Clinical, angiographic and procedural correlates of quantitative coronary dimensions after directional coronary atherectomy

AbstractTo define the clinical, angiographic and procedural correlates of quantitative coronary dimensions after directional coronary atherectomy, 400 lesions in 378 patients were analyzed with use of qualitative morphologic and quantitative angiographic methods. Successful atherectomy, defined by a <75% residual area stenosis, tissue retrieval and the absence of in-hospital ischemic complications, was performed in 351 lesions (87.7%). After atherectomy, minimal cross-sectional area increased from 1.2 ± 1.1 to 6.6 ± 4.4 mm2(p < 0.001) and percent area stenosis was reduced from 87 ± 10% to 31 ± 42% (p < 0.001).By univariate analysis, device size (p < 0.001) and left circumflex artery lesion location (p = 0.004) were associated with a larger final minimal cross-sectional area. Conversely, restenotic lesion (p = 0.002), lesion length ≥ 10 mm (p = 0.018) and lesion calcification (p = 0.035) were quantitatively associated with a smaller final minimum cross-sectional area. With use of stepwise multivariate analysis to control for the reference area, atherectomy device size (p = 0.003) and left circumflex lesion location (p = 0.007) were independently associated with a larger final minimal cross-sectional area, whereas restenotic lesion (p = 0.010), diffuse proximal disease (p = 0.033), lesion length ≥ 10 mm (p = 0.026) and lesion calcification (p = 0.081) were significantly correlated with a smaller final minimal cross-sectional area. The number of specimens excised, the number of atherectomy passes and atherectomy balloon inflation pressure did not correlate with the final minimal cross-sectional area.Thus, directional atherectomy results in marked improvement of coronary lumen dimensions, at least in part correlated with the presence of certain clinical, angiographic and procedural factors at the time of atherectomy

Clinical angiographic and histologic correlates of eetasia after directional coronary atherectomy

Directional coronary atherectomy can cause ectasia (final area stenosis = 75%, was present in 50% of patients without procedural ectasia and in 70% of patients with marked ectasia (residual area stenosis &lt;-20%; P = 0.12). It is concluded that excision beyond the normal arterial lumen may occur after directional coronary atherectomy, related, in part, to angiographic and procedural features noted at the time of atherectomy. Restenosis tends to occur more often in patients with marked ectasia after coronary atherectomy.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/30232/1/0000626.pd

Quantitative analysis of factors influencing late lumen loss and restenosis after directional coronary atherectomy

Although encouraging initial results have been demonstrated after directional atherectomy, the mechanisms and predictors of late lumen loss and restenosis after this procedure have not been evaluated. To examine these issues, clinical and angiographic follow-up were obtained in 262 (96%) and 212 (77%) of 274 patients undergoing successful directional coronary atherectomy. Symptom recurrence developed in 87 (33%) patients and angiographic restenosis was found in 93 (44%). Restenosis was highest in restenotic lesions in saphenous vein grafts (78% [95% confidence interval (CI): 56 to 100%]) and lowest in new-onset lesions in the left anterior descending (27% [95% CI: 15 to 39%]) and circumflex (14% [95% CI: 0 to 43%]) coronary arteries. Residual lumen diameter immediately after atherectomy was smaller in re-stenotic lesions (p = 0.002) and in lesions &gt;=10 mm in length (p = 0.02). Late lumen loss was associated with the minimal lumen diameter immediately after atherectomy (p =10 mm in length (p = 0.018), saphenous vein graft lesion location (p = 0.025) and male gender (p = 0.045) were independent predictors for restenosis. It is concluded that restenosis after directional atherectomy is related both to factors resulting in a suboptimal initial result and to factors contributing to excessive late lumen loss. These results may have implications for lesion selection in patients undergoing directional coronary atherectomy.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/30957/1/0000629.pd

Mediastinal Masses

The mediastinum is defined as the thoracic region limited by the pleural spaces laterally, the ster- num anteriorly, the vertebral column posteriorly, the thoracic inlet superiorly, and the diaphragm inferiorly. The mediastinum contains different types of tissue including the thymus gland, part of trachea and esophagus, the great vessels, the heart, lymph nodes, fat, and nerves. Mediastinal masses can derive from each of those tissue and can be malformative, neoplastic, or infective