Percutaneous transluminal angioplasty of a brachial artery occlusion after cardiac catheterization.
Explore the source record for details and available documents.
Angiography↗
Biomedical subjects
G Dorros
Publications and source records attributed to G Dorros.
Coronary artery bypass surgery in patients over age 70 years: report from the Milwaukee Cardiovascular Data Registry.
Between 1972 and 1985, 674 coronary bypass patients greater than or equal to 70 years (70% male, mean age 73 years) were among 10,622 patients with both catheterization and operative data entered into the Milwaukee Cardiovascular Data Registry. These greater than or equal to 70 years patients were analyzed regarding the operative morbidity, the 30-day operative mortality and the operative mortality's relation to coronary artery disease and ventricular wall motion abnormalities. The operative mortality was not different for the 174 patients operated upon before and the 500 patients after 1980. A mean of 3.4 grafts were placed during surgery. The complications encountered included a 7.1% perioperative infarction rate, a 4.2% incidence of cerebrovascular accident, a 3.6% incidence of reoperation for bleeding, a 2.4% incidence of renal failure, and a 2.1% incidence of pulmonary embolism. The overall operative mortality was 7.4%. The extent of coronary artery disease was distributed among patients such that 8.4% had single-, 28.0% had double-, and 63.6% had triple-vessel disease. The operative mortality as related to the extent of coronary artery disease was 5.2% for single-, 8.9% for double-, and 7.0% for triple-vessel disease. The operative mortality was 6.7% with no and 7.9% with left ventricular wall motion abnormalities. The operative mortality was 1.9% with 1 segmental wall motion abnormality, and increased to 13.3% (p less than 0.05) with 4-6 segmental wall motion abnormalities.(ABSTRACT TRUNCATED AT 250 WORDS)
Acute Kidney Injury↗
Multiple lesion transluminal coronary angioplasty in single and multivessel coronary artery disease: acute outcome and long-term effect.
Multiple lesion transluminal coronary angioplasty was performed in 428 patients. Angioplasty was attempted in 1,047 lesions (2.4/patient), with an angiographic success achieved in 94%: 2 lesions were attempted in 74%, 3 in 21%, 4 in 5% and 5 or more in 1% of cases. A clinical success was achieved in 404 (94%) of the patients: 95% with and 93% without prior surgery and in 94% of those with single vessel disease and 94% of those with multivessel disease. Significant complications occurred in 17 patients (4.0%): 11 (2.5%) had a transmural infarction, 9 (2.1%) required urgent surgery and 6 (1.4%) died. An apparent lesion recurrence occurred in 106 (26%) of 404 patients with 81 of 89 patients (91%) having a successful second angioplasty. A second apparent lesion recurrence occurred in 15 patients (19%), with 13 of the 15 patients having a successful third angioplasty. A sustained clinical improvement (mean follow-up period 28.3 +/- 16 months) was obtained in 208 (83%) of 250 patients with successful angioplasty. The cumulative probability of survival at 51 months was 93% in these 250 patients. Survival was adversely affected by the presence of prior bypass surgery (no prior surgery 97% versus prior surgery 81%; p less than 0.05). These data suggest that multiple lesion angioplasty can be successfully performed with a good success rate, an acceptable incidence of complications and a reasonable expectation of satisfactory long-term clinical improvement.
Angioplasty, Balloon↗
Hyponatremia after percutaneous balloon aortic valvuloplasty.
Explore the source record for details and available documents.
Aortic Valve Stenosis↗
[Multiple transluminal coronary angioplasty].
Explore the source record for details and available documents.
Angioplasty, Balloon↗
Percutaneous transluminal coronary angioplasty in patients over the age of 70 years.
Percutaneous transluminal coronary angioplasty (PTCA) was attempted in 109 patients over the age of 70 years (mean age 75.9). The patients' clinical characteristics showed 55% with multivessel coronary disease, 86% with significant angina pectoris (Class II to IV), 16% with prior bypass surgery, and 2.7% with left ventricular dysfunction. Angioplasty data showed the mean percent diameter stenosis was reduced from 83 +/- 12% to 15 +/- 16%. One lesion was dilated in 67%, two lesions in 30%, and three lesions in 3% of the patients. A successful dilatation was achieved in 138/148 lesions (89%) with 90/109 patients (83%) clinically improved at hospital discharge. Significant complications were encountered in six patients (5.5%): three transmural infarctions (2.8%), two mortalities (1.8%), and one emergency surgical procedure (0.9%). Follow-up data (greater than or equal to 1 year) are available in 77 patients: 68 patients (92%) had an improved anginal status [49 patients (65%) had no angina]. During a mean follow-up of 23 +/- 10 months, there were two myocardial infarctions and three deaths. A clinically apparent recurrence occurred in 14 patients (17%). Repeat angioplasty was successfully performed in 13/14 patients. Bypass surgery was performed during the follow-up in three patients (two of whom had had a recurrence after a second successful angioplasty; one patient died during elective surgery). Transluminal coronary angioplasty can be performed in patients over age 70 with a good success rate, an acceptable complication rate, a relatively low clinically apparent recurrence rate, and should be considered as a therapeutic modality and alternative for the selected geriatric patient.
Aged↗
The brachial artery method to transluminal internal mammary artery angioplasty.
A new catheter technique to perform angioplasty of the right or left internal mammary artery coronary graft utilizing the brachial artery approach is described. Utilization of the ipsilateral brachial artery permitted cannulation of the internal mammary artery with preformed polyurethane Teflon-lined guide catheters. The coronary dilatation catheter was passed through the guiding catheter into the internal mammary artery. This technique permitted successful access into the ipsilateral mammary artery in eight patients, the left internal mammary artery graft in five and the right in three patients. The angioplasty procedure was successfully performed in seven of eight cases (spasm of the left internal mammary artery precluded successful dilatation catheter passage in one case). No brachial artery complications were encountered. In two cases, angioplasty was successfully performed in additional coronary vessels. Follow-up of 1-16 months (mean: 7.7 months) revealed no clinical evidence of restenosis. The ipsilateral brachial artery approach utilizing preshaped guiding catheters for visualization and introduction of dilatation catheters into the internal mammary artery graft is a safe and successful approach, and it is an acceptable alternative to the femoral technique.
Adult↗
Coronary angioplasty in patients who undergo multiple vessel angioplasties, and in patients who have multivessel coronary disease.
Percutaneous transluminal coronary angioplasty (PTCA) was performed in patients who underwent multiple vessel angioplasties (MVA) and in patients with multivessel coronary disease (MCD). There were 235 MVA patients who underwent 255 procedures during which 600 lesions were dilated. Two lesions were dilated in 75% of cases, and three lesions in 16% of cases. 93% of the lesions were successfully dilated and 91% of the patients were clinically improved. Complications encountered included a 1.6% mortality, a 3.5% incidence of transmural infarction, and a 2.4% emergency surgery rate. Significant complications occurred in 13 patients (4.6%). A clinically apparent restenosis occurred in 51 patients (24%) with a repeat PTCA performed in 25/26 patients (96%), elective surgery in 14 patients, and the remainder were treated medically. 82% of patients remain clinically improved more than one year after a successful PTCA. There were 331 MCD patients who underwent 387 procedures during which 662 lesions were dilated. One lesion was dilated in 47% of cases, two lesions in 39% of cases, three lesions in 9% of cases, and four or more lesions in 5% of cases. 91% of the lesions were successfully dilated, and 90% of the patients were clinically improved. Complications encountered included a 1.6% mortality, a 3.1% incidence of transmural infarction, and a 3.9% emergency surgery rate. Significant complications were encountered in 35 patients (9%). A clinically apparent restenosis occurred in 46 patients (21%) with a repeat PTCA performed in 29/31 patients (94%), elective surgery in nine patients, and the remainder were treated medically. 86% of patients remain clinically improved more than one year after a successful PTCA. PTCA can be performed in carefully selected patients undergoing MVA, and in MCD patients with a good success rate, a low complication rate, and a satisfactory long term benefit. However, a large clinical trial would be most beneficial in establishing PTCA's role in the treatment of extensive coronary disease.
Angina Pectoris↗
Complex coronary angioplasty in patients with prior coronary artery bypass surgery, in situations utilizing multiple coronary angioplasties, and in coronary occlusions.
Coronary artery bypass surgery not only provides symptomatic relief but also may prolong life in a significant percentage of patients. Repeat bypass surgery succeeds in providing symptomatic relief in a lesser number of patients, but it is associated with a higher morbidity and mortality than primary operations. Angioplasty, an interventional, therapeutic catheter technique, is applicable to a large number of patients who have undergone bypass surgery and who are sufficiently symptomatic to require consideration of another revascularization procedure. The gratifying results of successful lesion dilatation coupled with clinical improvement of the patient, the acceptable mortality and morbidity statistics, and the long-term symptomatic relief are comparable to those for repeat coronary bypass graft surgery. In addition, technologic advances in angioplasty equipment, as well as more knowledgeable interventionists, will enable more lesions to be successfully reached, traversed, and dilated with, it is hoped, a lower morbidity and mortality. We would estimate that 30 to 50 per cent of those patients requiring repeat revascularization operations today can undergo an angioplasty procedure with at least comparable clinical results and better morbidity and mortality statistics than those achieved with repeat bypass surgery. Selected patients underwent transluminal coronary angioplasty of varying combinations of arterial and/or vein graft stenoses. A multiple dilatation procedure was defined as successful when dilatation was achieved in all lesions in which it was attempted or when the considered-critical stenosis was dilated successfully and the patient was clinically improved. Angioplasty was successful in 93 per cent of all lesions in which it was attempted, and these successful dilatations produced a clinical improvement in 92 per cent of the patients. No complication whatsoever was experienced in 81 per cent of cases. The complications encountered included a 1.3 per cent mortality rate, a myocardial infarction rate of 6.9 per cent (3.0 per cent per lesion attempted), and an emergency surgery rate of 2.6 per cent (1.1 per cent per lesion attempted). Follow-up data show that a sustained clinical improvement was obtained in 96.8 per cent of the patients in whom the procedure was successful (with or without a repeat angioplasty). These data indicate that multiple coronary angioplasties can be performed during the same procedure, that clinical improvement can be achieved, and that the complication rate is acceptable.(ABSTRACT TRUNCATED AT 400 WORDS)
Angioplasty, Balloon↗
Acute coronary events associated with percutaneous transluminal coronary angioplasty.
Acute coronary events reported in patients enrolled in the NHLBI PTCA Registry were analyzed. Data were collected on 3,079 patients from 105 contributing centers. Coronary vascular events (dissection, occlusion, spasm, embolism, perforation or rupture) or ischemic events (MI or prolonged angina) occurred in 418 patients (13.6%). Major complications (MI), emergency surgery or death) occurred in 280 patients (67%) with acute coronary events. The most frequent events were prolonged angina, which occurred in 211 (6.8%), and MI, in 170 (5.5%). Coronary dissection, occlusion and spasm each occurred in approximately 5% of patients. Coronary embolism, perforation and rupture were rare (less than 0.2% for each). Dissection and occlusion each had a high frequency (greater than 80%) of associated major complications. A substantially lower incidence of major complications occurred in patients with isolated coronary spasm (18%) or prolonged angina (35%). Clinical and angiographic predictors for overall and specific events were identified. Coronary events occurred more frequently in women and patients with unstable angina. Eccentric lesions were associated with a higher rate of coronary events, and event rates were lower with single discrete lesions than with other types of lesions. The frequency of any coronary event, MI, prolonged angina and coronary spasm each decreased with increasing experience with PTCA. The frequency of dissection and occlusion did not change with experience.
Acute Disease↗
In-hospital mortality rate in the National Heart, Lung, and Blood Institute Percutaneous Transluminal Coronary Angioplasty Registry.
Twenty-nine patients died among the first 3,079 patients enrolled in the NHLBI PTCA Registry. The overall morality rate was 0.9%; the mortality rate was 0.8% in patients with 1-vessel CAD, 1.0% in those with multivessel CAD (excluding left main CAD), and 3.8% in those with left main CAD (p less than 0.01). The in-hospital morality rate was significantly higher among women (p less than 0.01), in patients older than 60 years, in patients with previous CABG (p less than 0.01), the presence of left main CAD, (p less than 0.01), in patients who required dilatation of a vein graft stenosis (p less than 0.05), and in patients who had had angina for longer than 6 months (p less than 0.01).
Adult↗
Emergency coronary bypass surgery after coronary angioplasty: the National Heart, Lung, and Blood Institute's Percutaneous Transluminal Coronary Angioplasty Registry experience.
The frequency and outcome of emergency CABG for complications of PTCA in the NHLBI PTCA Registry were analyzed. Emergency surgery was performed in 202 patients (6.6%). The most frequent indications for emergency operation were coronary dissection in 46%, coronary occlusion in 20%, prolonged angina in 14% and coronary spasm in 11%. Emergency surgery was most often necessary in patients in whom lesions could not be reached or traversed, but more than 25% of patients who required emergency surgery had initially successful dilatation followed by abrupt reclosure of the vessel. The mortality rate with emergency CABG was 6.4%, and nonfatal MI occurred in 41% of patients, with Q waves developing in approximately 60% of patients with MI. However, 53% of patients managed with emergency CABG for severe ischemic events with PTCA did not have evidence of MI or die and had an uncomplicated postoperative course. No baseline clinical predictors of emergency surgery were identified. Lesion eccentricity was associated with a significant increase in frequency of emergency operation, and the incidence of emergency surgery declined with increasing experience with PTCA.
Angioplasty, Balloon↗
Long-term efficacy of percutaneous transluminal coronary angioplasty (PTCA): report from the National Heart, Lung, and Blood Institute PTCA Registry.
The NHLBI PTCA Registry has collected data from 3,079 patients who underwent PTCA at 105 centers from September 1977 through September 1981 that document the initial risks and benefits of PTCA. A subgroup of 2,272 patients at 65 centers was chosen to examine the long-term effects of PTCA (97% follow-up). All patients were followed for 1 year, 191 for 3 years and 57 for 4 years. Initial success occurred in 1,397 (61%), and 72% remained improved at 1 year with no further procedures; during the first year of follow-up, 14% had repeat PTCA, 12% had CABG, 3% had MI and 1.6% died. After 1 year, 67% were asymptomatic; of these, 52% had no other procedure, 7% had a second PTCA and 8% had CABG. Follow-up at 2 to 4 years was similar except that there were few repeat PTCA or CABG procedures after 1 year. The annual mortality rate after PTCA in patients with 1-vessel diseases was less than 1% per year and with multivessel CAD, 3% per year. Thus, successful PTCA alone results in sustained improvement in 84% of patients; 59% were asymptomatic (12% had repeat PTCA). PTCA offers extended effective therapy in selected patients with CAD.
Angioplasty, Balloon↗
Return to work after coronary angioplasty: a report from the National Heart, Lung, and Blood Institute Percutaneous Transluminal Coronary Angioplasty Registry.
Employment status was analyzed in 2,250 patients enrolled at 65 clinical centers in the NHLBI PTCA Registry. Patients were classified into 3 groups depending on the outcome of PTCA. In 63.6%, PTCA was successful without MI or CABG (Group A); in 25.3%, PTCA was unsuccessful and was followed by CABG (Group B); and in 11.1%, PTCA was unsuccessful and was followed by medical therapy alone (Group C). At entry, 68.3% of all patients were employed full- or part-time. The clinical characteristics of the 3 groups were different. Patients in Group C had a higher incidence of previous MI and previous CABG. In addition, patients in Group C had a significantly decreased baseline employment rate compared with those in Group A. At a mean follow-up of 1.5 years, there was a small but similar decrease in the percentage employed full- or part-time in all groups. Employment status also was analyzed in a subset of 1,150 patients working full- or part-time at baseline and aged 60 years or younger, who would be expected to have the highest return to work rates. At a mean follow-up of 1.4 years, 81 to 86% of patients remained working irrespective of the outcome of PTCA. However, patients with successful PTCA returned to work significantly sooner. The occurrence of chest pain during follow-up in these patients was an important predictor of return to work, irrespective of the outcome of dilatation. In patients with chest pain during follow-up, only 77% were working, compared with 90% of patients who had not had chest pain.
Angioplasty, Balloon↗
Relative cost of coronary angioplasty and bypass surgery in a one-vessel disease model.
A national study was carried out to determine the relative costs of PTCA and CABG. Baseline clinical criteria for the 2 groups were similar. Data were collected in 186 sets for the PTCA group and 175 sets for the CABG group. Male patients make up 81% of the PTCA group and 80% of the CABG group. Mean hospital stay was 12 +/- 5 days in the CABG group, compared with 4 +/- 2 days in the PTCA group (p less than 0.001). The base charges for hospital and professional components of the CABG procedure were $15,580 +/- $2,159, whereas the same charges for the PTCA procedure were $5,315 +/- $2,159 (p less than 0.001). With an 80% primary success rate, which was the group mean success rate, the average dollar savings per PTCA procedure would be $7,149, or $7,149,000 per 1,000 cases. Thus, PTCA for revascularization in 1-vessel CAD is significantly more cost-effective than CABG in the short term.
Aged↗
Complex coronary angioplasty: multiple coronary dilatations.
Selected patients underwent PTCA of multiple stenoses in different vessels or in the same vessel. Three hundred nine patients underwent 685 PTCA procedures in various combinations of arterial and vein graft stenoses. A multiple dilatation procedure was defined as successful when all lesions attempted were successfully dilated, or when the considered-critical-stenosis was successfully dilated and this resulted in a patient clinical improvement. Angiographic success was achieved in 599 of 685 lesions attempted (87.4%) and in 285 of 309 patients (92.2%). Complications included a mortality rate of 1.0%, an MI rate of 4.2% per patient and 1.9% per lesion attempted, and a 3.6% incidence of emergency CABG. Follow-up data show that 58 patients (20.4%) had clinical evidence of a lesion recurrence, and that 92.5% (37 of 40 patients) who underwent repeat angioplasty had a successful procedure. A sustained clinical improvement was obtained in 264 of 309 patients (85.4%). The data indicate that multiple dilatations are feasible with good success rates and acceptable complication rates. Further evaluation of this extended application of PTCA is needed to clearly establish its role in the therapy of CAD.
Adult↗
The brachial artery method to peripheral transluminal angioplasty.
The brachial artery method to peripheral (percutaneous) transluminal angioplasty is described. A total of 232 angioplasties were attempted using the brachial and femoral artery techniques with a success achieved in 204 cases (88%): in 167 of 176 (95%) stenoses, and in 37 of 56 (66%) occlusions. 114 attempts were made via the brachial artery method with a success achieved in 109 (96%): in 98 of 102 (96%) stenoses, and in 11 of 12 (92%) occlusions. 68% of the attempts were made in the ileofemoral system with a success achieved in 73 cases (94%): in 66 of 70 (94%) stenoses, and 7 of 8 occlusions. All of the attempted renal, subclavian, and superficial femoral artery stenoses were successfully dilated. One local brachial artery complication was encountered. The brachial artery method to peripheral transluminal angioplasty is an acceptable and complementary alternative to the transfemoral technique.
Angioplasty, Balloon↗
Percutaneous transluminal coronary angioplasty in patients with prior coronary artery bypass grafting.
Percutaneous transluminal coronary angioplasty (PTCA) has been used to treat patients with prior coronary artery bypass grafting who have stenosis of a saphenous vein graft and/or a native artery. During 53 months, 61 patients underwent 105 angioplasty attempts. Eighty lesions (76%) were successfully dilated in 46 of 61 patients (75%). Success in a patient was determined by a greater than or equal to 20% decrease in the percent diameter stenoses coupled with an improved clinical response; 52 patients had one prior CABG and nine patients had two or more prior CABGs. Multivessel disease was present in 56 patients (92%). A vein graft stenosis was successfully dilated in 26 of 33 cases (79%)--19 of 25 (76%) at an anastomotic site and seven of eight (88%) in the graft body. An arterial stenosis was successfully dilated in 37 of 52 cases (71%)--18 of 22 (82%) in the left anterior descending, 13 of 22 (59%) in the circumflex, 21 of 26 (81%) in the right coronary, and two (100%) in the left main coronary artery. There is no statistically significant difference in the incidence of success in dilating a vein graft or native artery. Complications included: one emergency CABG (1.6%), three myocardial infarctions (4.9%), and two deaths (3.3%). There were 15 unsuccessful PTCAs: Ten patients had elective CABG, one had emergency CABG, two received medical treatment, and two died. Forty-six patients are being followed-up: Twenty-eight (61%) continue to do clinically well, seven (15%) had another PTCA and remain well, and 10 (16%) had elective CABG because of restenosis and/or disease progression. There was one late death and one late myocardial infarction. Thus, 35 patients (57%) had continued clinical success without the need for repeat CABG; 89% had no angina or improved angina, and 90% had improved exercise treadmill results. PTCA is technically feasible in selected patients with prior CABG and can achieve a clinical response with an acceptable complication rate when compared to repeat CABG.
Angina Pectoris↗