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Biomedical subjects

B Lancelin

Publications and source records attributed to B Lancelin.

At least 19 recordsLinked to original sources
PubMed2004

[Visualization of coronary tree and detection of coronary artery stenosis using 16-slice, sub-millimeter computed tomography: preliminary experience].

PURPOSE: multislice CT has been shown as a promising tool for coronary artery imaging. Our goal was to investigate the value of the new sixteen-slice, CT technology for non-invasive visualization of coronary arteries and assessment of coronary stenosis. MATERIALS AND METHODS: we assessed coronary artery visualization in 30 consecutive patients using 16-slice CT and compared the findings with conventional coronary angiography. The whole heart was scanned using 0.75 millimeter slices after injection of contrast medium. Retrospective ECG-gated reconstructions were performed and images were analyzed using axial CT, maximum intensity projection and 3D images, blind to the conventional angiography findings. Seventeen main coronary segments of more than 1.5 mm were analyzed and stenosis was graded on a four-point scale. RESULTS: CT angiography attained diagnostic quality for the whole coronary artery tree in 90% (27/30) of patients. Sixteen of 493 segments (4%) were not interpreted because of substantial motion artifacts (n=12) or heavy calcifications or stenting (n=4). Thirty seven of the 43 cases of significant stenosis (>50%) identified on coronary angiograms were correctly identified with multislice CT. All 6 false negatives involved stenosis of the circumflex artery or branches. Five false positive stenoses were found in 432 non stenotic segments. The sensitivity was thus 86%, specificity 99% for stenosis of more than 50%. CONCLUSION: 16-slice CT provides an excellent visualization of the coronary tree in most patients, allowing accurate non-invasive detection of significant coronary stenosis. Stenoses of the left circumflex artery remain more difficult to detect.

Aged↗
PubMed2004

[Diagnosis of acute myocardial infarction using multislice computed tomography in emergency room].

Managing chest pain in emergency remains a diagnostic challenge because of the speediness and the accuracy that request. The authors report the case of a 40 years old patient admitted for chest pain with suspected aortic dissection. Multislice computed tomography (sixteen-slice CT) was performed at the patient's admission, initial diagnosis was rapidly corrected, showing both and accurately show both antero-septal defect perfusion and an acute occlusion of the proximal left anterior descending artery. Angioplasty was performed in emergency within the 6 first hours after onset of the symptoms. Multislice computed tomography was able to identify accurately not only the chest pain etiology but also to show the culprit artery, leading to quick and oriented percutaneous coronary intervention.

Adult↗
PubMed2004

[Anomalies in myocardial contrast uptake revealed by multislice cardiac CT during acute myocarditis].

Acute myocarditis can display many various clinical appearances. Endomyocardial biopsy is an invasive investigation for which the sensibility is insufficient in mild cases and when it is performed too early. Multislice cardiac CT with ECG synchronisation and injection of contrast medium allows visualisation of the coronary arteries and the study of myocardial contrast uptake. We report the cases of two patients with a mild myocarditis where multislice CT performed early showed multiple areas of increased myocardial contrast uptake consistent with a diffuse inflammatory disorder. Coronary angiography was normal in these two patients. Multislice cardiac CT could be a useful non-invasive investigation for the early diagnosis of this disease.

Acute Disease↗
PubMed2003

[Non-invasive coronarography: myth or reality].

Slice Imaging technology progress allows a good approach of coronary arteries. MRI and Multislice Computed Tomography (MSCT) are in competition. Inspite of important progress, MRI of coronary artery disease remains "disappointing". With this imaging technology, there is a good plaque burden and myocardium visualisation. MST, and particularly with 16 slice technology, allows a good coronary stenosis identification. This technology enables soft plaque and myocardial ischemia detection. It is now possible to detect coronary heart disease with MSCT, which can replace or help a coronary angiogram in some indications.

Angioplasty, Balloon, Coronary↗
PubMed2001

Percutaneous transluminal angioplasty of ostial lesions of internal mammary artery grafts.

The internal mammary artery (IMA) is currently the best graft for coronary bypass surgery and is therefore preferentially anastomosed to major arteries, usually the left anterior descending (LAD) artery. This graft may develop a stenosis, most often at the distal anastomosis. Ostial stenoses are rare and their pathophysiology uncertain. While angioplasty of distal anastomotic lesions provides adequate results, the very small number of published cases of angioplasty of ostial lesions explains the lack of knowledge on results of this type of procedure. The authors report six procedures of this type on five patients, including two with stenting. The primary success rate was 100%, with only one hospital complication in the form of pulmonary edema. Mean follow-up for 35 months revealed one sudden death due to probable restenosis, another death 3 years after angioplasty from rapid fatal shock without complementary investigation, and one case of unstable angina secondary to intrastent restenosis. These results suggest that this type of angioplasty is technically feasible with low risk, and that the restenosis rate seems relatively high, potentially presenting as sudden death, in the same way as unprotected dilatation of the native left main artery. A very close clinical follow-up of these patients is therefore necessary, with angiographic control in case of suspected ischemia.

Aged↗
PubMed2000

A comparison of systematic stenting and conventional balloon angioplasty during primary percutaneous transluminal coronary angioplasty for acute myocardial infarction. STENTIM-2 Investigators.

OBJECTIVES: In a multicenter, randomized trial, systematic stenting using the Wiktor stent was compared to conventional balloon angioplasty with provisional stenting for the treatment of acute myocardial infarction (AMI). BACKGROUND: Primary angioplasty in AMI is limited by in-hospital recurrent ischemia and a high restenosis rate. METHODS: A total of 211 patients with AMI <12 h from symptom onset, with an occluded native coronary artery, were randomly assigned to systematic stenting (n = 101) or balloon angioplasty (n = 110). The primary end point was the binary six-month restenosis rate determined by core laboratory quantitative angiographic analysis. RESULTS: Angiographic success (Thrombolysis in Myocardial Infarction [TIMI] flow grade 3 and residual diameter stenosis <50%) was achieved in 86% of the patients in the stent group and in 82.7% of those in the balloon angioplasty group (p = 0.5). Compared with the 3% cross-over in the stent group, cross-over to stenting was required in 36.4% of patients in the balloon angioplasty group (p = 0.0001). Six-month binary restenosis (> or = 50% residual stenosis) rates were 25.3% in the stent group and 39.6% in the balloon angioplasty group (p = 0.04). At six months, the event-free survival rates were 81.2% in the stent group and 72.7% in the balloon angioplasty group (p = 0.14), and the repeat revascularization rates were 16.8% and 26.4%, respectively (p = 0.1). At one year, the event-free survival rates were 80.2% in the stent group and 71.8% in the balloon angioplasty group (p = 0.16), and the repeat revascularization rates were 17.8% and 28.2%, respectively (p = 0.1). CONCLUSIONS: In the setting of primary angioplasty for AMI, as compared with a strategy of conventional balloon angioplasty, systematic stenting using the Wiktor stent results in lower rates of angiographic restenosis.

Angioplasty, Balloon↗
PubMed2000

[Angor with occlusion of the left main coronary artery treated with angioplasty].

The occlusion of the left main coronary artery is rare and generally fatal. However, some subjects do survive. The two conditions necessary for survival appear to be the existence of a dominant right coronary artery and above all a rapidly functional left-right collaterality. The time lapse between occlusion and the introduction of an efficient collateral system is fundamental to patient survival. If the time lapse is too long, there is a risk of myocardial infarction, often complicated by cardiogenic shock, with a poor prognosis even after deocclusion. In this study, the case is reported of a patient with left main coronary artery occlusion presenting as unstable angor without an increase in enzymatic levels, and with a totally functional left-right collaterality. Deocclusion angioplasty was successfully performed. Finally, the short- and medium-term results of left main coronary artery angioplasty have been discussed.

Angina Pectoris↗
PubMed1997

[Why so many stents?].

BETTER THAN ANGIOPLASTY: Prolonging inflation with a perfusion balloon decreases the risk of acute coronary occlusion after angioplasty. The longer the artery remains patent, the greater the chances of 0% residual stenosis. This is what the sent allows. Stent act on both mechanisms of stenosis: elastic recoil and fibrous remodeling of the arterial plaque. TARGETTED ACTION: Stents improve angioplasty prevention of acute stenosis. They have a real action on preventing degeneration of the saphenous graft and lead to a significant reduction in the rate of restenosis of the dilated site. There are however two specific complications: subacute occlusion and greater incidence of vascular events. Stents are particularly indicated for the treatment of restenosis and chronic occlusions. TWO IMPROVEMENTS: Risks related to the implantation of a foreign body in the vascular system have been reduced with the use of ticlopidine and high-pressure stent implantation. POSITIVE RESULTS: Stents have produced better angiographic results. They limit restenosis and the number of revascularizations required in treated patients. Several questions concerning indications remain open.

Angioplasty, Balloon, Coronary↗
PubMed1997

[Medical treatment after implantation of intracoronary stents].

RATIONALE FOR ANTITHROMBOSIS THERAPY: Introducing a foreign body into the coronaries raises the risk of thrombosis in the acute phase and for the 4 following weeks. The objective of antithrombotic therapy is to inhibit platelet adhesion and aggregation or to induce hypocoagulability. AT IMPLANTATION: High-dose heparin is given in a bolus following pretreatment with aspirin. ASPIRIN-TICLOPIDINE COMBINATION: The risk of subacute thrombosis is low, about 1%, and the rate of vascular complications is minimal. Treatment is simple and compatible with short hospitalization.

Anticoagulants↗
PubMed1997

[Different types of coronary stents].

GENERAL CHARACTERISTICS: Several criteria are used for coronary stent design: biocompatibility, i.e. the capacity to resist thrombotic events and corrosion, flexibility, radial force sufficient to resist elastic recoil, percentage of the lesion covered, radio-opacity, minimal shortening at opening, absence of effect on collateral branches, possibility to use small calibre probe guides, and cost. TWO CATEGORIES: Both tubular stents (self-expanding stents and balloon stents) and filamentary stents (made of stainless steel or tantalum) are used, THE IDEAL STENT: There is no one ideal stent. Choice is dictated by the characteristics of the lesion and by the status of the artery to treat.

Coronary Disease↗
PubMed1996

[Isolated anomalous origin of a septal artery from a third coronary ostium. Apropos of a case].

The authors report the case of a patient undergoing coronary angiography for angina who had an anomalous origin of the septal perforator artery from a separate ostium. Anomalies of the coronary arteries may consist not only of anomalous trajectories and coronary fistulae but also of anomalous origins of the main coronary arteries. The anomalous origin of a septal artery from a separate ostium is very rare accounting for 0.5% of cases in the medical literature. In some cases, this artery provides a collateral circulation for occluded main coronary vessels, thereby preserving left ventricular contractility.

Angina Pectoris↗
PubMed1996

[Is plasma lipoprotein (a) level a reliable indicator predicting restenosis after angioplasty?].

Lipoprotein (a) [Lp(a)] is an independent genetically determined marker of coronary artery disease. It is present in the atheromatous plaque with a molecular structure similar to that of plasminogen. Its role in postangioplasty restenosis is a possibility but is controversial. A population of 103 coronary patients underwent angioplasty with control coronary angiography before the 6th month; there were 53 good results and 50 cases of restenosis. The Lp(a) was measured by immunonephelemetry (threshold value of 250 mg/l). A subgroup with Lp(a) concentrations > 250 mg/l was identified. The average concentrations of Lp(a) in the two groups without restenosis (368 +/- 350 mg/l) and with restenosis (418 +/- 434 mg/l) were not statisticaly different (p = 0.2). When cases with Lp(a) > 250 mg/l were considered alone, the tendency to higher average concentrations of Lp(a) in the group with restenosis (777 +/- 424 mg/l) compared with the group without restenosis (656 +/- 340 mg/l) was more clear-cut but did not achieve statistical significance (p = 0.08). The individual scatter of Lp(a) being very wide (83 to 1,450 mg/l in the group without restenosis and 90 to 1,740 mg/l in the group with restenosis), it is impossible to predict restenosis from this parameter in a given individual. No correlations were observed between the different lipid fractions and restenosis. The extension of the lesions and the angioplasty site did not correlate with restenosis in this study. The authors conclude: 1) that the Lp(a) concentration has no individual predictive value for restenosis; 2) individuals with Lp(a) concentrations > 250 mg/l have an increased risk of restenosis (NS); 3) these results confirm other recent publications; and 4) further research into the isoforms of Lp(a) in each group could provide interesting data.

Aged↗
PubMed1995

[Extraction of intravascular foreign bodies].

OBJECTIVE: Loss or displacement of foreign material within the cardiovascular system is not an uncommon event. Foreign bodies include fragments of diagnosis equipment, ruptured catheters or malpositioned or displaced intravascular prostheses. The incidence has increased with the development of endovascular catheterism and raises the problem of extraction. METHODS: We report our experience with percutaneous extraction of intravascular foreign bodies. RESULTS: There were 56 cases. Percutaneous extraction was successful in 53. In 11 cases, the procedure was carried out during a catheterism procedure and in the others the initial event had occurred earlier. The delay to extraction varied from a few hours to several years. CONCLUSION: Percutaneous extraction of intravascular foreign bodies should be attempted before surgical removal, an often difficult high-risk procedure. The literature does not provide data on the frequency of intravascular foreign bodies.

Adolescent↗
PubMed1994

"Pseudo-narrowing" during right coronary angioplasty: how to diagnose correctly without withdrawing the guidewire.

The straightening of a sinuous proximal segment of a coronary artery using the stiffness of the guidewire has recently been recognized as likely to cause false coronary lesions. The accurate diagnosis between a true dissection and a pseudo-lesion is usually only done once all intra-coronary material has been removed into the guiding catheter. Such a manoeuvre may prove dangerous in case of dissection. We propose to demonstrate that it is possible to diagnose this phenomenon while leaving the guidewire within the coronary artery, and withdrawing it progressively until its floppy segment rests equally on either side of the suspect lesion.

Angioplasty, Balloon, Coronary↗
PubMed1994

Should we avoid ostial implantations of Wiktor stents?

Complications arising during stent implantations in coronary arteries have been reduced by technological progress and the accumulated experience of interventional cardiologists. Retrospective and prospective randomized studies with several types of stents are currently available and show improved short and mid-term results. Wiktor stent provides increased flexibility for ease of implantation particularly in curved lesions. However, the flexibility of the Wiktor stent is also associated with low resistance in the longitudinal axis. We report four cases (in 4 out of 6 ostial lesions treated and 4 out of 43 Wiktor stents implanted during a 9-month period) in which stents have become unraveled during procedures on ostial lesions (2 saphenous venous grafts and 2 native coronary arteries). Death occurred in one case and one patient was treated by emergency coronary bypass surgery. In three cases the distal extremity of the guiding catheter stretched the stent meshes during the final control angiograms, and in one case the stent was stretched during withdrawal of the deflated balloon into the guiding catheter. We believe that it is preferable to avoid using this stent in ostial lesions.

Angioplasty, Balloon, Coronary↗
PubMed1992

[Cardiology in general hospitals. A cooperative survey on medical teams, technical means and activity].

A national enquiry carried out in 1990 in the departments of cardiology of general and private non-profit making hospitals established the status of these departments and the evolution of their personnel and equipment since their creation. The enquiry involved two thirds of the cardiology departments of the general hospitals (119/180) and showed that most (66%) were established between 1974 and 1988. Implanted in fairly important cities with catchment areas of 100,000 to 400,000 people, they have an average of 32 beds (range 11 to 100) and 7.25 coronary care beds (range 4 to 19); 347 doctors work full (211) or part time (136) in these departments. These two types of work are allowed in the majority of these units (64/119). Specialist certified cardiologists practice in 62 departments (56%). The usual technical equipment is available in 80% of the units (Doppler echocardiography, exercise stress testing, Holter monitoring, right heart catheterisation). Permanent pacing is performed in 65% of these hospitals, more so in the provinces than in the Paris region. Coronary angiography is only available in 21%, radioisotopic investigations in 15% and coronary angioplasty in 12% of these centres. A prospective study performed in 1990 concerning 110 hospitals recruited 1,030 myocardial infarctions, which enabled the total number of infarcts hospitalised in the coronary care units of the general hospitals to be estimated at about 21,000 (60% of French myocardial infarctions).

Angioplasty↗