Search PubMed⌕ Search

Biomedical subjects

T Meinertz

Publications and source records attributed to T Meinertz.

At least 109 records · Page 6Linked to original sources
PubMed1999

Coronary angioplasty in octogenarians. Quality of life and costs.

BACKGROUND: Improvement in quality of life is the major motivation for angioplasty in very elderly patients. The alleviation of symptoms with this method is therefore of particular interest. However, little is known about the impact of angioplasty in terms of quality of life in octogenarian patients and what the treatment costs are. METHODS AND RESULTS: We prospectively compared patients aged 80 years or above (n=34, 83+/-3 years) with younger patients (n=34, 62+/-8 years) regarding their quality of life following coronary angioplasty. Patients were interviewed immediately following angioplasty and 6 months later using the SF-36 health survey. Key determinants of costs and follow-up for 6 months were documented. The number of diseased vessels, interventions performed and number of lesions treated were comparable in both groups. Success rates were lower in the octogenarian than in the control group (88 vs 97%). In both groups angioplasty significantly improved the ability to fulfil physical role expectations and decreased bodily pain. Both the effects on Role Physical and on Bodily Pain were more pronounced in the octogenarian patients. Determinants of costs did not differ significantly between the two groups. CONCLUSIONS: Our data demonstrate that in octogenarians with symptomatic coronary heart disease, coronary angioplasty significantly increases physical abilities and decreases pain. Further, these effects were more pronounced in octogenarian patients than in younger patients.

Aged↗
PubMed1999

Impact of the ECG for detection of intraatrial conduction block after atrial flutter ablation.

Induction of complete bidirectional conduction block via the posterior isthmus of the right atrium is introduced as a standard endpoint for catheter ablation of atrial flutter. The present study sought to investigate the impact of changes in P wave duration and morphology detected by the surface ECG during coronary sinus and posterolateral right atrial stimulation as a marker for conduction block. Morphology and duration changes of the paced P wave before and after radiofrequency catheter (RFC) ablation were estimated in 22 patients referred for ablation of atrial flutter. We looked for a morphology change of the terminal portion in the 12-lead ECG and an increment of P wave duration. In 16 of 22 patients in whom atrial flutter ablation resulted in a complete bidirectional block, the conduction block was unidirectional in 4 patients and conduction times remained unchanged in 2 patients. After induction of complete bidirectional block a change of the terminal portion of the P wave towards a more positive morphology in one or more inferior leads was detected in 14 (88%) of 16 patients during coronary sinus stimulation and in 15 (94%) of 16 patients during posterolateral right atrial stimulation. These changes were predominantly observed in the inferior leads. Positive morphology changes of the terminal P wave portion in the inferior leads indicating conduction block with a sensitivity of 86% and a specificity of 100% were observed. An increment of 10 ms or more in P wave duration indicates conduction block with a specificity of 100% and a sensitivity of 67%. There was a significantly larger increment of P wave duration during coronary sinus (CS) stimulation compared to posterolateral right atrial stimulation (38 +/- 21 vs 16 +/- 21 ms). The analysis of P wave duration and morphology in the inferior leads of the surface ECG is a reliable tool to assess the intraatrial conduction after atrial flutter ablation. Different conduction during coronary sinus and posterolateral right atrial pacing may cause a different P wave duration after ablation.

Aged↗
PubMed1999

Effects of body position and exercise on evoked response signal for automatic threshold activation.

The Autocapture function controls and optimizes the output of the ventricular pulse amplitude automatically. For this reason an automatic test has to be performed during follow-up to measure the evoked response signal and lead polarization for the calculation of the appropriate evoked response sensitivity setting. The aim of the study was to assess whether body position and exercise influence the evoked response and polarization. Both parameters were determined in the supine and upright position and subsequently during supine and upright symptom-limited ergometry. The study included 14 patients with the VVIR pacemaker Regency SR+ who had received the ventricular pacing leads Membrane E 1450 T (n = 8), CapSure Z 5034 (n = 4), or SX 60 (n = 2). The evoked response signal was 7.4 +/- 3.3 mV during supine and increased to 9.7 +/- 5.6 mV (+35%) during upright position (P < 0.05). The exercise tests were terminated at 105 +/- 36 W (supine) and 110 +/- 34 W (upright). There was a gradual insignificant decrease of the evoked response during each exercise test with a mean decrease of -1.1 +/- 0.9 mV (-15%; supine) and -1.6 +/- 2.1 mV (-16%; upright). The evoked response increased within 5 minutes during recovery to the initial values. Polarization remained unchanged during both tests. The pacemaker did not recommend activating autocapture in four patients who all had received high-ohmic pacing leads. In conclusions, the measurement of the evoked response in supine position seems to represent the worst case. Physical activities did not effect autocapture function in patients with the recommended lead, but the pacemaker did not always recommend Autocapture activation in some patients with high-ohmic pacing leads.

Aged↗
PubMed1999

Atrial flutter ablation using a technique for detection of conduction block within the posterior isthmus.

Catheter ablation orientated on the induction of a functional intraatrial block within the posterior isthmus of the tricuspid annulus has been shown to effectively abolish atrial flutter. In order to improve and simplify the current technique, a strategy based on an electrode catheter for combined right atrial and coronary sinus mapping and stimulation was explored prospectively. Twenty-four consecutive patients referred for catheter ablation of recurrent type I atrial flutter were included. A steerable 7 Fr catheter (Medtronic/Cardiorhythm) composed of two segments with 20 electrodes was used for right atrial and coronary sinus activation mapping and stimulation. Multiple steering mechanisms allowing intubation and positioning of the distal part within the coronary sinus were incorporated into the device. Adequate positioning of the mapping catheter was achieved solely via a transfemoral approach in all patients after 7.7 +/- 4.6 minutes, providing stable electrogram recordings during the entire ablation procedure. Radiofrequency current ablation (16.3 +/- 9.6 pulses) caused a significant bidirectional increase of the mean intraatrial conduction times via the posterior isthmus irrespective to the stimulation interval. Significant changes of intraatrial conduction properties were induced during ablation in 22 of 24 patients (bidirectional block: n = 18, unidirectional block: n = 3, conduction delay: n = 1, unchanged conduction: n = 2). Following ablation atrial flutter was noninducible in all patients. Twenty-two of 24 patients (92%) remained free of atrial flutter episodes during a follow-up of 12.5 +/- 5.7 months. Two of six patients without a bidirectional conduction block had a recurrence of atrial flutter. Atrial flutter ablation guided by the induction of an intraatrial conduction block can be effectively performed with this novel strategy for combined mapping of the posterior tricuspid isthmus, including coronary sinus and right atrial free wall. This transfemoral approach has a high accuracy with respect to the detection of radiofrequency current-induced changes of intraatrial conduction patterns.

Atrial Flutter↗
PubMed1999

Impact of long-term ECG recording on the detection of paroxysmal atrial fibrillation in patients after an acute ischemic stroke.

An ECG recording time of 24 hours has a low yield to detect atrial arrhythmias in patients after an acute ischemic stroke. The present study investigated whether a recording time of 72 instead of 24 hours detects paroxysmal atrial fibrillation in more patients. The study prospectively included 82 consecutive patients 2-3 weeks after an acute ischemic stroke. All patients had sinus rhythm in the resting ECGs and no history of atrial fibrillation or flutter. The frequency of atrial fibrillation was assessed after 24, 48, and 72 hours of ambulatory ECG monitoring. An ECG monitoring time of 72 hours documented paroxysmal atrial fibrillation in five (6%) patients. The episode of paroxysmal atrial fibrillation occurred in only one patient within 24 hours. The other patients had their first episode of atrial fibrillation between 24 and 48 hours (n = 2) and between 48 and 72 hours (n = 2). These five patients were older (age = 70 +/- 5 years), whereas the mean age of the remaining patients was 59 +/- 13 years. All five patients had cardiovascular disease in comparison to 36 of 77 patients and reported palpitations in comparison to 6 of 77 of the remaining patients. In conclusion, ambulatory ECG monitoring over 72 hours detected after the first recording day four of five patients in whom paroxysmal atrial fibrillation could be documented for the first time. The 72-hour recording time improved, compared to the 24-hour period, the detection of paroxysmal atrial fibrillation in patients after an ischemic stroke. It seems to be more efficient to perform prolonged ECG recording mainly in older patients with a cardiovascular disease and/or a history of palpitations.

Acute Disease↗
PubMed1999

Is there an association of atrial septal aneurysm with arrhythmias?

An association of atrial septal aneurysm (ASA) with cardiac arrhythmias has been described, and it has been suggested that undulating movements of the aneurysm initiate these arrhythmias, thereby causing arterial embolism. In this prospective study, all available electrocardiograms were reviewed and Holter monitoring was performed in 50 consecutive patients with echocardiographic diagnosis of ASA in order to assess the relationship between the occurrence of arrhythmias, morphologic characteristics of ASA and arterial embolism. Significant arrhythmias were identified in 26 (52%) patients (supraventricular n = 15, ventricular n = 6, both n= 5). Patients with arrhythmias were older (65 +/- 12 vs. 54 +/- 13 years, p = 0.005), frequently had palpitations (21/26 vs. 1/24, p < 0.0001) and an abnormal resting electrocardiogram (18/26 vs. 5/24, p < 0.001). By echocardiography, patients with arrhythmias had a larger left atrial (42.8 +/- 7.4 vs. 35.3 +/- 4.6 mm, p < 0.0001) and left ventricular enddiastolic diameter (53.8 +/- 5.6 vs. 49.7 +/- 4.1, p < 0.01) and a higher prevalence of associated mitral valve prolapse (12/26 vs. 4/24, p = 0.05). Potential cardiovascular causes for arrhythmia other than ASA were present in the great majority of patients with documented arrhythmias (24/26 vs. 7/24, p < 0.0001). The base diameter of ASA was larger in patients with arrhythmias (25.5 +/- 6.2 vs. 21.4 +/- 3.4, p < 0.01) and correlated with a larger left atrial diameter (r = 0.72, p < 0.0001). Concerning the mobility of ASA (maximal protrusion or phasic excursion), there was no significant difference between the two patient groups. Arterial embolism, however, predominantly occurred in ASA patients without arrhythmias (16/24 vs. 9/26, p < 0.05). In conclusion, the majority of patients with ASA and arrhythmias has underlying structural heart disease other than ASA which may be responsible for the arrhythmias observed. Arrhythmias in association with ASA do not play a major role as a mechanism for arterial embolism.

Adult↗
PubMed1999

Uni- and bipolar pacing threshold measurements with capturecontrol, a new automatic pacemaker function for capture verification. Comparison of the automatic and the manual pacing threshold measurement.

It is mandatory in pacemaker patients to determine the pacing threshold at each follow-up visit. To facilitate the pacing threshold measurements, complete automatic pacemaker tests are being developed. A new pacemaker algorithm for automatic capture verification (Capturecontrol) detects the presence of the evoked response signal 70-100 ms after the pacing pulse. The aim of this study was to determine the uni- and bipolar pacing thresholds using this automatic pacemaker function and compare them with the manually determined threshold. The study included 14 patients with the DDD pacemaker Logos (Biotronik) connected to the high-ohmic ventricular pacing lead Synox SX 60-BP (Biotronik). At predischarge and 8, 14, 20 and 26 weeks after implantation the uni- and bipolar pacing thresholds were assessed manually and with the automatic pacemaker function at 0.4 ms duration. Mean pacing thresholds determined with the automatic pacemaker function were not different from the manually measured values. This applied to uni- and bipolar pacing. Seventy percent of all unipolar and 67% of all bipolar measurements had no deviation. A deviation of 0.1 V between manual and automatic threshold measurement was observed in 25% (unipolar) and 28% (bipolar), respectively. A 0.2-volt difference occurred in 3% in the unipolar measurements. Deviations >/=0.3 V were found in 2% of all unipolar and in 5% of all bipolar measurements. In conclusion, automatic pacing threshold measurements using the Capturecontrol algorithm were similar compared to the manually determined thresholds. The excellent agreement between the two methods was observed for bipolar as well as unipolar pacing and on condition that all patients had a high-ohmic ventricular pacing lead. Therefore, fewer requirements are necessary for Capturecontrol than for presently available systems. Such pacemaker functions can help to speed up the measurements during follow-up visits.

Aged↗
PubMed1998

Ventricular tachycardia during follow-up in patients resuscitated from ventricular fibrillation: experience from stored electrograms of implantable cardioverter-defibrillators.

OBJECTIVE: The purpose of this study was to use the electrogram storage capabilities of the implantable cardioverter-defibrillator (ICD) to categorize any arrhythmic event during follow-up in a group of patients who had survived an episode of ventricular fibrillation (VF) and to possibly identify clinical predictors of future arrhythmic events. BACKGROUND: Little is known about the electrophysiologic characteristics of ventricular arrhythmias recurring during follow-up in survivors of VF as the sole documented arrhythmia at the time of resuscitation. METHODS: Forty patients (58+/-10 years; 73% men; left ventricular ejection fraction 42+/-18%; 70% with coronary artery disease) who had survived an episode of VF and subsequently received an ICD capable of intracardiac electrogram recording and storage were followed for 23+/-11 months. In all patients, the arrhythmogenic substrate was investigated by means of programmed electrical stimulation (PES). RESULTS: Among the 40 patients, 41 episodes of ventricular arrhythmias were documented in 13 patients (33%): 36 episodes of ventricular tachycardias (VT) were recorded in 11 patients (28%) and 5 episodes of VF were recorded in the remaining 2 patients (5%). Age, gender, cardiac disease and left ventricular ejection fraction failed to distinguish between patients with clinical recurrences and patients without. The sensitivity, specificity and positive accuracy of PES were 29%, 63% and 46%, respectively, for prediction of ventricular arrhythmia recurrence; 45%, 70% and 36%, respectively, for prediction of VT; and 50%, 98% and 50%, respectively, for prediction of VF during follow-up. CONCLUSIONS: In survivors of VF receiving ICD therapy, VT is the most common ventricular arrhythmia recorded on device-incorporated electrograms during follow-up. This finding, associated with the relatively well-preserved ventricular function, may account for the ability of these patients to survive at time of the index arrhythmia; the use of antitachycardia pacing as a modality to treat arrhythmia recurrences may contribute to reduce the incidence of shock during follow-up in these patients.

Aged↗
PubMed1998

[Cost-effectiveness of a rapid test for troponin in emergency admissions].

BACKGROUND AND OBJECTIVE: The assessment of patients with acute chest pain according to the risk of cardiac involvement takes time and expensive tests. This study was undertaken to evaluate whether the measurement of troponin 1 (Tnl) would reliably recognize those patients with an increased risk of cardiac disease so that unnecessary hospital stay could be avoided or at least reduced. PATIENTS AND METHODS: A qualitative rapid test for Tnl was performed, at emergency admission and 4 hours later, on the blood of 812 consecutive patients with acute left-chest pain of < or = 12 hours' duration. Admission was decided on the basis of clinical symptoms, ECG findings and CK-MB results. All cardiac events (death, myocardial infarction) within the next 30 days were recorded for all patients. RESULTS: Of the 812 patients (56% males; average age 62 +/- 12 years) 65% were admitted. At a daily cost of DM 635 and a mean duration of stay of 4.2 days, the total costs were DM 173,000 per 100 evaluated patients. None of the patients with a negative Tnl test and normal or ECGs that were not interpretable regarding ischaemic signs had cardiac events during the follow-up period of 30 days. By restricting hospitalization to patients with positive Tnl test and/or ST-T changes in the ECG a cost reduction of up to 14% could be achieved (P < 0.01). The cost of the Tnl test (DM 18) would be covered by reducing the number of admitted patients by about 2.1%. CONCLUSION: Performance of two Tnl tests is a cost-effective way of assessing the risk of cardiac events in patients with acute left-chest pain.

Aged↗
PubMed1998

Protection of side-branches in coronary lesions with a new stent design.

Side-branches often complicate stenting of coronary lesions. We investigated a new stent, characterized by four wider cells in its center, which can be expanded up to 3.5 mm and which are meant to be placed over the ostium of a major side-branch. Forty-seven consecutive patients with lesions involving 48 side-branches received one side-branch stent each. Stent deployment was successful in all patients. Twenty-five side-branches needed additional treatment. Nineteen side-branches received a PTCA, and 6 additional side-branches were stented. Postinterventional CK-(creatine kinase) elevation was observed in 3 patients (6%). One additional patient was sent for CABG on the day of the procedure due to loss of a stent intended to be placed into the side-branch. The investigated stent proved to be a safe and effective tool to treat this complex subgroup of stenoses in the presence of favorably preserved flow in the side-branches, with a low incidence of periprocedural complications.

Angioplasty, Balloon, Coronary↗
PubMed1998

[Pacemaker therapy in patients with atrial fibrillation].

Pacemaker therapy in patients with atrial fibrillation means the best current pacemaker therapy for patients with bradycardias with the aim to avoid the onset of atrial fibrillation and to establish DDD pacing despite of a history of atrial tachyarrhythmias. The newer application of pacing is the suppression of atrial arrhythmias in patients with medical refractory atrial tachyarrhythmias. Patients with slow ventricular rates and permanent atrial fibrillation should receive a VVI-pacemaker, if the bradycardias causes syncope, dizziness or a decrease of their exercise tolerance. In case of chronotropic incompetence the pacemaker should provide rate responsive pacing. Patients with sick sinus syndrome should receive an atrial (AAI) or dual-chamber (DDD) pacemaker, because patients with these in contrast to VVI-pacemakers develop less often atrial fibrillation and subsequent complications such as atrial thromboembolism. A dual-chamber or VDD-pacemaker--the latter connected to a VDD-single-lead--is indicated in patients with advanced AV-block. Atrial fibrillation occurs in 3 to 6% of the patients with no history of arrythmia and is, if pacemakers have no automatic mode switch, an often reason to program the devices to the VVI-pacing mode. Nowadays, most DDD(R)-pacemakers provide an automatic mode switch: During an atrial tachycardia the pacemaker switches to a VVI/VVIR mode and restores the initial DDD(R)-pacing mode with termination of the arrhythmia. In respect to the newer applications, one approach to prevent atrial tachyarrhythmias is permanent atrial pacing. As lower pacing rates of 80 to 90 ppm are usually needed and many patients hardly tolerate these pacing rates, new algorithms are under clinical investigation. Another approach is the simultaneous depolarization of the right and left atrium. Biatrial pacing is performed with one lead in the high right atrium and another lead in the coronary sinus. Another solution is bifocal atrial pacing with leads placed in the high right atrium and in the coronary sinus ostium. One effect of the new pacing techniques is to shorten interatrial conduction times. Therefore, biatrial pacing has become a therapy to prevent atrial arrhythmias deriving from delayed interatrial conduction times. As atrial reentry circuits seem to be important in atrial fibrillation, multisite atrial pacing is also performed in patients with medical refractory paroxysmal atrial fibrillation. Preliminary results suggest a more effective prevention of atrial fibrillation; nevertheless, these techniques should be still restricted to patients enrolled in clinical studies.

Atrial Fibrillation↗
PubMed1998

[High frequency current ablation of ectopic atrial tachycardia. Different mapping strategies for localization of right- and left-sided origin].

UNLABELLED: Ectopic atrial tachycardia (EAT) is a rare form of supraventricular tachycardia and often drug-resistant. Radiofrequency catheter (RFC) ablation offers an alternative therapy suggesting a high efficacy rate. Localization of the EAT origin is proposed to be efficacious by various mapping strategies. We analyzed the efficacy of different mapping strategies for localization of right and left sided EAT foci. METHODS AND PATIENTS: In a cohort of 48 patients (25 female: age 35 +/- 18 years) RFC ablation of 40 right and 12 left sided EAT foci was performed. Mapping of the right atrium was achieved with 2 ablation catheters using the "encircling" technique (Figure 1). We looked for an early bipolar local electrogram in relation to the onset of the P-wave and a QS-complex in the unipolar electrogram. The bipolar local electrogram was retrospectively analyzed for a fragmented morphology and duration of more than 50 ms (Figure 3). In case of mechanical block of the EAT during mapping P-wave pace mapping over the mapping catheter was performed (Figure 4). RESULTS: RFC ablation succeeded in 44 patients with 46 EAT foci (Figure 5). Left sided EAT origin was in 40% in the region of the pulmonary veins. Two left sided foci were abladed within the coronary sinus. An anteroseptal location in vicinity to the bundle of His was found in 4 cases (Figure 6). There were no differences between left and right sided origin regrading session duration (304 +/- 131 vs 241 +/- 101 min) and fluoroscopic time (39 +/- 29 vs 31 +/- 19 min). The activation time related to the onset of the P-wave was at successful ablation site for left sided origin significantly earlier compared to a right sided origin (45 +/- 22 vs 30 +/- 18 ms). Fragmenation of the bipolar local electrogram was found before successful RFC application in 86% in the left and in 65% in the right atrium. The unipolar electrogram showed in 87% of all cases a QS-complex before the successful RFC pulse. In 16% a beat to beat change of the unipolar electrogram could be found at successful ablation site (Figure 7). Both criteria had a low specify and sensitivity. Mechanical block could be induced during mapping in 10 patients (20%). In these cases RFC application at a site with a perfect match of P-wave pace mapping succeeded in 8 patients. In 2 patients the same EAT occurred within the following 24 hours. During a follow-up of 4 to 58 months there were additionally recurrence of EAT in 3 patients (3 to 6 months after ablation). No influence of the AV nodal conduction was observed after ablation of anteroseptal EAT foci. Other acute or chronic complications were not observed. CONCLUSIONS: 1. RFC ablation of right and left sided EAT foci is a safe and efficacious treatment. There were no differences regarding session duration and fluoroscopic time between right and left sided foci. 2. Activation mapping showed an earlier activation time for left sided origin compared to right sided. 3. Mechanical block could be induced in 20% of cases. P-wave pace mapping might offer a strategy to localize the focus during mechanical block.

Adolescent↗
PubMed1998

[The intraoperative measured stimulation impedance of pacemaker electrodes is not a predictor for their longevity].

UNLABELLED: As pacing impedance is inversely related to pacing current, the increase of pacing impedance additionally decreases pacing current. Whether the impedance measurement at implantation predicts the outcome during follow-up, was studied in 87 patients who received the VDD-single lead UniPass 425 connected to the pacemaker Unity (Sulzer Intermedics). The impedance changes between implantation and 6 months follow-up were assessed for each patient. Similar impedance values were defined, if the two measurements were within a range < or = -100 to +100 omega. Six-months impedance was lower or higher compared to implantation, if the difference exceeded > -100 or > +100 omega. At implantation, impedance was 535 +/- 98 omega (range: 333-811 omega) and significantly increased to 604 +/- 160 omega (range: 361-1150 omega) after 6 months. Mean difference between the two measurements was 69 +/- 162 omega (range: -336 bis + 560 omega). Similar impedance had 43 (implantation: 527 +/- 75 omega, 6 months: 531 +/- 87 omega), lower values 11 (implantation: 660 +/- 83 omega, 6 months: 494 +/- 73 omega) and higher values 33 patients (implantation: 503 +/- 99 omega, 6 months: 735 +/- 168 omega). Compared to the patients with similar impedance patients with lower impedance had a significantly higher impedance values at implantation. CONCLUSIONS: Pacing impedance increased significantly within 6 months after implantation. Pacing impedance changed > 100 omega in 51% of the patients. The long-term follow-up of pacing impedance can be predicted generally, but not for the individual patient.

Aged↗
PubMed1998

[Acute results of ablation of coronary in-stent restenoses with eccentric excimer laser catheters].

UNLABELLED: Laser catheters which run eccentrically on a guide wire were developed for maximization of luminal gain by excimer laser angioplasty (ELCA). We investigated the safety and efficacy of ELCA with these new catheters plus PTCA in patients with restenoses or occlusions in coronary stents. ELCA was performed in 57 patients (60 +/- 9 years) with stenoses in 75 stents (35 AVE Micro stents, 26 Palmaz-Schatz stents, 7 NIR stents, 7 other stents). In 44 patients eccentric 1.7 mm catheters and in 13 patients 2.0 mm catheters were used. The success of the intervention was analyzed by intravascular ultrasound (IVUS) in a subgroup of 7 patients treated with five 1.7 mm and two 2.0 mm catheters. The laser catheters could be advanced through the in-stent restenoses in 56 patients. A passage inhibition occurred in one patient with an inadequately expanded stent < 2.0 mm in diameter. ELCA reduced the diameter stenoses from 77 +/- 10% before intervention to 44 +/- 8% after treatment with the 1.7 mm catheter (n = 43) or to 34 +/- 9% after passages with the 2.0 mm catheter (P < 0.001). PTCA further reduced the diameter stenosis to 11 +/- 12% (P < 0.001). The IVUS analysis revealed a smooth ablation profile in all patients. In 4 patients creatine kinase elevations > or = 2 times normal value occurred. There was no evidence of a Q-wave infarction. No dissections were observed within the stents. Outside of the stents there were dissections in 5 vessels, which required the implantation of additional stents. CONCLUSIONS: ELCA with eccentric laser catheters for treatment of in-stent restenosis is safe and effective. The incidence of complications is acceptable.

Adult↗
PubMed1998

The concept of protective stent placement after successful recanalization of chronic total coronary occlusions: a matched pair analysis in 100 patients.

OBJECTIVE: Interim results of successful balloon angioplasty for total coronary occlusions (TCO) are disappointing due to the high rate of restenosis and reocclusion. Adjunctive stenting has been suggested to improve patency rate after recanalization of total coronary occlusions (TCO); however, this concept of protective stenting has not been substantiated in a case control study. METHODS: To test the efficacy of protective stenting of TCO, 100 patients were subjected to a matched pair analysis (block design) comparing conventional PTCA with protective stenting (Palmaz-Schatz stents) after successful recanalization of TCO followed by a standard antithrombotic regimen. Matching parameters included age (+/- 3.5 years), sex, cardiovascular risk factor, and lesion anatomy. Coronary angiography and QCA were performed before pair assignment, after the intervention, and at a mean follow-up of 5 +/- 1.5 months. RESULTS: There were no deaths or myocardial infarctions related to the intervention in the entire study cohort; bleeding at the puncture site was observed in two patients in both groups. Binary reocclusion and restenosis (> or = 50%) rates were observed in 8% and 0% in stented patients versus 30% and 22% in the group with no protective stenting, respectively (p < 0.01). Target lesion reintervention was necessary in 8% after protective stenting as compared to 58% after PTCA alone (p < 0.001). At 6 months follow-up, 62% of stented patients were free of any symptoms versus 23% with PTCA (p < 0.01). CONCLUSIONS: Protective stenting improves the immediate and follow-up angiographic and clinical results of PTCA in chronic total coronary occlusions. Stenting of successfully recanalized total coronary occlusions should be a routine procedure.

Aged↗