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Biomedical subjects

C Macaya

Publications and source records attributed to C Macaya.

At least 127 records · Page 7Linked to original sources
PubMed1991

[The results of percutaneous transluminal coronary angioplasty in lesions with thrombi].

Previous studies have suggested that the results of coronary angioplasty are poorer when the attempted lesion has a thrombus associated. With the aim of assessing the results of coronary angioplasty in lesions with thrombus, 1,192 consecutive coronary lesions attempted were prospectively analyzed. Of these, 88 (7%) had associated an angiographic intraluminal filling defect consistent with thrombus (group I) and were compared with the remaining 1,104 lesions (93%) without thrombus (group II). Age (56 +/- 12 vs 59 +/- 10 years) was similar in both groups, but patients in group I required more frequently dilatation after a myocardial infarction (acute phase or following thrombolytic therapy) (36% vs 12%, p less than 0.005) but infrequently for stable angina (6% vs 21%, p less than 0.005). Left ventricular ejection fraction (60 +/- 13% vs 63 +/- 12%) and the number of diseased vessels (1.46 +/- 0.7 vs 1.58 +/- 0.8) were similar in groups I and II, respectively, but lesions in group I were less frequently located in the left anterior descending coronary artery (35% vs 53%, p less than 0.025). Furthermore, lesions in group I were more frequently total occlusions (35% vs 4%, p less than 0.001), and were more severe (94 +/- 6% vs 87 +/- 8%, p less than 0.005), eccentric (81% vs 54%, p less than 0.005), irregular (72% vs 32%, p less than 0.005) and more frequently located at bend points (31% vs 17%, p less than 0.05). Primary angiographic success was lower in group I (79% vs 92%, p less than 0.001) and, after dilatation, the incidence of luminal irregularities (34% vs 15%, p less than 0.001) and early reocclusion (10% vs 1%, p less than 0.05) was higher in this group. However, when patients presenting with total occlusions were excluded from both groups primary angiographic success was similar (90% vs 91%) for groups I and II, respectively. We conclude that: 1) Lesions with intracoronary thrombus usually present other unfavourable angiographic characteristics for dilatation. 2) Results of coronary angioplasty in lesions with thrombus are similar to those obtained in other lesions when totally occluded vessels are excluded.

Angioplasty, Balloon, Coronary↗
PubMed1990

Percutaneous transluminal coronary angioplasty after non-Q-wave acute myocardial infarction.

The value of percutaneous transluminal coronary angioplasty (PTCA) for ischemia after a non-Q-wave acute myocardial infarction (AMI) was assessed prospectively in 33 consecutive patients. In 30 patients the indication for the procedure was post-AMI angina and 3 patients underwent PTCA for silent ischemia. A total of 43 lesions were attempted at 63 +/- 94 days after the non-Q-wave AMI. Primary PTCA success was obtained in 30 (91%) patients and no major complications occurred. Angiographic evaluation was performed either for symptoms or for protocol (7 +/- 1 months after PTCA) in 28 (93%) of the 30 patients with successful PTCA, but 2 patients (7%) who were asymptomatic refused the repeat angiogram. Twenty (71%) had no restenosis and 8 (29%) had restenosis. Of these, 5 patients with restenosis underwent a successful repeat PTCA (6 +/- 1 months after the initial procedure). At the last clinical follow-up (17 +/- 8 months), 2 of the 30 (7%) patients successfully dilated presented with stable angina despite medical treatment, whereas the rest (93%) remained asymptomatic. During the study period no patient died, had an AMI or required coronary artery bypass grafting. Thus, selected patients with ischemia after a non-Q-wave AMI, a "high-risk population," can be effectively treated with PTCA with an initial success rate and angiographic restenosis rate similar to that of the general PTCA population and appear to have sustained symptomatic benefit remaining free of subsequent cardiac events.

Angina Pectoris↗
PubMed1990

Repeat coronary angioplasty during the same angiographic diagnosis of coronary restenosis.

To determine whether any differences exist in results of treatment of restenosis with repeat angioplasty when the procedure is performed during diagnosis or, as an alternative, when it is performed as a separate elective procedure, we prospectively compared the outcome of 48 consecutive procedures (including 51 lesions) at the time of initial cardiac catheterization (group 1) with the outcome of 26 consecutive elective procedures (including 30 lesions) (group 2). Before control angiography was performed, the anatomic and procedural characteristics of the previous dilatation and the new symptomatic status were carefully reevaluated in all patients. Baseline clinical and angiographic characteristics including age, sex, ejection fraction, and number of diseased vessels in which repair was attempted were similar in both groups. Reasons for angioplasty were also similar with unstable angina being the most frequent indication: 29 (60%) in group 1 versus 13 (50%) in group 2. (p = NS). Morphology of the lesions was also similar, although longer lesions (greater than 12 mm) were dilated in group 2 (13 (43%) vs 10 (20%) in group 1; p less than 0.05). Angiographic success was achieved in 51 lesions (100%) in group 1 versus 28 (93%) in group 2 (p = NS). Primary angioplasty success (in the absence of major complications) was achieved in 46 (95%) procedures in group 1 versus 24 (92%) in group 2 (p = NS). Two patients in group 1 had a myocardial infarction, but there were no other major complications in either group. Preliminary data suggest that the outcome of repeat coronary angioplasty for restenosis is similar whether it is performed at the time of diagnostic catheterization or later on as an independent elective procedure.

Aged↗
PubMed1990

[Coronary angioplasty: experience at the University Hospital of Madrid].

The results of 963 consecutive coronary angioplasties, with 1.135 lesions attempted in 816 patients, were prospectively analyzed. Initial angiographic success (residual stenosis less than 50%) was achieved in 1.017 lesions (89.6%), and final success was obtained in 838/963 procedures (87%). Major complications included: emergency surgery in 4 cases (0.4%), acute myocardial infarction in 28 (2.9%), and death during hospitalization in nine (0.9%). Surgical stand-by was required only for cases with vital risk should the attempted vessel occlude. This criteria was present in 230 (23.8%) angioplasties. Coronary angioplasty was performed during the diagnostic procedure in 300 (31.1%) case, with final success in 264 (88%) of them. A exercise test was achieved before the procedure in 419 (50%) successful angioplasties and in 246 (58.7%) of them it was abnormal because of angina (with or without ST depression). After procedure, exercise could be performed in 780 cases (93%), and the result remained unchanged in only 44 (5.6%) (p less than 0.01). At discharge 780 (93%) patients with final success considered themselves clinically improved. In our experience, coronary angioplasty is a good myocardial revascularization technique, with high success, low rate of major complications, and that provides a good clinical outcome. Surgical stand-by may be unnecessary in prost of angioplasty procedures if patients selection is carefully done, also, this approach makes it possible to perform angioplasty at time of diagnostic catheterization.

Adult↗
PubMed1990

[Coronary angioplasty on calcified lesions].

To assess the value of coronary angioplasty in calcified lesions we have prospectively compared the clinical, procedural and anatomic characteristics of 55 calcified lesions (group A) with 830 lesions without calcium (group B). Patients in group A were older (67.2 +/- 8 vs 58.8 +/- 11 years), had a higher incidence of 3 vessel disease (20% vs 8%, p less than 0.05), and received less frequently a complete revascularization (50% vs 68%, p less than 0.05). Lesions in group A were more frequently located in the left anterior descending coronary artery and tended to be longer (0.86 +/- 0.5 vs 0.67 +/- 0.5 cm, p less than 0.1) whereas were rare at distal segments (9% vs 19%, p less than 0.05). In addition, group A lesions were more eccentric (81% vs 58%, p less than 0.05), more irregular (67% vs 33%, p less than 0.05), and frequently were located at bifurcation (42% vs 26%, p less than 0.05). More balloon inflations were required in group A (4.1 +/- 2.4 vs 3.1 +/- 1.4, p less than 0.05), but the maximal pressures utilized were similar in both groups (7.9 +/- 2.5 vs 7.6 +/- 1.9 atm). Dilatation success was achieved in 80% of the lesions in group A vs 90.1% in group B (p less than 0.05). Univariate analysis revealed a trend towards a higher restenosis rate--per lesion--in group A (42.8% vs 30.5%, p less than 0.1), which was not longer present after step-wise logistic regression analysis.(ABSTRACT TRUNCATED AT 250 WORDS)

Angioplasty, Balloon, Coronary↗
PubMed1990

[Characteristics of coronary angioplasty in young patients].

To assess the characteristics and efficacy of coronary angioplasty in young people (less than 40 years old) (YCA) we have compared the clinical and anatomic characteristics, and the results of 27 YCA (35 lesions), with those of 732 procedures (854 lesions) performed in patients older than 40 years of age (NYCA). Clinical indication for dilatation were similar in both groups, but YCA were performed more frequently during an acute myocardial infarction (18.5 vs 4.5%, p less than 0.005). In addition, lesions in NYCA were frequently located in the left anterior descending coronary artery (51% vs 31%, p less than 0.05) were more eccentric (61% vs 37%, p less than 0.025) and tended to be more irregular (37% vs 26%, NS), and calcified (6.5% vs 0%, NS) than lesions in YCA, which more frequently presented a total occlusion (23% vs 8%, p less than 0.005) and tended to be longer (7.7 +/- 4.5 vs 6.8 +/- 4.7 mm, NS). Furthermore, YCA had a more complete coronary revascularization than NYCA (84% vs 66%, p less than 0.05). Angioplasty success per lesion (88.6% vs 89.5%), or procedure (77.8% vs 87%), was similar in both groups. The number of acute reocclusions was higher in YCA (8.6 vs 2%, p less than 0.05), but when patients with acute myocardial infarction were excluded from the analysis this difference was not longer present. Angiographic control was available in 20 YCA lesions (9 [45%] with restenosis) and in 567 NYCA lesions (178 [31%] with restenosis, NS).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

[Transluminal angioplasty for aortic coarctation in newborns and infants].

It has been done transluminal angioplastic with catheter balloon in 14 patients who are under 1 year of age and who are affected by aortic coarctation. For this study, they were divided in two groups. The first one was formed by newborn children whose transcoarctation gradient was 52 mm Hg in average. The second group was integrated by 9 newborn children whose transcoarctation gradient was 59 mm Hg. After this experience was done the gradient descended to 9 and 15 mm Hg respectively. Twenty four hours later, two months later and over two more months, there were follow-up of the clinical situation, the evolution of the pulse, differential arterial pressure and the need of surgery. Of the first group only one of the patients, who is now 2 years old, is in good clinical condition; the others needed to be surgically intervened. Of the second group 4 patients, all of whom were over 3 months old at the time of the angioplastic had positive results. The rest needed surgical intervention.

Angioplasty, Balloon↗
PubMed1989

[Coronary angioplasty performed at the same time as diagnostic coronarography].

To evaluate the results of coronary angioplasty performed during the diagnostic coronary angiogram, we have compared 185 of these procedures with the characteristics of 446 consecutive angioplasties accomplished in a separate procedure from the diagnostic angiogram. There were no differences in the clinical characteristics in both groups, but more angioplasties during diagnosis were indicated after a myocardial infarction (23% vs 10%, p less than 0.001), whereas less angioplasties in this group had prior stable angina (12% vs 21%, p less than 0.025). In addition, a greater number of the angioplasties during diagnosis were used in the treatment of restenosis (24% vs 5%, p less than 0.001), and the procedure was performed as a clinical emergency in 28% vs 2%, p less than 0.001. The initial angiographic success, and the final angioplasty success in the absence of mayor complications was 93% vs 88%, p less than 0.1, and 81% vs 82%, in the angioplasties performed during diagnosis and as a separate procedure, respectively. Therefore, in our experience, the angioplasty performed during the diagnostic coronary angiogram is an effective means of treatment in patients with coronary artery disease, in particular those after myocardial infarction or those presenting with restenosis, yielding a similar rate of success both, per lesion and per procedure, than the conventional approach, the angioplasty in a separate independent procedure. These results suggest that angioplasty performed during diagnosis probably could be extended to a greater number of patients.

Aged↗