The efficacy and safety of coronary angioplasty for stenoses adjacent to coronary aneurysms were studied in 25 patients (19 men and 6 women, mean age 62 +/- 11 years). The study represented 1.1% of patients undergoing coronary angioplasty during the study time period. The aneurysm diameter exceeded 1.8 +/- 0.2 times the normal artery diameter. Eleven (44%) of these aneurysms were localized in the left anterior descending, 3 (12%) in the circumflex and 11 (44%) in the right coronary artery. Percent diameter stenosis was reduced from 72 +/- 10% to 23 +/- 19%, and transstenotic gradient from 51 +/- 13 to 15 +/- 9 mmHg when measured. Clinical success (absence of pain on discharge without coronary bypass surgery, death, or infarction) was achieved in 24 (96%) patients. In one patient acute vessel closure occurred. No embolic events or coronary artery rupture occurred. Seventeen (71%) of the 24 successful patients remained asymptomatic at clinical follow-up (mean = 7.7 +/- 5.0 months). At late follow-up, one patient had sustained a myocardial infarction, two had elective bypass surgery, and two had successful repeat angioplasty. The data from this small patient population suggest that angioplasty for a stenosis adjacent to a coronary aneurysm can be performed safely with a high primary success rate.

Aged↗

PubMedDate not supplied

The mucopolysaccharidoses: characterization by cranial MR imaging.

PURPOSE: To characterize MR findings in mucopolysaccharidoses (MPS), to aid in diagnosis and categorization, and to define the role of MR in preoperative evaluation. MATERIALS AND METHODS: Six children with Hurler syndrome (MPS IH), five with Hunter syndrome (MPS II), and three with Sanfilippo A syndrome (MPS IIIA) were studied by routine T1-weighted and T2-weighted images at 1.5 T. MR findings were graded retrospectively. RESULTS: All had hallmark cribriform changes (sieve-like or multicystic) involving peri- and supraventricular, parietal, white matter (12), corpus callosum (8), and basal ganglia (4), which did not enhance. The cerebellum and brain stem were not involved with these cribriform changes. The most severe degree of cribriform changes occurred in children with Hunter and Hurler syndromes, correlating with non-central nervous system somatic involvement, but inversely related to degree of atrophy, ventricular enlargement, and white matter changes. Mental retardation was most severe in children with Hurler syndrome and correlated with chronicity of the disease. Severity of mental retardation did not correlate with severity of cribriform changes. CONCLUSIONS: Based on our observations, we postulate that in the natural course of MPS, cribriform changes occurred first, followed by white-matter changes and, last, atrophy. More severe degrees of cribriform changes plus involvement of the corpus callosum may suggest a poorer prognosis. Optimal therapeutic intervention may be at the time of cribriform changes before atrophy has occurred. MR can define and grade these changes.

Adolescent↗