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C Di Mario

Publications and source records attributed to C Di Mario.

At least 55 records · Page 3Linked to original sources
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

Cutting balloon angioplasty for the treatment of in-stent restenosis.

The results using the Cutting Balloon for the treatment of in-stent restenosis may be superior to those of conventional percutaneous transluminal coronary angioplasty (PTCA) or even the combination of PTCA preceded by rotational atherectomy. The reasons for these possible differences are not yet well defined. The case we report suggests that the Cutting Balloon achieves a better final result than conventional PTCA, by making the tissue more amenable to being pushed outward through the stent struts.

Angioplasty, Balloon, Coronary↗
PubMed2000

Left internal mammary artery graft perforation repair using polytetrafluoroethylene-covered stents.

The increase in the use of the left internal mammary artery (LIMA) as graft of choice to the left anterior descending coronary artery for conventional and minimally invasive coronary artery bypass surgery has led to an increased incidence of LIMA pathologic lesions early after surgery. The lesion, commonly located in the body of the LIMA graft, is usually caused by mechanical injury during harvesting of the vessel. In this context, percutaneous intervention with stent implantation can be complicated by vessel rupture, which usually requires emergency surgical repair. We describe two cases of stent implantation in newly placed LIMA grafts complicated by vessel rupture, which were successfully repaired using polytetrafluoroethylene-covered stents.

Aged↗
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

Greater late lumen loss after successful coronary balloon angioplasty in the proximal left anterior descending coronary artery is not explained by extent of vessel wall damage or plaque burden.

OBJECTIVES: We investigated whether the greater late lumen loss after coronary balloon angioplasty in the proximal left anterior descending artery (P-LAD) compared with that in other segments might be related to differences in vascular dimensions or morphology as determined by angiography and intravascular ultrasound imaging. BACKGROUND: The greater late lumen loss after angioplasty in the P-LAD that has been observed in several studies has not been explained. METHODS: We studied 178 patients and 194 coronary artery lesions by quantitative angiography and 30 MHz intravascular ultrasound imaging after successful balloon angioplasty. Vessel wall morphology was compared among three proximal and three nonproximal segments. Follow-up quantitative angiography for late lumen loss calculation was performed in 168 lesions. Multivariate analysis was used to determine predictors of late lumen loss. RESULTS: Absolute and relative late loss were significantly greater at the P-LAD compared with the pooled group of other segments (0.42 +/- 0.60 mm vs. 0.10 +/- 0.48 mm, p = 0.0008 and 0.14 +/- 0.24 vs. 0.03 +/- 0.17, p < 0.001). Also, a greater percentage of calcific lesions (65% vs. 44%, p = 0.034), a lower incidence of rupture (51% vs. 74%, p = 0.009) and a larger reference segment plaque area (5.4 +/- 2.2 mm2 vs. 4.7 +/- 1.9 mm2, p = 0.05) were found in the P-LAD. In multivariate analysis however, these variables were not predictive of late loss. CONCLUSIONS: Greater late lumen loss after coronary balloon angioplasty of the P-LAD is not explained by differences in atherosclerotic plaque burden or in vessel wall damage.

Aortic Dissection↗
PubMed2000

Intracoronary ultrasound measurements in women with myocardial infarction without significant coronary lesions.

METHODS: Morphologic characteristics of coronary arteries in eight women with myocardial infarction and angiographically normal or not significantly stenosed vessels were investigated with intracoronary ultrasound. The infarct-related vessel was assessed by three-dimensional volumetric analysis and compared with a control vessel from a noninfarcted area. RESULTS: Atherosclerosis was found in all infarct-related arteries. The plaques were predominantly soft, eccentric, poorly calcified, and with little lipid pools or none at all. Although the average area and thickness of plaques and cross-sectional narrowing of the infarct-related arteries were greater than those of control arteries, there were no pathognomonic characteristics of plaques in the infarct-related vessels. CONCLUSION: The possibility that atherosclerosis is the main etiologic factor for myocardial infarction can not be excluded even for women without an angiographically obvious coronary stenosis in the infarct-related vessels.

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↗
PubMed2000

Multivessel coronary stenting: predictors of early and late outcome.

BACKGROUND: At present, only few data are available on the early and late outcome following multivessel coronary stenting. Of note, in these studies, the left anterior descending (LAD) artery was treated in less than 40% of cases. These patients may not fully represent the population commonly referred for surgical revascularization. METHODS: In-hospital and long-term (18 +/- 4 months) events were evaluated in 272 consecutive patients who had multivessel stent implantation including the LAD artery in each case. All clinical, angiographic, and procedural variables were analyzed to identify the predictors of acute and long-term major adverse coronary events. RESULTS: Eighteen patients (6.6%) had in-hospital major adverse coronary events (death 0.7%, coronary artery bypass grafting 0.4%, and myocardial infarction 6.3%). Acute and subacute stent thrombosis rates were 1.5 and 1.1%, respectively. At 18 +/- 4 months, event-free survival was 71%. Target lesion revascularization was performed in 54 (20%) patients (42 coronary angioplasty and 12 coronary artery bypass grafting). The jeopardy score was the predictor of in-hospital major adverse coronary events (p = 0.016, odds ratio 1.34, 95% confidence interval 1.05-1.69), and diabetes mellitus was the predictor of long-term major adverse coronary events (p = 0.027, odds ratio 2.80, 95 % confidence interval 1.12-6.96). CONCLUSIONS: Multivessel coronary stent implantation with treatment of the LAD artery in all instances is a safe procedure with low acute and long-term major adverse coronary events. The risk-benefit ratio must be assessed carefully for each patient, particularly taking into account the jeopardy score and the presence of diabetes mellitus.

Aged↗
PubMed2000

Predictors of long-term clinical outcome in patients undergoing multiple vessel stenting for coronary artery disease.

BACKGROUND: Coronary artery stenting reduces the restenosis rate compared to coronary angioplasty alone. With the increased number of procedures completed with stent placement there has been a parallel increase in the number of procedures performed in patients with multivessel disease and therefore a rise in the number of patients receiving multiple stents. The clinical outcome and the predictors of the outcome of patients receiving multiple stents are not known. METHODS: To evaluate the clinical outcome of patients with multivessel coronary artery disease undergoing multiple stenting we studied 133 consecutive patients who had received > 1 stent in at least two vessels. A total of 375 coronary stents (2.8 stent per patient) were implanted in elective procedure situations. Clinical follow-up was complete in 100%. RESULTS: During follow-up 2 patients (1.5%) died (1 cardiac death), 4 patients (3%) had acute myocardial infarction, 96 patients (72.1%) remained angina-free, and 31 patients (23.3 %) had recurrence of angina. Repeat revascularization procedure was performed in 45 patients (33.8%); 43 patients (32.3%) underwent coronary angioplasty; 2 patients (1.5%) underwent coronary artery bypass grafting. The female gender and the presence of diabetes were significant (p < 0.05) predictors for coronary angioplasty or coronary artery bypass grafting procedures during follow-up. Recurrence of angina was also significantly (p < 0.05) associated with unstable angina at the time of the first procedure as well as diabetes and the female gender. Diabetes, the female gender and unstable angina were highly predictive factors of major adverse cardiac events during follow-up. CONCLUSIONS: Multiple vessel stenting in patients with multivessel coronary artery disease is associated with an acceptable immediate and long-term clinical outcome and could be considered as an alternative therapeutic option in these patients. Predictors of an adverse long-term outcome are the female gender and the presence of diabetes mellitus.

Angioplasty, Balloon, Coronary↗
PubMed2000

Contemporary percutaneous treatment of saphenous vein graft stenosis: immediate and late outcomes.

PURPOSE: The aim of this study was to evaluate the immediate and long-term outcomes following percutaneous treatment of an unselected series of saphenous vein graft (SVG) lesions. METHODS AND RESULTS: Consecutive interventions on 129 saphenous vein graft lesions in 101 patients were reviewed. Stents were implanted in 114 lesions (88%), which included the use of polytetrafluoroethylene-covered stents in 22 lesions (17%) and abciximab in 20 patients (20%). Angiographic success was achieved in 125 lesions (97%). In-hospital major adverse cardiac events (MACE) occurred in 11 patients (11%), with myocardial infarction being the most frequent event. Treatment of degenerated SVG lesions and SVG lesions with larger reference diameters correlated with the incidence of in-hospital MACE [odds ratio (OR) = 7.69 and 2.65, respectively; 95% confidence interval (CI) = 1.80Eth 32.8 and 0.99Eth 7.10, respectively)]. Clinical follow-up was achieved in all patients at 25 +/- 21 months. Successful revascularization to all three distributions of the major coronary arteries negatively correlated [relative risk (RR) = 0.43; 95% CI = 0.20Eth 0.92)], while treatment of a degenerated SVG positively correlated (RR = 1.92; 95% CI = 1.05Eth 3.51) with the occurrence of follow-up MACE. A final effective blood supply to the anterior wall and a higher left ventricular ejection fraction was found to negatively correlate with the occurrence of follow-up death (RR = 0. 20 and 0.61, respectively; 95% CI = 0.06Eth 0.60 and 0.41Eth 0.90, respectively). CONCLUSION: Treatment of SVG lesions continues to be associated with a high incidence of myocardial infarction, particularly in cases of degenerated SVG lesions. An effective blood supply to the anterior wall and a higher left ventricular ejection fraction were protective for the occurrence of death during the follow-up period.

Aged↗
PubMed2000

Long-term changes in the response of conductance and resistance coronary vessels to endothelium-dependent and independent vasodilators. A double-blind placebo-controlled study of the effect of a 6-month treatment with cilazapril.

BACKGROUND: The aim of this study was to assess the effect of a 6-month treatment with the inhibitor of the angiotensin-converting enzyme cilazapril on the response of conductance and resistance vessels to endothelium-dependent and independent vasodilators, in a randomized placebo-controlled parallel group single center study. METHODS: Quantitative angiographic and Doppler flow time-averaged peak velocity measurements were performed in an artery with < 30% diameter stenosis after sequential selective intracoronary injection of papaverine (7 mg), acetylcholine (0.036, 0.36 and 3.6 microg/ml at 2 ml/min) and isosorbide dinitrate. Repeated assessment was performed after a 6-month treatment with cilazapril 20 mg/day or placebo. Thirty-four patients were enrolled in the study undergoing elective percutaneous coronary interventions for stable angina. Main outcome measures were percent differences from baseline and absolute measurements of mean coronary cross-sectional area, coronary flow time-averaged peak velocity and flow resistance in the initial study and at follow-up for the placebo and the treated group. RESULTS: No significant differences between the placebo and the treated group were observed in the modifications of cross-sectional area after acetylcholine and isosorbide dinitrate and in the response of time-averaged peak velocity to papaverine. After the maximal concentration of acetylcholine a high but statistically not significant increase in flow and a decrease in flow resistance were observed in the treated group (medians: 45% increase vs 4% increase for coronary flow, and 44% decrease vs 1% increase for flow resistance in the cilazapril and in the treated group, respectively, p = NS). CONCLUSIONS: In patients with coronary artery disease, a 6-month treatment with 20 mg of cilazapril/day did not modify the response to endothelium-independent and dependent vasodilators of epicardial arteries without any significant stenoses but induced a consistent, although not significant, increase in flow and decrease in flow resistance after acetylcholine.

Acetylcholine↗
PubMed2000

Coronary stenting beyond standard indications. Immediate and follow-up results.

BACKGROUND: Coronary stent has become an accepted treatment modality for selected indications. However, the literature shows diverse results when indications for coronary stenting are different from those tested in large randomized trials. The purpose of this study was to determine immediate and follow-up clinical and angiographic results in patients treated with coronary stenting for indications not specifically tested in large randomized trials. METHODS: Coronary stents were implanted in a total of 2060 lesions (1757 patients) in seven groups with expanded indications: left main coronary lesions, calcified lesions, small vessels (< 3 mm in size), small vessels with diffuse disease, large vessels with diffuse disease, and bifurcation lesions treated with stents in both branches or with one stent implanted only in the major branch. Stents were implanted using high balloon pressure for final inflation and in most cases with intravascular ultrasound. Clinical follow-up was achieved in 96% of patients at a mean time of 12+/-7 months. RESULTS: Primary success (range 89-96%) and acute complications (range 5.7-13%) were comparable in all groups. At follow-up, the mortality rate was highest in the group of left main stenting (12.5%) but 20% of these patients had coronary stenting on non-elective basis. The restenosis rates ranged between 16-43%. The restenosis rate was highest in the group of bifurcation lesions with stent implantation in both vessels leading to a major adverse cardiac event (MACE) rate of 62% in this group. However, the survival rate at 1 and 2 years in the overall study group was 97 and 96%, and the event free survival was 76 and 74%, respectively. The procedure-related predictors of MACE were: final intravascular ultrasound result, use of stents with non-slotted tube morphology, final stent percent stenosis, and vessel size. CONCLUSIONS: Coronary stenting beyond standard indications is feasible, with acceptable primary success and complication rates. However, the overall MACE rates were relatively high (34-62%), in particular for the indication of bifurcation lesions with stents implanted in both vessels.

Age Factors↗
PubMed2000

Surgical and percutaneous myocardial angiogenesis induction. Part I--laser revascularization.

Coronary artery bypass surgery and angioplasty provide symptomatic relief in patients with ischemic heart disease, but despite advancement in technique and devices, these methods are not applicable in a subset of patients with angina refractory to medical treatment. Bypass surgery may not be feasible because of lack of suitable conduits, diffuse coronary artery disease or poor distal run-off, and coronary angioplasty is sometimes not applicable due to chronic total occlusion, diffuse disease or extreme tortuosity. Transmyocardial laser revascularization and the stimulation of neoangiogenesis by a variety of growth factors have recently emerged as a new tool in the management of these patients. In the first part of this article, we review laser-induced direct myocardial revascularization, its indications, potential risks, and published clinical trials. The induction of neoangiogenesis using different growth factors or the genes encoding for them will be the subject of the second part of our review.

Angina Pectoris↗