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Biomedical subjects

M Haude

Publications and source records attributed to M Haude.

At least 73 records · Page 4Linked to original sources
PubMed1999

New signs characteristic of myocardial bridging demonstrated by intracoronary ultrasound and Doppler.

BACKGROUND: Large discrepancies exist concerning the incidence of myocardial bridging. This has been reported to be 0.5%-2.5% following coronary angiography but 15%-85% following autopsy. The purpose of the study was to use intravascular ultrasound and intracoronary Doppler to study the morphology and flow characteristics of myocardial bridging in order to find feasible parameters of this syndrome. METHODS AND RESULTS: Intravascular ultrasound was performed in 62/69 patients in whom typical angiographic 'milking effects' were present. In 48 patients, intracoronary Doppler was performed. A specific, echolucent 'half moon' phenomenon surrounding the myocardial bridge was found in all the patients. The thickness of the half moon area was 0.47 +/- 0.19 mm in diastole and 0.52 +/- 0.23 mm in systole. There was systolic compression of the myocardial bridge with a lumen reduction during systole of 36.4 +/- 8.8%. Using intracoronary Doppler, a characteristic early diastolic 'finger tip' phenomenon was observed in 42 (87%) of the patients. All patients showed no or reduced antegrade systolic flow. Coronary flow velocity reserve was 2.03 +/- 0. 54. After intracoronary nitroglycerin injection, retrograde systolic flow occurred in 37 (77%) of the 48 patients, with a velocity of -22. 2 +/- 13.2 cm. s(-1). Intravascular ultrasound revealed atherosclerotic involvement of the proximal segment in 61 (88%) of the 69 patients, with an area stenosis of 42 +/- 13%. No plaques were found in the bridge or distal segments in the 62 patients in whom it was possible to introduce the ultrasound catheter throughout the bridging segment. CONCLUSION: Myocardial bridging is characterized by the following morphological and functional signs: a specific, echolucent half moon phenomenon over the bridge segment, which exists throughout the cardiac cycle; systolic compression of the bridge segment of the coronary artery; accelerated flow velocity at early diastole (finger-tip phenomenon); no or reduced systolic antegrade flow; decreased diastolic/systolic velocity ratio; retrograde flow in the proximal segment, which is provoked and enhanced by nitroglycerin injection.

Blood Flow Velocity↗
PubMed1999

Intravascular ultrasound classification of atherosclerotic lesions according to American Heart Association recommendation.

BACKGROUND: Intravascular ultrasound (IVUS) offers a new modality by which to image the vessel wall in high resolution. The aim of the study was to classify atherosclerotic lesions using IVUS according to American Heart Association (AHA) recommendation. METHODS: IVUS was performed using a 20 or 30 MHz mechanically rotated catheter in 190 patients (aged from 35 to 75 years, mean 59 +/- 9 years) who presented with suspicion of coronary artery disease based on clinical examination. RESULTS: Of the 190 patients, 49 (26%) (group A) were found to have normal or nearly normal coronary arteries, whereas the other 141 (74%) (group B) had significant angiographic stenosis (> 50% luminal narrowing). IVUS image interpretation was based on the recommendation of the Committee on Vascular Lesions of the Council on Atherosclerosis (AHA). In group A, a total of 822 segments were evaluated with IVUS; 444 (54%) were found to have plaque formation. Among these 444 segments, type II lesions were found in 145 (33%), type III lesions in 110 segments (25%), type IV and Va lesions in 169 segments (38%), and type Vb in 18 segments (4%). The severity of plaque area stenosis increased from type II to IV. In group B, only the most stenotic segments (n = 141) on angiography were selected for analysis. No significant differences were found among different lesion types with respect to the severity of plaque area stenosis. Type Vb and Vc lesions presented mainly, but not exclusively, as stable angina, whereas type VI lesions presented mainly as unstable angina. Some patients (12%) with stable angina had complicated lesions (type VIa-VIc). CONCLUSIONS: It is now possible to use intravascular ultrasound to classify atherosclerotic lesions according to the AHA recommendations that were based on histological examination. Standardized reports of IVUS can now be based on these recommendations. Even in angiographically normal coronary arteries, advanced atherosclerotic lesions are found, explaining the potential risk of acute coronary syndromes in this group of patients. In patients with angiographically severe coronary disease, clinical symptoms correlate mainly with plaque characteristics, rather than with the severity of stenosis.

Adult↗
PubMed1999

Screening of ruptured plaques in patients with coronary artery disease by intravascular ultrasound.

AIM: To visualise the characteristics of ruptured plaques by intravascular ultrasound (IVUS) and to correlate plaque characteristics with clinical symptoms to establish a quantitative index of plaque vulnerability. METHODS: 144 consecutive patients with angina were examined using IVUS. Ruptured plaques, characterised by a plaque cavity and a tear on the thin fibrous cap, were identified in 31 patients (group A), of whom 23 (74%) presented with unstable angina. Plaque rupture was confirmed by injecting contrast medium filling the plaque cavity during IVUS examination. Of the patients without plaque rupture (group B, n = 108), only 19 (18%) had unstable angina. RESULTS: No significant differences were found between groups A and B in relation to plaque and vessel area (p > 0.05). Mean (SD) per cent stenosis in group A was less than in group B, at 56.2 (16.5)% v 67.9 (13.4)%; p < 0.001. Area of the emptied plaque cavity in group A (4.1 (3.2) mm2) was larger than the echolucent zone in group B (1.32 (0.79) mm2) (p < 0.001). The plaque cavity to plaque ratio in group A (38.5 (17.1)%) was larger than the echolucent area to plaque ratio in group B (11.2 (8.9)%) (p < 0.001). The thickness of the fibrous cap in group A was less than in group B, at 0.47 (0.20) mm v 0.96 (0.94) mm; p < 0.001. CONCLUSIONS: Plaques seem to be prone to rupture when the echolucent area is larger than 4.1 (3.2) mm2, when the echolucent area to plaque ratio is greater than 38.5 (17.1)%, and when the fibrous cap is thinner than 0.7 mm. IVUS can identify plaque rupture and vulnerable plaques. This may influence patient management and treatment.

Adult↗
PubMed1998

Nonischemic chest pain induced by coronary interventions: a prospective study comparing coronary angioplasty and stent implantation.

BACKGROUND: Chest pain frequently occurs without any signs of ischemia within the first 24 hours after coronary interventions. To test the hypothesis that this pain may be due to local vessel injury ("stretch pain"), we performed a prospective study enrolling patients after PTCA, stent implantation, or diagnostic coronary angiography alone. METHODS AND RESULTS: A total of 145 patients after coronary angiography were evaluated by a validated questionnaire for quantifying postinterventional chest pain within 24 hours. To detect myocardial ischemia, all patients were evaluated with a 12-lead ECG and cardiac isoenzymes immediately after the procedure and the morning after. After stent implantation, 21 of the 51 patients (41.2%) developed chest pain, compared with 4 of the 33 patients (12.1%) undergoing PTCA and 6 of the 61 patients (9.8%) with a diagnostic angiography (P<0.001). Of these 31 patients who developed chest pain, only 3 (9.7%) felt that the pain was similar to previously experienced angina pectoris. The minimal lumen diameter after intervention was significantly larger in the stent group than in the PTCA group (3.14+/-0.75 versus 1.95+/-0.67 mm; P<0. 001). No patient had changes in the ECG compared with before intervention, but 3 patients after stent implantation had a rise in cardiac isoenzymes. No other major adverse cardiac events occurred until discharge. CONCLUSIONS: Nonischemic chest pain develops in almost half of all patients undergoing stent implantation and seems to be related to vessel overexpansion caused by the stent in the diseased vessel segment.

Aged↗
PubMed1998

Coronary-artery stenting compared with balloon angioplasty for restenosis after initial balloon angioplasty. Restenosis Stent Study Group.

BACKGROUND: Intracoronary stenting reduces the rate of restenosis after angioplasty in patients with new coronary lesions. We conducted a prospective, randomized, multicenter study to determine whether intracoronary stenting, as compared with standard balloon angioplasty, reduces the recurrence of luminal narrowing in restenotic lesions. METHODS: A total of 383 patients who had undergone at least one balloon angioplasty and who had clinical and angiographic evidence of restenosis after the procedure were randomly assigned to undergo standard balloon angioplasty (192 patients) or intracoronary stenting with a Palmaz-Schatz stent (191 patients). The primary end point was angiographic evidence of restenosis (defined as stenosis of more than 50 percent of the luminal diameter) at six months. The secondary end points were death, Q-wave myocardial infarction, bypass surgery, and revascularization of the target vessel. RESULTS: The rate of restenosis was significantly higher in the angioplasty group than in the stent group (32 percent as compared with 18 percent, P= 0.03). Revascularization of the target vessel at six months was required in 27 percent of the angioplasty group but in only 10 percent of the stent group (P=0.001). This difference resulted from a smaller mean (+/-SD) minimal luminal diameter in the angioplasty group (1.85+/-0.56 mm) than in the stent group (2.04+/-0.66 mm), with a mean difference of 0.19 mm (P=0.01) at follow-up. Subacute thrombosis occurred in 0.6 percent of the angioplasty group and in 3.9 percent of the stent group. The rate of event-free survival at 250 days was 72 percent in the angioplasty group and 84 percent in the stent group (P=0.04). CONCLUSIONS: Elective coronary stenting was effective in the treatment of restenosis after balloon angioplasty. Stenting resulted in a lower rate of recurrent stenosis despite a higher incidence of subacute thrombosis.

Aged↗
PubMed1998

Randomised comparison of implantation of heparin-coated stents with balloon angioplasty in selected patients with coronary artery disease (Benestent II)

BACKGROUND: The multicentre, randomised Benestent-II study investigated a strategy of implantation of a heparin-coated Palmar-Schatz stent plus antiplatelet drugs compared with the use of balloon angioplasty in selected patients with stable or stabilised unstable angina, with one or more de-novo lesions, less than 18 mm long, in vessels of diameter 3 mm or more. METHODS: 827 patients were randomly assigned stent implantation (414 patients) or standard balloon angioplasty (413 patients). The primary clinical endpoint was event-free survival at 6 months, including death, myocardial infarction, and the need for revascularisation. The secondary endpoints were the restenosis rate at 6 months and the cost-effectiveness at 12 months. There was also one-to-one subrandomisation to either clinical and angiographic follow-up or clinical follow-up alone. Analyses were by intention to treat. FINDINGS: Four patients (one stent group, three angioplasty group) were excluded from analysis since no lesion was found. At 6 months, a primary clinical endpoint had occurred in 53 (12.8%) of 413 patients in the stent group and 79 (19.3%) of 410 in the angioplasty group (p=0.013). This significant difference in clinical outcome was maintained at 12 months. In the subgroup assigned angiographic follow-up, the mean minimum lumen diameter was greater in the stent group than in the balloon-angioplasty group, (1.89 [SD 0.65] vs 1.66 [0.57] mm, p=0.0002), which corresponds to restenosis rates (diameter stenosis > or =50%) of 16% and 31% (p=0.0008). In the group assigned clinical follow-up alone, event-free survival rate at 12 months was higher in the stent group than the balloon-angioplasty group (0.89 vs 0.79, p=0.004) at a cost of an additional 2085 Dutch guilders (US$1020) per patient. INTERPRETATION: Over 12-month follow-up, a strategy of elective stenting with heparin-coated stents is more effective but also more costly than balloon angioplasty.

Adult↗
PubMed1998

Improved assessment of coronary stenosis severity using the relative flow velocity reserve.

BACKGROUND: Myocardial fractional flow reserve (FFR) is based on pressure measurements. We have now sought to establish a Doppler-based concept of relative flow velocity reserve (RFVR) for the functional assessment of stenosis severity in epicardial coronary arteries. A clear threshold value to discriminate the functional severity of a coronary stenosis does not exist for coronary flow velocity reserve (CVR) based on intracoronary Doppler measurements. In contrast, the concept of FFR, which is based on intracoronary pressure measurements, has been extensively validated. An FFR value below 0.75 reliably indicates a significant stenosis. METHODS AND RESULTS: RFVR is calculated as the ratio between distal CVR in the stenosed target vessel and distal CVR in a nonstenotic reference vessel. In 21 patients, RFVR was determined in 24 target vessels by use of intracoronary adenosine and correlated to the FFR, determined as the ratio of mean poststenotic to aortic pressures, in the target vessel. Stenosis severity was classified according to quantitative coronary angiography analysis. Reference diameter was 3.0+/-0.4 mm (mean+/-SD), and area stenosis was 74+/-15% (range, 40% to 95%). CVRs in the target and reference vessels were 2.1+/-0.5 and 2.6+/-0.7, respectively. FFR ranged from 0.49 to 0.99 (mean, 0.81+/-0.15) and RFVR from 0.53 to 1.0 (mean, 0.82+/-0.13). Poststenotic CVR did not correlate with either percent area stenosis (r=0.27, P=NS) or FFR (r=0.33, P=NS). In contrast, FFR as well as RFVR showed a curvilinear relation to percent area stenosis (r=0.89, P<0.0001 and r=0.79, P<0.0001, respectively). There was a close linear correlation between FFR and RFVR (r=0.91, P<0.0001). CONCLUSIONS: RFVR correlates closely to FFR and to percent area stenosis, whereas the correlation of CVR with FFR and percent area stenosis is rather poor. RFVR is a promising new concept for assessment of coronary stenosis severity and clinical decision making based on Doppler measurements.

Aged↗
PubMed1998

[Treatment of coronary pseudoaneurysm by stent-graft implantation].

HISTORY AND CLINICAL FINDINGS: A 54-year-old man was urgently admitted because of sudden onset of progressively worsening angina pectoris, his first attack. Physical examination was unremarkable. INVESTIGATIONS: Electrocardiography and laboratory tests excluded acute myocardial infarction. With the exception of hypercholesterolemia (total cholesterol 247 mg/dl) laboratory tests were normal. Coronary angiography revealed a 60% eccentric narrowing in the proximal part of the interventricular branch with adjacent aneurysmatic dilatation. Intravascular ultrasound (IVUS) showed a coronary pseudoaneurysm, its cavity communicating with the empty atheroma hole of an adjacent ruptured coronary plaque. TREATMENT AND COURSE: A 19 mm stent graft was implanted, via a percutaneously inserted balloon-catheter system, in the region of the stenosis and the pseudoaneurysm. Subsequent angiography demonstrated a smooth nonstenotic lumen. The membrane of the graft (made of polytetrafluoroethylene [PTFE]), fixed between two thin metal stents, had occluded the pseudoaneurysm. Occlusion of an immediately distal septal branch briefly produced an asymptomatic rise of creatine kinase to maximally 173 U/l. Oral medication included ticlopidine hydrochloride (2 x 250 mg daily for 4 weeks). The patient was symptom-free after the procedure and was discharged 5 days later. CONCLUSION: Implantation of a new type of stent-graft provides quick and uncomplicated treatment of a coronary aneurysm. The membrane fixed between two stents prevents wash out of any thrombi. The method may also be applicable to other potentially thrombus-containing lesions.

Blood Vessel Prosthesis Implantation↗
PubMed1998

Comparison of electron-beam computed tomography and intracoronary ultrasound in detecting calcified and noncalcified plaques in patients with acute coronary syndromes and no or minimal to moderate angiographic coronary artery disease.

We compared intracoronary ultrasound (ICUS) and electron-beam computed tomography (EBCT) on a coronary segmental basis in 40 consecutive patients with acute coronary syndromes and no or minimal to moderate angiographic disease (53+/-10 years; 34 men, 6 women). ICUS was used to define plaques, and EBCT was used to quantify coronary calcium (using a threshold of a CT density > 130 Hounsfield units in an area > 1.03 mm2). In a site-by-site analysis, coronary segments were defined as normal if both methods were negative, as containing noncalcified plaques if only ICUS was positive, and as containing calcified plaques if both methods were positive. A total of 222 coronary segments were analyzed (5.6+/-1.9 segments per patient). In 36 patients (90%), a total of 95 segments with plaques were identified, whereas in 4 patients (10%), only normal segments were seen. Of the 95 segments with plaques, 61 (64%) were calcified, and 34 (36%) were noncalcified. There was a linear relationship between the number of segments with calcified and with noncalcified plaques (r = 0.86, p <0.0001), but the mean relative frequency of segments with calcified plaques (55+/-38%) was highly variable. Calcium was found in 15 of 16 patients (93%) with 3 or more segments with plaques, while it was found in only 12 of 20 patients (60%) with one or 2 segments with plaques (p = 0.026). Younger age, higher low-density lipoprotein-cholesterol levels, diabetes, and active smoking predicted a higher relative frequency of segments with noncalcified plaques. Thus, in patients with acute coronary syndromes but no angiographically critical stenoses, there is a linear relationship between segments with calcified plaques versus segments with noncalcified plaques. However, while the mean ratio of these segments is close to 1:1, it is highly variable among individual patients.

Acute Disease↗
PubMed1998

Analysis of vessel wall morphology, blood flow velocity, and the hemostatic system in a patient with a large intracoronary thrombus.

A patient with AMI caused by a large thrombus in the proximal LAD was successfully treated with PTCA and an intracoronary lysis combined with the platelet-receptor antagonist c7E3. Analysis of cellular hemostasis after 1 and 6 months revealed a sustained platelet activation despite combined anti-platelet therapy with ASA and ticlopidine. A progredient slow-flow phenomenon appeared during control angiographies, confirmed by intracoronary Doppler examination.

Abciximab↗
PubMed1998

Extramural vessel wall hematoma causing a reduced vessel diameter after coronary stenting: diagnosis by intravascular ultrasound and treatment by stent implantation.

An extramural vessel wall hematoma occurred immediately after implanting a coronary stent in an in-stent-restenosis of the intermedius branch. Angiography showed a significant luminal reduction distal to the intervention site. Intravascular ultrasound revealed an extramural echolucent zone compressing the vessel lumen. Stent implantation compressed the hematoma and allowed adequate myocardial perfusion. This demonstrates the value of intravascular ultrasound (IVUS) in cases of unusual angiographic results which can help to manage complications after coronary intervention.

Coronary Angiography↗
PubMed1998

[Digital archiving of imaged heart catheter studies on CD-R. Detection of irreversible CD damage].

The digital archiving has great advantages compared to the standard 35-mm X-ray cinefilm documentation. The data are immediately available and quantitative coronary angiography possible. In addition the technical progress is enhancing the availability of data. The loss of films is nearly eliminated, as only copies of the digital archive data are delivered. In addition a big advantage concerning pollution is present, when CD Rs are used. We report about the damage of CD Rs after 89, 162, 181 and 252 days when they were stored in polypropylene material containing envelopes. The damaged CD Rs all belonged to the provider Verbatim, whereas CD Rs of the provider Rank Xerox or Kodak were never damaged. In contrary to the Verbatim company, Rank Xerox gave written confirmation for 10-year storage and a written confirmation, that the storage in the polypropylene envelopes is possible. Mechanical, thermal damage and damage by humidity have to be discussed as well as chemical interactions of the CD Rs surface with the polypropylene material. As the digital storage for X-ray images has to be provided for 10 years in Germany, it is concluded, that the storage in polypropylene envelopes has to be avoided, when a written confirmation by the company is not given. These observations should stimulate to better control and analyze the real storage availabilities of digital data and provide in the future other media than CD R for long-term archiving.

CD-ROM↗
PubMed1998

[Management of coronary perforation after percutaneous balloon angioplasty with a new membrane stent].

A 59 year old patient underwent percutaneous transluminal coronary angioplasty of a de novo stenosis of the proximal right coronary artery. Vessel perforation occurred after balloon angioplasty and was successfully treated by implantation of a new stent graft, which completely covered the perforation without residual leakage. Emergency coronary surgery could, thus, be avoided.

Angioplasty, Balloon, Coronary↗
PubMed1998

[New imaging methods for visualizing coronary arteries].

Techniques in the field of coronary artery imaging can be divided into two groups: invasive and non-invasive methods. Apart from the conventional coronary artery angiography, invasive methods include intracoronary ultrasound, intracoronary angioscopy, and optical coherence tomography. Non-invasive methods include magnetic resonance tomography, synchrotron-coronary angiography, and electron beam computed tomography. In the late 1980s, intracoronary ultrasound has come into clinical practice. It offers a real-time, cross-sectional image of the coronary artery in high resolution. Coronary arteries enlarge in the presence of atherosclerotic plaque formation in order to compensate for luminal narrowing caused by plaque formation (remodeling). With coronary angiography, the plaque formation cannot be detected until a lumen reduction of about 40-45%. With intravascular ultrasound, the early stages of atherosclerosis can clearly be demonstrated. In combination with the intracoronary Doppler technique, syndrome X can be differentiated. Another important role of intracoronary ultrasound in the diagnosis of coronary artery disease is to guide coronary interventions and to assess the result of coronary interventions especially to evaluate the result of stent implantation. Due to the clinical use of intracoronary ultrasound and the guidance of high pressure stent implantation, the incidence of acute stent thrombosis has decreased to about 1%. Coronary angioscopy portrays the surface of the vessel lumen. It is helpful to identify the mural thrombus especially to differentiate fresh and chronic thrombus formation. Magnetic resonance tomography is able to image the coronary arterial contour of the proximal segment. With today's gating technique, it is possible to portray the whole coronary tree and avoid disturbances resulting from the heart beat and respiration. Electron beam computed tomography is a very promising technique in screening for coronary artery disease. It is a very sensitive method to identify coronary calcification and, thus, to detect atherosclerotic plaque. Studies have shown that the presence of calcification almost invariably indicates the presence of coronary artery disease and that the absence of calcification can nearly rule out significant coronary artery disease. Moreover, a close correlation exists between the amount of calcification and the severity of coronary artery disease. Additionally, in combination with contrast injection, coronary artery perfusion can be evaluated. This is important to assess the conductance of coronary stent and bypass graft.

Coronary Artery Disease↗
PubMed1998

[Arguments against conventional balloon dilatation of recurrences within the stent].

Today, stent restenosis is the major limitation of coronary stent implantation. Despite several prospective randomized trials, which documented significantly lower restenosis rates after stenting compared to conventional balloon angioplasty for the treatment of de-novo stenoses, restenotic lesions, bypass graft stenoses and symptomatic dissections, in daily clinical practice restenosis rates after coronary stenting are reported between 18% and 78% depending on the lesions treated. Interventional treatment options for symptomatic stent restenosis include repeat balloon angioplasty, a combination of ablative approaches (rotablation, laser angioplasty, directional atherectomy) with balloon angioplasty, and stent-in-stent (sandwich technique) placement. Long-term success for the treatment of focal (< or = 10 mm) stent restenosis seems to be equivalent for all these strategies with a restenosis rate of about 30% while after balloon angioplasty of diffuse (> 10 mm) stent restenosis restenosis rates range between 35% and 85%. From a pathophysiological point of view it seems conclusive that balloon angioplasty can only achieve a limited lumen by plastic deformation of the obstructive neointimal tissue, which is responsible for stent restenosis. In this situation techniques, which ablate the neointimal tissue, can create a more adequate lumen without extensive vessel trauma supported by lower restenosis rates between 25% and 56% compared to balloon angioplasty alone. Prospective randomized trial are needed in the future to support a superiority of ablative techniques over conventional balloon angioplasty for the treatment of stent restenosis.

Angioplasty, Balloon, Coronary↗
PubMed1998

Current concepts of coronary flow reserve for clinical decision making during cardiac catheterization.

Measurements of coronary flow reserve, once used only for research, have gained wide acceptance as an additional diagnostic approach in the decision-making process of diagnostic cardiac catheterization and coronary interventions. Apart from the noninvasive determination of coronary flow reserve, intracoronary Doppler flow wires have facilitated decision making in the catheterization laboratory. Different techniques, unstandardized procedures, and data from uncomparable patient populations have remained a confounding factor. This review examines current concepts of coronary flow reserve as well as methodologic considerations and pitfalls. Applications of coronary flow reserve for periinterventional assessment are evaluated on the background of practical guidance. According to a detailed examination of arterial structure and function, a normal coronary flow reserve exceeds a value of 3.0. Values below 3.0 suggest involvement of microvascular disease caused by functional or structural alterations. The influences of various factors such as age, hemodynamics, hypercholesterolemia, hypertrophy, hypertension, syndrome X, and coronary artery disease are discussed in relation to the effect on coronary flow reserve. From available information, measurements of coronary flow reserve are an adjunct to current interventional technology to optimize individual patient care. Further efforts should be undertaken to incorporate these new methods into our routine clinical decision making.

Blood Flow Velocity↗
PubMed1998

Intravascular ultrasound (IVUS) examination reverses therapeutic decision from percutaneous intervention to a surgical approach in patients with alterations of the left main stem.

Intravascular ultrasound (IVUS) represents a new method to assess vessel lumen and wall morphology. To prospectively evaluate the usefulness of IVUS for further therapeutic decisions in left main stem (LM) lesions with unclear angiographic definition, this study was launched. We studied 56 patients with significant stenosis of the LAD and/or LCX arteries and questionable LM morphology. 30-MHz IVUS catheters with 2.9 or 3.2 F outer diameters were used. A significant luminal reduction of the left main stem was defined as an area stenosis greater than 50% or a minimal luminal diameter smaller than 3 mm as determined by IVUS. 36 of 56 patients (61%) fulfilled these criteria. Additionally, 12 patients showed a ruptured plaque within the LM. 30 of these 36 patients were originally thought to be candidates for angioplasty. After positive IVUS 34 of these 36 patients were sent to surgery. No perioperative ischemic complications occurred. In angiographically unclear left main stem findings. IVUS establishes a definitive diagnosis. After IVUS confirmation of significant left main stem pathology operative management should be the preferred approach as compared to transluminal coronary interventions. However, prospective randomized studies are needed to define the most efficient approach.

Angioplasty, Balloon, Coronary↗