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Biomedical subjects

B D Rutherford

Publications and source records attributed to B D Rutherford.

At least 37 records · Page 2Linked to original sources
PubMed1990

Usefulness of angioplasty during acute myocardial infarction in patients with prior coronary artery bypass grafting.

The efficacy and risk of reperfusion strategies for myocardial infarction in patients with prior coronary artery bypass surgery are uncertain. In this study 72 patients with prior bypass grafting underwent direct percutaneous transluminal coronary angioplasty without antecedent thrombolytic therapy. There were 26 anterior and 46 inferior infarctions, including 11 patients (15%) in cardiogenic shock. The baseline ejection fraction was less than 40% in 47 (65%) patients. Angioplasty was successful in 41 of 48 (85%) vein grafts and 24 of 24 (100%) arteries (difference not significant) at 5.1 +/- 4.0 hours from the onset of symptoms (79% treated less than 6 hours). There were no urgent bypass operations, strokes or transfusions. In-hospital survival was 90% (nonshock 95% vs shock 64%, p less than 0.01). Symptomatic acute reclosure occurred in 1 patient. Predischarge coronary arteriography in 34 patients demonstrated continued vessel patency in 32 infarct vessels (94%), although 5 of these vessels were redilated for restenoses. Predischarge paired ventriculography in 26 patients showed an increase in ejection fraction from 44 +/- 16% to 51 +/- 18% (p less than 0.01). One- and 3-year actuarial survival was 89 and 87%. Thus, prior coronary surgery should not preclude reperfusion therapy by direct angioplasty, which can be accomplished with low procedural risk, improvements in ventricular function and excellent in-hospital and late survival.

Aged↗
PubMed1990

Procedural outcome of angioplasty for total coronary artery occlusion: an analysis of 971 lesions in 905 patients.

This study analyzes the results of angioplasty in 905 consecutive patients with 971 total occlusions. The procedures were performed by five cardiologists from January 1980 to January 1989 at one institution. The overall success rate per lesion was 72%. Even the most experienced operator (524 occlusions attempted) has continued to improve on a learning curve, with 83% of his most recent 100 occlusions successfully dilated. Procedural death occurred in seven patients (0.8%), five patients (0.6%) sustained a myocardial infarction and seven patients (0.8%) required urgent coronary bypass surgery. Complications were significantly more likely to occur in the elderly, in women and in patients with triple vessel disease and depressed left ventricular function. Compared with angioplasty in 6,950 patients with nonoccluded stenoses, angioplasty of total occlusions had a lower success rate (72% versus 96%, p = 0.001), although the complication rate was also lower (1.9% versus 3.5%, p = 0.01). Multivariate analysis of 20 clinical and angiographic variables in 100 consecutive patients undergoing angioplasty of 104 total occlusions in 1988 identified only bridging collateral vessels (85% success rate if absent versus 18% if present, p less than 0.001) and a tapered occlusion morphology (88% success rate if present versus 59% if absent, p = 0.01) as independent correlates of procedural outcome. Other variables, including the estimated duration of occlusion, lesion length and location, and extent of disease were unrelated to technical success. With present techniques and sufficient operator experience, 70% to 80% of total occlusions can be successfully recanalized by coronary angioplasty with a complication rate of less than 2%.(ABSTRACT TRUNCATED AT 250 WORDS)

Angiography↗
PubMed1990

Direct coronary angioplasty in acute myocardial infarction: outcome in patients with single vessel disease.

Percutaneous transluminal coronary angioplasty was performed as primary therapy in 215 consecutive patients (aged 56 +/- 11 years, 75% male) with acute myocardial infarction and single vessel coronary artery disease. Wide patency of the infarct-related artery was restored in 212 patients (99%). Complications consisted of one urgent coronary bypass operation (0.5%); there were no procedural deaths. A recurrent ischemic event before discharge occurred in eight patients (4%). The in-hospital mortality rate was 1%; five of six patients presenting with cardiogenic shock were alive at discharge. In 126 patients in whom predischarge angiography was performed, the ejection fraction improved from 55 +/- 12% to 61 +/- 12% (p less than 0.005) and increased by greater than or equal to 5% units in 66 patients (52%). Regional wall motion improved in 60 patients (48%). By multivariate analysis, a depressed initial ejection fraction, a limited increase in serum creatine kinase, young age and sustained patency of the infarct-related artery were found to be independent predictors of improvement in left ventricular function. Follow-up data were available in 214 patients (99.5%) at a mean interval of 35 months. The actuarial 3 year cardiac survival rate was 92%. By multivariate analysis, only the baseline ejection fraction correlated with long-term cardiac survival. Nine patients (4%) sustained a late nonfatal myocardial infarction, and 11 patients (5%) underwent subsequent coronary bypass surgery. At late follow-up study, 149 (77%) of 194 patients alive were free of angina. In summary, in patients with acute myocardial infarction and single vessel disease, coronary angioplasty without prior thrombolytic therapy can be performed with a high success rate and few procedural complications. After direct angioplasty, regional wall motion and global ejection fraction improve in 50% of patients, especially in those with depressed initial left ventricular function. This approach results in an excellent early and late event-free survival.

Adult↗
PubMed1990

Inflation pressure requirements during coronary angioplasty.

To examine the balloon inflation pressures required for successful percutaneous transluminal coronary angioplasty (PTCA), the maximal inflation pressure required for 477 coronary lesions in 200 consecutive patients was determined retrospectively. When graded balloon inflations just sufficient to achieve full expansion were used, the maximal inflation pressure used was less than or equal to 8 atm in 412 stenoses (86%) and was less than or equal to 10 atm in 463 stenoses (97%). Successful PTCA was achieved in 98% of lesions with a 3.5% major procedural complication rate. In a second group of 100 patients studied prospectively, the inflation pressure required to achieve full balloon expansion was less than or equal to 8 atm in 214 of 232 stenoses (92%) and less than or equal to 10 atm in 228 stenoses (98%). Thus, PTCA of coronary stenoses can be achieved with high success rates and low complication rates when graded inflations to pressures just sufficient to achieve full balloon expansion are performed. Most coronary stenoses will respond to pressures less than or equal to 8-10 atm.

Adult↗
PubMed1990

High-dose contrast agent administration during complex coronary angioplasty.

To examine the necessity and consequences of high-dose contrast media administration during coronary angioplasty, the records of 730 consecutive patients over a 6-month period were reviewed. The 54 patients (7%) requiring contrast agent doses greater than or equal to 400 ml were examined in detail. The mean contrast dose in this group was 496 +/- 76 ml (range 400 to 785 ml). Their mean age was 63 +/- 11 years (range 36 to 83 years), 10 patients had diabetes mellitus (19%), and four patients had a baseline creatinine level greater than or equal to 1.5 mg/dl (7%). Following coronary angioplasty, the serum creatinine rose from 1.1 +/- 0.2 to 1.2 +/- 0.3 (p = 0.08). The creatinine rose greater than or equal to 0.5 mg/dl in six patients (11%) and greater than or equal to 1.0 mg/dl in one patient (2%). Five of these six patients had either diabetes mellitus, baseline renal insufficiency, or both. Oliguria was not observed. The most important procedural factors contributing to the high doses of contrast media were multilesion and multivessel angioplasty in 96% and 83% of patients, respectively, prior bypass surgery in 52%, and combined diagnostic cardiac catheterization and angioplasty in 13%. Thus renal dysfunction following high-dose contrast agent administration during complex coronary angioplasty is infrequently associated with nephrotoxicity. Whenever possible, contrast doses in patients with diabetes mellitus and renal insufficiency should be minimized.

Adult↗
PubMed1990

Supported "high risk" coronary angioplasty using intraaortic balloon pump counterpulsation.

Hemodynamic support may be desirable for selected patients with high risk characteristics undergoing elective coronary angioplasty. Twenty-eight high risk patients were studied with elective intraaortic balloon pump support over a recent 30 month period. Their mean age was 66 years; 10 patients were greater than or equal to 70 years old. Class III or IV angina was present in 23 patients (82%). The mean left ventricular ejection fraction was 24% (range 15% to 50%) and was less than 30% in 25 patients (89%). Three vessel disease was present in 26 patients (93%) and 7 patients had significant left main coronary artery disease. Ninety (96%) of 94 attempts to dilate stenoses were successful, including multivessel angioplasty in 21 patients (75%) and five left main coronary artery dilations. Decreases in systolic blood pressure to less than or equal to 70 mm Hg occurred in 11 patients (39%), but augmented diastolic pressure was greater than or equal to 90 mm Hg at all times. No deaths or myocardial infarctions occurred within 72 h of coronary angioplasty. Vascular complications requiring surgical repair occurred in three patients who had good operative results and no need for transfusions. Thus, intraaortic balloon pump support in patients with high risk features undergoing elective coronary angioplasty appears effective and relatively benign, although definite benefit cannot be proved without a randomized study. Newer techniques, such as in-laboratory cardiopulmonary bypass, must be compared with the results obtained with intraaortic balloon pump support alone.

Aged↗
PubMed1990

Results of primary angioplasty for acute myocardial infarction in patients with multivessel coronary artery disease.

The influence of multivessel coronary artery disease on the outcome of reperfusion therapy for myocardial infarction has not been fully characterized. Direct coronary angioplasty without antecedent thrombolytic therapy was performed during evolving myocardial infarction in 285 patients with multivessel coronary artery disease at 5.2 +/- 4.2 h after the onset of chest pain. Two vessel disease was present in 163 patients (57%) and three vessel disease in 122 (43%). An anterior infarct was present in 123 patients (43%), cardiogenic shock in 33 (12%) and age greater than or equal to 70 years in 59 (21%). Angioplasty of the infarct-related vessel was successful in 256 patients (90%), including 92% with two vessel and 88% with three vessel disease (p = NS). Emergency bypass surgery was needed in six patients (2%). In-hospital death occurred in 33 patients (12%), including 13 with two vessel and 20 with three vessel disease (p less than 0.05). The mortality rate was only 4% in the subgroup of 101 patients who met entry criteria for thrombolytic trials. The in-hospital mortality rate was 45% in patients in shock and 7% in patients not in shock (p less than 0.01). Logistic regression analysis identified shock and age greater than or equal to 70 years as independently associated with in-hospital death. In 135 patients who underwent predischarge left ventriculography, global ejection fraction increased from 50% to 57% (p less than 0.001) and regional wall motion in the infarct zone improved in 59% of patients. Follow-up data were available in 251 patients (99%) at a mean of 35 +/- 19 months.(ABSTRACT TRUNCATED AT 250 WORDS)

Angioplasty, Balloon, Coronary↗
PubMed1990

Multivessel coronary angioplasty from 1980 to 1989: procedural results and long-term outcome.

From June 1980 to January 1989, 3,186 patients had coronary angioplasty of two (2,399 patients) or three (787 patients) of the three major epicardial coronary systems. A mean of 3.6 lesions (range 2 to 14) were dilated per patient, with a 96% success rate. Acute complications were seen in 94 patients (2.9%) and included Q wave infarction in 47 (1.4%), urgent coronary artery bypass surgery in 33 (1%) and death in 31 (1%). Multivariate correlates of in-hospital death included impaired left ventricular function, age greater than or equal to 70 years and female gender. Complete long-term follow-up data were available for the first 700 patients and the follow-up period averaged 54 +/- 15 months in duration. Actuarial 1 and 5 year survival rates were 97% and 88%, respectively, and were not different in patients with two or three vessel disease. By Cox regression analysis, age greater than or equal to 70 years, left ventricular ejection fraction less than or equal to 40% and prior coronary artery bypass surgery were associated with an increased mortality rate during the follow-up period. Repeat revascularization procedures were required in 322 patients (46%). Restenosis resulted in either repeat angioplasty or bypass surgery in 227 patients (32%). Repeat coronary angioplasty was performed for isolated restenosis in 126 patients (18%), for restenosis and disease progression at new sites in 85 patients (12%) and for new disease progression alone in 54 patients (8%). Coronary bypass surgery was required in 110 patients (16%) during the follow-up period.(ABSTRACT TRUNCATED AT 250 WORDS)

Angioplasty, Balloon, Coronary↗
PubMed1990

Short- and long-term outcome of percutaneous transluminal coronary angioplasty in chronic dialysis patients.

Accelerated atherosclerosis occurs in chronic renal failure. The role of percutaneous transluminal coronary angioplasty (PTCA) in chronic renal failure patients requiring dialysis has not been characterized. We studied 17 chronic dialysis patients requiring PTCA over a 6-year period. Their mean age was 60 years, four were diabetic, eight had severe hypertension, and seven had unstable angina. Angiographic success was achieved in 47 of 49 (96%) stenoses attempted, including multivessel PTCA in 12 patients. There was one procedural death, two non-Q wave myocardial infarctions following PTCA, and one additional in-hospital noncardiac death. The 15 survivors were asymptomatic on discharge (mean stay 11 days), but recurrent angina developed within 6 months in 12 patients. Angiography in 11 of these 12 patients demonstrated restenosis of 26 of 32 (81%) dilated sites. Repeat PTCA in six patients was followed by return of angina in four patients with restenosis in 11 of 12 sites. Bypass surgery was ultimately performed in four patients with long-term angina relief. During follow-up (mean 20 months), seven patients died (five from chronic renal failure, two cardiac deaths). Thus although PTCA in chronic dialysis patients is technically feasible and provides relief of angina, aggressive restenosis limits the long-term benefit. Coronary bypass surgery may be the preferred therapy for this unique patient group.

Angina Pectoris↗
PubMed1990

Catheterization laboratory events and hospital outcome with direct angioplasty for acute myocardial infarction.

To assess the safety of direct infarct angioplasty without antecedent thrombolytic therapy, catheterization laboratory and hospital events were assessed in consecutively treated patients with infarctions involving the left anterior descending (n = 100 patients), right (n = 100), and circumflex (n = 50) coronary arteries. The groups of patients were similar for age (left anterior descending coronary artery, 59 years; right coronary artery, 58 years; circumflex coronary artery, 62 years), patients with multivessel disease (left anterior descending coronary artery, 55%; right coronary artery, 55%; circumflex coronary artery, 64%), and patients with initial grade 0/1 antegrade flow (left anterior descending coronary artery, 79%; right coronary artery, 84%; circumflex coronary artery, 90%). Cardiogenic shock was present in eight patients with infarction of the left anterior descending coronary artery, four with infarction of the right coronary artery, and four with infarction of the circumflex coronary artery. Major catheterization laboratory events (cardioversion, cardiopulmonary resuscitation, dopamine or intra-aortic balloon pump support for hypotension, and urgent surgery) occurred in 10 patients with infarction of the left anterior descending coronary artery, eight with infarction of the right coronary artery, and four with infarction of the circumflex coronary artery (16 of 16 shock and six of 234 nonshock patients, p less than 0.001). There was one in-laboratory death (shock patient with infarction of the left anterior descending coronary artery).(ABSTRACT TRUNCATED AT 250 WORDS)

Angioplasty, Balloon, Coronary↗
PubMed1989

Early and late results of coronary angioplasty without antecedent thrombolytic therapy for acute myocardial infarction.

Direct coronary angioplasty without antecedent thrombolytic therapy was performed in 500 consecutive patients with acute myocardial infarction. Anterior and inferior infarctions were noted in 217 and 283 patients, respectively. Two hundred fifteen patients (43%) had 1-vessel disease, 85 patients (17%) were greater than 70 years of age and 39 (8%) presented in cardiogenic shock. Successful angioplasty of the infarct vessel was achieved in 94% of patients. The overall in-hospital mortality was 7.2%. Cardiogenic shock, 3-vessel disease and failed angioplasty were the 3 strongest multivariate correlates of early mortality. Reocclusion of the infarct-vessel was noted in 47 (15%) of the 307 patients with angiographic follow-up before hospital discharge. Significant bleeding complications occurred in only 3% of patients; stroke or myocardial rupture was not seen. The global ejection fraction increased from 53% on the preangioplasty ventriculograms to 59% at 1 week (p less than 0.001). Significant regional wall motion improvement in the infarct segments was noted in 53% of patients. Global ejection fraction improved most dramatically in patients presenting with baseline ejection fractions less than or equal to 45% (increasing from 36 to 50%). The 1- and 5-year survival rates after hospital discharge were 95 and 84%, respectively. The 1-year reinfarction rate was 3%. Thus, direct coronary angioplasty was highly effective in reestablishing infarct-vessel patency and salvaging ischemic myocardium, resulting in low in-hospital and long-term mortality.

Angioplasty, Balloon, Coronary↗
PubMed1989

Left main coronary angioplasty: early and late results of 127 acute and elective procedures.

The results of 127 left main (LM) coronary angioplasties were reviewed to assess short- and long-term effectiveness. Three major subgroups were considered: (1) elective "protected" (defined as the presence of a patent bypass graft to the left coronary circulation) patients (n = 84); (2) elective "unprotected" patients (n = 33); and (3) acute patients, in whom LM coronary angioplasty was performed in the setting of an acute myocardial infarction (n = 10). Successful LM dilation was achieved in 94% of elective patients and 90% of acute patients. Procedural mortality was 4.3% in elective patients (2.4 and 9.1% in protected and unprotected patients, respectively, p = 0.14) and 50% in the acute subgroup. Long-term follow-up data, available for 98% of patients, revealed actuarial 3-year survival rates of 90 and 36% in elective protected and unprotected subgroups, respectively (p less than 0.0005). In the acute subgroup, 3 patients (30%) were alive at the time of follow-up; all had undergone coronary artery bypass surgery. Thus, although elective angioplasty of an unprotected LM coronary artery is technically feasible, the long-term prognosis of such patients is very poor. LM angioplasty in this subgroup should be reserved for patients in whom surgical revascularization is not an option. In contrast, elective angioplasty of a protected LM coronary artery can be accomplished safely with good long-term results. LM coronary angioplasty for acute myocardial infarction can be effective as a salvage procedure; however, adjunctive coronary bypass surgery is important for long-term survival.

Aged↗
PubMed1989

A randomized trial of corticosteroids for the prevention of restenosis in 102 patients undergoing repeat coronary angioplasty.

To examine the effect of corticosteroid therapy on the development of restenosis following successful percutaneous transluminal coronary angioplasty (PTCA), we randomized 102 patients with restenosis following prior PTCA to receive high-dose steroids (n = 52) or no steroids (n = 50). The steroid regimen consisted of 125 mg methylprednisolone I.M. the night before and morning of the PTCA, and prednisone 60 mg p.o. Q.D. for 1 week. post-PTCA. Angiographic follow-up at 6 months was available in 27 steroid-treated patients (52%) and 27 controls (54%). The per lesion incidence of restenosis was similar in the two groups (36% vs. 40%, respectively, P = NS). Clinical follow-up was available in the remaining patients at a mean interval of 1.2 years. The clinical correlates of restenosis (incidence and severity of angina, positive treadmill exercise test, nonfatal infarction or death) were similar in the steroid treated and control groups (24% vs. 39%, respectively, P = .56). At late follow-up, 30 steroid-treated patients (58%) and 26 control patients (52%) had no clinical or angiographic evidence of restenosis (P = NS). In conclusion, a short course of high-dose corticosteroid therapy does not significantly reduce the frequency of restenosis following PTCA.

Angiography↗
PubMed1989

Short-term outcome and long-term follow-up following coronary angioplasty in the young patient: an 8-year experience.

From 8000 consecutive percutaneous transluminal coronary angioplasty (PTCA) procedures performed between 1980 and 1988, 89 separate PTCA procedures (1.1%) were performed in 71 patients less than or equal to 35 years of age. Multivessel disease was present in 41 patients (58%). Eleven procedures (12.4%) were done for acute myocardial infarction. Of 253 lesions attempted, 242 (95.6%) were successfully dilated. Complications consisted of just a single urgent bypass operation (1.1%). At mean follow-up of 32 months, 50 patients (72.5%) were asymptomatic. Late events consisted of one death (1.4%), four nonfatal infarctions (5.8%), and seven bypass surgeries (10.1%). Seventeen patients (24.6%) required 25 repeat PTCAs; restenosis was present in 12 of these patients while progression of native disease was noted in nine patients. In the young patient with coronary artery disease, PTCA can be performed safely, with a high success rate and few complications. Though the 3-year survival is excellent, a significant proportion of these patients develop nonfatal infarction or require repeat PTCA or bypass surgery, often for progression of native disease in addition to restenosis.

Adult↗
PubMed1989

Repeat coronary angioplasty: efficacy of a third angioplasty for a second restenosis.

To determine the efficacy of repeat percutaneous transluminal coronary angioplasty, 74 patients were studied who underwent a third angioplasty for a second restenosis of one coronary artery segment. The procedure was successful in 93% of patients. Procedural complications included emergency bypass surgery (three patients) and in-hospital death (two patients). At late follow-up (mean 18 months, range 7 to 49), 30 patients (43%) had a third restenosis treated with either a fourth angioplasty (16 patients), coronary bypass surgery (11 patients) or medical management (1 patient). Thirty-nine patients (57%) had no restenosis on the basis of follow-up angiography or absence of symptoms previously attributed to restenosis. Factors associated with a third restenosis included a shorter time interval (less than 3 months) between previous angioplasty procedures and dilation of the left anterior descending coronary artery. Among the 16 patients undergoing a fourth angioplasty for a third restenosis, the procedural success rate was 94%. One patient required emergency bypass surgery. At late follow-up (mean 16 months, range 7 to 38), eight patients (53%) had a fourth restenosis treated with either a fifth angioplasty (one patient), bypass surgery (five patients) or medical management (two patients). Considering all 74 patients undergoing a third angioplasty for a second restenosis, 27% had bypass surgery, 5% died, 4% were managed medically and 64% were free of angina at late follow-up after either a third, fourth or fifth angioplasty. Restenosis rates after a third or fourth angioplasty procedure for recurrent restenosis are higher than those for the initial procedures.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

"High-risk" percutaneous transluminal coronary angioplasty.

Of 6,500 percutaneous transluminal coronary angioplasty procedures performed between June 1980 and June 1987, 3,501 (1,604 single lesion and 1,897 multiple lesion) were performed in "low-risk" patients with a procedure-related mortality of 0.2 to 0.3%. In comparison, several clinical variables were identified that increased procedural risk by up to 50-fold. These factors include left main dilatation (n = 103, mortality 3.9%), left main equivalent dilatation (n = 77, mortality 2.6%), ejection fraction less than or equal to 40% (n = 664, mortality 2.7%), age greater than or equal to 70 years (n = 1,038, mortality 1.4%), dilatation of all 3 vessels (n = 305, mortality 1.3%), combined diagnostic catheterization and angioplasty for unstable angina (n = 193, mortality 1.5%), and percutaneous transluminal coronary angioplasty for acute myocardial infarction (n = 446, mortality 8.5%). Important considerations in the selection and management of these high-risk patients are discussed.

Age Factors↗
PubMed1988

Hugging balloons: coronary angioplasty of oversized vessels with side-by-side balloons.

Angioplasty of large (greater than 4.0-mm) saphenous vein grafts using the largest available (4.0-mm) balloon catheters may result in inadequate graft dilatation. To avoid leaving a significant residual stenosis, two balloon catheters can be inflated side by side across the stenosis. Herein, we report two cases where this "hugging balloon" technique was used to achieve wide graft patency.

Angioplasty, Balloon↗