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PubMed1999

Multivariable analysis of predictive factors related to outcome at 6 months after intra-arterial thrombolysis for acute ischemic stroke.

BACKGROUND AND PURPOSE: Recent reports have suggested that a rapid assessment of pretreatment residual cerebral blood flow (CBF) could be used to optimize selection criteria for thrombolysis in patients with acute ischemic stroke to improve clinical outcome. We investigated retrospectively residual CBF and other clinical factors related to outcome at 6 months after intra-arterial thrombolysis by using multivariable analysis. METHODS: Seventy-six patients received intra-arterial thrombolysis within 6 hours of symptom onset. The multiple regression method was used to analyze associations between the modified Rankin scale (MRS) at 6 months after treatment and clinical factors including age, infarction type, duration of ischemia, dose of urokinase, degree of recanalization, hemorrhage, National Institutes of Health Stroke Scale score (NIHSSS), and residual CBF evaluated by pretreatment single-photon emission-computed tomography; these values were assessed with the use of the regional-to-cerebellar activity (R/CE) ratio of ischemic region to cerebellum and asymmetry index. RESULTS: MRS at 6 months was good (0 to 3) in 65% and poor (4 to 6) in 35%. Factors significantly related to MRS at 6 months were R/CE ratio (P<0.0001), NIHSSS at baseline and the following day (P<0.0001), cardioembolic infarction (P=0.0014), age (P=0.0074), and recanalization grade (P=0. 007). NIHSSS of >20, R/CE ratio of <0.35, cardioembolic infarction, incomplete recanalization (grade <3), and older age (>75 years) were determined to be significant independent predictors of poor outcome. CONCLUSIONS: The residual CBF, neurological score at baseline and the following day, age, and recanalization grade correlated significantly with long-term outcome. The NIHSSS of >20 and R/CE ratio of <0.35 were determined to be significant independent predictors of poor outcome by multivariable analysis.

Acute Disease↗
PubMed1995

Intrathrombus administration of tissue plasminogen activator in acute cerebrovascular occlusion.

Intraarterial thrombolysis for acute cerebrovascular occlusion has achieved recanalization at a 50-90% rate. Clinical outcome has been unpredictable. The authors sought to test the hypothesis that intrathrombus administration of recombinant tissue plasminogen activator (rt-PA) would improve recanalization rate and to assess the possibility that clinical outcome would be predicted by the extent of collateral flow. Seven patients with acute cerebrovascular occlusion (less than six hours in 6, twenty-four hours in 1) were treated with intrathrombus rt-PA at 1 mg/minute. Examinations were scored on a five-point motor scale. Collateral flow was assessed angiographically. Vessels recanalized in 5 patients, 3 of whom had good outcomes. Vessels failed to recanalize in 2 patients, 1 of whom had good outcome. Good collateral flow was evident in all 4 patients with good outcome and in none of those with poor outcome. Intrathrombus administration of rt-PA is technically feasible. Favorable clinical outcome is more likely in the presence of good collateral flow. In the absence of good collateral flow, ultra-early intervention may be necessary.

Acute Disease↗
PubMed1996

Plasma viscosity increase with progression of peripheral arterial atherosclerotic disease.

Increased blood and plasma viscosity has been described in patients with coronary and peripheral arterial disease. However, the relation of viscosity to the extent of arterial wall deterioration--the most important determinant of clinical manifestation and prognosis of the disease--is not well known. Therefore, the authors studied plasma viscosity as one of the major determinants of blood viscosity in patients with different stages of arterial disease of lower limbs (according to Fontaine) and its relation to the presence of some risk factors of atherosclerosis. The study encompassed four groups of subjects: 19 healthy volunteers (group A), 18 patients with intermittent claudication up to 200 m (stage II; group B), 15 patients with critical ischemia of lower limbs (stage III and IV; group C), and 16 patients with recanalization procedures on peripheral arteries. Venous blood samples were collected from an antecubital vein without stasis for the determination of plasma viscosity (with a rotational capillary microviscometer, PAAR), fibrinogen, total cholesterol, alpha-2-macroglobulin, and glucose concentrations. In patients with recanalization procedure local plasma viscosity was also determined from blood samples taken from a vein on the dorsum of the foot. Plasma viscosity was most significantly elevated in the patients with critical ischemia (1.78 mPa.sec) and was significantly higher than in the claudicants (1.68 mPa.sec), and the claudicants also had significantly higher viscosity than the controls (1.58 mPa.sec). In patients in whom a recanalization procedure was performed, no differences in systemic and local plasma viscosity were detected, neither before nor after recanalization of the diseased artery. In all groups plasma viscosity was correlated with fibrinogen concentration (r=0.70, P < 0.01) and total cholesterol concentration (r=0.24, P < 0.05), but in group C (critical ischemia) plasma viscosity was most closely linked to the concentration of alpha-2-macroglobulin (r=0.78, P < 0.01). These results indicate that in patients with peripheral arterial disease plasma viscosity increases with the progression of the atherosclerotic process and is correlated with the clinical stages of the disease.

Aged↗
PubMed2001

Endovascular stent-grafting in the treatment of superficial femoral artery occlusive disease.

PURPOSE: To explore the feasibility of using a flexible stent-graft in the treatment of superficial femoral artery occlusive lesions. METHODS: Thirty-five patients (26 men; median age 65 years, range 41-85) with long-segment occlusions of the femoropopliteal arteries were treated with the Hemobahn endovascular prosthesis. The median occlusion length was 22 cm (range 4-40). Endografting was performed in conjunction with additional recanalization procedures as needed. RESULTS: Primary recanalization and deployment of 47 Hemobahn endografts was successful in all cases; 12 patients had 2 devices implanted. The adjunctive recanalization techniques included balloon thrombectomy (n = 28), ring-stripper disobliteration (n = 7), local thrombolysis (n = 2), mechanical rotational thrombectomy (n = 2), local thromboendarterectomy and femoral bifurcation patch angioplasty (n = 14), iliac artery stenting (n = 3), and bypass grafting (n = 2). The median ankle-brachial index rose from 0.25 preoperatively to 0.87. Over an average 7-month follow-up (range 1-18), 10 (28.6%) occlusions occurred; 6 stent-graft thromboses were treated successfully with thrombectomy only. The other 4 occlusions were permanent. Life-table analysis documented cumulative primary and secondary patency rates of 73.2% and 82.6%, respectively, at 1 year. CONCLUSIONS: Intraoperative use of the Hemobahn endograft is feasible and effective in restoring adequate distal perfusion in the short term, especially when combined with conventional recanalization techniques.

Adult↗
PubMed2005

Persistent hyperglycemia is associated with left ventricular dysfunction in patients with acute myocardial infarction.

BACKGROUND: The relationship of changes in blood glucose concentrations after admission to left ventricular (LV) dysfunction in patients with recanalized anterior acute myocardial infarction (AMI) remains unclear. METHODS AND RESULTS: Blood glucose concentrations were measured on admission and 24 h after symptom onset in 210 patients with recanalized anterior AMI within 6 h of symptom onset. Of them, 142 had hyperglycemia on admission, defined as a blood glucose >or=8.9 mmol/L, and 68 patients did not. Among the patients with admission hyperglycemia, 49 had persistent hyperglycemia, defined as a blood glucose >or=8.9 mmol/L 24 h after onset, and 93 did not. The incidences of myocardial blush grade of 0/1 after recanalization indicating impaired myocardial perfusion (71%), and peak creatine kinase concentration (5,631+/-2,855 mU/ml) were higher and predischarge LV function (43+/-11%) was lower in patients with persistent hyperglycemia than in those without (p<0.01). Multivariate analysis showed that persistent hyperglycemia was independently associated with LV dysfunction, defined as a predischarge LV ejection fraction <or=40% (odds ratio 7.38, p=0.001). CONCLUSIONS: Persistent hyperglycemia at 24 h after symptom onset is associated with LV dysfunction before discharge in patients with recanalized anterior AMI.

Adult↗
PubMed1993

Implications of delayed image on simultaneous thallium-201/technetium-99m pyrophosphate dual emission computed tomography early after acute myocardial infarction.

This study aimed investigate whether thallium-201 and technetium-99m pyrophosphate dual rest-redistribution emission computed tomography early after intracoronary thrombolysis may provide supplementary information for the management of patients with acute myocardial infarction. Fifty patients who received intracoronary thrombolysis underwent simultaneous dual emission computed tomography 3 days after first acute myocardial infarction. All patients who had a technetium-99m pyrophosphate accumulation were selected. Thallium-201/technetium-99m pyrophosphate overlap in the initial and delayed images early after intracoronary thrombolysis identified successful recanalization with sensitivities of 68% and 90% (p < 0.05), specificities of 47% 79% (p < 0.05), positive predictive accuracies of 68% and 88%, negative predictive accuracies of 47% and 80% (p < 0.05), and overall accuracy of 60% and 86% (p < 0.01), respectively. The patients were divided into 3 groups according to the change in thallium-201 uptake from the initial image to the delayed image on dual emission computed tomography: 20 patients had no change in thallium-201 uptake (fixed type), 16 had increases in thallium-201 uptake (redistribution type), and 14 had decreases in thallium-201 uptake (reverse redistribution type). The number of patients with successful recanalization was significantly higher in the redistribution type than in the other types (redistribution type vs reverse redistribution type or fixed type; p < 0.01, respectively). In the redistribution type a frequency of reinfarction in the same infarcted area during the hospital course was significantly higher than in the other types (redistribution type vs reverse redistribution type or fixed type; p < 0.05, respectively), which was mainly due to the patients having high grade residual stenosis. Thus, a thallium-201/technetium-99m pyrophosphate overlap in the delayed image early after acute myocardial infarction can be used as an index for predicting successful early recanalization and probably viable myocardium. In addition, the redistribution patterns on thallium-201 emission computed tomography early after intracoronary thrombolysis can be helpful in identifying patients with successful early recanalization and a high risk subset.

Adult↗
PubMed1992

Thrombolytic effects of a novel modified tissue plasminogen activator, E6010, on coronary thrombosis in the pig.

This study was conducted to compare the thrombolytic effect of a novel modified tissue plasminogen activator, E6010, with that of recombinant human tissue plasminogen activator (t-PA), administered by single intravenous bolus injection in pigs with occlusive coronary thrombosis. Thrombosis was induced by electrical stimulation of the intimal surface of the left circumflex coronary artery. Coronary blood flow velocity and hemodynamic parameters were observed for 1 hr after complete cessation of coronary flow. Ten minutes after heparin injection (300 U/kg), E6010, t-PA or placebo was intravenously administered as a bolus. E6010 at 0.2 and 0.4 mg/kg caused recanalization of the occluded coronary artery in 1 of 6 and 5 of 5 pigs, respectively. The time to recanalization after 0.4 mg/kg of E6010 was 22 +/- 11 min (mean +/- S.E.M.). t-PA (0.4 mg/kg) caused recanalization in only 1 of 5 pigs. Recanalization did not occur in any of the 6 animals administered placebo. Plasma clearance of E6010 was smaller than that of t-PA (4.9 +/- 0.3 vs. 9.4 +/- 3.8 ml/min/kg). There were no significant differences in plasma levels of fibrinogen, alpha 2-plasmin inhibitor and plasminogen among the placebo, E6010 and t-PA groups. These results suggest that the slower clearance of E6010 from plasma contributes to the effective thrombolytic action of E6010 following single intravenous bolus injection.

Animals↗
PubMed2000

Simultaneous intravascular two-dimensional plus Doppler ultrasound is useful for evaluation of postischemic vasodilatation: plasm NOx - levels determined by the Griess method may not reflect the extent of postischemic NO-induced vasodilatation.

Our objective was 1) to assess postischemic vasodilatation using simultaneous intravascular two-dimensional and Doppler ultrasound, and 2) to clarify whether plasma nitrite and nitrate (NOx-) levels change during postischemic vasodilatation. The vascular cross-sectional area (CSA) was evaluated in 18 mongrel dogs, and the average instantaneous peak velocity (APV) in the iliac arteries after the 5-min occlusion of blood flow was determined. Plasma NOx- levels were measured at the baseline, during the occlusion of blood flow, and 1.5, 3, and 10 min after recanalization. The %CSA significantly increased from 30 s to 7 min after the recanalization, and maximal vasodilatation was observed at 1.5 min after the recanalization (14.1 +/- 0.9 to 15.8 +/- 1.0 mm2, p< 0.0001 vs. baseline). Plasma NOx- levels were significantly reduced during the occlusion of blood flow and remained reduced at 1.5, 3, and 10 min after recanalization compared with the baseline values. We concluded that simultaneous intravascular two-dimensional and Doppler ultrasound is useful for assessment during postischemic vasodilatation, and that plasma NOx- levels assayed with the Griess reagent do not significantly increase, even when maximal vasodilatation is observed.

Animals↗
PubMed1976

Healing of deep venous thrombosis: venographic findings in a randomized study comparing streptokinase and heparin.

Sequential ascending venographic studies were used to assess the healing of deep venous thrombosis in 50 patients randomly assigned to streptokinase or heparin therapy. Various degrees of thrombolysis and/or recanalization were demonstrated by venograms performed on the fourth and tenth days of treatment. Late follow-up studies (mean, 7 months after treatment) showed three basic patterns of resolution: (1) return to normal, (2) complete recanalization, and (3) incomplete recanalization and/or collateralization. Loss of valves or their function was associated with recanalization. The character, speed, and outcome of healing reflected the nature and extent of thrombosis, prior thrombotic disease in the extremity, and the type and timing of treatment. Streptokinase was highly effective and preferable to heparin in patients with deep vein thrombosis when therapy was begun within 4 days of onset of symptoms. In later stages of acute or recurrent deep vein thrombosis, the effectiveness of both drugs was significantly reduced.

Aged↗
PubMed1998

Temporal pattern of blood volume change in cerebral infarction: evaluation with dynamic contrast-enhanced T2*-weighted MR imaging.

OBJECTIVE: The purposes of this study were to evaluate the temporal pattern of blood volume change in cerebral infarction and to provide a guideline in the interpretation of blood volume data, which are known to vary according to the stage of infarction. SUBJECTS AND METHODS: Thirty-three patients with large middle cerebral infarctions were examined one to three times (one time in 20 patients, two times in eight patients, and three times in five patients) after the onset of stroke by dynamic contrast-enhanced T2*-weighted MR imaging and MR angiography. A total of 54 infarctions (29 in an acute stage [up to 7 days], 15 in a subacute stage [8-21 days], and 10 in a chronic stage [22-35 days]) were included. After blood volume maps were created, blood volume ratios (blood volume of the infarcted region divided by blood volume of corresponding contralateral region) were compared at different stages. Likewise, findings on MR angiography were compared at different stages. RESULTS: Mean blood volume ratios in each stage of infarction were 0.46 in the acute stage, 1.48 in the subacute stage, and 0.73 in the chronic stage (p < .001). Recanalization of occluded arteries occurred in 21% of infarctions in the acute stage and 80% in the subacute stage. Infarctions with recanalization had higher blood volume ratios than did those without recanalization (p < .001). A biphasic pattern of blood volume ratios was found in 13 patients who underwent at least two MR examinations: increased blood volume in the subacute stage and decreased blood volume in the chronic stage, regardless of recanalization (p < .01). CONCLUSION: Blood volume that initially decreases in cerebral infarction increases in the subacute stage, reflecting reperfusion hyperemia. Blood volume decreases again in the chronic stage. The time interval between onset of stroke and MR examination must be considered for correct interpretation of blood volume data in cerebral infarction at various stages.

Adolescent↗
PubMed2003

Guglielmi detachable coil embolization of cerebral aneurysms: 11 years' experience.

OBJECT: The authors report on their 11 years' experience with embolization of cerebral aneurysms using Guglielmi Detachable Coil (GDC) technology and on the attendant anatomical and clinical outcomes. METHODS: Since December 1990, 818 patients harboring 916 aneurysms were treated with GDC embolization at University of California at Los Angeles Medical Center. For comparative purposes, the patients were divided into two groups: Group A included their initial 5 years' experience with 230 patients harboring 251 aneurysms and Group B included the later 6 years' experience with 588 patients harboring 665 aneurysms. Angiographically demonstrated complete occlusion was achieved in 55% of aneurysms and a neck remnant was displayed in 35.4% of lesions. Incomplete embolization was performed in 3.5% of aneurysms, and in 5% occlusion was attempted unsuccessfully. A comparison between the two groups revealed a higher complete embolization rate in patients in Group B compared with that in Group A patients (56.8 and 50.2%, respectively). The overall morbidity/mortality rate was 9.4%. Angiographic follow ups were obtained in 53.4% of cases of aneurysms, and recanalization was exhibited in 26.1% of aneurysms in Group A and 17.2% of those in Group B. The overall recanalization rate was 20.9%. Note that recanalization was related to the size of the dome and neck of the aneurysm. Overall incidence of delayed aneurysm rupture was 1.6%, a rate that improved in the past 5 years to 0.5%. Ten of 12 delayed ruptures occurred in large or giant aneurysms. CONCLUSIONS: The clinical and postembolization outcomes in patients treated with the GDC system have improved in the past 5 years. Aneurysm recanalization, however, is still a major limitation of current GDC therapy. Follow-up angiography is mandatory after GDC embolization of cerebral aneurysms. Further technical and device improvements are mandatory to overcome current GDC limitations.

Adult↗
PubMed1999

[Clinical study of therapeutic time window of local fibrinolysis for acute middle cerebral artery occlusion].

We evaluated the efficacy of local intra-arterial fibrinolysis (LIF) used in tissue plasminogen activator (t-PA) and its indication for acute middle cerebral artery (MCA) occlusion on angiographic degree of leptomeningeal collateral flow in a series of 26 patients (mean age: 67.2 years old). The occlusion types were classified into three types: (1) M 1 proximal occlusion (N = 8) involved the lenticulostriate arteries (LSA), (2) M 1 distal occlusion (N = 6) without involvement of the LSA to M 2 bifurcation, (3) M 2-3 occlusion (N = 12). In M 1 proximal and distal type, 100% patients had complete or partial recanalization till 5.3 and 6 hours, and 91.7% recanalized in M 2-3 type within 3.96 hours from attack on the average. Small cerebral infarction post LIF showed in 50%, but had no clinical change for the worse in all types. There was 65% in excellent or good prognosis on 2 months after attack. Within the range of 600,000-2,400,000 units of t-PA (mean = 1,107,000 units), small hemorrhagic transformation were developed in 5 cases (19.2%) without influence on its outcome. It means that below 2,400,000 units t-PA for LIF were safety amounts. In patients with poor collateral flow in angiographic findings, good prognosis could be possible in 75% within 4 hours (M = 3.96 hours) recanalization on the average. We conclude that LIF used in t-PA would be efficatious in M 1 proximal occlusion within 4 hours of onset and in patients with poor collateral flow when recanalized within 4 hours after attack.

Acute Disease↗
PubMed2000

[Regression of deep venous thrombosis].

The submitted prospective randomized study investigated the way and rate of regression of deep venous thrombosis of the lower extremities during a six-month out-patient follow up. On discharge on the 5th to 10th day after establishment of the diagnosis the thrombosis had not disappeared in any of the patients, in two patients progression was observed despite anticoagulant therapy. After three months 4.8% thromboses were recanalized, after 6 months 33.3%. In 33.3% of patients recanalization in a distal-proximal direction was found, in 19% in a proximal-distal direction and in 33.3% recanalization occurred throughout the thrombotic occlusion. Thromboses recanalized more quickly in patients under 50 years of age.

Anticoagulants↗
PubMed2001

[Chronic venous occlusion in hemodialysis-related fistula: diagnosis and endovascular treatment].

The main reasons of fistula dysfunction are stenosis and thrombosis. There are two kinds of thrombosis: acute and chronic. Acute thrombosis is total fistula occlusion while chronic occlusion is partial venous occlusion with collateral veins, which lead to impair fistula's function. 450 dialysis fistulas were referred to US (ultrasound) examination. Among 392 patients with fistula dysfunction, 71 presented chronic venous occlusion in hemodialysis shunt. 35 patients were qualified to endovascular recanalization. The mean length of the occluded segment was 3-35 cm (subclavian vein 2-4 cm). 38 patients underwent angiography (35 before endovascular treatment). Technique of recanalization included antegrade venous puncture, insertion guidewire (0.021'), catheter (5 Fr), balloon catheter (5-8 mm) and in 2 cases stent placement. Colour Doppler allowed to diagnose 34 (97%) cases of chronic venous occlusion in hemodialysis shunt. Decrease of mean flow volume in brachial artery--709 +/- 395 ml/min. (50-1500 ml/min) was statistically significant (p = 0.0015). Normal mean flow volume was 1242 +/- 641 ml/min. 20 of 35 recanalization procedures were performed successfully. The main reason of failure was perforation or false channel. Mean primary patency was 75% after 3 months. Mean cumulative was 85% (10/12) after 6 months. Chronic venous occlusion is often present in hemodialysis shunt and reduces flow volume. Percutaneous recanalization results aren't magnificent but there is only kind treatment for many patients with fistula failure.

Adult↗
PubMed2002

Thromboaspiration in the basilar artery: report of two cases.

Recanalization of the basilar artery is not always achieved with intraarterial fibrinolysis. We report two cases of thromboaspiration in the basilar artery in which recanalization with fibrinolysis was successful. Thromboaspiration requires favorable anatomy and a fresh nonadhesive clot. It reduces the time for recanalization, has no hemorrhagic risk, and may prevent distal clot migration. Thromboaspiration may be attempted as an adjunct or alternative to intraarterial fibrinolysis for basilar artery recanalization.

Adult↗
PubMed2003

[Intraarterial thrombolysis in the treatment of acute ischemic stroke: Technical and clinical results].

PURPOSE: To evaluate the safety and recanalization efficacy of local IA rt-PA delivery in patients with acute ischemic stroke. MATERIALS AND METHODS: Fifteen patients with acute ischemic stroke were treated; of these, 10 were carotid artery stroke, 5 were vertebrobasilar territory stroke cases. The neurological status of the patients were graded according to the Glascow Coma Scale and National Institutes of Heart Stroke Scale. All patients underwent a CT examination on admission. In addition, 4 patients had diffusion-weighted and one patient had a perfusion MR examination. Patients of carotid territory stroke were treated within 6 hours from the stroke onset. There was no time limitation for the basilar artery territory. The Rankin Scale (RS) was used as outcome measures. RESULTS: Two of the 10 patients with carotid artery stroke had carotid territory occlusions, 8 had middle cerebral artery main trunk occlusions. Four patients had symptomatic hemorrhage; of these, 3 died within 24 hours. At the third month 4 patients had a good outcome. Of 5 patients with basilar artery stroke, 4 had basilar artery occlusions. In one patient, the basilar artery was open but the flow of the contrast material was very slow. Two patients with unsuccessful recanalization due to underlying high grade atherosclerotic stenosis and one patient with successful recanalization died. At the third month, the other patient with succesful recanalization had a poor outcome (RS 4). The patient with slow basilar artery flow developed from RS 5 to RS 1 and was discharged without any neurological deficit. CONCLUSION: In acute ischemic stroke, local IA thrombolysis is a safe and feasible treatment when the right patient is selected. Hemorrhage does not exceed that which occurs in the natural history of the disease and with other treatment methods.

Adult↗
PubMedDate not supplied

[Comparative analysis of open and endoscopic operative procedures outcomes for posterior urethra obliteration in males].

Endoscopic recanalization of posterior urethra (PU) obliteration (a novel method) was compared to open reconstructive-plastic operations. 242 patients with PU and vesicular cervix obliterations entered the study. 93 patients of group 1 have undergone open reconstructive-plastic operations, 149 patients of group 2 were operated endoscopically (endoscopic recanalization under transrectal ultrasonic control). Before surgery the patients were examined using standard tests, sonourethrography and intraoperative transurethral ultrasonic investigation were added. Recurrence rate in group 1 and 2 was 29.1 and 16.8%, respectively. The following complications were observed in group 1: acute pyelonephritis (22.5%), enuresis (14%), orchoepididymitis (9.7%), urinary fistulas (5.4%). The patients needed long-term postoperative immobilization (10-16 days, mean 14.8 +/- 1.1 days). After endoscopic recanalization under transrectal ultrasonic control, group 2 patients developed acute pyelonephritis (4.8%), orchoepididymitis (4%), orthostatic enuresis (4%), short-term urethral fever (85.9%). Bed regime in this group was necessary for 1-2 days (1.3 +/- 0.4 days). Mean postoperative hospital stay was 2.5-fold less in group 2. The conclusion is made that endoscopic recanalization under transrectal ultrasonic control has advantages over open reconstructive-plastic surgery: less frequent pyoinflammatory complications, enuresis, the absence of such complications as impotence, short penis, formation of urinary fistulas.

Adolescent↗
PubMed1984

Determinants of infarct size in patients successfully treated by intracoronary thrombolysis.

In 125 patients successfully treated by intracoronary thrombolysis, data were analyzed to determine the amount of regional wall motion impairment. In 85 patients with complete occlusion of the affected vessel and successful recanalization, ventriculographic study could be performed immediately after recanalization of the vessel and repeated 3 days thereafter. Unexpectedly, no correlation could be seen between the amount of wall motion impairment and the time interval of coronary vessel occlusion. For assessment of other influencing factors two subgroups were analyzed, one with large infarction despite short occlusion time and the other with small infarction despite long occlusion time. The significant differences between these two groups was in regard to the occluded coronary vessels: In the first group, most patients had anterior infarctions caused by left anterior descending (LAD) occlusion, whereas in the second group, there were no LAD occlusions at all. According to the data that we compiled, the location of the occluded coronary vessel was the most important factor in determining infarct size. Taking this into account, recovery of the impaired wall motion up to the third day after infarction was separately analyzed in LAD occlusion or inferior infarction and was found to be more pronounced in the first. Immediate recovery after recanalization however, which could be analyzed in 40 patients who had angiographic studies before recanalization as well as afterwards, was more pronounced in inferior infarction.

Journal Article↗