Serial angiographic follow-up after palmaz-schatz stent implantation: Comparison with conventional balloon angioplasty

AbstractObjectives. Serial angiographic follow-up study was designed to evaluate the temporal mode of lumen diameter changes after Palmaz-Schatz stent implantation, and the results were compared with those from a cohort of patients undergoing balloon angioplasty.Background. Restenosis remains a major limitation of balloon angioplasty. The Palmaz-Schatz balloon expandable coronary stent is now under clinical investigation to evaluate its efficacy in preventing restenosis.Methods. Serial angiographic follow-up study was performed the day after stent implantation and at 1, 3 and 6 months after the procedure. The stent group consisted of 96 patients who had 97 lesions with a single stent. A cohort of 179 patients with 192 lesions were selected as the balloon group by the criteria of final balloon size ≥3 mm and lesion length <20 mm.Results. A significantly larger lumen diameter was obtained immediately after stent implantation (2.9 ± 0.4 mm [mean ± SD] in the stent group vs. 2.1 ± 0.5 mm in the balloon group, p < 0.001). At 3 to 6 months of follow-up, a significantly larger lumen diameter was maintained in the start group (2.2 ± 0.6 vs. 1.5 ± 9.7 mm, p < 0.001). The late restenosis rate according to a binary definition was significantly lower to the stent group (13% vs. 39%, p < 0.001). Stenosis exacerbation, frequently observed within 24 h after balloon angioplasty, was not found after stenting. Between the next day and 1 month, regression was dominant in the balloon group, whereas progression of stenosis was observed in the stent group. The greatest tendency to restenosis was observed in both groups between 1 and 3 months after the procedure. Between 3 and 6 months, significantly greater diameter loss was found in the stent group.Conclusions. The Palmaz-Schatz stent was effective in reducing the restenosis rate in this highly selected cobort of patients. Reduction in restenosis rate was dependent on a larger lumen obtained immediately. Late loss of diameter was significantly greater after stenting. The restenosis rate after stenting should be evaluated by follw-up angiography at 6 months rather than at 3 months, which is adequate after conventional balloon angioplasty

Coronary lumen at six-month follow-up of a new radiopaque Cordis tantalum stent using quantitative angiography and intracoronary ultrasound.

To determine the reliability of geometric (edge-detection) quantitative coronary angiographic analysis (QCA) of restenosis within a new Cordis tantalum stent, QCA and intracoronary ultrasound (ICUS) measurements were compared in both an experimental restenosis model and in the clinical follow-up of patients. In the experimental series, Plexiglas phantom vessels with concentric stenosis channels ranging from 0.75 to 3.0 mm in diameter and with a reference diameter of 3.0 mm were imaged both before and after their insertion in tantalum stents. In the clinical series, the agreement of QCA and ICUS measurements were studied in 23 patients who had undergone coronary implantation of the new tantalum stent and in 23 patients who had undergone balloon angioplasty 6 months previously. The reliability of QCA declined in the presence of the radiopaque stent (accuracy of QCA decreased from -0.07 to -0.12 mm), whereas the reliability of lumen measurements by ICUS was independent of the presence of the radiopaque stent (-0.12 and -0.13 mm). Without the stent, the average minimal luminal diameter (MLD) obtained by QCA of the 1.00 mm Plexiglas vessel was 1.00 +/- 0.01 mm, and the 3.00 mm reference vessel diameter was 2.81 +/- 0.05 mm, providing a 64 +/- 1% diameter stenosis. After introduction of the stent, the average MLD and reference vessel diameter were 0.99 +/- 0.06 and 3.36 +/- 0.17 mm, respectively, providing a diameter stenosis of 71 +/- 2%. ICUS measurements (2.77 mm) of the reference vessel diameter (3.00 mm) were unaffected by the presence of the stent. (ABSTRACT TRUNCATED AT 250 WORDS

Local Thrombolysis for Acute Massive Pulmonary Embolism using a Pulse-Infusion-Thrombolysis Catheter

Acute massive pulmonary embolism (PE) is a common life-threatening condition requiring emergent and suitable treatment. The aim of this study is to assess the efficacy and safety of local thrombolysis with a pulse-infusion-thrombolysis (PIT) catheter in the management of acute massive PE. Thirty-nine patients with PE were treated with catheter directed intervention (CDI). CDI involves suction embolectomy and local thrombolysis with a PIT catheter. Procedural success was achieved in all patients (100%). After the CDI, a significant increase of mean systemic blood pressure was observed (93.8 ± 22.0 mmHg versus 100.8 ± 22.9 mmHg, P = 0.02), and pulmonary perfusion on the basis of Miller score was improved (19.6 ± 7.6 versus 16.3 ± 7.1, P = 0.04). Clinical success was achieved in 36 of 39 patients (92.3%). Two patients died of PE after CDI despite a successful recanalization, and 1 patient died of disseminated intravascular coagulation after the CDI. No major complication occurred in the remaining 36 patients and minor complications developed in 3 patients (7.7%). Local thrombolysis using a PIT catheter for massive PE is safe and effective treatment with minimal complication

Atherosclerotic coronary lesions with inadequate compensatory enlargement have smaller plaque and vessel volumes: observations with three dimensional intravascular ultrasound in vivo.

OBJECTIVE: To compare vessel, lumen, and plaque volumes in atherosclerotic coronary lesions with inadequate compensatory enlargement versus lesions with adequate compensatory enlargement. DESIGN: 35 angiographically significant coronary lesions were examined by intravascular ultrasound (IVUS) during motorised transducer pullback. Segments 20 mm in length were analysed using a validated automated three dimensional analysis system. IVUS was used to classify les

The association of C-reactive protein with an oxidative metabolite of LDL and its implication in atherosclerosis

C-reactive protein (CRP) is one of the strongest independent predictors of cardiovascular disease. We have previously reported that oxidized LDL (oxLDL) interacts with beta 2-glycoprotein I (beta 2GPI), implicating oxLDL/P2GPI complexes as putative autoantigens in autoimmune-mediated atherosclerotic vascular disease. In this study, we investigated the interaction of CRP with oxLDL/beta 2GPI complexes and its association with atherosclerosis in patients with diabetes mellitus (DM). CRP/oxLDL/R2GPI complexes were predominantly found in sera of DM patients with atherosclerosis. In contrast, noncomplexed CRP isoforms were present in sera of patients with acute/chronic inflammation, i.e., various pyrogenic diseases, rheumatoid arthritis (RA), and DM. Immunohistochemistry staining colocalized CRP and beta 2GPI together with oxLDL in carotid artery plaques but not in synovial tissue from RA patients, strongly suggesting that complex formation occurs during the development of adierosclerosis. Serum levels of CRP correlated with soluble forms of intercellular adhesion molecule-1 and vascular cell adhesion molecule-1, and oxLDL/beta 2GPI complexes correlated with total cholesterol and hemoglobin Al c. Thus, the generation of CRP/oxLDL/beta 2GPI complexes seems to be associated with arterial inflammation, hyperglycemia, and hypercholesterolemia. CRP/oxLDL/R2GPI complexes can be distinguished from pyrogenic noncomplexed CRP isoforms and may represent a more specific and predictive marker for atherosclerosis