Biomedical subjects

C Briguori

Publications and source records attributed to C Briguori.

At least 19 recordsLinked to original sources

PubMed2003

Clinical and angiographic outcome of directional atherectomy followed by stent implantation in de novo lesions located at the ostium of the left anterior descending coronary artery.

BACKGROUND: Lesions located at the ostium of the left anterior descending coronary artery (LAD) are considered an ideal target for directional atherectomy (DCA), but few data are available about the value of using this strategy before stenting in comparison with stenting alone. OBJECTIVES: To investigate the immediate and mid term clinical and angiographic results of DCA followed by stent implantation for ostial LAD lesions. DESIGN: Retrospective comparison of the immediate and mid term angiographic and clinical results of a series of 117 consecutive patients with de novo lesions located at the ostium of the LAD. Of these, 46 underwent DCA before stenting and 71 were treated with stenting alone. RESULTS: Technical success in the two groups was similar at around 98%. DCA plus stenting provided a larger minimum lumen diameter at the end of the procedure than stenting alone (3.57 (0.59) mm v 3.33 (0.49) mm, p = 0.022). There were no differences for in-hospital major adverse events (MACE) (7.5% for atherectomy plus stenting, and 5.3% for stenting alone; p = 0.41). All patients had clinical follow up at a mean of 7.9 (2.7) months. Angiographic follow up was done in 89 patients (76%) at a mean of 5.9 (2.2) months. The atherectomy plus stenting group had a larger minimum lumen diameter than the stenting group (2.79 (0.64) mm v 2.26 (0.85) mm, p = 0.004) and a lower binary restenosis rate (13.8% v 33.3%, p = 0.031). Six month MACE were reduced in the atherectomy plus stenting group (8.7% v 23.9%, p = 0.048). CONCLUSIONS: Debulking before stenting in de novo lesions located at the ostium of the LAD is safe and is associated with a high rate of technical success. Follow up data show that DCA plus stenting results in a significantly larger minimum lumen diameter and a lower incidence of restenosis than stenting alone.

Angioplasty, Balloon, Coronary↗

PubMed2002

Discrepancy between angiography and intravascular ultrasound when analysing small coronary arteries.

AIMS: A small reference diameter may be the consequence of high plaque burden and diffuse disease. The reference vessel diameter in small coronary arteries may vary according to the method of measurement used. We endeavoured to confirm the difference between data from examinations conducted using angiography with that revealed by intravascular ultrasound. METHODS AND RESULTS: Between March 1993 and October 1999, 344 consecutive patients with 419 lesions in small vessels (< or =2.75 mm, Small group) and 953 patients with 1161 lesions in large vessels (Large group) underwent intravascular ultrasound-guided percutaneous transluminal angioplasty in our Institution. The mean difference between the intravascular ultrasound and the angiographic reference diameter (Delta(IVUS-Angio)) was 1.3+/-0.5 mm in the Small group and 1.0+/-0.6 mm in the Large group (P<0.001). There was a stronger correlation between plaque burden and Delta(IVUS-Angio)in the Small group (r=0.80, P<0.001) than in the Large group (r=0.59, P<0.001). An Delta(IVUS-Angio)> or =0.30 mm occurred in 99.5% of cases in the Small group and in 90% in the Large group (P<0.001). An Delta(IVUS-Angio)> or =0.50 mm occurred in 96% of case in the Small group and 80% in the Large group (P<0.001). Predictors of Delta(IVUS-Angio)> or =0.50 in the Small group were: proximal or middle lesion site, vessel type (left anterior descending artery, diagonal and obtuse marginal branches) and female sex. An Delta(IVUS-Angio)> or =1.0 mm occurred in 71% of cases in the Small group and in 49% in the Large group (P<0.001). Predictors of Delta(IVUS-Angio)> or =1.0 mm in the Small group were: proximal or middle lesion site, female sex, and lesion length. CONCLUSIONS: A high percentage of vessels measuring < or =2.75 mm are large vessels with a high plaque burden. This condition is particularly prevalent in females, with lesions in the proximal or middle left anterior descending artery, and in obtuse marginal and diagonal branches.

Aged↗

PubMed2002

Carotid artery stenting in the first 100 consecutive patients: results and follow up.

BACKGROUND: Carotid artery stenting is now used as an alternative to surgical endarterectomy. The availability of cerebral protection systems has expanded the area of application of this procedure. OBJECTIVE: To assess the feasibility, safety, and immediate and late clinical outcome in patients undergoing percutaneous carotid interventions. METHODS: Between January 1999 and December 2000, 100 consecutive patients with 102 carotid artery stenoses were treated (71 men, 29 women, mean (SD) age 67 (8) years): 49 had coronary artery disease, 28 had previous stroke or transient ischaemic attack (TIA). On the basis of the Mayo Clinic carotid endarterectomy risk scale, 73 patients were grade III-IV and 13 grade VI. RESULTS: Baseline diameter stenosis was 78.8 (10)%, with a mean lesion length of 12.6 (5.8) mm. Angiographic success was obtained in 99 lesions (97.0%) with a final diameter stenosis of 2.4 (3.5)%. Procedural success was obtained in 96 patients (96%). Selective cannulation of three carotid arteries was impossible owing to severe vessel tortuosity. Carotid stenting was performed in 97 of the treated lesions, and protection devices were used in 67 lesions. In-hospital complications occurred in seven patients (six TIA, one (category 1) minor stroke). No major stroke or death occurred. All patients were discharged from the hospital after an average of 2.5 days. At 12 (6.2) months of follow up restenosis occurred in three patients (3.4%) (one patient with carotid occlusion had TIA). Six patients had died: two from cerebrovascular events (5 and 11 months after the procedure) and four from cardiovascular causes. CONCLUSIONS: Carotid stenting appears feasible and safe, with few major complications. Long term follow up is affected by a high incidence of cardiovascular mortality.

Adult↗

PubMed2001

Immediate and long-term clinical and angiographic results from Wiktor stent treatment for true bifurcation narrowings.

From January 1996 to December 1998, 90 consecutive patients with true bifurcation lesions underwent percutaneous coronary angioplasty with Wiktor stent implantation in our centers. In 1 group (group I, n = 45), a simple approach (main vessel stenting and balloon angioplasty of the side branch) was pursued. In the other group (group II, n = 45), both the main vessel and the side branch were stented ("T" technique). There was no significant difference in clinical and angiographic characteristics between the 2 groups. Angiographic and procedural successes were 100% and 95.6%, respectively, in both groups. Angiographic results for the side branch were better in group II than in group I. In-hospital and long-term (12 month) major cardiac events were similar in the 2 groups. Target lesion revascularization was 15.5% in group I and 35.5% in group II (p = 0.12). In the main vessel, restenosis rate was 12.5% in group I and 25% in group II (p = 0.15). In the side branch, restenosis rate was 37.5% in group II and 12.5% in group I (p = <0.05; odds ratio 2.42; 95% confidence interval 1.05 to 6.26). Event-free probability at 12 months was 61% in group II and 80% in group I (p = 0.10). When dealing with true bifurcation lesions, a simple strategy is associated with a lower risk of restenosis in the side branch. In contrast, a complex approach does not appear to give any benefit in terms of early or long-term outcome or restenosis rate.

Angioplasty, Balloon, Coronary↗

PubMed2001

Emergency stenting to treat neurological complications occurring after carotid endarterectomy.

OBJECTIVES: The purpose of this study was to assess the efficacy of emergency stent implantation for the treatment of perioperative stroke after carotid endarterectomy (CEA). BACKGROUND: Carotid endarterectomy has been proven safe and effective in reducing the risk of stroke in symptomatic and asymptomatic patients with >60% carotid artery stenosis. However, perioperative stroke has been reported in 1.5% to 9% of CEA cases. The management of such a complication is challenging. Recently, percutaneous transluminal carotid angioplasty with stent deployment has emerged as a valuable and alternative strategy for the treatment of carotid artery disease. METHODS: Between April 1998 and February 2000, 18 of the 995 patients (1.8%) who had CEA in our institution experienced perioperative major or minor neurological complications. Of these, 13 patients underwent emergency carotid angiogram and eventual stent implantation, whereas the remaining five had surgery re-exploration. RESULTS: Carotid angiogram was performed within 20+/-10 min and revealed vessel flow-limiting dissection (five cases) or thrombosis (eight cases). Percutaneous transluminal carotid angioplasty with direct stenting (self-expandable stent) was performed in all 13 cases. Angiographic success was 100%. Complete remission of neurological symptoms occurred in 11 of the 13 patients treated by stent implantation and in one of the five patients treated by surgical re-exploration (p = 0.024). CONCLUSIONS: Stent implantation seems to be a safe and effective strategy in the treatment of perioperative stroke complicating CEA, especially when carotid dissection represents the main anatomic problem.

Aged↗

PubMed2001

Intravascular ultrasound criteria for the assessment of the functional significance of intermediate coronary artery stenoses and comparison with fractional flow reserve.

The functional significance of coronary artery stenoses of intermediate severity is important in determining strategy in patient care. Intravascular ultrasound (IVUS) is often used to evaluate coronary stenosis severity. However, at present, few data are available about the role IVUS in the assessment of functional significance of intermediate lesions. Myocardial fractional flow reserve (FFR) <0.75 is a reliable index of a functionally severe coronary stenosis. In 53 lesions we assessed (1) by pressure wire: FFR (index of functional significance), and (2) by IVUS: minimal lumen cross-sectional area (MLA, square millimeters), minimal lumen diameter (MLD, millimeters), lesion length (millimeters), and percent area stenosis at the lesion site. By regression analysis, percent area stenosis and lesion length had a significant inverse correlation with FFR (r = -0.58, p <0.001, r = -0.41, p <0.004, respectively). MLD and MLA showed a significant positive relation with FFR (r = 0.51, p <0.001, r = 0.41, p <0.004, respectively). By using a receiver operating characteristic (ROC) curve, we identified a percent area stenosis > 70% (sensitivity 100%, specificity 68%), a MLD < or = 1.8 mm (sensitivity 100%, specificity 66%), a MLA < or =4.0 mm2 (sensitivity 92%, specificity 56%), and a lesion length of >10 mm (sensitivity 41%, specificity 80%) to be the best cut-off values to fit with a FFR <0.75. The combined evaluation of both percent area stenosis and MLD made the IVUS examination more specific (sensitivity 100%, specificity 76%). In 53 intermediate coronary lesions found by angiography, IVUS area stenosis >70%, MLD < or =1.8 mm, MLA < or =4.0 mm2, and lesion length > 10 mm reliably identified functionally critical intermediate coronary stenoses.

Cardiac Catheterization↗

PubMed2001

Cutting balloon angioplasty for the treatment of in-stent restenosis: a matched comparison with rotational atherectomy, additional stent implantation and balloon angioplasty.

OBJECTIVES: The purpose of the study was to determine whether cutting balloon angioplasty (CBA) has advantages over other modalities in treatment of in-stent restenosis (ISR). BACKGROUND: Controversies exist regarding optimal treatment for ISR. Recently, CBA emerged as a tool in management of ISR. METHODS: A total of 648 lesions treated for ISR were divided into four groups according to the treatment strategy: CBA, rotational atherectomy (ROTA), additional stenting (STENT), and percutaneous transluminal coronary angioplasty (PTCA). Following the matching process, 258 lesions were entered into the analysis. RESULTS: Baseline clinical and angiographic characteristics were similar among the groups (p = NS). Acute lumen gain was significantly higher in the STENT group (2.12 +/- 0.7 mm), whereas in the CBA group the gain was similar to one achieved following ROTA and following PTCA (1.70 +/- 0.6 vs. 1.79 +/- 0.5 mm and 1.56 +/- 0.7 mm, respectively; p = NS). The lumen loss at follow-up was lower for the CBA versus ROTA and versus STENT (0.63 +/- 0.6 vs. 1.30 +/- 0.8 mm and 1.36 +/- 0.8 mm, respectively; p < 0.0001), yielding a lower recurrent restenosis rate (20% vs. 35.9% and 41.4%, respectively; p < 0.05). By multivariate analysis, CBA (odds ratio [OR] = 0.17; confidence interval [CI], 0.06 to 0.51; p = 0.001) and diffuse restenosis type at baseline (OR = 2.07; CI, 1.15 to 3.71; p = 0.02) were identified as predictors of target lesion revascularization. CONCLUSIONS: We conclude that CBA is a safe and efficient technique for treatment of ISR, with immediate results similar to atheroablation and better clinical and angiographic outcomes at follow-up. This approach might be implemented as a viable option in management of focal ISR and to prepare diffuse ISR for brachytherapy treatment.

Aged↗

PubMed2001

Determinants and clinical significance of natriuretic peptides and hypertrophic cardiomyopathy.

AIMS: Atrial and brain natriuretic peptide levels closely reflect impaired left ventricular function in patients with heart failure. In the present study we assessed the determinants and the clinical significance of atrial and brain natriuretic peptide plasma levels in hypertrophic cardiomyopathy. METHODS AND RESULTS: In 44 patients with hypertrophic cardiomyopathy (40+/-15 years) we evaluated: (a) atrial and brain natriuretic peptide plasma levels; (b) left ventricular hypertrophy; (c) left ventricular ejection fraction; (d) transmitral and pulmonary venous flow velocity patterns, and left atrial fractional shortening; (e) left ventricular outflow tract gradient; (f) maximal oxygen consumption. Left ventricular hypertrophy influenced only brain natriuretic peptide levels (r=0.32;P<0.05). Atrial and brain natriuretic peptide plasma levels did not correlate with left ventricular ejection fraction, but correlated with left ventricular outflow tract gradient (r=0.35;P<0.05; and r=0.40, P=0.022, respectively) and left atrial fractional shortening (r=-0.57;P<0.001, and r=-0.35;P<0.05, respectively). Atrial but not brain natriuretic peptide plasma levels were inversely related to maximal oxygen consumption (r=-0.35;P<0.05). By stepwise multiple regression analysis, left atrial fractional shortening and left ventricular outflow tract gradient were the only predictors of atrial and brain natriuretic peptide plasma levels, respectively. CONCLUSIONS: In hypertrophic cardiomyopathy, atrial natriuretic peptide plasma levels are mainly determined by diastolic function: this explains the relationship with exercise tolerance. In contrast, brain natriuretic peptide plasma levels are mainly determined by left ventricular outflow tract gradient.

Adolescent↗

PubMed2001

Endovascular stenting for the nutcracker phenomenon.

PURPOSE: To present a case highlighting the efficacy of stent implantation for left renal vein (LRV) entrapment, otherwise known as the nutcracker phenomenon. CASE REPORT: A 17-year-old boy presented with a history of gross hematuria and left flank pain. Magnetic resonance angiography documented compression of the LRV between the superior mesenteric artery and aorta. A Memotherm stent was successfully placed across the LRV to restore adequate luminal flow after a Wallstent failed to adequately span the narrowed segment. Spiral CT angiography at 6 months confirmed LRV patency; the patient remains asymptomatic and free of hematuria at 12 months. CONCLUSIONS: Endovascular stenting for the nutcracker phenomenon is safe and effective and may represent a valuable approach for lessening the morbidity of surgical procedures.

Adolescent↗

PubMed2001

Characterization of total occlusions with intracoronary ultrasound: the importance of the duration of occlusion.

OBJECTIVE: To assess the impact of the occlusion duration on the characteristics of coronary occlusive plaques. BACKGROUND: The percutaneous recanalization of chronic total coronary occlusions is a technically demanding and yet often unsuccessful procedure due to unfavorable morphological changes described by histology but not well defined in vivo. METHODS: Thirty-five consecutive total occlusions of > or = 1 month duration in previously untreated native coronary arteries were studied using intracoronary ultrasound following dilatation with a 1.5 mm balloon. Plaque characteristics of lesions with an occlusive duration of > or = 3 months (old occlusions) and those of < 3 months (recent occlusions) were then compared. The ultrasound cross-section where there was maximal plaque accumulation at the site of occlusion was analyzed for its qualitative and quantitative characteristics. The lesion remodeling index was defined as the vessel area at occlusion divided by the vessel area at a proximal reference. RESULTS: The old occlusion group comprised 11 lesions whereas 16 lesions were found in the recent occlusion group; the occlusion duration was undetermined in the remaining 8 lesions, and the mean occlusion duration was found to be 4.9 +/- 4.3 months, over a range of 1 36 months. The baseline clinical and angiographic characteristics were similar in the 2 groups. The lesion remodeling index was found to be significantly lower in older occlusions than in the more recent occlusions (0.75 +/- 0.14 vs. 1. 06 +/- 0.25; p = 0.007) and the duration of the occlusion also correlated with the length of calcified segment as determined by ultrasound (p = 0.040), and with a smaller angiographic proximal reference diameter (p = 0.043). CONCLUSION: Long-standing occlusions undergo lesion shrinkage and exhibit more extensive calcification.

Adult↗

PubMed2001

Assessment of the functional significance of coronary lesions using a monorail catheter.

Myocardial fractional flow reserve (FFR) < 0.75 is a reliable index of a functionally severe coronary stenosis. FFR is best assessed by a sensor-tipped pressure monitoring guidewire (PW). The purpose of this study was to assess whether a multifunctional probing catheter (MFP), a 3 French dual-lumen monorail catheter, can be used to accurately measure intracoronary pressure and FFR. In 35 lesions (35 patients; learning group), we calculated FFR by both PW (FFRPW) and MFP (FFRMFP). Using ROC analysis, the FFRMFP value of 0.65 had the highest sensitivity with the FFRPW < 0.75. FFRMFP cut-off (0.65) was tested in 40 patients (testing group). In all cases, lumen diameter was documented by an intracoronary ultrasound examination. In the learning group, the FFRPW was 0.82 +/- 0.17 and FFRMFP was 0.70 +/- 0.23 (r = 0.88; p < 0.001). The FFRMFP cut-off value (0.65) correctly predicted the FFRPW in 37/40 cases in the testing group. In the 3 discordant cases, FFR was critical (< 0.65) by MFP and normal (> 0.75) by PW. In all these cases, minimal lumen cross-sectional area was < 2.8 mm2. When FFRMFP is > 0.65, FFRPW is always > 0.75. These data demonstrate that even with larger cross-sectional area than a pressure wire, the MFP catheter can easily and reliably be used to assess the functional severity of coronary stenosis.

Cardiac Catheterization↗

PubMed2001

Predictors of re-occlusion after successful recanalization of chronic total occlusion.

UNLABELLED: The objective of this study was to highlight the incidence and predictors of re-occlusion after successful recanalization of chronic total coronary occlusions. METHODS AND RESULTS: Following successful recanalization and stent implantation in 716 coronary lesions (665 patients) with chronic total occlusion, four hundred and five (56.6%) lesions (375 patients) underwent repeat angiography within 6 months. Restenosis (> or = 50% lumen narrowing) was observed in 151 (37.3%) lesions; forty-three (10.6%) of these lesions had complete re-occlusion and constituted the study population. In this group, final angiographic minimal lumen diameter (MLD) was 2.6 +/- 0.51 mm and final percent diameter stenosis was 18 +/- 11. Univariate analysis revealed significant correlation between re-occlusion and restenotic lesions, final balloon diameter, final percent diameter stenosis, final angiographic MLD, number of stents per lesion and total stent length. By multivariate analysis, the only independent predictor of re-occlusion was total stent length (OR = 1.46, 95% CI = 1.12-1.82; p = 0.0069). CONCLUSION: Re-occlusion occurs in about 11% of cases after stenting chronic total occlusion. The most important predictor of re-occlusion seems to be stent length.

Aged↗

PubMed2001

Thrombocytopenia and purpura-like lesions associated with clopidogrel.

We report a case of moderate thrombocytopenia associated with purpura-like phenomenon (four ecchymoses) that occurred within 72 hours of clopidogrel initiation and resolved promptly with drug withdrawal. This 61-year-old patient previously experienced an adverse skin reaction to ticlopidine without changes in the platelet count and without any other laboratory abnormalities. Since the introduction of clopidogrel instead of ticlopidine for the prevention or treatment of several cardiovascular diseases, only 11 cases of thrombotic thrombocytopenic purpura among more than 3 million individuals treated with clopidogrel have been reported. Recently, a case of severe thrombocytopenia, without concomitant purpura-like lesions, during therapy with clopidogrel has been described. To our knowledge, this is the first case of thrombocytopenia associated with purpura-like lesions with no evidence of thrombotic thrombocytopenic purpura during clopidogrel treatment.

Clopidogrel↗

PubMed2000

Emergency polytetrafluoroethylene-covered stent implantation to treat coronary ruptures.

BACKGROUND: Coronary perforation is a life-threatening complication of percutaneous interventions. In the past few years, the implantation of covered stents has emerged as a strategy for treatment when the traditional conservative approach (ie, prolonged balloon inflation and reversal of anticoagulation) fails. METHODS AND RESULTS: Since May 1997 (when polytetrafluoroethylene [PTFE]-covered stents were available at our institutions), 11 of the 12 consecutive patients who had coronary ruptures that were unsuccessfully sealed with prolonged balloon inflation and reversal of anticoagulation were treated with 12 PTFE-covered stents (PTFE group). The efficacy of the PTFE-covered stent was compared with that of noncovered stents, which were used to treat 17 perforations (non-PTFE group). One patient sustained a very distal perforation that was not suitable for covered stent sealing and underwent emergency surgery. All vessel ruptures treated with PTFE-covered stent implantation were successfully sealed. The time necessary to deploy the stent was 10+/-3 minutes (range, 4 to 15 minutes). All patients but one were discharged from the hospital and had an optimal early clinical outcome. One patient underwent emergency bypass surgery and died in the intensive care unit. The occurrence of cardiac tamponade and the necessity for emergency surgery was significantly lower in the PTFE group than in the non-PTFE group. At 14+/-4 months, the 10 discharged patients had not experienced any major adverse cardiac events. CONCLUSIONS: This preliminary study supports the utility of the PTFE-covered stent for the nonsurgical treatment of vessel ruptures.

Aged↗

PubMed2000

Polytetrafluoroethylene-covered stent for the treatment of narrowings in aorticocoronary saphenous vein grafts.

We compared the outcome of patients with saphenous graft disease treated with polytetrafluoroethylene (PTFE)-covered stents or noncovered stents. Angiographic success was similar; non-Q-wave myocardial infarction was lower in the PTFE group (p = 0.06) and long-term major cardiac events and restenosis rate were similar in the 2 groups. Implantation of PTFE-covered stent in vein graft disease seems to reduce the occurrence of distal embolization.

Aged↗

PubMed2000

Coronary stenting versus balloon angioplasty in small coronary artery with complex lesions.

The impact of stenting on small vessels (< 3.0 mm) with complex lesions (B2-C) is still controversial. Restenosis rate in this population is high (> 40%). We compared early and late outcome of patients with complex coronary lesions in small vessel treated with traditional coronary angioplasty (angioplasty group) and with elective stent implantation (stent group). Angioplasty group (n = 97) and stent group (n = 112) were comparable for all clinical and angiographic characteristics. All patients in the two groups had clinical and angiographic follow-up. Major adverse cardiac events (MACE) and restenosis rate were evaluated. No patients in the two groups experienced in-hospital death or bypass surgery. Myocardial infarction occurred in four patients in the angioplasty group and in seven patients in the stent group (P = 0.36). No patients in either the angioplasty or the stent group had acute stent thrombosis, whereas subacute stent thrombosis occurred in only one patients of the stent group (0.9%). Long-term MACEs (20 +/- 4 month) were not different in the two groups (angioplasty group 39% vs. stent group 44%, P = 0.35). Target lesion revascularization rate was 33% in the angioplasty group and 34% in the stent group (P = 0.50). Restenosis rate was not statistically different in the two groups (stent group 41% vs. angioplasty group 38%, P = 0.41). In conclusion, compared to balloon angioplasty, elective stent implantation in small vessels with complex lesions does not improve early and late outcome. Cathet. Cardiovasc. Intervent. 50:390-397, 2000.

Angioplasty, Balloon, Coronary↗

PubMed2000

Bifurcation lesions: two stents versus one stent--immediate and follow-up results.

OBJECTIVES: The purpose of this study was to evaluate two different techniques of stent placement in bifurcation lesions. BACKGROUND: Although stent placement with dedicated techniques has been suggested to be a useful therapeutic modality for bifurcation lesions, limited information is available if stent placement on the side branch and on the parent branch provides any advantage over a simpler strategy of stenting the parent vessel and balloon angioplasty of the side branch. METHODS: Between March 1993 and April 1999, we treated a total of 92 patients with bifurcation lesions with two strategies: stenting both vessels (group B, n = 53) or stenting the parent vessel and balloon angioplasty of the side branch (group P, n = 39). Paired angiograms were analyzed by quantitative angiography, and clinical follow-up was obtained. RESULTS: Stent placement on both branches resulted in a lower residual stenosis (7.4 +/- 10.9% vs. 23.4% +/- 18.7%, p < 0.001) in the side branch. Acute procedural success was similar in the two groups (group B: 87% vs. Group P: 92%). In-hospital major adverse cardiac events (MACE) occurred only in group B (13% vs. 0%, p < 0.05). At the six-month follow-up, the angiographic restenosis rate (group B: 62% vs. Group P: 48%) and the target lesion revascularization rate (38% vs. 36%, respectively) were similar in the two groups. There was no difference in the incidence of six-month total MACE (51% vs. 38%). CONCLUSIONS: For the treatment of true bifurcation lesions, a complex strategy of stenting both vessels provided no advantage in terms of procedural success and late outcome versus a simpler strategy of stenting only the parent vessel.

Aged↗

PubMed2000

Progressive decrease of outflow gradient and septum thickness after percutaneous alcoholization of the interventricular septum in hypertrophic obstructive cardiomyopathy.

BACKGROUND: The aim of this study was to evaluate the immediate- and mid-term results of percutaneous transluminal septal myocardial ablation (PTSMA) of the interventricular septum performed in 15 consecutive patients with hypertrophic obstructive cardiomyopathy between 1996 and 1999. METHODS: Prior to intervention, all patients (7 males, 8 females, mean age 62 +/- 11 years) complained of severe dyspnea (NYHA functional class III-IV) despite medical treatment with beta-blockers and/or verapamil. Family history of hypertrophic cardiomyopathy was present in 2 cases. Dehydrated alcohol (4.8 +/- 1.5 ml/pt) was selectively infused into the first septal perforator artery through over-the-wire balloon catheters. In 5 patients a second or a third septal branch was treated because the intraventricular gradient persisted above 50 mmHg after the initial alcohol infusion. RESULTS: Alcohol infusion induced an average peak creatine phosphokinase level of 1,524 +/- 427 IU/l. No iterating ventricular arrhythmias occurred during the procedure or in the 2-3 days of continuous ECG monitoring after the procedure. Two patients (13%) developed a complete atrioventricular block after the procedure, requiring permanent double-chamber pacing. Electrocardiographic changes included a > 2 mm ST segment elevation and transient right bundle branch block or left anterior/left posterior hemiblock in all patients. Peak basal intraventricular gradient decreased from 80 +/- 27 to 24 +/- 27 mmHg (p < 0.01) during cardiac catheterization and from 81 +/- 27 to 35 +/- 25 mmHg (p < 0.01) at the echocardiographic control performed during the hospital stay. At follow-up (mean 5.1 +/- 3.6 months), all patients were in NYHA functional class I or II. Repeat echocardiography showed a further significant decrease in intraventricular gradient to 25 +/- 26 mmHg (p < 0.01) and a progressive decrease in intraventricular septum thickness (25 +/- 5 mm before treatment, 21 +/- 6 mm before hospital discharge, 17 +/- 3 mm at follow-up, p < 0.01). CONCLUSIONS: PTSMA of the intraventricular septum effectively relieves symptoms in selected patients with hypertrophic obstructive cardiomyopathy. The immediate decrease in intraventricular gradient is followed by a further decline at follow-up with a progressive reduction in the intraventricular septum thickness.

Aged↗