbidity in high-risk patients. This is caused in part by the avoid- ance of cardiopulmonary bypass-related morbidity and manipulation of the aorta coupled with minimally inva- sive techniques. Hybrid revascularization is currently reserved for particularly

Gavin J. Murphy; Alan J. Bryan; Gianni D. Angelini

14

Coronary Revascularization Using Bilateral Internal Thoracic Arteries: Safe with Skeletonization?  

PubMed Central

Substantial evidence exists to support a long-term survival benefit with bilateral internal thoracic artery (BITA) revascularization in coronary artery bypass grafting. However, this technique remains grossly underutilized worldwide and especially in the United States. In this review, we discuss evidence for the advantages of BITA grafting as well as the associated the risk of sternal wound complications. We then review a growing body of literature that suggests ‘skeletonization’ of the internal thoracic artery during harvest confers a protective benefit against sternal wound infection in patients receiving BITA.

Wehman, Brody; Taylor, Bradley

2014-01-01

15

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  

Microsoft Academic Search

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

Konstantinos G. Kostopoulos; Athanasios I. Kranidis; Konstantina P. Bouki; John P. Antonellis; Kostas G. Kappos; Fivi E. Rodogianni; Nikolaos J. Zamanis; Anthony G. Tavernarakis; Christos T. Lolas; Lambros P. Anthopoulos

1996-01-01

16

Optimal timing of abdominal aortic aneurysm repair after coronary artery revascularization.  

PubMed Central

OBJECTIVE: The authors ascertained the optimal timing of repair of an abdominal aortic aneurysm (AAA) after coronary artery revascularization. SUMMARY BACKGROUND DATA: Cardiac events are the most common cause of death after elective repair of AAA. Preoperative coronary revascularization has significantly reduced postoperative cardiac complications after elective AAA repair. Currently, most patients undergo repair of asymptomatic AAA within 6 months after the coronary revascularization. METHODS: The authors performed a retrospective review of patients who underwent repair or scheduled repair of an asymptomatic AAA within 6 months after coronary artery bypass graft (CABG) between March 1988 and October 1993. RESULTS: There was no mortality in the group of patients (n = 14) who underwent repair of AAA simultaneously or within 14 days of coronary revascularization. In contrast, there was a significantly increased mortality rate of 3 of 9 (33%) in patients scheduled to undergo repair of the AAA more than 2 weeks after coronary revascularization (p < 0.05). All nonsurvivors died between 16 and 29 days after CABG, and died as a result of ruptured AAA. CONCLUSION: Elective AAA repair should be undertaken simultaneously or within 2 weeks of coronary artery revascularization because of an increased risk of postoperative AAA rupture seen after this time period. In addition, simultaneous or early postoperative AAA repair does not increase the overall operative risk.

Blackbourne, L H; Tribble, C G; Langenburg, S E; Mauney, M C; Buchanan, S A; Sinclair, K N; Kron, I L

1994-01-01

17

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

2010-01-01

18

Technical aspects of total revascularization in off-pump coronary bypass via sternotomy approach  

Microsoft Academic Search

Background. Cardiopulmonary bypass and cardioplegic arrest result in known physiologic inflammatory, coagulopathic, and embolic states that may result in end-organ damage. Interest in off-pump complete coronary revascularization using sternotomy exposure is therefore increasing.Methods. Using specific surgical and anesthetic techniques, we have been able to achieve total revascularization using off-pump coronary artery bypass grafting procedures (OP-CAB) through a sternotomy approach. Exposure

Fritz J. Baumgartner; Ali Gheissari; Eli R. Capouya; George P. Panagiotides; Alireza Katouzian; Taro Yokoyama

1999-01-01

19

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

PubMed

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

2013-11-01

20

Off-pump total arterial revascularization for anomalous origin of the left coronary artery from the pulmonary artery.  

PubMed

Anomalous origin of the left coronary artery from the pulmonary artery is a rare but potentially lethal congenital anomaly, especially if presented later in adulthood. We report a previously healthy young man who had a sudden cardiac arrest at a Zumba class, was resuscitated, and was successfully treated with off-pump total arterial revascularization and ligation of the left main stem of anomalous origin. PMID:24296196

Jujjavarapu, Krishnam Raju; Salhiyyah, Kareem; Witzke, Herbert; Amrani, Mohamed

2013-12-01

21

Hybrid Coronary Revascularization Using Limited Incisional Full Sternotomy Coronary Artery Bypass Surgery in Multivessel Disease: Early Results  

PubMed Central

Background There are several modalities of coronary artery revascularization for multivessel coronary artery disease. Hybrid coronary revascularization (HCR) with minimally invasive direct coronary artery bypass grafting was introduced for high-risk patients, and recently, many centers have been using it. Limited incisional full sternotomy coronary artery bypass (LIFCAB) involves left internal thoracic artery (LITA)-to-left anterior descending coronary artery (LAD) anastomosis through a sternotomy with a minimal skin incision; it could be considered another technique for minimally invasive LITA-to-LAD anastomosis. Our center has performed HCR using LIFCAB, and in this paper, we report our short-term results, obtained in the past 3 years. Methods The medical records of 38 patients from May 2010 to June 2013 were analyzed retrospectively. The observation period after HCR was 1 to 37 months (average, 18.3±10.3 months). The patency of revascularization was confirmed with postoperative coronary angio-computerized tomography or coronary angiography. Results There were 3 superficial wound complications, but no mortalities. All the LITA-to-LAD anastomoses were patent in the immediate postoperative and follow-up studies, but stenosis was detected in 3 cases of percutaneous coronary intervention. Conclusion HCR using LIFCAB is safe and yields satisfactory results from the viewpoint of revascularization for multivessel disease.

Kang, Joonkyu; Lee, Seok In; Moon, Mi Hyung; Kim, Hwan Wook; Jo, Gyun Hyun

2014-01-01

22

Directional coronary atherectomy can be successfully performed in the elderly.  

PubMed

The influence of age on the clinical and angiographic outcome of directional coronary atherectomy is evaluated. Results demonstrate that DCA can be performed successfully in the vast majority (78.7-90%) of patients in all age groups. However, there is a non-statistical trend toward decreased success rates in the elderly (P > .05). Major ischemic complications and groin complications tend to be more common in the elderly (P > .05). Blood transfusions are required significantly more often in the elderly (P < .05). Directional coronary atherectomy is a useful method of coronary artery revascularization in all age groups, including the elderly. PMID:8055563

Movsowitz, H D; Manginas, A; Emmi, R P; Bruss, J; Kothapali, S; Wells, E; Ledley, G S; Kotler, M N; Nakhjavan, F K; Yazdanfar, S

1994-04-01

23

[Percutaneous coronary intervention versus bypass surgery in patients with diabetes and multivessel coronary disease : Coronary revascularization after FREEDOM].  

PubMed

Is coronary revascularization required in a patient with chronic stable coronary artery disease or can optimized medical therapy (OMT) alone be a sufficient alternative? This question has been controversially discussed for non-diabetics as well as for diabetics since the COURAGE and BARI 2D trials. According to our present knowledge, a patient will benefit from coronary revascularization only when either a non-invasive test method, such as single photon emission computed tomography (SPECT) or positron emission tomography (PET) myocardial scintigraphy, stress echocardiography or stress nuclear magnetic resonance imaging, can detect relevant, objective evidence of ischemia >10% of the left ventricular myocardium or when a pathological fractional flow reserve (FFR) <0.80 can be measured in an invasive procedure for an angiographically detectable coronary stenosis. If similar relevant ischemia can be non-invasively or invasively objectified in a patient with chronic stable multivessel coronary artery disease, the often controversially discussed question arises particularly in diabetics whether a percutaneous coronary intervention (PCI) with implantation of drug-eluting stents or coronary artery bypass surgery should be favored. The FREEDOM study (Future Revascularization Evaluation in Patients with Diabetes Mellitus: Optimal Management of Multivessel Disease), published in November 2012, was the first prospective randomized study to examine this issue in diabetic patients with multivessel coronary artery disease. Despite a higher rate of stroke in the surgical cohort, after an average follow-up time of 3.8 years a significant prognostic advantage in favor of bypass surgery was detected for a combined primary endpoint of all-cause mortality, nonfatal myocardial infarction and nonfatal stroke. Thus, in the new ESC guidelines on diabetes, pre-diabetes and cardiovascular diseases developed with the EASD of the European Society of Cardiology and published in 2013, coronary bypass surgery has a class I, level of evidence A recommendation for patients with diabetes mellitus, chronic stable multivessel coronary disease and a synergy between PCI with taxus and cardiac surgery (SYNTAX) score >22. The decision for or against a PCI/stent implantation or coronary bypass surgery in a diabetic patient with chronic stable multivessel coronary artery disease should therefore be made with the patient only after a detailed informed consent discussion and comprehensive explanation of both treatment options. In controversial cases, particularly with an equivocal SYNTAX score around 22, relevant comorbidities or anticipated method-specific complications, a one-stage ad hoc intervention during the diagnostic coronary angiography should be rejected in favor of a two-stage procedure with prior discussion of both treatment options in the heart team comprising noninvasive cardiologists, interventional cardiologists and cardiac surgeons. PMID:24740094

Dörr, R; Stumpf, J; Dalibor, J; Simonis, G; Spitzer, S G

2014-05-01

24

Morbidity and mortality associated with carotid endarterectomy: Effect of adjunctive coronary revascularization  

Microsoft Academic Search

The occurrence of significant carotid disease in patients requiring coronary revascularization results in the dilemma of whether simultaneous or staged operations should be performed. To determine appropriate therapy we reviewed this experience at Emory University Hospital. During a 10-year period from 1983 to 1992, 110 patients underwent carotid endarterectomy during the same hospitalization or simultaneously with coronary artery bypass; 907

Kellie A. Coyle; Brett C. Gray; Robert B. Smith III; Atef A. Salam; Thomas F. Bodson; Elliot L. Chaikof; Alan B. Lumsden

1995-01-01

25

Intravascular ultrasound-guided revascularization of a chronically occluded left main coronary artery  

PubMed Central

We describe a case of a left main coronary artery (LMCA) chronic total occlusion (CTO), which we elected to treat through percutaneous coronary intervention (PCI). In this case report, we briefly review the prevalence of LMCA CTO, discuss the feasibility of PCI versus surgical revascularization and highlight the importance of intravascular ultrasound in the guidance of these complex procedures.

De Caterina, Alberto Ranieri; Cuculi, Florim; Banning, Adrian P.

2013-01-01

26

Outcomes of coronary stenoses deferred revascularization for borderline versus nonborderline fractional flow reserve values.  

PubMed

Current evidence supports deferral of revascularization for lesions with fractional flow reserve (FFR) values >0.80. The natural history after deferral of revascularization of lesions with borderline FFR values is unknown. This study evaluated the outcomes of patients after deferred revascularization of coronary stenoses based on a borderline FFR value. We retrospectively studied 720 patients with 881 intermediate-severity coronary stenoses who underwent FFR assessment from October 2002 to July 2010 and were deferred revascularization. Patients were divided into gray zone (0.75 to 0.80), borderline (0.81 to 0.85), and nonborderline (>0.85) FFR groups. Any subsequent percutaneous coronary intervention or coronary artery bypass grafting of a deferred stenosis during follow-up was classified as a deferred lesion intervention (DLI). Patient and/or lesion characteristics and clinical outcomes were compared between the FFR groups using univariate and propensity score-adjusted inverse probability of weighting Cox proportional hazards analyses. During a mean follow-up of 4.5 ± 2.1 years, 157 deferred lesions (18%) underwent DLI by percutaneous coronary intervention (n = 117) or coronary artery bypass grafting (n = 40). No statistically significant differences were observed in clinical outcomes between the gray zone and borderline FFR groups. Lesions with a borderline FFR were associated with a significantly higher risk of DLI compared with lesions with nonborderline FFR values (hazard ratio 1.63, 95% confidence interval 1.14 to 2.33, p = 0.007). Lesions deferred revascularization because of a borderline FFR (0.81 to 0.85) were associated with a higher risk of DLI compared with lesions with a nonborderline FFR (>0.85). Further study is needed to determine the optimal management of coronary stenoses with a borderline FFR value. PMID:24837255

Depta, Jeremiah P; Patel, Jayendrakumar S; Novak, Eric; Masrani, Shriti K; Raymer, David; Facey, Gabrielle; Patel, Yogesh; Zajarias, Alan; Lasala, John M; Singh, Jasvindar; Bach, Richard G; Kurz, Howard I

2014-06-01

27

Projected long-term costs of coronary stenting in multivessel coronary disease based on the experience of the Bypass Angioplasty Revascularization Investigation (BARI)  

Microsoft Academic Search

Background Stents are now used in the majority of percutaneous coronary revascularization procedures. It is not clear whether the higher initial cost of stenting is later repaid by reducing costly complications and repeat revascularization procedures, especially for patients with multivessel disease. Methods To project the long-term costs of using coronary stents, angioplasty, or bypass surgery to treat patients with multivessel

Cynthia A. Yock; Derek B. Boothroyd; Douglas K. Owens; Carla Winston; Mark A. Hlatky

2000-01-01

28

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.

2009-01-01

29

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

1997-01-01

30

Effect of Difficulty Affording Health Care on Health Status After Coronary Revascularization  

Microsoft Academic Search

Background—An objective of the United States' Healthy People 2010 Initiative is to eliminate disparities based on socioeconomic status. We assessed the effect of difficulty affording health care on the health status (symptoms, function, and quality of life) of patients treated with percutaneous coronary intervention or CABG. Methods and Results—A consecutive, single-center cohort of 480 patients undergoing coronary revascularization received the

John Spertus; Carole Decker; Catherine Woodman; John House; Phil Jones; James O'Keefe; A. Michael Borkon

2011-01-01

31

Detection of Gender Differences in Incomplete Revascularization after Coronary Artery Bypass Surgery Varies with Classification Technique  

PubMed Central

Background. Incomplete revascularization negatively affects survival after coronary artery bypass surgery (CABG). Since gender and classification technique might impact outcome and reporting, we investigated their effect on revascularization patterns and mortality. Methods. A cohort of bypass patients (N = 1545, 23% women) was enrolled prospectively. The degree of revascularization was determined as mathematical difference between affected vessels upon diagnosis and number of grafts or the surgeon's rating on the case file. Results. Although men displayed more triple-vessel disease, they obtained complete revascularization more frequently than women (85% versus 77%, P < 0.001). The two calculation methods identified analogous percentages of incompletely revascularized patients, yet there was only a 50% overlap between the two groups. Mathematically, more women, older patients, and patients with NYHA class III/IV appeared incompletely revascularized, while the surgeons identified more patients undergoing technically challenging procedures. Regardless of the definition, incompleteness was a significant risk factor for mortality in both genders (mathematical calculation: HR 2.62, 95% CI 1.76–3.89, P < 0.001; surgeon: HR 2.04, 95% CI 1.35–3.89, P = 0.001). Conclusions. Given the differences in identification patterns, we advise that the mathematical calculation be performed after-procedure in all patients regardless of the surgeons' rating to uncover additional subjects at increased risk.

Oertelt-Prigione, Sabine; Kaltenbach, Martin; Hetzer, Roland; Regitz-Zagrosek, Vera; Baretti, Rufus

2013-01-01

32

Revascularization for unprotected left main stem coronary artery stenosis stenting or surgery.  

PubMed

For coronary artery disease with unprotected left main stem (LMS) stenosis, coronary artery bypass grafting (CABG) is traditionally regarded as the "standard of care" because of its well-documented and durable survival advantage. There is now an increasing trend to use drug-eluting stents for LMS stenosis rather than CABG despite very little high-quality data to inform clinical practice. We herein: 1) evaluate the current evidence in support of the use of percutaneous revascularization for unprotected LMS; 2) assess the underlying justification for randomized controlled trials of stenting versus surgery for unprotected LMS; and 3) examine the optimum approach to informed consent. We conclude that CABG should indeed remain the preferred revascularization treatment in good surgical candidates with unprotected LMS stenosis. PMID:18308155

Taggart, David P; Kaul, Sanjay; Boden, William E; Ferguson, T Bruce; Guyton, Robert A; Mack, Michael J; Sergeant, Paul T; Shemin, Richard J; Smith, Peter K; Yusuf, Salim

2008-03-01

33

Closed chest hybrid coronary revascularization for multivessel disease - current concepts and techniques from a two-center experience.  

PubMed

Hybrid coronary revascularization combining minimally invasive coronary surgery and percutaneous coronary intervention (PCI) allows sternal preserving treatment of multivessel coronary disease. The main principle of the technique includes placement of mammary artery graft to the left anterior descending coronary artery (LAD) and performance of PCI in non-LAD target vessels. This principle is based on increasing data showing equivalent results of PCI with coronary revascularization using saphenous vein grafts in selected patients. Providing that perioperative and long-term results are as good as the results of conventional surgical revascularization, this option seems to be quite appealing for patients and referring cardiologists. This concept has been designed to allow rapid rehabilitation and minimize periprocedural pain under concomitant preservation of the patient's body integrity. Robotically assisted endoscopic approaches for hybrid coronary revascularization set the pace for a closed-chest treatment of multivessel coronary disease. The time point of PCI, the use of different anticoagulation protocols as well as the stent selection are some of the variables, which affect outcome. We additionally report on the midterm results of 130 after-closed-chest hybrid-coronary procedures in two institutions. Hybrid procedures using robotic technology and PCI allow closed chest treatment of multivessel coronary artery disease. Single- and double-bypass grafts are feasible and simultaneous interventions can be performed. The overall safety of the procedure seems to be adequate and perioperative clinical results are satisfactory. Intermediate term survival and freedom from angina are excellent. PMID:21459599

Bonaros, Nikolaos; Schachner, Thomas; Wiedemann, Dominik; Weidinger, Felix; Lehr, Eric; Zimrin, David; Friedrich, Guy; Bonatti, Johannes

2011-10-01

34

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

2002-01-01

35

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

2000-01-01

36

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

2003-01-01

37

Consideration of a New Definition of Clinically Relevant Myocardial Infarction After Coronary Revascularization  

PubMed Central

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.

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.

2014-01-01

38

Comparison of hybrid coronary revascularization versus coronary artery bypass grafting in patients ?65 years with multivessel coronary artery disease.  

PubMed

Hybrid coronary revascularization (HCR) combines minimally invasive left internal mammary artery-to-left anterior descending coronary artery grafting with percutaneous coronary intervention of non-left anterior descending coronary arteries. The safety and efficacy of HCR in patients ?65 years of age is unknown. In this study, patients aged ?65 years were included who underwent HCR at an academic center from October 2003 to September 2013. These patients were matched 1:4 to similar patients treated with coronary artery bypass grafting (CABG) using a propensity-score matching algorithm. Conditional logistic regression and Cox regression stratified on matched pairs were performed to evaluate the association between HCR and CABG, and 30-day major adverse cardiovascular and cerebrovascular events (a composite of mortality, myocardial infarction, and stroke), periprocedural complications, and 3-year all-cause mortality. Of 715 patients (143 of whom underwent HCR and 572 CABG) in the propensity score-matched cohort, rates of 30-day major adverse cardiovascular and cerebrovascular events were comparable after HCR and CABG (5.6% vs 3.8%, odds ratio 1.46, 95% confidence interval 0.65 to 3.27, p = 0.36). Compared with CABG, HCR resulted in fewer procedural complications (9.1% vs 18.2%, p = 0.018), fewer blood transfusions (28.0% vs 53.3%, p <0.0001), less chest tube drainage (838 ± 484 vs 1,100 ± 579 cm(3), p <0.001), and shorter lengths of stay (<5 days: 45.5% vs 27.4%, p = 0.001). Over a 3-year follow-up period, mortality rates were similar after HCR and CABG (13.2% vs 16.6%, hazard ratio 0.81, 95% confidence interval 0.46 to 1.43, p = 0.47). Subgroup analyses in high-risk patients (Charlson index ?6, age ?75 years) rendered similar results. In conclusion, although the present data are limited, we found that in older patients, the use of HCR is safe, has fewer procedural complications, entails less blood product use, and results in faster recovery with similar longitudinal outcomes relative to conventional CABG. PMID:24878119

Harskamp, Ralf E; Puskas, John D; Tijssen, Jan G; Walker, Patrick F; Liberman, Henry A; Lopes, Renato D; Vassiliades, Thomas A; Peterson, Eric D; Halkos, Michael E

2014-07-15

39

Myocardial Revascularization for the Elderly: Current Options, Role of Off-pump Coronary Artery Bypass Grafting and Outcomes  

PubMed Central

The increase in life expectancy has confronted cardiac surgery with a rapidly growing population of elderly patients requiring surgical myocardial revascularization. Recent advances in surgical and anesthetic techniques and improvements in postoperative care have made coronary artery bypass grafting an established therapeutic option for the treatment of coronary artery disease in this group of patients. However, conventional coronary artery bypass grafting on cardiopulmonary bypass is associated with significant risk and related morbidity and mortality in the elderly. In recent years off-pump coronary artery bypass grafting has emerged as a safe and less invasive strategy for surgical myocardial revascularization. Off-pump coronary artery bypass grafting by avoiding the deleterious effects of cardiopulmonary bypass can offer potential benefits to elderly patients requiring surgical myocardial revascularization. This review article provides an overview of the age-related cardiovascular changes, epidemiology of coronary artery disease in the elderly and focuses on outcomes of surgical myocardial revascularization with special emphasis on the impact of off-pump coro-nary artery bypass surgery in the elderly.

Raja, Shahzad G

2012-01-01

40

Three-Year Outcomes of Multivessel Revascularization in Very Elderly Acute Coronary Syndrome Patients  

PubMed Central

Background Comparative effectiveness of interventional treatment strategies for the very elderly with acute coronary syndrome remains poorly defined due to study exclusions. Interventions include percutaneous coronary intervention (PCI), usually with stents, or coronary artery bypass grafting (CABG). The elderly are frequently directed to PCI because of provider perceptions that PCI is at therapeutic equipoise with CABG and that CABG incurs increased risk. We evaluated long-term outcomes of CABG versus PCI in a cohort of very elderly Medicare beneficiaries presenting with acute coronary syndrome. Methods Using Medicare claims data, we analyzed outcomes of multivessel PCI or CABG treatment for a cohort of 10,141 beneficiaries age 85 and older diagnosed with acute coronary syndrome in 2003 and 2004. The cohort was followed for survival and composite outcomes (death, repeat revascularization, stroke, acute myocardial infarction) for three years. Logistic regressions controlled for patient demographics and comorbidities with propensity score adjustment for procedure selection. Results Percutaneous coronary intervention showed early benefits of lesser morbidity and mortality, but CABG outcomes improved relative to PCI outcomes by three years (p < 0.01). At 36 months post-initial revascularization, 66.0% of CABG recipients survived (versus 62.7% of PCI recipients, p < 0.05) and 46.1% of CABG recipients were free from composite outcome (versus 38.7% of PCI recipients, p < 0.01). Conclusions In very elderly patients with ACS and multivessel CAD, CABG appears to offer an advantage over PCI of survival and freedom from composite endpoint at three years. Optimizing the benefit of CABG in very elderly patients requires absence of significant congestive heart failure, lung disease, and peripheral vascular disease.

Sheridan, Brett C.; Stearns, Sally C.; Rossi, Joseph S.; D'Arcy, Laura P.; Federspiel, Jerome J.; Carey, Timothy S.

2010-01-01

41

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

2011-01-01

42

Revascularization Options for Ischemic Cardiomyopathy: On-Pump and Off-Pump Coronary Artery Bypass Surgery  

Microsoft Academic Search

Patients with ischemic cardiomyopathy and markedly reduced left ventricular (LV) function should be evaluated for coronary artery bypass surgery (CABG) before other surgical options are considered. The success of surgery depends on the presence of viable myocardium and target coronary arteries of acceptable quality. Long-term survival in this setting may be comparable to that with cardiac transplantation. Off-pump CABG can

Kamal R. Khabbaz; David DeNofrio; Marwan Kazimi; Philip A. Carpino

2004-01-01

43

Myocardial viability testing and impact of revascularization on prognosis in patients with coronary artery disease and left ventricular dysfunction: a meta-analysis  

Microsoft Academic Search

ObjectivesThis study pools data from published series examining late survival with revascularization versus medical therapy after myocardial viability testing in patients with severe coronary artery disease (CAD) and left ventricular (LV) dysfunction.

Kevin C Allman; Leslee J Shaw; Rory Hachamovitch; James E Udelson

2002-01-01

44

How does the right gastroepiploic artery compare with the saphenous vein for revascularization of the right coronary artery?  

PubMed Central

A best evidence topic was written according to a structured protocol. The question addressed was ‘is the saphenous vein graft or right gastroepiploic artery a better conduit for revascularization of the right coronary artery?’ One hundred and five articles were found using a designated search, of which 10 articles were found to represent the best available evidence to answer the clinical question. Of these 10 articles, two were reports of a randomized controlled trial and represented the highest level of evidence, whereas eight articles were retrospective observational studies. All were published between 2002 and 2012. Outcome measures varied considerably, but mostly included graft patency at varying periods of follow-up. The randomized evidence suggested that the saphenous vein had better early (6-month) and mid-term (3-year) graft patency than the right gastroepiploic artery when used for right coronary artery revascularization. The use of the saphenous vein was also found to be predictive of superior graft function using multivariate regression; however, a more recent propensity score analysis identified gastroepiploic-right coronary grafts to yield superior very long-term (>10 years) clinical outcomes. Overall, based on the best quality evidence and in view of technical limitations and flow characteristics of the right gastroepiploic artery, it appears that saphenous vein grafts may offer superior outcomes for revascularization of the right coronary artery in most cases, and should be preferentially used.

Mukherjee, Dayal; Cheriyan, Jerry; Kourliouros, Antonios; Athanasiou, Thanos

2012-01-01

45

Successful percutaneous coronary intervention during cardiac arrest with use of an automated chest compression device: a case report  

PubMed Central

Ventricular tachycardia or fibrillation (VT/VF) in patients with ST-elevation myocardial infarction (STEMI) is associated with poor prognosis. Performing manual chest compressions is a serious obstacle for treatment with percutaneous coronary intervention (PCI). Here we introduce a case with refractory VT/VF where the patient was successfully treated with an automated chest compression device, which made revascularization with PCI possible.

Libungan, Berglind; Dworeck, Christian; Omerovic, Elmir

2014-01-01

46

An improved technique for long saphenous vein harvesting for coronary revascularization.  

PubMed

A prospective study was undertaken to assess the functional quality of long saphenous vein for coronary revascularization when it has been harvested by means of multiple small incisions and use of the Mayo "stripper." This avoids a "long cut" and the major wound problems commonly associated with it. Between January, 1979, and July, 1984, 2,439 patients underwent coronary artery bypass graft with long saphenous vein harvested by this technique. No major wound problems occurred, and minor wound problems were seen in only 23 patients (0.9%). Vein quality was assessed by histological studies of veins, postoperative graft angiography, and exercise testing. Both light electron microscopy and scanning electron microscopy demonstrated that the vein was of good quality and that the intima had been preserved. Postoperative graft angiography and exercise testing confirmed high patency rates for the vein grafts (93%). Vein harvesting with this technique is easy, gives good quality vein, both morphologically and functionally, for grafting, is associated with a minimum of wound problems, and has cosmetically superior results. PMID:3488043

Meldrum-Hanna, W; Ross, D; Johnson, D; Deal, C

1986-07-01

47

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

48

Preoperative evaluation of myocardial viability by thallium-201 imaging in patients with old myocardial infarction who underwent coronary revascularization  

Microsoft Academic Search

The myocardial uptake and redistribution in thallium scintigraphy and the regional wall motion by echocardiography were evaluated\\u000a by a semi-quantitative method in 42 patients who previously had myocardial infarction (50 target vessels) and underwent coronary\\u000a revascularization. The aim of this study was to elucidate the significance of the initial image, delayed image and redistribution\\u000a on thallium-201 scintigraphy for clinical diagnosis

Hitoshi Naruse; Mitsumasa Ohyanagi; Tadaaki Iwasaki; Takashi Miyamoto; Minoru Fukuchi

1992-01-01

49

Coronary artery disease, coronary revascularization, and outcomes in chronic advanced systolic heart failure  

PubMed Central

Background Associations between coronary artery disease (CAD) and outcomes in systolic heart failure (HF) and that between coronary artery bypass graft (CABG) and outcomes in patients with HF and CAD have not been examined using propensity-matched designs. Methods Of the 2707 patients with advanced chronic systolic HF in the Beta-Blocker Evaluation of Survival Trial (BEST), 1593 had a history of CAD, of whom 782 had prior CABG. Using propensity scores for CAD we assembled a cohort of 458 pairs of CAD and no-CAD patients. Propensity scores for prior CABG in those with CAD were used to assemble 500 pairs of patients with and without CABG. Matched patients were balanced on 68 baseline characteristics. Results All-cause mortality occurred in 33% and 24% of matched patients with and without CAD respectively, during 26 months of median follow-up (hazard ratio {HR} when CAD was compared with no-CAD, 1.41; 95% confidence interval {CI}, 1.11–1.81; P=0.006). HR's (95% CIs) for CAD-associated cardiovascular mortality, HF mortality, and sudden cardiac death (SCD) were 1.53 (1.17–2.00; P=0.002), 1.44 (0.92–2.25; P=0.114) and 1.76 (1.21–2.57; P=0.003) respectively. CAD had no association with hospitalization. Among matched patients with HF and CAD, all-cause mortality occurred in 32% and 39% of those with and without prior CABG respectively (HR for CABG, 0.77; 95% CI, 0.62–0.95; P=0.015). Conclusions In patients with advanced chronic systolic HF, CAD is associated with increased mortality, and in those with CAD, prior CABG seems to be associated with reduced all-cause mortality but not SCD.

Gheorghiade, Mihai; Flaherty, James D.; Fonarow, Gregg C.; Desai, Ravi V.; Lee, Richard; McGiffin, David; Love, Thomas E.; Aban, Inmaculada; Eichhorn, Eric J.; Bonow, Robert O.; Ahmed, Ali

2010-01-01

50

Interventional Revascularization of Coronary Artery Lesions in Diabetic Patients; In-hospital and One Year Follow up  

PubMed Central

Background Diabetes mellitus is a life threatening disease accompanied by several micro- and macro vascular complications. Several modalities are available for interventional revascularization of coronary artery lesions, but their efficacy in diabetic patients is studied only in few patients. Materials and Method This study evaluated major in- hospital complications and clinical outcome after one year in 200 consecutive patients who underwent percutaneous Coronary Intervention from 2007 to 2009. Results Our findings showed comparable single and 2 vessel stenting, regarding major adverse cardiovascular event in diabetic and nondiabetic patients. In connection with long term and in hospital outcome, no statistically significant difference was found between one and two vessel stenting when drug eluting stent was used in diabetic patients. Conclusion The use of drug eluting stent in single or two vessel disease of diabetic patients is technically satisfactory and clinically safe and can substitute for coronary artery bypass grafting.

Zibaeenezhad, Mohammad Javad; Aslani, Amir; Moniri, Alireza; Kheiri, Mohammad Ali; Heydari, Seyed Taghi; Amanat, Ahmad; Daneshvar, Zahra

2012-01-01

51

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

PubMed

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

2012-04-01

52

What is the optimal revascularization technique for isolated disease of the left anterior descending artery: minimally invasive direct coronary artery bypass or percutaneous coronary intervention?  

PubMed

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was, 'What is the optimal revascularization technique for isolated disease of the left anterior descending artery (LAD) in terms of patient survival, morbidity such as myocardial infarction (MI) and need for repeat target vessel revascularization: minimally invasive direct coronary artery bypass graft (MIDCAB) or percutaneous coronary intervention (PCI)?' Altogether 504 papers were found using the reported search, of which 13 represented the best evidence to answer the clinical question. Outcome parameters that were used in the assessment include the incidence of major adverse cardiovascular or cerebral events (MACCEs), mortality and the rate of repeat target vessel revascularization. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of the papers are tabulated. One meta-analysis showed no significant difference in terms of individual incidences of MI, stroke or mortality, but when considered as a composite MACCE outcome, this was found to be significantly lower in the MIDCAB group. Moreover, further meta-analytical data have revealed a 5-fold increase in the need for repeat revascularization with PCI, with some centres reporting rates of up to 34%. However, retrospective data have shown that average length of hospital stay was longer in the MIDCAB group (7.4 ± 3.2 vs 3.4 ± 3.5 days; P < 0.001). We conclude that there are obvious proven benefits with MIDCAB, namely in terms of a reduced need for repeat target vessel revascularization and incidence of MACCE, and one study has even shown that there is a long-term survival benefit in 'real-world' clinical practice. However, given that there is a lack of well-powered randomized controlled trial and long-term follow-up data to prove a mortality benefit in support of MIDCAB, patients requiring revascularization of isolated proximal LAD stenosis and being considered for percutaneous coronary intervention should be discussed in a multidisciplinary team setting prior to intervention. PMID:24667582

Patel, Akshay J; Yates, Martin T; Soppa, Gopal K R

2014-07-01

53

Fractional flow reserve for the assessment of complex multivessel disease in a patient after hybrid coronary revascularization.  

PubMed

We present a case of a 43-year-old woman with history of hybrid coronary revascularization [endoscopic atraumatic coronary artery bypass (ACAB)] of left internal mammary artery (LIMA) to the left anterior descending artery (LAD) and stent implantation in right coronary artery (RCA), who presented 6 years later with recurrent atypical angina. Coronary angiography revealed patent LIMA to LAD and RCA stent, with a new lesion in an obtuse marginal artery and significant progression of disease in the proximal/mid LAD proximal to LIMA touchdown. To further evaluate the hemodynamic significance of these new disease segments, the patient underwent fractional flow reserve (FFR) assessment of the left coronary system with subsequent stent implantation in the proximal/mid LAD. This case illustrates (1) the critical value of FFR assessment in determining the ischemia provoking lesions in this post ACAB patient with complex multivessel coronary artery disease; and (2) the accelerated progression of atherosclerosis in bypassed segments as compared to segments proximal to stents. PMID:22899601

Corban, Michel T; Eshtehardi, Parham; Samady, Habib

2013-06-01

54

Evaluation of the Effect of Concurrent Chronic Total Occlusion and Successful Staged Revascularization on Long-Term Mortality in Patients with ST-Elevation Myocardial Infarction  

PubMed Central

Aims. To investigate the impact of chronic total occlusion (CTO) in non-infarct-related artery (IRA) on the long-term prognosis and evaluate the clinical significance of staged revascularization in patients with ST-segment elevation myocardial infarction (STEMI). Methods. 1266 STEMI patients with primary percutaneous coronary intervention (PCI) were categorized as single-vessel disease (SVD), multivessel disease (MVD) without and with CTO. We study the clinical outcomes of patients after primary PCI in the following 3 years. Additionally, patients with CTO received staged revascularization, and major adverse cardiac events (MACE) during 3-year follow-up were recorded. Results. Presence of CTO was a predictor of both early mortality [hazard ratio (HR) 3.4, 95% confidence interval (CI) 2.4–4.5, P < 0.01] and late mortality (HR 1.9, 95% CI 1.4–3.6, P < 0.01), whereas MVD without CTO was only a predictor of early mortality (HR 1.7, 95% CI 1.3–2.3, P < 0.05). In CTO group, 100 patients had successful CTO recanalization, and 48 patients failed. During 3-year follow-up, patients with failed procedure had higher cardiac mortality (22.9% versus 9.0%, P = 0.020) and lower MACE-free survival (50.0% versus 72.0%, P = 0.009) compared to patients with successful procedure. Conclusion. The presence of CTO and not MVD alone is associated with long-term mortality. Successful revascularization of CTO in the non-IRA is associated with improved clinical outcomes in patients with STEMI undergoing primary PCI.

Shi, Guoxiang; He, Pengcheng; Liu, Yuanhui; Lin, Yaowang; Yang, Xing; Chen, Jiyuan; Zhou, Yingling; Tan, Ning

2014-01-01

55

The 2013 Canadian Cardiovascular Society Heart Failure Management Guidelines Update: focus on rehabilitation and exercise and surgical coronary revascularization.  

PubMed

The 2013 Canadian Cardiovascular Society Heart Failure Management Guidelines Update provides focused discussions on the management recommendations on 2 topics: (1) exercise and rehabilitation; and (2) surgical coronary revascularization in patients with heart failure. First, all patients with stable New York Heart Association class I-III symptoms should be considered for enrollment in a tailored exercise training program, to improve exercise tolerance and quality of life. Second, selected patients with suitable coronary anatomy should be considered for bypass graft surgery. As in previous updates, the topics were chosen in response to stakeholder feedback. The 2013 Update also includes recommendations, values and preferences, and practical tips to assist the clinicians and health care workers manage their patients with heart failure. PMID:24480445

Moe, Gordon W; Ezekowitz, Justin A; O'Meara, Eileen; Howlett, Jonathan G; Fremes, Steve E; Al-Hesayen, Abdul; Heckman, George A; Ducharme, Anique; Estrella-Holder, Estrellita; Grzeslo, Adam; Harkness, Karen; Lepage, Serge; McDonald, Michael; McKelvie, Robert S; Nigam, Anil; Rajda, Miroslaw; Rao, Vivek; Swiggum, Elizabeth; Virani, Sean; Van Le, Vy; Zieroth, Shelley; Arnold, J Malcolm O; Ashton, Tom; D'Astous, Michel; Dorian, Paul; Giannetti, Nadia; Haddad, Haissam; Isaac, Debra L; Kouz, Simon; Leblanc, Marie-Hélène; Liu, Peter; Ross, Heather J; Sussex, Bruce; White, Michel

2014-03-01

56

Does the right internal thoracic artery or saphenous vein graft offer superior revascularization of the right coronary artery?  

PubMed Central

A best evidence topic was written according to a structured protocol. The question addressed was whether the right internal thoracic artery (RITA) provides a superior outcome for revascularization of the right coronary artery (RCA) compared with the saphenous vein graft (SVG). Using a designated search strategy, 226 articles were found, of which five represented the best available evidence. The authors, journal, date, country of publication, study type, patient group studied, relevant outcomes and results were tabulated. Of these five studies, one offered level I evidence (data from a randomized trial) and four were level II studies (reports of observational data). The outcome measures varied considerably, but most included graft patency at varying levels of the follow-up. The randomized data showed strong evidence favouring the SVG, mainly in terms of mid-term patency. With the exception of a large cohort study that demonstrated the superior patency of the RITA compared with the SVG in the right coronary territory, the observational studies showed better results for SVG in graft patency, reintervention and cardiovascular complication rate. Overall, and in view of the methodological limitations and the different weight of evidence among studies, it appears that the SVG may offer a superior outcome for revascularization of the RCA when compared with the RITA.

Mukherjee, Dayal; Cheriyan, Jerry; Kourliouros, Antonios; Athanasiou, Thanos

2012-01-01

57

Total Arterial Off-pump Coronary Revascularization with a Bilateral Internal Mammary Artery Y Graft (208 cases)  

PubMed Central

Objective: The aim was to evaluate the early outcome of off-pump coronary artery bypass grafting (OPCABG) with a bilateral internal mammary artery (BIMA) Y configuration graft to achieve total arterial myocardial revascularization. Materials and Methods: From October 2002 to December 2008, 208 patients (196 male and 12 female patients) underwent OPCABG by only using a BIMA Y configuration graft. The average age of the patients was 56.5±11.3 years, with the age range being 33–78 years. A total of 167 (80.2%) cases had triple-vessel disease. Left main stem disease was found in 33 (15.9%) cases, and double-vessel disease was found in 8 (3.9%) cases. The semiskeletonization skill was used to harvest the two IMAs, and then the free right internal mammary artery was anastomosed end-to-side to the in situ left internal mammary artery to composite a Y configuration graft. Off-pump and sequential anastomosis methods were used to perform coronary artery bypass surgery for the patients. Graft patency was assessed by using the HT311 transit time flowmeter (USA Transonic Systems Inc.), intraoperatively. Results: We performed distal anastomoses of the grafts in 728 patients, the average being 3.5±1.3 per person. No one died and got recurrent angina within 30 days after operation. Conclusion: OPCABG by using the BIMA Y graft was safe and effective to achieve total arterial revascularization, and avoid surgical operation on the ascending aorta, and other incisions.

Yang, Jun-Feng; Zhang, Hong-Chao; Gu, Cheng-Xiong; Wei, Hua

2012-01-01

58

Successful revascularization of re-stenosis of lower extremity arteries with localized delivery of paclitaxel.  

PubMed

Restenosis after percutaneous revascularization techniques is a challenging issue in patients with severe peripheral arterial disease. We report two cases where multiple revascularization techniques had been used previously, but restenosis occurred. We used an irrigation balloon to deliver paclitaxel locally into the tissues to obtain better results. PMID:18655111

Latif, Faisal; Hennebry, Thomas A

2008-08-01

59

Myocardial viability assessment by endocardial electroanatomic mapping: comparison with metabolic imaging and functional recovery after coronary revascularization  

Microsoft Academic Search

OBJECTIVESThe objective of this study was to compare electroanatomic mapping for the assessment of myocardial viability with nuclear metabolic imaging using positron emission computed tomography (PET) and with data on functional recovery after successful myocardial revascularization.BACKGROUNDAnimal experiments and first clinical studies suggested that electroanatomic endocardial mapping identifies the presence and absence of myocardial viability.METHODSForty-six patients with prior (?2 weeks) myocardial

Karl-Christian Koch; Juergen vom Dahl; Monika Wenderdel; Bernd Nowak; Wolfgang M Schaefer; Alexander Sasse; Christoph Stellbrink; Udalrich Buell; Peter Hanrath

2001-01-01

60

Long-Term Survival With Revascularization in South Asians Admitted With an Acute Coronary Syndrome (from the Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease Registry).  

PubMed

People of South Asian (SA) descent are particularly susceptible to acute coronary syndromes (ACS). Yet, little information exists regarding their overall prognosis. The purpose of this study was to compare short- and long-term clinical outcomes of SA and European Canadians admitted with an ACS. Using the Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease registry, 63,393 patients with ACS were reviewed (January 1999 to March 2012). After excluding Chinese patients, 1,825 SAs were compared with 60,791 European Canadians. Both groups were propensity matched, and outcomes were compared. Adjustment was performed using a 3:1 propensity matching technique. Adjusted 30-day and 1-year mortality rates were similar between SA and European patients with ACS (2.6% vs 2.7%, p = 0.93; 5.0% vs 4.8%, respectively, p = 0.75). Repeat angiography did not differ (9.9% vs 9.2%, p = 0.35), yet repeat revascularization within 1 year was greater in SA patients (9.8% vs 7.6%, p <0.01). Improved long-term survival (median 64 months, interquartile range 66 months) was noted with SA patients (hazard ratio [HR] 0.82, 95% confidence interval [CI] 0.71 to 0.95). In particular, long-term survival was observed in SA patients receiving coronary artery bypass grafting (HR 0.75, 95% CI 0.52 to 1.08) and percutaneous coronary intervention (HR 0.75, 95% CI 0.59 to 0.96). In conclusion, SA patients treated with revascularization appear to have improved long-term survival after ACS, compared with European Canadians. As such, clinicians should be cognitive of ethnic-based outcomes when determining therapeutic strategies in patient management. PMID:24927971

Kaila, Kendeep S; Norris, Colleen M; Graham, Michelle M; Ali, Imtiaz; Bainey, Kevin R

2014-08-01

61

Successful primary PCI in a patient with single coronary artery.  

PubMed

Sudden occlusion of the only patent coronary artery is usually a devastating event. We describe the case of a successful percutaneous recanalization of a single coronary artery originating at the right sinus of Valsalva. PMID:23735366

Pawlowski, Krzysztof; Dorniak, Waldemar; Klaudel, Jacek

2013-06-01

62

Evolution in practice patterns and long-term outcomes of coronary revascularization from bare-metal stent era to drug-eluting stent era in Japan.  

PubMed

Treatment of coronary artery disease has significantly changed over the past decade including an introduction of drug-eluting stents and a more stringent adherence to evidence-based medications. However, the impact of these advanced treatment methods on the practice patterns and long-term outcomes in patients undergoing coronary revascularization in the real world has not been yet fully evaluated. The present study population consisted of the 2 groups of patients who underwent their first coronary revascularization in the Coronary REvascularization Demonstrating Outcome Study in Kyoto Registry Cohort-1 (bare-metal stent era: January 2000 to December 2002, n = 8,986) and Cohort-2 (drug-eluting stent era: January 2005 to December 2007, n = 10,339). Compared with Cohort-1, the proportion of patients treated with percutaneous coronary intervention significantly increased in Cohort-2 (73% vs 81%, p <0.001), particularly for 3-vessel disease (50% vs 61%, p <0.001) and left main disease (18% vs 36%, p <0.001). Evidence-based medications were more frequently used in Cohort-2. The cumulative 2-year incidence of and the adjusted risk for all-cause death were not significantly different between Cohort-1 and Cohort-2 (6.2% vs 6.4%, p = 0.69, and hazard ratio [HR] 0.91, 95% confidence interval [CI] 0.81 to 1.03, p = 0.15). Adjusted risks for both myocardial infarction and repeated coronary revascularization were significantly reduced in Cohort-2 compared with Cohort-1 (HR 0.80, 95% CI 0.67 to 0.96, p = 0.02, and HR 0.73, 95% CI 0.69 to 0.77, p <0.001, respectively). In conclusion, despite changes in treatment methods over time, the long-term mortality of patients undergoing coronary revascularization in the real-world clinical practice has not been changed, although there was a significant reduction of myocardial infarction and repeated coronary revascularization. PMID:24792736

Shiomi, Hiroki; Morimoto, Takeshi; Makiyama, Takeru; Ono, Koh; Furukawa, Yutaka; Nakagawa, Yoshihisa; Kadota, Kazushige; Onodera, Tomoya; Takatsu, Yoshiki; Mitsudo, Kazuaki; Kita, Toru; Sakata, Ryuzo; Okabayashi, Hitoshi; Hanyu, Michiya; Komiya, Tatsuhiko; Yamazaki, Fumio; Nishiwaki, Noboru; Kimura, Takeshi

2014-05-15

63

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

1975-01-01

64

Surgical Revascularization for Acute Coronary Insufficiency: Analysis of Risk Factors for Hospital Mortality  

Microsoft Academic Search

Background. A retrospective study of 444 patients undergoing urgent and emergent coronary artery bypass grafting for acute coronary insufficiency was performed to identify the risk factors for hospital death specifically associated with the clinical severity of the acute coronary insufficiency syndrome.Methods. The patients were divided into three groups—urgent, emergent A, and emergent B—on the basis of the evolution of the

Biagio Tomasco; Antonino Cappiello; Rosario Fiorilli; Archimede Leccese; Raniero Lupino; Antonio Romiti; Ugo F Tesler

1997-01-01

65

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

1980-01-01

66

Importance of diabetes mellitus and systemic hypertension rather than completeness of revascularization in determining long-term outcome after coronary balloon angioplasty (the LDCMC registry). Lady Davis Carmel Medical Center.  

PubMed

The study examined the 10-year outcome in a cohort of 227 unselected, consecutive patients (age 58+/-10 years) undergoing coronary balloon angioplasty between 1984 and 1986 and followed in a single cardiac center (Lady Davis Carmel Medical Center registry). In particular, we sought to identify the relative importance of the systemic risk factors diabetes and hypertension and the extent of coronary disease as opposed to procedure-related technical variables, the immediate success of the procedure, or completeness of revascularization. By life-table analysis (99% follow-up), 94% of the patients were alive at 5 years, and 77% at 10 years after angioplasty. Ten-year survival was reduced in patients with diabetes mellitus (59% vs 83%, p = 0.0008), in patients with previous myocardial infarction (68% vs 85%, p = 0.01), in patients with ejection fraction <50% (55% vs 82%, p = 0.005), and in patients with 3-vessel disease (58% vs 84% and 86% for 1- and 2-vessel disease, respectively, p = 0.04). Diabetes mellitus was the major independent predictor of poor survival (adjusted odds ratio 3.1, 95% confidence interval 1.55 to 6.19, p = 0.001). Survival at 10 years was identical in 199 patients in whom angioplasty was complete and in 25 in whom the balloon catheter did not cross the lesion, although bypass surgery was more frequent in the latter group (45% vs 21%, p = 0.001). Incomplete revascularization did not predict poor survival (72% vs 79% with complete angioplasty, p = NS). Event-free survival at 10 years for the whole group was 29%, and 49% of patients survived with no event other than a single repeat angioplasty procedure. Multivessel disease, hypertension, and diabetes mellitus were independent predictors of decreased event-free survival, but incomplete revascularization was not. Thus, long-term outcome after coronary balloon angioplasty was related to diabetes mellitus, systemic hypertension, and extent of coronary disease, but not to the immediate success of the procedure or completeness of revascularization. PMID:9732877

Halon, D A; Merdler, A; Flugelman, M Y; Shifroni, G; Khader, N; Shiran, A; Shahla, J; Lewis, B S

1998-09-01

67

Early Risk of Mortality after Coronary Artery Revascularization in Patients with Left Ventricular Dysfunction and Potential Role of the Wearable Cardioverter Defibrillator  

PubMed Central

Background Implantable cardioverter defibrillator (ICD) implantation for prevention of sudden cardiac death is typically deferred for 90 days after coronary revascularization, but mortality may be highest early after cardiac procedures in patients with ventricular dysfunction. We determined mortality risk in post-revascularization patients with left ventricular ejection fraction (LVEF) ?35% and compared survival to those discharged with a wearable cardioverter defibrillator (WCD). Methods and Results Hospital survivors after surgical (CABG) or percutaneous (PCI) revascularization with LVEF?35% were included from Cleveland Clinic and national WCD registries. Kaplan-Meier, Cox proportional hazards, propensity score-matched survival and hazard function analyses were performed. Early mortality hazard was higher among 4149 patients discharged without a defibrillator compared to 809 with WCDs (90-day mortality post-CABG 7% vs. 3%, p=0.03; post-PCI 10% vs. 2%, p<0.0001). WCD use was associated with adjusted lower risks of long-term mortality in the total cohort (39%, p<0.0001) and both post-CABG (38%, p=0.048) and post-PCI (57%, p<0.0001) cohorts (mean follow-up 3.2 years). In propensity-matched analyses, WCD use remained associated with lower mortality (58% post-CABG, p=0.002; 67% post-PCI, p<0.0001). Mortality differences were not attributable solely to therapies for ventricular arrhythmia. Only 1.3% of the WCD group had a documented appropriate therapy. Conclusions Patients with LVEF?35% have higher early compared to late mortality after coronary revascularization, particularly after PCI. As early hazard appeared less marked in WCD users, prospective studies in this high risk population are indicated to confirm whether WCD use as a bridge to LVEF improvement or ICD implantation can improve outcomes after coronary revascularization.

Zishiri, Edwin T.; Williams, Sarah; Cronin, Edmond M.; Blackstone, Eugene H.; Ellis, Stephen G.; Roselli, Eric E.; Smedira, Nicholas G.; Gillinov, A. Marc; Glad, Jo Ann; Tchou, Patrick J.; Szymkiewicz, Steven J.; Chung, Mina K.

2013-01-01

68

Impact of impaired glomerular filtration rate and revascularization strategy on one-year cardiovascular events in acute coronary syndrome: data from Taiwan acute coronary syndrome full spectrum registry  

PubMed Central

Background The optimal revascularization strategy for patients with impaired glomerular filtration rate (IGFR) has not been established in acute coronary syndrome (ACS). We investigated the prognosis and impact of IGFR and invasive strategy on the cardiovascular outcomes in the ACS population. Methods In a Taiwan national-wide registry, 3093 ACS patients were enrolled. The invasive strategy was defined as patients with ST-elevation ACS (STE-ACS) undergoing primary angioplasty or fibrinolysis or coronary angiography with intent to revascularization performed within 72 hours of symptom onset in non-ST-elevation ACS (NSTE-ACS). IGFR was defined as an estimated GFR of less than 60 ml/min per 1.73 m2. Primary endpoint was a composite of death, non-fatal myocardial infarction or stroke at one year. Results Patients with IGFR (n?=?1226) had more comorbidities but received less evidence-based medications during admission than those without IGFR (n?=?1867). The primary endpoint-free survival rate is lower in the IGFR patients, in the whole, STE-ACS and NSTE-ACS population (all log-rank tests p?

2014-01-01

69

Coronary revascularization with or without cardiopulmonary bypass in patients with preoperative nondialysis-dependent renal insufficiency  

Microsoft Academic Search

Background. Preoperative renal insufficiency is a predictor of acute renal failure in patients undergoing conventional coronary artery bypass grafting. Off-pump coronary artery bypass operations have been shown to reduce renal dysfunction in patients with normal renal function, but the effect of this technique in patients with preoperative nondialysis-dependent renal insufficiency is unknown.Methods. From June 1996 to December 1999, data of

Raimondo Ascione; Guy Nason; Sharif Al-Ruzzeh; Chung Ko; Franco Ciulli; Gianni D Angelini

2001-01-01

70

Sensitivity and specificity of the RAND\\/UCLA Appropriateness Method to identify the overuse and underuse of coronary revascularization and hysterectomy  

Microsoft Academic Search

There is no empirical evidence on the sensitivity and specificity of methods to identify the possible overuse and underuse of medical procedures. To estimate the sensitivity and specificity of the RAND\\/UCLA Appropriateness Method. Parallel three-way replication of the RAND\\/UCLA Appropriateness Method for each of two procedures, coronary revascularization and hysterectomy. Maximum likelihood estimates of the sensitivity and specificity of the

Paul G Shekelle; R. E Park; James P Kahan; Lucian L Leape; Caren J Kamberg; Steven J Bernstein

2001-01-01

71

Coronary revascularization strategy for ST elevation myocardial infarction with multivessel disease: experience and results at 1-year follow-up.  

PubMed

Primary percutaneous coronary intervention (PCI) of culprit lesions (CLs) is the standard of care in patients presenting with ST elevation myocardial infarction (STEMI). However, optimal revascularization strategy for significant nonculprit lesions (non-CLs) in the setting of STEMI remains controversial. The importance of defining of such a strategy lies in the fact that approximately 50% of patients with STEMI have multivessel disease (MVD). The aim of this study was to describe characteristics, therapeutic strategies, and 1-year outcomes in a cohort of patients with STEMI and MVD. We retrospectively analyzed a cohort of 63 patients with STEMI and MVD obtained from a 5-year catheterization database. MVD was defined as ?70% stenosis of ?2 epicardial coronary arteries. This cohort was followed for a period of 1 year for major adverse cardiac events (MACE was defined as acute coronary syndrome, new onset heart failure, or death) and all-cause mortality. PCI with stent placement was the major therapeutic procedure (87.5%) performed for CLs. Non-CLs did not undergo interventions in a majority of individuals (47.6%), while the remaining patients underwent PCI (29%) and coronary artery bypass graft surgery (22%) for non-CLs. At 1-year follow-up, prevalence of MACE events and death in the entire cohort were 30% and 15%, respectively. A trend for better outcomes (1-year cumulative MACE events but not mortality) was observed in CL-only intervention cohort compared with non-CL intervention. The PCI and Coronary artery bypass graft surgery cohorts did not show any significant difference in clinical outcomes. In this retrospective cohort of patients with MVD who presented with STEMI, no intervention of noncritical lesions was the prevalent approach, reflecting guideline recommendations. CL-only intervention strategy showed a better clinical outcome than non-CL intervention. Intervention of noncritical lesions therefore did not seem to improve MACEs or all-cause mortality at 1-year of follow-up and might in fact have had a detrimental effect on outcomes. PMID:20027110

Mohamad, Tamam; Bernal, Juan M; Kondur, Ashok; Hari, Pawan; Nelson, Katrina; Niraj, Ashutosh; Badheka, Apurva; Hassna, Samer; Kiernan, Tom; Elder, Mahir D; Gardi, Delair; Schreiber, Theodore

2011-01-01

72

Clinical Significance of A Single Multi-Slice CT Assessment in Patients with Coronary Chronic Total Occlusion Lesions Prior to Revascularization  

PubMed Central

Accurate assessment of coronary chronic total occlusion (CTO) lesion is essential to design an appropriate procedural strategy before revascularization. The present study aims to evaluate the significance of a single multislice computed tomography (MSCT) examination in patients with CTO lesion. We retrospectively analyzed the clinical data of 23 CTO lesions in twenty patients underwent computed tomography coronary angiography (CTCA) and SPECT. The CTCA was more powerful and sensitive to determine the CTO lesion length (100% v.s 47.8%) and to identify the length and location of calcification in occluded vessels compared with the coronary angiography (CAG). The LVEF measured by MSCT was comparable to that from the gated SPECT. Myocardial perfusion imaging showed that the location of the early defect region identified by MSCT was corresponded to the nuclide filling defect on the stressed 201thallium-SPECT imaging. The late hyperenhancement on MSCT was presented as incomplete nuclide filling on the 99mTc-MIBI imaging. The results suggested that a single MSCT examination in previous myocardial infarction without revascularization facilitates to provide some valuable information on the nature of the occluded lesion, myocardial perfusion and globe cardiac function, which would be helpful to design appropriate revascularization strategy in these subjects.

Qu, Xinkai; Fang, Weiyi; Gong, Kaizheng; Ye, Jianding; Guan, Shaofeng; Li, Ruogu; Xu, Yingjia; Shen, Yan; Zhang, Min; Liu, Hua; Xie, Wenhui

2014-01-01

73

Clinical Significance of A Single Multi-Slice CT Assessment in Patients with Coronary Chronic Total Occlusion Lesions Prior to Revascularization.  

PubMed

Accurate assessment of coronary chronic total occlusion (CTO) lesion is essential to design an appropriate procedural strategy before revascularization. The present study aims to evaluate the significance of a single multislice computed tomography (MSCT) examination in patients with CTO lesion. We retrospectively analyzed the clinical data of 23 CTO lesions in twenty patients underwent computed tomography coronary angiography (CTCA) and SPECT. The CTCA was more powerful and sensitive to determine the CTO lesion length (100% v.s 47.8%) and to identify the length and location of calcification in occluded vessels compared with the coronary angiography (CAG). The LVEF measured by MSCT was comparable to that from the gated SPECT. Myocardial perfusion imaging showed that the location of the early defect region identified by MSCT was corresponded to the nuclide filling defect on the stressed 201thallium-SPECT imaging. The late hyperenhancement on MSCT was presented as incomplete nuclide filling on the 99mTc-MIBI imaging. The results suggested that a single MSCT examination in previous myocardial infarction without revascularization facilitates to provide some valuable information on the nature of the occluded lesion, myocardial perfusion and globe cardiac function, which would be helpful to design appropriate revascularization strategy in these subjects. PMID:24905494

Qu, Xinkai; Fang, Weiyi; Gong, Kaizheng; Ye, Jianding; Guan, Shaofeng; Li, Ruogu; Xu, Yingjia; Shen, Yan; Zhang, Min; Liu, Hua; Xie, Wenhui

2014-01-01

74

Magnesium-supplemented warm blood cardioplegia in patients undergoing coronary artery revascularization  

Microsoft Academic Search

Background. Although there is growing evidence to suggest that the administration of magnesium (Mg2+) to patients undergoing coronary artery bypass grafting (CABG) and to patients after myocardial infarction is beneficial, the addition of Mg2+ to cardioplegic solutions remains controversial. The aim of this study was to compare the effects of intermittent warm blood cardioplegia with and without Mg2+ supplementation on

Mark Yeatman; Massimo Caputo; Pradeep Narayan; Attilio A Lotto; Raimondo Ascione; Alan J Bryan; Gianni D Angelini

2002-01-01

75

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: enrica_mariano@hotmail.com; 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)

2008-05-15

76

Clinical and angiographic follow-up after coronary angioplasty in patients with two-vessel disease: influence of completeness and adequacy of revascularization on long-term outcome.  

PubMed

To assess the influence of the degree of revascularization on long-term results with angioplasty in multivessel disease, 151 consecutive patients with double-vessel disease and successful angioplasty in at least one vessel were prospectively followed up for a mean of 14 months (range 6 to 30 months) with clinical evaluation, an exercise stress test, and routine angiography. Patients were divided into three groups according to completeness and adequacy of revascularization: group 1--complete revascularization (no residual stenosis > or = 70%, 51 patients); group 2--incomplete but functionally adequate revascularization (residual stenosis > or = 70% in a vessel < 2 mm in diameter or supplying akinetic or dyskinetic segments of the left ventricle, 56 patients); group 3--incomplete and inadequate revascularization (residual stenosis > or = 70% in a vessel > or = 2 mm in diameter supplying normal or hypokinetic segments, 45 patients). There were no late deaths; one myocardial infarction occurred in group 1 patients, three in group 2, and two in group 3 patients (p = NS). Recurrence of angina was lower in group 1 (13 of 51 or 26%) and group 2 (16 of 56 or 28%) compared with group 3 (23 of 45 or 51%, p < 0.01). A positive stress test for ischemia was present in 20 patients (39%) of group 1, in 30 (54%) of group 2, and in 26 patients (58%) of group 3.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8197975

Cavallini, C; Risica, G; Olivari, Z; Marton, F; Franceschini, E; Giommi, L

1994-06-01

77

Similar late revascularization rates 10 to 12 years after angioplasty or bypass surgery for multivessel coronary artery disease: a report from the Lady Davis Carmel Medical Center (LDCMC) Registry.  

PubMed

We compared completed long-term outcome and late repeat revascularization rates in 272 consecutive patients with multivessel coronary disease who underwent revascularization (95 angioplasty cohort, 177 surgical cohort) between 1984 and 1986. Long-term survival was similar at 12 years in the angioplasty (70%) and surgical (74%) cohorts (p = NS), and repeat revascularization, although more frequent in the angioplasty patients during the first 5 years of follow-up, was performed equally in the 2 patient cohorts after 10 to 12 years of follow-up. PMID:11074213

Halon, D A; Flugelman, M Y; Merdler, A; Rennert, H S; Weisz, G; Shahla, J; Lewis, B S

2000-11-15

78

All-cause mortality benefit of coronary revascularization vs. medical therapy in patients without known coronary artery disease undergoing coronary computed tomographic angiography: results from CONFIRM (COronary CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational Multicenter Registry)  

PubMed Central

Aims To date, the therapeutic benefit of revascularization vs. medical therapy for stable individuals undergoing invasive coronary angiography (ICA) based upon coronary computed tomographic angiography (CCTA) findings has not been examined. Methods and results We examined 15 223 patients without known coronary artery disease (CAD) undergoing CCTA from eight sites and six countries who were followed for median 2.1 years (interquartile range 1.4–3.3 years) for an endpoint of all-cause mortality. Obstructive CAD by CCTA was defined as a ?50% luminal diameter stenosis in a major coronary artery. Patients were categorized as having high-risk CAD vs. non-high-risk CAD, with the former including patients with at least obstructive two-vessel CAD with proximal left anterior descending artery involvement, three-vessel CAD, and left main CAD. Death occurred in 185 (1.2%) patients. Patients were categorized into two treatment groups: revascularization (n = 1103; 2.2% mortality) and medical therapy (n = 14 120, 1.1% mortality). To account for non-randomized referral to revascularization, we created a propensity score developed by logistic regression to identify variables that influenced the decision to refer to revascularization. Within this model (C index 0.92, ?2 = 1248, P < 0.0001), obstructive CAD was the most influential factor for referral, followed by an interaction of obstructive CAD with pre-test likelihood of CAD (P = 0.0344). Within CCTA CAD groups, rates of revascularization increased from 3.8% for non-high-risk CAD to 51.2% high-risk CAD. In multivariable models, when compared with medical therapy, revascularization was associated with a survival advantage for patients with high-risk CAD [hazards ratio (HR) 0.38, 95% confidence interval 0.18–0.83], with no difference in survival for patients with non-high-risk CAD (HR 3.24, 95% CI 0.76–13.89) (P-value for interaction = 0.03). Conclusion In an intermediate-term follow-up, coronary revascularization is associated with a survival benefit in patients with high-risk CAD by CCTA, with no apparent benefit of revascularization in patients with lesser forms of CAD.

Min, James K.; Berman, Daniel S.; Dunning, Allison; Achenbach, Stephan; Al-Mallah, Mouaz; Budoff, Matthew J.; Cademartiri, Filippo; Callister, Tracy Q.; Chang, Hyuk-Jae; Cheng, Victor; Chinnaiyan, Kavitha; Chow, Benjamin J.W.; Cury, Ricardo; Delago, Augustin; Feuchtner, Gudrun; Hadamitzky, Martin; Hausleiter, Joerg; Kaufmann, Philipp; Karlsberg, Ronald P.; Kim, Yong-Jin; Leipsic, Jonathon; Lin, Fay Y.; Maffei, Erica; Plank, Fabian; Raff, Gilbert; Villines, Todd; Labounty, Troy M.; Shaw, Leslee J.

2012-01-01

79

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

1991-01-01

80

Retrograde versus antegrade delivery of cardioplegic solution in myocardial revascularization. A clinical trial in patients with three-vessel coronary artery disease who underwent myocardial revascularization with extensive use of the internal mammary artery.  

PubMed

The effects of retrograde and antegrade delivery of cardioplegic solution on myocardial function were evaluated and compared in 60 patients who underwent myocardial revascularization. All patients had three-vessel coronary artery disease, and the revascularization was done with extensive use of the internal mammary artery. Seventy-five percent of the distal anastomoses were performed with the internal mammary artery. Myocardial protection consisted of St. Thomas' Hospital cardioplegic solution, topical slushed ice, and systemic hypothermia (28 degrees C). The patients were randomly separated into two groups: group A (n = 30), who received antegrade cardioplegia, and group B (n = 30), who received retrograde cardioplegia. With the exception of the total dose of cardioplegic solution (p = 0.02), there was no significant difference between the two groups that concerned septal myocardial temperature at the moment of asystole and after infusion of the total dose of cardioplegic solution. Cardiac function was assessed before and after the patient was weaned from cardiopulmonary bypass. In the immediate postoperative period there was a significant increase in right atrial pressure of the patients who underwent antegrade cardioplegia. For the other registered parameters there was no significant difference either in the immediate postoperative period or 6 hours later. Release of creatine kinase MB isoenzyme was the same in the two groups. Clinical outcome in terms of mortality, prevalence of perioperative infarction, prevalence of low cardiac output, and rhythm and conduction disturbances was similar in both groups. Technical problems related to cannulation and decannulation of the coronary sinus were not encountered. Multivariate analysis showed that occlusion of the left anterior descending coronary artery (p = 0.012) is an essential contraindication of antegrade delivery of cardioplegic solution. Analysis of the patients with an occlusion of the left anterior descending coronary artery who underwent antegrade (n = 9) and retrograde (n = 10) cardioplegia showed a significant difference in the total dose of cardioplegic solution (p = 0.02) and septal myocardial temperature at the moment of asystole (p = 0.008) and after infusion of the total dose of cardioplegic solution (p = 0.015). The mean arterial systolic blood pressure in the antegrade group was significantly lower than in the retrograde group (p = 0.003). Preservation of the left ventricular stroke work index was significantly better in the retrograde group (namely, 85% of its initial value versus 71% in the antegrade group, p = 0.0116).(ABSTRACT TRUNCATED AT 400 WORDS) PMID:8487564

Noyez, L; van Son, J A; van der Werf, T; Knape, J T; Gimbrère, J; van Asten, W N; Lacquet, L K; Flameng, W

1993-05-01

81

[Acute myocardial infarction after blunt polytrauma -- successful coronary intervention].  

PubMed

Acute myocardial infarction following blunt chest trauma is a well reported but rare finding. Especially in severely injured patients the optimal therapy of the myocardial infarction is not well established, since anticoagulants, platelet aggregation inhibitors or thrombolytics are frequently contraindicated under these conditions. We report a case of a 41-year-old man, who presented with an acute myocardial infarction in combination with a severe polytrauma (multiple rib fractures, hematothorax, pelvic bone fractures, multiple injuries of intestinal organs) after a motorcycle accident with a blunt chest and abdominal trauma. After surgical treatment of the injuries of the bones and the intestinal organs a coronary angiography was immediately performed. The left anterior descending and the circumflex coronary artery were occluded in the mid-portion of the vessels. Coronary recanalization by PTCA and the implantation of coronary stents were successful in both vessels. Despite of a non-optimal blood flow after recanalization and stenting in one vessel (LAD TIMI II flow after recanalization), and a non-optimal accompanying medical therapy, during and after intervention (intravenous heparin starting 8 hours after the coronary intervention and platelet inhibitors starting 4 days after the intervention) the coronary angiogram after 2 months documented both vessels patent without a reocclusion or a restenosis. The case report documents, that in traumatic myocardial infarctions the treating of both, the attending injuries and the myocardial ischemia, is feasible. Early coronary angiography and coronary interventions, with or without stent-implantation, are indicated, even in cases in which an adequate accompanying medical therapy with heparin and platelet inhibitors is contraindicated. PMID:12557122

Mauser, M; Schwenk, M; Schmelzeisen, H; Fleischmann, D; Fösel, T

2003-02-01

82

Reoperation after coronary bypass grafting.  

PubMed Central

Coronary artery bypass grafting is one of the most commonly performed surgical procedures in the western world, and myocardial revascularization during the first operation is well established. But patients are now surviving beyond the patency of their primary grafts. Repeat myocardial revascularization can be performed successfully in patients who have adequate ventricular function and graftable distal vessels. Images Figures 1-2 Figure 3 Figure 5

Menkis, A. H.; Carley, S. D.; Clough, T. M.

1993-01-01

83

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

2010-01-01

84

Effect of coronary percutaneous revascularization on interferon-gamma and interleukin-10 producing CD4+ T cells during acute myocardial infarction.  

PubMed

T lymphocytes play an important role in the induction and progression of acute coronary syndromes (ACS). To gain insight into how different T cell subsets can influence ACS, we analyzed the frequencies of circulating CD4+ T cells producing either pro-inflammatory interferon(IFN)-gamma or anti-inflammatory interleukin (IL)-10 in subjects presenting with ST-elevation myocardial infarction (STEMI). The effect of coronary bare metal (BS) and paclitaxel-eluting stent (PES) on the balance between CD4+IFN-gamma+ and CD4+IL-10+ lymphocytes was also investigated. Peripheral blood mononuclear cells (PBMC) were isolated from 38 consecutive patients with STEMI before and 48 hrs or 6 days after implantation of either BS or PES. Twenty patients with no history of coronary artery disease were included as basal controls. PBMC were stimulated in vitro with anti-CD3/anti-CD28 monoclonal antibodies, and CD4+IFN- gamma+ or CD4+IL-10+ T cells were detected by flow cytometry intracellular staining. The frequency of peripheral CD4+IL-10+ T cells was significantly higher in STEMI patients as compared with controls. Conversely, the frequency of CD4+IFN-gamma+ T lymphocytes did not differ between STEMI and subjects without history of coronary artery disease. Six days after the revascularization procedure, the percentage of CD4+IL-10+ T cells was significantly decreased in BS but not in the PES group, whereas the relative percentage of CD4+IFN-gamma+ T lymphocytes were diminished in both groups as compared with baseline levels. Our data indicate that STEMI is associated with a peripheral expansion of CD4+IL-10+ T lymphocytes, and that primary coronary revascularization with implantation of either BS or PES is followed by a reduction in circulating CD4+IFN-gamma+ T lymphocytes. PES implantation, however, appears to inhibit the relative decrease of the IL-10 producing lymphocyte as observed in BS implanted patients, shifting the balance between pro-inflammatory and anti-inflammatory T cell populations in favor of the latter. PMID:18179752

Sardella, G; De Luca, L; Francavilla, V; Accapezzato, D; Di Roma, A; Gianoglio, O; Colantonio, R; Mancone, M; Fedele, F; Paroli, M

2007-01-01

85

On-pump beating-heart versus conventional coronary artery bypass grafting for revascularization in patients with severe left ventricular dysfunction: early outcomes  

PubMed Central

Background We sought to evaluate the effects of on-pump beating-heart versus conventional coronary artery bypass grafting techniques requiring cardioplegic arrest in patients with coronary artery disease with left ventricular dysfunction. Methods We report the early outcomes associated with survival, morbidity and improvement of left ventricular function in patients with low ejection fraction who underwent coronary artery bypass grafting between August 2009 and June 2012. Patients were separated into 2 groups: group I underwent conventional coronary artery bypass grafting and group II underwent an on-pump beating-heart technique without cardioplegic arrest. Results In all, 131 patients underwent coronary artery bypass grafting: 66 in group I and 65 in group II. Left ventricular ejection fraction was 26.6% ± 3.5% in group I and 27.7% ± 4.7% in group II. Left ventricular end diastolic diameter was 65.6 ± 3.6 mm in group I and 64.1 ± 3.2 mm in group II. There was a significant reduction in mortality in the conventional and on-pump beating-heart groups (p < 0.001). Perioperative myocardial infarction and low cardiac output syndrome were higher in group I than group II (both p < 0.05). Improvement of left ventricular function after the surgical procedure was better in group II than group I. Conclusion The on-pump beating-heart technique is the preferred method for myocardial revascularization in patients with left ventricular dysfunction. This technique may be an acceptable alternative to the conventional technique owing to lower postoperative mortality and morbidity.

Erkut, Bilgehan; Dag, Ozgur; Kaygin, Mehmet Ali; Senocak, Mutlu; Limandal, Husnu Kamil; Arslan, Umit; Kiymaz, Adem; Aydin, Ahmet; Kahraman, Nail; Calik, Eyup Serhat

2013-01-01

86

Baseline LDL-C and Lp(a) Elevations Portend a High Risk of Coronary Revascularization in Patients after Stent Placement  

PubMed Central

Background and Aim. Incidence of coronary restenosis after stent placement is high. Our study was going to investigate whether Lp(a) elevation was potential for predicting coronary restenosis and whether the effects of Lp(a) elevation on coronary restenosis were dependent on LDL-C level. Methods and Results. Totally 832 participants eligible for stent placement were enrolled and followed up for monitoring clinical end points. Baseline characteristics were collected. According to the cut point of Lp(a), participants were divided into low Lp(a) group (Lp(a) < 30?mg/dL) and high Lp(a) group (Lp(a) ? 30?mg/dL). Furthermore, based on baseline LDL-C level, participants were divided into LDL-C < 1.8?mmol/L and ?1.8?mmol/L subgroups. Clinical end points including major adverse cardiovascular events (MACE), cardiovascular death, nonfatal myocardial infarction, ischemic stroke, and coronary revascularization (CR) were compared. Patients in high Lp(a) groups more frequently presented with acute coronary syndrome and three vessel stenoses. In subgroup of LDL-C < 1.8?mmol/L, no significant differences of cardiovascular outcomes were found between low and high Lp(a) groups. While in the subgroup of LDL-C ? 1.8?mmol/L, incidences of MACE and CR were significantly higher in high Lp(a) group, and odds ratio for CR was 2.05. Conclusion. With baseline LDL-C and Lp(a) elevations, incidence of CR is significantly increased after stent placement.

Cai, Anping; Li, Liwen; Zhang, Ying; Mo, Yujin; Li, Zhigen; Mai, Weiyi; Zhou, Yingling

2013-01-01

87

Early Detection of Myocardial Ischemia after Successful Percutaneous Coronary Angioplasty  

Microsoft Academic Search

We evaluated the functional significance of angiographically successful percutaneous transluminal coronary angioplasty (PTCA) in 50 patients before and after PTCA using an atrial pacing stress test. Before balloon angioplasty, 40\\/50 patients had transient ST-segment changes on the intracoronary (IC) ECG. After PTCA 14\\/50 patients continued to have ischemic changes on IC-ECG. Atrial pacing stress tests can be performed easily in

Avanindra Jain

1997-01-01

88

Off-pump axillo-coronary artery bypass: a simple approach for high-risk myocardial revascularization.  

PubMed

We report the case of a 66-year-old male with increasing angina occurring after two previous coronary artery surgery procedures. The second operation had been complicated by severe mediastinitis necessitating surgical drainage, and sternal stabilization. Angiography revealed an occlusion of the LAD bypass with a patent LAD associated with a stenotic circumflex coronary artery. The ascending aorta was severely calcified. An off-pump axillo-LAD coronary artery bypass was safely performed in conjunction with stenting of the circumflex artery. This approach dramatically simplified the procedure and reduced the operative risk. At the 52-month follow-up, the patient is free of any angina symptoms. PMID:23594154

Grandmougin, Daniel; Maureira, Juan-Pablo; Fiore, Antonio; Vanhuyse, Fabrice; Elfarra, Mazen; Roudmane, Nezha; Portocarrero, Eric; Delolme, Maria-Christina; Folliguet, Thierry; Villemot, Jean-Pierre

2013-07-01

89

Intracoronary Compared to Intravenous Abciximab in Patients with ST Segment Elevation Myocardial Infarction Treated with Primary Percutaneous Coronary Intervention Reduces Mortality, Target Vessel Revascularization and Reinfarction after 1 Year  

Microsoft Academic Search

Objectives: Administration of the glycoprotein IIb\\/IIIa inhibitor abciximab to patients with ST segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI) improves outcome. Data have suggested that an intracoronary (IC) bolus might be superior to the standard intravenous (IV) administration. We have previously reported reduced short-term mortality and need for target vessel revascularization (TVR) with the IC route.

Allan Zeeberg Iversen; Soeren Galatius; Ulrik Abildgaard; Anders Galloe; Peter Riis Hansen; Sune Pedersen; Thomas Engstroem; Jan Skov Jensen

2011-01-01

90

Excimer laser debulking for percutaneous coronary intervention in left main coronary artery disease  

Microsoft Academic Search

Excimer laser has been successfully applied to complex atherosclerotic plaques in acute coronary syndromes; however, its role\\u000a in debulking in left main coronary artery disease has not been fully explored. Details of a series of 20 patients who underwent\\u000a excimer laser revascularization of a spectrum of left main coronary artery lesions are presented. Twenty symptomatic patients\\u000a who received excimer laser

On Topaz; Pritam R. Polkampally; Pramod K. Mohanty; Maged Rizk; Julie Bangs; Nelson L. Bernardo

2009-01-01

91

Chronic total occlusion in ostium of right coronary artery - retrograde approach as the first-choice method of revascularization?  

PubMed Central

Recanalization of chronic total occlusion (CTO) located in the ostium may require the operator's ability to use the retrograde approach. We present a case of opening a chronically occluded right coronary artery (RCA) by the retrograde approach after an unsuccessful attempt of recanalization by classic antegrade technique.

Kameczura, Tomasz; Surowiec, Slawomir; Janus, Bogdan; Derlaga, Boguslaw; Dudek, Dariusz; Czarnecka, Danuta

2013-01-01

92

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

2012-01-01

93

Coronary artery anatomy before and after direct revascularization surgery: clinical and cinearteriographic studies in 67 selected patients.  

PubMed

This report relates the postoperative clinical and cineangiographic status of 67 patients selected from a total of 202 patients who underwent coronary artery surgery at the Peter Bent Brigham Hospital from July, 1970, to July, 1972. The mean interval after operation was 12.6 months. Ninety-one per cent of the 67 patients were improved from their preoperative status. Forty-eight patients (71 per cent) were studied to evaluate recurrence of mild to moderate angina or occurrence of interval myocardial infarction, and 19 patients (29 per cent) were entirely asymptomatic. In the 67 patients studied, 112 coronary arteries received a total of 115 grafts. (There were 89 ungrafted coronary arteries.) Total graft patency rate for the 58 patients in whom angina was totally or significantly relieved was 65 per cent. However, one or more grafts were patent in 52 (90 per cent) of these 58 patients. In grafted arteries, progression was found in segments proximal to the graft in 37 per cent of arteries, at the site of anastomosis in 10 per cent, and distal to the site of anastomosis in 17 per cent. The frequency of obstruction distal to the site of anastomosis was not significantly different from the frequency of progression in nongrafted arteries, in contrast to preliminary data from this laboratory. Overall and regional progression in grafted arteries appeared to occur primarily within the first four months after surgery and was found, thereafter, in a constand percentage of vessels studied. Progression in coronary arteries was independent of patency or occlusion of the graft to the vessel. It is hypothesized that while proximal progression is probably a consequence of altered hydraulic factors, distal lesions seem to represent natural progression of atherosclerotic disease. PMID:1078929

Levine, J A; Bechtel, D J; Gorlin, R; Cohn, R F; Herman, M V; Cohn, L H; Collins, J J

1975-05-01

94

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))

1991-06-01

95

Successful transcatheter closure of coronary artery fistula in a child with single coronary artery: a heavy load and a long road.  

PubMed

Single coronary artery is an uncommon variation of the coronary circulation. After transposition of great arteries, coronary artery fistulas are the most common associated cardiac anomalies in these patients. Transcatheter closure of coronary artery fistula (CAF) involving single coronary artery is a challenging intervention. In the absence of contralateral coronary artery, a complex anatomy of the CAF and a large myocardial perfusion territory of the dominant circulation pose an additional risk during interventional procedure. We report our experience of a successful transcatheter closure of a coronary artery fistula in a patient with single coronary artery. PMID:23361942

Phasalkar, Manjunath; Thakkar, Bhavesh; Poptani, Vishal

2013-07-01

96

Does off-pump coronary revascularization confer superior organ protection in re-operative coronary artery surgery? A meta-analysis of observational studies  

PubMed Central

Off-pump coronary artery bypass surgery (OPCAB) has been hypothesised to be beneficial in the high-risk patient population undergoing re-operative coronary artery bypass graft surgery (CABG). In addition, this technique has been demonstrated to provide subtle benefits in end-organ function including heart, lungs and kidney. The aims of this study were to assess whether OPCAB is associated with a lower incidence of major adverse cardiovascular and cerebrovascular events (MACCE) and other adverse outcomes in re-operative coronary surgery. Twelve studies, incorporating 3471 patients were identified by systematic literature review. These were meta-analysed using random-effects modelling. Primary endpoints were MACCE and other adverse outcomes including myocardial infarction, stroke, renal dysfunction, low cardiac output state, respiratory failure and atrial fibrillation. A significantly lower incidence of myocardial infarction, stroke, renal dysfunction, low cardiac output state, respiratory failure and atrial fibrillation was observed with OPCAB (OR 0.58; 95% CI (confidence interval) [0.39-0.87]; OR 0.37; 95% CI [0.17-0.79]; OR 0.39; 95% CI [0.24-0.63]; OR 0.14; 95% CI [0.04-0.56]; OR 0.36; 95% CI [0.24-0.54]; OR 0.41; 95% CI [0.22-0.77] respectively). Sub-group analysis using sample size, matching score and quality score was consistent with and reflected these significant findings. Off-pump coronary artery bypass grafting reduces peri-operative and short-term major adverse outcomes in patients undergoing re-operative surgery. Consequently we conclude that OPCAB provides superior organ protection and a safer outcome profile in re-operative CABG.

2014-01-01

97

Does off-pump coronary revascularization confer superior organ protection in re-operative coronary artery surgery? A meta-analysis of observational studies.  

PubMed

Off-pump coronary artery bypass surgery (OPCAB) has been hypothesised to be beneficial in the high-risk patient population undergoing re-operative coronary artery bypass graft surgery (CABG). In addition, this technique has been demonstrated to provide subtle benefits in end-organ function including heart, lungs and kidney. The aims of this study were to assess whether OPCAB is associated with a lower incidence of major adverse cardiovascular and cerebrovascular events (MACCE) and other adverse outcomes in re-operative coronary surgery. Twelve studies, incorporating 3471 patients were identified by systematic literature review. These were meta-analysed using random-effects modelling. Primary endpoints were MACCE and other adverse outcomes including myocardial infarction, stroke, renal dysfunction, low cardiac output state, respiratory failure and atrial fibrillation. A significantly lower incidence of myocardial infarction, stroke, renal dysfunction, low cardiac output state, respiratory failure and atrial fibrillation was observed with OPCAB (OR 0.58; 95% CI (confidence interval) [0.39-0.87]; OR 0.37; 95% CI [0.17-0.79]; OR 0.39; 95% CI [0.24-0.63]; OR 0.14; 95% CI [0.04-0.56]; OR 0.36; 95% CI [0.24-0.54]; OR 0.41; 95% CI [0.22-0.77] respectively). Sub-group analysis using sample size, matching score and quality score was consistent with and reflected these significant findings. Off-pump coronary artery bypass grafting reduces peri-operative and short-term major adverse outcomes in patients undergoing re-operative surgery. Consequently we conclude that OPCAB provides superior organ protection and a safer outcome profile in re-operative CABG. PMID:24961148

Sepehripour, Amir H; Harling, Leanne; Ashrafian, Hutan; Casula, Roberto; Athanasiou, Thanos

2014-01-01

98

Preprocedural coronary CT angiography significantly improves success rates of PCI for chronic total occlusion.  

PubMed

Chronic total occlusions of coronary arteries occur in about 20% of patients with suspected coronary artery disease and are more frequent with increasing age. The success rate of interventions is lower (55-80%) compared to conventional lesions (>90%). Coronary CT angiography (coronary CTA) provides information about the occluded segment, which cannot be obtained from invasive angiograms (XA). We therefore hypothesized that preprocedural coronary CTA may improve success rates of percutaneous coronary intervention (PCI) for coronary arteries (CTO). 30 patients with chronic total coronary artery occlusions (mean age 73 years, 26 men) and predicted high complexity were imaged by coronary CTA prior to PCI for CTO. CT data sets were acquired with a 64 detector row dual source scanner and retrograde ECG gating, 0.6 mm collimation and z-flying focal spot, yielding isovoxel spatial resolution of about 0.4 mm. Based on the CT data sets, established complexity criteria for CTO (Euro CTO club, Di Mario et al. in EuroIntervention 3(1):30-43, 2007) were evaluated and compared to invasive coronary angiography. Three-dimensional volume-rendered images of the occluded coronary artery were displayed in the catheterization lab during PCI to guide the advancement of the wire. PCI success, defined as the ability to advance the guide wire into the distal lumen with thrombolysis in myocardial infarction III flow was compared to 43 controls without coronary CTA using propensity score matching based on established criteria of procedural success. The course of the occluded segments was visualized by coronary CTA in all cases. Calcification, lesion length, stump morphology and presence of side branches were underestimated by invasive angiograms when compared to coronary CTA. PCI success rate in 30 patients who underwent pre-procedural CTA was significantly higher than in patients without prior coronary CTA [unmatched: CT 90% (27/30) vs. no CT 63% (27/43), p = 0.009; matched: CT 88% (22/25) vs. no CT 64% (16/25) p = 0.03]. Through information not readily seen on invasive coronary angiography, coronary CTA can significantly enhance success rates of PCI for CTO. PMID:23793727

Rolf, Andreas; Werner, Gerald S; Schuhbäck, Annika; Rixe, Johannes; Möllmann, Helge; Nef, Holger M; Gundermann, Constantin; Liebetrau, Christoph; Krombach, Gabriele A; Hamm, Christian W; Achenbach, Stephan

2013-12-01

99

Isolated LAD Revascularization in the Modern Era: Demographics and Preliminary Outcomes1  

Microsoft Academic Search

Revascularization of the left anterior descending coronary artery is an important, evolving and controversial topic. There are differences in patient selection, hospital stay and readmission, and hospital cost. We reviewed our institutional experience in 190 consecutive patients who underwent isolated initial left anterior descending revascularization via angioplasty, angioplasty plus stenting, conventional coronary artery bypass grafting and minimally invasive direct coronary

ARI-NK MANNKH; ISADORA NEWMAN; ED SYRON; RICHARD JOSKPHSON

100

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

SciTech Connect

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 vessels that resulted in no residual coronary lesion with greater than 50% diameter stenosis. Restenosis was defined as a residual stenosis at the time of repeat angiography of greater than 50% of luminal diameter. Restenosis occurred in 40% of the patients. The 111 patients were randomly subdivided into a learning group (n = 84) and a testing group (n = 27). A logistic discriminant analysis was performed in the learning group and the logistic model was used to estimate a logistic probability of restenosis. This probability of restenosis was validated in the testing group. In the learning group of 84 patients univariate analysis of 39 factors revealed 8 factors related to restenosis: recurrence of angina (p less than 0.0001), postangioplasty abnormal finding on exercise thallium-201 scintigram (p less than 0.0001), exercise thallium-201 scintigram score (p less than 0.0001), difference between exercise and rest ST segment depression (p less than 0.001), postangioplasty exercise ST segment depression (p less than 0.001), absolute postangioplasty stenosis diameter (p less than 0.003), postangioplasty exercise work load (p less than 0.03) and postangioplasty exercise heart rate (p less than 0.05).

Renkin, J.; Melin, J.; Robert, A.; Richelle, F.; Bachy, J.L.; Col, J.; Detry, J.M.; Wijns, W. (Univ. of Louvain Medical School, Brussels (Belgium))

1990-11-01

101

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)

1999-05-15

102

A unique and unexplained ricochet leak post PCI - Successfully treated with intra-coronary glue  

PubMed Central

We herein describe a unique case of coronary artery perforation treated with covered stent with repeat cardiac tamponade resulting out of a fresh unexplained leak from a remote vessel (Ricochet) and successfully treated with intra-coronary injection of sterile synthetic glue, cyanoacrylate.

Goel, Pravin K.; Syal, Sanjeev K.

2014-01-01

103

Successful transcatheter closure of bilateral multiple coronary arterial fistulae in one session  

PubMed Central

Coronary artery fistulae represent the most frequent congenital anomalies of the coronary arteries, but multiple bilateral fistulae are a rare condition. Current therapeutic options for symptomatic patients are percutaneous closure and cardiac surgery. Transcatheter closure of fistulae using coils is preferred as an effective and safe alternative to surgery. Here we report the case of a patient with congenital coronary artery fistulae arising from both the left and right coronary arteries draining individually into the right pulmonary artery treated successfully with a transcatheter approach.

Jafarov, Parviz; Ismailoglu, Ziya; Tasal, Abdurrahman

2014-01-01

104

Blood flow capacity via direct acute myocardial revascularization  

Microsoft Academic Search

The concept of direct myocardial revascularization, achieving myocardial perfusion through means other than the normal coronary vasculature, has a long history with the most widely investigated technique being the Vineberg procedure; current interest centers around the encouraging preliminary clinical results obtained with transmyocardial laser revascularization. Despite significant previous research, the acute blood flow potential through the direct myocardial route remains

T. Kohmoto; G. Uzun; A. Gu; S.-M. Zhu; C. R. Smith; D. Burkhoff

1997-01-01

105

Heart Rate Recovery and Impact of Myocardial Revascularization on Long-Term Mortality  

Microsoft Academic Search

Background—Although heart rate recovery (HRR) predicts mortality after exercise testing, its ability to identify patients likely to benefit after revascularization is unknown. We sought to determine whether HRR can identify patients likely to have improved survival after revascularization. Methods and Results—A total of 8861 patients undergoing treadmill nuclear or echocardiographic testing were divided into early revascularization (percutaneous coronary intervention or

Michael S. Chen; Eugene H. Blackstone; Claire E. Pothier; Michael S. Lauer

2010-01-01

106

Primary percutaneous coronary intervention for refractory cardiac arrest.  

PubMed

The identification and treatment of reversible causes is paramount to the success of resuscitation in cardiac arrest, particularly when standard therapy has failed. Acute coronary occlusion is one such cause, and the introduction of primary percutaneous coronary intervention services may provide an opportunity for emergency revascularization in this setting. This article describes 2 patients with cardiac arrest as a result of coronary occlusion, in which standard therapeutic measures proved futile. The first patient had refractory ventricular fibrillation, and the second had an episode of ventricular fibrillation followed by true pulseless electrical activity: total cessation of ventricular activity. In both examples, external mechanical compression and primary percutaneous coronary intervention facilitated coronary revascularization and achieved return of spontaneous circulation, leading to survival to hospital discharge. PMID:24210369

Clayton, Benjamin J; Gribbin, Guy M; Taggu, Wasing

2014-08-01

107

A Case Report of Coronary Arteriovenous Fistulas with an Unruptured Coronary Artery Aneurysm Successfully Treated by Surgery  

PubMed Central

A 58-year-old female with a history of Wolff-Parkinson-White syndrome presented at our institution with palpitations and chest pain. Electrocardiography revealed paroxysmal supraventricular tachycardia with a heart rate of 188 beats/min. Antiarrhythmic drugs were ineffective, and tachycardia was resolved by electrical cardioversion. Transthoracic echocardiography revealed abnormal vessels around the right coronary artery (RCA) and pulmonary artery (PA); in addition, we suspected coronary arteriovenous fistula (CAVF). Coronary angiography and coronary computed tomography revealed dilated fistula vessels, with a 1?cm saccular aneurysm around the RCA, originating from the proximal RCA and left anterior descending artery into the main trunk of PA. Therefore, we confirmed the diagnosis of CAVF with an unruptured aneurysm. We surgically ligated and clipped the fistula vessels and resected the aneurysm. The resected aneurysm measured 1 × 1?cm in size. Pathological examination of the resected aneurysm revealed hypertrophic walls comprising proliferating fibroblasts cells thin elastic fibers. Very few atherosclerotic changes manifested in the aneurysm walls. We report the case of a patient with CAVF and an unruptured coronary artery aneurysm who was successfully treated by surgery.

Takeuchi, Nobuhiro; Takada, Masanori; Nishibori, Yoshiharu; Maruyama, Takao

2012-01-01

108

[The successes and failures in the primary prevention of coronary disease].  

PubMed

The modification of major behavioural and environmental risk factors has helped reduce coronary heart disease. It seems, however, that prevention results were not so good as expected. It is assumed that the major cause of this apparent unsuccessful data is basically due to world population ageing, as it is known that coronary heart disease is much more frequent in older people. Therefore the current life expectancy shows that the preventive measures have indeed been successful. From the analysis and discussion of the preventive epidemiological recommendations and the identification of new risk factors, the Authors suggest new strategies for health promotion and particularly for coronary heart disease reduction. PMID:10466374

Clara, J G; de Pádua, F

1999-01-01

109

Association between intraprocedural thrombotic events and adverse outcomes after primary percutaneous coronary intervention for ST-segment elevation myocardial infarction (a Harmonizing Outcomes With RevasculariZatiON and Stents in Acute Myocardial Infarction [HORIZONS-AMI] Substudy).  

PubMed

The present study sought to determine the extent to which adverse angiographic events encountered during percutaneous coronary intervention for ST-segment elevation myocardial infarction (STEMI) are associated with adverse clinical outcomes. Patients with STEMI represent a cohort at particularly high risk of intraprocedural thrombotic events (IPTEs). The overall frequency and implications of IPTEs occurring in patients with STEMI have not been systematically quantified in previous studies. A total of 3,163 patients undergoing primary percutaneous coronary intervention with stent implantation for STEMI in the Harmonizing Outcomes with RevasculariZatiON and Stents in Acute Myocardial Infarction (HORIZONS-AMI) trial underwent detailed frame-by-frame core laboratory angiographic analysis to assess IPTEs. The clinical outcomes at 30 days were compared between the patients with and without IPTEs. IPTEs, defined as the development of new or increasing thrombus, abrupt vessel closure, no reflow, slow reflow, and distal embolization at any point during the procedure, occurred in 386 patients (12.2%). The independent predictors of IPTE were thrombus at baseline, lesion length, and randomization to bivalirudin; the patients with IPTEs were also more likely to receive bailout glycoprotein IIb/IIIa inhibitors and unplanned thrombectomy. Compared with patients without IPTEs, the patients with IPTEs had higher 30-day rates of composite major adverse cardiovascular events (death, myocardial infarction, ischemic target vessel revascularization, and stroke; 7.8% vs 4.2%, p = 0.002), major bleeding not related to coronary artery bypass grafting (11.8% vs 6.5%, p <0.001), and all-cause death (4.2% vs 1.8%, p = 0.002). On multivariate analysis, IPTEs were independently associated with 30-day major adverse cardiovascular events, major bleeding, and death. In conclusion, the development of IPTEs in patients undergoing primary percutaneous coronary intervention for STEMI was associated with subsequent adverse outcomes, including major adverse cardiovascular events, major bleeding, and death. Additional studies of strategies to decrease the occurrence of IPTEs are warranted. PMID:24169019

Kirtane, Ajay J; Sandhu, Prabhdeep; Mehran, Roxana; McEntegart, Margaret; Cristea, Ecaterina; Brener, Sorin J; Xu, Ke; Fahy, Martin; Généreux, Philippe; Wessler, Jeffrey D; Stone, Gregg W

2014-01-01

110

Transmyocardial laser revascularization: surgical experience overview.  

PubMed

Transmyocardial revascularization (TMR) using holmium:yttrium-aluminium-garnet (YAG) and carbon dioxide lasers has been approved by the United States Food and Drug Administration for the treatment of medically refractory angina in patients without conventional options. In prospective, randomized trials, patients who received TMR experienced improved angina, better-event free survival, and reduction in cardiac-related rehospitalizations when compared to patients remaining on medical therapy alone. In addition, TMR as an adjunct to coronary artery bypass grafting (CABG) has resulted in improved clinical status for patients who would not be completely revascularized by CABG alone. PMID:10867764

Allen, K B; Shaar, C J

2000-06-01

111

Fractional flow reserve or optical coherence tomography guidance to revascularize intermediate coronary stenosis using angioplasty (FORZA) trial: study protocol for a randomized controlled trial  

PubMed Central

Background The management of patients with angiographically intermediate coronary lesions is a major clinical issue. Fractional flow reserve provides validated functional insights while optical coherence tomography provides high resolution anatomic imaging. Both techniques may be applied to guide management in case of angiographically intermediate coronary lesions. Moreover, these techniques may be used to optimize the result of percutaneous coronary intervention. We aim to compare the clinical and economic impact of fractional flow reserve versus optical coherence tomography guidance in patients with angiographically intermediate coronary lesions. Methods/Design Patients with at least one angiographically intermediate coronary lesion will be randomized (ratio 1:1) to fractional flow reserve or optical coherence tomography guidance. In the fractional flow reserve arm, percutaneous coronary intervention will be performed if fractional flow reserve value is ?0.80, and will be conducted with the aim of achieving a post-percutaneous coronary intervention fractional flow reserve target value of ?0.90. In the optical coherence tomography arm, percutaneous coronary intervention will be performed if percentage of area stenosis (AS%) is ?75% or 50 to 75% with minimal lumen area <2.5 mm2, or if a major plaque ulceration is detected. In case of percutaneous coronary intervention, optical coherence tomography will guide the procedure in order to minimize under-expansion, malapposition, and edge dissections. Cost load and clinical outcome will be prospectively assessed at one and thirteen months. The assessed clinical outcome measures will be: major cardiovascular events and occurrence of significant angina defined as a Seattle Angina Questionnaire score <90 in the angina frequency scale. Discussion The FORZA trial will provide useful guidance for the management of patients with coronary artery disease by prospectively assessing the use of two techniques representing the gold standard for functional and anatomical definition of coronary plaques. Trial registration Clinicaltrials.gov NCT01824030

2014-01-01

112

Developing a new hybrid revascularization program: a road map for hospital managers and physician leaders.  

PubMed

Hybrid coronary revascularization, which involves minimally invasive direct coronary artery bypass surgery using the left internal mammary artery to left anterior descending and percutaneous coronary intervention using drug-eluting stents for the remaining diseased coronary vessels, is an innovative approach to decrease the morbidity of conventional surgery. Little information is available to guide hospital managers and physician leaders in implementing a hybrid revascularization program. In this article, we describe the people-process-technology issues that managers and leaders are likely to encounter as they develop a hybrid revascularization program in their practice. PMID:22861054

Harjai, Kishore J; Samy, Sanjay; Pennypacker, Barbara; Onofre, Bonnie; Stanfield, Pamela; Yaeger, Lynne; Stapleton, Dwight; Esrig, Barry C

2012-12-01

113

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.

2010-01-01

114

Coronary embolism complicating aortic valve endocarditis: treatment with successful coronary angioplasty.  

PubMed

A 59-year-old female was hospitalised with the diagnosis of infective endocarditis. On the fifth day of her antibiotic treatment, she experienced an anterior ST segment elevation myocardial infarction. Emergency transthoracic echocardiography showed that the vegetation on the aortic valve did not exist anymore. It was thought to be an embolic myocardial infarction. Primary percutaneous coronary intervention with conventional balloon angioplasty was performed. TIMI-3 flow was obtained after intervention. Antibiotic treatment was continued for 6 weeks. She was uneventful at the end of the 3-month follow-up. PMID:17070609

Ural, Ertan; Bildirici, Ula?; Kahraman, Göksel; Komsuo?lu, Baki

2007-07-31

115

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

116

Improved myocardial function during exercise after successful percutaneous transluminal coronary angioplasty  

SciTech Connect

Fifty-nine consecutive patients with coronary-artery disease undergoing percutaneous transluminal coronary angioplasty were evaluated with radionuclide ventriculography at rest and during exercise before angioplasty (when possible) and afterward, when it was successful. Thirty-eight patients (64%) had an angiographically successful procedure. Three (5%) had coronary occlusion as a complication. Arterial stenosis was reduced from 74 +- 2% to 31 +- 3% (mean +- S.E.M.). The mean ejection fraction was 55 +- 3% during exercise before the procedure. After successful angioplasty, the ejection fraction was unchanged at rest but increased to 62 +- 2% (P < 0.001) during exercise. Regional dysfunction was present during exercise in 94% of the patients before the procedure and in only 8% after successful angioplasty. Of the 38 patients in whom the procedure was successful, 19 had sustained improvement for over six months, and eight for three to six months. Eleven patients had recurrence of symptoms; the second angioplasty was initially successful in nine. In 24 patients remaining asymptomatic for six months (19 after the first procedure and five after the second), the left ventricular ejection fraction during exercise remained stable or improved.

Kent, K.M.; Bonow. R.O.; Rosing, D.R.; Ewels, C.J.; Lipson, L.C.; McIntosh, C.L.; Bacharach, S.; Green, M.; Epstein, S.E.

1982-02-25

117

Repair of ischemic mitral regurgitation does not increase mortality or improve long-term survival in patients undergoing coronary artery revascularization: A propensity analysis  

Microsoft Academic Search

BackgroundThe purpose of this study was to compare operative mortality and midterm outcome of patients with ischemic mitral regurgitation (MR) undergoing either coronary artery bypass grafting (CABG) alone or CABG with mitral valve (MV) repair.

Michael D. Diodato; Marc R. Moon; Michael K. Pasque; Hendrick B. Barner; Nader Moazami; Jennifer S. Lawton; Marci S. Bailey; Tracey J. Guthrie; Bryan F. Meyers; Ralph J. Damiano

2004-01-01

118

Successful percutaneous stenting of a right gastroepiploic coronary bypass graft using monorail delivery system: a case report.  

PubMed

The right gastroepiploic artery (RGEA) is being successfully used as an arterial conduit in a selected group of patients undergoing coronary artery bypass graft surgery. However, myocardial ischemia may result due to spasm, occlusion, and stenosis of this graft. The anastamosis site at distal right coronary artery (RCA) or posterior descending artery (PDA) is the most common location for stenosis of an in situ gastroepiploic coronary bypass graft. Balloon angioplasty of such stenoses has been reported with optimal short-term results. Stent deployment would decrease the restenosis rate, so that repeat procedures could be minimized for these technically challenging lesions. We describe a case of successful deployment of a stent with monorail delivery system at the anastamotic site stenosis of an in situ gastroepiploic right coronary artery bypass graft. This percutaneous coronary intervention could prevent redo coronary artery bypass graft surgery. Cathet. Cardiovasc. Intervent. 49:197-199, 2000. PMID:10642773

Alam, M; Safi, A M; Mandawat, M K; Anderson, J E; Kwan, T; Feit, A; Clark, L T

2000-02-01

119

Transaortic endarterectomy for primary mesenteric revascularization.  

PubMed

The optimal approach to revascularization for chronic mesenteric ischemia has not been firmly established during the past three decades. The present study was undertaken to evaluate the safety and results of primary mesenteric revascularization for chronic mesenteric ischemia by transaortic endarterectomy. A descriptive retrospective analysis of 14 patients who underwent trap-door transaortic endarterectomy for primary mesenteric revascularization was performed. Clinical presentations of the patients included abdominal pain (n=13) and weight loss (n=7). All patients underwent preoperative aortography and subsequent elective reconstruction. Demographic features, perioperative, and long-term outcomes were analyzed. The study population consisted of 12 females and two males with a mean age of 67 years. The mean operative duration was 3 hours with an ischemic time of 33 minutes. The initial success rate of mesenteric revascularization was 93%. One early graft failure was salvaged with urgent embolectomy without bowel resection. There was no hospital mortality, but the overall postoperative morbidity rate was 50% (n=7). Thirteen patients (93%) were discharged within 2 weeks. Late recurrent ischemia and intestinal infarction developed in one patient, requiring emergency bowel resection. Sustained relief of symptoms was achieved in 13 of 14 patients (93%). The overall survival rates were 85% +/-10.0% and 77% +/-11.7% at 1 and 3 years, respectively. Transaortic endarterectomy is a safe and effective technique for elective primary mesenteric revascularization for patients with chronic mesenteric ischemia. This approach allows simultaneous revascularization of multiple visceral arteries and achieves durable relief of symptoms. PMID:12244421

Lau, Hung; Chew, David K; Whittemore, Anthony D; Belkin, Michael; Conte, Michael S; Donaldson, Magruder C

2002-01-01

120

Successful retrieval of a fractured and embolised Judkin's catheter during a coronary angiogram.  

PubMed

We report the successful retrieval of a large broken segment of right Judkin's catheter using a snare catheter by a retrograde approach. A 69-year-old woman presented with an anterior wall myocardial infarction. A coronary angiogram revealed severe stenosis of distal left main coronary artery, ostio-proximal portion of the left anterior descending artery and the ostial left circumflex artery. During right shoot, the Judkin's right catheter was broken at almost 15 cm from the distal end. The distal end of the broken catheter was lying in the ascending aorta, whereas proximal end was in the left subclavian artery. First, we snared the distal end and pulled out the catheter in right common iliac artery but owing to the curvature of the fragment, this attempt was unsuccessful. Finally, we were successful in removing the fractured segment retrogradely through the arterial sheath placed in left femoral artery. PMID:23832994

Patra, Soumya; Sadananda, K S; Agrawal, Navin; Manjunath, Cholenahally Nanjappa

2013-01-01

121

Successful Embolization of Coronary Arteriovenous Fistula Using an Interlocking Detachable Coil  

Microsoft Academic Search

.   Although the efficacy and feasibility of coil embolization of coronary arteriovenous fistulas have been reported, the procedure\\u000a may be complicated by migration of the coil into peripheral vessels or pulmonary arteries. We report two cases of successful\\u000a coil embolization of such lesions using an interlocking detachable coil. This system can provide safer and more effective\\u000a coil embolization in patients

Y. Ogoh; T. Akagi; T. Abe; K. Hashino; N. Hayabuchi; H. Kato

1997-01-01

122

Radiation-induced mitral and tricuspid regurgitation with severe ostial coronary artery disease: a case report with successful surgical treatment.  

PubMed

A 71-year-old woman presented with congestive heart failure due to severe mitral and tricuspid regurgitations. In addition, she had significant ostial right coronary stenosis. She received radiation therapy following left radical mastectomy for carcinoma of breast in the past. She underwent successful combined mitral valve replacement, tricuspid annuloplasty, and coronary artery bypass graft for radiation-induced heart disease. PMID:7656309

Raviprasad, G S; Salem, B I; Gowda, S; Leidenfrost, R

1995-06-01

123

Generalized spasm of the right coronary artery after successful stent implantation provoked by intracoronary administration of ergonovine.  

PubMed

Coronary spasm may be one of the reasons for the appearance of chest pain after successful percutaneous coronary interventions, and is potentially hazardous when myocardial ischemia occurs. Coronary spasm can be diagnosed by intracoronary administration of ergonovine as a selective spasm provocative test. We report here the case of a patient who had chest pain and ST segment elevation 10 days after successful right coronary artery stent implantation. Repeat angiography was performed, with results of no in-stent stenosis and no stenosis in other segments. Since coronary artery spasm was considered as a possible reason, a spasm provocative test was attempted. Following ergonovine administration (total dose, 50 mug) into the right coronary artery, severe spasm with 99% stenosis developed over the whole artery except the stented segment. Isosorbide dinitrate was injected immediately, and the provoked spasm was soon relieved. Intravascular ultrasound revealed no neointima at the stented segment and diffuse and mild low-echogenic concentric plaque at the distal as well as proximal segment of the stent. Most reports regarding coronary artery spasm provocative tests have focused on focal lesions before interventional therapy, or during interventional procedures. Although it is quite rare, potential coronary spasm should be considered when chest symptoms recur after percutaneous coronary interventions without angiographic representation. PMID:17064794

Li, Yuxin; Honye, Junko; Takayama, Tadateru; Saito, Satoshi

2007-07-10

124

Endovascular stents for renal artery revascularization.  

PubMed

Revascularization cures or attenuates the clinical manifestations of renal artery stenosis (hypertension, ischemic nephropathy, pulmonary edema, angina, and congestive heart failure). Traditional approaches have been sub-optimal due to low rates of success and long-term patency after angioplasty, and to relatively high rates of perioperative morbidity and mortality. Endovascular stent placement is an alternative interventional method for renal artery revascularization. Technical success rates are excellent, and the impact on clinical outcomes (blood pressure, renal function, and cardiac complications) is promising. PMID:9864668

Tuttle, K R; Raabe, R D

1998-11-01

125

Optimal treatment of multivessel complex coronary artery disease  

PubMed Central

The aim of the present study was to investigate major cardiac events and the similarities and differences of medical costs among patients with multivessel complex coronary artery disease (MCCAD) during the three-year follow-up. The MCCAD patients had undergone single complete revascularization (CR), fractionated revascularization (FR) or partial revascularization (PR) and the present study aimed to screen the optimal treatment program. A total of 2,309 MCCAD patients who had been treated at a single center in the last decade, among which 1,020 cases underwent single CR, 856 cases successively underwent FR and 433 cases only underwent PR, were followed-up for three years. Major cardiac events, including all-cause mortality, myocardial infarction, severe heart failure, rehospitalization and revascularization (coronary artery bypass grafting and coronary stent reimplantation), were set as the end points. In addition, the three-year medical costs associated with heart disease were analyzed. The three-year cardiac event rate in the CR group (17%) was significantly lower compared with the other two groups and the average three-year medical costs in the CR group (62,100 RMB) were significantly lower than those in the other two groups. Therefore, under permissive conditions, single CR is the optimal and most economical treatment strategy for patients with MCCAD.

SUN, HAIHUI; CUI, LIANQUN

2014-01-01

126

Impact of atrial fibrillation in patients with ST-elevation myocardial infarction treated with percutaneous coronary intervention (from the HORIZONS-AMI [Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction] trial).  

PubMed

Atrial fibrillation (AF) has been associated with worse outcomes after primary percutaneous coronary intervention (PCI) for acute myocardial infarction. The aim of this study was to evaluate the incidence and impact of new-onset AF after primary PCI in patients with ST-segment elevation myocardial infarctions from the Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) trial. HORIZONS-AMI was a large-scale, multicenter, international, randomized trial comparing different antithrombotic regimens and stents during primary PCI in patients with ST-segment elevation myocardial infarctions. Three-year ischemic and bleeding end points were compared between patients with and without new-onset AF after PCI. Of the 3,602 patients included in the HORIZONS-AMI study, 3,281 (91.1%) with sinus rhythm at initial presentation had primary PCI as their primary management strategy. Of these, new-onset AF developed in 147 (4.5%). Compared with patients without AF after PCI, patients with new-onset AF had higher 3-year rates of net adverse clinical events (46.5% vs 25.7%, p <0.0001), mortality (11.9% vs 6.3%, p = 0.01), reinfarction (16.4% vs 7.0%, p <0.0001), stroke (5.8% vs 1.5%, p <0.0001), and major bleeding (20.9% vs 8.2%, p <0.0001). By multivariate analysis, new-onset AF after PCI was a powerful independent predictor of net adverse clinical events (hazard ratio 1.74, 95% confidence interval 1.30 to 2.34, p = 0.0002) and major adverse cardiac events (hazard ratio 1.73, 95% confidence interval 1.27 to 2.36) at 3 years. In conclusion, new-onset AF after PCI for ST-segment elevation myocardial infarction was associated with markedly higher rates of adverse events and mortality. PMID:24176066

Rene, A Garvey; Généreux, Philippe; Ezekowitz, Michael; Kirtane, Ajay J; Xu, Ke; Mehran, Roxana; Brener, Sorin J; Stone, Gregg W

2014-01-15

127

Cardiac arrest during percutaneous coronary intervention in a patient 'resistant' to clopidogrel - successful 50-minute mechanical chest compression  

PubMed Central

We report a case of 72-year-old female patient with end-stage chronic kidney disease, undergoing percutaneous coronary intervention (PCI) that resulted in a cardiac arrest caused by a thrombus mediated flow limitation in the left coronary artery. With mechanical cardiopulmonary resuscitation (CPR) PCI of the left main artery was performed successfully during 50 min cardiac arrest. The patient was discharged from the hospital without compromising cardiac function and neurological deficits.

Szymkiewicz, Pawel; Sciborski, Krzysztof; Orda, Alina; Karolko, Bozena; Jonkisz, Anna; Lebioda, Arleta; Mysiak, Andrzej

2013-01-01

128

Influence of Crossover on Mortality in a Randomized Study of Revascularization in Patients with Systolic Heart Failure and Coronary Artery Disease  

PubMed Central

Background To assess the influence of therapy crossovers on treatment comparisons and mortality at 5 years in patients with ischemic heart disease and heart failure randomly assigned to medical therapy alone (MED) or to MED and coronary artery bypass surgery (CABG) in the Surgical Treatment for Ischemic Heart Failure (STICH) trial. Methods and Results The influence of early crossover (within the first year following randomization) on 5-year mortality was assessed using time-dependent multivariable Cox models. CABG was performed in 65/602 (10.8%) patients assigned to MED and 55/610 (9.0%) patients assigned to CABG received MED only. Common reasons for crossover from MED to CABG were progressive symptoms or acute decompensation. MED-assigned patients who underwent CABG had lower 5-year mortality than those who received MED only (25% vs. 42%; hazard ratio (HR) 0.50 confidence interval (CI) 0.30-0.85, p=0.008). The main reason for crossover from CABG to MED was patient/family decision. Five patients did not undergo their assigned CABG within a year but died before receiving surgery without status change. They were deemed crossover to MED. The CABG to MED crossover population had higher 5-year mortality compared to those treated with CABG per protocol (59% vs. 33%; HR: 2.01; CI 1.36-2.96, p<0.001). CABG was associated with lower mortality compared to MED in per protocol and several time-dependent analyses (all p<0.05). Conclusions CABG reduced mortality in both the per protocol and crossover STICH patient populations. Crossover from assigned therapy therefore diminished the impact of CABG on survival in STICH when analyzed by intention to treat.

Doenst, Torsten; Cleland, John G.F.; Rouleau, Jean L.; She, Lilin; Wos, Stanislaw; Ohman, E. Magnus; Krzeminska-Pakula, Maria; Airan, Balram; Jones, Robert H.; Siepe, Matthias; Sopko, George; Velazquez, Eric J.; Racine, Normand; Gullestad, Lars; Filgueira, Jose Luis; Lee, Kerry L.

2013-01-01

129

Successful percutaneous coronary intervention of chronic total occlusion of the right coronary artery using "bidirectional kissing-balloon" technique.  

PubMed

We report on a 74-year-old man with chronic total occlusion (CTO) of the right coronary artery treated with percutaneous coronary intervention using the bidirectional kissing-balloon technique. When an antegrade approach fails, a retrograde approach to recanalize a CTO is reasonable. However, when the exit of the CTO is bifurcated and a protection wire does not advance antegrade into the side branch after wire externalization, loss of blood flow after ballooning or stenting may result. We report on the usefulness of the bidirectional kissing-balloon technique for a retrograde approach to chronically totally occluded coronary arterial bifurcation lesions. PMID:24907092

Numasawa, Yohei; Hamazaki, Yuji; Takahashi, Toshiyuki

2014-06-01

130

Successful endovascular aneurysm repair for abdominal aortic aneurysm in a patient with severe coronary artery disease undergoing off-pump coronary artery bypass grafting.  

PubMed

It is well known that patients with abdominal aortic aneurysm (AAA) often have concomitant coronary artery disease (CAD). In cases of AAA with severe CAD requiring coronary artery bypass grafting (CABG), two therapeutic strategies regarding the timing of CABG can be considered: staged or simultaneous operations. However, the ideal treatment of patients with large AAA and critical CAD remains controversial. We experienced a case of successful endovascular aneurysm repair after off-pump CABG in a 70-year-old patient who had a huge AAA and critical CAD. PMID:24855606

Kim, Sun Min; Cho, Jae Yeong; Kim, Ju Han; Park, Keun-Ho; Sim, Doo Sun; Hong, Young Joon; Ahn, Youngkeun; Jeong, Myung Ho

2014-04-01

131

Successful Endovascular Aneurysm Repair for Abdominal Aortic Aneurysm in a Patient with Severe Coronary Artery Disease Undergoing Off-Pump Coronary Artery Bypass Grafting  

PubMed Central

It is well known that patients with abdominal aortic aneurysm (AAA) often have concomitant coronary artery disease (CAD). In cases of AAA with severe CAD requiring coronary artery bypass grafting (CABG), two therapeutic strategies regarding the timing of CABG can be considered: staged or simultaneous operations. However, the ideal treatment of patients with large AAA and critical CAD remains controversial. We experienced a case of successful endovascular aneurysm repair after off-pump CABG in a 70-year-old patient who had a huge AAA and critical CAD.

Kim, Sun Min; Cho, Jae Yeong; Kim, Ju Han; Park, Keun-Ho; Sim, Doo Sun; Hong, Young Joon; Ahn, Youngkeun

2014-01-01

132

[A successful case of transaortic coronary patch angioplasty for left coronary ostial stenosis in a middle-aged woman].  

PubMed

A 46-year-old woman was admitted to our hospital because of effort angina. Electrocardiogram on exercise showed a significant ST depression in I, II, III, aVF, and V3-6 201Thallium myocardial scintigram demonstrated a low uptake lesion on effort and redistribution in anterior wall of left ventricle. Coronary angiography showed a 50% stenosis only in the left coronary ostium. Operation was carried out by transaortic patch angioplasty using autologous pericardium fixed with 0.25% glutaraldehyde. Her postoperative course was uneventful. Anginal discomfort disappeared, and favorable results was obtained. Recent reports suggest that an isolated coronary ostial stenosis is a distinct clinical entity which is different from the usual atherosclerotic ischemic heart disease. The transaortic patch angioplasty might be useful operative method for the isolated coronary ostial stenosis. PMID:7861073

Kuki, S; Yoshida, K; Taketani, S; Matsumura, R; Okuda, A

1994-12-01

133

Direct Myocardial Revascularization without Extracorporeal Circulation: Technique and Initial Results  

PubMed Central

In a 10-month period, 68 patients underwent saphenous vein bypass revascularization without extracorporeal circulation. Distal sutures were performed with interruption of coronary flow without any devices for perfusion of the coronary artery; the proximal sutures were completed with tangential clamping of the aorta. Most frequently, the anterior descending and the distal right coronary arteries were revascularized; of 225 patients who underwent bypass surgery, this technique was possible in 68 cases (30.2%). The 30-day hospital mortality was 1.5%, and perioperative myocardial infarction, as determined by daily electrocardiograms (ECGs) and creatine phosphokinase isoenzyme (CKMB), occurred in two patients. Control hemodynamic studies were performed in 22 of the 68 patients (32.4%) with a patency rate of 84.2% in the grafts restudied. Images

Buffolo, Enio; Andrade, Jose Carlos S.; Succi, Jose Ernesto; Leao, Luiz Eduardo V.; Cueva, Clotario; Branco, Joao Nelson; Carvalho, Antonio Carlos C.; Galluci, Costabile

1985-01-01

134

Experimental study of myocardial revascularization by CO2 laser  

NASA Astrophysics Data System (ADS)

The coronary lesions are usually diffuse, so bypass and PTCA are indicated in only a limited proportion of coronary patients. Revascularization with laser was studied in our laboratory. Fifteen dogs with mimic myocardial ischemia by multiple coronary artery ligation were divided into two groups, five acting as a control group. In 10, CO2 laser was adopted in making a series of channels in the myocardium. We aimed to evaluate the effect of laser in revascularization, and to document long-term follow up. Our experiment demonstrated that laser-producing channels protect myocardium from ischemic events. Postoperative improvement of ventricular function and increased regional myocardial perfusion were observed. Microscopic and SEM examination at intervals of 3 days to 3 months showed the patency of channels and development of collateral circulation.

Wu, Ming-Ying; Li, Gong-Song; Li, Jun-Heng

1993-03-01

135

Successful retrieval of a broken intravascular ultrasound catheter tip in the coronary artery.  

PubMed

We report the successful retrieval of a broken intracoronary intravascular ultrasound (IVUS) catheter tip that was mostly invisible on fluoroscopy by using a snare catheter and pulling from distal to proximal. An 80-year-old male had presented with effort-related angina for one month. A coronary angiogram revealed severe stenosis of the proximal portion of the left anterior descending artery (LAD). Percutaneous coronary intervention (PCI) was planned for the lesion. During pre-procedural IVUS examination, the IVUS catheter fractured leaving the tip of the IVUS catheter inside the LAD. An attempt was made to remove the IVUS catheter tip by engaging the free proximal end of the tip with a loop snare. This attempt failed due to the free proximal end of the IVUS catheter tip being invisible on fluoroscopy. A loop snare was instead delivered distal to the IVUS catheter tip through a microcatheter, and the IVUS wire of the catheter tip was manipulated into the loop. The loop snare was then pulled back securely catching the IVUS catheter tip. The broken IVUS catheter tip was subsequently removed. This novel technique is effective for retrieving intracoronary foreign bodies. PMID:20944198

Funatsu, Atsushi; Kobayashi, Tomoko; Nakamura, Shigeru

2010-10-01

136

A case of percutaneous coronary intervention procedure successfully bailed out from multiple complications in hemodialysis patient.  

PubMed

A 73 year-old male who underwent coronary artery bypass surgery (CABG) 8 years ago had PCI performed on him for a diffuse calcified stenotic lesion in the right coronary artery (RCA). Following 2.5 mm non-compliant balloon dilatation supported with a child catheter (Dio from Goodman), we implanted a stent to the distal RCA through this catheter. However, because the tip of Dio was trapped by the implanted stent, it was stretched and almost ruptured by pulling it. Next, we tried to implant a stent for mid RCA with buddy wire technique, but we could not deploy it because of calcification. When we tried to withdraw this stent system, the stent was accidentally dislodged from the balloon. We could withdraw the stent with twisting two wires. However, because one of these wires had crossed a small artery in the distal RCA at twisting, a tip of this wire was fractured when the stent was removed. We could remove this wire with gooseneck snare. Finally, we successfully implanted stents in the mid RCA with balloon anchor technique and to the proximal RCA. PMID:22810922

Kawamura, Yota; Nagaoka, Masakazu; Ito, Daiki; Iseki, Harukazu; Ikari, Yuji

2013-01-01

137

Incidence of spasm at the site of previous successful transluminal coronary angioplasty: effect of ergometrine maleate in consecutive patients.  

PubMed Central

The incidence of coronary artery spasm at the site of previous successful angioplasty and its importance in leading to subsequent restenosis or recurrence of symptoms are unknown. Fourteen consecutive patients with single vessel coronary artery disease who had undergone successful percutaneous transluminal angioplasty were studied. All patients were given ergometrine maleate (ergonovine maleate) intravenously during repeat cardiac catheterisation six weeks to three months after angioplasty. Five patients demonstrated excessive luminal reduction (spasm) at the site of previous angioplasty that led to luminal stenoses ranging from 50% to 79%. Two of these patients developed chest pain and ST segment changes during ergometrine maleate provocation and they also showed maximal vasoconstriction. The remaining nine patients did not develop important luminal change at the site of angioplasty after ergometrine maleate. Ergometrine maleate administration resulted in less than or equal to 20% reduction in lumen diameter of adjacent apparently normal sections of the coronary arteries in all but two patients. At the site of previous angioplasty in the five patients with spasm, however, the lumen was constricted by a mean (SD) of 51 (12)%, whereas in the nine patients not demonstrating spasm mean reduction was 12 (7)%. Thus hypersensitivity to ergometrine maleate at the site of previous successful angioplasty was demonstrated in over a third of consecutive patients with single vessel coronary artery disease. The importance of this finding to long term results of coronary angioplasty needs to be investigated further. Images Fig. 4

Quyyumi, A A; Raphael, M; Perrins, E J; Shapiro, L M; Rickards, A F; Fox, K M

1986-01-01

138

Clinical efficacy of transluminal extraction coronary atherectomy.  

PubMed

Mechanical revascularization has revolutionized the treatment of coronary artery disease. The transluminal extraction-endarterectomy catheter (TEC) system was developed recently and permits the excision and extraction of atherosclerotic lesions of the coronary artery and the bypass graft. The system includes a motor-driven flexible torque catheter with rotating conical shaped stainless steel blades distally. The proximal end of the TEC system consists of a mechanical housing which controls the vacuum, the rotating cutter (750 RPM) and the cutter excursion (4 cm). After safety testing of the TEC system in dogs and human peripheral arterial disease, percutaneous transluminal coronary atherectomies employing the TEC have been performed in 25 patients (six women, 19 men, mean age, 64 +/- 12 years) with the diameter of the stenosis greater than or equal to 75% in one or more coronary arteries. Twenty-eight atherosclerotic lesions were treated in 26 native coronary arteries. The overall success rate (less than 50% residual stenosis in all lesions) was 92%. There was one instance of hematoma proximal to the excised target lesion, and one instance of atherectomized debris embolization. There were no instances of dissection, perforation, coronary spasms or death related to the procedure. The results indicate that the TEC system can be used safely and effectively to treat coronary artery disease with a high success rate. PMID:1354696

Kuan, P

1992-03-01

139

Thrombolysis Followed by Early Revascularization: An Effective Reperfusion Strategy in Real World Patients with ST-Elevation Myocardial Infarction  

Microsoft Academic Search

Background: Several trials suggested superiority of primary percutaneous coronary intervention (PPCI) angioplasty over thrombolysis in patients with ST-elevation myocardial infarction (STEMI), but many trials were characterized by low rates of early revascularization in patients treated with initial thrombolysis. We tested the hypothesis that in patients with hemodynamically stable STEMI, initial thrombolysis followed by an active early rescue\\/definitive revascularization strategy could

Ronen Jaffe; David A. Halon; Basheer Karkabi; Jacob Goldstein; Ronen Rubinshtein; Moshe Y. Flugelman; Basil S. Lewis

2007-01-01

140

Unprotected Left Main Percutaneous Coronary Intervention in a 108-Year-Old Patient  

PubMed Central

With the increase in life expectancy, the proportion of very elderly people is increasing. Coronary artery disease (CAD) is an important cause of mortality and morbidity in this age group, for which myocardial revascularization is often indicated. Percutaneous coronary intervention (PCI) in the very elderly bears the inherent risks of complications and mortality, but the potential benefits may outweigh these risks. A number of observational studies, registries, and few randomized controlled trials have shown the safety and feasibility of PCI in octogenarians and nonagenarians. However, PCI is only rarely done in centenarians; so, the outcome of percutaneous coronary revascularization in this age group is largely unknown. PCI in a centenarian with complex CAD is described here; the patient presented with unstable angina despite optimum medical therapy, and surgery was declined. Good angiographic success was followed by non-cardiac complications, which were managed with a multidisciplinary approach.

Rahman, Afzalur

2014-01-01

141

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. Thomas

1996-09-01

142

Penile Revascularization in the Treatment of Impotence  

PubMed Central

New clinical developments in the diagnosis and treatment of male sexual dysfunction have occurred in the past several years. Much of this information has not been disseminated to the general medical public. Of particular note, a series of reliable penile prosthetic devices for the treatment of advanced erectile dysfunction is now considered to be established and valid surgical therapy. The new diagnostic techniques of nocturnal penile tumescence monitoring, penile plethysmography, penile sphygmomanometry and phalloarteriography are beginning to show that some patients with erectile impotence have arteriosclerosis of the penile arteries. These patients were formerly considered to have psychogenic or idiopathic impotence. Some of these patients with vasculogenic impotence may benefit from the new surgical technique of penile revascularization, thus obviating the need for penile prosthetic implants. A preliminary report of a small series of cases of corpus cavernosum revascularization using the microsurgical implantation of the inferior epigastric artery directly into the corpus cavernosum with prolonged systemic anticoagulation gives a cure/improvement rate of 40 percent. Better selection of patients for operation and perfection of surgical technique offer the chance for improvement in this rate of success. The proper role of corpus cavernosum revascularization in the treatment of impotence remains to be clearly defined. However, these preliminary results, coupled with several reports from Europe, are sufficiently encouraging to justify continued clinical investigation and surgical experience with penile revascularization for vasculogenic impotence. ImagesFigure 1.Figure 2.Figure 3.

Sharlip, Ira D.

1981-01-01

143

Functional assessment of multivessel coronary artery disease: ischemia-guided percutaneous coronary intervention.  

PubMed

Invasive evaluation and treatment of coronary artery disease (CAD) has traditionally been based upon coronary angiography to determine the need for and the success of revascularization. However, coronary angiography augmented with fractional flow reserve (FFR) creates a paradigm shift, providing a more complete functional assessment of coronary lesions. Measuring FFR to identify ischemic lesions and guide revascularization results in fewer adverse outcomes, including persistent angina, myocardial infarction, and mortality. An ischemic lesion identified by FFR is more likely to lead to adverse events when compared with an angiographically similar lesion with nonischemic FFR when both are treated medically. Although the mechanism explaining this is unclear, it is likely multifactorial, including the impact of mechanical forces, upregulation of inflammatory mediators, and the amount of distal myocardial tissue at risk. Using both anatomic and ischemia-guided assessments (such as the Functional SYNTAX Score) aids in the therapeutic decision-making process in patients with multivessel CAD. This review focuses on the evidence for FFR-guided management of multivessel CAD. PMID:25072658

Schwartz, Jonathan G; Fearon, William F

2014-09-01

144

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

1997-01-01

145

Full myocardial revascularization with bilateral internal mammary artery Y grafts  

PubMed Central

Background Bilateral internal mammary artery (BIMA) grafting in coronary artery surgery provides better long term outcomes than single internal mammary artery and saphenous vein grafting but the optimum configuration of BIMAs has not been established. This study analyzed perioperative and late outcomes of patients who underwent BIMA grafting with a composite Y configuration. Methods Patients (n=922) who underwent BIMA Y grafting were identified from a cardiac surgical database and then cross matched against hospital and cardiology databases and the state death register to identify episodes of repeat coronary angiography, cardiac surgical re-intervention and death. Analysis of repeat angiography was performed after retrieval of the angiogram reports. Results In 95% of patients, full myocardial revascularization was achieved with BIMAs alone, using a composite Y configuration with an average of 4.1 IMA to coronary artery anastomoses per patient. The perioperative mortality was 1.5% and the 5-, 10- and 15-year survival estimates were 95%, 87% and 77% respectively. Analysis of 166 symptom-driven post-discharge coronary angiograms showed grafts to the left anterior descending artery and increasing severity of coronary artery stenosis at preoperative angiography as predictors of anastomotic patency. Conclusions Full myocardial revascularization can be achieved with reasonable safety in most patients with triple vessel disease and good left ventricular function, and provides good late survival.

Naidoo, Rishendran; Byth, Karen; Chen, Cheng; Denniss, A. Robert

2013-01-01

146

Intraoperative Doppler coronary artery finder.  

PubMed

Time-consuming difficulty is occasionally encountered in finding coronary arteries or previously placed vascular grafts during coronary revascularization procedures. A catheter-tipped, continuous-wave Doppler ultrasonic probe with simple audio output has been shown to be capable of expediting the search for these vessels. PMID:921376

Moulder, P V; Teague, M J; Manuele, V J; Brunswick, R A; Daicoff, G R

1977-11-01

147

Comparison of the angiographic and scintigraphic evaluation of the success of percutaneous transluminal coronary angioplasty  

SciTech Connect

The hemodynamic effects of percutaneous transluminal coronary angioplasty (PTCA) are difficult to assess as the change in the degree of arterial stenosis (AS) or transluminal pressure gradients (TPG) do not portray the functional result of this procedure. Diminished maximal hyperemic blood flow (MHBF) characterizes a functionally significant coronary lesion and the ratio of MHBF to basal coronary blood flow: the coronary flow reserve (CFR), which now can be estimated at the time of coronary angiography (CA), is an alternative approach to determining the physiologic significance of a lesion. CFR was obtained in 5 patients with single vessel coronary artery disease (CAD) and compared to stress Thallium-201 myocardial scintigraphy (T1), ejection fraction (EF) and ventricular wall motion (WM) by radionuclide ventriculography (RNV) and the results of CA (AS and TPG) before and after PTCA. Despite the persistence of moderate AS and/or a TPG, T1 and WM returned to normal when CFR was normalized. Thus, T1 and RNV are reliable, noninvasive indicators of the functional results of PTCA and can be used to assess its hemodynamic effects.

Le Grand, V.; Wueron, F.; O'Neil, W.W.; Juni, J.; Gross, M.D.; Vogel, R.

1984-01-01

148

Low-level laser therapy prevents prodromal signal complications on saphenectomy post myocardial revascularization.  

PubMed

Abstract Background and objective: One of the most frequent treatments for ischemic heart disease is myocardial revascularization, often applying the saphenous vein as a coronary graft. However, postoperative complications may occur, such as saphenous dehiscence. According to the literature, low-level laser therapy (LLLT) has been used in the treatment of several inflammatory processes in patients. Recently, its uses have expanded to include LLLT preventive therapy and postoperative treatment. Despite our department's successful application of LLLT in the treatment of saphenectomy incisions, many colleagues are still uncertain as to laser theraphy's benefits. Therefore, the study's purpose was to evaluate tissue repair of prodromal surgical incisions after the administration of LLLT. Materials and methods: The pilot study included 14 patients, divided into two groups. Both groups of patients received the traditional treatment; additionally, the Laser Group (n=7) received diode laser treatment (?=780?nm, fluence=19?J/cm(2), pulse=25?mW, time=30?sec, energy=0.75?J, irradiance=625?mW/cm(2), beam spot size 0.04?cm(2)), which was applied on the edges of the saphenectomy incision. The Control Group (n=7) received conventional treatment exclusively. Results: In the Laser Group: all seven patients showed significant improvement, whereas the Control Group had twice as many complications, including critical rates of incisional dehiscence. Conclusions: LLLT was valuable in preventing prodromal complications in saphenectomy post myocardial revascularization. PMID:24841340

Pinto, Nathali Cordeiro; Pereira, Mara Helena Corso; Tomimura, Suely; de Magalhães, Ana Carolina; Pomerantzeff, Pablo M; Chavantes, Maria Cristina

2014-06-01

149

Comparison of the Short-Term Survival Benefit Associated With Revascularization Compared With Medical Therapy in Patients With No Prior Coronary Artery Disease Undergoing Stress Myocardial Perfusion Single Photon Emission Computed Tomography  

Microsoft Academic Search

Background—The relationship between the amount of inducible ischemia present on stress myocardial perfusion single photon emission computed tomography (myocardial perfusion stress (MPS)) and the presence of a short-term survival benefit with early revascularization versus medical therapy is not clearly defined. Methods and Results—A total of 10 627 consecutive patients who underwent exercise or adenosine MPS and had no prior myocardial

Rory Hachamovitch; Sean W. Hayes; John D. Friedman; Ishac Cohen; Daniel S. Berman

150

Different Impact of Diabetes Mellitus on In-Hospital and 1-Year Mortality in Patients with Acute Myocardial Infarction Who Underwent Successful Percutaneous Coronary Intervention: Results from the Korean Acute Myocardial Infarction Registry  

PubMed Central

Background/Aims The aim of this study was to evaluate the impact of diabetes mellitus (DM) on in-hospital and 1-year mortality in patients who suffered acute myocardial infarction (AMI) and underwent successful percutaneous coronary intervention (PCI). Methods Among 5,074 consecutive patients from the Korea AMI Registry with successful revascularization between November 2005 and June 2007, 1,412 patients had a history of DM. Results The DM group had a higher mean age prevalence of history of hypertension, dyslipidemia, ischemic heart disease, high Killip class, and diagnoses as non-ST elevation MI than the non-DM group. Left ventricular ejection fraction (LVEF) and creatinine clearance were lower in the DM group, which also had a significantly higher incidence of in-hospital and 1-year mortality of hospital survivors (4.6% vs. 2.8%, p = 0.002; 5.0% vs. 2.5%, p < 0.001). A multivariate analysis revealed that independent predictors of in-hospital mortality were Killip class IV or III at admission, use of angiotensin converting enzyme inhibitors or angiotensin-II receptor blockers, LVEF, creatinine clearance, and a diagnosis of ST-elevated MI but not DM. However, a multivariate Cox regression analysis showed that DM was an independent predictor of 1-year mortality (hazard ratio, 1.504; 95% confidence interval, 1.032 to 2.191). Conclusions DM has a higher association with 1-year mortality than in-hospital mortality in patients with AMI who underwent successful PCI. Therefore, even when patients with AMI and DM undergo successful PCI, they may require further intensive treatment and continuous attention.

Park, Keun-Ho; Jeong, Myung Ho; Chae, Shung Chull; Hur, Seung Ho; Kim, Young Jo; Seong, In Whan; Chae, Jei Keon; Hong, Taek Jong; Cho, Myeong Chan; Bae, Jang Ho; Rha, Seung Woon; Jang, Yang Soo

2012-01-01

151

Recovery of regional myocardial dysfunction after successful coronary angioplasty early after a non-Q wave myocardial infarction  

SciTech Connect

More aggressive therapy has been suggested for patients who have a non-Q wave myocardial infarction (MI) because of the frequency of subsequent unstable angina, recurrent MI, and high mortality rate compared to patients with Q wave MI. The present study was undertaken to investigate the effect of coronary angioplasty on regional myocardial function of the infarct zone in patients with angina early after a non-Q wave MI. The study population consisted of 36 patients undergoing successful coronary angioplasty within 30 days of a non-Q wave MI, in whom sequential left ventricular angiograms of adequate quality were obtained before the initial procedure and at follow-up angiography. The global ejection fraction increased significantly from 60 +/- 9% to 67 +/- 6% (p = 0.0003). This significant increase in the global ejection fraction was primarily due to a significant improvement in the regional myocardial function of the infarct zone. The results of the present study show not only that ischemic attacks early after a non-Q wave MI may lead to prolonged regional myocardial dysfunction but more important that this depressed myocardium has the potential to achieve normal contraction after successful coronary angioplasty.

Suryapranata, H.; Serruys, P.W.; Beatt, K.; De Feyter, P.J.; van den Brand, M.; Roelandt, J. (University Hospital Rotterdam (Netherlands))

1990-08-01

152

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

PubMed

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

2002-01-01

153

A Unique Complication With Use of the GuideLiner Catheter in Percutaneous Coronary Interventions and its Successful Management.  

PubMed

The "GuideLiner" is an easy-to-use catheter designed for deep seating in coronary arteries. The GuideLiner can be used to provide extra guidance support for equipment delivery during difficult coronary interventions or for coaxial alignment in tortuous vessels. There are a few GuideLiner-related complications reported in the literature, which include stent damage on advancement or on withdrawal, dissection, pressure dampening and ischemia, kinking of the balloon, and displacement of the GuideLiner catheter distal marker. We report another unique and previously unreported GuideLiner-related complication and its successful management. In our case, we experienced dislodgment of the distal cylinder of the GuideLiner from the push rod into the aortic root. The embolized cylinder was removed percutaneously using a novel approach without any complications. PMID:24717280

Bhat, Tariq; Baydoun, Hassan; Tamburino, Frank

2014-04-01

154

Idiopathic primary chylopericardium with associated chylothorax following coronary artery surgery--successful conservative treatment.  

PubMed

A 58-year-old Asian male underwent an uneventful triple coronary bypass that included a pedicled left internal mammary artery (LIMA) graft. On the third postoperative day, following resumption of full oral intake he developed a high output left-sided chylothorax. Initial therapy with a medium chain trigylceride diet and intercostal drainage showed no improvement. CT scan demonstrated a chylopericardium that was drained percutaneously. Complete resolution occurred 2 weeks later with adequate drainage and institution of total parenteral nutrition avoiding further surgery. We discuss the etiology and management of this rare complication following coronary surgery. PMID:18435645

Sachithanandan, Anand; Nanjaiah, Prakash; Rooney, Stephen J; Rajesh, Pala B

2008-01-01

155

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

1999-01-01

156

Microvascular function/dysfunction downstream a coronary stenosis.  

PubMed

For decades coronary macrovascular atherosclerosis has been considered the principal manifestation of coronary heart disease, with most of our effort dedicated to identifying and removal of coronary stenosis. However, growing body of literature indicates that coronary microcirculation also contributes substantially to the pathophysiology of cardiovascular disease. An understanding of mechanisms regulating microvascular function is of critical importance in understanding its role in disease, especially because these regulatory mechanisms vary substantially across species, vascular bed and due to comorbidities. Indeed, the most obvious consequence of coronary stenosis is that it may limit blood supply to the dependent myocardium to the point of causing ischaemia during exercise or even at rest. However, this flow limiting effect is not only due to the passive hydraulic effect of a narrowed conduit, but also to active responses in the coronary microcirculation triggered by the presence of an epicardial stenosis. To understand this problem it is important to review the inter-related mechanisms that regulate flow to the left ventricular wall and modulate transmural distribution of flow. These regulatory mechanisms operate hierarchically and are heterogeneously distributed along the coronary vascular tree. It is also important to discuss the effect of myocardial performance in modulating both blood flow demands and coronary resistance. Some of the interactions between coronary stenosis and microcirculation are transient, like those documented in acute coronary syndromes or during percutaneous interventions. However, microcirculatory remodeling may be triggered by a chronic coronary stenosis, leading to a sustained impairment of blood supply even after successful removal of the epicardial stenosis. A deeper understanding of these phenomena may explain paradoxical findings in patients undergoing coronary revascularization, particularly when functional tests are used in their assessment. These aspects are discussed in detail in this review. PMID:23173585

Guarini, Giacinta; Capozza, Paola Giuseppina; Huqi, Alda; Morrone, Doralisa; Chilian, William M; Marzilli, Mario

2013-01-01

157

Does coronary angiography before emergency aortic surgery affect in-hospital mortality?  

Microsoft Academic Search

OBJECTIVESTo study the relationship between coronary angiography and in-hospital mortality in patients undergoing emergency surgery of the aorta without a history of coronary revascularization or coronary angiography before the onset of symptoms.BACKGROUNDIn the setting of acute ascending aortic dissection warranting emergency aortic repair, coronary angiography has been considered to be desirable, if not essential. The benefits of defining coronary anatomy

Marc S Penn; Nicholas Smedira; Bruce Lytle; Sorin J Brener

2000-01-01

158

Successful repair for a giant coronary artery aneurysm with coronary arteriovenous fistula complicated by both right- and left-sided infective endocarditis.  

PubMed

We report a rare case of a 65-year-old woman who underwent an emergent lifesaving heart operation for an undiagnosed right coronary artery aneurysm with a coronary arteriovenous fistula complicated by active infective endocarditis, which affected the aortic valve, mitral valve, and coronary sinus. We performed direct closure of the coronary arteriovenous fistula, ligation of the right coronary artery aneurysm, double coronary artery bypass grafting, and double valvular replacement. Five years after the operation, she had no sign of congestive heart failure or infection, and was not receiving antibiotics. PMID:19830518

Umezu, Kentaro; Hanayama, Naoji; Toyama, Akihiko; Hobo, Kyoko; Takazawa, Arifumi

2009-10-01

159

Myocardial viability assessed by Dobutamine echocardiography in acute myocardial infarction after successful primary coronary angioplasty  

Microsoft Academic Search

Dobutamine echocardiography (5 and 10 ?g\\/kg\\/ min) was performed in 40 patients 4 ± 1 days after acute myocardial infarction reperfused by primary coronary angioplasty. The left ventricle was divided into 11 segments. Reversible myocardial dysfunction was indicated by a decrease in at least 2 grades in the total segmental score. Follow-up echocardiography was performed 2 months later. Contractile reserve

Florence Leclercq; Patrick Messner-Pellenc; Christophe Moragues; François Rivalland; Denis Carabasse; Jean-Marc Davy; Robert Grolleau-Raoux

1997-01-01

160

Successful resuscitation of cardiac arrest caused by CO2 embolism with intra-aortic injection of epinephrine during off-pump coronary bypass surgery -a case report-  

PubMed Central

Although compressed gas (CO2) blowers have been used safely to aid accurate grafting during off-pump coronary bypass surgery, hemodynamic collapse due to gas embolism into the right coronary artery may occur. Supportive measures to facilitate gas clearance by increasing the coronary perfusion pressure have been reported to be successful in restoring hemodynamic stability. However, right ventricular dysfunction and atrioventricular nodal ischemia may hinder effective systemic delivery of the vasoactive medications, even when performing resuscitative measures such as direct cardiac massage. We herein report a case of cardiac arrest that was caused by a right coronary gas embolism and that could not be restored by cardiac resuscitation. When supportive measures fail, direct aortic injection of epinephrine to increase the coronary perfusion pressure can be attempted before initiating cardiopulmonary bypass, and this approach may be life-saving in situations that limit systemic drug delivery from the venous side despite the performance of direct cardiac massage.

Lee, Choon Soo; Yoon, Yeo Sam; Shim, Jae-Kwang

2013-01-01

161

Successful resuscitation of cardiac arrest caused by CO2 embolism with intra-aortic injection of epinephrine during off-pump coronary bypass surgery -a case report-.  

PubMed

Although compressed gas (CO2) blowers have been used safely to aid accurate grafting during off-pump coronary bypass surgery, hemodynamic collapse due to gas embolism into the right coronary artery may occur. Supportive measures to facilitate gas clearance by increasing the coronary perfusion pressure have been reported to be successful in restoring hemodynamic stability. However, right ventricular dysfunction and atrioventricular nodal ischemia may hinder effective systemic delivery of the vasoactive medications, even when performing resuscitative measures such as direct cardiac massage. We herein report a case of cardiac arrest that was caused by a right coronary gas embolism and that could not be restored by cardiac resuscitation. When supportive measures fail, direct aortic injection of epinephrine to increase the coronary perfusion pressure can be attempted before initiating cardiopulmonary bypass, and this approach may be life-saving in situations that limit systemic drug delivery from the venous side despite the performance of direct cardiac massage. PMID:24427464

Lee, Choon Soo; Yoon, Yeo Sam; Shim, Jae-Kwang; Lim, Hyun Kyoung

2013-12-01

162

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.

1988-01-01

163

Long-Term Survival After Surgical Revascularization for Moderate Ischemic Mitral Regurgitation  

Microsoft Academic Search

Background. We sought to characterize patient survival and degree of late mitral regurgitation (MR) in patients undergoing surgical revascularization with moderate ischemic MR. Methods. We retrospectively reviewed 251 patients undergoing coronary artery bypass graft (CABG) surgery between 1991 and 2001 with 3 ischemic MR, including 31 patients who had concomitant mitral annuloplasty. Univariate and multivariable testing was employed. Results. Actuarial

Daniel R. Wong; Arvind K. Agnihotri; Judy W. Hung; Gus J. Vlahakes; Cary W. Akins; Alan D. Hilgenberg; Joren C. Madsen; Thomas E. MacGillivray; Michael H. Picard; David F. Torchiana

2010-01-01

164

Successful radiofrequency catheter ablation of common atrial flutter at the bottom of a coronary sinus diverticulum.  

PubMed

We describe a patient who underwent radiofrequency (RF) catheter ablation of cavo-tricuspid isthmus-dependent atrial flutter (AFL). Extensive ablation at the isthmus failed to terminate the AFL. A coronary sinus (CS) diverticulum arising from the proximal portion of the middle cardiac vein was found near the isthmus. An RF energy application at the bottom of the CS diverticulum resulted in completion of a bidirectional block line at the isthmus, as well as AFL termination. PMID:22331174

Igarashi, Miyako; Tada, Hiroshi; Sekiguchi, Yukio; Aonuma, Kazutaka

2012-11-01

165

The place of directional coronary atherectomy for the treatment of in-stent restenosis.  

PubMed

The beneficial short and long-term results of coronary stenting have resulted in a dramatic increase in stent utilization, accounting for greater than 80% of coronary interventions [1--9]. However, the long-term beneficial effect of coronary stenting is limited by the occurrence of a 14 to 61% restenosis rate [10--13]. The optimal percutaneous revascularization strategy for the treatment of in-stent restenosis remains undetermined. Although balloon angioplasty has been performed with high initial procedural success, the long-term results are disappointing due to significant recurrence [14--18]. In this article we describe the feasibility, safety, immediate and long-term outcome of directional coronary atherectomy (DCA) as a treatment modality in a cohort of patients undergoing percutaneous intervention for the treatment of in-stent restenosis at the Massachusetts General Hospital. PMID:11244518

Palacios, I F; Sanchez, P L; Mahdi, N A

2000-12-01

166

Advanced coronary artery disease: Appropriate end points for trials of novel therapies  

Microsoft Academic Search

Background The segment of patients with advanced coronary artery disease, or disease that is not amenable to conventional revascularization therapies, continues to grow. Because the natural history of these patients is less defined, the appropriate end points for trials of novel revascularization therapies involving patients with advanced coronary artery disease are not certain. Methods and Results The Mediators of Social

David E. Kandzari; La Choi Lam; Eric L. Eisenstein; Nancy Clapp-Channing; Jennifer T. Fine; Robert M. Califf; Daniel B. Mark; James G. Jollis

2001-01-01

167

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

1993-01-01

168

Angiogenic response induced by mechanical transmyocardial revascularization  

Microsoft Academic Search

Background: Angiogenesis is the proposed mechanism of transmyocardial revascularization. We evaluated mechanical transmyocardial revascularization in a chronically ischemic porcine model by measuring myocardial angiogenic response. Methods: Ameroid constrictors were implanted 6 weeks before mechanical transmyocardial revascularization. Group I (n = 5) and group II (n = 3) animals received 30 punctures with an 18-gauge needle and samples were harvested at

Victor Chu; Jin-qiang Kuang; Amy McGinn; Adel Giaid; Stephen Korkola; Ray C.-J. Chiu

1999-01-01

169

Non-invasive computed tomography coronary angiography as a gatekeeper for invasive coronary angiography.  

PubMed

To determine the rate of subsequent invasive coronary angiography (ICA) and revascularization in relation to computed tomography coronary angiography (CTA) results. In addition, independent determinants of subsequent ICA and revascularization were evaluated. CTA studies were performed using a 64-row (n = 413) or 320-row (n = 224) multidetector scanner. The presence and severity of CAD were determined on CTA. Following CTA, patients were followed up for 1 year for the occurrence of ICA and revascularization. A total of 637 patients (296 male, 56 ± 12 years) were enrolled and 578 CTA investigations were available for analysis. In patients with significant CAD on CTA, subsequent ICA rate was 76%. Among patients with non-significant CAD on CTA, subsequent ICA rate was 20% and among patients with normal CTA results, subsequent ICA rate was 5.7% (p < 0.001). Of patients with significant CAD on CTA, revascularization rate was 47%, as compared to a revascularization rate of 0.6% in patients with non-significant CAD on CTA and no revascularizations in patients with a normal CTA results (p < 0.001). Significant CAD on CTA and significant three-vessel or left main disease on CTA were identified as the strongest independent predictors of ICA and revascularization. CTA results are strong and independent determinants of subsequent ICA and revascularization. Consequently, CTA has the potential to serve as a gatekeeper for ICA to identify patients who are most likely to benefit from revascularization and exclude patients who can safely avoid ICA. PMID:22576679

de Graaf, Fleur R; van Velzen, Joëlla E; de Boer, Stephanie M; van Werkhoven, Jacob M; Kroft, Lucia J; de Roos, Albert; Sieders, Allard; de Grooth, Greetje J; Jukema, J Wouter; Schuijf, Joanne D; Bax, Jeroen J; Schalij, Martin J; van der Wall, Ernst E

2013-01-01

170

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.

2011-01-01

171

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

172

Successful catheter ablation of focal atrial tachycardia from the non-coronary aortic cusp.  

PubMed

We describe a patient with frequent episodes of unusual paroxysmal supraventricular tachycardia. During the electrophysiological examination, the tachycardia was easily induced and terminated by atrial pacing. The earliest activation during right atrial activation mapping was located near the atrioventricular node and the His bundle. However, detailed mapping of the aortic root demonstrated that the local activation in the non-coronary aortic cusp preceded the activation at the His bundle region. Radiofrequency catheter ablation at this site terminated the tachycardia with no complications. PMID:17350980

Raatikainen, M J Pekka; Huikuri, Heikki V

2007-04-01

173

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

2012-01-01

174

Assessment of myocardial viability using coronary zero flow pressure after successful angioplasty in patients with acute anterior myocardial infarction  

PubMed Central

Objectives: To investigate the relation between coronary flow reserve (CFR), coronary zero flow pressure (Pzf), and residual myocardial viability in patients with acute myocardial infarction. Designs: Prospective study. Setting: Primary care hospital. Patients: 27 consecutive patients with acute anterior myocardial infarction. Main outcome measures:18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) was used in 27 patients who underwent successful intervention within 12 hours of onset of a first acute anterior myocardial infarction. Within three days before discharge they had < 25% stenosis in the culprit lesion as determined by angiography 24 (3) days after acute myocardial infarction. Pzf and the slope index of the flow-pressure relation (SIFP) were calculated from the simultaneously recorded aortic pressure and coronary flow velocity signals at peak hyperaemia.%FDG was quantified by comparing FDG uptake in the infarct myocardium with FDG uptake in the normal myocardium. Results: There was a correlation between %FDG and CFR, where y = ?1.477x + 62.517, r = ?0.072 (NS). There was also a correlation between %FDG and SIFP, where y = ?0.975x + 60.542, r = ?0.045 (NS), and a significant correlation between %FDG and Pzf, where y = ?0.98x + 85.108, r = ?0.696 (p < 0.001). Conclusions: CFR does not correlate with FDG-PET at the time of postreperfusion evaluation of residual myocardial viability. The parameter that correlates best with residual myocardial viability is Pzf and this may be a useful index for predicting patient prognosis.

Shimada, K; Sakanoue, Y; Kobayashi, Y; Ehara, S; Hirose, M; Nakamura, Y; Fukuda, D; Yamagishi, H; Yoshiyama, M; Takeuchi, K; Yoshikawa, J

2003-01-01

175

Coronary subclavian steal syndrome: an extracoronary cause of acute coronary syndrome.  

PubMed

Significant atherosclerotic changes of the coronary arteries are the common cause of cardiac chest pain. We report the case of an 80-year-old woman suffering from unstable angina caused by extracoronary atherosclerosis. The patient had an extensive medical history with severe coronary heart disease and cardiac bypass surgery (LIMA to LAD, two venous bypass grafts). An urgent coronary angiography was performed. The angiogram displayed the already known three-vessel disease, the bypass grafts were in a good functional condition. Subsequently, a stenosis of the proximal segment of the left subclavian artery was detected. Measurement of the pullback pressure gradient confirmed the significance of the stenosis. We suspected a "steal phenomenon" concerning the bypass graft LIMA to LAD. An ad hoc PTA with consecutive stenting (self-expandable stent) enabled a successful revascularization of the left subclavian artery without any adverse effects to the vertebral arteries. Cardiac chest pain did not occur any more. Coronary Subclavian Steal Syndrome should be considered a rare but important differential diagnosis in acute coronary syndrome after bypass surgery. PMID:23817863

Schatzl, Stefan; Karnik, Ronald; Gattermeier, Martin

2013-08-01

176

Characteristics of coronary heart disease in renal transplant recipients.  

PubMed

The aim of this study was to identify the characteristics of coronary heart disease (CHD) in renal transplant recipients as well as to assess the impact of coronary angiography on allograft function. The 21 cases including 2 women and 19 men who underwent coronary angiography were retrospectively studied for age at transplantation and at diagnosis of coronary disease; risk factors; angio findings; serum creatinine and blood urea nitrogen (BUN) values before and after angio; and revascularization procedures. The mean ages at transplantation and at diagnosis were 40 +/- 7 years and 44 +/- 7 years, respectively. Eighteen patients (86%) had hypertension, 16 (76%) exhibited hyperlipidemia, and 5 (24%) diabetes mellitus. Coronary angiography revealed three-vessel disease in 10 patients, two-vessel disease in 3 patients, one-vessel disease in 4 patients, ectatic vessels in 2 patients, and normal coronary arteries in 2 patients. The mean serum creatinine and BUN levels after angio were not significantly different from the baseline values (pre creatinine and BUN 1.7 +/- 0.5 mg/dL and 33.8 +/- 8.6 mg/dL versus post 1.8 +/- 0.6 mg/dL and 32.8 +/- 10.0 mg/dL, respectively). Ten patients with three-vessel disease underwent coronary artery bypass surgery; 4 patients, coronary angioplasty. The other patients received medical therapy. The study showed an increased likelihood of three-vessel disease among recipients compared with the general population and confirmed that coronary artery bypass surgery may be performed successfully in these patients. In conclusion coronary angiography is a safe diagnostic procedure with respect to allograft function. PMID:15013330

Pirat, B; Müderrisoglu, H; Korkmaz, M E; Ozin, B

2004-01-01

177

Successful nitinol stent implantation in a large coronary aneurysm: post-interventional patency assessment by magnetic resonance imaging  

Microsoft Academic Search

Nitinol stents are thought to exhibit reduced occurrence of artifacts and may be suitable for magnetic resonance imaging (MRI)\\u000a evaluation of stent localization and in-stent patency even in coronary-sized stent grafts. A 54-year-old male patient presented\\u000a with a large coronary post-stenotic aneurysm of the right coronary artery (RCA) beside significant stenoses of the left circumflex\\u000a coronary artery (LCX) and the

Frank Breuckmann; Kai Nassenstein; Dirk Boese; Dieter Opherk; Harald H. Quick; Jörg Barkhausen; Raimund Erbel

2006-01-01

178

Risk-Stratified Cardiovascular Screening Including Angiographic and Procedural Outcomes of Percutaneous Coronary Interventions in Renal Transplant Candidates  

PubMed Central

Background. Benefits of cardiac screening in kidney transplant candidates (KTC) will be dependent on the availability of effective interventions. We retrospectively evaluated characteristics and outcome of percutaneous coronary interventions (PCI) in KTC selected for revascularization by a cardiac screening approach. Methods. In 267 patients evaluated 2003 to 2006, screening tests performed were reviewed and PCI characteristics correlated with major adverse cardiovascular events (MACE) during a follow-up of 55 months. Results. Stress tests in 154 patients showed ischemia in 28 patients (89% high risk). Of 58 patients with coronary angiography, 38 had significant stenoses and 18 cardiac interventions (6.7% of all). 29 coronary lesions in 17/18 patients were treated by PCI. Angiographic success rate was 93.1%, but procedural success rate was only 86.2%. Long lesions (P = 0.029) and diffuse disease (P = 0.043) were associated with MACE. In high risk patients, cardiac screening did not improve outcome as 21.7% of patients with versus 15.5% of patients without properly performed cardiac screening had MACE (P = 0.319). Conclusion. The moderate procedural success of PCI and poor outcome in long and diffuse coronary lesions underscore the need to define appropriate revascularization strategies in KTC, which will be a prerequisite for cardiac screening to improve outcome in these high-risk patients.

Mockel, Martin; Mueller, Eda; Bocksch, Wolfgang; Babel, Nina; Schindler, Ralf; Reinke, Petra

2014-01-01

179

Remote revascularization of abdominal wall transplants using the forearm.  

PubMed

Primary abdominal wall closure following small bowel transplantation is frequently impossible due to contraction of the abdominal domain. Although abdominal wall transplantation was reported 10 years ago this, technique has not been widely adopted, partly due to its complexity, but largely because of concerns that storing the abdominal allograft until the end of a prolonged intestinal transplant procedure would cause severe ischemia-reperfusion injury. We report six cases of combined small bowel and abdominal wall transplantation where the ischemic time was minimized by remotely revascularizing the abdominal wall on the forearm vessels, synchronous to the intestinal procedure. When the visceral transplant was complete, the abdominal wall was removed from the forearm and revascularized on the abdomen (n?=?4), or used to close the abdomen while still vascularized on the forearm (n?=?2). Primary abdominal wall closure was achieved in all. Mean cold ischemia was 305?min (300-330?min), and revascularization on the arm was 50?min (30-60?min). Three patients had proven abdominal wall rejection, all treated successfully. Immediate revascularization of the abdominal wall allograft substantially reduces cold ischemia without imposing constraints on the intestinal transplant. Reducing storage time may also have benefits with respect to ischemia-reperfusion-related graft immunogenicity. PMID:24797611

Giele, H; Bendon, C; Reddy, S; Ramcharan, R; Sinha, S; Friend, P; Vaidya, A

2014-06-01

180

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

2013-01-01

181

Success and Challenges of a Community Healthy Lifestyles Intervention in Merseyside (UK) to Target Families at Risk from Coronary Heart Disease  

ERIC Educational Resources Information Center

Objective: To document the lifestyle health impacts (activity, diet and physiological), along with the operational success and challenges, of a programme for families presenting one or more coronary heart disease (CHD) risk factor. Design: Data are based on a wider evaluation of a government-funded community initiative conducted in a deprived area…

Peerbhoy, D.; Majumdar, A. J.; Wightman, N. A.; Brand, V. L.

2008-01-01

182

Revascularization and pediatric aneurysm surgery.  

PubMed

Object Aneurysms are relatively rare in the pediatric population and tend to include a greater proportion of large and giant lesions. A subset of these large and giant aneurysms are not amenable to direct surgical clipping and require complex treatment strategies and revascularization techniques. There are limited data available on the management of these lesions in the pediatric population. This study was undertaken to evaluate the outcome of treatment of large and giant aneurysms that required microsurgical revascularization and vessel sacrifice in this population. Methods The authors retrospectively identified all cases in which pediatric patients (age < 18 years) with aneurysms were treated using cerebral revascularization in combination with other treatment modalities at their institution between 1989 and 2013. Results The authors identified 27 consecutive patients (19 male and 8 female) with 29 aneurysms. The mean age of the patients at the time of treatment was 11.5 years (median 13 years, range 1-17 years). Five patients presented with subarachnoid hemorrhage, 11 with symptoms related to mass effect, 2 with stroke, and 3 with seizures; in 6 cases, the aneurysms were incidental findings. Aneurysms were located along the internal carotid artery (n = 7), posterior cerebral artery (PCA) (n = 2), anterior cerebral artery (n = 2), middle cerebral artery (MCA) (n = 14), basilar artery (n = 2), vertebral artery (n = 1), and at the vertebrobasilar junction (n = 1). Thirteen were giant aneurysms (45%). The majority of the aneurysms were fusiform (n = 19, 66%), followed by saccular (n = 10, 34%). Three cases were previously treated using microsurgery (n = 2) or an endovascular procedure (n = 1). A total of 28 revascularization procedures were performed, including superficial temporal artery (STA) to MCA (n = 6), STA to PCA (n = 1), occipital artery to PCA (n = 1), extracranial-intracranial (EC-IC) bypass using radial artery graft (n = 3), EC-IC using a saphenous vein graft (n = 7), STA onlay (n = 3), end-to-end anastomosis (n = 1), and in situ bypasses (n = 6). Perioperative stroke occurred in 4 patients, but only one remained dependent (Glasgow Outcome Scale [GOS] score 3). At a mean clinical follow-up of 46 months (median 14 months, range 1-232 months), 26 patients had a good outcome (GOS score 4 or 5). There were no deaths. Five patients had documented occlusion of the bypass graft. The majority of aneurysms (n = 24) were obliterated at last follow-up. There was a single case of a residual aneurysm and one case of recurrence. Angiographic follow-up was unavailable in 3 cases. Conclusions Cerebral revascularization remains an essential tool in the treatment of complex cerebral aneurysms in children. PMID:24745343

Kalani, M Yashar S; Elhadi, Ali M; Ramey, Wyatt; Nakaji, Peter; Albuquerque, Felipe C; McDougall, Cameron G; Zabramski, Joseph M; Spetzler, Robert F

2014-06-01

183

Orthotopic heart transplant for treatment-resistant cardiomyopathy in Kawasaki syndrome: report of a successful case.  

PubMed

Kawasaki disease is a systemic vascular inflammatory disorder of yet unknown cause that is associated with critical cardiovascular complications. Several long-term medical therapies, coronary revascularization, and heart transplant have been introduced to treat coronary artery lesions. This report describes a 20-year-old man with Kawasaki disease manifesting as intermittent chest pain and nausea who had advanced decompensated cardiomyopathy (ejection fraction, 15%) diagnosed. Coronary artery bypass surgery and implantation of a cardioverter defibrillator had been performed, although no significant clinical improvement was observed. Finally, a successful orthotopic bicaval heart transplant was performed. Follow-up examination after 1 year revealed normal cardiac function with no evidence of organ rejection. This experience demonstrated that heart transplant might be a successful method of treating permanent ischemic cardiomyopathy in patients with Kawasaki syndrome. PMID:24311402

Mirhosseini, Seyed Mohsen; Asadollahi, Shadi; Fakhri, Mohammad

2013-12-01

184

Prevention of neurological injury during myocardial revascularization in patients with calcific degenerative aortic disease.  

PubMed

Neurological injury following myocardial revascularization may result from embolization of atheromatous debris from the diseased ascending thoracic aorta. Eight patients with calcified aortas who underwent elective myocardial revascularization suffered major strokes as a result of manipulation and clamping of the diseased ascending aorta during a 30-month period before July, 1981. computerized axial tomography scans demonstrated multiple cerebral infarctions in each patient. Six patients never regained consciousness and died as a result of neurological injury; 2 patients regained consciousness but were left with major neurological deficits. Later, 21 patients with calcific aortic degenerative disease underwent a specific operative protocol, designed to prevent neurological injury during elective myocardial revascularization. All 21 patients recovered without neurological complications. Specific attention to operative technique allowed this difficult group of patients with incapacitating angina and calcific degenerative aortic disease to have the benefit of coronary bypass. PMID:3954502

Landymore, R W; Kinley, C E; Murphy, D A; Sullivan, J A

1986-03-01

185

Standard versus low-dose weight-adjusted heparin in patients treated with the platelet glycoprotein IIb/IIIa receptor antibody fragment abciximab (c7E3 Fab) during percutaneous coronary revascularization. PROLOG Investigators.  

PubMed

Blockade of the platelet glycoprotein IIb/IIIa receptor by abciximab (c7E3 Fab) during coronary intervention reduces the incidence of ischemic complications, but has been associated with a doubling of the risk for bleeding complications. The present pilot study investigated whether modification of heparin dosing and/or early sheath removal would reduce the hemorrhagic complications associated with abciximab. One hundred three patients undergoing coronary intervention received abciximab (0.25 mg/kg bolus, 10 microg/min infusion for 12 hours) and aspirin and were randomized by a 2 x 2 factorial design to 1 of 2 weight-adjusted heparin doses and to 1 of 2 strategies for heparin discontinuation and vascular sheath removal. In the "standard-dose heparin" group, an initial bolus of 100 U/kg was administered to achieve a procedural activated clotting time (ACT) > or = 300 seconds; in the "low-dose heparin" group, an initial bolus of 70 U/kg was administered without adjustment for ACT. In the "late sheath removal" arm, heparin infusion was continued for the 12-hour duration of abciximab infusion, followed by sheath removal; in the "early sheath removal" group, heparin was stopped after the interventional procedure and sheaths were removed during the abciximab infusion. There were no apparent differences between patients randomized to the different treatment groups with regard to the occurrence of ischemic end points. Rates of bleeding and blood transfusion were reduced by low-dose heparin and early sheath removal and were lowest when both strategies were combined. Reduction and weight adjustment of heparin dose and early sheath removal in the setting of platelet inhibition with abciximab during coronary intervention may be useful in diminishing the incidence of hemorrhagic complications without loss of clinical efficacy. PMID:9036746

Lincoff, A M; Tcheng, J E; Califf, R M; Bass, T; Popma, J J; Teirstein, P S; Kleiman, N S; Hattel, L J; Anderson, H V; Ferguson, J J; Cabot, C F; Anderson, K M; Berdan, L G; Musco, M H; Weisman, H F; Topol, E J

1997-02-01

186

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

Microsoft Academic Search

BACKGROUND. Directional coronary atherectomy is a new technique of coronary revascularization by which atherosclerotic plaque is excised and retrieved from target lesions. With respect to the rate of restenosis and clinical outcomes, it is not known how this procedure compares with balloon angioplasty, which relies on dilation of the plaque and vessel wall. We compared the rate of restenosis after

Eric J. Topol; Ferdinand Leya; Cass A. Pinkerton; Patrick L. Whitlow; Berthold Hofling; Charles A. Simonton; Ronald R. Masden; Patrick W. Serruys; Martin B. Leon; David O. Williams; Spencer B. King; B. Daniel; D. B. Mark; J. M. Isner; D. R. Holmes; S. G. Ellis; K. L. Lee; G. P. Keeler; L. G. Berdan; T. Hinohara; R. M. Califf

1993-01-01

187

Coronary-Subclavian Steal Syndrome: Percutaneous Approach  

PubMed Central

Coronary subclavian steal syndrome is a rare ischemic cause in patients after myocardial revascularization surgery. Subclavian artery stenosis or compression proximal to the internal mammary artery graft is the underlying cause. The authors present a clinical case of a patient with previous history of non-ST elevation myocardial infarction, triple coronary bypass, and effort angina since the surgery, with a positive ischemic test. Coronary angiography revealed a significant stenosis of the left subclavian artery, proximal to the internal mammary graft.

Raposo, Luis; Leal, Silvio; Goncalves, Pedro Araujo; Mesquita Gabriel, Henrique; Teles, Rui Campante; Almeida, Manuel Sousa; Mendes, Miguel

2013-01-01

188

Successful intraoperative identification of an anomalous origin of the left coronary artery from the pulmonary artery using real time three-dimensional transesophageal echocardiography.  

PubMed

Anomalous origin of the left coronary artery (LCA) from the pulmonary artery (ALCAPA) is a rare congenital defect that presents only infrequently in adults. An adult diagnosed with ALCAPA, heart failure, and mitral regurgitation underwent surgical ligation of the anomalous origin of the LCA from the pulmonary artery (PA) and coronary artery bypass grafting (CABG). The anomalous origin in the PA and proximal segment of the left anterior descending artery (LAD) was successfully delineated via real time, three-dimensional transesophageal echocardiography during surgery. This modality allows for fast assessment and novel views of complex cardiac abnormalities and can aid in perioperative monitoring.? PMID:21564280

Jin, Yao Dong; Hsiung, Ming C; Tsai, Shen Kou; Chang, Chung-Yi; Wei, Jeng; Ou, Ching-huei; Chang, Yi Cheng; Lee, Kuo Chen; Sue, Sung-How

2011-08-01

189

Early percutaneous transluminal coronary angioplasty or coronary bypass surgery following thrombolytic treatment of acute myocardial infarction.  

PubMed

Coronary reocclusion rates following intracoronary streptokinase (IC-SK) infusion remain significantly high despite anticoagulation. Early intervention by coronary angioplasty (PTCA) or coronary bypass surgery (CABG) was advocated to minimize such risk and/or maintain coronary reperfusion. Of 71 consecutive patients (60 men, 11 women; mean age, 54.9 years) who underwent IC-SK infusion for acute myocardial infarction (MI) 50 had early CABG, 18 had PTCA, and three had both procedures. Sixty-four of the 71 had successful thrombolysis. Thirty-six patients had either CABG or PTCA within three days, 22 patients within seven days, and 13 patients within two weeks. There was no immediate or in-hospital mortality, and all patients remained alive through the follow-up period of three to 36 months. Functional class (FC) 1 was achieved in 45 patients, FC 2 in 22 patients, FC 3 in three patients, and FC 4 in one patient. Sixty-seven patients (94 percent) were free of chest pain through the follow-up period. These data suggest that early intervention by CABG and/or PTCA in suitable candidates could be achieved with reduced risk and expected to yield favorable results. This favorable trend could be related to maintenance of myocardial perfusion by these procedures, initially induced by thrombolysis. Long-term, large-scale studies are needed to confirm the role of optimal timing of such procedures, but we believe that such results indicate that early revascularization yields promising results. PMID:2952466

Salem, B I; Gowda, S; Haikal, M; Leidenfrost, R; Cox, J L; Ferguson, T

1987-05-01

190

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.

2013-01-01

191

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

PubMed

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. PMID:23521838

Bobylev, Dmitry; Fleissner, Felix; Zhang, Ruoyu; Haverich, Axel; Ismail, Issam

2013-01-01

192

Coronary endarterectomy: new flavors from old recipes.  

PubMed

Coronary endarterectomy is an old surgical procedure against coronary artery disease first described by Baily et al. in 1957. Despite its first adverse results, several current publications have shown that coronary endarterectomy with on-pump or off-pump coronary artery bypass grafting can be safely performed with acceptable mortality, morbidity, and angiographic patency rates. Coronary endarterectomy can assure complete revascularization supplying the myocardium with satisfactory blood flow in cases of a diffusely diseased left anterior descending artery or diffuse calcification, thus preventing residual ischemia. Hence, it is important to evaluate current results, rethink this old recipe, and redefine its indications. PMID:24674746

Papakonstantinou, Nikolaos A; Baikoussis, Nikolaos G; Apostolakis, Efstratios

2014-06-01

193

Current Status of Coronary Intervention in Patients with ST-Segment Elevation Myocardial Infarction and Multivessel Coronary Artery Disease  

PubMed Central

Primary percutaneous coronary intervention (PCI) is a standard interventional treatment modality for ST-segment elevation myocardial infarction (STEMI). Diagnostic coronary angiogram during PCI reveals multivessel coronary artery disease in about half of patients with STEMI, and it is difficult to make decision on the extent of intervention in these patients. Although revascularization for the infarct-related artery only is still effective for STEMI patients, several studies have reported the efficacy of multivessel revascularization during primary PCI, as well as in a staged PCI procedure. Clinicians should consider clinical aspects such as initial cardiogenic shock and myocardial viability when performing primary multivessel intervention, including the risks and benefits of multivessel revascularization in patients undergoing primary PCI. This review describes the current status of performing multivessel PCI in patients with STEMI and proposes an optimal revascularization strategy based on the previous literature.

Kim, Min Chul; Kim, Sang Hyung; Hong, Young Joon; Kim, Ju Han; Ahn, Youngkeun

2014-01-01

194

Current Status of Coronary Intervention in Patients with ST-Segment Elevation Myocardial Infarction and Multivessel Coronary Artery Disease.  

PubMed

Primary percutaneous coronary intervention (PCI) is a standard interventional treatment modality for ST-segment elevation myocardial infarction (STEMI). Diagnostic coronary angiogram during PCI reveals multivessel coronary artery disease in about half of patients with STEMI, and it is difficult to make decision on the extent of intervention in these patients. Although revascularization for the infarct-related artery only is still effective for STEMI patients, several studies have reported the efficacy of multivessel revascularization during primary PCI, as well as in a staged PCI procedure. Clinicians should consider clinical aspects such as initial cardiogenic shock and myocardial viability when performing primary multivessel intervention, including the risks and benefits of multivessel revascularization in patients undergoing primary PCI. This review describes the current status of performing multivessel PCI in patients with STEMI and proposes an optimal revascularization strategy based on the previous literature. PMID:24876852

Kim, Min Chul; Jeong, Myung Ho; Kim, Sang Hyung; Hong, Young Joon; Kim, Ju Han; Ahn, Youngkeun

2014-05-01

195

Open perilunate injury with lunate revascularization after complete ligamentous avulsion.  

PubMed

Perilunate dislocations are a devastating injury to the carpus that carry a guarded long-term prognosis. Mayfield type 4 perilunate dislocations are rare, high-energy injuries that carry a risk for avascular necrosis (AVN) of the lunate. When AVN ensues and the carpus collapses, primary treatment with a proximal row carpectomy or arthrodesis has been advocated. This case reports a successful clinical result and revascularization of an extruded lunate with open reduction and internal fixation. This type 4, Gustilo grade 1 open perilunate dislocation exhibited complete avulsion of all lunate ligamentous attachments. Management included open reduction and internal fixation as well as carpal tunnel release through a combined dorsal and volar approach. Despite concerns for lunate AVN due to complete disruption of lunate vascularity, a 10-month postoperative clinical and radiographic examination demonstrated no pain with activities of daily living as well as a revascularized lunate. PMID:24876511

Arango, Dillon; Tiedeken, Nathan C; Ayzenberg, Mark; Raphael, James

2014-01-01

196

Open perilunate injury with lunate revascularization after complete ligamentous avulsion  

PubMed Central

Perilunate dislocations are a devastating injury to the carpus that carry a guarded long-term prognosis. Mayfield type 4 perilunate dislocations are rare, high-energy injuries that carry a risk for avascular necrosis (AVN) of the lunate. When AVN ensues and the carpus collapses, primary treatment with a proximal row carpectomy or arthrodesis has been advocated. This case reports a successful clinical result and revascularization of an extruded lunate with open reduction and internal fixation. This type 4, Gustilo grade 1 open perilunate dislocation exhibited complete avulsion of all lunate ligamentous attachments. Management included open reduction and internal fixation as well as carpal tunnel release through a combined dorsal and volar approach. Despite concerns for lunate AVN due to complete disruption of lunate vascularity, a 10-month postoperative clinical and radiographic examination demonstrated no pain with activities of daily living as well as a revascularized lunate.

Arango, Dillon; Tiedeken, Nathan C.; Ayzenberg, Mark; Raphael, James

2014-01-01

197

Total arterial revascularization with an internal thoracic artery and radial artery T graft  

Microsoft Academic Search

Background. Proximal anastomosis of the radial artery to the side of the internal thoracic artery (ITA) permits complete arterial revascularization in most patients, with the aim of improving long-term results of coronary artery bypass through greater long-term graft patency. The short-term results, however, have yet to be defined. We therefore reviewed our early experience with this grafting strategy.Methods. Between October

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

1999-01-01

198

Total Arterial Revascularization With an Internal Thoracic Artery and Radial Artery T Graft  

Microsoft Academic Search

Background. Proximal anastomosis of the radial artery to the side of the internal thoracic artery (ITA) permits complete arterial revascularization in most patients, with the aim of improving long-term results of coronary artery bypass through greater long-term graft patency. The short-term results, however, have yet to be defined. We therefore reviewed our early experience with this graft- ing strategy. Methods.

Thoralf M. Sundt III; Hendrick B. Barner; Cynthia J. Camillo; William A. Gay

199

Clinical Lipid Control Success Rate Before and After Percutaneous Coronary Intervention in Iran; a Single Center Study  

PubMed Central

Background High cholesterol levels have long been considered an independent risk factor for cardiovascular disease (CVD). Objective Controlling risk factors such as dyslipidemia in patients with coronary artery disease is necessary. We aimed to evaluate the success rate of lipid control, during 9 months follow-up after percutaneous coronary intervention (PCI). Patients and Methods A total of 195 patients (67.7% men, mean age = 57.8 ± 9.4 years) who underwent PCI in Tehran Heart Center were included. Serum lipid profiles were measured in all the patients before PCI and at 9-month follow-up. Dyslipidemia was defined as serum levels of LDL-C ? 100 or TG ? 150 or TC ? 200 or HDL-C ? 40 mg/dl in the men and ? 50 mg/dl or less in the women, or non-HDL-C ? 130 mg/dl with or without the consumption of lipid-lowering agents. During follow up, all patients were given atorvastatin 20-40 mg/day. Results Overall, 26.2% had diabetes mellitus, 42.6% had hypertension, and 34.9% were smokers. Dyslipidemia was more common in the women. At 9-month follow-up, there was no significant changes in terms of the prevalence of high HDL-C or low TG in patients; however, a significant increase was seen in the prevalence low TC in patients (63.6% vs. 80.5%; p value < 0.001), LDL-C (47.2% vs. 65.6%; p value < 0.001), and non-HDL-C (40.0% vs. 63.1%; p value < 0.001). Conclusions Although by current treatments, the prevalence of patients with low TC, LDL-C and non-HDL-C has significantly increased; dyslipidemia persisted in a considerable proportion of patients. These results necessitate further investigations into the relationship between high serum lipids and long-term outcome of patients after PCI as well as further evaluations of the dyslipidemia treatment strategies.

Hosseini, Seyed Kianoosh; Tahvildari, Maryam; Alemzadeh Ansari, Mohammad Javad; Nakhjavani, Manouchehr; Esteghamati, Alireza; Lotfi Tokaldany, Masoumeh

2013-01-01

200

Myocardial viability, coronary flow reserve, and in-hospital predictors of late recovery of contractility following successful primary stenting for acute myocardial infarction  

Microsoft Academic Search

Objective: To assess the relation between myocardial viability, coronary flow reserve, and recovery of myocardial contractility after stenting for acute myocardial infarction.Design: Consecutive sample prospective study.Setting: University hospital.Patients: 41 patients with single vessel disease and successful primary stenting for a first acute myocardial infarction.Interventions:201Tl single photon emission computed tomography, contrast ventriculography, and intracoronary Doppler performed 7 (1) days after primary

F Beygui; C Le Feuvre; G Helft; C Maunoury; J P Metzger

2003-01-01

201

One-year outcome in multivessel coronary disease patients undergoing coronary stenting.  

PubMed

The purpose of this study was to assess 1-year clinical outcome of patients with multivessel coronary artery disease (CAD) who underwent coronary stenting and were prospectively enrolled in the Registro Impianto Stent Endocoronarico (RISE). Of 939 consecutive patients included in the registry, 377 patients with angiographic evidence of multivessel CAD had a 1-year clinical follow-up. All patients underwent PTCA and single or multiple stenting in at least one vessel. Angiographic optimization was usually performed by using high-pressure balloon dilation. After the procedure, continuation of aspirin (at least 250 mg/day) was recommended, whereas the use of anticoagulation or ticlopidine was determined by the physician in charge of the patient in the various centers. Major adverse cardiac events were defined as death, Q-wave or non-Q-wave myocardial infarction and target vessel revascularization. Mean age of patients (311 men, 66 women) was 60 +/- 10 years. Globally, there were 596 stents implanted (72% Palmaz-Schatz stents) in 434 vessels. In about 75% of the procedures, an inflation pressure > 12 atm was used. Angiographic success rate was 98.5%. After stenting, 77% of patients received antiplatelet treatment with ticlopidine and aspirin. During hospitalization, there were 34 major adverse cardiac events in 24 patients. At 1-year follow-up, 309 patients were alive and event-free; cumulative incidence of death, myocardial infarction, and repeat revascularization were 2.9%, 4.7%, and 10.8%, respectively. By Cox regression analysis, multiple stents implantation (HR 1.72, 95% CI 1-2.97), left anterior descending artery revascularization (HR 1.86, 95% CI 1.01-3.42), use of inflation pressure > 12 atm (HR 0.93, 95% CI 0.89-0.97), ticlopidine therapy (HR 0.41, 95% CI 0.23-0.74), and stent length (HR 1.03, 95% CI 1.01-1.05) were associated with 1-year major cardiac events. In patients with multivessel CAD undergoing stent implantation in at least one vessel, 1-year follow-up is favorable and the need for repeat revascularization procedures, based on clinical data, is lower than previously reported for conventional PTCA. Cathet. Cardiovasc. Intervent. 48:343-349, 1999. PMID:10559809

De Servi, S; Mariani, G; Bossi, I; Klersy, C; Rubartelli, P; Niccoli, L; Repetto, A; Giommi, L; Baduini, G; Maresta, A; Repetto, S

1999-12-01

202

Carotid revascularization: risks and benefits  

PubMed Central

Despite a decline during the recent decades in stroke-related death, the incidence of stroke has remained unchanged or slightly increased, and extracranial carotid artery stenosis is implicated in 20%–30% of all strokes. Medical therapy and risk factor modification are first-line therapies for all patients with carotid occlusive disease. Evidence for the treatment of patients with symptomatic carotid stenosis greater than 70% with either carotid artery stenting (CAS) or carotid endarterectomy (CEA) is compelling, and several trials have demonstrated a benefit to carotid revascularization in the symptomatic patient population. Asymptomatic carotid stenosis is more controversial, with the largest trials only demonstrating a 1% per year risk stroke reduction with CEA. Although there are sufficient data to advocate for aggressive medical therapy as the primary mode of treatment for asymptomatic carotid stenosis, there are also data to suggest that certain patient populations will benefit from a stroke risk reduction with carotid revascularization. In the United States, consensus and practice guidelines dictate that CEA is reasonable in patients with high-grade asymptomatic stenosis, a reasonable life expectancy, and perioperative risk of less than 3%. Regarding CAS versus CEA, the best-available evidence demonstrates no difference between the two procedures in early perioperative stroke, myocardial infarction, or death, and no difference in 4-year ipsilateral stroke risk. However, because of the higher perioperative risks of stroke in patients undergoing CAS, particularly in symptomatic, female, or elderly patients, it is difficult to recommend CAS over CEA except in populations with prohibitive cardiac risk, previous carotid surgery, or prior neck radiation. Current treatment paradigms are based on identifying the magnitude of perioperative risk in patient subsets and on using predictive factors to stratify patients with high-risk asymptomatic stenosis.

O'Brien, Marlene; Chandra, Ankur

2014-01-01

203

"Of coronary arteries and men": the fight of a dialysis patient against his coronary arteries.  

PubMed

Acute myocardial infarction (AMI) in dialysis patients is associated with high mortality rate. Large randomized controlled trials documenting the benefits of revascularization in the general population have excluded chronic dialysis patients. Few observational data suggest that revascularization may provide a survival benefit compared with medical treatment alone also in these patients. We report a case of a dialysis patient who survived five documented AMIs, underwent five coronary angiographies in 11 years, had several episodes of angina pectoris and underwent percutaneous transluminal coronary angioplasty (PTCA) with stenting and heart surgery for coronary bypassing. It represents a highly unusual therapeutic approach and might contribute to support also in dialysis patients the use of revascularization to improve survival. PMID:24502603

Vertolli, Ugo; Vinci, Claudio; Rebeschini, Mirca; Ruffatti, Annamaria; Scaparrotta, Giuseppe; Napodano, Massimo; Naso, Agostino; Calò, Lorenzo A

2014-05-01

204

[Coronary angioplasty for the recovery of myocardial function after acute myocardial infarction: mid- and long-term results].  

PubMed

Sixty-three patients with previous myocardial infarction and documented hypoperfused reversibly dysfunctional myocardium after 201thallium tomography and/or echo-dobutamine were candidates to coronary angioplasty. Patients were enrolled at four hospitals (Naples, Milan, Pisa and Varese) and evaluated by different study protocols, while endpoint (presence of myocardial viability and efficacy of coronary angioplasty to improve dysfunctional myocardium) was similar. Sixty-two patients underwent successful angioplasty, and early evaluation (between 1 and 3 months after procedure) showed the ability of either 201thallium tomography and/or dobutamine echocardiography, to identify hypoperfused reversibly dysfunctional myocardium. Ten patients underwent late (after 8 +/- 2 months) evaluation of both wall motion and myocardial perfusion showing a sustained improvement in 25/32 hypoakinetic myocardial segments. Our data confirm the efficacy of revascularization of hypoperfused dysfunctional myocardial segments by coronary angioplasty. Further studies are warranted to obtain a better patient stratification and to evaluate the long-term results. PMID:7634311

Piscione, F; Ceravolo, R; Indolfi, C; Perrone-Filardi, P; Prastaro, M; Focaccio, A; Pace, L; Vezzuto, P; Chiariello, M

1994-12-01

205

Arrhythmias following Revascularization Procedures in the Course of Acute Myocardial Infarction: Are They Indicators of Reperfusion or Ongoing Ischemia?  

PubMed Central

Objective. The most important step in the treatment of ST elevation myocardial infarction is to sustain myocardial blood supply as soon as possible. The two main treatment methods used today to provide myocardial reperfusion are thrombolytic therapy and percutaneous coronary intervention. In our study, reperfusion arrhythmias were investigated as if they are indicators of coronary artery patency or ongoing ischemia after revascularization. Methods. 151 patients with a diagnosis of acute ST elevation myocardial infarction were investigated. 54 patients underwent primary percutaneous coronary intervention and 97 patients were treated with thrombolytic therapy. The frequency of reperfusion arrythmias following revascularization procedures in the first 48 hours after admission was examined. The relation between reperfusion arrhythmias, ST segment regression, coronary artery patency, and infarct related artery documented by angiography were analyzed. Results. There was no statistically significant difference between the two groups in the frequency of reperfusion arrhythmias (P = 0.355). Although angiographic vessel patency was higher in patients undergoing percutaneous coronary intervention, there was no significant difference between the patency rates of each group with and without reperfusion arrythmias. Conclusion. Our study suggests that recorded arrhythmias following different revascularization procedures in acute ST elevation myocardial infarction may not always indicate vessel patency and reperfusion. Ongoing vascular occlusion and ischemia may lead to various arrhythmias which may not be distinguished from reperfusion arrhythmias.

Tatli, Ersan; Alicik, Guray; Buturak, Ali; Yilmaztepe, Mustafa; Aktoz, Meryem

2013-01-01

206

Cost-effective selection of patients for coronary angiography  

Microsoft Academic Search

In patients suspected of having coronary artery disease (CAD), noninvasive testing has been playing an increasing role in selecting patients who would require coronary angiography for either the “definitive” diagnosis of CAD or as a prelude to planning myocardial revascularization. A mathematic model is presented that defines cost-effective utility of nuclear cardiology testing for diagnosis of CAD and selection of

Jamshid Maddahi; Sanjiv S. Gambhir

1997-01-01

207

Reperfusion strategies in acute coronary syndromes.  

PubMed

The appropriate timing of angiography to facilitate revascularization is essential to optimize outcomes in patents with ST-segment-elevation myocardial infarction and non-ST-segment-elevation acute coronary syndromes. Timely reperfusion of the infarct-related coronary artery in ST-segment-elevation myocardial infarction both with fibrinolysis or percutaneous coronary intervention minimizes myocardial damage, reduces infarct size, and decreases morbidity and mortality. Primary percutaneous coronary intervention is the preferred reperfusion method if it can be performed in a timely manner. Strategies to reduce health system-related delays in reperfusion include regionalization of ST-segment-elevation myocardial infarction care, performing prehospital ECGs, prehospital activation of the catheterization laboratory, bypassing geographically closer nonpercutaneous coronary intervention-capable hospitals, bypassing the percutaneous coronary intervention-capable hospital emergency department, and early and consistent availability of the catheterization laboratory team. With implementation of such strategies, there has been significant improvement in process measures, including door-to-balloon time. However, despite reductions in door-to-balloon times, there has been little change during the past several years in in-hospital mortality, suggesting additional factors including patient-related delays, optimization of tissue-level perfusion, and cardioprotection must be addressed to improve patient outcomes further. Early angiography followed by revascularization when appropriate also reduces rates of death, MI, and recurrent ischemia in patients with non-ST-segment-elevation acute coronary syndromes, with the greatest benefits realized in the highest risk patients. Among patients with non-ST-segment-elevation acute coronary syndromes with multivessel disease, choice of revascularization modality should be made as in stable coronary artery disease, with a goal of complete ischemic revascularization. PMID:24902975

Bagai, Akshay; Dangas, George D; Stone, Gregg W; Granger, Christopher B

2014-06-01

208

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

2013-01-01

209

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. J. M.; Beek, W. J.

1999-02-01

210

Endovascular management of patients with coronary artery disease and diabetic foot syndrome: A long-term follow-up  

PubMed Central

Background To investigate the long-term results of global coronary and peripheral interventional treatment of diabetic foot patients. Methods We retrospectively included 220 diabetic patients (78.5 ± 15.8 years, 107 females, all with Fontaine III or IV class) who were referred to our centre for diabetic foot syndrome and severe limb ischemia from January 2006 to December 2010. Patients were evaluated by a team of interventional cardiologists and diabetologists in order to assess presence of concomitant coronary artery disease (CAD) and eventual need for coronary revascularization. Stress-echo was performed in all patients before diagnostic peripheral angiography. Patients with indications for coronary angiography were submitted to combined diagnostic angiography and then to eventual staged peripheral and coronary interventions. Doppler ultrasonography and foot transcutaneous oximetry of transcutaneous oxygen pressure (TcPO2) before and after the procedure were performed as well as stress-echocardiography and combined cardiologic and diabetic examination at 1 and 6 month and yearly. Results Stress-echocardiography was performed in 94/220 patients and resulted positive in 56 patients who underwent combined coronary and peripheral angiography. In the rest of 126 patients, combined coronary and peripheral angiography was performed directly for concomitant signs and symptoms of coronary heart disease in 35 patients. Coronary revascularization was judged necessary in 85/129 patients and was performed percutaneously after peripheral interventions in 72 patients and surgically in 13 patients. For Diabetic foot interventions the preferred approach was ipsilateral femoral antegrade in 170/220 patients (77.7%) and contralateral cross-over in 40/220 patients (18.8%) and popliteal retrograde + femoral antegrade in 10/220 patients (4.5%). Balloon angioplasty was performed in 252 legs (32 patients had bilateral disease): the procedure was successful in 239/252 legs with an immediate success rate of 94.8% and a significant improvement in TcPO2 and ABI with ulcer healing in 233/252 legs (92.4%). Freedom from major amputation was 82.8% at a mean follow-up of 3.1 ± 1.8 years (range 1 to 5 years) whereas survival was 88%. Conclusions Global coronary and peripheral endovascular management of diabetic foot syndrome patients seems to lead to an high immediate success and limb salvage rates and increasing survival compared to historical series.

Rigatelli, Gianluca; Cardaioli, Paolo; dell'Avvocata, Fabio; Giordan, Massimo; Lisato, Giovanna; Mollo, Francesco

2011-01-01

211

Coronary artery disease associated with severe mitral and tricuspid valve regurgitation after left pneumonectomy: report of a successful hybrid procedure.  

PubMed

The literature concerning heart surgery after pneumonectomy is still poor. Moreover, there is still a lack of a standardized approach to such a patient in the decision-making process. Here, we report a case of a patient who had previously had left pneumonectomy for malignancy and who had coronary artery disease and mitral and tricuspid regurgitation treated with a hybrid procedure. PMID:24771204

Gennari, Marco; Kassem, Samer; Teruzzi, Giovanni; Agrifoglio, Marco

2014-08-01

212

Myocardial ischemia is a key factor in the management of stable coronary artery disease  

PubMed Central

Previous studies demonstrated that coronary revascularization, especially percutaneous coronary intervention (PCI), does not significantly decrease the incidence of cardiac death or myocardial infarction in patients with stable coronary artery disease. Many studies using myocardial perfusion imaging (MPI) showed that, for patients with moderate to severe ischemia, revascularization is the preferred therapy for survival benefit, whereas for patients with no to mild ischemia, medical therapy is the main choice, and revascularization is associated with increased mortality. There is some evidence that revascularization in patients with no or mild ischemia is likely to result in worsened ischemia, which is associated with increased mortality. Studies using fractional flow reserve (FFR) demonstrate that ischemia-guided PCI is superior to angiography-guided PCI, and the presence of ischemia is the key to decision-making for PCI. Complementary use of noninvasive MPI and invasive FFR would be important to compensate for each method’s limitations. Recent studies of appropriateness criteria showed that, although PCI in the acute setting and coronary bypass surgery are properly performed in most patients, PCI in the non-acute setting is often inappropriate, and stress testing to identify myocardial ischemia is performed in less than half of patients. Also, some studies suggested that revascularization in an inappropriate setting is not associated with improved prognosis. Taken together, the presence and the extent of myocardial ischemia is a key factor in the management of patients with stable coronary artery disease, and coronary revascularization in the absence of myocardial ischemia is associated with worsened prognosis.

Iwasaki, Kohichiro

2014-01-01

213

Early increase in myocardial perfusion after stem cell therapy in patients undergoing incomplete coronary artery bypass surgery.  

PubMed

Incomplete revascularization is associated with worse long-term outcomes. Autologous bone marrow cells (BMC) have recently been tested in patients with severe coronary artery disease. We tested the hypothesis that intramyocardial injection of autologous BMC increases myocardial perfusion in patients undergoing incomplete coronary artery bypass grafting (CABG). Twenty-one patients (19 men), 59?±?7 years old, with limiting angina and multivessel coronary artery disease (CAD), not amenable to complete CABG were enrolled. BMC were obtained prior to surgery, and the lymphomonocytic fraction separated by density gradient centrifugation. During surgery, 5 mL containing 2.1?±?1.3?×?108 BMC (CD34+?=?0.8?±?0.3%) were injected in the ischemic non-revascularized myocardium. Myocardial perfusion was assessed by magnetic resonance imaging (MRI) at baseline and 1 month after surgery. The increase in myocardial perfusion was compared between patients with <50% (group A, n?=?11) with that of patients with >50% (group B, n?=?10) of target vessels (stenosis???70%) successfully bypassed. Injected myocardial segments included the inferior (n?=?12), anterior (n?=?7), and lateral (n?=?2) walls. The number of treated vessels (2.3?±?0.8) was significantly smaller than the number of target vessels (4.2?±?1.0; P?successfully treated. This strategy may be an adjunctive therapy for patients suffering from a more advanced (diffuse) CAD not amenable for complete direct revascularization. PMID:21061106

Gowdak, Luís Henrique Wolff; Schettert, Isolmar Tadeu; Rochitte, Carlos Eduardo; Lisboa, Luiz Augusto Ferreira; Dallan, Luís Alberto Oliveira; César, Luiz Antônio Machado; de Oliveira, Sérgio Almeida; Krieger, José Eduardo

2011-02-01

214

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

2003-01-01

215

Right Internal Mammary Artery Implantation into Right Ventricular Myocardium for Revascularization of the Entire Heart  

PubMed Central

The left internal mammary artery implant combined with epicardiectomy and free omental graft provides three extra-coronary sources of blood. This operation tested in dogs with 92% main-stem occlusion of three coronary arteries protected 75% of the animals. Applied clinically in over 100 patients, the operation resulted in 90% improvement. To obtain complete myocardial revascularization, the right internal mammary artery has been used as a fourth source of extra-coronary blood. In 57 animals, the right internal mammary arteries were implanted into the anterior walls of the right ventricle; in 80% this vessel formed anastomoses with the right coronary tree, and in 65% with the right and left coronary arteriolar systems. Six patients are described who underwent right internal mammary artery implantation; five of these in addition had the combined operation of left internal mammary artery implant, epicardiectomy and free omental graft. All patients had completely blocked right coronary arteries; in addition, five had advanced disease of the left coronary arterial tree. ImagesFig. 1aFig. 1b

Vineberg, Arthur M.; Zamora, Benjamin O.

1966-01-01

216

Wire-Probing Technique to Revascularize Subacute or Chronic Internal Carotid Artery Occlusion  

PubMed Central

Summary During endovascular revascularization of subacute and chronic occlusion of the cervical internal carotid artery (ICA) it may be difficult to penetrate the lesion. Selecting the appropriate “true lumen”, a remnant of what had been the arterial lumen, at the initial step may facilitate the procedure. Because plaque at the carotid bifurcation is known to propagate from the posterior wall, a gateway to this “true lumen” should exist in the anterior side of the occluded stump. This hypothesis was studied retrospectively in our series of revascularizing ICA subacute and chronic occlusion. Eleven patients underwent endovascular revascularization for symptomatic cervical ICA occlusion. Procedures were performed by initially penetrating the occluded stump with a guidewire, followed by supporting catheter advancement through the occluded segment to secure the distal normal arterial lumen. Cases were analyzed with regard to the location of initial guidewire penetration. Eight patients underwent successful revascularization. In five cases, the entry point to the occluded stump was located at the anterior side, and in three, at the posterior side. Two posterior stump penetration cases were met with resistance in guidewire advancement, whereas penetration was smooth in the anterior cases. In addition, two posterior stump penetration cases resulted in contrast stasis in the posterior ICA wall. In our series of revascularizing cervical ICA subacute and chronic occlusion, initially targeting the anterior side of the occluded stump resulted in favorable results. This may be the result of selecting the “true lumen” at the beginning of the procedure.

Namba, K.; Shojima, M.; Nemoto, S.

2012-01-01

217

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

2013-01-01

218

Revascularization for Symptomatic Occlusion of the Anterior Cerebral Artery Using Superficial Temporal Artery  

PubMed Central

Isolated symptomatic occlusion of the anterior cerebral artery (ACA) is a rare condition and until date, only few cases regarding the revascularization of the ACA have been reported. This paper reports on successful attempt to revascularize the ACA using superficial temporal artery (STA) in patient with isolated symptomatic occlusion of the ACA. A 69-year-old man presented with several episodes of transient weakness involving left lower extremity. Cerebral angiography showed occlusion of the right ACA at the A2 segment. After medical treatment failure, the patient underwent STA-ACA bypass surgery. Subsequent to surgery, there was immediate disappearance of transient ischemic attack and follow-up angiography showed favorable revascularization of the ACA territory. Bypass surgery can be considered in the patients with symptomatic occlusion of the ACA, who have experienced failure in medical treatment.

Lee, Sang Chul; Kang, Hyun-Seung; Kim, Jeong Eun

2013-01-01

219

Off-pump versus on-pump myocardial revascularization in low-risk patients with one or two vessel disease: perioperative results in a multicenter randomized controlled trial  

Microsoft Academic Search

BackgroundTo evaluate hospital mortality and morbidity after myocardial revascularization in a prospective and multicenter study, comparing on-pump versus off-pump in a special subset of patients with lesions in the left descending artery, alone or associated with the right coronary artery.

Luís Roberto Gerola; Enio Buffolo; Waldir Jasbik; Bruno Botelho; João Bosco; Luís A Brasil; João Nelson R Branco

2004-01-01

220

Revascularization in treatment of mesenteric infarction.  

PubMed Central

This study compares results of primary revascularization with primary intestinal resection in treatment of acute mesenteric artery occlusion in 48 surgical patients. All cases were verified by surgical exploration, angiography or autopsy. Fifteen occlusions were caused by mesenteric thrombosis and 33 by superior mesenteric artery embolization. Primary revascularization was done in 6 of 15 patients with arteriosclerotic mesenteric thrombosis. Total bowel salvage was achieved in 4 patients but no patient with mesenteric thrombosis treated by any method survived long term. Primary embolectomy was done in 11 patients with superior mesenteric artery embolization. Ttoal bowel salvage was achieved in 8 patients. Three of 11 patients died. Primary exploration and/or resection was done in 11 patients; 9 died. All 11 umoperated patients died. A continuation of attempts at mesenteric revascularization is advocated. Images Fig. 1. Fig. 2. Fig. 3. Fig. 4.

Bergan, J J; Dean, R H; Conn, J; Yao, J S

1975-01-01

221

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

PubMed

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

2013-07-01

222

Platelet-Rich Plasma Supplemented Revascularization of an Immature Tooth Associated with a Periapical Lesion in a 40-Year-Old Man  

PubMed Central

The present case report is the first of its kind that documents the successful outcome of “revascularization,” a regeneration-based treatment protocol in a mature adult patient. It belies the myth that “revascularization” should only be done in children and young, adolescent patients. The misconception that stem cells number as well as viability in older age group patients will not allow revascularization to be successful is also contradicted by this case. The paper highlights all the mechanisms that come into play and the enhancing of regenerative response by supplementation with platelet-rich plasma (PRP).

Jadhav, Ganesh Ranganath; Logani, Ajay

2014-01-01

223

Percutaneous transluminal coronary angioplasty after intracoronary streptokinase in evolving acute myocardial infarction.  

PubMed

To achieve optimal myocardial revascularization and prevent rethrombosis of the infarct-related coronary artery, percutaneous transluminal coronary angioplasty (PTCA) was attempted in 18 patients with evolving acute myocardial infarction (9 anterior and 9 inferior) after administration of intracoronary streptokinase. PTCA was attempted 338 +/- 151 minutes after the onset of symptoms. After thrombolytic therapy, 11 patients had a severe residual stenosis and 7 a persistent total occlusion of the infarct-related coronary artery. PTCA was successful in 13 of 18 patients: in 9 of 11 with coronary stenoses and in 4 of 7 with total coronary occlusions. PTCA reduced the severity of the coronary lesion from 91 +/- 2% to 27 +/- 7% (p less than 0.001), and the transstenotic pressure gradient from 38 +/- 5 to 6 +/- 2 mm Hg (p less than 0.01). One patient in cardiogenic shock died during urgent coronary surgery after unsuccessful PTCA. After PTCA, all patients received heparin and antiplatelet agents. One patient had reinfarction with reocclusion of the infarct-related artery 5 days after PTCA. The other 12 patients had an uneventful hospital course, and cardiac catheterization before hospital discharge (8 to 17 days) revealed reocclusion of the infarct-related coronary artery in 3 and persistent patency in 9. Persistent patency of the infarct-related artery was associated with preservation of left ventricular end-diastolic volume (initial 86 +/- 6 ml/m2, follow-up 91 +/- 6 ml/m2), and improvement in left ventricular ejection fraction in some patients. PMID:3155590

Papapietro, S E; MacLean, W A; Stanley, A W; Hess, R G; Corley, N; Arciniegas, J G; Cooper, T B

1985-01-01

224

Coronary-Pulmonary Artery Fistula Associated with Right Heart Failure: Successful Closure of Fistula with a Graft StentA Case Report  

Microsoft Academic Search

Coronary artery fistula constitutes a rare congenital anomaly. The reported incidence of this anomaly ranges from 0.1% to 0.2% of the population undergoing coronary angiography. Coronary-pulmonary artery fistula is an extremely rare congenital anomaly of the coronary artery. Its real incidence is unknown. The authors report a case of coronary-pulmonary artery fistula that caused right heart failure in a 77-year-old

Yusuf Atmaca; Timuçin Altin; Ça?da? Özdöl; Gülgün Pamir; Nail Ça?lar; Dervi? Oral

2002-01-01

225

Effects of crystalloid and blood cardioplegic solutions on myocardial cooling during myocardial revascularization.  

PubMed

Cardioplegic protection during ischemic arrest is impaired in patients with serious coronary artery disease, resulting in large regional temperature gradients and impaired myocardial cooling. Recent data have suggested that the viscosity of cardioplegic solutions may affect their distribution beyond coronary artery stenosis. This study compared the effects of asanguineous and blood cardioplegic solutions on myocardial cooling in 26 such patients who underwent elective myocardial revascularization; 15 were subjected to blood cardioplegia and 11 to crystalloid cardioplegia. One litre of blood or asanguineous cardioplegic solution was infused into the aortic root at a constant infusion pressure. Samples for viscosity determination were taken from both cardioplegic solutions during their infusion. Regional myocardial temperature was measured distal to coronary artery obstructions following administration of the cardioplegic agent. Although the viscosity of the blood solution was 250% greater than the asanguineous solution, regional myocardial temperatures were not significantly different beyond the coronary artery stenosis. Regional temperature was reduced to less than 15 degrees C after infusion of the cardioplegic agent in regional myocardium with a normal coronary circulation. Marked temperature gradients were observed distal to a critical stenosis, with temperatures ranging between 18 degrees C and 20 degrees C for stenosis, and about 23 degrees C for obstruction. The authors conclude that the marked difference in viscosity between crystalloid and blood cardioplegic solutions does not significantly affect their distribution beyond a coronary artery stenosis. PMID:6609757

Landymore, R W; Kinley, C E

1984-05-01

226

Off-pump coronary artery bypass grafting: the Zurich experience.  

PubMed

Coronary artery bypass grafting (CABG) is the surgical procedure of choice for treatment of multi-vessel coronary artery disease. The rising risk profile of the patients requiring isolated CABG and the economic pressure have prompted us to devise new operative strategies to treat these patients. Elimination of the cardiopulmonary bypass is one possible answer to the dilemma of maintaining the quality of care and reducing the exploding costs of our health system. Therefore, we developed the off-pump coronary artery bypass grafting (OPCAB) for patients requiring isolated CABG. In our experience the key to successful OPCAB relies on the order of revascularization of the myocardial walls (anterior, inferior, lateral), use of intracoronary shunt, no-touch technique for the proximal aortic anastomosis with heart string â (Guidant, IN, USA), close collaboration with the anesthesiologists, early and aggressive administration of anti-platelet therapy, endoscopic vein harvest by perfusionists, and improved body temperature control. Following these concepts, we have been able to offer the OPCAB procedure to over 90% of our patients and to reduce perioperative morbidity and global costs. PMID:16112937

Tavakoli, R; Reuthebuch, O; Hofer, C; Grünenfelder, J; Genoni, M

2005-01-01

227

Loss of Short Term Symptomatic Benefit in Patients with an Occluded Infarct Artery is Unrelated to Non-Protocol Revascularization: Results from the Occluded Artery Trial (OAT)  

PubMed Central

Background The Occluded Artery Trial found that routine late (3–28d post-MI) percutaneous coronary intervention (PCI) of an occluded infarct-related artery (IRA) did not reduce death, re-infarction or heart failure relative to medical treatment (MED). Angina rates were lower in PCI early, but the advantage over MED was lost by 3 years. Methods Angina and revascularization status were collected at 4 months, then annually. We assessed whether non-protocol revascularization procedures in MED accounted for loss of the early symptomatic advantage of PCI. Results Seven per 100 more PCI patients were angina-free at 4 months (p<0.001) and 5 per 100 at 12 months (p=.005) with the difference narrowing to 1 per 100 at 3 years (p=.34). Non-protocol revascularization was more frequent in MED (5-yr rate 22% vs. 19% PCI, p=.05). Indications for revascularization included acute coronary syndromes (39% PCI vs. 38% MED), stable angina/inducible ischemia (39% in each group), and physician preference (17% PCI vs. 15% MED). Revascularization rates among patients with angina at any time during follow up (35% of cohort) did not differ by treatment group (5-year rates 26% PCI vs. 28% MED). Most symptomatic patients were treated without revascularization during follow-up (77%). Conclusions In a large randomized clinical trial of stable post-MI patients, the modest benefit on angina from PCI of an occluded IRA was lost by 3 years. Revascularization was slightly more common in MED during follow up but was not driven by acute ischemia, and almost one in five procedures were attributed to physician preference alone.

Devlin, Gerard; Reynolds, Harmony R.; Mark, Daniel B.; Rankin, James M.; Carvalho, Antonio C.; Vozzi, Carlos; Sopko, George; Caramori, Paulo; Dzavik, Vladimir; Ragosta, Michael; Forman, Sandra A.; Lamas, Gervasio A.; Hochman, Judith S.

2010-01-01

228

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

1997-01-01

229

[A case of coronary perforation after directional coronary atherectomy].  

PubMed

Directional coronary atherectomy was performed on a 69-year-old female with angina pectoris. She suffered from coronary perforation as a result of cardiac tamponade and shock. Pericardial drainage and hemostasis were performed immediately using a perfusion catheter. The patient was transferred to the operating room for perforation repair and coronary artery bypass grafting to the distal portion of the left anterior descending artery. The procedure was performed successfully. Although acute coronary perforation associated with directional coronary atherectomy is rare, it can be managed temporarily by a perfusion catheter and we successfully performed coronary artery bypass grafting. PMID:8990888

Baba, H; Okawa, Y; Hashimoto, M; Koike, S; Matsumoto, K

1996-12-01

230

Frequency, Predictors and Consequences of Crossing Over to Revascularization within 12 months of Randomization to Optimal Medical Therapy in the COURAGE Trial  

PubMed Central

Background In COURAGE, some stable ischemic heart disease (SIHD) patients randomized to optimal medical therapy (OMT) crossed over to early revascularization. The predictors and outcomes of patients who crossed over from OMT to revascularization are unknown. Methods and Results We compared characteristics of OMT patients who did and did not undergo revascularization within 12 months and created a Cox regression model to identify predictors of early revascularization. Patients' health status was measured with the Seattle Angina Questionnaire (SAQ). To quantify the potential consequences of initiating OMT without percutaneous coronary intervention (PCI), we compared the outcomes of crossover patients with a matched cohort randomized to immediate PCI. Among 1148 patients randomized to OMT, 185 (16.1%) underwent early revascularization. Patient characteristics independently associated with early revascularization were worse baseline SAQ scores and healthcare system. Among 156 OMT patients undergoing early revascularization matched to 156 patients randomized to PCI, rates of mortality (HR= 0.51 (0.13, 2.1) and nonfatal MI (HR=1.9 (0.75-4.6) were similar, as were 1-year SAQ scores. OMT patients, however, experienced worse health status over the initial year of treatment and more unstable angina admissions (HR=2.8 (1.1, 7.5)). Conclusion Among COURAGE patients assigned to OMT alone, patients' angina, dissatisfaction with their current treatment and, to a lesser extent, their health system were associated with early revascularization. Since early crossover was not associated with an increase in irreversible ischemic events, or impaired 12-month health status, these findings support an initial trial of OMT in SIHD with close follow-up of the most symptomatic patients.

Spertus, John A; Maron, David J; Cohen, David J; Kolm, Paul; Hartigan, Pam; Weintraub, William S.; Berman, Daniel S.; O'Rourke, Robert A.; Teo, Koon K; Shaw, Leslee J.; Sedlis, Steven; Knudtson, Merril; Aslan, Mihaela; Dada, Marcin; Boden, William E.; John Mancini, G.B.

2013-01-01

231

Endoscopic greater saphenous vein harvesting reduces the morbidity of coronary artery bypass surgery  

Microsoft Academic Search

Background: Most coronary artery bypass grafting (CABG) operations still involve the use of greater saphenous vein (GSV) for one or more grafts, even with the increasing use of arterial conduits for coronary revascularization. Wound complications from GSV harvesting are common, and sometimes severe. In order to reduce the morbidity of this procedure, we adopted a technique of endoscopic vein harvesting

Chance D. Felisky; Daniel L. Paull; Mark E. Hill; R. Alan Hall; Mary Ditkoff; William G. Campbell; Steven W. Guyton

2002-01-01

232

Renal insufficiency is an independent predictor of mortality after percutaneous coronary intervention  

Microsoft Academic Search

The present study was designed to evaluate whether the presence of renal disease during percutaneous coronary intervention (PCI) is associated with worse outcomes at 1 year in a multicenter study. The incidence of death, myocardial infarction, coronary artery bypass grafting, repeat PCI, and repeat revascularization were prospectively collected on 4,602 patients (6,542 lesions) in 2 waves of patients who underwent

Srihari S Naidu; Faith Selzer; Alice Jacobs; David Faxon; David S Marks; Janet Johnston; Katherine Detre; Robert L Wilensky

2003-01-01

233

Blood Flow in Composite Arterial Grafts and Effect of Native Coronary Flow  

Microsoft Academic Search

Background. Total arterial coronary revascularization can be achieved by joining arteries together as a compos- ite graft with the proximal left internal mammary artery as the only source of blood inflow. Proof of the capacity of this composite conduit to provide adequate blood flow to the coronary circulation is required. Methods. The radial artery was anastomosed to the left internal

Alistair G. Royse; Colin F. Royse; Karen L. Groves; Gang Yu; M App Sc

2010-01-01

234

An approach to the rational use of revascularization in heart failure patients.  

PubMed

The most common cause of heart failure with reduced ejection fraction (HFrEF) is coronary artery disease. A multitude of factors come into play when deciding whether a patient with HFrEF and coronary artery disease should have coronary artery bypass graft (CABG) surgery, percutaneous coronary intervention, or medical therapy alone. For candidates for percutaneous coronary intervention and CABG, evidence from large registries would suggest that patients with 2-vessel coronary artery diseases and proximal left anterior descending disease and all patients with 3-vessel coronary artery disease do better with CABG. For patients that are candidates for medical therapy with or without CABG, the results of the Surgical Treatment for Ischemic Heart Failure (STICH) trial indicate that with CABG, the reduction of mortality is not statistically significant (hazard ratio [HR], 0.86; P = 0.12). However, CABG is superior in reducing cardiovascular deaths (HR, 0.81; P = 0.05), and the combination of cardiovascular deaths and cardiovascular hospitalizations (HR, 0.74; P < 0.001). Patients undergoing CABG have an upfront risk that is eliminated by 2 years and thereafter do better. The assessment of cardiac viability or reversible ischemia does not appear to be helpful in determining which individuals will improve more with CABG. Patients with severe mitral regurgitation who undergo CABG appear to benefit from simultaneous valve repair but not from the addition of surgical ventricular reconstruction of the left ventricle, although in specific patients this might be considered. The totality of evidence would thus suggest that patients with HFrEF should be evaluated for the possibility of coronary revascularization if they are candidates for CABG. PMID:24484914

Rouleau, Jean L; Bonow, Robert O

2014-03-01

235

Evidence for Prevention of Death and Myocardial Infarction With Platelet Membrane Glycoprotein IIb\\/IIIa Receptor Blockade by Abciximab (c7E3 Fab) Among Patients With Unstable Angina Undergoing Percutaneous Coronary Revascularization fn1 fn1 This study was supported by Centocor, Inc., Malvern, Pennsylvania  

Microsoft Academic Search

Objectives. We sought to evaluate whether patients with unstable angina undergoing coronary intervention derive particular clinical benefit from potent platelet inhibition.Background. Plaque rupture and platelet aggregation are pathogenetic processes common to unstable angina and ischemic complications of percutaneous coronary intervention.Methods. Of the 2,099 patients undergoing a coronary intervention in the Evaluation of 7E3 in Preventing Ischemic Complications (EPIC) trial, 489

A. Michael Lincoff; Robert M. Califf; Keaven M. Anderson; Harlan F. Weisman; Frank V. Aguirre; Neal S. Kleiman; Robert A. Harrington; Eric J. Topol

1997-01-01

236

Effectiveness of percutaneous laser revascularization therapy for refractory angina  

PubMed Central

Refractory angina is a debilitating disease characterized by persistent cardiac pain resistant to all conventional treatments for coronary artery disease. Percutaneous myocardial laser revascularization (PMLR) has been proposed to improve symptoms in these patients. We used meta-analysis to assess the effectiveness of PMLR versus optimal medical therapy for improving angina symptoms, health-related quality of life (HRQL), and exercise performance; the impact on all-cause mortality was also examined. Seven trials, involving a total of 1,213 participants were included. Our primary analyses showed that at 12-month follow-up, those who had received PMLR had ?2 Canadian Cardiovascular Society class angina symptom reductions, OR 2.13 (95% CI, 1.22 to 3.73), as well as improvements in aspects of HRQL including angina frequency, SMD = 0.29 (95% CI, 0.05 to 0.52), disease perception, SMD = 0.37 (95% CI, 0.14 to 0.61), and physical limitations, SMD = 0.29 (95% CI, 0.05 to 0.53). PMLR had no significant impact on all-cause mortality. Our secondary analyses, in which we considered data from one trial that featured a higher-dose laser group, yielded no significant overall impact of PMLR across outcomes. While PMLR may be effective for improving angina symptoms and related burden, further work is needed to clarify appropriate dose and impact on disease-specific mortality and adverse cardiac events.

McGillion, Michael; Cook, Allison; Victor, J Charles; Carroll, Sandra; Weston, Julie; Teoh, Kevin; Arthur, Heather M

2010-01-01

237

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.

1993-06-01

238

Determinants of blood utilization during myocardial revascularization.  

PubMed

Blood transfusion during cardiac surgical procedures has steadily decreased, but little information is available regarding the factors that determine its necessity or amount. To determine the predictors of blood utilization during myocardial revascularization, 441 consecutive patients undergoing primary myocardial revascularization were studied. Forty-four patients (10%) received blood during hospitalization with a mean transfusion of 0.3 +/- 1.4 units per patient. Age, sex, weight, body surface area, preoperative hematocrit, blood volume, and red blood cell volume were examined univariately for trends. All demonstrated a statistically significant trend for both need and amount of transfusion (p less than 0.001). Neither number of grafts nor duration of cardiopulmonary bypass demonstrated statistically significant trends. All univariately significant factors were evaluated by multivariate logistic regression analysis. Red cell volume was the best predictor of the need for transfusion (p less than 0.001), followed by age. No other factors improved predictive capabilities. We conclude that preoperative red cell mass and age are the principal determinants of the need for and quantity of blood transfused during myocardial revascularization. Use of this information may greatly improve the efficiency of ordering blood before operation. PMID:4051620

Cosgrove, D M; Loop, F D; Lytle, B W; Gill, C C; Golding, L R; Taylor, P C; Forsythe, S B

1985-10-01

239

Spontaneous coronary artery dissection.  

PubMed

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

2013-09-01

240

Therapeutic options in coronary artery disease: Focusing on the guidelines  

PubMed Central

There are three options for the treatment of patients with coronary artery disease: coronary artery bypass graft surgery (CABG), percutaneous coronary intervention (PCI) and optimal medical treatment alone. While there has been an active interface between CABG and PCI, medical treatment has not been as vociferously advocated. However, it performs well in randomized trials and is still a treatment arm in studies such as the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial. The present review compares these options in acute and chronic coronary syndromes, including the indications for each as summarized by recent American College of Cardiology and American Heart Association guidelines. While the landscape in Canada is changing for CABG and PCI, with an increase in the latter procedure for patients with multivessel disease, optimal medical treatment alone is very effective. There are few subsets, particularly in chronic syndromes, in which revascularization is indicated for prognosis alone.

Schwartz, Leonard

2009-01-01

241

New Technologies in Coronary Artery Surgery  

PubMed Central

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.

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

2013-01-01

242

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: mkatsetos@yahoo.com; Toce, Dale T. [St. Francis Hospital and Medical Center, University of Connecticut, Hartford, Connecticut, Department of Cardiovascular Disease (United States)

2003-11-15

243

Racial Disparities in the Use of Cardiac Revascularization: Does Local Hospital Capacity Matter?  

PubMed Central

Objective To assess the extent to which the observed racial disparities in cardiac revascularization use can be explained by the variation across counties where patients live, and how the within-county racial disparities is associated with the local hospital capacity. Data Sources Administrative data from Pennsylvania Health Care Cost Containment Council (PHC4) between 1995 and 2006. Study Design The study sample included 207,570 Medicare patients admitted to hospital for acute myocardial infarction (AMI). We identified the use of coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI) procedures within three months after the patient’s initial admission for AMI. Multi-level hierarchical models were used to determine the extent to which racial disparities in procedure use were attributable to the variation in local hospital capacity. Principal Findings Blacks were less likely than whites to receive CABG (9.1% vs. 5.8%; p<0.001) and PCI (15.7% vs. 14.2%; p<0.001). The state-level racial disparity in use rate decreases for CABG, and increases for PCI, with the county adjustment. Higher number of revascularization hospitals per 1,000 AMI patients was associated with smaller within-county racial differences in CABG and PCI rates. Meanwhile, very low capacity of catheterization suites and AMI hospitals contributed to significantly wider racial gap in PCI rate. Conclusions County variation in cardiac revascularization use rates helps explain the observed racial disparities. While smaller hospital capacity is associated with lower procedure rates for both racial groups, the impact is found to be larger on blacks. Therefore, consequences of fewer medical resources may be particularly pronounced for blacks, compared with whites.

Li, Suhui; Chen, Arnold; Mead, Katherine

2013-01-01

244

Coronary Angiography  

MedlinePLUS

... x rays to show the insides of your coronary arteries. The coronary arteries supply oxygen-rich blood to your heart. A ... called plaque (plak) can build up inside the coronary arteries. The buildup of plaque in the coronary arteries ...

245

Intraoperative epicardial ultrasound probe for visualization of embedded coronary arteries: a novel approach.  

PubMed

The identification of coronary anatomy at the time of cardiac revascularization can be problematic. Preoperative studies (ie, coronary angiography) can aid in the mapping of the coronary anatomy. However, there remain a select few patients with intramyocardial coronaries that provide challenges for surgical dissection during revascularization. Probing the visible portion of the coronary artery, intraoperative cine angiography, thermal angiography, and epicardial Doppler probes have been used to identify the coronary anatomy intraoperatively. Aggressive surgical maneuvers can result in damage and increased time on cardiopulmonary bypass. Previous studies have used epicardial echocardiography on patients undergoing off-pump coronary artery bypass grafting. We report 2 cases in patients undergoing cardiac revascularization on cardiopulmonary bypass where the use of a high-frequency epicardial ultrasound probe facilitated the identification of the embedded coronary arteries. We describe a technique of using antegrade and retrograde cardioplegia administration sequentially to locate the coronary arteries. Easy availability and familiar technology make the epicardial Doppler probe an attractive tool for the identification of embedded coronary arteries. PMID:24345781

Setty, Sudarshan; Bello, Ricardo; Leff, Jonathan D

2014-03-01

246

[Differential therapy in coronary heart disease].  

PubMed

The various contemporary therapeutic options for coronary artery disease (CAD) require differentiated, individualized treatment strategies. The foundations of CAD therapy are lifestyle modifications targeted on the individual risk profile of the patients. Pharmacological therapy of CAD should prevent secondary coronary events (e.g. platelet aggregation inhibitors and statins) and reduce angina in symptomatic patients (e.g. short-acting nitrates, beta blockers, calcium channel blockers and if necessary ivabradine and ranolazine). Revascularization therapy has to be performed promptly in patients with acute coronary syndromes; however, in patients with stable CAD the decision to perform revascularization therapy has to consider symptoms, detection of ischemia and if appropriate intracoronary assessment of hemodynamic relevance of an intermediate stenosis (fractional flow reserve). The differential indications of percutaneous coronary intervention compared to coronary artery bypass grafting depend on the severity of coronary artery disease and the morphology (SYNTAX score), comorbidities and the will of the individual patient. The international guidelines emphasize the value of an interdisciplinary treatment decision in a "heart team". In summary, differential therapy of CAD has become challenging in the current clinical practice; future developments will probably further improve individualized strategies to treat patients with CAD. PMID:24477633

Wienbergen, H; Hambrecht, R

2014-03-01

247

Mechanical Revascularization for Acute Ischemic Stroke: A Single-Center, Retrospective Analysis  

SciTech Connect

BackgroundEndovascular mechanical revascularization (thrombectomy) is an increasingly used method for intracranial large vessel recanalization in acute stroke. The purpose of the study was to analyze the recanalization rate, clinical outcome, and complication rate in our stroke patients treated with mechanical revascularization. A total of 57 patients with large vessel stroke (within 3 h for anterior and 12 h for posterior circulation) were treated with mechanical revascularization at a single center during 24 months. The primary goal of endovascular treatment using different mechanical devices was recanalization of the occluded vessel. Recanalization rate (reported as thrombolysis in cerebral infarction [TICI] score), clinical outcome (reported as National Institutes of Health Stroke Scale [NIHSS] score and modified Rankin scale [mRS] score), as well as periprocedural complications were analyzed. The mean age of the patients was 63.1 {+-} 12.9 years, with baseline median NIHSS score of 14 (interquartile range, 9.5-19). Successful recanalization (TICI 2b or 3) was achieved in 41 (72 %) patients. Twenty patients (35 %) presented with favorable outcome (mRS {<=}2) 30 days after stroke. Overall, significant neurological improvement ({>=}4 NIHSS point reduction) occurred in 36 (63 %) patients. A clinically significant procedure-related adverse events (vessel disruption, peri/postprocedural intracranial bleeding) defined with decline in NIHSS of {>=}4 or death occurred in three (5 %) patients. The study showed a high recanalization rate with improved clinical outcome and a low rate of periprocedural complications in our stroke patients treated with mechanical revascularization. Therefore, we could conclude that endovascular revascularization (primary or in combination with a bridging thrombolysis) was an effective and safe procedure for intracranial large vessel recanalization in acute stroke.

Jeromel, Miran, E-mail: miran.jeromel@gmail.com; Milosevic, Z. V., E-mail: zoran.milosevic@guest.arnes.si; Kocijancic, I. J., E-mail: igor.kocijancic@gmail.com; Lovric, D., E-mail: dimitrijlavric@yahoo.com [University Medical Centre Ljubljana, Clinical Institute of Radiology, Department for Diagnostic and Interventional Neuroradiology (Slovenia); Svigelj, V., E-mail: viktor.svigelj@gmail.com; Zvan, B., E-mail: bojana.zvan@guest.arnes.si [University Medical Centre Ljubljana, Division Vascular and Intensive Neurology, Department of Neurology (Slovenia)

2013-04-15

248

[Coronary stents: 30 years of medical progress].  

PubMed

The history of interventional cardiology has been marked by several technologic revolutions since the late 1970s. The first key step was the use of inflatable balloon angioplasty as an alternative to CABG surgery for coronary revascularization, followed by intracoronary delivery of bare metal stent (BMS) and drug eluting stents (DES) to drastically reduce intracoronary restenosis observed with BMS. Improved stents platforms and polymers (absorbable or biocompatible) led to a dramatic reduction in the rate of late stent thrombosis. Self-expanding stents are now available to improve stent a position especially in acute myocardial infarction. The emergence of new fully bioabsorbable stents that can be combined with antiproliferative drugs is the ongoing revolution. A new generation of stents is continuously improving and likely to become the ideal stent for coronary revascularization in the near future. PMID:24685222

Silvain, Johanne; Cayla, Guillaume; Collet, Jean-Philippe; Fargeot, Catherine; Montalescot, Gilles

2014-03-01

249

[Characteristics of coronary diseases in women].  

PubMed

Clinical picture of coronary artery disease is different in men and women. Later incidence of coronary disease in women than in men, presence of less typical symptoms, lower specificity of non invasive diagnostic tests as well as higher mortality during percutaneous or surgical revascularization are underlined. Aim of the study was to examine clinical variables, diagnostic and treatment methods in women with coronary disease on the basis of retrospective analysis of patients hospitalized in the Department of Coronary Artery Disease of the Jagiellonian University Medical School in Cracow between 1991 and 1999. 929 patients aged 31-95 years mean 56.95 +/- 10.02 years were enrolled in the study. Clinical usefulness in women with coronary disease of diagnostic tests: electrocardiographic exercise test, exercise thalium-201 scintigraphy and stress echo-cardiography with dobutamine were analyzed. The highest sensitivity was found in exercise scintigraphy (92.9%) compared to ECG exercise test (80.6%) and stress echocardiography with dobutamine (76.9%). The highest specificity characterized stress echocardiography with dobutamine (76.9%) versus exercise scintigraphy (34.7%) and ECG exercise test (25.9%). Between 1991 and 1999 women with coronary artery disease consisted 19.4% of all patients hospitalized in the Department of Coronary Artery Disease in Cracow. Among patients investigated with coronary angiography there were 18.2% of women. Among percutaneously revascularized patients women constituted 17.8%. In the analyzed period 3.5-fold increase of the number of women with CAD hospitalized in the Department of Coronary Artery Disease in Cracow, 7.5-fold increase of the number of women investigated with coronary angiography and 10.5-fold increase of the number of percutaneously or surgically revascularized women was observed. On the basis of performed diagnostic tests 650 women (69.9%) were treated pharmacologically. In 157 patients (16.9%) percutaneous coronary angioplasty was performed, in 118 patients (12.7%) coronary artery bypass surgery was done. In 4 women (4.3%) heart transplantation was performed. PMID:15058019

Okraska-Bylica, Agnieszka; Piwowarska, Wies?awa; Paradowski, Andrzej; Gajos, Grzegorz; Gackowski, Andrzej; Matysek, Jerzy

2003-01-01

250

Coronary artery bypass grafting to a calcified right coronary artery  

Microsoft Academic Search

A severely calcified coronary artery demands a special technique in coronary artery bypass surgery. We have successfully developed\\u000a a “punch-out” technique for a calcified right coronary artery in a dialysis patient. After an incision into the target coronary\\u000a artery, the calcified arterial wall was resected using a punch to make an oval hole for anastomosis. Limited endarterectomy,\\u000a which consisted of

Masaru Yoshikai; Keiji Kamohara; Junji Yunoki

2002-01-01

251

Recent developments in coronary atherectomy.  

PubMed

Percutaneous coronary atherectomy (PCA) is one of the newest treatments for coronary artery disease. In this technique, arterial plaque is mechanically removed from the interior of the artery by a tool located on the tip of a catheter placed inside the coronary artery nonsurgically. Clinical studies of several coronary atherectomy devices are in process in the United States and abroad. As atherosclerotic material is removed or debulked, abrupt reclosure or restenosis rates may potentially be lower compared with conventional percutaneous transluminal coronary angioplasty (PTCA). PCA may also clear longer and more diffuse lesions, with long-term clinical success, than are successfully being treated by PTCA. Due to the rigidity of the atherectomy catheter, only lesions in major coronary arteries may be approached with these devices at present. It is hoped that PCA may supplement current methods of treating coronary artery disease, including coronary artery bypass graft surgery and PTCA. PMID:2345316

Abben, R; Walker, C M

1990-05-01

252

Pulp Revascularization in Immature Permanent Tooth with Apical Periodontitis Using Mineral Trioxide Aggregate  

PubMed Central

Mineral trioxide aggregate (MTA) is a material that has been used worldwide in several clinical applications, such as apical barriers in teeth with immature apices, repair of root perforations, root-end filling, pulp capping, and pulpotomy. The purpose of this case report was to describe successful revascularization treatment of an immature mandibular right second premolar with apical periodontitis in a 9-year-old female patient. After preparing an access cavity without anesthesia, the tooth was isolated using a rubber dam and accessed. The canal was gently debrided using 5% sodium hypochlorite (NaOCl) and 3% hydrogen peroxide irrigant. And then MTA was packed into the canal. X-ray photographic examination showed the dentin bridge 5 months after the revascularization procedure. Thickening of the canal wall and complete apical closure were confirmed 10 months after the treatment. In this case, MTA showed clinical and radiographic success at revascularization treatment in immature permanent tooth. The successful outcome of this case suggests that MTA is reliable and effective for endodontic treatment in the pediatric dentistry.

Saeki, Katsura; Shiono, Yasuhiro; Maki, Kenshi

2014-01-01

253

Selective Coronary Arteriography  

PubMed Central

The technique of selective coronary arteriography, as described originally by Sones, was employed in 255 patients. Successful catheterization of both coronary arteries was carried out in 88% of these patients, and in the last 100 examinations both coronary arteries were entered in 95 patients. Selective coronary arteriography is a useful diagnostic tool but is a potentially hazardous form of examination as we encountered four episodes of ventricular fibrillation in the present series. ImagesFig. 1Fig. 2Figs. 3A-DFig. 3EFig. 3FFig. 4Fig. 5Fig. 6Fig. 7Fig. 8Fig. 9

Parker, John O.; Challis, Thomas W.; West, Roxroy O.

1966-01-01

254

The morphology of the inferior epigastric artery has implications on its use as a conduit for myocardial revascularization.  

PubMed

The inferior epigastric artery (IEA) is a new arterial graft for myocardial revascularization. We examined the inferior epigastric artery, the internal thoracic artery (ITA) and representative sections of the coronary arteries in 45 postmortem examinations, for microscopic signs of atherosclerosis. In addition, a morphometric evaluation of the intima and media of both conduits was performed. The intima of the ITA is significantly thicker, but atherosclerosis is absent. There are fewer fenestrations/mm in the internal elastic lamina (IEL) (4.00 +/- 1.60 versus 4.62 +/- 1.46) of the IEA and the combined thickness of media and intima is lower (0.20 +/- 0.04 mm versus 0.30 +/- 0.06 mm). However, 24% of IEAs showed medial calcification of variable degrees. We conclude that the IEA should not be used routinely for myocardial revascularization until the long-term patency of this graft has been explored. PMID:8043284

Wahba, A; Offerdal, K; von Sommoggy, S; Birnbaum, D E

1994-01-01

255

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

1999-09-01

256

Revascularization using arterial conduits for abdominal angina due to isolated and spontaneous dissection of the superior mesenteric artery.  

PubMed

Isolated spontaneous dissection of the superior mesenteric artery is rare, and the surgical treatment is not established. We performed successfully total revascularization using arterial conduits (left radial artery and right epigastric artery) and present here the first report to our knowledge of a surgically treated case. PMID:15834681

Kochi, Kazuhiro; Orihashi, Kazumasa; Murakami, Yoshiaki; Sueda, Taijiro

2005-05-01

257

Revascularization Using Arterial Conduits for Abdominal Angina Due to Isolated and Spontaneous Dissection of the Superior Mesenteric Artery  

Microsoft Academic Search

Isolated spontaneous dissection of the superior mesenteric artery is rare, and the surgical treatment is not established. We performed successfully total revascularization using arterial conduits (left radial artery and right epigastric artery) and present here the first report to our knowledge of a surgically treated case.

Kazuhiro Kochi; Kazumasa Orihashi; Yoshiaki Murakami; Taijiro Sueda

2005-01-01

258

Precordial QT Dispersion does not Predict Inducibility of Ventricular Tachyarrhythmias at Post-Revascularization Electrophysiologic Study  

Microsoft Academic Search

Objectives: We tested the hypothesis that revascularization would decrease QT interval dispersion and that QT interval dispersion would predict the outcome of the electrophysiologic study following revascularization.

Satish R. Raj; L. Brent Mitchell; D. George Wyse; Henry J. Duff; Robert S. Sheldon; Daniel Roach; Anne M. Gillis

2002-01-01

259

Indirect cerebral revascularization with a temporoparietal fascial flap in pediatric moyamoya patients: a novel technique and review of current surgical options.  

PubMed

Moyamoya syndrome is a progressive occlusive disease of the cerebral vessels. There are a variety of surgical treatments directed at revascularizing the ischemic brain in pediatric moyamoya disease. Many reports of varying success with both direct and indirect type of procedures can be found in medical literature. We present a novel technique, encephalo-TPF-synangiosis (ETS) with a pedicled bone flap, for indirect moyamoya revascularization in pediatric patients. A three-quarters osteoplastic temporal craniotomy was created. A pedicled temporoparietal fascial flap was passed intracranially through the temporalis muscle and placed into contact with the pial surface. The bone flap was the reaffixed to the skull. We performed 8 ETS in 6 patients. This is a well-vascularized, highly reliable method that offers broad-based surface area for revascularization. We also offer a composite overview of current surgical indirect revascularization techniques. PMID:24220400

Wong, Wendy W; Hiersche, Matthew A; Zouros, Alexander; Martin, Mark C

2013-11-01

260

Intermittent antegrade hyperkalaemic warm blood cardioplegia supplemented with magnesium prevents myocardial substrate derangement in patients undergoing coronary artery bypass surgery  

Microsoft Academic Search

Objective: The influence of the addition of magnesium on myocardial protection with intermittent antegrade warm blood hyperkalaemic cardioplegia in patients undergoing coronary artery surgery was investigated and compared with intermittent antegrade warm blood hyperkalaemic cardioplegia only. Methods: Twenty-three patients undergoing primary elective coronary revascularization were rando- mized to one of two different techniques of myocardial protection. In the first group,

M. Caputoa; A. J. Bryan; A. M. Calafioreb; M.-S. Suleiman; G. D. Angelini

261

Intermittent antegrade hyperkalaemic warm blood cardioplegia supplemented with magnesium prevents myocardial substrate derangement in patients undergoing coronary artery bypass surgery  

Microsoft Academic Search

Objective: The influence of the addition of magnesium on myocardial protection with intermittent antegrade warm blood hyperkalaemic cardioplegia in patients undergoing coronary artery surgery was investigated and compared with intermittent antegrade warm blood hyperkalaemic cardioplegia only. Methods: Twenty-three patients undergoing primary elective coronary revascularization were randomized to one of two different techniques of myocardial protection. In the first group, myocardial

M Caputo; A. J Bryan; A. M Calafiore; M.-S Suleiman; G. D Angelini

1998-01-01

262

Reversal of flow in the mammary artery to treat subclavian steal syndrome in conjunction with coronary bypass surgery.  

PubMed

Occasionally patients with multi-vessel disease present with coronary stenoses and subclavian steal syndrome. A novel surgical approach for the treatment of these vascular problems is described. The in situ left internal mammary artery was used to create an aortosubclavian shunt, thus restoring antegrade vertebral flow and vein grafts were used for coronary revascularization. PMID:21172534

John, Alexander; Hofmann, Steffen; Ostowar, Abazar; Ferdosi, Abbas; Warnecke, Henning

2011-01-01

263

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

1988-01-01

264

Clinical and angiographic analysis with a cobalt alloy coronary stent (driver) in stable and unstable angina pectoris.  

PubMed

The Clinical and Angiographic analysis with a Cobalt Alloy Coronary Stent (Driver) (CLASS) study was a prospective, nonrandomized, multicenter study designed to assess the safety and efficacy of a cobalt-chromium alloy-based stent in patients with stable or unstable angina pectoris. A total of 203 lesions were treated in 202 enrolled patients. The percentage of major adverse cardiac event-free patients was 87.6% (177 of 202) at 6 months (primary safety end point; major adverse cardiac events were defined as death, myocardial infarction, emergency bypass surgery, or target lesion revascularization [percutaneous transluminal coronary angioplasty or coronary artery bypass grafting]). The angiographic success rate (primary efficacy end point) was 100%, and the procedural success rate was 98%. The binary in-stent restenosis rate at 6 months was 12.6%. Our results have demonstrated that the Driver cobalt-chromium alloy stent can be used with a low 6-month incidence of major adverse cardiac events, a low 6-month binary restenosis rate, and high angiographic and procedural success rates. PMID:16442394

Legrand, Victor; Kelbaek, Henning; Hauptmann, Karl Eugen; Glogar, Dietmar; Rutsch, Wolfgang; Grollier, Gilles; Vermeersch, Paul; Elias, Joseph; De Cock, Cornelis Carolus

2006-02-01

265

Surgical revascularization in chronic mesenteric ischemia.  

PubMed

Chronic mesenteric ischemia (CMI) is a disease causing death either by starvation or enteromesenteric infarction. Diagnosis is often delayed before the patient is referred to a vascular surgery unit. Atherosclerosis is the main cause of CMI. Arteriography is essential in diagnosing CMI and delineating the atherosclerotic lesions. The revascularization procedure consists in an aortomesenteric bypass reconstructing 1-3 visceral arteries. This paper presents two consecutive CMI cases treated at the Vascular Surgery Unit of the Ia?i "Sf Spiridon" Hospital during 2010. Both patients had symptoms suggestive of mesenteric and aortoiliac diseases. CT angiography revealed specific lesions both for aortoiliac disease and stenotic or occlusive lesions in the celiac trunk and mesenteric arteries. Both cases benefited from aortobifemural bypass surgery using a synthetic graft associated with aortic-superior mesenteric artery bypass with reversed vein graft (in the first case both mesenteric arteries were revascularized). Immediate and remote results were favorable, with remission of intestinal symptoms and weight gain. Bypass patency was followed-up by CT angiography and Doppler ultrasound. CMI is a diagnostic and therapeutic challenge. Open surgery provides symptom remission in 90% of cases. Permeability at 5 years is 80-90% for open surgery, higher than by endovascular therapy. Average permeability of the two types of intervention is 70% at 5 years, similar to the infraaortic bypasses. PMID:24505908

Popa, R F; Strobescu, Cristina; Baroi, Genoveva; Raza, A

2013-01-01

266

Surgical revascularization techniques for diabetic foot  

PubMed Central

Diabetes is an important risk factor for atherosclerosis. The diabetic foot is characterized by the presence of arteriopathy and neuropathy. The vascular damage includes non-occlusive microangiopathy and macroangiopathy. Diabetic foot wounds are responsible for 5–10% of the cases of major or minor amputations. In fact, the risk of amputation of the lower limbs is 15–20% higher in diabetic populations than in the general population. The University of Texas classification is the reference classification for diabetic wounds. It distinguishes non-ischemic wounds from ischemic wounds which are associated with a higher rate of amputation. The first principles of treatment are the control of pain of an eventual infection. When ischemia is diagnosed, restoration of pulsatile blood flow by revascularization may be considered for salvaging the limb. The treatment options are angioplasty with or without stenting and surgical bypass or hybrid procedures combining the two. Distal reconstructions with anastomosis to the leg or pedal arteries have satisfactory limb-salvage rates. Subintimal angioplasty is a more recent endovascular technique. It could be suggested for elderly patients who are believed to be unsuitable candidates for a conventional bypass or angioplasty. The current article would focus on the various revascularization procedures.

Kota, Siva Krishna; Kota, Sunil Kumar; Meher, Lalit Kumar; Sahoo, Satyajit; Mohapatra, Sudeep; Modi, Kirtikumar Dharmsibhai

2013-01-01

267

Vital Pulp Therapy--Current Progress of Dental Pulp Regeneration and Revascularization  

PubMed Central

Pulp vitality is extremely important for the tooth viability, since it provides nutrition and acts as biosensor to detect pathogenic stimuli. In the dental clinic, most dental pulp infections are irreversible due to its anatomical position and organization. It is difficult for the body to eliminate the infection, which subsequently persists and worsens. The widely used strategy currently in the clinic is to partly or fully remove the contaminated pulp tissue, and fill and seal the void space with synthetic material. Over time, the pulpless tooth, now lacking proper blood supply and nervous system, becomes more vulnerable to injury. Recently, potential for successful pulp regeneration and revascularization therapies is increasing due to accumulated knowledge of stem cells, especially dental pulp stem cells. This paper will review current progress and feasible strategies for dental pulp regeneration and revascularization.

Zhang, Weibo; Yelick, Pamela C.

2010-01-01

268

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

2013-01-01

269

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

PubMed

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

2010-01-01

270

Reconstruction of esophageal defects with microsurgically revascularized jejunal segments: a report of 13 cases.  

PubMed

Experimental free transfer of a jejunal segment to a recipient bed in the neck was successfully performed in 5 mongrel dogs. This was followed by clinical application of 2 different microvascular procedures in 13 patients for repair of esophageal defects. In 7 of these patients a free jejunal transfer was used; in 6 of these patients a pedicled jejunal graft with revascularization of its distal end by microvascular anastomosis was used. The esophageal defects were located in the cervical portion in 7 cases, the cervicothoracic portion in 5 cases, and the thoracic portion in 1 case. Ten (77%) of the 13 procedures were successful. PMID:6783730

Chang, T S; Hwang, O L; Wang-Wei

1980-12-01

271

Successful Surgical Treatment of a Septuagenarian with Anomalous Right Coronary Artery from the Pulmonary Artery with an Eleven Year Follow-Up  

PubMed Central

An anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA) is a very rare coronary artery anomaly with only 98 cases reported in literature till date. We report the oldest surgically treated patient and the fourth ever septuagenarian with this anomaly diagnosed ante-mortem with an eleven year follow-up. The literature on this anomaly was reviewed and discussed to highlight the clinical implications.

Kuba, Paresh Kumar; Sharma, Jasvinder; Sharma, Ashok

2013-01-01

272

Serum protein profiles predict coronary artery disease in symptomatic patients referred for coronary angiography  

PubMed Central

Background More than a million diagnostic cardiac catheterizations are performed annually in the US for evaluation of coronary artery anatomy and the presence of atherosclerosis. Nearly half of these patients have no significant coronary lesions or do not require mechanical or surgical revascularization. Consequently, the ability to rule out clinically significant coronary artery disease (CAD) using low cost, low risk tests of serum biomarkers in even a small percentage of patients with normal coronary arteries could be highly beneficial. Methods Serum from 359 symptomatic subjects referred for catheterization was interrogated for proteins involved in atherogenesis, atherosclerosis, and plaque vulnerability. Coronary angiography classified 150 patients without flow-limiting CAD who did not require percutaneous intervention (PCI) while 209 required coronary revascularization (stents, angioplasty, or coronary artery bypass graft surgery). Continuous variables were compared across the two patient groups for each analyte including calculation of false discovery rate (FDR ? 1%) and Q value (P value for statistical significance adjusted to ? 0.01). Results Significant differences were detected in circulating proteins from patients requiring revascularization including increased apolipoprotein B100 (APO-B100), C-reactive protein (CRP), fibrinogen, vascular cell adhesion molecule 1 (VCAM-1), myeloperoxidase (MPO), resistin, osteopontin, interleukin (IL)-1?, IL-6, IL-10 and N-terminal fragment protein precursor brain natriuretic peptide (NT-pBNP) and decreased apolipoprotein A1 (APO-A1). Biomarker classification signatures comprising up to 5 analytes were identified using a tunable scoring function trained against 239 samples and validated with 120 additional samples. A total of 14 overlapping signatures classified patients without significant coronary disease (38% to 59% specificity) while maintaining 95% sensitivity for patients requiring revascularization. Osteopontin (14 times) and resistin (10 times) were most frequently represented among these diagnostic signatures. The most efficacious protein signature in validation studies comprised osteopontin (OPN), resistin, matrix metalloproteinase 7 (MMP7) and interferon ? (IFN?) as a four-marker panel while the addition of either CRP or adiponectin (ACRP-30) yielded comparable results in five protein signatures. Conclusions Proteins in the serum of CAD patients predominantly reflected (1) a positive acute phase, inflammatory response and (2) alterations in lipid metabolism, transport, peroxidation and accumulation. There were surprisingly few indicators of growth factor activation or extracellular matrix remodeling in the serum of CAD patients except for elevated OPN. These data suggest that many symptomatic patients without significant CAD could be identified by a targeted multiplex serum protein test without cardiac catheterization thereby eliminating exposure to ionizing radiation and decreasing the economic burden of angiographic testing for these patients.

2012-01-01

273

[Myocardial revascularization surgery in an 87-year-old patient. A case report].  

PubMed

A 87 years old patient, with independent life style, presented unstable angina in spite of medication. Cineangiocoronariography demonstrated severe triarterial lesions, with good distal segments and preserved left ventricular contractility. Three saphenous vein grafts were performed. Some clinical measures were employed: a) manitol, furosemide and Ringer solution were infused two hours before and during surgery; the infusion was maintaned during the two postoperative days; b) limited use of nephrotoxic agents; c) adequate doses of medication; d) red cells infusion in spite of higher hematocrit levels than those present in younger patients; e) early start of respiratory physiotherapy and deambulation. Mean arterial pressure was maintained over 80 mm/Hg during surgery. During the period of extracorporeal circulation a hollow capillary membrane oxygenador was employed. Immediate postoperative course, up till six months, was free of coronary insufficiency symptoms. This case demonstrates the benefits of myocardial revascularization in elderly patients, respecting some peculiarities of the geriatric therapeutics. PMID:2629674

Wajngarten, M; Jatene, F B; Bosisio, I B; Azul, L G; Pileggi, F J; Jatene, A D

1989-09-01

274

Comparison of outcomes in patients having isolated transcatheter aortic valve implantation versus combined with preprocedural percutaneous coronary intervention.  

PubMed

Coronary artery disease negatively affects the outcome of patients undergoing surgical aortic valve replacement and practice guidelines recommend revascularization at time of surgery. In patients undergoing transcatheter aortic valve implantation (TAVI), the impact of preprocedural percutaneous coronary intervention (PCI) on TAVI outcome has not been examined. We aimed in the present study to assess the feasibility and safety of performing PCI before TAVI and to evaluate procedural, 30-day, and 6-month clinical outcomes. We retrospectively analyzed 125 patients who underwent successful TAVI at a single institution and divided them into an isolated TAVI and a PCI + TAVI group. During the study period, a strategy of preprocedural PCI of all significant (>50%) lesions in major epicardial vessels was adopted. Study end points were adjudicated in accordance with the Valve Academic Research Consortium consensus on event definition. All patients were treated with the Medtronic CoreValve prosthesis (n = 55 with PCI + TAVI and n = 70 with isolated TAVI). Thirty-day mortality was 2% versus 6% for patients treated with PCI + TAVI versus isolated TAVI, respectively (p = 0.27). Neither periprocedural nor spontaneous myocardial infarction occurred in either group. Rates of 30-day stroke, major bleeding, major vascular complications, and the Valve Academic Research Consortium-defined combined safety end point (11% vs 13%, p = 0.74) did not differ between the 2 groups. Patients' symptoms significantly improved in the first month after TAVI, and extent of improvement did not differ between groups. Adverse events at 6 months were comparable. In conclusion, PCI before TAVI appears feasible and safe. Based on these early results revascularization should become an important consideration in patients with coronary artery disease undergoing TAVI. PMID:22133754

Abdel-Wahab, Mohamed; Mostafa, Ahmad E; Geist, Volker; Stöcker, Björn; Gordian, Ken; Merten, Constanze; Richardt, Doreen; Toelg, Ralph; Richardt, Gert

2012-02-15

275

Late-onset heart failure as a mechanism for adverse long-term outcome in diabetic patients undergoing revascularization (a 13-year report from the Lady Davis Carmel Medical Center registry).  

PubMed

The adverse long-term prognosis following myocardial revascularization in diabetic patients has been ascribed to accelerated coronary disease, a higher incidence of late coronary restenosis after revascularization, and myocardial dysfunction. To examine the development of heart failure and its prognostic implications in diabetic patients, we analyzed the long-term (13-year) follow-up data of 363 patients-193 percutaneous transluminal coronary angioplasties and 170 coronary artery bypass operations-revascularized in a single cardiovascular center from 1984 to 1986. Baseline characteristics (age, previous infarction, baseline ventricular function) were similar in the 80 diabetic and 283 nondiabetic patients; multivessel disease and hypertension were marginally more common in diabetics (p = NS). Cumulative incidence of hospitalization for heart failure was high in the diabetic cohort (25% vs 11%, p = 0.001), with a rapidly increasing incidence after 5 years. Survival after first hospitalization for heart failure was markedly reduced in diabetics (11 of 20 [55%] vs 25 of 31 [81%] at 3 years; p = 0.04), as was survival free of further hospitalization for heart failure (5 of 20 [25%] vs 20 of 30 [63%]; p <0.005). Long-term 13-year survival (43% vs 78%, p <0.0001) and survival free of heart failure (33% vs 71%, p <0.0001) were decreased in diabetics, especially those with reduced ventricular function at baseline (17% vs 42%, p = 0.07). Multivariate analysis showed diabetes to be the strongest independent predictor of decreased survival (odds ratio 3. 6, 95% confidence interval 2.0 to 6.2; p <0.0001) and survival free of heart failure (odds ratio 4.0, 95% confidence interval 2.2 to 7. 1; p <0.0001) in patients undergoing revascularization. In summary, late-onset heart failure was frequent in diabetic patients after percutaneous transluminal coronary angioplasty or coronary artery bypass grafting, and once present heralded an unrelenting progressive downhill clinical course. PMID:10856386

Halon, D A; Merdler, A; Flugelman, M Y; Rennert, H S; Weisz, G; Shahla, J; Lewis, B S

2000-06-15

276

Utility of magnetic resonance arteriography for distal lower extremity revascularization  

Microsoft Academic Search

Purpose: Magnetic resonance arteriography (MRA) of the lower extremities affords several possible advantages over conventional contrast arteriography (CA). We hypothesized that MRA of the infrageniculate vessels was sufficiently accurate to replace CA before revascularization procedures in patients with limb-threatening ischemia.Methods: Fifty-three extremities in 49 patients were prospectively evaluated before attempted infrageniculate revascularization procedures with preoperative infrageniculate time-of-flight MRA (cost, $170\\/study)

Thomas S. Huber; Martin R. Back; R. James Ballinger; William C. Culp; Timothy C. Flynn; Paul S. Kubilis; James M. Seeger

1997-01-01

277

Chronic total coronary occlusions.  

PubMed

Chronic total coronary occlusions (CTO) occur in up to one-third of patients undergoing coronary angiography. Indications for opening CTOs include relief of angina, improving left ventricular function, decreasing the need for coronary artery bypass surgery, and improved long-term survival. Newer technology, wire-based and non-wired-based, has improved the ability to cross these previously uncrossable lesions, thereby improving the acute success rates of opening these lesions. Also, the advent of drug-eluting stents has markedly increased the long-term patency of these complex lesions. Therefore, the clinical demand for opening these chronically occluded arteries has increased. PMID:16781941

Braden, Gregory A

2006-05-01

278

[Simultaneous carotid and vertebral revascularization in the aged].  

PubMed

Five patients of a mean age of 76, have been submitted to combined vertebral and carotid artery revascularization for a severe vertebro-basilar insufficiency. Vertebral artery revascularization consisted of a transposition to the common carotid artery in one case and of a carotid-distal vertebral artery saphenous bypass graft. The associated carotid artery revascularization consisted of a carotid endarterectomy with patch in 4 cases and without patch in one case. There were no postoperative mortality and no postoperative stroke. Postoperative morbidity included a transitory revascularization syndrome, a myocardial ischemia and a Horner's syndrome. Complete relief of vertebrobasilar symptoms was obtained in 4 patients whereas in one patient only a mild positional vertigo persisted. All vascular reconstructions have been assessed with postoperative arteriography and duplex-scan every six months. At 11 months mean follow-up, all revascularizations are patent. Combined carotid and vertebral artery surgery is effective in well selected cases, and it does not enhance the risk of the two operations performed separately. It also eliminate the possibility of failure of isolated carotid revascularization for vertebrobasilar symptoms. PMID:9432582

Illuminati, G; Caliò, F G; Bertagni, A; Piermattei, A; Vietri, F; Martinelli, V

1997-09-01

279

[Revascularization of the carotid and vertebral arteries in the elderly].  

PubMed

From January 1994 to July 2004, 323 patients underwent 348 revascularization of carotid bifurcation for atherosclerotic stenoses. Eighty eight patients (group A) were 75 year-old or older, whereas 235 (group B) were younger than 75 years. Postoperative mortality/neurologic morbidity rate was 1% in group A, and 1.4% in group B. At 5 years, patency and freedom from symptoms/stroke were, respectively, 91% and 92% in group A, and 89% and 91% in group B. None of these differences was statistically significant. In the same time period, 26 internal carotid arteries were revascularized in 24 patients, 75 or more aged, for a symptomatic kinking. Postoperative mortality/morbidity rate was absent, whereas, at 5 years, patency and freedom from symptoms/stroke were, respectively, 88% and 92%. Twelve vertebral arteries were revascularized in 12 patients, 75 or more aged, for invalidating symptoms of vertebrobasilar insufficiency. Postoperative mortality/neurologic morbidity rate was absent. In one case postoperative recurrence of symptoms occurred, despite a patent revascularization. Patency and freedom from symptoms/stroke were 84% and 75%, at 5 years. Revascularization of carotid and vertebral arteries in the elderly can be accomplished with good results, superposable to those of standard revascularization of carotid bifurcation in a younger patients' population. PMID:15803810

Illuminati, G; Bezzi, M; D'Urso, A; Giacobbi, D; Ceccanei, G; Vietri, F

2004-01-01

280

Drug-Eluting Stents in Multivessel Coronary Artery Disease: Cost Effectiveness and Clinical Outcomes  

PubMed Central

Multivessel coronary artery disease is more often treated either with coronary artery bypass surgery (CABG) or percutaneous coronary intervention (PCI) with stenting. The advent of drug-eluting stent (DES) has changed the revascularization strategy, and caused an increase in the use of DES in multivessel disease (MVD), with reduced rate of repeat revascularization compared to conventional bare metal stent. The comparative studies of DES-PCI over CABG have shown comparable safety; however, the rate of major adverse cerebrovascular and cardiac events and repeat revascularization was significantly higher with DES-PCI at long term. In diabetic patients with MVD, concern of repeat revascularization with DES-PCI is persistent. More recent, one-year economic outcomes have reported that the CABG is favored among patients with high angiographic complexity. The higher rate of repeat revascularization with DES-PCI in MVD would lead to increased economic burden on patient at long term besides bearing high cost of DES. In diabetic MVD patients, CABG is associated with having better clinical outcomes and being more cost-effective approach when compared to DES-PCI at long term.

Panchal, Kanaiya; Patel, Snehal; Bhatt, Parloop

2012-01-01

281

Acute Coronary Stent Thrombosis in Cancer Patients: A Case Series Report  

PubMed Central

There have been a growing numbers of patients diagnosed with malignancy and coronary artery disease simultaneously or serially. In the era of percutaneous coronary intervention (PCI), stent thrombosis has been a rare but challenging problem. Recently, we experienced two unique cases of acute stent thrombosis in patients with malignancy. The first case showed acute and subacute stent thrombosis after PCI. The second case revealed simultaneous thromboses in stent and non-treated native coronary artery. We believe that we need rigorous precautions in the treatment of patients with coronary artery disease and malignancy, especially with regards to deciding how and whether to revascularize, as well as which anti-platelet agents to select.

Lee, Joo Myung

2012-01-01

282

Guidelines for percutaneous coronary interventions. The Task Force for Percutaneous Coronary Interventions of the European Society of Cardiology.  

PubMed

In patients with stable CAD, PCI can be considered a valuable initial mode of revascularization in all patients with objective large ischaemia in the presence of almost every lesion subset, with only one exception: chronic total occlusions that cannot be crossed. In early studies, there was a small survival advantage with CABG surgery compared with PCI without stenting. The addition of stents and newer adjunctive medications improved the outcome for PCI. The decision to recommend PCI or CABG surgery will be guided by technical improvements in cardiology or surgery, local expertise, and patients' preference. However, until proved otherwise, PCI should be used only with reservation in diabetics with multi-vessel disease and in patients with unprotected left main stenosis. The use of drug-eluting stents might change this situation. Patients presenting with NSTE-ACS (UA or NSTEMI) have to be stratified first for their risk of acute thrombotic complications. A clear benefit from early angiography (<48 h) and, when needed, PCI or CABG surgery has been reported only in the high-risk groups. Deferral of intervention does not improve outcome. Routine stenting is recommended on the basis of the predictability of the result and its immediate safety. In patients with STEMI, primary PCI should be the treatment of choice in patients presenting in a hospital with PCI facility and an experienced team. Patients with contra-indications to thrombolysis should be immediately transferred for primary PCI, because this might be their only chance for quickly opening the coronary artery. In cardiogenic shock, emergency PCI for complete revascularization may be life-saving and should be considered at an early stage. Compared with thrombolysis, randomized trials that transferred the patients for primary PCI to a 'heart attack centre' observed a better clinical outcome, despite transport times leading to a significantly longer delay between randomization and start of the treatment. The superiority of primary PCI over thrombolysis seems to be especially clinically relevant for the time interval between 3 and 12 h after onset of chest pain or other symptoms on the basis of its superior preservation of myocardium. Furthermore, with increasing time to presentation, major-adverse-cardiac-event rates increase after thrombolysis, but appear to remain relatively stable after primary PCI. Within the first 3 h after onset of chest pain or other symptoms, both reperfusion strategies seem equally effective in reducing infarct size and mortality. Therefore, thrombolysis is still a viable alternative to primary PCI, if it can be delivered within 3 h after onset of chest pain or other symptoms. Primary PCI compared with thrombolysis significantly reduced stroke. Overall, we prefer primary PCI over thrombolysis in the first 3 h of chest pain to prevent stroke, and in patients presenting 3-12 h after the onset of chest pain, to salvage myocardium and also to prevent stroke. At the moment, there is no evidence to recommend facilitated PCI. Rescue PCI is recommended, if thrombolysis failed within 45-60 min after starting the administration. After successful thrombolysis, the use of routine coronary angiography within 24 h and PCI, if applicable, is recommended even in asymptomatic patients without demonstrable ischaemia to improve patients' outcome. If a PCI centre is not available within 24 h, patients who have received successful thrombolysis with evidence of spontaneous or inducible ischaemia before discharge should be referred to coronary angiography and revascularized accordingly--independent of 'maximal' medical therapy. PMID:15769784

Silber, Sigmund; Albertsson, Per; Avilés, Francisco F; Camici, Paolo G; Colombo, Antonio; Hamm, Christian; Jørgensen, Erik; Marco, Jean; Nordrehaug, Jan-Erik; Ruzyllo, Witold; Urban, Philip; Stone, Gregg W; Wijns, William

2005-04-01

283

[Revascularization? Only as the last resort!].  

PubMed

Revascularization has been suggested for treatment of necrotic immature permanent teeth. The desirable outcome of the treatment is continuous growth of the root, maturation of the dentin walls underneath the cervical seal and apical closure. Despite of increasing numbers of case reports, a uniform treatment protocol has not been set. This procedure has many shortcomings of which tooth discoloration is the most prevalent and easy to observe. The severe discoloration is attributed to the use of Mincocycline in the antibiotic dressing, or to the use of MTA for the seal. The maturation of the root is not predictable and does not always occur. The outcome should be evaluated radiographically and clinically. Sensibility testing may not be possible due to the large MTA plug in the root canal. It is recommended only when alternative procedures such as apexificaiton, pulpotomy or pulp capping are impossible. The patient and his parents should be aware of the potential discoloration and must be committed to routine follow ups. Currently, this procedure should be limited to incisor or premolar teeth in which the crown is longer than the root, or the canal's width is larger than that of the dentinal wall. PMID:24303740

Slutzky-Goldberg, I; Heling, I

2013-07-01

284

Deceleration Time in Ischemic Cardiomyopathy Relation to Echocardiographic and Scintigraphic Indices of Myocardial Viability and Functional Recovery After Revascularization  

Microsoft Academic Search

Background—In patients with heart failure secondary to left ventricular (LV) systolic dysfunction, a short deceleration time (DT) successfully predicts clinical outcome. The impact of myocardial viability and revascularization on the mitral inflow velocities, however, is unknown. Methods and Results—Forty patients with ischemic cardiomyopathy underwent 201Tl scintigraphy (SPECT) and 2D, Doppler, and dobutamine echocardiography (DE, to 40 mg z kg21 z

Yongqi Yong; Sherif F. Nagueh; Sarah Shimoni; Kesavan Shan; Zuo-Xiang He; Michael J. Reardon; George V. Letsou; Jimmy F. Howell; Mario S. Verani; Miguel A. Quiñones; William A. Zoghbi

2010-01-01

285

Endoscopic vein harvest for coronary artery bypass grafting: technique and outcomes  

Microsoft Academic Search

Background: The greater saphenous vein is a common conduit for coronary revascularizations. Traditional vein harvesting uses long incision(s) that can lead to significant morbidities. A minimally invasive technique has been developed that allows the harvest of much of the saphenous vein with one incision and fewer morbidities. Methods: Our technique and outcomes on 110 patients with minimally invasive harvest (endoscopic

Z. Davis; H. Kurt Jacobs; Mark Zhang; Celia Thomas; Yolanda Castellanos

1998-01-01

286

Chronic Kidney Disease, Mortality, and Treatment Strategies among Patients with Clinically Significant Coronary Artery Disease  

Microsoft Academic Search

Cardiovascular disease is an important cause of mortal- ity among patients with chronic kidney disease (CKD). This study describes associations between CKD, cardiac revascularization strategies, and mortality among patients with CKD and cardio- vascular disease. All patients undergoing cardiac catheterization at Duke University Medical Center (1995 to 2000) with documented stenosis 75% of at least one coronary artery and available

DONAL N. REDDAN; LYNDA ANNE SZCZECH; ROBERT H. TUTTLE; LINDA K. SHAW; ROBERT H. JONES; STEVE J. SCHWAB; MARK STAFFORD SMITH; ROBERT M. CALIFF; DANIEL B. MARK; WILLIAM F. OWEN JR

2003-01-01

287

Long-term patency of cephalic vein in coronary bypass surgery.  

PubMed

In the situation where the saphenous veins were unavailable, cephalic vein was the second choice in the beginning of 1980s. The routine use of saphenous vein and recent enthusiasm for arterial surgical myocardial revascularization lead to less attention on this conduit. We reported a patient undergoing redo coronary bypass surgery after 18 years of having cephalic vein grafts. PMID:18598332

Tjang, Yanto Sandy; Hornik, Lech; Seifert, Dirk; Körfer, Reiner

2008-01-01

288

Differential Neointimal Response to Coronary Artery Injury in Pigs and Dogs Implications for Restenosis Models  

Microsoft Academic Search

Neointimal hyperplasia occurs in the coronary arteries after percutaneous revascularization procedures and is a reparative response that frequently causes recurrent stenosis. Prior animal studies have shown that neointimal tissue thickness is proportional to the depth of arterial injury. Because animal models are increasingly used to test therapeu- tic strategies against restenosis, the purpose of this study was to evaluate the

Robert S. Schwartz; William D. Edwards; Kent R. Bailey; Allan R. Camrud; Michael A. Jorgenson; David R. Holmes

289

Coronary angiography  

MedlinePLUS

Cardiac angiography; Angiography - heart; Angiogram - coronary ... Coronary angiography is usually done along with cardiac catheterization . Before the test starts, you will be given a mild sedative to help you relax. An area of your body, usually the ...

290

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

2012-01-01

291

Early Outcomes of Double-Vessel Coronary Endarterectomy in Comparison with Single-Vessel Coronary Endarterectomy  

PubMed Central

Our goal was to investigate the safety of single- and double-vessel coronary endarterectomy as an adjunct to coronary artery bypass grafting in patients with diffuse coronary disease. In reviewing the records of 9,443 patients who underwent isolated coronary artery revascularization over a 4-year period, we found 310 patients (3.28%) who underwent concomitant coronary artery endarterectomy, 39 of whom (12.6%) required double endarterectomy (Group 2) and the rest of whom required single endarterectomy (Group 1). Variables of these groups were compared by means of univariate analysis. In Group 1, 76.3% were men, with a mean age of 58.73 ± 9.36 yr. Regarding postoperative myocardial infarction as evaluated by electrocardiography and the MB isoenzyme of creatine kinase, 13% of the patients in Group 1 and 15.4% in Group 2 were so affected. The early mortality rate was 3.3% in Group 1 and 10.3% in Group 2 (P <0.05). In univariate analysis, the following variables were significant: 3-vessel disease, postoperative atrial fibrillation, dialysis, length of hospital stay, and death. In multivariate analysis of endarterectomized arteries, the vascular combinations most strongly associated with death were left anterior descending coronary artery + right coronary artery and right coronary artery + diagonal. There was no association between endarterectomy of particular vessels and perioperative myocardial infarction. Although coronary endarterectomy has become a safe procedure, adding a 2nd endarterectomy worsens the prognosis dramatically, and surgeons should be especially cautious about such an addition if the 1st endarterectomy is in left anterior descending coronary artery or right coronary artery territory.

Marzban, Mehrab; Karimi, Abassali; Ahmadi, Hossein; Davoodi, Saeed; Abbasi, Kyomars; Movahedi, Namvar; Salehiomran, Abbas; Abbasi, Seyed Hesameddin; Kawoosi, Yasaman; Yazdanifard, Parin

2008-01-01

292

The prognostic value of multidetector coronary CT angiography for the prediction of major adverse cardiovascular events: a multicenter observational cohort study.  

PubMed

To assess the prognostic value of coronary artery stenosis identification by coronary computed tomographic angiography (CCTA) for the prediction of major adverse cardiac events (MACE) in a multicenter prospective cohort study. We performed a prospective multicenter observational cohort study of symptomatic patients with suspected or known coronary artery disease (CAD) (n = 172; 57% male) undergoing CCTA in accordance to ACC/AHA Appropriateness Criteria from 4 sites in and around Paris, France, and followed for a mean duration of 22.0 +/- 4.5 months (interquartile range 18-26 months). Coronary arteries by CCTA were interpreted by physicians blinded to the patient characteristics for the presence or absence obstructive (>or=70% luminal diameter stenosis), as well as for plaque composition categorized as non-calcified, calcified or "mixed." MACE was defined as death, non-fatal myocardial infarction, unstable angina or target vessel revascularization. MACE event rates were compared between patients with or without obstructive plaque and with differing plaque compositions. MACE event rates were significantly higher in patients with obstructive coronary artery stenosis by CCTA compared to those without (61.1% vs. 3.9%, P < 0.01). In patients with obstructive stenosis, mixed (83.3% vs. 25.3%, P < 0.01) and calcified (94.4% vs. 50.7%, P < 0.01) plaque presence was significantly higher than in patients without obstructive stenosis, with no differences in prevalence of non-calcified plaque (27.8% vs. 20.8%, P = NS). For MACE, the negative predictive value of no observed coronary artery plaque was 100% in the follow-up period. In this prospective multicenter study of symptomatic patients with suspected or known CAD undergoing CCTAs interpreted by imagers blinded to patient characteristics, CCTA presence of plaque severity and composition successfully identifies patients at risk for incident MACE events. Importantly, a negative CCTA portends an extremely low risk for incidence MACE. PMID:20349139

Min, James K; Feignoux, J; Treutenaere, J; Laperche, T; Sablayrolles, J

2010-08-01

293

Pulp revascularization in an immature necrotic tooth: a case report.  

PubMed

Immature permanent teeth damaged by caries or trauma can present a challenge to dentistry. Currently, triple antibiotic paste (TAP) containing ciprofloxacin, metronidazole, and minocycline is used to attempt revascularization in necrotic immature teeth. Therefore, the purpose of this report was to present a case of pulp revascularization in an immature necrotic tooth. An 8-year-old male presented with trauma to the permanent maxillary left and right central incisors. Upon clinical and radiographic examination, the left central incisor was deemed necrotic. Revascularization therapy was performed over multiple visits. At 11 months follow-up, healing of the periapical area and apexogenesis were found to be complete. With an increasing breadth of clinical evidence and practitioner acceptance, regenerative techniques may become a standard technique in treating immature necrotic permanent teeth. PMID:23265169

Gelman, Richard; Park, Helen

2012-01-01

294

Clinical complications in the revascularization of immature necrotic permanent teeth.  

PubMed

The purpose of this case series was to report on the use of a technique of revascularization for necrotic immature permanent teeth, several problems encountered, and solutions to those problems. Eighteen pulp revascularizations were performed in 2009 using the original protocol of revascularization (adapted from the AAE/AAPD joint meeting in 2007 in Chicago). The protocol consisted of opening the canal and disinfecting it with sodium hypochlorite, sealing in a triple antibiotic paste for 2-6 weeks, re-opening, re-irrigating, creating a blood clot in the canal, and sealing with an MTA barrier over the clot. Three problems were encountered during the treatment: (1) bluish discoloration of the crown; (2) failure to produce bleeding; and (3) collapse of the mineral trioxide aggregate (MTA) material into the canal. Modifications to solve these problems included: changing one of the antibiotics, using a local anesthesia without epinephrine, and adding collagen matrix to the blood clot. PMID:23211919

Dabbagh, Basma; Alvaro, Emanuel; Vu, Duy-Dat; Rizkallah, Jean; Schwartz, Stephane

2012-01-01

295

Chronic mesenteric ischemia and therapeutic paradigm of mesenteric revascularization.  

PubMed

Chronic mesenteric ischemia is a life-threatening clinical problem resulting in death from inanition and/or bowel infarction, if left untreated, albeit low disease prevalence. Typical presentation is postprandial abdominal pain, severe weight loss, and altered bowel habit. Surgical revascularization of the superior mesenteric artery provides effective long-term treatment for chronic intestinal ischemia. Eleven patients underwent superior mesenteric artery revascularization, nine of them with open retrograde superior mesenteric artery bypass and two with angioplasty and stenting. All patients except one made a satisfactory recovery in this cohort. Major complication included one graft thrombosis leading to bowel ischemia and death. The rest all recovered weight in 3-6 months with a follow up period of 6 to 28 months. Two patients had recurrence of symptoms due to failing bypass requiring stenting for assisted primary patency. Superior mesenteric artery revascularization can be performed with minimal morbidity and mortality, providing excellent symptom relief and quality of life. PMID:23996740

Parameshwarappa, Shashidhar Kallappa; Savlania, Ajay; Viswanathan, Sidharth; Gadhinglajkar, Srinivas; Raman, Kapilamoorthy Tirur; Unnikrishnan, Madathipat

2014-03-01

296

Revascularization/Regeneration performed in immature molars: case reports.  

PubMed

These 3 case reports the outcome of revascularization treatment in necrotic immature molars. During treatment, a tri antibiotic mix was used to disinfect the pulp for 2 weeks. Then a blood clot was created in the canal, over which mineral trioxide aggregate was placed. After 24 months, the immature molars showed continuation of root development. The patients were asymptomatic, no sinus tracts were evident and apical periodontitis was resolved Results from these cases show that revascularization/regeneration using 3Mix-MP method could be effective for managing immature permanent molar teeth with pulpal necrosis. PMID:23855165

Sönmez, I S; Akbay Oba, A; Erkmen Almaz, M

2013-01-01

297

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

1999-01-01

298

On-pump versus off-pump coronary artery bypass surgery: what is the status after ROOBY, DOORS, CORONARY and GOPCABE?  

PubMed

Off-pump coronary artery bypass surgery has been purported to be safer than conventional coronary artery bypass surgery performed using cardiopulmonary bypass. This theory was supported by a number of early series, but failed to be confirmed by a number of small, randomized, controlled trials. Conversely, it has been suggested that revascularization after off-pump surgery is associated with fewer grafts and lower graft patency, potentially leading to a higher risk of cardiovascular morbidity and need for repeated coronary interventions. Since 2009, four major randomized controlled trials have been published, increasing the level of evidence significantly. PMID:23834696

Houlind, Kim

2013-07-01

299

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

2011-01-01

300

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

301

Hypotheses, design, and methods for the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) Trial.  

PubMed

The Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) is a National Institutes of Health (NIH)-sponsored randomized clinical trial that evaluates treatment efficacy for patients with type 2 diabetes mellitus and angiographically documented stable coronary artery disease. Using a 2 x 2 factorial design, BARI 2D compares revascularization combined with aggressive medical treatment versus aggressive medical treatment alone; simultaneously, BARI 2D compares 2 glycemic control strategies, insulin sensitization versus insulin provision. All patients have goals of glycosylated hemoglobin values <7.0% and uniform control of hypertension, dyslipidemia, and obesity following recommended medical guidelines. The primary end point of BARI 2D is all-cause 5-year mortality analyzed by intention to treat, and the principal secondary end point is the combination of death, myocardial infarction, and stroke. A total of 2,368 patients have been enrolled at 49 clinical centers throughout North America, South America, and Europe. The study enrollment period was January 2001 through March 2005, and the patient treatment and follow-up phase is expected to extend at least through May 2007. Participants are treated at the local BARI 2D clinical sites on a monthly basis for the first 6 months and then every 3 months until the end of the study. Within BARI 2D, central management centers oversee the control of glycemia, plasma lipid levels, hypertension, and obesity. The randomized clinical trial collects data on patient symptoms, clinical measurements, medications, and clinical events as well as data from centralized evaluations of angiograms, electrocardiograms, nuclear stress tests, blood and urine specimens, and relative economic costs. PMID:16813734

Brooks, Maria Mori; Frye, Robert L; Genuth, Saul; Detre, Katherine M; Nesto, Richard; Sobel, Burton E; Kelsey, Sheryl F; Orchard, Trevor J

2006-06-19

302

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.

2012-01-01

303

Should we consider off-pump coronary artery bypass grafting in patients with acute coronary syndrome?  

PubMed Central

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether off-pump coronary artery bypass (OPCAB) grafting should be considered as an alternative to the conventional on-pump surgery (ONCAB) in patients presenting with acute coronary syndrome (ACS) requiring emergency revascularization. Eighty-two papers were identified by a systematic search, of which nine were judged to best answer the clinical question. Of these, one was a randomized controlled trial and the remaining eight were retrospective observational studies. The author, journal, date, patient group, country of publication, relevant outcomes, results and study weaknesses were tabulated. In total, these nine studies included 3001 patients (n = 817 OPCAB, 2184 ONCAB) undergoing emergency revascularization in the setting of ACS. The timing between the onset of ACS and operative intervention ranged from 6 to 72 h. All cases were categorized as urgent/emergent according to the National confidential enquiry into patient outcome and death classification of intervention. Six studies included patients with preoperative cardiogenic shock; however the majority of patients were haemodynamically stable at the time of surgery. Three out of nine studies showed an improvement in 30-day mortality with OPCAB although the remaining six reveal no significant mortality benefit. No difference in long-term mortality was observed between the two techniques. OPCAB was associated with significantly fewer grafts per patient (six studies) and less complete revascularization (two studies). We conclude that whilst OPCAB may have a beneficial effect on 30-day mortality in haemodynamically stable patients undergoing emergency revascularization, there is a lack of high-quality data with clearly defined patient demographics. Future studies must ensure adequate preoperative matching between OPCAB and ONCAB groups and clearly categorize haemodynamic status, disease pattern and time to surgery in order to determine the patients in whom OPCAB may confer the greatest benefit.

Moscarelli, Marco; Harling, Leanne; Ashrafian, Hutan; Athanasiou, Thanos

2013-01-01

304

[Massive pulmonary embolism mimicking ST-elevation acute coronary syndrome successfully treated with hybrid therapy in a trauma patient receiving nadroparin: diagnostic and therapeutic dilemmas].  

PubMed

A case of a 48-year-old woman with a comminuted fracture of the left tibia and receiving prophylactic doses of nadroparin, with massive pulmonary embolism mimicking ST-elevation acute coronary syndrome and complicated by cardiogenic shock and cardiac arrest, is presented. Pulmonary angiography showed total right pulmonary artery occlusion. Intraarterial thrombolysis with reduced dose of alteplase (50 mg), platelet GP IIb/IIIa blockade with eptifibatide, endovascular embolus fragmentation with a pigtail rotation catheter, and rescue pulmonary balloon angioplasty were performed, after which complete recovery was achieved. On day 4 of hospitalisation the patient was transferred to the orthopaedic ward where she underwent uneventful tibial surgery. PMID:17979054

Latacz, Pawe?; Rostoff, Pawe?; Wyderka, Rafa?; Rudnik, Andrzej; Kondys, Marek; Marut, Agata; Buszman, Pawe?; Piwowarska, Wies?awa

2007-10-01

305

Changes in activated partial thromboplastin time and international normalised ratio after on-pump and off-pump surgical revascularization of the heart.  

PubMed

Surgical revascularization of the heart (CABG - coronary artery bypass grafting) is one way of treating coronary heart disease. Bleeding is one of the serious and frequent complications of heart surgery and can result in increased mortality and morbidity. Hemostasis disorder may be secondary consequences of surgical bleeding, preoperative anticoagulant therapy, and the use of cardiopulmonary bypass. Tests used for routine evaluation of the coagulation system are activated partial thromboplastin time (APTT) and international normalized ratio (INR). The study encountered 60 patients who were hospitalized at the Clinic for Cardiovascular Diseases, University Clinical Center Tuzla. Patients underwent elective coronary artery bypass heart surgery either with cardiopulmonary bypass (on-pump CABG) or without it (off-pump CABG). The aim of this study was to compare the changes in coagulation tests (APTT, INR) in patients who were operated on-pump and patients operated off-pump. Our study showed that the values of APTT and INR tend to increase immediately after surgery. Twenty-four hours after surgery these values are declining and they are approaching the preoperative values in all observed patients (p <0.05). Comparing APTT between the groups we found that postoperative APTT levels are significantly higher in the group of patients who underwent surgery with cardiopulmonary bypass (p <0.05). Changes in coagulation tests after surgical revascularization of the heart are more pronounced in patients who were operated with on-pump technique compared to patients operated off-pump technique. PMID:24856377

Selimovi? ?eke, Lejla; Imamovi?, Semir; Ljuca, Farid; Jerki?, Zoran; Imamovi?, Goran; Hadžimeši?, Munevera; Pojski?, Aida; Kov?i?, Jasmina

2014-05-01

306

Percutaneous approach to treatment of coronary disease in a patient with uremic cardiomyopathy.  

PubMed

Uremic cardiomyopathy is chronic ischemic left ventricular dysfunction characterized by heart failure, myocardial ischemia, hypotension in dialysis and arrhythmia. This nosologic entity represents a leading cause of morbidity and mortality among patients with end-stage renal disease receiving long-term hemodialysis. It is intuitive that revascularization in the presence of coronary artery disease in these patients represents an effective option for improving their prognosis. Although the surgical option seems to be followed by the best clinical outcome, some patients refuse this option and others are not good candidates for surgery. The present report describes the case of a patient affected by uremic cardiomyopathy and severe coronary artery disease in whom revascularization with percutaneous coronary angioplasty was followed by a significant improvement in quality of life. PMID:21526049

Petrillo, Gianluca; Cirillo, Plinio; Prastaro, Maria; D'Ascoli, Greta Luana; Piscione, Federico

2011-04-26

307

Evolution of coronary stents in patients with diabetes: are clinical outcomes still improving?  

PubMed

Diabetic patients are prone to diffuse and accelerated atherosclerosis, which increases the likelihood of requiring myocardial revascularization. Diabetes mellitus is a strong risk factor for restenosis following coronary stenting, with greater need for repeat revascularization and inferior clinical outcomes. Despite the recent advances in drug-eluting stent technology, diabetic patients are still at higher risk of adverse clinical events after coronary angioplasty. The focus of this review is to describe the evolution of the percutaneous management of diabetic patients with coronary artery disease and to define if any real progress has been made in terms of safety and efficacy with the use of the second generation drug-eluting stents in this high-risk population. PMID:24939631

Kassimis, George; De Maria, Giovanni Luigi; Patel, Niket; Banning, Adrian P

2014-08-01

308

Congenital coronary artery fistulae: a rare cause of heart failure in adults  

PubMed Central

Coronary artery fistulae are uncommon, reported in 0.25% of patients undergoing coronary angiography. Two patients with congenital coronary artery fistula and coronary artery disease who presented with symptoms of exacerbated congestive heart failure out of proportion to their atherosclerotic burden were successfully treated by epicardial fistula ligation and coronary artery bypass grafting with marked improvement in functional status.

2014-01-01

309

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.

2008-01-01

310

Contrast-Enhanced Electron Beam CT and Multidetector-Row CT in the Evaluation of Coronary Stent Patency  

Microsoft Academic Search

High-pressure stent implantation is an established technique to maintain luminal integrity following interventional revascularization\\u000a in native coronary arteries and bypass grafts. Large controlled randomized trials demonstrated superior long-term patency\\u000a in comparison to percutaneous transluminal coronary angioplasty (PTCA) alone (8–13). The beneficial effects of stent implantation on restenosis can be attributed to larger acute lumen dimensions compared\\u000a to balloon angioplasty, and

Heiko Pump; Stefan Möhlenkamp; Raimund Erbel; Rainer Seibel

311

Single coronary artery anomaly causing ischemic mitral insufficiency.  

PubMed

Single coronary artery anomaly is rarely seen, and although it can present with sudden death, chest pain, arrhythmia, myocardial infarction, or congestive heart failure, it can also be asymptomatic. We describe the case of a 58-year-old man with single coronary artery anomaly in whom the coronary artery stemmed from the left coronary sinus and caused ischemic mitral insufficiency due to left anterior descending artery stenosis. He underwent successful mitral valve repair and coronary bypass. PMID:24771737

Ay, Yasin; Ayd?n, Cemalettin; Ay, Nuray Kahraman; Inan, Bekir; Ba?el, Halil; Zeybek, Rahmi

2014-05-01

312

Validating intramyocardial bone marrow stem cell therapy in combination with coronary artery bypass grafting, the PERFECT Phase III randomized multicenter trial: study protocol for a randomized controlled trial  

PubMed Central

Background For the last decade continuous efforts have been made to translate regenerative cell therapy protocols in the cardiovascular field from ‘bench to bedside’. Successful clinical introduction, supporting safety, and feasibility of this new therapeutic approach, led to the initiation of the German, Phase III, multicenter trial - termed the PERFECT trial (ClinicalTrials.gov Identifier: NCT00950274), in order to evaluate the efficacy of surgical cardiac cell therapy on left ventricular function. Methods/Design The PERFECT trial has been designed as a prospective, randomized, double-blind, placebo controlled, multicenter trial, analyzing the effect of intramyocardial CD 133+ bone marrow stem cell injection in combination with coronary artery bypass grafting on postoperative left ventricular function. The trial includes patients aged between 18 and 79?years presenting with a coronary disease with indication for surgical revascularization and reduced global left ventricular ejection fraction as assessed by cardiac magnet resonance imaging. The included patients are treated in the chronic phase of ischemic cardiomyopathy after previous myocardial infarction. Discussion Patients undergoing coronary artery bypass grafting in combination with intramyocardial CD133+ cell injection will have a higher LV ejection fraction than patient who undergo CABG alone, measured 6?months after the operation. Trial registration ClinicalTrials.gov Identifier: NCT00950274

2012-01-01

313

Successful treatment of bleeding large duodenal gastrointestinal stromal tumour in a patient under dual antiplatelet therapy after recent drug-eluting coronary stent implantation.  

PubMed

We report a case of a 69-year-old man who started dual antiplatelet therapy (APT) with aspirin and clopidogrel after recent implantation of drug-eluting coronary stent and developed massive bleeding due to large duodenal gastrointestinal stromal tumour (GIST). Following endoscopic haemostasis and discontinuation of dual APT, neoadjuvant chemotherapy with imatinib was started under continuation of 'single' APT with aspirin. A good chemotherapeutic response was achieved without recurrence of bleeding, and subsequent less invasive surgical resection of the tumour was performed, while preoperative single APT was continued for prevention of stent thrombosis. The patient recovered well without any thromboembolic or bleeding events. Neoadjuvant imatinib therapy and subsequent less invasive surgery under continuation of APT is one of the preferred approaches for patients with duodenal GIST with severe thromboembolic comorbidities, as in the current case. PMID:24777088

Fukuyama, Keita; Fujikawa, Takahisa; Kuramitsu, Shoichi; Tanaka, Akira

2014-01-01

314

Relationship Between Vein Graft Failure and Subsequent Clinical Outcomes After Coronary Artery Bypass Surgery  

PubMed Central

Background Vein graft failure (VGF) is common after coronary artery bypass graft surgery, but its relationship with long-term clinical outcomes is unknown. In this retrospective analysis, we examined the relationship between VGF, assessed by coronary angiography 12 to 18 months after coronary artery bypass graft surgery, and subsequent clinical outcomes. Methods and Results Using the Project of Ex Vivo Vein Graft Engineering via Transfection IV (PREVENT IV) trial database, we studied data from 1829 patients who underwent coronary artery bypass graft surgery and had an angiogram performed up to 18 months after surgery. The main outcome measure was death, myocardial infarction, and repeat revascularization through 4 years after angiography. VGF occurred in 787 of 1829 patients (43%). Clinical follow-up was completed in 97% of patients with angiographic follow-up. The composite of death, myocardial infarction, or revascularization occurred more frequently among patients who had any VGF compared with those who had none (adjusted hazard ratio, 1.58; 95% confidence interval, 1.21–2.06; P=0.008). This was due mainly to more frequent revascularization with no differences in death (adjusted hazard ratio, 1.04; 95% confidence interval, 0.71–1.52; P=0.85) or death or myocardial infarction (adjusted hazard ratio, 1.08; 95% confidence interval, 0.77–1.53; P=0.65). Conclusions VGF is common after coronary artery bypass graft surgery and is associated with repeat revascularization but not with death and/or myocardial infarction. Further investigations are needed to evaluate therapies and strategies for decreasing VGF to improve outcomes in patients undergoing coronary artery bypass graft surgery.

Lopes, Renato D.; Mehta, Rajendra H.; Hafley, Gail E.; Williams, Judson B.; Mack, Michael J.; Peterson, Eric D.; Allen, Keith B.; Harrington, Robert A.; Gibson, C. Michael; Califf, Robert M.; Kouchoukos, Nicholas T.; Ferguson, T. Bruce; Alexander, John H.

2013-01-01

315

High Thoracic Epidural Anesthesia for Coronary Artery Bypass Grafting Using Two Different Surgical Approaches in Conscious Patients  

Microsoft Academic Search

Recent developments in coronary artery bypass graft surgery (CABG) without cardiopulmonary bypass made the sole use of high thoracic epidural anesthe- sia (TEA) in conscious patients feasible. Previously, TEA has been reported only for single-vessel CABG via lateral thoracotomy. We investigated the feasibil- ity and complications of sole TEA in 20 patients un- dergoing beating-heart arterial revascularization via partial lower

Paul Kessler; Gerd Neidhart; Dorothee H. Bremerich; Tayfun Aybek; Selami Dogan; Volker Lischke; Christian Byhahn

2002-01-01

316

CAROTID ULTRASOUND, BLOOD LIPIDS AND WAIST DETERMINATION CAN PREDICT A FUTURE CORONARY REVASCULARISATION IN THE TYPE 2 DIABETIC COHORT  

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

317

Myocardial viability during dobutamine echocardiography predicts survival in patients with coronary artery disease and severe left ventricular systolic dysfunction  

Microsoft Academic Search

Objectives. The purpose of this study was to assess whether the presence or absence of myocardial viability during dobutamine echocardiography (DE) predicts survival in patients with coronary artery disease (CAD) and severe left ventricular (LV) dysfunction.Background. In patients with CAD, the presence of myocardial viability during DE identifies viable myocardium and predicts recovery of LV systolic function after revascularization. However,

Imran Afridi; Paul A Grayburn; Julio A Panza; Jae K Oh; William A Zoghbi; Thomas H Marwick

1998-01-01

318

Vascular complications of intra-aortic balloon insertion in patients undergoing coronary reavscularization: analysis of 911 cases  

Microsoft Academic Search

Objective: Intra-aortic balloon pump (IABP) is a well-accepted and widely used mechanical circulatory support in cardiac surgical practice. We evaluated the vascular complications of IABP and risk factors associated with the development of these complications in patients undergoing myocardial revascularization. Methods: Between January 1994 and December 2000, a total of 911 patients undergoing coronary artery bypass grafting received IABP. The

Zile Singh Meharwal; Naresh Trehan

2002-01-01

319

Vascular complications of intra-aortic balloon insertion in patients undergoing coronary reavscularization: analysis of 911 cases  

Microsoft Academic Search

Objective: Intra-aortic balloon pump (IABP) is a well-accepted and widely used mechanical circulatory support in cardiac surgical practice. We evaluated the vascular complications of IABP and risk factors associated with the development of these complications in patients undergoing myocardial revascularization. Methods: Between January 1994 and December 2000, a total of 911 patients undergoing coronary artery bypass grafting received IABP. The

Zile Singh Meharwal; Naresh Trehan

2010-01-01

320

Successful surgical treatment with mitral valve replacement and coronary embolectomy in a patient with active infective endocarditis complicated by multiple septic embolisms involving cerebral arteries and the right coronary artery.  

PubMed

The proper management of a patient with active infective endocarditis (IE) remains to be determined, especially when his or her condition is complicated with intracranial mycotic aneurysm. Here we present a 46-year-old company employee hospitalized with a subarachnoid hemorrhage caused by a ruptured mycotic aneurysm. Cardiac echography showed a verruca on the posterior mitral cusp and leaflet destruction, resulting in severe valvular regurgitation (determined pathogen was ?-streptococcus). High-dose antibiotic infusion and restriction of physical activity to prevent heart failure were combined with emergency craniotomy drainage and coiling of the necks of two cerebral mycotic aneurysms. After 2 months of conservative therapy for IE, he suddenly collapsed with hypotension and bradycardia because of embolic occlusion of the proximal right coronary artery (RCA). An emergent operation was carried out to remove the emboli in the RCA and to replace the mitral valve with a mechanical prosthesis. The postoperative course was uneventful. Although disturbances of spatial recognition and manual dexterity remained, he was able to walk and talk. After postoperative sufficient-duration antibiotic therapy, which lasted 20 days, he was transferred to a rehabilitation center. PMID:20859727

Yamasaki, Manabu; Watanabe, Sunao; Abe, Kohei; Uenishi, Michiko; Kawazoe, Kohei

2010-09-01

321

Immediate Results and Six-Month Clinical Outcome after Percutaneous Coronary Intervention in Patients with Prior Coronary Artery Bypass Surgery  

PubMed Central

Background Redo coronary artery bypass grafting surgery (CABG) is associated with a higher risk of mortality than the first operation. However, the impact of percutaneous coronary intervention (PCI) on the outcome in such patients is currently unclear. We evaluated the in-hospital and six-month clinical outcomes of post-CABG patients who underwent PCI in our center. Methods Between April 2008 and July 2009, 71 post-CABG patients (16 women and 55 men) underwent 110 stent implantations (74% drug-eluting stents) for 89 lesions. Sixty percent of the PCI procedures were performed on the native coronary arteries, 32% on graft arteries, and 8% on both types of vessels. Major adverse cardiac events (MACE) were recorded in hospital and at six months’ follow-up. Results The procedural success rate was 93%, and the in-hospital MACE rate was 5.6 % (1 death, 3 myocardial infarctions). At 6 months, the incidence of MACE was 5.6% (no death or myocardial infarction, but 4 target lesion revascularizations) and 4 (5.6 %) in-stent restenoses. There was no statistically significant difference in the comparison of MACE between the patients treated in either native arteries or in the grafts (15% vs.12%, p value = 0.8). According to the univariate analysis, hypertension and the use of the bare metal stent vs. the drug-eluting stent were the significant predictors of MACE, whereas the multivariate analysis showed that only hypertension (OR = 3.7, 95% CI 3.4–4, p value < 0.048) was the independent predictor of MACE. The mean of the left ventricular ejection fraction had no effect on the incidence of MACE (p value = 0.9). The multivariate analysis showed hypertension (p value < 0.048) and the use of the bare metal stent (p value < 0.018) were the independent predictors of MACE. The chronic total occlusion (CTO) (p value < 0.01) was the independent predictor of the success rate. The prevalence of diabetes had no impact on the incidence of MACE according to the univariate analysis (p value = 0.9). Our multivariate analysis showed that hypertension and the use of the bare metal stent were the independent predictors of MACE and that chronic total occlusion was the independent predictor of the procedural failure rate. Conclusion PCI is preferable to redo CABG for post-CABG patients. The independent predictors of MACE were hypertension and bare metal stents.

Behboudi, Fatemeh; Vakili, Hossein; Hashemi, Seyed Reza; Hekmat, Manouchehr; Safi, Morteza; Namazi, Mohammad Hasan

2011-01-01

322

Comparison of Bare-Metal Stents and Drug-Eluting Stents in Coronary Ostial Lesions (from the National Heart, Lung, and Blood Institute Dynamic Registry)  

PubMed Central

We compared the effectiveness of drug-eluting stents (DESs) to bare-metal stents (BMSs) in ostial lesions from an unrestricted patient cohort with 3-year follow-up. DESs have proved more effective at decreasing repeat revascularization rates compared to BMSs in patients with uncomplicated coronary artery disease. Whether DESs provide similar benefits in ostial lesions is not clearly defined. We analyzed data from 775 patients in the National, Heart, Lung, and Blood Institute Dynamic Registry undergoing stenting of ostial lesions with DESs or BMSs. Patients were followed for 3 years for the occurrence of myocardial infarction (MI), repeat revascularization (coronary bypass surgery/repeat percutaneous coronary intervention), and death. In total 439 patients had 464 ostial lesions treated with BMSs and 336 patients had 351 ostial lesions treated with DESs. Adjusted DES versus BMS 3-year hazard ratios were 1.03 (95% confidence interval 0.60 to 1.78, p = 0.90) for death, 1.40 (0.83 to 2.37, p = 0.21) for MI, and 0.81 (0.59 to 1.11, p = 0.19) for repeat revascularization. In patients undergoing percutaneous coronary intervention for aorto-ostial disease (n = 200), death and repeat revascularization did not differ between stent types, but DES-treated patients had more MI during follow-up. For coronary ostial disease (n = 574), 3-year observed rates of death or MI did not differ; however, repeat revascularization was more common in the BMS group. In conclusion, use of DESs for ostial lesions was associated with no difference in the hazard of death, MI, or overall rates of repeat revascularization compared to BMS use.

Vasaiwala, Samip; Vlachos, Helen; Selzer, Faith; Marroquin, Oscar; Mulukutla, Suresh; Abbott, J. Dawn; Williams, David O.

2012-01-01

323

[Local development of coronary angioplasty].  

PubMed

From December 1980 to January 1989, over 1600 coronary angioplasty procedures were performed at the University Hospital of Geneva. The increase in interventions per year has been particularly marked since 1983 and coronary angioplasty procedures have since outnumbered coronary bypass operations, although the latter have been increasing too. The shortening of the waiting list for bypass surgery and the ageing of the surgical population can be attributed to coronary angioplasty. In the German-speaking part of Switzerland and in the country as a whole, coronary bypass surgery still dominates angioplasty in terms of numbers. Multivessel coronary angioplasty has decreased in importance in Geneva and accounts currently for about 10% of the procedures. The general growth of coronary angioplasty is therefore due to improvement in early detection of coronary artery disease, thus yielding good candidates for angioplasty, and to more frequent attempts at recanalization of chronic total coronary occlusions. This development is in keeping with that observed at the University Hospital of Lausanne but contrasts with those at the University Hospitals of Basel and Zurich. There, coronary angioplasty has gained importance only over the last 2 years, due to extension of indications to multivessel angioplasty. Primary success of the most recent 1500 interventions in Geneva was 85% with an incidence of major complications of 6% (infarction 3.5%, emergency surgery 2.0%, death 0.5%). In spite of technical improvements, there has been no persistent amelioration of results of coronary angioplasty over time. This may be explained by the fact that technically more intricate lesions (e.g., chronic total occlusions) have been tackled.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2529632

Meier, B

1989-07-29

324

Mid term results after bone marrow laser revascularization for treating refractory angina  

PubMed Central

Background To evaluate the midterm results of patients with angina and diffuse coronary artery disease treated with transmyocardial revascularization in combination with autologous stem cell therapy. Methods Nineteen patients with diffuse coronary artery disease and medically refractory class III/IV angina were evaluated between June 2007 and December 2009 for sole therapy TMR combined with intramyocardial injection of concentrated stem cells. At the time of surgery, autologous bone marrow (120cc) was aspirated from the iliac crest. A cardiac MRI and an isotopic test were performed before and after the procedure. Follow-up was performed by personal interview. Results There were no perioperative adverse events including no arrhythmias. Mean number of laser channels was 20 and the mean total number of intramyocardially injected cells per milliliter were: total mononuclear cells(83.6 × 106), CD34+ cells(0.6 × 106), and CD133+ cells(0.34 × 106). At 12 months mean follow-up average angina class was significantly improved (3.4 ± 0.5 vs 1.4 ± 0.6; p = 0.004). In addition, monthly cardiovascular medication usage was significantly decreased (348 ± 118 vs. 201 ± 92; p = 0.001). At six months follow up there was a reduction in the number of cardiac hospital readmissions (2.9 ± 2.3 vs. 0.5 ± 0.8; p < 0.001). MRI showed no alterations regarding LV volumes and a 3% improvement regarding ejection fraction. Conclusions The stem cell isolator efficiently concentrated autologous bone marrow derived stem cells while the TMR/stem cell combination delivery device worked uneventfully. An improvement in clinical status was noticed in the midterm follow-up. Images test showed no morphological alterations in the left ventricle after the procedure.

2010-01-01

325

Cavernous artery revascularization in vasculogenic impotence: new simplified technique.  

PubMed

A new simplified technique of cavernous artery revascularization is presented. The arterial inflow to the corpora is obtained through a counterflow end-to-end anastomosis of the inferior epigastric artery to the proximal stump of the transected dorsal penile artery. The revascularization of the cavernous artery occurs through the common penile artery. This operation is particularly suitable for patients showing pudendal or common penile artery obstruction at arteriography. Optimal distal perfusion is obtained by a cross end-to-side anastomosis of the distal stump of the dorsal artery to the contralateral dorsal penile artery. To date 5 patients have been operated on using this method with good functional results in 80 per cent. PMID:3603904

Carmignani, G; Pirozzi, F; Spano, G; Corbu, C; De Stefani, S

1987-07-01

326

PERFUSION FOR MYOCARDIAL REVASCULARIZATION WITHOUT AN ARTIFICIAL OXYGENATOR (New Method to Reduce Surgical Morbidity)  

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

1979-01-01

327

Laser–Tissue Interaction During Transmyocardial Laser Revascularization  

Microsoft Academic Search

Background. The clinical procedure known as transmyocardial revascularization has recently seen its renaissance. Despite the promising preliminary clinical results, the associated mechanisms are subject to much discussion. This study is an attempt to unravel the basics of the interaction between 800-W CO2 laser radiation and biological tissue.Methods. Time-resolved flash photography was used to visualize the laser-induced channel formation in water

E. Duco Jansen; Martin Frenz; Kamuran A Kadipasaoglu; T. Joshua Pfefer; Hans J Altermatt; Massoud Motamedi; Ashley J Welch

1997-01-01

328

Laser-Tissue Interaction During Transmyocardial Laser Revascularization  

Microsoft Academic Search

Background. The clinical procedure known as trans- myocardial revascularization has recently seen its renais- sance. Despite the promising preliminary clinical results, the associated mechanisms are subject to much discus- sion. This study is an attempt to unravel the basics of the interaction between 800-W CO2 laser radiation and bio- logical tissue. Methods. Time-resolvedflash photography was used to visualize the laser-induced

E. Duco Jansen; Martin Frenz; Kamuran A. Kadipasaoglu; T. Joshua Pfefer; Hans J. Altermatt; Massoud Motamedi; Ashley J. Welch

329

Laser-tissue interaction during transmyocardial laser revascularization  

Microsoft Academic Search

The clinical procedure known as transmyocardial revascularization has recently seen its renaissance. Despite the promising preliminary clinical results, the associated mechanisms are subject to much discussion. This study is an attempt to unravel the basics of the interaction between 800 W carbon-dioxide laser radiation and biological tissue. Time-resolved flash photography was used to visualize the laser-induced channel formation in water

E. Duco Jansen; Martin Frenz; Kamuran A. Kadipasaoglu; T. Joshua Pfefer; Hans J. Altermatt; Massoud Motamedi; Ashley J. Welch

1996-01-01

330

Prophylactic Tranexamic Acid and ?-Aminocaproic Acid for Primary Myocardial Revascularization  

Microsoft Academic Search

Background. The efficacy of prophylactic ?-aminocaproic acid and tranexamic acid to reduce transfusions after primary myocardial revascularization was evaluated in a teaching hospital context.Methods. Patients (n = 134) received either ?-aminocaproic acid (15-g bolus + infusion of 1 g\\/h), high-dose tranexamic acid (10-g bolus + placebo infusion), or normal saline solution in a double-blind fashion. Anticoagulation and conduct of cardiopulmonary

Jean-François Hardy; Sylvain Bélisle; Charles Dupont; François Harel; Danielle Robitaille; Micheline Roy; Lyne Gagnon

1998-01-01

331

Early and mid-term results of minimally invasive coronary artery bypass grafting  

PubMed Central

Introduction Minimally invasive coronary artery bypass grafting (MICABG) is a less invasive method of performing surgical revascularization. This technique coupled with use of off pump technique of surgical revascularization makes it truly less invasive. This method is highly effective even in high-risk patients. Results of this procedure are comparable to standard off pump technique and are better than percutaneous coronary intervention utilizing drug-eluting stent. We present an early and mid-term result of the use of this technique. Method We enrolled 33 patients for analysis operated between 2008 and 2012. Operation was performed utilizing off-pump technique of coronary artery bypass grafting through a minimal invasive incision. Left internal mammary artery graft was done for single vessel disease and radial artery was utilized for other grafts if required. Median follow up of 2.5 years (6 months–4 years) is available. Results Median age was 58.5 years (41–77) and all were male. Single vessel disease was present in 7, double vessel in 14 and triple vessel disease in 12 patients. All the patients had normal left ventricular size and function. There was no operative and 30-day mortality. Conversion to median sternotomy to complete the operation was done in 6.6% (2 out of 33 patients). One patient had acute myocardial infarction and there were no deaths during follow up. Conclusion MICABG is a safe and effective method of revascularization in low risk candidates for coronary artery bypass grafting.

Pande, Shantanu; Agarwal, Surendra K.; Gupta, Devendra; Mohanty, Satayapriya; Kapoor, Aditya; Tewari, Satyendra; Bansal, Anubhav; Ambesh, Sushil P.

2014-01-01

332

Cardiac Power Index, Mean Arterial Pressure, and Simplified Acute Physiology Score II Are Strong Predictors of Survival and Response to Revascularization in Cardiogenic Shock.  

PubMed

Short-term prognostic factors in patients with cardiogenic shock (CS) have previously been established using only hemodynamic parameters without taking into account classic intensive care unit (ICU) severity score or organ failure/support. The aim of this study was to assess early predictors of in-hospital mortality of a monocentric cohort of patients with ST-elevation myocardial infarction complicated by early CS. We retrospectively studied 85 consecutive patients with CS complicating acute myocardial infarction and Thrombolysis in Myocardial Infarction flow grade 3 after percutaneous coronary revascularization. All patients were managed according to the following algorithm: initial resuscitation by a mobile medical unit or in-hospital critical care physician unit followed by percutaneous coronary revascularization and CS management in the ICU. Prehospital CS was diagnosed in 69% of cases, initially complicated by an out-of-hospital cardiac arrest in 64% of cases. All patients were treated with vasopressors, 82% were ventilated, and 22% underwent extrarenal epuration. The 28-day mortality rate was 39%. Under multivariate analysis, initial cardiac power index, mean arterial pressure of less than 75 mmHg at hour 6 of ICU management, and Simplified Acute Physiology Score II were independent predictive factors of in-hospital mortality. In conclusion, parameters directly related to cardiac performance and vascular response to vasopressors and admission Simplified Acute Physiology Score II are strong predictors of in-hospital mortality. PMID:24827392

Popovic, Batric; Fay, Renaud; Cravoisy-Popovic, Aurelie; Levy, Bruno

2014-07-01

333

Association between adiponectin production in coronary circulation and future cardiovascular events in patients with coronary artery disease.  

PubMed

Adiponectin has antiatherosclerotic properties and is also produced in the local coronary circulation. We previously reported that significantly less adiponectin was produced in the coronary circulation of patients with than without coronary artery disease (CAD). The goal of this study was to determine whether adiponectin production in the coronary circulation could predict future cardiovascular events in patients with CAD.Forty-eight CAD patients whose left anterior descending coronary arteries required percutaneous coronary intervention (PCI) were enrolled. The amount of adiponectin production in the coronary circulation was defi ned as the plasma adiponectin level at the great cardiac vein minus that at the orifice of the left coronary artery. All patients were divided by adiponectin production level in the coronary circulation into the adiponectin-positive production group (> 0 µg/ mL) and adiponectin-negative production group (? 0 µg/mL). Median follow-up period was 66 months (maximum, 108 months). The primary endpoint was the combined occurrence of major adverse cardiovascular events (MACE), including rehospitalization due to unstable angina, heart failure, nonfatal myocardial infarction, revascularization with PCI or coronary artery bypass grafting, ischemic stroke, and cardiovascular death.Sixteen MACE occurred. The incidence of MACE was signifi cantly higher in the adiponectin-negative production group than in the adiponectin-positive production group (P = 0.02). In multivariate analysis, adiponectin-negative production was a predictor of MACE (P = 0.03). Kaplan-Meier analysis revealed that the MACE-free rate was signifi cantly lower in the adiponectin-negative production group than in the adiponectin-positive production group.Adiponectin production in the coronary circulation with CAD may be associated with MACE. PMID:24806386

Kawagoe, Junji; Ishikawa, Tetsunori; Iwakiri, Hironao; Date, Haruhiko; Imamura, Takuroh; Kitamura, Kazuo

2014-05-26

334

Combined endarterectomy of the internal carotid artery and persistent hypoglossal artery: an unusual case of carotid revascularization.  

PubMed

Persistence of the hypoglossal artery is an unusual congenital abnormality of the carotid arterial system, and the simultaneous occurrence of atheromatous disease in the internal carotid artery and persistent hypoglossal artery is even more uncommon. Carotid surgery in this situation is challenging, and the surgeon must be aware of potential inherent pitfalls. A 74-year-old woman with asymptomatic stenosis of both internal carotid and hypoglossal arteries associated with occlusion of the contralateral internal carotid artery underwent successful revascularization. The anatomy of this unusual lesion and the surgical strategies, which included cranial nerve dissection and mandibular subluxation, are reviewed. PMID:8769929

Cartier, R; Cartier, P; Hudan, G; Rousseau, M

1996-04-01

335

Combined endarterectomy of the internal carotid artery and persistent hypoglossal artery: an unusual case of carotid revascularization  

PubMed Central

Persistence of the hypoglossal artery is an unusual congenital abnormality of the carotid arterial system, and the simultaneous occurrence of atheromatous disease in the internal carotid artery and persistent hypoglossal artery is even more uncommon. Carotid surgery in this situation is challenging, and the surgeon must be aware of potential inherent pitfalls. A 74-year-old woman with asymptomatic stenosis of both internal carotid and hypoglossal arteries associated with occlusion of the contralateral internal carotid artery underwent successful revascularization. The anatomy of this unusual lesion and the surgical strategies, which included cranial nerve dissection and mandibular subluxation, are reviewed.

Cartier, Raymond; Cartier, Paul; Hudon, Gilles; Rousseau, Marc

1996-01-01

336

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

2010-01-01

337

Thirty-year patency of a coronary sequential venous bypass graft.  

PubMed

The optimal conduit of second choice in surgical coronary revascularization  remains a matter of debate. Radial artery grafts are believed to have a better patency rate than the saphenous vein grafts, although no conclusive results have been reported. This report describes the late result of a coronary revascularization with sequential venous bypass performed 30 years earlier.MethodsAn 80-year-old woman was admitted for dyspnoea on exertion and recent-onset angina due to severe aortic valve stenosis. Thirty years earlier, the patient had undergone revascularization with coronary bypass grafting performed using a sequential saphenous vein graft anastomosed on first diagonal branch and on left anterior descending coronary artery. Coronary angiography showed the occlusion of the native left anterior descending artery and the good patency of the previous described sequential vein graft.ResultsSurgical inspection confirmed the patency and the soft pliability of the venous graft and the surgeon decided to do not replace the previous graft with a pedicled LIMA (Left Internal Mammary Artery) graft.   The patient underwent 21-mm biological Edwards Perimount Magna Ease prosthesis implantation. Postoperative course was uneventful and the patient was discharged on the seventh day after surgery.ConclusionsThis case report demonstrated the potential extreme long-term patency of a sequential saphenous vein graft in coronary bypass surgery, raising the question if vein grafts should be really considered the conduits of last resort for coronary artery bypass surgery. Long-term follow-up of randomized trials comparing radial artery versus saphenous vein grafts are warranted in order to give conclusive  answers to this ongoing debate. PMID:24897971

Molardi, Alberto; Nicolini, Francesco; Benassi, Filippo; Gallingani, Alan; Gherli, Tiziano; Spaggiari, Igino

2014-01-01

338

Coronary Angioplasty  

MedlinePLUS

... Risks Clinical Trials Links Spanish Version Related Topics Atherosclerosis Coronary Heart Disease Cardiac Catheterization Heart Attack Stents ... up inside your arteries. This condition is called atherosclerosis (ath-er-o-skler-O-sis). Atherosclerosis can ...

339

Coronary Calcium Scan  

MedlinePLUS

... 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 ...

340

Isolated Left Main Coronary Artery Stenosis after Thoracic Radiation Therapy: To Operate or Not to Operate  

PubMed Central

Radiation therapy of neoplasms involving the chest or mediastinum results in a wide spectrum of cardiac complications including coronary artery disease, which can present in patients with few or no traditional cardiac risk factors. We report a case of radiation induced coronary artery disease in a 60-year-old female with a history of stage IIIA nonsmall cell lung carcinoma which was diagnosed eight years earlier and treated with chemotherapy and radiotherapy. She presented to the hospital with atypical chest pain that had occurred intermittently over the preceding week. Her initial electrocardiogram and cardiac enzymes were within normal limits. However, following an indeterminate exercise nuclear stress test, she developed chest pain and elevated cardiac enzymes. Coronary angiography demonstrated 90% stenosis of the left main coronary artery ostium, without any evidence of atherosclerotic disease or stenosis in other coronary arteries. She underwent surgical revascularization, which revealed dense adhesions surrounding the heart. During surgery, she developed severe bleeding and died. Coronary artery disease can present within years of radiation exposure, and ostial lesions are typical. Treatment is often challenging because of the effects of radiation on other tissues and the risks of revascularization procedures. Therefore, a multidisciplinary team approach should be considered.

Alsara, Osama; Alsarah, Ahmad; Kalavakunta, Jagadeesh K.; Abela, George S.

2013-01-01

341

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.

2009-01-01

342

Depression treatment in patients with coronary artery disease: a systematic review.  

PubMed

Objective: Depression has been linked to adverse coronary artery disease outcomes. Whether depression treatment improves or worsens coronary artery disease prognosis is unclear. This 25-year systematic review examines medical outcomes, and, secondarily, mood outcomes of depression treatment among patients with coronary artery disease. Data Sources: We systematically reviewed the past 25 years (January 1, 1986-December 31, 2011) of prospective trials reporting on the medical outcomes of depression treatment among patients with established coronary artery disease using keywords and MESH terms from OVID MEDLINE. Search 1 combined depression AND coronary artery disease AND antidepressants. Search 2 combined depression AND coronary artery disease AND psychotherapy. Search 3 combined depression AND revascularization AND antidepressants OR psychotherapy. Study Selection: English-language longitudinal randomized controlled trials, with at least 50 depressed coronary artery disease patients, reporting the impact of psychotherapy and/or antidepressants on cardiac and mood outcomes were included. Data Extraction: Data extracted included author name, year published, number of participants, enrollment criteria, depression definition/measures (standardized interviews, rating scales), power analyses, description of control arms and interventions (psychotherapy and/or medications), randomization, blinding, follow-up duration, follow-up loss, depression scores, and medical outcomes Results: The review yielded 10 trials. Antidepressant and/or psychotherapy did not significantly influence coronary artery disease outcomes in the overall population, but most studies were underpowered. There was a trend toward worse coronary artery disease outcomes after treatment with bupropion. Conclusions: After an acute coronary syndrome, depression often spontaneously remitted without treatment. Post-acute coronary syndrome persistence of depression predicted adverse coronary artery disease outcomes. Antidepressant and/or psychotherapy, particularly as part of the Coronary Psychosocial Evaluation Studies intervention, may improve prognosis in persistent depression among post-acute coronary syndrome patients. Noradrenergic antidepressants should be prescribed cautiously in patients with coronary artery disease. PMID:24511449

Ramamurthy, Gita; Trejo, Edgardo; Faraone, Stephen V

2013-01-01

343

Myocardial Revascularization in Dyalitic Patients: In-Hospital Period Evaluation  

PubMed Central

Background Coronary artery bypass grafting currently is the best treatment for dialytic patients with multivessel coronary disease, but hospital morbidity and mortality related to procedure is still high. Objective Evaluate results and in-hospital outcomes of coronary artery bypass grafting in dialytic patients. Methods Retrospective unicentric study including 50 consecutive and not selected dialytic patients, who underwent coronary artery bypass grafting in a tertiary university hospital from 2007 to 2012. Results High prevalence of cardiovascular risk factors was observed (100% hypertensive, 68% diabetic and 40% dyslipidemic). There was no intra-operative death and 60% of the procedures were performed off-pump. There were seven (14%) in-hospital deaths. Postoperative infection, previous heart failure, cardiopulmonary bypass, abnormal ventricular function and surgical re-exploration were associated with increased mortality. Conclusion Coronary artery bypass grafting is feasible to dialytic patients although high in-hospital morbidity and mortality. It is necessary better understanding about metabolic aspects to plan adequate interventions.

Miranda, Matheus; Hossne, Nelson Americo; Branco, Joao Nelson Rodrigues; Vargas, Guilherme Flora; da Fonseca, Jose Honorio de Almeida Palma; Pestana, Jose Osmar Medina de Abreu; Juliano, Yara; Buffolo, Enio

2014-01-01

344

Does Intraoperative Evaluation of Left Ventricular Contractile Reserve Predict Myocardial Viability? A Clinical Study Using Dobutamine Stress Echocardiography in Patients Undergoing Coronary Artery Bypass Graft Surgery  

Microsoft Academic Search

To determine the contractile reserve of the left ventricle dur- ing reperfusion as a predictor of myocardial viability in pa- tients undergoing coronary artery bypass graft surgery, we measured the response of left ventricular regional wall mo- tion and thickening by using dobutamine stress echocardi- ography (DSE) after myocardial revascularization. All pa- tients were monitored with radial and pulmonary arterial

Jancqueline M. Leung; Wayne H. Bellows; Darwin Pastor

2004-01-01

345

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

1997-01-01

346

Repair of mycotic coronary aneurysm without cardiopulmonary bypass: case report.  

PubMed

Mycotic aneurysms of the coronary arteries are extremely rare, with 15 cases reported. We report the successful treatment of a mycotic aneurysm of the left anterior descending coronary artery by coronary artery bypass grafting with aneurysm ligation and resection without the use of cardiopulmonary bypass. PMID:15454373

Pratt, Jerry W; Kukielka, Gilbert; Brown, David A

2004-01-01

347

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

2013-01-01

348

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

2011-01-01

349

Gender gap in acute coronary heart disease: Myth or reality?  

PubMed Central

AIM: To investigate potential gender differences in the prevalence of cardiovascular risk factors, cardiovascular disease (CVD) management, and prognosis in acute coronary syndrome (ACS). METHODS: A systematic literature search was performed through Medline using pre-specified keywords. An additional search was performed, focusing specifically on randomized controlled clinical trials in relation to therapeutic intervention and prognosis. In total, 92 relevant articles were found. RESULTS: Women with CVD tended to have more hypertension and diabetes at the time of presentation, whereas men were more likely to smoke. Coronary angiography and revascularization by percutaneous coronary intervention were performed more often in men. Women were at a greater risk of short-term mortality and complications after revascularization. Interestingly, women under 40 years presenting with ACS were at highest risk of cardiovascular death compared with men of the same age, irrespective of risk factors. This disadvantage disappeared in older age. The long-term mortality risk of ACS was similar in men and women, and even in favor of women. CONCLUSION: Mortality rates are higher among young women with ACS, but this difference tends to disappear with age, and long-term prognosis is even better among older women.

Claassen, Mette; Sybrandy, Kirsten C; Appelman, Yolande E; Asselbergs, Folkert W

2012-01-01

350

Off-pump versus on-pump coronary bypass in high-risk subgroups  

Microsoft Academic Search

Background. Cardiopulmonary bypass (CPB) has pathophysiologic sequelae that may be more severe in high-risk subsets. We wanted to determine whether off-pump coronary bypass (OPCAB) could optimize outcomes.Methods. Our database of 242 OPCAB patients undergoing complete revascularization was compared to a base of 483 CABG patients undergoing CPB. Results were compared for the overall series and in the following high-risk subsets:

Taro Yokoyama; Fritz J Baumgartner; Ali Gheissari; Eli R Capouya; George P Panagiotides; Richard J Declusin

2000-01-01

351

Interposition vein graft for giant coronary aneurysm repair  

NASA Technical Reports Server (NTRS)

Coronary aneurysms in adults are rare. Surgical treatment is often concomitant to treating obstructing coronary lesions. However, the ideal treatment strategy is poorly defined. We present a case of successful treatment of a large coronary artery aneurysm with a reverse saphenous interposition vein graft. This modality offers important benefits over other current surgical and percutaneous techniques and should be considered as an option for patients requiring treatment for coronary aneurysms.

Firstenberg, M. S.; Azoury, F.; Lytle, B. W.; Thomas, J. D.

2000-01-01

352

Long-term functional status and quality of life after lower extremity revascularization  

Microsoft Academic Search

Objective: The objective of this study was to assess the longer term (up to 7 years) functional status and quality of life outcomes from lower extremity revascularization. Methods: This study was designed as a cross-sectional telephone survey and chart review at the University of Minnesota Hospital. The subjects were patients who underwent their first lower extremity revascularization procedure or a

Jeremy Holtzman; Michael Caldwell; Craig Walvatne; Robert Kane

1999-01-01

353

Combined revascularization surgery for childhood moyamoya disease: STA-MCA and encephalo-duro-arterio-myo-synangiosis  

Microsoft Academic Search

We present surgical techniques for optimal revascularization in childhood moyamoya disease. During the past 10 years we performed\\u000a revascularization surgery for childhood moyamoya disease using direct revascularization with superficial temporal artery to\\u000a middle cerebral artery (STA-MCA) anastomosis and indirect revascularization of encephalo-duro-arterio-myo-synangiosis (EDAMS)\\u000a 43 times. Points of this surgery are as follows: (1) craniotomy and durai opening for the most

Kiyohiro Houkin; Hiroyasu Kamiyama; Akihiro Takahashi; Satoshi Kuroda; Hiroshi Abe

1997-01-01

354

A probability database for decision-analytic models of coronary revascularization procedures.  

PubMed Central

The time required to extract probabilities from medical literature is a primary reason decision analysis is not used more frequently for individual patient management decisions. Objective clinical trial information from the medical literature for one management decision was placed in a database which provided probabilities when queried. The database was tested with decision-analytic models of specific patient cases from the medical literature. Performance was assessed in terms of the ability to select trials which resembled the patients' individual characteristics, the number of trials providing probabilities for a given outcome, and the number of follow-up points available for that outcome. The timely assistance the database provides in expediting literature review and synthesis could enable the more common use of decision analysis in management decisions for individual patients.

Murphy, J. F.; Marrs, K. A.; Kahn, M. G.

1995-01-01

355

Restenosis after directional coronary atherectomy and balloon angioplasty: comparative analysis based on matched lesions  

Microsoft Academic Search

OBJECTIVES. Late lumen narrowing after directional coronary atherectomy was assessed by quantitative coronary angiography and compared with that after balloon angioplasty. BACKGROUND. Directional coronary atherectomy has been introduced as an alternative technique for balloon angioplasty and may reduce the incidence of restenosis. METHODS. A prospectively collected consecutive series of 87 native coronary artery lesions successfully treated with atherectomy were matched

Victor A. Umans; S. Strikwerda; Brand van den M. J. B. M; Jaegere de P; Feyter de P. J; P. W. J. C. Serruys; D. P. Foley; W. R. M. Hermans

1993-01-01

356

Long term outcomes of saphaneous vein graft intervention in elderly patients with prior coronary artery bypass graft  

PubMed Central

Objectives To investigate the procedure characteristics and long term follow-up of percutaneous coronary intervention (PCI) for saphaneous vein graft (SVG) lesions in the elderly patients. Methods From December 2005 to December 2011, 84 graft lesions were treated percutaneously. Seventeen were located at proximal anastomosis, 48 were located at SVG body, 19 were located at distal anastomosis. Primary endpoint was defined as major adverse cardiovascular events (MACE, composite of cardiac death, target vessel revascularization, acute myocardial infarction). Results The graft age was 6.7 ± 4.0 years. Most anastomosis lesions (80.0%) presented within one year post coronary artery bypass grafting (CABG). Proximal anastomosis lesion had the lowest successful rate for PCI compared with graft body and distal anastomosis lesions (70.6% vs. 91.7%, 79.0%, P < 0.05). The distal embolic protection device was used in 19.1% of patients, most frequently used in body graft PCI (29.2%, P < 0.01). The diameter of the stent was smallest in distal anastomosis group (2.9 ± 0.4 mm, P < 0.05). The highest post dilatation pressure was required in the proximal anastomosis (17.8 ± 2.7 atm, P < 0.05). The patients were followed up for 24.3 ± 16.9 months. MACE occurred in 18.57% of patients. Incidence of MACE was highest among proximal anastomosis PCI (47.1% vs. body graft PCI 16.7%, distal anastomosis PCI 21.1%; P < 0.05). Old myocardial infarction was the predictive factor for the poor clinical outcomes (P = 0.04). Conclusions PCI of SVG lesions is feasible with lower success rate. PCI of ostial graft anastomosis lesions had the lowest procedure success rate and highest MACE rate compared with graft body and distal anastomosis lesions. Old myocardial infarction was a predictive factor of poor outcomes.

Wang, Ji-Hong; Liu, Wei; Du, Xin; Ma, Chang-Sheng; Wu, Xue-Si

2014-01-01

357

Baseline clinical and angiographic variables associated with long-term outcome after successful intracoronary stent implantation.  

PubMed

Although randomized studies have demonstrated improved outcomes with stents over balloon angioplasty in straightforward coronary narrowings in low-risk patients, this advantage is less clear for complex lesions and high-risk patients. This study was designed to identify clinical and angiographic variables that are associated with long-term outcome after stent implantation. We identified 1,709 patients undergoing successful stent placement without in-hospital major adverse events. We analyzed clinical, lesional, and procedural variables to determine their correlation with outcome. Mean duration of follow-up was 1.6 +/- 1.4 years. Cox proportional-hazards models and stepwise methods were used to assess which covariates were potentially related to each end point. The occurrence of death/myocardial infarction (MI) was associated with any history of congestive heart failure (relative risk [RR] 3.3, 95% confidence interval [CI] 2.3 to 4.7, p <0.0001), procedure within 24 hours of MI (RR 2.3, CI 1.3 to 4.1, p = 0.0048), vein graft intervention (RR 1.8, CI 1.3 to 2.6, p = 0.0007), and prior MI (RR 1.8, CI 1.2 to 2.6, p = 0.004). Repeat revascularization was associated with multivessel stent placement (RR 1.8, CI 1.2 to 2.8, p = 0.006) and stent for abrupt closure (RR 1.7, CF 1.1 to 2.7, p = 0.03), but was less frequent with de novo lesions and right coronary artery lesions (RR 0.6, CI 0.5 to 0.8, p = 0.0007, and RR 0.8, CI 0.6 to 1.0, p = 0.05, respectively). The cumulative end point of death/MI/repeat revascularization was associated with congestive heart failure (RR 1.7, CI 1.3 to 2.2, p <0.0001), multivessel stent placement (RR 1.6, Cl 1.1 to 2.3, p = 0.03), warfarin therapy (RR 1.4, CI 1.2 to 1.8, p = 0.001), and procedure within 24 hours of MI (RR 1.5, CI 1.1 to 2.1, p = 0.02), but was less frequent with complete revascularization and right coronary artery intervention (RR 0.8, CI 0.7 to 0.99, p = 0.04, and RR 0.7, CI 0.6 to 0.9, p = 0.009, respectively). Thus, this study demonstrates that there are readily identifiable characteristics in patients treated successfully with stents that are associated with long-term outcome. PMID:10513775

Mathew, V; Grill, D E; Scott, C G; Garratt, K N; Holmes, D R

1999-10-01

358

Revascularization of immature permanent incisors after severe extrusive luxation injury.  

PubMed

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

2012-01-01

359

Revascularization of immature permanent incisors after severe extrusive luxation injury.  

PubMed

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

2012-07-01

360

Rejection and indirect revascularization of glycerin-preserved tracheal implant.  

PubMed

The objective of the following study was to evaluate antigenicity, malacia and revascularization in glycerin-preserved canine tracheal allografts. Trachea with six cartilage rings (2.4 to 3.1 cm) were distributed in three study groups: autograft (21), allograft (18) and glycerin-preserved (22). We implanted two segments from different groups in the greater omentum of dogs. After 28 days, latex was injected in the canine aorta before the segments were harvested. We evaluated number of sectors with functional vessels, number of vessels dyed in the submucosa, acute arteritis score, incidence of acute rejection, cartilage lesion score, and malacia. The autograft group had a larger number of dyed vessels than the glycerin-preserved group. The autograft group also had a higher average number of quadrants with functional vessels than the allograft group and the glycerin-preserved group. The allograft group had a higher mean score for acute arteritis than the autograft group and more acute rejection than the glycerin-preserved group. The cartilage lesion score did not show any significant difference between groups. Malacia was not observed in any tracheal segment. Overall, the glycerin-preserved tracheal implant had low antigenicity and good rigidity, but showed incomplete revascularization. PMID:14514556

Saueressig, Maurício G; Moreschi, Alexandre H; Barbosa, Gilberto V; Edelweiss, Maria I A; de Souza, Felipe H; Savegnago, Fabrício L; de Macedo Neto, Amarílio V

2003-09-01

361

[Effectiveness of excimer laser coronary angioplasty in treatment of patients with in-stent restenosis].  

PubMed

In-stent restenosis (ISR), when treated with balloon angioplasty (PTCA) alone, has an angiographic recurrence rate of 30-85%. Ablating the hypertrophic neointimal tissue prior to PTCA is an attractive alternative, however late outcomes of such treatment have not been fully determined. This multicenter case control study assessed angiographic and clinical outcomes of 137 consecutive procedures in 125 patients treated for ISR with either PTCA alone (n = 58) or excimer laser assisted coronary angioplasty (ELCA, n = 67). Demographics were similar. Lesions selected for ELCA compared with those selected for \\PTCA were longer (17.1+/-9.9 mm vs. 13.6+/-9.1 mm; p=0,034), more complex (ACC/AHA type C: 36,5% vs. 14,3%; p=0,006), and with reduced antegrade flow (TIMI flow < 3: 18,9% vs. 4,8%; p = 0,025). ELCA- and PTCA treated patients had similar rates of procedural success (98,5 and 98,3%, respectively, p=1,0), major clinical complications (3,0% and 8,6%; respectively, NS), major cardiac events at 1 year (37,3 and 46,6%. respectively, NS), and target lesion revascularization (32,8 and. 34,5%; respectively, NS). These data suggest that ELCA in patients with complex in-stent restenosis is as safe and effective as PTCA. Despite higher lesion complexity in ELCA-treated patients, no increase in event rates was observed. PMID:14593354

Pershukov, I V; Niiazova-Karben, Z A; Batyraliev, T A; Er?onuchu, B; Giuler, N; Temamogullari, A; Ozgul', S; Akgul', F; Kaday?fchi, S; Serchelik, A; Dogru, O; Demirbash, O; Shengiul', Kh; Karaus, A; Kalenich, O; Preobrazhenski?, D V; Peresypko, M K; Petrakova, L N; Sidorenko, B A

2003-01-01

362

The 'Perfect Storm' and Acute Coronary Syndrome Onset: Do Psychosocial Factors Play a Role?  

PubMed Central

The revolution in cardiac care over the past two decades, characterized by emergent revascularization, drug eluting stents, anti-platelet medications, and advanced imaging has had little impact on overall ACS recurrence, or ACS prevention. The “Perfect Storm” refers to a confluence of events and processes, including atherosclerotic plaque, coronary flow dynamics, hemostatic and fibrinolytic function, metabolic and inflammatory conditions, neurohormonal dysregulation, and environmental events that give rise to, and result in an ACS event. In this article we illustrate the limits of the traditional main effect research model, giving a brief description of the current state of knowledge regarding the development of atherosclerotic plaque and the rupturing of these plaques that defines an ACS event. We then apply the Perfect Storm conceptualization to describe a program of research concerning a psychosocial vulnerability factor that contributes to increased risk of recurrent ACS and early mortality, and that has defied our efforts to identify underlying pathophysiology and successfully mount efforts to fully mitigate this risk.

Burg, Matthew M.; Edmondson, Donald; Shimbo, Daichi; Shaffer, Jonathan; Kronish, Ian M.; Whang, William; Alcantara, Carmela; Schwartz, Joseph E.; Muntner, Paul; Davidson, Karina W.

2013-01-01

363

Novel drug-eluting stents in the treatment of de novo coronary lesions  

PubMed Central

Due to safety concerns in recent years, much effort has been devoted to improving the outcomes associated with drug-eluting stents (DESs). This review summarizes the current status of methodological and technical achievements reported in second-generation DES. Novel stents are described based on the component (the platform, the polymer, and the drug) that has undergone the most significant changes compared to earlier generation DES. An overview of the currently available evidence on the use of novel coronary devices in patients undergoing coronary revascularization is also reviewed.

Capodanno, Davide; Dipasqua, Fabio; Tamburino, Corrado

2011-01-01

364

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

PubMed

Thirty percent of diagnostic angiograms have at least 1 chronic total occlusion (CTO). The 10-year survival of patients with a CTO is improved if they have the CTO successfully recanalized. The success of recanalization with conventional wires is 50% and the impact of new technology on recanalization is unknown. This abstract reports a single center experience with one such new device, the Lumend Frontrunner catheter in revascularization of this difficult lesion subset. A consecutive series of 18 patients with CTO's of native coronary arteries were enrolled in this single center, single operator series. The mean age of the CTO was 5.3 years. The indication for attempt at recanalization was ischemia in the territory of the CTO on SPECT imaging. Success was defined as TIMI flow restoration and < 40% residual stenosis. Primary success (defined as TIMI 3 Flow restoration and < 40% residual stenosis) was achieved in 77% of patients. At 30 days and out to 6 months, clinical TVR was 11% (2/18) in this difficult lesion subset. Conventional predictors of failure to recanalize CTOs do not appear to hold true with the use of the Frontrunner catheter. In this small series, dual cusp injections and use of the Microglide catheter appears to correlate with favorable outcomes. Fluoroscopy times and contrast use are high when attempting recanalization of CTOs with this technology. PMID:16775901

Loli, Akil; Liu, Rex; Pershad, Ashish

2006-06-01

365

Synchronized Coronary Venous Retroperfusion During Coronary Angioplasty  

Microsoft Academic Search

\\u000a Synchronized diastolic coronary venous retroperfusion is a technique by which autologous arterial blood is shunted from the\\u000a femoral artery into the coronary veins. Phasic diastolic occlusion of the coronary sinus by a balloon catheter compartmentalizes\\u000a the coronary venous system, preventing regurgitation of arterial blood into the right atrium. Triggered collapse of the balloon\\u000a during systole facilitates normal physiologic coronary venous

Sheila Kar; Alice K. Jacobs; David P. Faxon

366

Carotid and coronary disease management prior to open and endovascular aortic surgery. What are the current guidelines?  

PubMed

Several bodies produce broadly concurring and updated guidelines for the evaluation and treatment of cardiovascular disease in both surgical and non-surgical patients. Recent developments include revised recommendations on preoperative stress testing, referral for possible coronary revascularization and medical management. It is recognized that non-invasive cardiac tests are relatively poor at predicting perioperative risk, and "prophylactic" coronary revascularization has a limited role. The planned aortic intervention (open or endovascular repair) also influences preoperative management. Patients presenting for elective abdominal aortic aneurysm (AAA) repair should only be referred for cardiological testing if they have active symptoms of coronary artery disease (CAD), known CAD and poor functional exercise capacity, or multiple risk factors for CAD. Coronary revascularization before AAA surgery should be limited to patients with established indications, so cardiac stress testing should only be performed if it would change management i.e. the patient is a candidate for and would benefit from coronary revascularization. When endovascular aortic repair is planned, it is reasonable to proceed to surgery without further cardiac stress testing or evaluation unless otherwise indicated. All non-emergency patients require medical optimization, but perioperative beta blockade benefits only certain patients. Some of the data informing recent guidelines have been questioned and some guidelines are being revised. Current guidelines do not specifically address the management of patients with known or suspected carotid artery disease who may require aortic surgery. For these patients, an individualized approach is required. This review considers recent guidelines. Algorithms for investigation and management based on their recommendations are included. PMID:24796897

Thompson, J P

2014-04-01

367

[Two cases of acute coronary syndrome after intake of Clavis Panax].  

PubMed

Atherosclerotic cardiovascular disease is an epidemic in today's world. It is one of the most common causes of hospitalization and death. Therefore, remedies to control or heal the disease are continuously sought. In addition to scientifically researched therapies, patients frequently utilize alternative medicine. However, effective and toxic doses, metabolisms, and drug interactions of the herbs and herbal nutrition supplements are largely unknown. Herein, we present two cases with acute coronary syndrome. The first case was admitted with a diagnosis of acute inferior myocardial infaction (MI) and a stent was implanted to the occluded right coronary artery (RCA). There was a 50% stenosis in his left anterior descending artery (LAD). He was admitted with a diagnosis of non-ST elevation MI (NSTEMI) 6 months later. In the coronary angiogram, there was stent restenosis in RCA, the lesion in LAD had become thrombotic and progressed to a stenosis of 90%. He was referred to surgical revascularization. The second case was admitted for acute inferior MI and a stent was implanted to the occluded circumflex artery. Two months later, he was hospitalized for NSTEMI. Progression of coronary plaques to stenosis and stent restenosis was detected and he was referred to surgical revascularization. Both patients used the product sold as Clavis Panax, which contains panax ginseng, tribulus terrestris, and oat, after their first coronary intervention. Intake of a mixture of plant extracts may have serious consequences in humans as drug interactions and side effects are unknown. PMID:22864326

Atar, Asl? ?nci; Er, Okan; Güven, Abdullah; Eryonucu, Beyhan

2012-04-01

368

Coronary Subclavian Steal Syndrome: An Unusual Cause of Angina in a Post-CABG Patient  

PubMed Central

Coronary subclavian steal syndrome is a rare complication of coronary artery bypass grafting surgery (CABG) when a left internal mammary artery (LIMA) graft is utilized. This syndrome is characterized by retrograde flow from the LIMA to the left subclavian artery (SA) when a proximal left SA stenosis is present. We describe a unique case of an elderly male who underwent CABG 6 years ago who presented with prolonged chest pain, mildly elevated troponins, and unequal pulses in his arms. A CTA of the chest demonstrated a severely calcified occluded proximal left SA jeopardizing his LIMA graft. Subclavian angiography was performed with an attempt to revascularize the patient's occluded left SA which was unsuccessful. We referred the patient for nuclear stress testing which demonstrated a moderate size area of anterior ischemia on imaging; the patient exercised to a fair exercise capacity of 7 METS with no chest pain and no ECG changes. Subsequent coronary angiography showed severe native three-vessel coronary artery disease with intermittent retrograde blood flow from the LIMA to the left SA distal to the occlusion, jeopardizing perfusion to the left anterior descending (LAD) coronary artery distribution. He declined further options for revascularization and was discharged with medical management.

Page, Brian J.

2014-01-01

369

Ultrasonic coronary angioplasty during coronary artery bypass grafting.  

PubMed

This preliminary study in 20 patients demonstrated that ultrasonic coronary angioplasty in the setting of bypass grafting is feasible, safe, and able to recanalize atherosclerotic vessels. Shorter monorail probes were superior to longer probes without guidewires in terms of success of vessel recanalization; >95% of particle debris was <25 microm in size. PMID:8914887

Eccleston, D S; Cumpston, G N; Hodge, A J; Pearne-Rowe, D; Don Michael, T A

1996-11-15

370

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.  

PubMed

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, Önder; Güven, Bar??; Yozgat, Y?lmaz; Özdemir, Rahmi; Me?e, Timur; Tavl?, Vedide; Alayunt, Emin Alp

2014-01-01

371

Myocardial Edema Imaging in Acute Coronary Syndromes  

PubMed Central

Acute coronary syndromes (ACS) continue to be the most common morbid condition of industrialized nations. The advent of and technical improvements in revascularization and medical therapy have led to a steady decline in mortality rates. However, many patients who suffer unstable angina or myocardial infarction require further testing and risk stratification to guide therapeutic selection and prognosis assignment. Myocardial edema imaging with cardiac magnetic resonance (CMR) affords the ability to define the amount of myocardium at risk, refine estimates of prognosis and provide guidance for therapies with excellent sensitivity compared to standard clinical markers. This review will discuss the rationale for edema imaging, how it is performed using CMR and its potential clinical applications.

Walls, Michael C.; Verhaert, David; Raman, Subha V.

2011-01-01

372

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

2008-01-01

373

Surgical management of a gigantic circumflex coronary artery aneurysm with fistulous connection to the coronary sinus  

Microsoft Academic Search

We report the successful management of a gigantic circumflex coronary artery aneurysm with fistulisation into the coronary sinus. Transoesophageal echocardiography allowed continuous visualisation of ventricular wall motion during dissection and closure of the aneurysm whilst operating on cardiopulmonary bypass on the beating heart.

Martin H. Chamberlain; Ronald Henry; Stacey Brann; Gianni D. Angelini

2001-01-01

374

Health Status after Treatment for Coronary Artery Disease and Type 2 Diabetes in the BARI 2D Trial  

PubMed Central

Background Health status is a key outcome for comparing treatments, particularly when mortality does not differ significantly. Methods and Results BARI 2D randomized 2368 patients with type 2 diabetes and stable ischemic heart disease to 1) prompt revascularization versus medical therapy and 2) insulin sensitization versus insulin provision. Randomization was stratified by the intended method of revascularization, coronary artery bypass graft surgery (CABG) or percutaneous coronary intervention (PCI). The Duke Activity Status Index (DASI) and RAND Energy, Health Distress and Self-rated Health were assessed at study entry and annually thereafter; linear mixed models were used to evaluate the effect of randomized treatment on these measures. Health status improved significantly from baseline to one-year (p<0.001) in each randomized treatment group. Compared with medical therapy, prompt revascularization was associated with significantly greater improvements in DASI (1.32 points, p<0.001), Energy (1.36 points, p=0.02) and Self-rated Health (1.77 points, p=0.007) but not Health Distress (?0.47, p=0.46). These treatment effects were largely maintained over four years of follow-up. The effect of revascularization on DASI was significantly larger in the subgroup of patients intended for CABG compared with the subgroup intended for PCI. Health status did not differ significantly on any of the four measures between the insulin provision and insulin sensitization strategies. Conclusion Prompt coronary revascularization was associated with small yet statistically significant improvements in health status compared with initial medical therapy among patients with diabetes and stable ischemic heart disease.

Brooks, Maria Mori; Chung, Sheng-Chia; Helmy, Tarek; Hillegass, William B.; Escobedo, Jorge; Melsop, Kathryn A.; Massaro, Elaine M.; McBane, Robert D.; Hyde, Pamela; Hlatky, Mark A.

2010-01-01

375

Percutaneous Coronary Intervention using a Full Metal Jacket with Drug-eluting Stents: Major Adverse Cardiac Events at One Year  

PubMed Central

Background The clinical benefit of percutaneous coronary intervention (PCI) for long coronary lesions is unclear; furthermore, concerns have been raised about its safety. Objectives To evaluate the predictors of major adverse cardiac events (MACE) associated with PCI using a full metal jacket (FMJ), defined as overlapping drug-eluting stents (DES) measuring > 60 mm in length, for very long lesions. Methods We enrolled 136 consecutive patients with long coronary lesions requiring FMJ in our single-center registry. The primary endpoint included the combined occurrence of all-cause death, myocardial infarction (MI), and target vessel revascularization (TVR). Demographic, clinical, angiographic, and procedural variables were evaluated using stepwise Cox regression analysis to determine independent predictors of outcome. Results The mean length of stent per lesion was 73.2 ± 12.3 mm and the mean reference vessel diameter was 2.9 ± 0.6 mm. Angiographic success was 96.3%. Freedom from MACE was 94.9% at 30 days and 85.3% at one year. At the one-year follow-up, the all-cause mortality rate was 3.7% (1.5% cardiac deaths), the MI rate was 3.7%, and the incidence of definite or probable stent thrombosis (ST) was 2.9%. Female gender [hazard ratio (HR), 4.40; 95% confidence interval (CI), 1.81-10.66; p = 0.001) and non-right coronary artery PCI (HR, 3.49; 95%CI, 1.42-8.59; p = 0,006) were independent predictors of MACE at one year. Freedom from adverse events at one year was higher in patients with stable angina who underwent PCI (HR, 0.33; 95%CI, 0.13-0.80; p = 0.014). Conclusions PCI using FMJ with DES for very long lesions was efficacious but associated with a high rate of ST at the one-year follow-up. However, the rate of cardiac mortality, nonprocedure-related MI, and MACE was relatively low. Target coronary vessel PCI, clinical presentation, and female gender are new contemporary clinical factors that appear to have adverse effects on the outcome of PCI using FMJ for long lesions.

Cale, Rita; Teles, Rui Campante; Almeida, Manuel; do Rosario, Ingrid; Sousa, Pedro Jeronimo; Brito, Joao; Raposo, Luis; Goncalves, Pedro de Araujo; Gabriel, Henrique Mesquita; Mendes, Miguel

2013-01-01

376

Coronary artery fistula (image)  

MedlinePLUS

A coronary artery fistula generally occurs when one of the coronary arteries fails to form properly during the development of the baby. Coronary artery fistula is an abnormal connection between one of ...

377

Development of a de novo arteriovenous malformation after bilateral revascularization surgery in a child with moyamoya disease.  

PubMed

The development of a de novo arteriovenous malformation (AVM) in patients with moyamoya disease is extremely rare. A 14-year-old girl developed an AVM in the right occipital lobe during the 4-year postoperative period following successful bilateral revascularization surgeries. She suffered a transient ischemic attack with hemodynamic compromise of the bilateral hemispheres at the age of 10 years. Results of an initial examination by 1.5-T MRI and MR angiography satisfied the diagnostic criteria of moyamoya disease but failed to detect any vascular malformation. Bilateral direct and indirect revascularization surgeries in the anterior circulation relieved her symptoms, and she underwent MRI and MR angiography follow-up every year after surgery. Serial T2-weighted MRI revealed the gradual appearance of flow voids in the right occipital lobe during the follow-up period. Magnetic resonance angiography ultimately indicated the development of an AVM 4 years after these surgeries when catheter angiography confirmed the diagnosis of an AVM in the right occipital lobe. The AVM remained asymptomatic, and the patient remained free of cerebrovascular events during the time she was observed by the authors. Acquired AVM in moyamoya disease is extremely rare, with only 3 pediatric cases including the present case being reported in the literature. The development of a de novo AVM in a postoperative patient with moyamoya disease appears to be unique, and this case may provide insight into the dynamic pathology of AVMs. PMID:24745340

Fujimura, Miki; Kimura, Naoto; Ezura, Masayuki; Niizuma, Kuniyasu; Uenohara, Hiroshi; Tominaga, Teiji

2014-06-01

378

[Transmyocardial laser revascularization: overview of clinical and experimental data].  

PubMed

Transmyocardial laser revascularization (TMLR) using carbon dioxide and Holmium YAG laser has been approved by FDA and is now under clinical evaluation in patients with refractory angina who are not candidate of CABG or PTCA. Original concept of TMLR was direct perfusion from left ventricle through channel created by laser. However, pathological analysis showed closed channel in almost all cases, and most possible mechanism of TMLR are now thought to be angiogenesis following to inflammatory response of laser injury. Most prospective randomized trial comparing TMLR and conservative medical treatment demonstrated significantly less angina in TMLR patients and better exercise tolerance and angina-free survival rate during follow-up period. On the other hand, no significant differences were demonstrated in overall mortality rate, myocardial perfusion or cardiac function. PMID:11676155

Nishida, H; Endo, M; Koyanagi, H

2001-10-01

379

Therapeutic angiogenesis for revascularization in peripheral artery disease.  

PubMed

Therapeutic angiogenesis for peripheral artery disease (PAD), achieved by gene and cell therapy, has recently raised a great deal of hope for patients who cannot undergo standard revascularizing treatment. Although pre-clinical studies gave very promising data, still clinical trials of gene therapy have not provided satisfactory results. On the other hand, cell therapy approach, despite several limitations, demonstrated more beneficial effects but initial clinical studies must be constantly validated by larger randomized, multi-center, double-blinded, placebo-controlled trials. This review focuses on previous and recent gene and cell therapy studies for limb ischemia, including both experimental and clinical research, and summarizes some important papers published in this field. Moreover, it provides a short comment on combined gene and cell therapy approach on the example of heme oxygenase-1 overexpressing cells with therapeutic properties. PMID:23566831

Grochot-Przeczek, Anna; Dulak, Jozef; Jozkowicz, Alicja

2013-08-10

380

Hypertension following myocardial revascularization: its prevalence and etiology.  

PubMed

Of 11 patients who underwent elective aortocoronary bypass operation using nonpulsatile flow with moderate hypothermia (28 degrees C), 8 had hypertension defined as blood pressure of 160/100 mm Hg or greater. The plasma renin level was not elevated during bypass by postoperatively in the intensive care unit it became significant (P < 0.05) elevated. An increase in the release of renin was associated with a rise in systemic vascular resistance and coincided with the onset of hypertension. Although the values of plasma catecholamines were elevated during bypass and in the intensive care unit, they did not appear to contribute appreciably to increases in systemic resistance. The authors conclude that an increase in the release of renin is associated with increased vascular resistance and elevated blood pressure following myocardial revascularization. PMID:7002271

Landymore, R W; Murphy, D A; Kinley, C E

1980-09-01

381

Echocardiographic assessment of revascularization completeness impact on diastolic dysfunction in ischemic heart disease.  

PubMed

Diastolic dysfunction indicates a functional abnormality of diastolic relaxation, filling, or distensibility of the left ventricle (LV), regardless of whether the LVEF is normal or abnormal. Diastolic dysfunction is practically always progressive and connected with higher morbidity and mortality rates, and, if not treated may lead to a diastolic heart failure. The golden standard for evaluation of diastolic function is echocardiography. One of the most important causes of diastolic dysfunction is ischemic heart disease. The revascularization of chronic myocardial ischemia can be partial (incomplete) or complete. Previous data have shown that the completeness of revascularization could have influence on clinical outcomes. The aim of this study was to asses, by means of echocardiography, the impact of completeness of revascularization on diastolic dysfunction in ischemic heart disease. This study included 65 consecutive patients with previously recognized diastolic dysfunction that met criteria for PCI revascularization. Two groups of patients were identified; one with complete revascularization achieved and another one with incomplete one. There were no statistical differences between two groups considering gender age, arterial hypertension, hyperlipoproteinaemia, previous CABG and left ventricle systolic function. In the incomplete revascularization group, the proportion of patients that had diabetes mellitus, previous myocardial infarction and previous PCI procedure were statistically higher (p < 0.05). The diastolic function recovery was statistically significant in both groups (p < 0.001), and there was no statistically significant difference in recovery between the two groups. Lack of recovery was registered in 18.2% patients with incomplete revascularization achieved, and 15.6% in the complete group, which was not significant, but shows a trend. The causes of somewhat worse recovery in the incomplete revascularization group could be attributed to the higher proportion of diabetics, to the somewhat older population and ultimately to the incomplete revascularization. The E/A ratio on diastolic transmitral flow as well as the E/E lat ratio on tissue doppler were found as the best echocardiographic parameters in diastolic function evaluation. In follow up recovery after complete or incomplete revascularization the tissue doppler (E/E lat) was recognized as the best parameter. In conclusion, we found that echocardiographic assessment of diastolic function recovery was a safe method, and our results showed that even in incomplete revascularization group of patients the recovery of diastolic function could be as good as in the complete one, if the indication for revascularization was correct. PMID:24611348

Sipi?, Tomislav; Stambuk, Kresimir; Trbovi?, Aleksandar; Kapov-Svilici?, Ksenija; Szavits-Nossan, Janko; Bernat, Robert

2013-12-01

382

Neovascularization (Angiogenesis) After Revascularization in Moyamoya Disease. Which Technique is Most Useful for Moyamoya Disease?  

Microsoft Academic Search

Summary  ??The effects of direct and indirect revascularization for moyamoya disease were analyzed for each donor artery to determine\\u000a which surgical procedure is most useful for the induction of neovascularization.\\u000a \\u000a In the past 12 years, 85 patients with moyamoya disease were surgically treated by combined surgery consisting of indirect\\u000a revascularization via encephalo-duro-arterio-myo-synangiosis (EDAMS) and direct revascularization via the superficial temporal\\u000a artery

K. Houkin; S. Kuroda; T. Ishikawa; H. Abe

2000-01-01

383

Transmyocardial laser revascularization plus cell therapy for refractory angina.  

PubMed

We report that the use of transmyocardial laser revascularization combined with intramyocardial injection is a therapeutic option for patients with severe ischemic heart disease (IHD) not amenable to conventional myocardial revascularization. Recently, cell therapy with autologous bone marrow cells (BMC) has been tested in clinical trials for severe IHD. We tested the hypothesis that TMLR combined with intramyocardial injection of BMC is safe, and may help increase the functional capacity and myocardial perfusion in patients with refractory angina. We enrolled 8 patients (7 men), 64+/-4 years old, with refractory angina, non-candidates for another procedure. TMLR (8+/-2 laser drills) was performed via a limited thoracotomy. BMC were obtained prior to surgery, and the lymphomonocytic fraction was separated by density gradient centrifugation. During surgery, 5 mL containing approximately 1.6+/-0.2 x 10(8) BMC (CD34+=1.7+/-0.4%) was delivered by multiple injections in the ischemic myocardium. We observed a reduction in the ischemic score as assessed by MRI from 1.56+/-0.09 (B) to 0.93+/-0.10 (6M) (P=0.01), as well as a reduction in functional class of angina from 3.6+/-0.2 (B) to 1.4+/-0.2 (6M) (P<0.0001). We concluded that, in this early experience, the combined strategy of TMLR plus cell therapy appeared to be safe, and may have synergistically acted to reduce myocardial ischemia, with clinically relevant improvement in functional capacity. PMID:17669519

Gowdak, Luís Henrique W; Schettert, Isolmar T; Rochitte, Carlos Eduardo; Rienzo, Marcos; Lisboa, Luiz Augusto F; Dallan, Luís Alberto O; César, Luiz Antônio M; Krieger, José Eduardo; Ramires, José Antônio F; de Oliveira, Sérgio A

2008-07-01

384

Platelet neuropeptide Y is critical for ischemic revascularization in mice  

PubMed Central

We previously reported that the sympathetic neurotransmitter neuropeptide Y (NPY) is potently angiogenic, primarily through its Y2 receptor, and that endogenous NPY is crucial for capillary angiogenesis in rodent hindlimb ischemia. Here we sought to identify the source of NPY responsible for revascularization and its mechanisms of action. At d 3, NPY?/? mice demonstrated delayed recovery of blood flow and limb function, consistent with impaired collateral conductance, while ischemic capillary angiogenesis was reduced (?70%) at d 14. This biphasic temporal response was confirmed by 2 peaks of NPY activation in rats: a transient early increase in neuronally derived plasma NPY and increase in platelet NPY during late-phase recovery. Compared to NPY-null platelets, collagen-activated NPY-rich platelets were more mitogenic (?2-fold vs. ?1.6-fold increase) for human microvascular endothelial cells, and Y2/Y5 receptor antagonists ablated this difference in proliferation. In NPY+/+ mice, ischemic angiogenesis was prevented by platelet depletion and then restored by transfusion of platelets from NPY+/+ mice, but not NPY?/? mice. In thrombocytopenic NPY?/? mice, transfusion of wild-type platelets fully restored ischemia-induced angiogenesis. These findings suggest that neuronally derived NPY accelerates the early response to femoral artery ligation by promoting collateral conductance, while platelet-derived NPY is critical for sustained capillary angiogenesis.—Tilan, J. U., Everhart, L. M., Abe, K., Kuo-Bonde, L., Chalothorn, D., Kitlinska, J., Burnett, M. S., Epstein, S. E., Faber, J. E., Zukowska, Z. Platelet neuropeptide Y is critical for ischemic revascularization in mice.

Tilan, Jason U.; Everhart, Lindsay M.; Abe, Ken; Kuo-Bonde, Lydia; Chalothorn, Dan; Kitlinska, Joanna; Burnett, Mary Susan; Epstein, Stephen E.; Faber, James E.; Zukowska, Zofia

2013-01-01

385

Long-term incidence and prognostic factors of the progression of new coronary lesions in Japanese coronary artery disease patients after percutaneous coronary intervention.  

PubMed

Revascularization of an initially non-target site due to its progression as a new culprit lesion has emerged as a new therapeutic target of coronary artery disease (CAD) in the era of drug-eluting stents. Using the Shinken database, a single-hospital-based cohort, we aimed to clarify the incidence and prognostic factors for progression of previously non-significant coronary portions after prior percutaneous coronary intervention (PCI) in Japanese CAD patients. We selected from the Shinken database a single-hospital-based cohort of Japanese patients (n = 15227) who visited the Cardiovascular Institute between 2004 and 2010 to undergo PCI. This study included 1,214 patients (median follow-up period, 1,032 ± 704 days). Additional clinically driven PCI to treat previously non-significant lesions was performed in 152 patients. The cumulative rate of new-lesion PCI was 9.5 % at 1 year, 14.4 % at 3 years, and 17.6 % at 5 years. There was no difference in background clinical characteristics between patients with and without additional PCI. Prevalence of multi-vessel disease (MVD) (82 vs. 57 %, p < 0.001) and obesity (47 vs. 38 %, p = 0.028) were significantly higher and high-density lipoprotein cholesterol (HDL) level (51 ± 15 vs. 47 ± 12 mg/dl, p < 0.001) was significantly lower in patients with additional PCI than those without. Patients using insulin (6 vs. 3 %, p = 0.035) were more common in patients with additional PCI. Multivariate analysis showed that MVD, lower HDL, and insulin use were independent determinants of progression of new culprit coronary lesions. In conclusion, progression of new coronary lesions was common and new-lesion PCI continued to occur beyond 1 year after PCI without attenuation of their annual incidences up to 5 years. Greater coronary artery disease burden, low HDL, and insulin-dependent DM were independent predictors of progression of new culprit coronary lesions. PMID:23807613

Kaneko, Hidehiro; Yajima, Junji; Oikawa, Yuji; Tanaka, Shingo; Fukamachi, Daisuke; Suzuki, Shinya; Sagara, Koichi; Otsuka, Takayuki; Matsuno, Shunsuke; Kano, Hiroto; Uejima, Tokuhisa; Koike, Akira; Nagashima, Kazuyuki; Kirigaya, Hajime; Sawada, Hitoshi; Aizawa, Tadanori; Yamashita, Takeshi

2014-07-01

386

Suppression of renin production in patients undergoing coronary artery bypass.  

PubMed

Twenty patients undergoing elective myocardial revascularization for coronary insufficiency were divided into two equal groups. In 10 patients, propranolol was discontinued 24 hours before operation while the remaining patients received propranolol until the day of operation. Plasma renin was elevated in the intensive care unit in the control group (p < 0.05) whereas patients receiving propranolol did not demonstrate significant elevation of plasma renin. Systemic vascular resistance was elevated in both groups in the intensive care unit (p < 0.05) and was associated with hypertension as defined by a blood pressure of greater than or equal to 160/100 mm Hg in 80% of the control patients and 70% of patients receiving propranolol. We conclude from this study that renin metabolism does not contribute significantly to the production of hypertension following coronary artery operation. PMID:7008725

Landymore, R W; Murphy, D A; Kinley, E; Parrott, J; Sai, O; Quirbi, A A

1980-12-01

387

Dobutamine Magnetic Resonance Imaging Predicts Contractile Recovery of Chronically Dysfunctional Myocardium After Successful Revascularization  

Microsoft Academic Search

Objectives. This study sought to evaluate whether myocardial viability, as assessed by magnetic resonance imaging (MRI), reliably predicts postrevascularization left ventricular (LV) recov- ery. Background. Compared with positron emission tomographic findings, MRI has proved to be a reliable technique for the identification of residual myocardial viability. However, the pre- dictive accuracy of MRI-assessed preserved end-diastolic wall thickness (DWT) and dobutamine-induced

FRANK M. BAER; PETER THEISSEN; CHRISTIAN A. SCHNEIDER

388

Dobutamine Magnetic Resonance Imaging Predicts Contractile Recovery of Chronically Dysfunctional Myocardium After Successful Revascularization  

Microsoft Academic Search

Objectives. This study sought to evaluate whether myocardial viability, as assessed by magnetic resonance imaging (MRI), reliably predicts postrevascularization left ventricular (LV) recovery.Background. Compared with positron emission tomographic findings, MRI has proved to be a reliable technique for the identification of residual myocardial viability. However, the predictive accuracy of MRI-assessed preserved end-diastolic wall thickness (DWT) and dobutamine-induced systolic wall thickening

Frank M Baer; Peter Theissen; Christian A Schneider; Eberhard Voth; Udo Sechtem; Harald Schicha; Erland Erdmann

1998-01-01

389

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

390

Atherectomy (directional, rotational, extractional) and its role in percutaneous revascularization.  

PubMed

After an initial wave of enthusiasm, atherectomy devices face a number of difficult issues today. The first two randomized studies comparing balloon angioplasty with directional atherectomy, the Coronary Angioplasty Versus Excisional Atherectomy Trial (CAVEAT) and the Canadian Coronary Atherectomy Trial (CCAT), showed no clinical benefit for atherectomy. Data from these trials, as well as other studies, suggest that the mechanism of lumen enlargement with atherectomy may be less beneficial than expected. A number of investigations are currently evaluating the benefit of even more aggressive debulking with directional coronary atherectomy, but in view of the increased incidence of acute complications, it is unlikely that this technique will increase its share in routine coronary angioplasty in the near future. Clinical evaluation of rotational and extractional atherectomy has not reached a conclusive phase yet, but results from registries and single-center observations show that these devices require adjunctive balloon angioplasty in a large proportion of cases, on the one hand, and that they do not solve the issue of restenosis, on the other. The difficulty in delineating the rationale for use of these devices highlights the urgent need for controlled and carefully designed device trials. PMID:7549084

Kaufmann, U P; Meyer, B J

1995-07-01

391

Inflammatory response after myocardial revascularization with or without cardiopulmonary bypass  

Microsoft Academic Search

Background. Tumor necrosis factor-? has been implicated in complications seen after cardiac operations with cardiopulmonary bypass. The release of tumor necrosis factor-? and its possible effects were studied in patients undergoing coronary artery bypass grafting with and without cardiopulmonary bypass.Methods. Twenty patients were studied, 10 with (group 1) and 10 without cardiopulmonary bypass (group 2). Serial blood samples were obtained

Luiz A Brasil; Walter J Gomes; Reinaldo Salomão; Enio Buffolo

1998-01-01

392

Coronary accordion effect mimicking coronary dissection  

PubMed Central

The coronary “accordion” effect is a rare pseudo-complication of percutaneous coronary intervention (PCI). It is usually observed due to straightening and shortening of tortuous vessels with stiff guidewires during PCI. In this case report, we present an interesting case of the coronary accordion effect observed in a 52-year-old woman undergoing PCI.

Balli, Mehmet; Akilli, Rabia Eker; Tekin, Kamuran; Cayli, Murat

2013-01-01

393

Coronary accordion effect mimicking coronary dissection.  

PubMed

The coronary "accordion" effect is a rare pseudo-complication of percutaneous coronary intervention (PCI). It is usually observed due to straightening and shortening of tortuous vessels with stiff guidewires during PCI. In this case report, we present an interesting case of the coronary accordion effect observed in a 52-year-old woman undergoing PCI. PMID:24570759

Cagliyan, Caglar Emre; Balli, Mehmet; Akilli, Rabia Eker; Tekin, Kamuran; Cayli, Murat

2013-01-01

394

Chronic low-perfusion state in children with moyamoya disease following revascularization  

Microsoft Academic Search

The distribution pattern of cerebral blood flow (CBF) was evaluated in 13 children with moyamoya disease after revascularization. Combined surgery involving encephaloduroarteriosynangiosis and encephalomyosynangiosis was performed in 21 hemispheres. CBF was assessed by dynamic imaging using N-isopropyl-p[123I]iodoamphetamine-single photon emission CT (IMP-SPECT) at 46 months on average after revascularization. None of the patients suffered recurrent ischemic attacks after the bilateral combined

Hiromi Sato; Noriko Sato; Norihiko Tamaki; Satoshi Matsumoto

1990-01-01

395

Impact of obstructive sleep apnea on cardiovascular outcomes in patients treated with percutaneous coronary intervention: rationale and design of the sleep and stent study.  

PubMed

Elucidating the effects of obstructive sleep apnea (OSA) on cardiovascular outcomes is crucial in risk assessments and therapeutic recommendations for affected individuals. The Sleep and Stent Study is a multicenter observational study investigating the relationships between OSA and cardiovascular outcomes in patients treated with percutaneous coronary intervention (PCI). Eight centers in 5 countries (Singapore, China and Hong Kong, India, Myanmar, and Brazil) are participating in the study, and the recruitment target is 1600 patients. Adult patients age 18 to 80 years who have undergone successful PCI are eligible. Recruited patients will undergo an overnight sleep study using a level-3 portable diagnostic device before hospital discharge. The sleep tracings will be analyzed by a certified sleep technologist and audited by a sleep physician, both of whom will be blinded to other study data. The patients will be divided into 2 groups based on apnea-hypopnea index (AHI): OSA (AHI ?15) and non-OSA (AHI <15) groups. The primary study endpoint of cardiovascular death, myocardial infarction, stroke, and unplanned revascularization will be compared between the OSA and non-OSA groups at a median follow-up of 2 years. Secondary endpoints include all-cause mortality, target-vessel revascularization, stent thrombosis, and hospitalization for heart failure. As of December 31, 2013, a total of 1358 patients have been recruited. Based on the complete preliminary results of the first 785 recruited patients, the prevalence of OSA was 48.3%. We expect the follow-up for primary endpoint to be completed in late 2015; study results will be presented in 2016. PMID:24945037

Loo, Germaine; Koo, Chieh-Yang; Zhang, Junjie; Li, Ruogu; Sethi, Rithi; Ong, Thun-How; Tai, Bee-Choo; Lee, Chi-Hang

2014-05-01

396

Lateral plantar artery bypass grafting: defining the limits of foot revascularization.  

PubMed

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