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V Legrand

Publications and source records attributed to V Legrand.

At least 55 records · Page 3Linked to original sources
PubMed1997

[Immediate and long-term clinical and angiographic results of the Wiktor stent in the treatment of chronic coronary occlusions].

BACKGROUND: Percutaneous transluminal coronary angioplasty (PTCA) of chronic total coronary artery occlusions is associated with very high restenosis and reocclusion rates. Coronary stenting has been proposed as a means of improving outcome. However, the Wiktor device for chronic coronary occlusion has never been tested in a large patient sample. This study reports the first multicenter experience with the Wiktor stent for treatment of chronic occlusions. METHODS: From January 1993 to December 1996, 89 consecutive patients with 91 chronic occlusions underwent Wiktor stent implantation after successful PTCA. Post-stenting regimen consisted of coumadin plus aspirin in the first 49 (55%) patients and aspirin plus ticlopidine in the following 40 (45%). RESULTS: Stenting was successful in 87 (98%) patients. At 1 month, 6% of patients had subacute stent thrombosis, 1% access-site complications and 3% major bleeding events. Stent thrombosis showed a univariate association with coumadin therapy (p = 0.009). Angiographic follow-up was obtained in 93% of 82 eligible patients. Restenosis rate was 32%, including 4% reocclusions. Through multiple logistic regression analysis, restenosis was independently associated with multiple stents (odds ratio-OR = 27.67, 95% confidence interval-CI = 4.25 to 79.95, p = 0.0008) and increasing values of occlusion length (OR = 1.23, 95% CI = 1.09 to 1.39, p = 0.001). Freedom from death, myocardial infarction or stented vessel revascularization was 87 and 72% at one and three years, respectively. CONCLUSIONS: Short- and long-term clinical and angiographic outcomes are favorable in patients undergoing Wiktor stent implantation for chronic coronary occlusion. Further technical refinements are needed to reduce restenosis rate in patients with long lesions and multiple stents.

Analysis of Variance↗
PubMed1996

Heparin-coated Palmaz-Schatz stents in human coronary arteries. Early outcome of the Benestent-II Pilot Study.

BACKGROUND: The purpose of the Benestent-II Pilot Study was to evaluate the safety of delaying and eliminating anticoagulant therapy in patients receiving a heparin-coated stent in conjunction with antiplatelet drugs. METHODS AND RESULTS: The study consisted of three initial phases (I, II, III) during which resumption of heparin therapy after sheath removal was progressively deferred by 6, 12, and 36 hours. In phase IV, coumadin and heparin were replaced by 250 mg ticlopidine and 100 mg aspirin. Of the 207 patients with stable angina pectoris and a de novo lesion in whom heparin-coated stent implantation was attempted, implantation was successful in 202 patients (98%). Stent thrombosis did not occur during all four phases, and the overall clinical success rate at discharge was 99%. Bleeding complications requiring blood transfusion or surgery fell from 7.9% in phase I to 5.9%, 4%, and 0% in the three following phases. Hospital stay was 7.4, 6.1, 7.2, and 3.1 days for the consecutive phases. The restenosis rate for the combined four phases was 13% (15% in phase I, 20% in phase II, 11% in phase III, and 6% in phase IV). The overall rate of reintervention for the four phases was 8.9%. At 6 months, 84%, 75%, 94%, and 92% of the patients of phases I to IV, respectively, were event free. For the four phases, the event-free rate was 86%, which compares favorably with the rate observed in the Benestent-I study (80%; relative risk, 0.68 [0.45 to 1.04]). CONCLUSIONS: The implantation of stents coated with polyamine and end-point-attached heparin in stable patients with one significant de novo coronary lesion is well tolerated, is associated with no (sub)acute stent thrombosis, and results in a favorable event-free survival after 6 months.

Aspirin↗
PubMed1996

Variability in estimation of coronary dimensions from 6F and 8F catheters.

To investigate the suitability of diagnostic 6F catheters for coronary angiographic measures in the clinical setting, we determined the relative accuracy and reproducibility of the measures obtained with these catheters as scaling devices in 59 stenoses. Comparison was made with duplicate injections, obtained before angioplasty, using an 8F guiding catheter as scaling device. Intra- and interobserver variability was evaluated in 15 stenoses. The coefficient of variation averaged 18.3% for the minimal lumen diameter, 10.4% for the percent stenosis, and only 7.4% for the reference diameter. Reproducibility of angiographic measures done with the 6F catheter was similar to that obtained with the 8F catheter, although accuracy was lower with the 6F for the measurement of reference diameter. Thus, quantitative coronary angiography (QCA) measures derived from routine diagnostic angiograms may be suitable for determination of reference diameter, allowing enough precision for determination of the size of a coronary device for intervention, but these measures may lack accuracy for precise determination of minimum diameter and percent stenosis, making their use questionable in studies looking at individual changes in coronary stenosis dimensions.

Coronary Angiography↗
PubMed1996

Percutaneous balloon pericardiotomy: a case report and analysis of mechanism of action.

A 33-year-old man with acquired immunodeficiency syndrome (AIDS) and cardiac tamponade underwent percutaneous balloon pericardiotomy. To elucidate the pathway of fluid elimination, at the end of the procedure, we injected methylene blue into the pericardial space. Contrary to previous belief, we found no blue discoloration of the pleural fluids, and thus we postulate that most of the fluid was eliminated by peritoneal resorption.

Acquired Immunodeficiency Syndrome↗
PubMed1996

Clinical and angiographic outcome of elective stent implantation in small coronary vessels: an analysis of the BENESTENT trial.

We examined the influence of vessel size using an intention-to-treat approach in 259 patients who underwent stent implantation and in 257 patients who underwent balloon angioplasty alone in the BENESTENT trial. In the stented population, smaller vessel size was associated with a higher stent:vessel ratio, a greater relative gain and a greater subsequent loss index, and a higher risk of adverse cardiac events. In the balloon angioplasty population small vessel size conveyed an increased requirement for revascularization but did not increase the risk of procedural failure or myocardial infarction during follow-up. Logistic regression indicated that decreasing vessel size (as a continous variable) was associated with an increasing risk of a cardiac event for both the stent and balloon angioplasty populations.

Angioplasty, Balloon, Coronary↗
PubMed1994

A comparison of balloon-expandable-stent implantation with balloon angioplasty in patients with coronary artery disease. Benestent Study Group.

BACKGROUND: Balloon-expandable coronary-artery stents were developed to prevent coronary restenosis after coronary angioplasty. These devices hold coronary vessels open at sites that have been dilated. However, it is unknown whether stenting improves long-term angiographic and clinical outcomes as compared with standard balloon angioplasty. METHODS: A total of 520 patients with stable angina and a single coronary-artery lesion were randomly assigned to either stent implantation (262 patients) or standard balloon angioplasty (258 patients). The primary clinical end points were death, the occurrence of a cerebrovascular accident, myocardial infarction, the need for coronary-artery bypass surgery, or a second percutaneous intervention involving the previously treated lesion, either at the time of the initial procedure or during the subsequent seven months. The primary angiographic end point was the minimal luminal diameter at follow-up, as determined by quantitative coronary angiography. RESULTS: After exclusions, 52 patients in the stent group (20 percent) and 76 patients in the angioplasty group (30 percent) reached a primary clinical end point (relative risk, 0.68; 95 percent confidence interval, 0.50 to 0.92; P = 0.02). The difference in clinical-event rates was explained mainly by a reduced need for a second coronary angioplasty in the stent group (relative risk, 0.58; 95 percent confidence interval, 0.40 to 0.85; P = 0.005). The mean (+/- SD) minimal luminal diameters immediately after the procedure were 2.48 +/- 0.39 mm in the stent group and 2.05 +/- 0.33 mm in the angioplasty group; at follow-up, the diameters were 1.82 +/- 0.64 mm in the stent group and 1.73 +/- 0.55 mm in the angioplasty group (P = 0.09), which correspond to rates of restenosis (diameter of stenosis, > or = 50 percent) of 22 and 32 percent, respectively (P = 0.02). Peripheral vascular complications necessitating surgery, blood transfusion, or both were more frequent after stenting than after balloon angioplasty (13.5 vs. 3.1 percent, P < 0.001). The mean hospital stay was significantly longer in the stent group than in the angioplasty group (8.5 vs. 3.1 days, P < 0.001). CONCLUSIONS: Over seven months of follow-up, the clinical and angiographic outcomes were better in patients who received a stent than in those who received standard coronary angioplasty. However, this benefit was achieved at the cost of a significantly higher risk of vascular complications at the access site and a longer hospital stay.

Angina Pectoris↗
PubMed1994

Dramatic improvement of severe dilated cardiomyopathy in an acromegalic patient after treatment with octreotide and trans-sphenoidal surgery.

Severe congestive heart failure developed in an acromegalic patient, and was successfully treated with octreotide followed by trans-sphenoidal surgery. Clinical, hormonal echocardiographic and haemodynamic findings as well as histological heart examination before and after treatment revealed that over-production of growth hormone may induce the myocardial cell degeneration responsible for mechanical heart dysfunction. In addition, this unique example demonstrates the reversibility of myocardial damage following octreotide and trans-sphenoidal surgery, leading to significant improvement in cardiac function with minimal diastolic dysfunction and moderate interstitial fibrosis.

Acromegaly↗
PubMed1993

An unusual case of cor triatriatum: clinical presentation and the haemodynamics of a rare anomaly.

The case of a 24-year-old woman with cor triatriatum sinister and a persistent left superior vena cava connected to the junction of the left upper pulmonary vein and left atrium is reported. A diagnosis of partial anomalous pulmonary venous return had been made and the patient underwent surgery. Inspection of the left atrium revealed a complex form of left triatrial heart. The general haemodynamics of the malformation are discussed, with particular emphasis on the features accounting for variation in the clinical presentation. This rare anomaly often remains undiagnosed before surgery and should be considered whenever obstruction of pulmonary venous flow above the mitral valve is not explained by pulmonary vein stenosis, mitral or mitral valve-linked abnormalities, atrial tumours or anomalous pulmonary venous drainage with high resistance to flow.

Adult↗
PubMed1992

Clinical value of digital radiographic coronary quantification: comparison with visual assessment and coronary flow reserve.

The value of quantitative assessment of coronary artery dimensions at the site of the most critical coronary stenosis was assessed by comparison with the correspondent reactive hyperaemia as measured by digital subtraction angiography and with the functional results. Thirty-two coronary lesions were analysed and flow reserve data were obtained in an additional 11 vascular distributions without coronary obstruction in 19 patients. Minimal diameter less than 1.25 mm and minimal area less than 1.5 mm2 at the site of the stenosis best separated vascular distributions with inadequate hyperaemic response from those with sufficient reactive hyperaemia (chi 2 = 19.57; P less than 0.0001). Identification of lesion severity based on videodensitometric percentage area stenosis greater than 70% or percentage diameter stenosis greater than 50% yielded similar but poorer results (respectively chi 2 = 14.53; P less than 0.001 and chi 2 = 10.29; P less than 0.005). Additionally, when visually determined percentage stenosis was compared to the quantitatively assessed value, only a fair correlation was observed (r = 0.74), with visual overestimation of lesion severity by an average of 11.1 +/- 9.8% (mean +/- SD). Reactive hyperaemia in vessels with coronary obstruction could be described from minimal coronary dimensions by a quadratic equation but did not correlate closely in this patient population (r = 0.54 with minimal diameter and r = 0.58 with minimal area).(ABSTRACT TRUNCATED AT 250 WORDS)

Angiography, Digital Subtraction↗