926 results found
Gijsen FJH, Migliavacca F, Schievano S, et al., 2008, Simulation of stent deployment in a realistic human coronary artery., Biomed Eng Online, Vol: 7
BACKGROUND: The process of restenosis after a stenting procedure is related to local biomechanical environment. Arterial wall stresses caused by the interaction of the stent with the vascular wall and possibly stress induced stent strut fracture are two important parameters. The knowledge of these parameters after stent deployment in a patient derived 3D reconstruction of a diseased coronary artery might give insights in the understanding of the process of restenosis. METHODS: 3D reconstruction of a mildly stenosed coronary artery was carried out based on a combination of biplane angiography and intravascular ultrasound. Finite element method computations were performed to simulate the deployment of a stent inside the reconstructed coronary artery model at inflation pressure of 1.0 MPa. Strut thickness of the stent was varied to investigate stresses in the stent and the vessel wall. RESULTS: Deformed configurations, pressure-lumen area relationship and stress distribution in the arterial wall and stent struts were studied. The simulations show how the stent pushes the arterial wall towards the outside allowing the expansion of the occluded artery. Higher stresses in the arterial wall are present behind the stent struts and in regions where the arterial wall was thin. Values of 200 MPa for the peak stresses in the stent strut were detected near the connecting parts between the stent struts, and they were only just below the fatigue stress. Decreasing strut thickness might reduce arterial damage without increasing stresses in the struts significantly. CONCLUSION: The method presented in this paper can be used to predict stresses in the stent struts and the vessel wall, and thus evaluate whether a specific stent design is optimal for a specific patient.
Schinkel AFL, Barlis P, van Beusekom HMM, et al., 2008, Optical Coherence Tomography Findings in Very Late (4 Years) Paclitaxel-Eluting Stent Thrombosis, JACC-CARDIOVASCULAR INTERVENTIONS, Vol: 1, Pages: 449-451, ISSN: 1936-8798
Tanimoto S, Rodriguez-Granillo G, Barlis P, et al., 2008, A novel approach for quantitative analysis of intracoronary optical coherence tomography: High inter-observer agreement with computer-assisted contour detection, CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Vol: 72, Pages: 228-235, ISSN: 1522-1946
Barlis P, Serruys PW, DeVries A, et al., 2008, Optical coherence tomography assessment of vulnerable plaque rupture: predilection for the plaque 'shoulder', EUROPEAN HEART JOURNAL, Vol: 29, Pages: 2023-2023, ISSN: 0195-668X
Rastan AJ, Boudriot E, Falk V, et al., 2008, Frequency and pattern of de-novo three-vessel and left main coronary artery disease; insights from single center enrolment in the SYNTAX study, EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY, Vol: 34, Pages: 376-383, ISSN: 1010-7940
Patterson MS, Vaina S, Serruys PW, 2008, Percutaneous treatment of an latrogenic cardiac fistula, CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Vol: 72, Pages: 259-262, ISSN: 1522-1946
Piazza N, de Jaegere P, Schultz C, et al., 2008, Anatomy of the Aortic Valvar Complex and Its Implications for Transcatheter Implantation of the Aortic Valve, CIRCULATION-CARDIOVASCULAR INTERVENTIONS, Vol: 1, Pages: 74-81, ISSN: 1941-7640
Piazza N, Grube E, Gerckens U, et al., 2008, Procedural and 30-day outcomes following transcatheter aortic valve implantation using the third generation (18 Fr) corevalve revalving system: results from the multicentre, expanded evaluation registry 1-year following CE mark approval., EuroIntervention, Vol: 4, Pages: 242-249, ISSN: 1774-024X
AIMS: To describe the procedural performance and 30-day outcomes following implantation using the 18 Fr CoreValve Revalving System (CRS) as part of the multicentre, expanded evaluation registry, 1-year after obtaining CE mark approval. METHODS AND RESULTS: Patients with symptomatic severe aortic stenosis and logistic Euroscore > or =15%, or age > or =75 years, or age > or =65 years associated with pre-defined risk factors, and for whom a physician proctor and a clinical specialist were in attendance during the implantation and who collected the clinical data, were included. From April 2007, to April 2008, 646 patients with a mean age of 81 +/- 6.6 years, mean aortic valve area 0.6 +/- 0.2 cm2, and logistic EuroSCORE of 23.1 +/- 13.8% were recruited. After valve implantation, the mean transaortic valve gradient decreased from 49.4 +/- 13.9 to 3 +/- 2 mmHg. All patients had paravalvular aortic regurgitation < or = grade 2. The rate of procedural success was 97%. The procedural mortality rate was 1.5%. At 30 days, the all-cause mortality rate (i.e, including procedural) was 8% and the combined rate of death, stroke and myocardial infarction was 9.3%. CONCLUSIONS: The results of this study demonstrate the high rate of procedural success and a low 30-day mortality in a large cohort of high-risk patients undergoing transcatheter aortic valve implantation (TAVI) with the CRS.
Otten AM, van Domburg RT, van Gameren M, et al., 2008, Population characteristics, treatment assignment and survival of patients with aortic stenosis referred for percutaneous valve replacement., EuroIntervention, Vol: 4, Pages: 250-255, ISSN: 1774-024X
AIMS: An increasing number of patients are referred for percutaneous aortic valve replacement (PAVR). Although case studies are available on outcome of selected patients, little is known about the demographics, treatment assignment and survival of the total referred population. METHODS AND RESULTS: This was a prospective observational cohort study. From September 2005 to September 2007, 100 patients were referred for PAVR of whom 39 underwent PAVR, 14 surgical valve replacement (AVR) and three balloon valvuloplasty (PABV). Another 16 refused treatment and 28 were no candidate (non severe aortic stenosis [n=11], asymptomatic and normal ventricular function [n=3], comorbidity [n=12], technically PAVR not feasible [n=2]). The logistic EuroSCORE (Mean, sd) was: 15 +/- 6% (PAVR), 9 +/- 11% (AVR), 22 +/- 15% (PABV), 25 +/- 14% (refusals) and 17 +/- 12% (no-candidate). The mean follow-up was 13 months (range 0-30 months). Cumulative survival at six months was 97%, 85% and 70%, for PAVR, AVR and refusals, respectively. At 12 months, it was 87%, 62% and 40% respectively. CONCLUSIONS: Not all patients referred for PAVR finally receive it. Approximately 15% of the patients received AVR and 30% were considered not eligible. This may reflect the lack of sufficient data and need for an improvement in the technology in order to offer PAVR to both lower and higher risk patients. Considering risk and outcome, it is conceivable that patients who refused treatment could have benefited the most from it.
Barragan P, Fajadet J, Sheiban I, et al., 2008, Elective implantation of sirolimus-eluting stents for bifurcated and non-bifurcated unprotected left main coronary artery lesions: clinical outcomes at one year., EuroIntervention, Vol: 4, Pages: 262-270, ISSN: 1774-024X
AIMS: Recent studies of drug-eluting stents for unprotected left main coronary artery (LMCA) disease have been encouraging. We examined the performance of sirolimus-eluting stents (SES) for this indication. METHODS AND RESULTS: This retrospective study included 228 consecutive patients (mean age = 68 +/- 11 years, 80.6% men, 26.3% diabetics) who underwent implantation of SES for de novo LMCA stenoses. The mean additive and logistic EuroSCOREs were 5.2 +/- 3.9 and 8.2 +/- 13.2, respectively. The main objective of this study was to measure the rate of major adverse cardiac events (MACE), including death, myocardial infarction and target lesion revascularisation (TLR) at 12 months. Other objectives were to measure the rates of in-hospital MACE and 12-month TLR. Outcomes in 143 patients with (BIF+ group), versus 84 patients without (BIF-group) involvement of the bifurcation were compared. The pre-procedural percent diameter stenosis (%DS) was 60.1 +/- 11.2 in the BIF+ versus 54.7 +/- 12.2% in the BIF- group (p=0.008), and decreased to 18.0 +/- 9.7 and 13.9 +/- 11.3%, respectively (ns), after SES implant. The overall in-hospital MACE rate was 3.5%, and similar in both subgroups. The 1-year MACE rate was 14.5% overall, 16.8% in the BIF+ and 10.7% in the BIF- subgroup (ns). CONCLUSIONS: SES implants in high-risk patients with LMCA stenoses were associated with a low 1-year MACE rate. Stenting of the bifurcation was associated with significant increases in neither mortality nor 1-year MACE rate.
de Jaegere PPT, van Dijk LC, van Sambeek MRHM, et al., 2008, How should I treat a patient with severe and symptomatic aortic stenosis who is rejected for surgical and transfemoral valve replacement and in whom a transapical implantation was aborted? Percutaneous reconstruction of the right ilio-femoral tract with balloon angioplasty followed by the implantation of self-expanding stents., EuroIntervention, Vol: 4, Pages: 292-296, ISSN: 1774-024X
BACKGROUND: A 74 year old male with a history of postero-lateral myocardial infarction in 1993 and coronary bypass surgery in 1994 was referred to the outpatient clinic in a frail general condition with signs of dyspnoea at rest. INVESTIGATIONS: Physical examination, electrocardiography, laboratory tests, coronary angiography, abdominal angiography, Echo-doppler, transesophageal echo. DIAGNOSIS: Aortic stenosis. MANAGEMENT: Valve replacement.
Bruining N, Tanimoto S, Otsuka M, et al., 2008, Quantitative multi-modality imaging analysis of a bioabsorbable poly-L-lactic acid stent design in the acute phase: a comparison between 2- and 3D-QCA, QCU and QMSCT-CA., EuroIntervention, Vol: 4, Pages: 285-291, ISSN: 1774-024X
AIMS: To investigate if three-dimensional (3D) based quantitative techniques are comparable to each other and to explore possible differences with respect to the reference method of 2D-QCA in the acute phase and to study whether non-invasive MSCT could potentially be applied to quantify luminal dimensions of a stented coronary segment with a novel bioabsorable drug-eluting stent made of poly-l-lactic-acid (PLLA). METHODS AND RESULTS: Quantitative imaging data derived from 16 patients enrolled at our institution in a first-in-man trial (ABSORB) receiving a biodegradable stent and who were imaged with standard coronary angiography and intravascular ultrasound were compared. Shortly, after stenting the patients also underwent a MSCT procedure. Standard 2D-QCA showed significant smaller stent lengths (p < 0.01). Although, the absolute measured stent diameters and areas by 2D-QCA tend to be smaller, the differences failed to be statistically different when compared to the 3D based quantitative modalities. Measurements made by non-invasive QMSCT-CA of implanted PLLA stents appeared to be comparable to the other 3D modalities without significant differences. CONCLUSIONS: Three-dimensional based quantitative analyses showed similar results quantifying luminal dimensions as compared to 2D-QCA during an evaluation of a new bioabsorbable coronary stent design in the acute phase. Furthermore, in biodegradable stents made of PLLA, non-invasive QMSCT-CA can be used to quantify luminal dimensions.
Vranckx P, Kint P-P, Morel M-A, et al., 2008, Identifying stent thrombosis, a critical appraisal of the academic research consortium (ARC) consensus definitions: a lighthouse and as a toe in the water., EuroIntervention, Vol: 4 Suppl C, Pages: C39-C44, ISSN: 1774-024X
Serruys PW, 2008, Self-promotional, or taking the lead?, EuroIntervention, Vol: 4, ISSN: 1774-024X
Wentzel JJ, Gijsen FJH, Schuurbiers JCH, et al., 2008, The influence of shear stress on in-stent restenosis and thrombosis., EuroIntervention, Vol: 4 Suppl C, Pages: C27-C32, ISSN: 1774-024X
Daemen J, Kukreja N, Serruys PW, 2008, Drug-eluting stents vs. coronary-artery bypass grafting, NEW ENGLAND JOURNAL OF MEDICINE, Vol: 358, Pages: 2641-2642, ISSN: 0028-4793
Meliga E, Garcia-Garcia HM, Valgimigli M, et al., 2008, Longest available clinical outcomes after drug-eluting stent implantation for unprotected left main coronary artery disease - The DELFT (Drug Eluting stent for LeFT main) registry, JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, Vol: 51, Pages: 2212-2219, ISSN: 0735-1097
Veltman CE, Soliman OII, Geleijnse ML, et al., 2008, Four-year follow-up of treatment with intramyocardial skeletal myoblasts injection in patients with ischaemic cardiomyopathy, EUROPEAN HEART JOURNAL, Vol: 29, Pages: 1386-1396, ISSN: 0195-668X
Khattab AA, Daemen J, Richardt G, et al., 2008, Impact of body mass index on the one-year clinical outcome of patients undergoing multivessel revascularization with sirolimus-eluting stents (from the arterial revascularization therapies study part II), AMERICAN JOURNAL OF CARDIOLOGY, Vol: 101, Pages: 1550-1559, ISSN: 0002-9149
Piazza N, Onuma Y, Jesserun E, et al., 2008, Early and Persistent Intraventricular Conduction Abnormalities and Requirements for Pacemaking After Percutaneous Replacement of the Aortic Valve, JACC-CARDIOVASCULAR INTERVENTIONS, Vol: 1, Pages: 310-316, ISSN: 1936-8798
Baldewsing RRA, Danilouchkine MG, Mastik F, et al., 2008, An inverse method for imaging the local elasticity of atherosclerotic coronary plaques, IEEE TRANSACTIONS ON INFORMATION TECHNOLOGY IN BIOMEDICINE, Vol: 12, Pages: 277-289, ISSN: 1089-7771
Sawada T, Shite J, Garcia-Garcia HM, et al., 2008, Feasibility of combined use of intravascular ultrasound radiofrequency data analysis and optical coherence tomography for detecting thin-cap fibroatheroma, EUROPEAN HEART JOURNAL, Vol: 29, Pages: 1136-1146, ISSN: 0195-668X
van der Lee C, Scholzel B, ten Berg JM, et al., 2008, Usefulness of clinical, echocardiographic, and procedural characteristics to predict outcome after percutaneous transluminal septal myocardial ablation, AMERICAN JOURNAL OF CARDIOLOGY, Vol: 101, Pages: 1315-1320, ISSN: 0002-9149
Otsuka M, Bruining N, Van Pelt NC, et al., 2008, Quantification of coronary plaque by 64-slice computed tomography: A comparison with quantitative intracoronary ultrasound, INVESTIGATIVE RADIOLOGY, Vol: 43, Pages: 314-321, ISSN: 0020-9996
Soliman OII, Geleijnse ML, Michels M, et al., 2008, Effect of successful alcohol septal ablation on microvascular function in patients with obstructive hypertrophic cardiomyopathy, AMERICAN JOURNAL OF CARDIOLOGY, Vol: 101, Pages: 1321-1327, ISSN: 0002-9149
Meliga E, Vranckx P, Regar E, et al., 2008, Proof-of-concept trial to evaluate haemoglobin based oxygen therapeutics in elective percutaneous coronary revascularisation. Rationale, protocol design and haemodynamic results., EuroIntervention, Vol: 4, Pages: 99-107, ISSN: 1774-024X
AIMS: To test the hypothesis that intracoronary infusion of pre-oxygenated HBOC-201 during brief, total coronary artery occlusion would preserve left ventricular function. METHODS: Immediately following a successful PCI, the target coronary artery was occluded without ("dry occlusion")--or with--infusion of pre-oxygenated HBOC-201 distal to the stent via the guidewire shaft of an over-the-wire balloon for up to three minutes at an infusion rate of 48 ml/min. A cross-over design was applied. Early signs of myocardial ischaemia were evaluated by left ventricular pressure-volume loops and intracoronary ECG. A 12-lead Holter ECG was activated before the PCI and deactivated four hours after the study period. Primary endpoints were change in left ventricular relaxation indices and in the sum of ST segment deviations. RESULTS: None of the measured parameters differed significantly from their respective baseline values during HBOC-201 infusion. By contrast, ejection fraction (EF), cardiac output (CO) and minimal rate of LV pressure change (dP/dTMIN) decreased significantly and the end diastolic pressure (EDP) and time constant of relaxation increased significantly during dry occlusions (P<0.05). The end diastolic pressure-volume relationship (EDPVR) at the fixed pressure level of 30 mmHg (V30), an index of myocardial compliance, reflected greater myocardial stiffness during dry occlusions compared to occlusions with HBOC-201 infusion. CONCLUSIONS: Intracoronary infusion of oxygenated HBOC-201 is capable of preserving left ventricular function, likely through maintenance of myocardial oxygenation. It is hypothesised, that in an acute setting, HBOC-201 could serve as an oxygen bridge to reperfusion by PCI extending the "golden" time period during which permanent myocardial damage is unlikely.
Sianos G, Barlis P, Di Mario C, et al., 2008, European experience with the retrograde approach for the recanalisation of coronary artery chronic total occlusions. A report on behalf of the euroCTO club., EuroIntervention, Vol: 4, Pages: 84-92, ISSN: 1774-024X
AIMS: Recanalisation rates of coronary chronic total occlusions (CTO) remain sub-optimal. The retrograde technique was recently introduced to improve success rates. METHODS AND RESULTS: From February 2005 until December 2007, 175 patients were treated with this technique in seven European centres by highly experienced operators: in 84 (48%) as primary strategy, in 41 (23.5%) immediately after antegrade failure and in 50 (28.5%) as a repeat procedure after previous antegrade failure. Baseline characteristics revealed a mean age 61.4 +/- 10.8 years with 29.5% and 39% of patients having diabetes and a prior history of MI, respectively. The mean occlusion duration was 50.8 months (determined in 32% of patients). The target vessel was: LAD 21%, LCX 6.3%, RCA 71.4%. Epicardial collaterals were accessed in 20.6% and septal in 79.4% of the patients. Overall success rate was 83.4%. In 80.6% a wire crossed the collaterals and successfully delivered distal to the occlusion; success rate in this group was 91.5%. The technique implemented in the retrograde facilitated successful recanalisation was: retrograde wire/balloon crossing in 28%, CART in 34% and marker wire/"knuckle" technique in 48%. There was a great diversity between centres referring to the retrograde technique used. According to the initial strategy success rates were: primary 89.3%, immediately after antegrade failure 65.9% and repeat procedure after antegrade failure in 88%. In patients with failure to cross the collaterals success rate was 50%. Septal rupture/haematoma occurred in 6.9% of the patients, periprocedural myocardial infarction (CK-MB rise) in 4% and TIA in 0.6% and wire entrapment in 0.6%. Mean fluoroscopy time was 59.3 mn and the mean contrast used was 420.9 ml. Drug eluting stents were implanted in all successfully recanalised vessels. CONCLUSIONS: There is great diversity amongst European centres with respect to how the retrograde strategy has been adopted and adapted. The retrograde app
Meliga E, Garcia-Garcia HM, Valgimigli M, et al., 2008, Diabetic patients treated for unprotected left main coronary artery disease with drug eluting stents: a 3-year clinical outcome study. The diabetes and drug eluting stent for LeFT main registry (D-DELFT)., EuroIntervention, Vol: 4, Pages: 77-83, ISSN: 1774-024X
AIMS: Diabetes mellitus (DM) plays an important role in the development of coronary artery disease. Although previous studies have associated drug-eluting stent (DES) implantation in diabetic patients with favourable clinical and angiographic outcomes, the very long-term efficacy of these devices in diabetic patients undergoing PCI for significant unprotected left main coronary artery (ULMCA) disease has not been established yet. METHODS AND RESULTS: Consecutive diabetic patients (n=100), who underwent elective PCI with DES for de novo lesions in an ULMCA between April 2002 and April 2004 in seven tertiary health care centres, were identified retrospectively and analysed. Consecutive non-diabetic patients (n=193), who underwent elective DES implantation for unprotected ULMCA disease, were selected as a control group. All patients were followed for at least 36 months. At 3-years follow-up, freedom from cardiac death & myocardial infarction (CDMI), target lesion revascularisation (TLR) and target vessel revascularisation (TVR) did not differ significantly between groups. The adjusted freedom from major adverse cardiac events (MACE, defined as the occurrence of CD, MI or TVR) was 63.4% in the DM group and 77.6% in the controls (p<0.001). When divided into IDDM and NIDDM sub-groups, insulin-dependent DM (IDDM) but not non IDDM (NIDDM) patients had significantly lower freedom from CDMI, TLR, TVR and MACE compared to controls. CONCLUSIONS: These results suggest that major improvements in DES technology and pharmacotherapy are still required to improve clinical outcome and that the decision to perform percutaneous revascularisation in this subset of patients should be taken cautiously and on a case by case basis.
Bonan R, Grube E, Gerckens U, et al., 2008, Experience with CorValve aortic replacement in patients for surgical aortic valve replacement, 13th Annual Interventional Vascular Therapeutics Angioplasty Summit-Transcatheter Cardiovascular Therapeutics Asia Pacific Symposium, Publisher: EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC, Pages: 21C-21C, ISSN: 0002-9149
Meliga E, Steendijk P, Valgimigli M, et al., 2008, Effects of percutaneous transluminal septal myocardial ablation for obstructive hypertrophic cardiomyopathy on systolic and diastolic left ventricular function assessed by pressure-volume loops., Am J Cardiol, Vol: 101, Pages: 1179-1184, ISSN: 0002-9149
The aim of the present study was to determine the long-term effects of percutaneous transluminal septal myocardial ablation (PTSMA) on systolic and diastolic left ventricular (LV) functions in patients with obstructive hypertrophic cardiomyopathy (HC). Ten consecutive patients with symptomatic HC despite optimal medical treatment were referred for PTSMA at our center. LV systolic and diastolic functions were assessed by online LV pressure-volume loops obtained by conductance catheter at baseline and at 6 months after the procedure. At follow-up, the mean gradients at rest and after extrasystole were significantly decreased compared with baseline (88 +/- 29 to 21 +/- 11 mm Hg and 130 +/- 50 to 35 +/- 22 mm Hg, respectively, p <0.01 for the 2 comparisons). End-systolic and end-diastolic pressures significantly decreased (p <0.01), whereas end-systolic and end-diastolic LV volumes significantly increased (p <0.01 for the 2 comparisons). Cardiac output and stroke volume were unchanged, as were ejection fraction (p = 0.25) and maximum dP/dt (p = 0.13). The slope of the end-systolic pressure-volume relation was not decreased, indicating a preserved contractility. The relaxation constant time, end-diastolic stiffness, projected volume of the end-diastolic pressure-volume relation at 30 mm Hg, and diastolic stiffness constant showed a significant improvement of active and passive myocardial diastolic properties. In conclusion, PTSMA is an effective method in the treatment of symptomatic patients with HC. At 6-month follow-up, the LV-aortic gradient was decreased and active and passive LV diastolic properties were increased. Myocardial contractility was not decreased and general hemodynamics was maintained.
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