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Biomedical subjects

R Erbel

Publications and source records attributed to R Erbel.

At least 181 records · Page 10Linked to original sources
PubMed1999

Tissue Doppler imaging (TDI) for on-line detection of regional early diastolic ventricular asynchrony in patients with coronary artery disease.

Diastolic filling of the left ventricle is often impaired in patients with coronary artery disease (CAD) in the absence of systolic wall motion abnormalities or previous myocardial infarction. The current study was designed to assess the ability of tissue Doppler imaging (TDI) for on-line detection of regional diastolic wall motion abnormalities to identify CAD in patients with preserved systolic function. 20 normal subjects (age 51 +/- 13 years) and 17 CAD patients with normal systolic function and > or = 70% luminal narrowing of the LAD (age 56 +/- 11 years) were included. Coronary anatomy was unknown to the echocardiographer. In the parasternal short axis and the apical 4-chamber-view, peak tissue velocities of the anterior/inferior and the midseptal/midlateral LV segments during rapid ejection (RE), isovolumic relaxation (IR), rapid filling (RF) and atrial contraction (AC) were analyzed by color-M-Mode-TDI. In the apical view, in 13 of 35 (37%) patients with adequate recordings, myocardial asynchrony was detected during IR: while the septum was moving inwards (red color-coding), the lateral wall was moving outwards (blue/green coding). In the remaining 22 patients (63%) a slow, synchronous outward motion of septum and lateral wall with homogeneous color-coding (blue/green) was seen. Unblinding of the coronary status revealed a critical LAD stenosis in all 13 patients (100%) with myocardial asynchrony. Analysis of midseptal peak velocities during IR revealed positive velocities (1.22 +/- 1.64 cm/s) in CAD patients and negative velocities (-1.39 +/- 0.81 cm/s) in normal subjects. Thus, TDI allowed for the on-line detection of early diastolic asynchrony in 13 of 16 (82%) patients with critical LAD-narrowing. Due to the rapid assessment of regional wall motion abnormalities, TDI might help to identify CAD in patients with normal systolic function.

Aged↗
PubMed1999

A prognostic computer model to individually predict post-procedural complications in interventional cardiology: the INTERVENT Project.

AIMS: The purpose of this part of the INTERVENT project was (1) to redefine and individually predict post-procedural complications associated with coronary interventions, including alternative/adjunctive techniques to PTCA and (2) to employ the prognostic INTERVENT computer model to clarify the structural relationship between (pre)-procedural risk factors and post-procedural outcome. METHODS AND RESULTS: In a multicentre study, 2500 data items of 455 consecutive patients (mean age: 61.1+/-8.3 years: 33-84 years) undergoing coronary interventions at three university centres were analysed. 80.4% of the patients were male, 16.7% had unstable angina, and 5.1%/10.1% acute/subacute myocardial infarction. There were multiple or multivessel stenoses in 16.0%, vessel bending >90 degrees in 14.5%, irregular vessel contours in 65.0%, moderate calcifications in 20.9%, moderate/severe vessel tortuosity in 53.2% and a diameter stenosis of 90%-99% in 44.4% of cases. The in-lab (out-of-lab) complications were: 0.4% (0.9%) death, 1.8% (0.2%) abrupt vessel closure with myocardial infarction and 5.5% (4.0) haemodynamic disorders. CONCLUSION: Computer algorithms derived from artificial intelligence were able to predict the individual risk of these post-procedural complications with an accuracy of >95% and to explain the structural relationship between risk factors and post-procedural complications. The most important prognostic factors were: heart failure (NYHA class), use of adjunctive/alternative techniques (rotablation, atherectomy, laser), acute coronary ischaemia, pre-existent cardiac medication, stenosis length, stenosis morphology (calcification), gender, age, amount of contrast agent and smoker status. Pre-medication with aspirin or other cardiac medication had a beneficial effect. Techniques, such as laser angioplasty or atherectomy were predictors for post-procedural complications. Single predictors alone were not able to describe the individual outcome completely.

Adult↗
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

Fusion of angiography and intravascular ultrasound in vivo: establishing the absolute 3-D frame orientation.

Data fusion of biplane angiography and intravascular ultrasound (IVUS) facilitates geometrically correct reconstruction of coronary vessels. The locations of IVUS frames along the catheter pullback trajectory can be identified, however the IVUS image orientations remain ambiguous. An automated approach to determination of correct IVUS image orientation in three-dimensional space is reported. Analytical calculation of the catheter twist is followed by statistical optimization determining the absolute IVUS image orientation. The fusion method was applied to data acquired in patients undergoing routine coronary intervention, demonstrating the feasibility and good performance of our approach.

Algorithms↗
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↗
PubMed1999

Wrist measurement of blood pressure: some critical remarks to oscillometry.

UNLABELLED: Oscillometric blood pressure measuring devices worn at the wrist are preferred by a growing part of hypertensive patients for self-measurement because of their compactness and ease of use. However, little is known about the accuracy of such instruments. The accuracy of such devices was evaluated by measuring the blood pressure at the end of a coronary angiography procedure in 27 subjects nearly simultaneously in the aortic arch, using a Statham P23 transducer, and at the wrist, using the blood pressure watch (BPW) by NAIS-Matsushita. Four replicate comparative measurements were performed in each subject. On average, the blood pressure measured by the BPW was found to be higher: systolic +1.2+/-(SD)10.2 mm Hg, diastolic +4.1+/-7.2 mm Hg. The correlation coefficient between the two methods was 0.85 for the systolic and 0.84 for the diastolic pressure, but 39% of the systolic and 22% of the diastolic differences were outside the range of +/-1 SD. There was no correlation between systolic differences and blood pressure or patients' variables, but multiple regression analysis revealed that the diastolic blood pressure differences were negatively correlated with the aortic diastolic pressure (r = 0.89, p<0.001), indicating that the BPW is less accurate to detect lower values. CONCLUSIONS: (1) Though the average systolic and diastolic deviations between both methods and the relative correlation coefficients suggest that the BPW is to be used carefully for monitoring blood pressure, the great variability of differences and the inability of the BPW to detect lower diastolic blood pressure calls for a mandatory validation test by an approved protocol before this new device can be recommended for general use. (2) On the basis of our results for wrist oscillometry with the BPW and data reported in the literature for upper-arm oscillometric devices, we recommend to use oscillometric devices only when they were validated properly. In particular, the oscillometric measurement should be employed with caution for epidemiological studies or for investigation of population groups (e.g., children or pregnant women) that are expected to display lower diastolic pressures.

Adult↗
PubMed1999

Indirect and direct simultaneous, comparative blood pressure measurements with the Bosotron 2 device.

Testing the accuracy of the automatic blood pressure measuring device Bosotron 2, we performed simultaneous, same-arm, comparative blood pressure measurements with three instruments (A, B, and C) of the device and by auscultation in the antecubital fossa by a trained observer in 24 volunteers each. The volunteers were evenly matched for age, sex, and blood pressure level. The mean systolic differences and their standard deviations (24 subjects each, n = 288 single measurements) were -1.32+/-3.8 mm Hg for instrument A, -0.99+/-3.9 mm Hg for instrument B, and -1.12+/-5.0 mm Hg for instrument C. The corresponding values for the diastolic differences were -2.71+/-4.4, -3.46+/-4.3, and -2.72+/-3.9 mm Hg, respectively. Combining the results for the three instruments, the comparison yielded a good accuracy (mean difference) and sufficient repeatability of the differences (standard deviation) for the systolic and diastolic blood pressures (systolic -1.14+/-4.3 mm Hg; diastolic -2.96+/-4.2 mm Hg). In addition to the British Hypertension Society protocol, in 33 patients with coronary artery disease the measurements using the three Bosotron 2 devices were compared with measurements within the aortic arch. The mean systolic/diastolic differences (+/-SD) were +1.45+/-4.3 and +7. 27+/-4.7 mm Hg for instrument A, +4.70+/-12.8 and +1.73+/-7.4 mm Hg for instrument B, and -3.74+/-8.0 and +5.61+/-2.6 mm Hg for instrument C. Combining the results of the three instruments, the blood pressure was determined to be only slightly higher (systolic +1.74+/-9.6 mm Hg; diastolic +4.87+/-5.6 mm Hg) by the Bosotron 2 R device as compared with the aortic arch pressure. The Bosotron 2 R device seems to be suitable for clinical use and for monitoring blood pressure during clinical-pharmacological studies.

Adolescent↗
PubMed1999

Improved coronary risk assessment with electron beam computed tomography in an asymptomatic female with familial hypercholesterolemia.

An asymptomatic 36-year-old woman had high cholesterol levels due to heterozygous familial hypercholesterolemia (FHC) and a family history of coronary artery disease (CAD) but no other risk factors. Exercise testing showed no signs of ischemia. Conventional drug therapy did not lower lipid levels adequately. However, low-density lipoprotein (LDL) apheresis, which effectively reduces cholesterol levels in patients with heterozygous FHC, was not indicated, according to current guidelines. Electron beam computed tomography demonstrated exceptionally high amounts of coronary calcium for the patient's age and sex. A subsequent coronary angiogram revealed advanced CAD, which justified the initiation of LDL apheresis to reduce her cholesterol levels. In patients with heterozygous FHC refractory to conventional lipid-lowering therapy, the presence of coronary calcium in the highest percentiles for age and sex (i.e., > 75th percentile) may warrant aggressive clinical management to improve prognosis, even if no symptoms or signs of ischemia are present.

Adult↗
PubMed1999

Predictors of adverse outcome 10 years after coronary angioplasty.

UNLABELLED: To determine which factors before percutaneous transluminal coronary angioplasty (PTCA) predict long-term outcome, we evaluated the clinical follow-up data from 535 patients 10 years after single-vessel PTCA. Events were defined as death, myocardial infarction, bypass surgery or repeat PTCA. During the follow-up period 79 patients (15%) died, 59 patients (11%) suffered a myocardial infarction, 107 patients (20%) had coronary artery bypass surgery and 141 patients (26%) underwent a redilatation. To determine the predictors of 10-year follow-up, 12 patient-related and 9 lesion parameters were analyzed by logistic regression analysis. Mortality was independently increased in patients with diabetes, with multi-vessel disease, after a previous myocardial infarction and in smokers. The presence of multi-vessel disease, symptoms of a higher angina class and younger age increased the risk for undergoing bypass surgery. In the statistical model with lesion parameters, the risk of bypass surgery was decreased if the stenosis was located in the distal segment of the coronary vessel and by a higher minimal luminal diameter before PTCA. CONCLUSION: Logistic regression analysis identified multi-vessel disease, diabetes, smoking and a previous myocardial infarction as independent clinical predictors of an adverse outcome 10 years after coronary angioplasty. Lesion parameters before PTCA seem to be less important with regard to the long-term outcome after PTCA.

Angioplasty, Balloon, Coronary↗
PubMed1998

Standardized guidelines for the interpretation of dobutamine echocardiography reduce interinstitutional variance in interpretation.

Subjective interpretation of dobutamine echocardiograms provides only moderate interinstitutional observer agreement if nonunified data acquisition and assessment criteria are applied. The present study was undertaken to evaluate parameters associated with low interinstitutional observer agreement in the interpretation of dobutamine echocardiograms and to analyze whether standardized interpretation criteria improve interinstitutional observer agreement. One hundred fifty dobutamine echocardiograms (dobutamine up to 40 microg/kg/min body weight and atropine up to 1 mg) were evaluated at 5 centers. Clinical, procedural, and echocardiographic parameters were included in the analysis of variables with significant impact on interinstitutional agreement. Standardized interpretative criteria were established, and 90 dobutamine echocardiograms were reanalyzed by 3 observers using a standardized image display. Multivariate analysis demonstrated low image quality (odds ratio [OR] 0.19, 95% confidence interval [CI] 0.08 to 0.45, p=0.0002), low severity of induced wall motion abnormality (OR 0.17, 95% CI 0.07 to 0.40, p <0.0001), and a low peak rate-pressure product (OR 0.93, 95% CI 0.43 to 2.27, p=0.0382) to result in a low interinstitutional agreement. Standardization of image display in cine loop format and of dobutamine stress echo interpretation criteria resulted in improvement in test result categorization as normal or abnormal, with a kappa value of 0.50, compared with 0.39 using the original subjective interpretation. In conclusion, image quality, the severity of induced wall motion abnormalities, and the obtained rate-pressure product have a significant impact on the interpretation homogeneity of dobutamine echocardiograms. Standardization of image display in cine loop format and of reading criteria results in improved interinstitutional agreement in interpretation of stress echocardiograms.

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

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

Role of intravascular ultrasound in the evaluation of mechanisms of coronary interventions and restenosis.

Intravascular ultrasound (IVUS) has emerged from being a research tool to becoming an intrinsic part of modern invasive cardiology. The main reason is its ability to obtain "in vivo" microanatomy. For the first time it is possible to base decisions not only on lumenograms but also on vessel wall assessment. The intervention-associated potential of IVUS includes the ability to allow optimal device selection, i.e., rotablators in calcified lesions or atherectomy devices in large plaque burden. The effects of percutaneous transluminal coronary angioplasty (PTCA) on vessel-wall morphology can be studied in great detail and the effect on luminal gain can be assessed almost on-line. Several groups have showed that the residual plaque area, even after angiographically successful PTCA, still lies in the range of 60%. A significant reduction of this percentage may influence long-term outcome after PTCA. Minimal luminal areas and residual plaque area after PTCA seem to be an indicator of restenosis, whereas the presence or absence of dissections seem to be less predictive. The main mechanism of restenosis after PTCA is vessel shrinkage, not intimal hyperplasia. Intravascular monitoring of stent expansion led to high-pressure stent deployment with a significant increase in postprocedural luminal diameters and finally the ability to withhold anticoagulation in patients with optimal stent deployment.

Angioplasty, Balloon, Coronary↗
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↗