In a single-center experience, initial failure of attempted stent delivery was relatively infrequent (2.7%) but was associated with increased need for urgent coronary bypass surgery. Delivery failure was more likely ...
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In a single-center experience, initial failure of attempted stent delivery was relatively infrequent (2.7%) but was associated with increased need for urgent coronary bypass surgery. Delivery failure was more likely with coiled stents and dislodgment from the delivery balloon was more likely with hand-mounted or radiolucent stents.
We evaluated the predictors of late clinical outcomes after stenting of protected left main coronary artery (LMCA) stenoses. Intravascular ultrasound (IVUS) guided stenting of protected LMCA stenoses was performed in ...
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We evaluated the predictors of late clinical outcomes after stenting of protected left main coronary artery (LMCA) stenoses. Intravascular ultrasound (IVUS) guided stenting of protected LMCA stenoses was performed in 87 consecutive patients between January 1994 and December 1996. Results were evaluated using conventional (clinical, angiographic, and IVUS) methodology. Late (12 month) clinical follow-up information was obtained in all patients. Initial procedural success was achieved in 86 patients (99%. There was 1 in-hospital death tin the 1 patient with a procedural Failure). There were no other in-hospital complications, including Q-wave myocardial infarction, emergency bypass surgery, or repeat coronary angioplasty. The overall target lesion revascularization (TLR) rate was 13%. Using multivariate logistic regression analysis, the only independent predictor of TLR was the postintervention lumen area by IVUS. A final lumen area greater than or equal to 7.0 mm(2) was obtained in 74 patients (86%);the TLR rate for these patients was 7%. This was compared with patients with a final lumen area <7.0 mm(2) in whom the TLR rate was 50% (p = 0.0011). Stenting of protected LMCA stenoses is safe and effective with acceptable long-term clinical outcomes. The most important factor determining long-term success was the postintervention lumen area by IVUS. (C) 1999 by Excerpta Medica, Inc.
Balloon angioplasty was introduced among the armament of therapy for coronary heart disease in 1977 by Gruentzig in Zurich. Since the first case was successful, this method of treatment spread out rapidly so that at t...
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Balloon angioplasty was introduced among the armament of therapy for coronary heart disease in 1977 by Gruentzig in Zurich. Since the first case was successful, this method of treatment spread out rapidly so that at the present time, more than 400,000 procedures are being performed per year in the U.S. The reason for such an explosive success includes the relative safety of the procedure, the reduction in cost as compared to surgical bypass procedures, the short in-hospital stay, and short recovery time.
We report the case of a patient with postinfarction rest angina, high grade ostial left main (LM) stenosis, and right and circumflex coronary occlusion. Coronary artery bypass was performed, yet all grafts failed with...
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We report the case of a patient with postinfarction rest angina, high grade ostial left main (LM) stenosis, and right and circumflex coronary occlusion. Coronary artery bypass was performed, yet all grafts failed within 2 months of surgery. We elected to proceed with coronary intervention oil the ostial LM lesion with intracoronary ultrasound lesion characterization and percutaneous cardiopulmonary bypass support. Rotablation followed by stent deployment achieved a successful angiographic outcome with no associated clinical complications. At 1-year-follow-up, the patient remains stable with evidence of mild restenosis. Interventional approaches in unprotected LM coronary stenoses are associated with high procedural risk. Combined atherectomy/ablation with stent placement guided by intracoronary ultrasound may enhance procedural and long-term outcome.
The protected left main coronary artery (LM) is accessible to percutaneous transluminal coronary angioplasty (PTCA), and the procedure is usually performed with large size catheter systems. This report describes a suc...
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The protected left main coronary artery (LM) is accessible to percutaneous transluminal coronary angioplasty (PTCA), and the procedure is usually performed with large size catheter systems. This report describes a successful PTCA of a partially protected LM through a 5Fr diagnostic catheter system in a patient with previous coronary artery bypass grafting. Such ail approach is time- and cost-efficient when combined with the diagnostic study.
The safety and efficacy of percutaneous transluminal coronary angioplasty (PTCA) was examined in a group of 91 octogenarians during 133 consecutive procedures and compared to the younger part of our PTCA population (3...
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The safety and efficacy of percutaneous transluminal coronary angioplasty (PTCA) was examined in a group of 91 octogenarians during 133 consecutive procedures and compared to the younger part of our PTCA population (3,443 procedures) during an 8-year study period. Most octogenarians presented with refractory or unstable angina pectoris and multivessel involvement, but had normal left ventricular function. The angiographic success rate was 84%. Technical failure was observed in 12% of cases and complications in 14%. Two early procedure related deaths were observed. Restenosis was estimated at 24%. The proportion surviving and the proportion without cardiac event estimated by the Kaplan-Meier method at 2 years were 0.89 and 0.60, respectively. In comparison to the younger population, the immediate angiographic success was lower as a result of a higher incidence of technical failure (P < 0.05). Otherwise, no difference in terms of restenosis or overall related complication rate was noted (P > 0.1). It is concluded that PTCA is an efficient and safe therapeutic option for octogenarians with severe or refractory angina pectoris. Technical failure is more frequently observed than in younger patients and explains a lower immediate angiographic success. Nevertheless, at 2-years follow-up, a large majority of patients are alive and asymptomatic.
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