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Biomedical subjects

L F Satler

Publications and source records attributed to L F Satler.

At least 91 records · Page 5Linked to original sources
PubMed1999

Preintervention arterial remodeling as an independent predictor of target-lesion revascularization after nonstent coronary intervention: an analysis of 777 lesions with intravascular ultrasound imaging.

BACKGROUND: Pathological and intravascular ultrasound (IVUS) studies have documented arterial remodeling during atherogenesis. However, the impact of this remodeling process on the long-term outcome after percutaneous intervention is unknown. METHODS AND RESULTS: We used preintervention IVUS to define positive and negative/intermediate remodeling in a total of 777 lesions in 715 patients treated with nonstent techniques. Positive remodeling (lesion external elastic membrane area greater than average reference) was present in 313 lesions; intermediate/negative remodeling (lesion external elastic membrane area less than or equal to reference) was present in the other 464. Baseline clinical and angiographic characteristics were similar, except for a slightly higher percentage of insulin-dependent diabetic patients (10.2% versus 6.1%; P=0.054) in the negative/intermediate-remodeling group. Angiographic success and in-hospital and short-term complications were comparable in the 2 groups. There was no significant correlation between remodeling (as a continuous variable) and final lumen area (r=0.06) or final lesion plaque burden (r=0.17). At 18+/-13 months of clinical follow-up, both groups had similar rates of death and Q-wave myocardial infarction: 3.4% and 2.5% for the negative/intermediate-remodeling group versus 2.7% and 2.7% for the positive-remodeling group. However, the target-lesion revascularization (TLR) rate was 20.2% for the negative/intermediate-remodeling group versus 31.2% for the positive-remodeling group (P=0.007), and remodeling, as a continuous variable, was strongly correlated with probability of TLR (P=0.0001). By multivariable logistic regression analysis, diabetes (OR=2.3), left anterior descending artery location (OR=1.8), and remodeling (OR=5.9) were independent predictors of TLR. CONCLUSIONS: Positive lesion-site remodeling is associated with a higher long-term TLR after a nonstent interventional procedure. Thus, long-term clinical outcome appears to be determined in part by preintervention lesion characteristics.

Aged↗
PubMed1999

Serial volumetric intravascular ultrasound assessment of arterial remodeling in left main coronary artery disease.

Serial volumetric intravascular ultrasound (IVUS) was used to study de novo, nontreated left main coronary arteries (LMCAs) in 31 patients. Using an automated contour detection algorithm, analysis of 7.2 +/- 2.5 mm long segments included arterial, lumen, and plaque volumes and plaque burden (plaque/arterial volumes). During follow-up (7.7 +/- 2.4 months), the percent change in lumen volume correlated with the percent change in arterial volume (r = 0.897, p <0.0001), but not with the percent change in plaque volume (r = 0.066, p = 0.7263). Percent changes in arterial volume correlated with percent changes in plaque + media volume (r = 0.448, p = 0.0115), indicating arterial remodeling. However, there was a spectrum of responses ranging from inadequate remodeling (decrease in lumen volume despite no increase or a decrease in plaque volume: i.e., arterial shrinkage) to overcompensation (an increase in lumen volume despite an increase in plaque volume). Serial volumetric IVUS (1) confirms the existence of both positive and negative remodeling in LMCA, and (2) shows that in moderate LMCA disease, luminal changes resulted primarily from positive versus negative remodeling, not plaque progression and/or regression.

Aged↗
PubMed1999

Tissue proliferation within and surrounding Palmaz-Schatz stents is dependent on the aggressiveness of stent implantation technique.

In-stent restenosis is entirely due to intimal hyperplasia. Histologic studies have indicated that intimal hyperplasia is related to the arterial injury induced during stent implantation. We used intravascular ultrasound (IVUS) imaging to study whether tissue proliferation inside and surrounding stents is related to the aggressiveness of the implantation technique. After intervention and follow-up (mean 5.6 +/- 3.7 months), serial IVUS imaging was performed in 102 native artery stented stenoses in 91 patients. Measurements at 5 predetermined segments within each stented lesion included external elastic membrane, stent, and lumen cross-sectional areas (CSAs). Calculations included mean plaque CSA growth outside of the stent (external elastic membrane-stent) and mean neointimal hyperplasia CSA and thickness within the stent (stent-lumen). Stenoses were categorized depending on the aggressiveness of stent placement (group 1, adjunct percutaneous transluminal coronary angioplasty pressure < 16 atm and/or balloon/artery ratio < 1.1; group 2, adjunct percutaneous transluminal coronary angioplasty pressure > or = 16 atm and balloon/artery ratio > or = 1.1). An aggressiveness score was calculated as balloon/artery ratio x inflation pressure. Mean intimal hyperplasia CSA (2.9 +/- 1.5 vs 2.2 +/- 1.6 mm2, p = 0.028), mean intimal hyperplasia thickness (0.34 +/- 0.19 vs 0.25 +/- 0.19 mm, p = 0.012), and mean peristent tissue growth CSA (2.5 +/- 1.0 vs 1.1 +/- 1.4 mm2, p = 0.003) were significantly greater in group 2 stenoses. In addition, intimal hyperplasia CSA and thickness correlated significantly with balloon/artery ratio x inflation pressures: r = 0.305, p = 0.002 and r = 0.329, p = 0.0007, respectively, as did peristent tissue proliferation CSA (r = 0.466, p = 0.001). Tissue proliferation inside and surrounding stents may be related to aggressiveness of the stent implantation technique.

Angioplasty, Balloon, Coronary↗
PubMed1999

Intravascular ultrasound predictors of target lesion revascularization after stenting of protected left main coronary artery stenoses.

We evaluated the predictors of late clinical outcomes after stenting of protected left main coronary artery (LMCA) stenoses. Intravascular ultrasound (IVUS) guided stenting of protected LMCA stenoses was performed in 87 consecutive patients between January 1994 and December 1996. Results were evaluated using conventional (clinical, angiographic, and IVUS) methodology. Late (12 month) clinical follow-up information was obtained in all patients. Initial procedural success was achieved in 86 patients (99%). There was 1 in-hospital death (in the 1 patient with a procedural failure). There were no other in-hospital complications, including Q-wave myocardial infarction, emergency bypass surgery, or repeat coronary angioplasty. The overall target lesion revascularization (TLR) rate was 13%. Using multivariate logistic regression analysis, the only independent predictor of TLR was the postintervention lumen area by IVUS. A final lumen area > or =7.0 mm2 was obtained in 74 patients (86%); the TLR rate for these patients was 7%. This was compared with patients with a final lumen area <7.0 mm2 in whom the TLR rate was 50% (p = 0.0011). Stenting of protected LMCA stenoses is safe and effective with acceptable long-term clinical outcomes. The most important factor determining long-term success was the postintervention lumen area by IVUS.

Aged↗
PubMed1999

Effects of dopamine and aminophylline on contrast-induced acute renal failure after coronary angioplasty in patients with preexisting renal insufficiency.

In phase 1 of this study, 60 patients undergoing coronary angioplasty were randomized to receive saline, dopamine, or aminophylline; the overall incidence of contrast-induced renal failure was 38%, without difference among the 3 groups. In phase 2 of this study, 72 patients with established contrast-induced renal failure were randomized to receive saline or dopamine; dopamine had a deleterious effect on the severity of renal failure, prolonging the course.

Acute Kidney Injury↗
PubMed1999

A large coronary artery saphenous vein bypass graft aneurysm with a fistula: case report and review of the literature.

We describe a patient who developed a large aneurysm of saphenous vein graft to the right coronary artery with a fistulous communication to the right atrium. The presence of a fistulous communication of a saphenous vein graft aneurysm after coronary bypass surgery to one of the heart chambers is extremely rare. The diagnosis was made by coronary angiography and confirmed by CT and MRI. At surgery the aneurysm was ligated and excised. The fistula to the right atrium was closed. Repeat coronary artery bypass surgery with aortic valve replacement was performed at the same time without complications. Cathet. Cardiovasc. Intervent. 48:214-216, 1999.

Coronary Aneurysm↗
PubMed1999

Procedural results and late clinical outcomes following multivessel coronary stenting.

OBJECTIVES: To evaluate in-hospital and long-term clinical outcomes in a large consecutive series of patients undergoing percutaneous multivessel stent intervention. BACKGROUND: High restenosis and recurrent angina rates have limited the clinical outcomes of multivessel coronary angioplasty before stents were available to improve angioplasty results. METHODS: We evaluated in-hospital and long-term clinical outcomes (death, Q-wave myocardial infarction [MI], and repeat revascularization rates at one year) in 398 consecutive patients treated with coronary stents in two (94% of patients) or three native arteries, compared to 1,941 patients undergoing stenting procedure in a single coronary artery between January 1, 1994 and August 29, 1997. RESULTS: Overall procedural success was obtained in 96% of patients with two- or three-vessel stenting and in 970% of patients with single-vessel stent intervention (p = 0.36). Procedural complications were also similar (3.8% for multivessel versus 2.9% for single vessel, p = 0.14). During follow up, target lesion revascularization was 15% in multivessel and 16% in single-vessel interventions (p = 0.38), and repeat revascularization (calculated per treated patient) was also similar for both groups (20% vs. 21%, p = 0.73). There was no difference in death (1.4% vs. 0.7%, p = 0.26), and Q-wave MI (1.2% vs. 0%, p = 0.02) was lower following multivessel interventions. Overall cardiac event-free survival was similar for both groups (p = 0.52). CONCLUSIONS: Unlike previous conventional angioplasty experiences, multivessel stenting has (1) similar in-hospital procedural success and major complication rates and (2) similar long-term (one year) clinical outcomes compared with single-vessel stenting. Thus, stents may be a viable therapeutic strategy in carefully selected patients with multivessel coronary disease.

Angioplasty, Balloon, Coronary↗
PubMed1999

One-year follow-up after intravascular ultrasound assessment of moderate left main coronary artery disease in patients with ambiguous angiograms.

OBJECTIVES: The purpose of this study was to correlate angiographic and intravascular ultrasound (IVUS) findings in left main coronary artery (LMCA) disease and identify the predictors of coronary events at one year in patients with LMCA stenoses. BACKGROUND: Significant (> or =50% diameter stenosis [DS]) LMCA disease has a poor long-term prognosis. METHODS: One hundred twenty-two patients who underwent angiographic and IVUS assessment of the severity of LMCA disease and who did not have subsequent catheter or surgical intervention were followed for one year. Standard clinical, angiographic and IVUS parameters were collected. RESULTS: The quantitative coronary angiography (QCA) reference diameter (3.91 +/- 0.76 mm, mean +/- 1 SD) correlated moderately with IVUS (4.25 +/- 0.78 mm, r = 0.492, p = 0.0001). The lesion site minimum lumen diameter (MLD) (2.26 +/- 0.82 mm) by QCA correlated less well with IVUS (2.8 +/- 0.82 mm, r = 0.364, p = 0.0005). The QCA DS measured 42 +/- 16%. During the follow-up period, 4 patients died, none had a myocardial infarction, 3 underwent catheter-based LMCA intervention and 11 underwent bypass surgery. Univariate predictors of events (p < 0.05) were diabetes, presence of another lesion whether treated with catheter-based intervention or untreated with DS > 50% and IVUS reference plaque burden and lesion lumen area, maximum lumen diameter, MLD, plaque area and area stenosis. Using logistic regression analysis diabetes mellitus, an untreated vessel (with a DS > 50%) and IVUS MLD were independent predictors of cardiac events. CONCLUSIONS: In selected patients assessed by IVUS, moderate LMCA disease had a one-year event rate of only 14%. Intravascular ultrasound MLD was the most important quantitative predictor of cardiac events. For any given MLD, the event rate was exaggerated in the presence of diabetes or another untreated lesion (>50% DS).

Adult↗
PubMed1999

Treatment of symptomatic cervical carotid dissections with endovascular stents.

OBJECTIVE: Symptomatic dissections of the cervical carotid artery (CCA) can be spontaneous or secondary to trauma and may be associated with pseudoaneurysms. Surgical treatment is often difficult or unavailable. We report the successful use of endovascular stents in the treatment of symptomatic dissection of the CCA. METHODS: Five consecutive patients with symptomatic CCA dissection were seen at our institution. There were four female patients and one male patient, ranging in age from 19 to 56 years. One dissection was spontaneous. The others were secondary to a gunshot wound (one patient), blunt neck trauma (two patients), and endovascular treatment of atherosclerotic carotid bifurcation disease (one patient). Balloon-expandable and self-expanding stents were placed via a transfemoral approach. RESULTS: Success in restoring the carotid lumen with two to five stents in each patient was angiographically demonstrated. There were no procedure-related complications. All patients experienced significant clinical improvement within the first 24 hours and complete long-term recovery. CONCLUSION: Symptomatic dissections of the CCA can be successfully treated by using endovascular stents.

Adult↗
PubMed1999

Intra-arterial reteplase for the treatment of acute limb ischemia.

The removal of urokinase from the market has created a dilemma for interventionists and vascular surgeons treating patients with acute limb threatening ischemia due to arterial thrombosis or embolization. Reteplase is a newer, fibrin-specific thrombolytic agent with properties that make it an attractive alternative to urokinase. We report two cases of successful treatment of acute, limb threatening ischemia with intra-arterial Reteplase therapy.

Acute Disease↗
PubMed1998

Procedural results and long-term clinical outcomes following coronary stenting in perimyocardial infarction syndromes.

Initial experiences with coronary stents in acute coronary syndromes have suggested higher risk of ischemic complications and stent thrombosis. We evaluated in-hospital and 1-year clinical outcomes of coronary stent implantation in perimyocardial infarction (MI) syndromes. We studied 334 consecutive patients undergoing stent interventions in the first week after acute MI. Stenting was performed within 24 hours (n = 31), within 1 to 3 days (n = 95), and within 4 to 7 days (n = 208). Stents were used to improve angioplasty results and to treat dissections and abrupt/threatened closure. Postprocedure anticoagulation regimens were aspirin, ticlopidine, and low molecular weight heparin. Overall procedural success was achieved in 93% of patients. Major in-hospital complications included death (1.0%), recurrent Q-wave MI (0.6%), and emergent bypass surgery (3.0%). Stent thrombosis occurred in 0.6% of patients. At follow-up, cardiac event-free survival was 80%, mortality 2.2%, recurrent MI 3.5%, and target lesion revascularization 11%. We conclude that coronary stenting in periinfarction syndromes was effective in achieving sustained clinical benefit up to 1 year with low morbidity and mortality. Thus, stents seem to be a viable therapeutic strategy in patients sustaining perimyocardial infarction syndromes.

Aged↗
PubMed1998

Intimal hyperplasia thickness at follow-up is independent of stent size: a serial intravascular ultrasound study.

The purpose of this study was to determine whether the thickness of the intimal hyperplasia (IH) layer that accumulates within Palmaz-Schatz stents is dependent on stent size. Intravascular ultrasound (IVUS) and quantitative angiographic (QCA) studies were performed after stent implantation and at follow-up (5.4 +/- 3.8 months) in 161 patients with 177 lesions treated with 221 Palmaz-Schatz stents. Stent and lumen cross-sectional area (CSA) were measured. IH CSA and thickness at follow-up were calculated and compared with stent CSA and circumference. Maximum IH CSA and thickness were measured at the smallest follow-up lumen CSA; mean IH CSA and thickness was averaged over the length of the stent. Maximum IH CSA measured 4.8 +/- 2.4 mm2, and mean IH CSA measured 2.8 +/- 2.2 mm2. Maximum IH thickness (at the smallest follow-up lumen CSA) measured 0.60 +/- 0.36 mm, and mean IH thickness (over the length of the stent) measured 0.30 +/- 0.19 mm. There was a weak, but significant correlation between mean and maximum IH CSA versus stent CSA (r = 0.215, p <0.0001 and r = 0.355, p <0.0001, respectively). However, there was no correlation between mean or maximum IH thickness versus stent CSA (r = 0.018, p = 0.643 and r = 0.056, p = 0.463, respectively) or stent circumference (r = 0.002, p = 0.956 and r = 0.069, p = 0.361, respectively). IH thickness was found to be independent of the stent size. This explains the known higher frequency of restenosis in smaller stents compared with larger stents.

Adult↗
PubMed1998

Clinical, intravascular ultrasound, and quantitative angiographic determinants of the coronary flow reserve before and after percutaneous transluminal coronary angioplasty.

This study evaluated the clinical, intravascular ultrasound (IVUS), and angiographic determinants of the coronary flow reserve (CFR) as measured by guidewire Doppler velocimetry. Using standard methodology, 86 consecutive patients were studied before intervention (n = 73 patients, including the assessment of intermediate stenoses) and/or after intervention (n = 39 patients, including after percutaneous transluminal coronary angioplasty (PTCA) in 27 and post-Palmaz-Schatz stent placement + high-pressure adjunct PTCA in 12). Only 5 patients were studied before intervention, post-PTCA, and poststent. Univariate and multivariate clinical, quantitative coronary angiography (QCA), and IVUS correlates of the CFR were evaluated. There was a linear relation between CFR and IVUS minimum lumen cross-sectional area (CSA): r = 0.771, p <0.0001 for the overall cohort; r = 0.831, p <0.0001 before intervention; r = 0.514, p = 0.0061 post-PTCA; and r = 0.623, p = 0.0306 poststent placement. Overall, an IVUS minimum lumen CSA of > or = 4.0 mm2 had a diagnostic accuracy of 89% in identifying a CFR of > or = 2.0. This diagnostic accuracy increased slightly to 92% when only the preintervention observations were considered. Using multivariate linear regression analysis, the independent determinants of the CFR in the overall cohort of 112 observations were IVUS minimum lumen CSA (p <0.0001), angiographic lesion length (p = 0.0101), and diabetes mellitus (p = 0.0371): r2 = 0.6224. When the subset of preintervention observations were analyzed separately, the independent determinants of the CFR were minimum lumen CSA (p <0.0001) and angiographic lesion length (p = 0.0095); r2 = 0.7176. Thus, the major determinants of the CFR in patients with coronary artery disease are lumen compromise (which is best assessed by the IVUS measurement of the minimum lumen CSA) and lesion length. A minimum lumen CSA > or = 4.0 mm2 has a high diagnostic accuracy in predicting a CFR > or = 2.0, especially before intervention.

Aged↗
PubMed1998

Early lumen loss after treatment of in-stent restenosis: an intravascular ultrasound study.

BACKGROUND: Mechanisms of recurrence after treatment of in-stent restenosis are unknown. METHODS AND RESULTS: We prospectively performed quantitative coronary angiography (QCA) and intravascular ultrasound (IVUS) in 37 lesions with Palmaz-Schatz stents enrolled in a study of intracoronary radiation for in-stent restenosis. Primary treatment was at the discretion of the operator: PTCA (n=8) or ablation+adjunct PTCA (n=29). Lesions were studied before intervention, immediately after primary intervention, and 42+/-8 minutes later. QCA measurements included minimal luminal diameter and diameter stenosis. Planar IVUS measurements included arterial, stent, lumen, and in-stent tissue areas. Stent, lumen, and in-stent tissue volumes were calculated by use of Simpson's rule. Compared with immediately after intervention, the delayed (42+/-8 minutes) minimal lumen area decreased by 20% (5.8+/-1.9 to 4.5+/-1.3 mm2, P<0.0001) and the lumen volume by 12% (58+/-41 to 52+/-37 mm3, P=0.0001). Ten lesions (27%) had a > or = 2.0-mm2 decrease in minimum lumen area. Lumen loss (1) resulted from increased tissue with the stent, (2) correlated with lesion length and preintervention in-stent tissue, and (3) was not seen angiographically. CONCLUSIONS: There is significant tissue reintrusion shortly after catheter-based treatment of in-stent restenosis. This was greater in longer lesions and those with a larger in-stent tissue burden, was not reflected in the QCA measurements, and may contribute to recurrence.

Aged↗