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At least 487 records · Page 27Linked to original sources
PubMed1992

Magnum/Magnarail versus conventional systems for recanalization of chronic total coronary occlusions: a randomized comparison.

The Magnum/Magnarail system consists of "over-the-wire" balloon catheters and a 0.021 inch (0.53 mm) guide wire with a 1 mm olive-shaped tip. To compare it to conventional systems, 100 consecutive unselected patients with chronic total coronary occlusions were randomly assigned to one of two groups. If the balloon could not be placed within 20 minutes of fluoroscopy time with the allocated system, a crossover to the other system was imposed. The Magnum group comprised 50 patients and 52 occlusions, and the conventional group included 50 patients and 51 occlusions. There were no significant differences with regard to the length of the occlusions (Magnum 1.4 +/- 1.3 mm, conventional 1.6 +/- 1.7 mm) or the duration (Magnum 1.4 +/- 1.9 months, conventional 1.4 +/- 1.8 months). The primary success rate before crossover with the Magnum/Magnarail system was 67% versus 45% with conventional systems (p less than 0.05). The Magnum/Magnarail system as a second tool after crossover was successful in 11 of 28 patients (39%) versus 2 of 16 patient (12%) in whom success was achieved with a conventional system as a second tool (p less than 0.05). An increase in the creatine kinase level (more than twice normal) was seen in one patient (2%) in the Magnum/Magnarail group and none in the conventional group. Q wave infarctions were not seen. There was one in-hospital death (2%) in the conventional group. There were no significant differences with regard to the number of guiding and balloon catheters or fluoroscopy time. The Magnum/Magnarail system proved superior to conventional systems for balloon recanalization of chronic total coronary occlusions in terms of higher success rates.

Aged↗
PubMed1987

Usefulness of recanalization to luminal diameter of 0.6 millimeter or more with intracoronary streptokinase during acute myocardial infarction in predicting "normal" perfusion status, continued arterial patency and survival at one year.

To determine whether arteriographic dimensions of the acutely recanalized coronary lumen provide information about regional perfusion or clinical outcome, quantitative arteriography was used to measure minimum luminal diameter achieved with intracoronary streptokinase administration in 44 patients with acute myocardial infarction (AMI). Degree of coronary reperfusion was independently assessed visually using the criteria applied in the multicenter Thrombolysis in Myocardial Infarction study. Minimum diameter and qualitative reperfusion grade were both assessed from 172 coronary injections during thrombolysis. Partial perfusion (grade 1 or 2) was seen in 95 of 135 injections (70%) in which the minimum diameter was less than 0.6 mm and complete perfusion (grade 3) was seen in 35 of 37 injections (95%) in which it was 0.6 mm or more (p less than 0.001). Repeat cardiac catheterization was performed at 5.5 +/- 4.9 weeks after AMI (n = 20). When vessels were opened acutely to a minimum diameter of less than 0.6 mm, 5 of 12 vessels (42%) were reoccluded at the time of restudy and 8 of 29 patients (28%) died within 12 months. By contrast, 0 of 8 vessels (0%) were reoccluded when the artery was opened to a diameter of at least 0.6 mm (difference not significant), and only 1 of 15 patients (7%) died (p less than 0.05). Of the patients with grade 1 o r 2 perfusion at the end of the thrombolytic infusion, 7 of 19 (37%) died within 12 months and 2 of 4 vessels (50%) reoccluded; of the patients with grade 3 perfusion, 2 of 25 (8%) died (p less than 0.05) and 2 of 16 vessels (13%) reoccluded (difference not significant).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

Comparison of left ventricular function and contractile reserve after successful recanalization by thrombolysis versus rescue percutaneous transluminal coronary angioplasty for acute myocardial infarction.

To determine how coronary reperfusion affects rest and exercise ventricular function after acute myocardial infarction (AMI), 63 patients with a patent infarct artery after intravenous thrombolytic therapy (lysis) were compared with 27 patients who failed thrombolysis but had successful acute recanalization by percutaneous transluminal coronary angioplasty (PTCA) as a "rescue" procedure. Contrast ventriculography was performed acutely and on day 7. Resting radionuclide ventriculography was performed at 24 hours and repeated with exercise on day 30. There were no differences in global ejection fraction (EF) between the 2 groups during acute contrast ventriculography. However, by 24 hours, the EF had deteriorated in the rescue group (40 +/- 17 vs 49 +/- 11% in the lysis group, p less than or equal to 0.05). No improvement occurred in either group on day 7. By day 30, an improvement in resting radionuclide EF 5.9 +/- 1.9% occurred in rescue patients and the difference between rescue and lysis groups was no longer significant (46 +/- 14 vs 50 +/- 11%, p = 0.12). A normal (greater than or equal to 5%) increase in EF with exercise occurred in 64%, with either normal or exercise-enhanced regional wall motion present in 67% of patients. A significant increase in EF occurred within the rescue group, from 46 +/- 14% at rest to 50 +/- 15% at peak exercise (p less than or equal to 0.0005). The EF increased with exercise from 50 +/- 11 to 58 +/- 15% in the lysis group (p less than or equal to 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)

Angioplasty, Balloon↗
PubMed1995

Spontaneous recanalization of the esophagus after exclusion using nonabsorbable staples.

Perforations of the thoracic esophagus can be fatal unless diagnosed promptly and treated effectively. Two patients in whom primary repair was not feasible were treated by esophageal exclusion and diversion using nonabsorbable stapling devices. Both patients had spontaneous recanalization of the esophagus without leakage or stricture formation. We conclude that nonabsorbable staples can be used safely to achieve effective esophageal exclusion, thereby allowing complete healing of the perforation. Furthermore, use of this technique may eliminate the necessity for another major procedure to reestablish esophageal continuity.

Adolescent↗
PubMed1980

Urethroscopic recanalization of urethral stenosis using argon laser.

A technique is presented for urethroscopic treatment of urethral stricture by Argon-Laser. A 23-watt Argon Laser is used as energy source. The radiation energy is applied into the urethra by means of a quartz fiber laser conductor. The flexible laser conductor can be inserted into the urethra through the opening of a standard urethroscope with water-inflow. It is necessary when withdrawing the urethroscope circularly to remove the entire stricture area down to the wall of the corpus cavernosum urethra, so that a totally smooth transition is created between the urethral sections proximal and distal to the stricture. The results of treatment were documented by infusion urethrography and uroflowmetric examination. The maximum flow rate (m) of 5.5 ml. before the treatment increased to 21.2 ml. after the operation. Among a total of 40 patients reconstriction occurred in 6 cases necessitating a renewal laser evaporization. These patients were treated in an early period of our urethroscopic laser recanalization. In these cases the stricture ring was not removed completely down to the wall of the corpus cavernosum urethra.

Endoscopes↗
PubMed1984

Recanalization of human arteries using Nd-YAG laser carried by optical fibre.

Nd-NAG laser carried by optical fibres 0.2 mm diameter was used in experimental studies to recanalize obstructed human cadaver arteries. Successful perforation of atheromatous plaques was obtained in all cases with a power of 12 W and a duration of exposure of 30-50 s provided that blood and not saline was used. The arterial wall was protected from injury by coaxial position of the optical fibre that was inserted into an inflated balloon catheter, and by circulating blood that cooled the system. The feasibility of guiding these devices in man was demonstrated in femoral and coronary arteries.

Arterial Occlusive Diseases↗
PubMed1989

Percutaneous recanalization and dilatation of a thrombotically occluded superior vena cava in a patient with a peritoneovenous shunt.

A superior vena cava syndrome developed in a patient with liver cirrhosis 6 months after implantation of a peritoneovenous shunt. Local fibrinolytic therapy resulted only in a transient improvement of clinical symptoms. Persistent patency of the superior vena cava and shunt function was regained only after percutaneous recanalization and balloon dilatation of the thrombotically occluded caval vein.

Angiography↗
PubMed1988

Intra-arterial ultrasonic imaging for recanalization by spark erosion.

Presently several new methods are being developed to recanalize obstructed arteries during catheterization. Intra-arterial high frequency ultrasonic imaging may be used as a guidance for these new techniques. Spark erosion is a new obstruction removal technology. Experiments have shown that this method can be applied in a selective way. An ultrasonic intra-arterial imaging system allows for the proper indication of the spark erosion catheter relative to the obstruction. The first in vitro results of this study illustrate that integration of catheter tip imaging and spark erosion is possible.

Angioplasty, Balloon↗
PubMed1994

Intravascular papillary endothelial hyperplasia: a neoplastic "actor" representing an exaggerated attempt at recanalization mediated by basic fibroblast growth factor.

Intravascular papillary endothelial hyperplasia (IPEH), a lesion of the extremities often encountered by hand surgeons, is characterized histologically by a florid endothelial proliferation that is exclusively intravascular in location and suggests an exaggerated attempt at thrombus recanalization. The mechanism behind this exaggerated response is unknown. Prompted by an apparent increase in cases of IPEH noted at our hospital in the past 2 years and the availability of frozen tissue from these cases, we undertook studies of IPEH designed to better elucidate the pathogenesis of this neoplastic "actor." Studies of eight such lesions revealed them to be uniformly diploid by DNA flow cytometric analysis. Further studies of five pooled cases by Northern blot and immunoblot revealed a 5-10-fold increase in basic fibroblast growth factor transcripts (7.0 and 3.7 kb) and a 10-20-fold increase in immunoreactive basic fibroblast growth factor protein compared to that exhibited by non-IPEH organizing thrombi and cavernous hemangiomas. These results suggest that the pathogenesis of IPEH involves an autocrine loop of endothelial basic fibroblast growth factor secretion stimulating endothelial cell proliferation.

Adult↗
PubMed1991

Recanalization of chronically occluded aortocoronary saphenous vein bypass grafts by extended infusion of urokinase: initial results and short-term clinical follow-up.

Chronic occlusion of saphenous vein aortocoronary bypass grafts is a common problem. Although percutaneous transluminal angioplasty of a saphenous vein with a stenotic lesion is feasible, angioplasty alone of a totally occluded vein graft yields uniformly poor results. Patients with such occlusion are often subjected to repeat aortocoronary bypass surgery. Experience with a new technique that allows angioplasty to be performed in a totally occluded saphenous vein bypass graft is reported. This technique utilizes infusion of prolonged low dose urokinase directly into the proximal portion of the occluded graft. Forty-six consecutive patients with 47 totally occluded grafts were studied. Patients had undergone end to side saphenous vein bypass grafting 1 to 13 (mean 7) years previously. All patients presented with new or worsening angina pectoris with ST-T changes or non-Q wave acute myocardial infarction and all had a totally occluded saphenous vein bypass graft. The new technique entailed the positioning of an angiographic catheter into the stub of the occluded graft and the advancement of an infusion wire into the graft. Patients were returned to the coronary care unit, where urokinase was delivered at a dose of 100,000 to 250,000 U/h. The total dose of urokinase ranged from 0.7 to 9.8 million U over 7.5 to 77 h (mean 31). After therapy, recanalization was seen in 37 (79%) of the 47 grafts. In 20 successfully treated patients, angiography was performed 1 to 24 (mean 11) months after treatment; 13 (65%) of these grafts were patent.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed2005

Collaterals and the recovery of left ventricular function after recanalization of a chronic total coronary occlusion.

BACKGROUND: A good collateral function in patients with regional myocardial dysfunction may indicate viability with the potential for left ventricular (LV) recovery after revascularization of a chronic total coronary occlusion (CTO). METHODS: A CTO (duration > 2 weeks) was successfully recanalized in 126 patients. During this procedure, the collateral function was assessed before the first balloon inflation by intracoronary Doppler and pressure wires. Collateral function indexes were calculated. Left ventricular function was assessed by the LV ejection fraction (LVEF) and the wall motion severity index (WMSI [SD/chords]). A repeat angiography was available in 119 patients after 4.9 +/- 1.4 m. An improvement of WMSI > or =1 SD/chord was considered significant. RESULTS: Left ventricular function was normal in 42%, regional dysfunction with LVEF > or = 0.60 was observed in 16%, and regional dysfunction with LVEF < 0.60 in 42%. The former had a better collateral function than patients with LV dysfunction. In 39% of patients with LV dysfunction, a significant myocardial recovery was observed at follow-up. The collateral function was similar in patients with and without recovery. However, patients with recovery had a lower peripheral resistance as an indicator of a better preserved microvascular integrity. CONCLUSIONS: Recovery of impaired LV function after revascularization of a CTO is not directly related to the quality of collateral function, as collateral development does not appear to require the presence of viable myocardium. However, a preserved microvascular integrity may be of relevance for myocardial recovery.

Angioplasty, Balloon, Coronary↗
PubMed2005

Value of preprocedure multislice computed tomographic coronary angiography to predict the outcome of percutaneous recanalization of chronic total occlusions.

We performed multislice computed tomographic coronary angiography in 45 patients who had chronic total occlusions and were scheduled for percutaneous recanalization. Multivariate analysis identified a blunt stump (by conventional angiography), occlusion length >15 mm, and severe calcification (by multislice computed tomographic coronary angiography) as independent predictors of procedural failure.

Coronary Angiography↗
PubMedDate not supplied

Delayed spontaneous recanalization of a totally occluded right coronary artery following failed percutaneous coronary intervention with associated Type F dissection: case report and review.

Coronary artery dissection is a well-known and frequent complication of percutaneous coronary intervention (PCI). We report the first case of a Type F dissection following PCI of the distal right coronary artery causing total vessel occlusion that could not be stented but was associated with late spontaneous recanalization and a favorable outcome.

Aged↗
PubMedDate not supplied

Recanalization and reversal of diffusion abnormalities and markedly reduced cerebral blood volume in a patient with transient ischemic attack.

Resolution of diffusion abnormalities is a finding that is rarely seen in hyperacute cerebral ischemia. We report a serial study of diffusion and perfusion magnetic resonance imaging (MRI) in a case of transient ischemic attack (TIA). In the current case, marked decrease of cerebral blood volume (CBV) as well as reduced diffusion in the affected middle cerebral arterial territory was shown by the initial diffusion and perfusion MRI at 1.5 h after onset. The initial MRI findings as well as neurological symptoms recovered probably due to prompt and spontaneous recanalization of thrombosed vessel.

Aged↗
PubMed2004

Use of abciximab prior to primary angioplasty in STEMI results in early recanalization of the infarct-related artery and improved myocardial tissue reperfusion - results of the Austrian multi-centre randomized ReoPro-BRIDGING Study.

AIMS: The aim of the ReoPro-BRIDGING Austrian multi-centre study was to investigate the effects of abciximab (ReoPro) on early reperfusion in ST-elevation myocardial infarction prior to or during primary percutaneous coronary angioplasty (pPCI). METHODS AND RESULTS: Fifty-five patients with STEMI were randomized either to start abciximab (0.25 mg/kg bolus followed by 10 microg/min infusion) during the organization phase for pPCI (Group 1, n=28) or immediately before pPCI (Group 2, n=27). The time between first bolus of abciximab and first balloon inflation of pPCI was 83+/-18 vs 21+/-13 min in Group 1 vs 2. The pre-pPCI ST-segment resolution (55+/-21.4% vs 42.4+/-18.2%, p=0.005), TIMI flow grade 3 (29% vs 7%, p=0.042), corrected TIMI frame count (58.4+/-32.7 vs 78.9+/-28.4 frame, p=0.018) %diameter stenosis (76.3 /63.5-100/ vs 100 /73.5-100/; median /interquartile range/, p=0.023), were significantly higher in Group 1 vs Group 2. Quantitative myocardial dye intensity measurement revealed a significantly higher grade of myocardial tissue perfusion (1 /0-9.25/ vs 0 /0-3.0/ grey pixel unit, p=0.048) in Group 1 before pPCI. Rapid release of cardiac enzymes was observed in Group 1 as compared with Group 2: rate of rise of CK was 210+/-209 vs 97+/-95 U/l/h (p=0.015). QRS score indicated a smaller infarct size in Group 1 (4.8+/-3.8 vs 7.6+/-3.5, p=0.011) on day 7. CONCLUSION: The use of abciximab in the organization phase for pPCI results in signs of early recanalization of the infarct-related artery and a subsequent improved myocardial tissue reperfusion.

Abciximab↗
PubMed2005

Intracoronary fibrin-specific thrombolytic infusion facilitates percutaneous recanalization of chronic total occlusion.

OBJECTIVES: We sought to investigate the benefit, predictors of procedural success, and safety of pre-procedural intra-coronary fibrin-specific lytic infusion (ICL) in patients with failed prior percutaneous coronary intervention (PCI) for chronic total occlusions (CTO). BACKGROUND: Percutaneous coronary intervention for CTO remains a challenge with a high incidence of procedural failure secondary to inability to cross the occlusion with the guidewire. METHODS: Eighty-five patients who underwent unsuccessful PCI procedures of CTO (more than three months' duration) had a repeat attempt of recanalization with the use of pre-procedural ICL. Patients received a weight-adjusted dose of either alteplase (tPA) (2 to 5 mg/h) or tenecteplase (TNK) (0.5 mg/h) for a total of 8 h. The total dose of ICL therapy was infused split between the guiding catheter and an intracoronary infusion catheter. A step-down multivariate logistic regression analysis was completed to determine the best predictors of procedural success. In-hospital major adverse cardiac events (MACE) including myocardial infarction, acute reocclusion, stroke, and death, as well as bleeding complications, were also examined. RESULTS: The procedure was successful in 46 of 85 cases (54%). Four of 85 (5%) contained dissections that did not result in perforations, tamponade, or MACE. The incidence of groin complications was 7 of 85 (8%) and of bleeding complications requiring transfusions was 3 of 85 (3.5%). On multivariate analysis, predictors of success were tapering morphology (odds ratio, 15.5; 95% confidence interval, 3.73 to 63; p = 0.0002) and lack of bridging collaterals (odds ratio, 5.08; 95% confidence interval, 1.53 to 17; p = 0.008). CONCLUSIONS: Intracoronary infusion of fibrin-specific thrombolytic therapy may provide a valuable and safe option for facilitating percutaneous revascularization of CTO.

Angioplasty, Balloon, Coronary↗
PubMed1999

Recanalization versus reperfusion for myocardial survival and preservation of ventricular geometry.

This article reviews the factors affecting myocardial ischemia and necrosis beyond coronary obstruction and in particular those related to the function of microcirculation and to the vulnerability of myocardial cells to deprivation as well as to restoration of blood flow. An effort has been spent to distinguish microcirculatory alterations during ischemia, after reversible ischemia, after irreversible ischemia, and in the presence of coronary atherosclerosis, independent of ischemia. Results show that the microcirculation plays a significant role in the production of ischemia and necrosis as well as in the modulation of the effect of large-vessel recanalization. The mechanisms, nature, and reversibility of microcirculatory changes cannot be generalized. They differ under different conditions and are poorly understood. The links of the chain plaque-microcirculation-myocardial cells cannot be separated; an integrated approach is needed to better understand and treat ischemic heart disease.

Coronary Artery Disease↗
PubMed2001

Determinants and prognostic significance of spontaneous coronary recanalization in acute myocardial infarction.

Spontaneous recanalization (SR) occurs after the onset of acute myocardial infarction (AMI), but its clinical significance in the reperfusion era remains uncertain. We evaluated the determinants and prognostic significance of SR in 196 consecutive patients with AMI who underwent primary angioplasty at our institution. The study population was divided into 2 groups according to the presence (group I, n = 44) or absence (group II, n = 152) of SR (Thrombolysis In Myocardial Infarction [TIMI] anterograde > or = 2 flow on the preintervention angiogram). The primary end point was the occurrence, within 6-weeks after AMI, of death, nonfatal reinfarction, and congestive heart failure. Baseline characteristics were similar between the 2 groups. Peak levels of creatine kinase were lower in group I than in group II (2,500 +/- 1,800 vs 4,000 +/- 2,900 U/L, respectively, p < 0.05). The rate of TIMI flow grade 3 after intervention was higher in group I than in group II (93.2% vs 79.6%, respectively, p < 0.05), and patients in group I had a faster corrected TIMI frame count than those in group II (22.7 +/- 12.4 vs 30.3 +/- 22.8, respectively, p < 0.05). Preinfarction angina (odds ratio [OR] 2.18, 95% confidence interval [CI] 1.10 to 4.33, p < 0.05), heavy thrombi (OR 0.10, 95% CI 0.01 to 0.74, p < 0.05), and good angiographic collaterals (OR 0.12, 95% CI 0.02 to 0.89, p < 0.05) were independent predictors of SR. Death, reinfarction, and severe arrhythmia were not different between the 2 groups. However, heart failure occurred more frequently in group II than in group I (15.1% vs 2.3%, respectively, p < 0.05). The primary end point was also significantly lower in group I than in group II (4.5% vs 18.4%, respectively, p < 0.05). In conclusion, SR in AMI is associated with faster coronary flow, smaller infarct size, and a better clinical outcome after primary angioplasty.

Aged↗