Biomedical subjects

Michael Haude

Publications and source records attributed to Michael Haude.

41 records · Page 3Linked to original sources

PubMed2002

Preprocedural statin medication reduces the extent of periprocedural non-Q-wave myocardial infarction.

BACKGROUND: Stenting-related myocardial injury has been recognized as a frequent and prognostically important event, the extent of which depends on microcirculatory impairment in association with platelet aggregation, inflammation, and increased oxidative stress. Recent studies underscored the non-lipid-lowering effects of 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins) with antithrombotic, antiinflammatory, and antioxidative aspects. Thus, we tested the hypothesis that preprocedural statin therapy is associated with a reduction in the extent of stenting-related myocardial injury. METHODS AND RESULTS: We stratified 296 consecutive patients who were undergoing stenting of a de novo stenosis according to the preprocedural status of statin therapy (229 statin-treated and 67 control patients). Incidence of periprocedural myocardial injury was assessed by analysis of creatine kinase (CK; upper limit of normal [ULN] 70 IU/L for women, 80 IU/L for men) and cardiac troponin T (cTnT; bedside test; threshold 0.1 ng/mL) before and 6, 12, and 24 hours after the intervention. Relative to control patients, the incidence of CK elevation >3x ULN was more than 90% lower in statin-treated patients (0.4% versus 6.0%, P=0.01). Statin therapy was the only factor independently associated with a lower risk of CK elevation >3x ULN (OR: 0.08, 95% CI: 0.01 to 0.75; P=0.03). The overall incidences of CK and cardiac troponin T elevation were slightly lower in statin-treated than in control patients (14.4% versus 20.9%, P=0.3, and 17.9% versus 22.4%, P=0.5, respectively). CONCLUSIONS: Preprocedural statin therapy is associated with a reduction in the incidence of larger-sized, stenting-related myocardial infarctions. Prospective, randomized trials are warranted to further assess this cardioprotective effect of statins in coronary intervention.

Biomarkers↗

PubMed2002

Extraction of large intracoronary thrombus in acute myocardial infarction by percutaneous Fogarty maneuver: intentional abuse of a novel interventional device.

Intracoronary thrombus in the infarct-related artery remains a challenge for interventional catheter-based techniques in acute myocardial infarction and may result in severe complications due to distal embolization. We describe a patient with acute myocardial infarction in whom a large intracoronary thrombus of the left anterior descending coronary artery was successfully removed by percutaneous Fogarty maneuver using an expanded filter protection device.

Adult↗

PubMed2002

Systematic use of a collagen-based vascular closure device immediately after cardiac catheterization procedures in 1,317 consecutive patients.

Despite recent advances in interventional cardiology, vascular access complications continue to be a significant problem. Conventional manual compression of the femoral access site is associated with prolonged immobilization and significant patient discomfort. We investigated the performance of a collagen-based closure device applied immediately after catheterization and its complication rate in 1,317 consecutive patients undergoing cardiac catheterization or coronary angioplasty. Patients undergoing coronary angioplasty (n = 644) received more heparin than patients with diagnostic cardiac catheterization (n = 673; 9,675 +/- 1,144 IU vs. 6,419 +/- 2,211 IU; P < 0.0001). Deployment success rates of the closure device were comparable for patients undergoing diagnostic vs. interventional procedures (95.8% vs. 96.7%; P = 0.46). Complete hemostasis immediately after deployment of the device was achieved in > 90% of all patients, but was lower in the interventional group (93.7% vs. 90.6%; P = 0.05). Major complications including any vascular surgery, major bleeding requiring transfusion, retroperitoneal hematoma, thrombosis or loss of distal pulses, groin infections, significant groin hematoma, and death were observed in 0.53% of all patients, with no differences between diagnostic or interventional patients (0.62% vs. 0.45%; P = 0.953). Subgroup analysis revealed female gender as a predictor of access site complications. Systematic sealing of femoral access sites after both diagnostic and interventional procedures allows for immediate sheath removal with reliable hemostasis. The use of a collagen-based closure device is associated with a low rate of clinically significant complications.

Aged↗

PubMed2002

[Future of interventional cardiology in the treatment of coronary artery disease].

BACKGROUND: The development of interventional cardiology (PCI) started already with the introduction of catheterization but was pushed forward by A. Grüntzig with the percutaneous transluminal coronary angioplasty (PTCA) 1977. In the beginning very slow progress could be observed. This changed when Grüntzig changes to Emory university, Atlanta. Already after 10 years alternative techniques were introduced like stent implantation and rotablation, coronary atherectomy, laser angioplasty, ultrasound therapy. During the following years, it became obvious that only for stent implantation (see W. Rutsch et al, Berlin, p.481) and rotablation (see T. Dill et al, Bad Nauheim, p.502) standard indications could be seen in addition to PTCA. Brachytherapy for treatment of in stent restenosis and laserwire recanalisation of occluded vessels were added. NEW METHODS: New protection systems - aspiration or filters - were introduced for increase of PCI safety in venous bypass stenosis (see C. Hamm et al, Bad Nauheim, p.527). The main step forward seems to be the introduction of drug eluting covered stent either with polymer (see E. Grube et al, Siegburg, p.508) or ceramic coating (see H. Wieneke et al, Essen, p.518). Restenosis rates, which were already reduced by bare stent for 20-30%, could be lowered below 10%. RESULTS: In patients with diabetes and main stem stenosis or multi vessel disease, coronary artery bypass surgery is indicated, but in other patients PCI seems to be as good as surgery in relation to mortality and myocardial infarction rates. With drug eluting stents the role of PCI may become even more pronounced, because the revascularization rate could be further reduced (see W. Rutsch, Berlin, p.481). CONCLUSION: The future will demonstrate even further main steps for interventions like the percutaneous bypass attempts and the introduction of gen-therapy (A. B. Buchwald, Göttingen, p.533). Meanwhile we can observe a drop of 1-2% mortality in coronary artery disease related to 60% influence of prevention and 40% to advanced PCI therapy. This is still a remarkable successful story in medicine provided by cardiology.

Angioplasty, Balloon, Coronary↗

PubMed1999

Assessment of ambiguous coronary lesions by intravascular ultrasound.

Until recently, coronary angiography has been regarded as the 'gold standard' for visualizing and quantifying coronary artery disease. Coronary angiography, however, is a luminographic technique revealing only the inner lumen of the coronary artery. In contrast, intravascular ultrasound investigations yield a detailed morphological description of the vessel wall and plaque characteristics. Based on these analyses, new insights into the pathogenesis of atherosclerotic coronary disease have evolved, including the remodeling phenomena. Thus, nowadays intravascular ultrasound can be regarded as the new 'gold standard' for the morphological assessment of lesion severity during cardiac catheterizations. Likewise, intracoronary Doppler and intracoronary pressure measurements have demonstrated their superiority in the functional assessment of coronary stenoses. Intravascular ultrasound investigations can be performed with high success and low complication rates. The present manuscript concentrates on the value of IVUS for the assessment of ambiguous lesions. Several forms of ambiguous lesions based on the angiographic appearance, i.e. intermediate lesion with undetermined stenosis severity, aneurysmatic widening of the coronary segment, ostial lesions, branching vessels, vessel tortuosity, main stem lesions, focal spasm, sites of plaque rupture, dissections, unclear haziness and contrast density changes are discussed and illustrated by respective angiographic and IVUS examples. Both the advantages and the limitations of angiographic and intravascular ultrasound examination are discussed in detail. In conclusion, additional intravascular ultrasound examination helps to diagnose accurately the underlying atherosclerotic disease, to define lesion characteristics and to optimize individual patient care and cost with respect to diagnostic catheterizations and coronary interventions.

Journal Article↗