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  • 1
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Journal of interventional cardiology 10 (1997), S. 0 
    ISSN: 1540-8183
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Left main coronary artery (LMCA) stenosis is usually treated with coronary artery bypass surgery. However, in high risk surgical patients, coronary stenting may be advantageous. We reviewed the records of all 16 patients who had undergone this procedure in our institution. Group I (nine patients, eight males, mean age 64.6 years) had protected LMCA disease. Group II (seven patients, six males, mean age 69.5 years) had unprotected LMCA disease. Procedural success was achieved in 15 patients. Outcome was divided into short-term (in hospital), and long-term events. The mean follow-up for both groups was 16.9 months and 9 months respectively. Three patients died (two in group II). Three patients had repeat revascularization procedure (group I). Six patients were asymptomatic (two in group I), and four had a significant improvement in angina symptoms. LMCA stenting is a relatively safe and effective revascularization procedure for patients with either protected or unprotected LMCA disease at high risk for surgery.
    Type of Medium: Electronic Resource
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  • 2
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Journal of interventional cardiology 10 (1997), S. 0 
    ISSN: 1540-8183
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Endovascular scaffolds have been tried in animals long ago, but it took 70 years to introduce stents into clinical practice. In 1994, two major randomized trials confirmed that stenting after percutaneous transluminal coronary angioplasty (PTCA) does indeed reduce the incidence of restenosis, as well as other events like myocardial infarctions and emergency surgery. Numerous stents are now in use: self-expanding and balloon-expandable stents; stainless steel stents; platinum and tantalum stents; flexible and articulated stents; and lately also heparin-coated stents. New designs with improved fluid dynamics and optimal conformability are now being used. All stents are foreign bodies, and may induce spasm and thrombosis. Meticulous drug treatment was thought to be essential in reducing the incidence of subacute thrombosis, but was associated with a significant number of local bleeding complications. Warfarin has even been suspected of favoring stent thrombosis. An optimal implantation strategy that aims at an absolutely perfect primary result, with no residual narrowing, with absence of dissections, and with complete stent expansion, has dramatically reduced both the complication rate after stenting and the need for heavy anticoagulation. The role of platelet inhibition after stenting is becoming increasingly clear. Ticlopidine in combination with aspirin is presently the recommended strategy. Polymer stents have not yet fulfilled their expectations but hold great promise as a matrix for future drug delivery systems, possibly in combination with metal. Metal stents with adequate structural properties seem to have restenosis rates of some 10%. Radioactive stents (to further reduce intimal hyperplasia) are currently in clinical investigation. In summary, stents have revolutionized the practice of transluminal angioplasty and have secured their place for the future.
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 1540-8183
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Mechanical femoral artery compression devices have several limitations. We compared a novel disposable beltheld pneumatic compression device to manual compression alone in 213 patients randomized into two equal groups. Both were comparable for age, gender, current therapy with aspirin (ASA) and warfarin, diameter of the arterial sheath, previous procedures via the same artery, procedure duration, and blood pressure. Manual compression time was 12 ± 3 minutes. Pneumatic compression was reduced during 60 minutes. Patient discomfort was assessed as none (82% vs 88%), mild (13% vs 8%), moderate (3% vs 4%), or severe (2% vs 0%) for the manual versus pneumatic group, respectively. Bleeding and hematoma occurred in 7.5% of patients with no difference between the treatment groups. However, manual compression was significantly more effective in the higher range of systolic blood pressure, and pneumatic in the lower range, with a cut point of approximately 170 mmHg. Predictors for bleeding were systolic blood pressure and dose of ASA. Among 113 patients with systolic blood pressure 〈 160 mmHg and low dose (75 mg) or no ASA, only / patient (0.9%) experienced bleeding while 31% of 16 patients with both elevated systolic blood pressure and high dose ASA (150–330 mg) bled. We conclude that pneumatic femoral artery compression does not reduce bleeding and hematoma compared with manual compression. The use of low dose (75 mg) or no ASA, as well as giving special attention to patients with elevated systolic blood pressure, may reduce the risk of bleeding after cardiac catheterization.
    Type of Medium: Electronic Resource
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  • 4
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Journal of interventional cardiology 9 (1996), S. 0 
    ISSN: 1540-8183
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: We describe a novel treatment for hypertrophic obstructive cardiomyoparhy, in which septal reduction is achived via transluminal induction of focal septal infarction. The results of the first three patients treated in this fashion have been recently reported; in this preliminary series, intraventricular pressure gradients could be dramatically reduced by the creation of a localized infarction of the ventricular septum. The procedure is well tolerated and effective in reducing the obstruction to left ventricular ourflow. Further studies are underway to fully evaluate the usefulness of the technique. (J Interven Cardiol 1996;9:393–397)
    Type of Medium: Electronic Resource
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  • 5
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Journal of interventional cardiology 7 (1994), S. 0 
    ISSN: 1540-8183
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Abrupt occlusion of the coronary artery during PTCA is a relatively common complication. The majority of the acute occlusions occur when there is a significant dissection at the site of the balloon expansion. The use of a temporary stent, which can be expanded and collapsed intraluminally, allowing repositioning and finally removal of the device, is reported in this article.
    Type of Medium: Electronic Resource
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  • 6
    ISSN: 1540-8183
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Intracoronary stents may be used to treat acute coronary occlusion following balloon angioplasty. We report the immediate and long-term results of emergency implantation of the self-expanding scent (Wallstent) in 39 patients with acute vessel closure. Stents were successfully deployed in 38 patients (97%). Procedural complications occurred in 14 patients (36%); one patient died, two required emergency coronary artery bypass graft surgery, nine sustained myocardial infarcts (one Q wave), and two had acute stent thrombosis successfully treated by intracoronary throtnbolysis and repeat angioplasty. Four patients (10%) had femoral artery bleeding, two required surgery. Angiographic follow-up was performed after 6 months in all 34 eligible patients, or earlier for symptoms. Two patients died prior to follow-up angiography. The stented segment was widely patent in 27 of the 34 patients (79%); restenosis within the stent was detected in 4 (12%) and thrombotic stent occlusion occurred in three (9%). Twenty-six of the 39 patients (67%) were free from major cardiac events and sytnptoms at 1 year. These results suggest that the self-expanding stent provides an attractive alternative to emergency surgery for the treatment of acute coronary occlusion following coronary angioplasty.
    Type of Medium: Electronic Resource
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  • 7
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Journal of interventional cardiology 7 (1994), S. 0 
    ISSN: 1540-8183
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 8
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Journal of interventional cardiology 12 (1999), S. 0 
    ISSN: 1540-8183
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Objective: To determine the early and late clinical outcomes following multiple stent deployment during a single percutaneous transluminal coronary angioplasty (PTCA) procedure. Methods: All patients who received two or more stents during a single PTCA were reviewed. An analysis was made of 114 patients (mean age = 61.2 years). A total of 268 stents were deployed, range 2–6 stents per PTCA (mean = 2.4). Stenting was performed as a primary procedure in 38 patients, for arterial dissection in 44, and for threatened closure in 32. At least two stents were deployed in the same vessel in 101 (88.6%) patients. Before discharge from hospital, there were 4 (3.6%) deaths, 6 (5.2%) patients required emergency coronary artery bypass grafting (CABG), and 2 (1.8%) patients required repeat PTCA. Three (2.6%) patients sustained acute myocardial infarction (AMI). The mean follow-up period was 10.6 months. After leaving hospital, there were no deaths, 5 (4.4%) patients required CABG, and 5 (4.4%) had a further PTCA. There was one (0.9%) AMI. The total event rate was 19.2%, which compares well with single stent trials in which event rates of 20.1% and 19.5% were reached. In addition, 19 (16.7%) patients had a recurrence of symptoms. Conclusion: It is possible to deploy multiple stents at a single intervention in the same or different vessels safely and with clinical outcomes that are similar to those in studies of single coronary stenting.
    Type of Medium: Electronic Resource
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  • 9
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Journal of interventional cardiology 7 (1994), S. 0 
    ISSN: 1540-8183
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Type of Medium: Electronic Resource
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  • 10
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Publishing Ltd
    Journal of interventional cardiology 13 (2000), S. 0 
    ISSN: 1540-8183
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Treatment of aorta-ostial saphenous vein graft lesions by conventional balloon angioplasty or other techniques (laser angioplasty, atherectomy) is limited by high restenosis rates. This study is designed to evaluate acute results and long-term follow-up of high risk patients undergoing stent implantation at aorto-ostial locations of vein graft orifices. Between July 1993 and July 1999 coronary stents were placed in 30 ostial lesions in 30 patients. Procedural success was achieved in the absence of any major complications in 27 patients (90%). Clinical follow-up was obtained in all 27 patients after 17.7 months. Clinical restenosis occurred in 10 patients (38.5%). A total of 18 patients (69.2%) underwent repeat angiography. Angiographic restenosis was present in 10 patients. Treatment of saphenous vein graft lesions can be accomplished safely and effectively using intracoronary stent implantation. Results are superior to those described for conventional balloon angioplasty or other adjunctive techniques.
    Type of Medium: Electronic Resource
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