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Biomedical subjects

L Finci

Publications and source records attributed to L Finci.

At least 37 records · Page 2Linked to original sources
PubMed1997

Coronary stenting in 1000 consecutive patients. Long-term clinical and angiographic results.

Coronary stent implantation has become an accepted treatment for selected patients but the long-term outcome after stent implantation has not been investigated in a large unselected population. This study reports clinical and angiographic results after coronary stent implantation in a consecutive group of 1000 patients treated between November 1989 and June 1994. A total of 2012 stents were implanted in 1216 lesions. The anticoagulation regimen after successful stenting was abolished in the last 499 patients, treated with aspirin and ticlopidina. Complex lesions (type B2, type C lesions and chronic total occlusions) were less frequent in the group with anticoagulation (67%, 355/529 lesions) than in the group without anticoagulation (76%, 485/641; p < 0.01). Vessel size was also significantly smaller in the group with no anticoagulation (3.21 +/- 0.50 mm vs 2.89 +/- 0.70 mm; p < 0.001). Procedural success was achieved in 96% of cases. Major complications occurred in 49 pts, including death (1%), emergency bypass surgery (2.7%), and myocardial infarction (2.1%). Subacute stent thrombosis, observed in 2.6% of the patients treated with anticoagulation, decreased to 1% in the last 499 patients receiving only antiplatelet drugs after high pressure stent expansion controlled with intravascular ultrasound (p < 0.05). Angiographic follow-up was obtained at a mean interval of 6.6 +/- 3.0 months in 718 patients (75% of the eligible candidates). The global restenosis rate (greater than 50% diameter stenosis) was 22%, with no statistically significant difference in patients with and without anticoagulation after stenting. Clinical follow-up was available in 890 patients at a mean interval of 14 +/- 17 months. Late cardiac events occurred in 251 patients and included: 159 repeat coronary angioplasties for restenosis (20%), 114 coronary angioplasties for de novo lesions (10%), 33 elective by-pass surgery operations (3.7%) and 42 late deaths (4.7%). At the most recent follow-up there were 719 pts (81%) free of anginal symptoms, including patients having repeat angioplasty for restenosis or disease progression. Coronary stenting has a low incidence of procedural complications and high-pressure ultrasound guided implantation has drastically reduced the risk of subacute thrombosis. Repeat procedures due to restenosis remain the most important limitation of the technique and do not seem to be affected by evolving technique and operator experience.

Angioplasty, Balloon, Coronary↗
PubMed1996

Implantation of the peripheral Wallstent for diffuse lesions in coronary arteries and vein grafts.

The Wallstent (Schneider, Bulach, Switzerland) is available in different lengths without much compromise in flexibility and radial support compared to some other stents. We treated 24 patients (26 vessels) with diffuse coronary lesions or vein graft lesions with intravascular ultrasound-guided peripheral Wallstent implantation. Average balloon pressure during stent optimization was 16.4 +/- 2.7 atm. The stents could be successfully implanted in 24 vessels. Minimal lumen diameter and percent diameter stenosis after stenting were 3.60 +/- 0.62 mm and -8 +/- 13%, respectively. Average stent length was 63.7 +/- 22.7 mm. There was one procedure-related complication. After stenting, all patients were treated only with antiplatelet agents. During 1-month follow-up, there was one subacute stent thrombosis due to incomplete coverage of a distal dissection. These preliminary results show the feasibility of this novel approach in selected lesions.

Adult↗
PubMed1996

Acute recoil of Palmaz-Schatz stent: a rare cause of suboptimal stent implantation--report of two cases with intravascular ultrasound findings.

It is generally believed that the Palmaz-Schatz stent maintains a strong radial force, preventing stent recoil. However, the capacity to prevent recoil is largely governed by the hardness or resistance of the lesion. We report two cases of "acute Palmaz-Schatz stent recoil," documented by intravascular ultrasound, and suggest a novel treatment of this unusual problem.

Angioplasty, Balloon, Coronary↗
PubMed1996

Results of coronary stenting for restenosis.

OBJECTIVES: This study attempted to analyze immediate and long-term angiographic and clinical results of coronary stent implantation for restenosis in a consecutive group of patients. BACKGROUND: The rate of stent utilization in patients with coronary artery disease has increased exponentially in recent years. There are many unanswered questions about the use of stenting in patients with restenosis, particularly with respect to late clinical and angiographic results. METHODS: A total of 159 stents were implanted in 128 consecutive patients with 139 lesions (mean 1.3 stents/patient). A technique of optimal stent expansion was used in all patients, and intravascular ultrasound guidance with no subsequent anticoagulation was performed in 41 patients. RESULTS: Stent implantation was successful in 126 patients (98%). Four patients (3.1%) had complications (in two after successful stenting): death in one, emergency bypass surgery operation in two and subacute stent thrombosis in one. Stents were implanted with a final balloon size (mean +/- SD) of 3.5 +/- 0.5 mm and a mean maximal pressure of 11 +/- 4 atm (range 8 to 20). Angiographic restenosis occurred in 27 patients (25%). Regression analysis on clinical and angiographic variables for prediction of restenosis showed no statistical significance for any variable. Late events occurred in 23 patients (19%). The actuarial survival rate was 98% at 1 year and at 3 years, and the event-free survival rate including freedom from repeat angioplasty for restenosis was 95% and 76%, respectively. CONCLUSIONS: The late angiographic outcome, restenosis rate and total clinical events are favorable for selected patients undergoing stent implantation for the indication of restenosis.

Aged↗
PubMed1995

Intracoronary stent insertion after balloon angioplasty of chronic total occlusions.

OBJECTIVES: This retrospective analysis was performed to assess the medium-term effectiveness of implanting intracoronary stents into chronic total occlusions that are successfully opened by balloon angioplasty. BACKGROUND: The value of percutaneous transluminal coronary angioplasty of chronic total occlusions is limited by a very high restenosis rate of 50% to 68%. Intravascular stents have been shown to reduce restenosis in a subset of patients with subtotal stenoses. It has not been demonstrated that the placement of stents into successfully opened chronic total coronary artery occlusions leads to lower rates of restenosis. METHODS: A consecutive series of patients with chronic total coronary occlusions successfully opened by balloon angioplasty received Palmaz-Schatz stents. Patients underwent clinical and angiographic follow-up at a mean of 6 months after stent insertion. Angiographic and clinical results were retrospectively analyzed. RESULTS: Fifty-nine patients underwent stenting of 60 chronic total coronary occlusions, with a 98% rate of successful stent deployment. Complications occurred in 5% of cases, all with subacute thrombosis. Angiographic follow-up was obtained in 88% of patients at a mean of 6 months and demonstrated an angiographic restenosis rate of 20%, with only one reocclusion. Among several variables examined, only the presence of a procedure-related moderate to severe dissection was associated with higher follow-up percent diameter stenoses and clinical events. At a mean of 14 months after stent insertion, 77% of patients remained free of symptoms or clinical events. CONCLUSIONS: The implantation of intracoronary stents into vessels with opened chronic total coronary occlusions is associated with favorable rates of angiographic restenosis and relief of symptoms. A randomized clinical trial comparing balloon angioplasty with stent-assisted balloon angioplasty in the treatment of chronic total coronary occlusions is indicated.

Aged↗
PubMed1994

Favourable results of treatment of narrowed saphenous vein grafts with Palmaz-Schatz stent implantation.

Although conventional balloon angioplasty of saphenous vein grafts can be performed with an acceptable acute success and complication rate, restenosis remains a major problem. However, this may be overcome by the implantation of Palmaz-Schatz stents. Palmaz-Schatz stent deployment was performed in our institution in 43 patients who were referred for PTCA of stenosed saphenous vein grafts. Thirty-seven were located at the mid-portion of the graft, seven at the ostium and six at the distal anastomosis. Overall, we used 59 standard length (15 mm) Palmaz-Schatz stents and 22 short (7 mm) stents. In 15 lesions (30%) multiple stents were implanted in tandem to treat diffuse disease. Angiographic success was achieved in 47 of the 50 attempted lesions (94%). Major cardiac complications occurred in three patients. Two patients had procedures complicated by the development of a Q wave myocardial infarction, one of whom underwent urgent CABG. One patient died. There was no episode of subacute thrombosis. The angiographic follow-up of 37 lesions (80% of eligible lesions) at a mean time of 5 +/- 2 months (range 1-8) showed a restenosis rate of 11% and residual post-stent diameter stenosis was associated with a significantly higher restenosis rate. However, no restenosis occurred in lesions receiving multiple stents. Clinical follow-up was performed in all patients, and at a mean of 25 months after the procedure, 64% were free from clinical events, including recurrent angina. Palmaz-Schatz stent implantation is an effective and safe procedure to treat narrowed vein grafts.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1994

Survival after percutaneous transluminal coronary angioplasty in patients with severe left ventricular dysfunction.

To assess the effects of coronary angioplasty in patients with severe left ventricular dysfunction, the results of procedures, performed between 1987 and 1991, in 100 patients (90 male) with left ventricular function < or = 0.35 (range, 0.20 to 0.35) and anginal symptoms were analyzed. Mean age was 62 +/- 10 years (range, 38 to 85 years). Ninety-five patients had previous myocardial infarction and 27 patients had previous coronary artery bypass grafting. Unstable angina was present in 81 percent of patients. Single-vessel disease was present in 6 patients, double vessel was present in 31 patients, and triple-vessel disease was present in 63 patients. Percutaneous transluminal coronary angioplasty (PTCA) was attempted on 164 vessels, 27 of these with chronic total occlusion. The overall angiographic success rate was 84 percent. Myocardial infarction occurred in four patients, six patients underwent urgent coronary bypass surgery, and seven patients died of cardiac causes. There was a 9 percent incidence of total in hospital mortality. Major complications were significantly more frequent in patients with triple-vessel disease. Clinical success was achieved in 75 patients, 55 of these with incomplete revascularization. Long-term follow-up (mean, 19 +/- 7 months) was available in all patients with clinical success. Thirteen patients had repeated PTCA, 8 patients had coronary surgery, and 13 patients died. In conclusion, in patients with severe left ventricular dysfunction, acute complications and late mortality rate are high. Patients with triple-vessel disease are a higher risk subset and have no long-term benefits by PTCA.

Angioplasty, Balloon, Coronary↗
PubMed1993

Treatment of simple and complex coronary stenosis using rotational ablation followed by low pressure balloon angioplasty.

High speed coronary rotational ablation followed by adjunctive low pressure coronary balloon angioplasty was used in 166 patients. Complex lesions were present in 63% of patients. Clinical success was achieved in 157 patients (95%). Angiographic success rate was 10% in A lesions, 95% in B1 lesions, 98% in B2 lesions, and 93% in C lesions. Mean vessel lumen diameter has increased from 0.4 mm to 1.4 mm after rotational ablation and to 2.3 mm following adjunctive balloon angioplasty. Left ventricular dysfunction, the presence of total occlusion, and the severity of stenosis before the procedure were predictive of clinical failure. There were three abrupt vessel closures (1.8%) with one Q wave myocardial infarction. Non-Q wave myocardial infarction occurred in 14 patients (8.4%) and three patients died during hospitalisation (1.8%). We conclude that rotational atherectomy followed by adjunctive low pressure balloon angioplasty gives comparable high success rates in different coronary lesions.

Angioplasty, Balloon, Coronary↗
PubMed1993

"Kissing" stents for bifurcational coronary lesion.

The coronary stents implantation into each vessel of a bifurcational lesion ("kissing" stents) in two patients is reported. The first patient had two short "kissing" stents implanted in an ostial lesion of the left anterior descending and the intermediate branch. The second patient had successful "kissing" stents implantation in the bifurcational lesion of the left main coronary artery.

Aged↗
PubMed1993

Coronary stenting for treatment of acute or threatened closure following dissection after coronary balloon angioplasty.

We studied 32 patients (age 58 +/- 9 years) who had been treated with a Palmaz-Schatz stent after significant dissection complicating percutaneous transluminal coronary angioplasty (PTCA). We attempted to cover the entire site of dissection with prosthesis. The presence of dissection after PTCA was associated with Thrombolysis in Myocardial Infarction grade 0 to 1 flow in 19 patients and grade 2 flow in 13. The stented arteries were: left anterior descending artery in 19 patients, right coronary artery in seven, and left circumflex artery in five. A single stent was implanted in 11 and multiple stents in 21 patients. Angiographic success was achieved in 30 patients (94%). Two patients (6%) had urgent coronary artery bypass graft surgery, two (6%) had a myocardial infarction, and one (3%) patient died. Subacute occlusion occurred in one patient (3%). Angiographic restenosis was found in three of nine patients (33%) with a single stent and 11 of 17 (65%) with multiple stents. Clinical follow-up at 11 +/- 3 months showed the necessity of coronary artery bypass graft surgery in two patients and repeat PTCA in nine (31%). We conclude that coronary stenting is an effective treatment for significant coronary dissection after PTCA with an acceptable incidence of major cardiac events at follow-up.

Acute Disease↗
PubMed1993

A novel strategy for stent deployment in the treatment of acute or threatened closure complicating balloon coronary angioplasty. Use of short or standard (or both) single or multiple Palmaz-Schatz stents.

OBJECTIVES: The purpose of this study was to determine the immediate and long-term angiographic and clinical results of coronary stenting as a specific therapy for intracoronary dissection associated with acute or threatened closure complicating percutaneous transluminal coronary angioplasty. BACKGROUND: Published reports contain conflicting results with regard to the benefit of stent insertion for coronary dissection. In particular, there is a wide range in the reported rates of subacute occlusion. METHODS: Palmaz-Schatz stents were inserted in 56 patients who had significant dissections and acute or threatened closure complicating coronary angioplasty. An attempt was made to cover the entire site of the dissection with short or standard single or multiple Palmaz-Schatz stents. The use of the short stent allowed complete coverage of the dissection, specifically in situations such as marked vessel tortuosity or the need to place a stent distal to a deployed stent. RESULTS: A single stent was implanted in 24 patients and multiple stents were implanted in 32 patients. A total of 138 stents (78 standard, 60 short stents) were implanted. The primary clinical success rate was 88% (49 of 56 patients). Complications occurred in seven patients (12.5%): Three patients (5%) required urgent bypass surgery; two patients (4%) had a myocardial infarction; and two patients (4%) died. Subacute occlusion occurred in one patient (2%). Clinical follow-up was available in all patients at a mean of 10 +/- 4 months. Thirty-nine (80%) of 49 patients were clinically asymptomatic. Angiographic restenosis was found in 15 (36%) of 42 patients on angiographic follow-up performed a mean of 5 months (median 6) after the procedure in 86% of the eligible patients. Nine patients had successful repeat angioplasty, and two had elective bypass surgery. CONCLUSIONS: The strategy of coronary stenting to completely cover the lesion is an effective treatment for large coronary dissection complicating angioplasty. A total major complication rate of 12.5% may be acceptable for this high risk group.

Angioplasty, Balloon, Coronary↗
PubMed1993

Early stress tests after successful coronary angioplasty.

The aim of this study was to determine feasibility, safety and yield of early stress tests after successful coronary angioplasty. In 351 consecutive patients with an early stress test performed within 3 days after successful coronary angioplasty, no cardiac or puncture site complications occurred. Seventeen percent of the stress tests remained positive after successful coronary angioplasty. An angiographic explanation, based on the data collected at the time of the angioplasty procedure, was present in 82% of the cases. Positive early stress tests typically only prompted modifications of the drug regimen.

Angioplasty, Balloon, Coronary↗
PubMed1992

Coronary stenting with a balloon-expandable stent after the recanalization of chronic total occlusions.

To diminish the restenosis rate after successful recanalization of chronic total coronary occlusion, we have implanted the Palmaz-Schatz stent in 6 patients. All procedures were successfully done without major complications. The angiographic follow-up at 6 months showed restenosis in one asymptomatic patient who had had 2 stents implanted. Five other patients had no evidence of restenosis.

Adult↗
PubMed1992

Initial experience with the disarticulated (one-half) Palmaz-Schatz stent: a technical report.

We developed an alternative method to stent suitable lesions located in anatomical settings considered to be too complex for regular Palmaz-Schatz stent placement. This method consists of using a disarticulated (one-half) Palmaz-Schatz stent. Eight patients underwent stenting utilizing this method. The left anterior descending was stented in five patients, the right coronary artery in one patient, the proximal and mid shaft of a vein graft in one patient, and a protected left main coronary artery in one patient. In all patients the stents were placed in addition to full stents. In four patients, 1 1/2 stents were placed; two patients had 2 1/2 stents; one patient had 3 1/2 stents and the last patient had a total of 5 stents placed (1 full stent and 8 half stents). One patient had 8 disarticulated stents placed. All half stents prepared for delivery were successfully deployed to the pre-designated angiographic site without complication.

Angioplasty, Balloon, Coronary↗
PubMed1992

Coronary stenting: single institution experience with the initial 100 cases using the Palmaz-Schatz stent.

We studied 100 patients who had coronary implantation of Palmaz-Schatz stents in our institution from November 1989 until March 1991. A total of 126 standard and 6 short stents were implanted. The patients' mean age was 58 +/- 5 years, and 97 were males. The indications were lesions with high risk of restenosis (29 patients), restenosis (27 patients), suboptimal result of angioplasty (24 patients), dissection (16 patients), and recanalized chronic total occlusion (6 patients). In 17 patients a brachial cut-down approach was used. Stents were correctly placed in 98 patients. Stent related complications occurred in 9 patients: major ischemic complications in 7 patients (acute myocardial infarction in 2 patients, emergency bypass surgery in 3 patients and emergency angioplasty in 2 patients); in 3 of these patients there was a subacute closure of the stent and in 2 patients there were delivery problems. Vascular complications at the site of arterial puncture occurred in 3 patients (some patients had more than one complication). A learning curve was observed. There was a decrease in the complication rate with the higher number of patients treated: 28% for the first 50 patients and 6% for the last 50 patients. Clinical follow-up was available in all patients. Of the 92 patients eligible for follow-up (7 +/- 2 months), 69 patients were asymptomatic and 23 had recurrence of angina: 19 patients for stent restenosis and 4 patients for coronary artery disease progression. Follow-up angiogram was done in 79/92 (86%) patients: 21 had restenosis (27%).(ABSTRACT TRUNCATED AT 250 WORDS)

Angina Pectoris↗
PubMed1992

Coronary angioplasty of chronic occlusions: factors predictive of procedural success.

In a retrospective study of 365 chronic total occlusions that were submitted for angioplasty, we studied the influence of 27 clinical, morphologic, and procedural variables as possible predictors of successful outcomes. Success rate was shown to be significantly influenced by the following variables: operator experience (41% in early patients, first 6 months; 73% in late patients, last 6 months of entire series; p less than 0.001), duration of occlusion (less than or equal to 1 month, 89%; 1 to 3 months 87%; greater than or equal to 3 months 45%; unknown 60%; p less than 0.001), morphology of occlusion (tapered, 83%; abrupt, 51%), length of occlusion (less than or equal to 15 mm, 71%; greater than 15 mm, 60%; p less than 0.001), and bridging collaterals (present, 29%; absent, 67%; p less than 0.001). None of the other clinical, angiographic, or procedural variables correlated with the success rate of coronary angioplasty. The calculated probability for an experienced operator (greater than 100 occlusions attempted) to successfully open an occlusion with favorable morphology (less than or equal to 1 month old, short, tapered, without bridging collaterals) is 99%. An attempt by the same operator to open an occlusion with unfavorable structure (greater than or equal to 3 months old, long, untapered) has only 47% probability of success. The probability increases to 84% when the occlusion is tapered. We concluded that in addition to the duration and the length of occlusion, tapered morphology, bridging collaterals, and operator experience can predict successful angioplasty in chronic total coronary occlusion.

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