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PubMed1989

[Rotation angioplasty--clinical experiences in 83 patients with chronic arterial vascular occlusion].

Chronic, total vascular occlusion represents the limit for use of balloon dilatation. Occlusions of the superficial femoral artery and popliteal artery of more than 10 cm in length have a low recanalization rate of 50 to 60% with conventional angioplasty. In iliac artery occlusions, in addition to a high rate of complications, the recanalization rate is only about 30 to 40%. Starting in 1984, we developed a slowly rotating (100 to 200 r.p.m.), electrically-driven, flexible catheter with a blunt tip, inside lumen and outer diameter of 2.2 mm for the purpose of recanalization (Figure 1). The theoretical basis was that such a catheter would seek the soft occluding thrombus as the path of least resistance. Since 1986, the procedure has been carried out in 56 patients with occlusion of the superficial femoral artery, 21 with occlusion of the popliteal artery and six with occlusion of the iliac artery. The duration of occlusion ranged between five and 48 months and the length of the occlusions between 5 and 35 cm (mean 12.5 cm); the patients were in Fontaine stage II and IV, the ankle arm-index ranged between 0 and 0.86 (mean 0,51). After antegrade or retrograde puncture of the common femoral artery and intra-arterial injection of 5,000 units of heparin, the rotation catheter was advanced through an 8F sheath through the occlusion by means of slow rotation (Figure 2). After contrast medium injection to document the intraluminal position of the catheter and the catheter exchange over a 0.35'' wire, the channel created was dilated.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1989

[A double-blind comparative study of intracoronary administration of GE-0943 and urokinase: multicenter study].

Coronary thrombolysis with plasminogen proactivator, GE-0943, was undertaken in patients with acute myocardial infarction and compared with urokinase. Fifty patients were given 6000 units of GE-0943 intracoronary and the totally occluded infarct-related arteries were recanalized in 92.0%. Fifty-four patients who were given 3000 units of GE-0943 intracoronary demonstrated a recanalization rate of 68.2%, while intracoronary administration of urokinase in 54 patients showed a recanalization rate of 70.4%. There was only one patient with hemorrhagic complication among GE-0943 3000-units group, none among GE-0943 6000-units group, and 5 among urokinase group. Thus, intracoronary administration of GE-0943 is very effective and safe with a dose up to 6000 units.

Adult↗
PubMed1989

[Intravenous streptokinase in acute myocardial infarction. Reduction of early in-hospital mortality].

A randomized study of the effects of intravenous streptokinase was performed in 214 patients with an acute myocardial infarction of less than 4 hours of whom 110 were included in the therapeutic group (SK) and 104 in the control group (C). Incidence of angiographic recanalization was higher in SK group (71 vs 28%, p less than 0.001) as that of non-significant residual coronary artery stenosis (less than 70%, 16% vs 3%, p less than 0.005), particularly in young patients (less than 45 years; 42% vs 8%, p less than 0.05). However, SK group presented a higher incidence of severe residual stenosis (90-99%) (SK, 42% vs C, 22%, p less than 0.01). Ejection fraction was higher among recanalized patients in both groups. Peak CPK-MB occurred earlier in SK group (13 vs 19 hours, p less than 0.001) and also among the recanalized patients of each group (SK, 12 vs 16 hours, p less than 0.001; C, 15 vs 21 hours, 0.002). The course of ST segment was similar in the 2 groups. The occurrence of ventricular arrhythmias within the first hour was greater in SK group (40% vs 20%, p less than 0.002), whereas the incidence of pericarditis (14% vs 35%, p less than 0.001) and of early mortality (less than 5 days, 2% vs 10%, p less than 0.02) was lower in SK group. The incidence of cardiac rupture, confirmed at necropsy in each of the 5 cases studied, was also lower in SK group (1 vs 8).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

[Intracoronary thrombolysis for high risk patients with acute myocardial infarction].

Fifty-four patients with acute myocardial infarction (AMI) were treated by percutaneous transluminal coronary recanalization (PTCR) within six hours after onset of symptoms or at the time of emergency coronary angiography. Of these, six patients had neither good collaterals nor recanalization, and followed by mechanical failure due to rupture of the left ventricular free wall or interventricular septum in five patients despite antihypertensive therapy. In the remaining 48 patients with good collaterals or recanalization, mechanical failure was statistically infrequent and occurred in only two patients (p less than 0.001). Ninety-four patients treated by PTCR were assessed in terms of mortality, cause of death and their hemodynamic findings. Cardiac deaths occurred in nine patients (9.6%); mechanical failure, in four; and cardiogenic shock due to the occlusion of the left main trunk, in five. Cardiac death was more frequently encountered in the era of the initial stage of PTCR (six of 53 cases: 11.3%) and the main cause was mechanical failure (four of six cases). On the other hand, cardiac death in recent years of PTCR was less (three of 41 cases: 7.3%), and all three had pump failure due to the occlusion of the left main trunk. Risk of mechanical failure was successfully resolved using intra-aortic balloon pumping and beta-blocker in addition to antihypertensive therapy. At the present time, PTCR and other supplementary therapy mentioned above reduced the mortality from mechanical failure and cardiogenic shock, but occlusion of the left main trunk remains an important cause of death in patients with AMI.

Aged↗
PubMed1987

Percutaneous transluminal coronary angioplasty without thrombolytic therapy in acute myocardial infarction.

Percutaneous transluminal coronary angioplasty (PTCA) in acute myocardial infarction (AMI) was performed in 42 patients (37 males, 5 females, average age 53 years). Recanalization of the stenosed or occluded infarction-related coronary artery was achieved within the first 14 to 50 min from the start of catheterization in 95% of cases. Three patients were transferred for emergency coronary bypass graft surgery (CABG) because of major multiple coronary lesions, immediately after angiographically successful PTCA. One of the patients died in cardiogenic shock. Four patients died between days 5 to 15 of hospitalization. Repeat coronary angiography was done in 27 of the 37 survivors at a mean interval of 2.5 months after AMI. Total reocclusion was found in 6 patients. The recanalized coronary artery had prevented its patency in 78% of the cases; restenosis was found in 5 patients, and was successfully dealt with renewed angioplasty in 3 patients. While the ejection fraction (EF) had remained largely unchanged, there was some improving tendency of left ventricular segmental kinetics, particularly in case of anterior wall infarction. PTCA without thrombolytic therapy seems to provide an effective and relatively prompt recanalizing procedure in the complex management of AMI.

Adult↗
PubMed1988

[A new method of laser angioplasty by contact sapphire: preliminary results. Apropos of 20 cases].

We report our first 20 cases of peripheral laser angioplasty using an optic fibre with contact sapphire tip. The equipment included a teflon catheter on which was screwed a round sapphire 2.2 mm in diameter. A 600 microns optic fibre connected to a Nd-Yag laser instrument was introduced into the catheter and placed in contact with the sapphire. Twenty patients underwent recanalization of femoral or popliteal arteries occluded on a length of 5 to 45 cm. The sapphire-tipped catheter was introduced by the Seldinger technique up to the site of occlusion. The 15 watt laser emission was set at intervals of one second. Sixteen out of the 20 occluded arteries were recanalized. Among the 4 failures, 3 were due to perforation and 1 to intraparietal progression. Angioplasty was performed with laser alone in 3 cases and with laser completed by balloon catheter in 13 cases. The minimum diameter of the laser-induced channel was 2 mm and was significantly increased (3.8 mm) by complementary balloon dilatation. In the 3 patients who underwent laser angioplasty alone, no noticeable improvement in distal blood flow was demonstrated by doppler velocimetry, and reocclusion occurred either soon afterwards (n = 2) or later (n = 1). Midterm results were much better in patients who had had additional balloon dilatation: early (3rd day) or late (2 months) reocclusion took place in only 3 patients. In the remaining 10 patients, followed up for periods of 1 week to 18 months (mean: 6 months), clinical improvement and recanalization were maintained.

Angioplasty, Balloon↗
PubMed1988

[Percutaneous transluminal angioplasty in peripheral arterial occlusive disease].

Non-surgical recanalization of arterial obstructions has gained world wide acceptance since the development of the balloon dilatation catheter by Gruentzig. The indication for this treatment depends on the clinical stage of the disease, on the location and extension of the occlusion and on the general clinical situation of the patient. Ideal situations with excellent short- and long-term results are stenoses of the iliac arteries and stenoses and short occlusions of the femoropopliteal arteries, whereas treatment of long occlusions of this region is less successful. Definite recommendations concerning additional medical therapy to improve the early and longterm patency rate cannot be given because of lacking studies. The most important advantage of PTA--compared to surgical recanalization--is the lower complication rate. A further improvement of early and late results can be expected by the combined use of different non-surgical recanalization procedures.

Angioplasty, Balloon↗
PubMed1985

[Ineffective use of lidocaine in preventing reperfusion arrhythmias in patients with acute myocardial infarct].

To study the efficacy of prophylactic lidocaine treatment on the genesis of ventricular tachyarrhythmias following recanalization of an occluded coronary artery, 49 patients with an acute myocardial infarction were studied. All patients underwent intracoronary thrombolysis. Patients were admitted within 3 hours of the onset of symptoms and were randomized into two groups: 23 patients received an intravenous infusion of lidocaine (2 mg/min), following an initial bolus of 200 mg, and the remaining 26 patients received no lidocaine. Reperfusion arrhythmias were documented in 16 of 20 successfully recanalized patients who received lidocaine and in 15 of 21 successfully recanalized patients without lidocaine treatment. There were no statistically significant differences between the two patient groups in the frequency of occurrence of ventricular tachycardias or ventricular fibrillation. Independent of lidocaine treatment, two types of ventricular tachycardia could be distinguished: the most frequent type 1 met the electrocardiographic criteria of tachycardia caused by enhanced automaticity, whereas the characteristics of the less frequent type 2 tachycardia suggested reentry or triggered activity as the underlying mechanism. Only type 2 ventricular tachycardias were accompanied by haemodynamic deterioration. Our results show that lidocaine, in the dosage given here, does not influence incidence or mechanisms of reperfusion tachyarrhythmias.

Angioplasty, Balloon↗
PubMed1987

[Intratracheal destruction of tumor lesions: laser or cryotherapy? A preliminary analysis].

Intrabronchial laser has become the reference method for palliative destruction of intrabronchial tumours. Cryotherapy, which destroys tumours by cold-induced lesion at -89.5 degrees C, has recently been introduced. Over a 3-month period, 8 patients with malignant or benign proliferative stenosis of the main bronchi and trachea were treated by laser through a flexible Bronchoscope, under general anaesthesia. During the same period, 8 patients were treated by cryotherapy through a non-rigid probe passed into a bronchoscope, under general anaesthesia; 5 of these patients had malignant intrabronchial lesions and 3 had benign or low-malignancy lesions (hamartochondroma, cylindroma, benign carcinoid). Destruction by laser was relatively or absolutely contra-indicated in these 8 patients on account of total bronchial stenosis, prolonged infiltrating stenosis or previous failure of laser. Satisfactory bronchial recanalization was obtained by laser in 3 out of 8 patients, but this technique partially failed in 5 patients with prolonged or partially infiltrating stenosis; 2 of these 5 patients were successfully treated by cryotherapy. Among the 8 patients treated by cryotherapy, 6 were significantly improved, with total bronchial recanalization and destruction of the tumoral nodules. In 1 case tumoral destruction was too incomplete for re-ventilation, and in the last patient the multiplicity of lesions made objective assessment of the results impossible. No major side-effect ascribable to cryotherapy was observed. Cryotherapy performed through a non-rigid probe therefore seems to be as safe and effective method of bronchial recanalization. It is relatively inexpensive, mobile and painless, but its effects are delayed by 8 to 10 days.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1986

[Long-term results following therapy with streptokinase in myocardial infarct].

Long term results of thrombolytic therapy in myocardial infarction are determined primarily by the effects of treatment in the acute phase. Out of a total of 370 patients undergoing recanalization therapy, 170 consecutive patients were examined over a period of one to three years (mean 1.5 years) by means of ECG, exercise testing, thallium myocardial scintigraphy, radionuclide ventriculography, coronary angiography and contrast ventriculography. Frequency of chest pain, left ventricular function, reinfarction rate and mortality were analyzed. The patient cohort was divided into three subgroups: 1. patients with successful PTCR who underwent PTCA or bypass graft surgery; 2. patients with successful PTCR who were managed medically without subsequent reinfarction; 3. patients with definitive occlusion or reinfarction. Mortality in the hospital phase (within 30 days) was 4.9% in patients undergoing successful recanalization procedures as compared to 12.3% for patients with definitive occlusion. Late mortality at 1.5 years was 12.3% and 16.2%, respectively. These figures are similar to those found in the literature. In-hospital mortality is clearly reduced by early recanalization within 200 minutes of occlusion, and there is a reduction in the ultimate extent of infarction as well as improvement in left ventricular function. In order to prevent reocclusion (in 10 to 20% of cases) and reinfarction additional interventions such as PTCA or bypass grafting should be employed as soon as possible in suitable cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiac Output↗
PubMed1975

Low fertility rate in vasovasostomized males and its possible immunologic mechanism.

Contradictory views have been expressed about the role of the various antisperm antibodies which develop after vasoligation. The present study was conducted in 50 normal fertile males, 50 vasectomized subjects and 25 subjects after recanalization of their vas deferens in order to investigate the development of various anti-sperm antibodies after vasectomy, along with their incidence, their persistence after successful relief of vaso-obstruction by vasovasostomy and their role in the causation of infertility in vasoanatomized normospermia males. Sperm agglutinating, immobilizing and haemagglutinating antibodies showed rises in titres with increase during the post-vasectomy period, indicating continuous antigenic stimulus. Age, post-operative complications and blood group did not seem to alter the results. 86% of subjects developed antisperm agglutinins, mostly tail-to-tail type (54.5%), 1-12 years after vasoligation, while only 2% of fertile men had circulating spermagglutinins. A lower incidence of positive sperm in the immobilization test than in the agglutination test suggests either that different antibodies are detected by these two tests or these tests have differing sensitivities. Of the 25 vasovasostomized subject, 13 (52%) cases became normospermic and 4 (16%) oligospermic while 8 (32%) remained azoospermics. Except for 3 oligospermic subjects, all had circulating spermagglutinins. Among the 13 normospermic vasovasostomized persons, a significant correlation was found between the titres of circulating antisperm agglutinins and autoagglutination of spermatozoa in their ejaculates; and also between the sperm immobilization values of their sera and the degree of their sperm motility. Three normospermic recanalized men, having low levels of sperm agglutinins and haemagglutinins with normal seminogram and no sperm immobilizing antibody, successfully impregnated their wives. Another 10 vasovasotomized infertile subjects had sperm agglutinins in significant titre; 5 showed positive sperm immobilization values, a similar number showed autoagglutination of sperm, while a decreased degree of motility of sperms was noted in 6 cases. Thus there was a significant correlation between the titres of anti-sperm antibodies and autoagglutination of spermatozoa, which might be an important cause of male infertility after successful anatomic relief of vasoobstruction. Histological studies of testicular biopsy showed normal spermatogenesis in azoospermic recanalized subjects, although they had high levels of antisperm antibodies. This suggests that these antibodies do not affect normal spermatogenesis, and sperm counts.

Adult↗
PubMed1979

[Removal of an acute occluding coronary thrombosis by means of a Sones-catheter (author's transl)].

In a 60-year-old male patient thrombotic occlusion of a dominant right coronary artery was recanalized by means of a Sones-Catheter (8F) two hours after the clinical onset of myocardial infarction. Before recanalization the inferior wall of the left ventricle was akinetic. After recanalization this akinesia and the clinical symptoms of myocardial infarction was almost completely relieved. As evidenced by ECG and enzymes there was only a minor necrosis of the inferior wall. After one week ventricular function angiographically was completely normal. In the right coronary artery there was a 50 percent proximal stenosis, thrombi were completely abolished. Possible implications of this case are discussed.

Acute Disease↗
PubMed1984

[Spontaneous dissecting aneurysms of the internal carotid artery. Prospective evaluation of the prognosis and arterial repermeation in 14 cases].

Fourteen patients with a spontaneous dissecting aneurysm of an internal carotid artery (ICA) have been admitted in our service since 1979 (incidence of 0,5 per 100,000 inhabitants per year). All these patients have been prospectively followed in order to determine their functional prognosis and a possible recanalization of the ICA. Three patients quickly died from an extensive middle cerebral artery infarct with brainstem compression. Among the 11 survivors, 7 completely recovered their functional ability or were left with very minor sequelae, and could go back to work. The 4 other patients remained with severe sequelae and could not work anymore. In the latter patients Doppler ultrasonographic study showed a persisting occlusion of the ICA, whereas a complete recanalization occurred in the former 7, usually as soon as the first month, on anticoagulant treatment. The presence on admission of a minor or moderate neurological deficit, a normal state of consciousness, an age above 45 years, and a patent collateral circulation allows to predict a favorable evolution (p less than 0.05). The same is true for the development of a partial or complete recanalization of the ICA on Doppler ultrasonography performed 2 to 4 weeks after admission. Sex, angiographic aspects of the dissection, and occurrence of headache or warning transient ischemic attacks had no prognostic significance in our study. Spontaneous dissecting aneurysms of the ICA can be a very serious disease, though nearly 50 p. 100 of the patients completely recover during the first months. Immediate anticoagulant therapy is still the treatment of choice and surgery is indicated only in those patients with recurrent episodes or a progressing stroke despite adequate anticoagulation.

Adult↗
PubMed1983

[Intracoronary thrombolysis as a treatment for evolving myocardial infarction].

Myocardial infarction is almost always the consequence of a thrombotic obstruction of one or more coronary arteries. We report our experience with the first 24 cases of intracoronary thrombolysis for recanalization of obstructed coronary arteries. 19 cases were successful, 1 case was partially successful and in 4 instances no reopening was observed. The amount of streptokinase used was 206 000 +/- 107 000 units, and reperfusion was achieved after 37 +/- 27.5 minutes. Recanalization of the vessel was accompanied by cessation of precordial pain and partial or complete normalization of the electrocardiogram. In one case bypass surgery was necessary because of reocclusion. Left ventricular function improvement after thrombolysis was dependent on the time-lag between occlusion and recanalization. These observations confirm others' experience that intracoronary thrombolysis appears to have favorable effects in patients with evolving myocardial infarction.

Coronary Disease↗
PubMedDate not supplied

Transcatheter embolization with Gelfoam and Avitene: the effect of Sotradecol on the duration of arterial occlusion.

Selective catheterization and embolization of both profunda femoris arteries were performed on eight mongrel dogs. In four dogs, Gelfoam alone (one side), and Gelfoam soaked in Sotradecol (contralateral side) was the embolic agent. In the other four dogs, Avitene in saline (one side), and Avitene suspended in Sotradecol (contralateral side) was the embolic agent. Ateriography followed by sacrifice and histologic examination were performed at two weeks (two dogs in each group) and two months (two dogs in each group) following embolization. In all dogs, histology confirmed the arteriographic appearance. In Gelfoam-embolized dogs, arteries embolized with Gelfoam alone were recanalized by two weeks; arteries embolized with Gelfoam/Sotradecol remained occluded at two months. In Avitene-embolized dogs, arteries embolized with Avitene in saline were moderately recanalized by two weeks and totally recanalized by two months; arteries embolized with Avitene/Sotradecol remained occluded at two months. Inflammatory changes were present in the walls of arteries embolized with Sotradecol. Sotradecol greatly increases the duration of arterial occlusion in Gelfoam and Avitene-embolized arteries.

Animals↗
PubMed1994

[When to begin reperfusion therapy in patients with acute myocardial infarct: in the early phase or whenever?].

As regards reperfusion therapy in patients with acute myocardial infarction, the general belief today is that early recanalization of the infarct-related artery--using either thrombolytic therapy or direct mechanical thrombolysis with angioplasty, and undertaken within 6 hours since the onset of ischaemia--can reduce the extent of necrosis, will reduce both mortality during hospitalization and one-year mortality, and will favourably limit regional expansion of the left ventricle affected by the infarction. Drawbacks include apparent reperfusion injury to the myocardium with possible impact on patients' mortality within the first 24 hours. The importance of reperfusion injury has not been fully established as yet. Delayed recanalization within 12 hours can only occasionally reduce the extent of necrosis (in specific cases where the development of necrosis has not yet been completed). The effect on patients' mortality remains unclear. While delayed institution of thrombolytic therapy must be considered on a case-by-case basis, it is not contraindicated. It does not seem advantageous to initiate thrombolytic therapy within 12 to 24 hours since the onset of ischemia. In such cases, percutaneous transluminal angioplasty may be more appropriate, but practical considerations and the costs involved render this option virtually unfeasible at present. However, delayed recanalization of the infarct-related artery using the latter method may exert a favourable effect on left ventricular remodeling. It should be noted it is no longer a mechanism of direct myocardial protection, as is the case in the early phase of infarction.

Angioplasty, Balloon, Coronary↗
PubMed1993

Reversible left ventricular dysfunction with coronary stenotic or obstructive lesions in Kawasaki disease.

BACKGROUND: Few studies have been reported on the prognosis or reversibility of ischemic myocardial lesions in Kawasaki disease. In this study, the pathophysiologic causes of reversible left ventricular dysfunction were evaluated in seven children with severe stenotic coronary lesions caused by Kawasaki disease. METHODS: The clinical process and the changes of coronary lesions in the repeated angiography were retrospectively evaluated in seven children. The ages of the seven patients (six boys and one girl) ranged from 7 to 15 years (mean, 10.4 +/- 2.6 y); the duration from the onset of Kawasaki disease to the last angiographic study ranged from 6 to 15 years (mean, 9.6 +/- 3.0 y). RESULTS: During the acute stage, an acute myocardial infarction was detected clinically in two patients, transient ST depression in two, and deep Q waves without any symptoms in the remaining three patients. In the first angiographic study (2 mo to 6 y after the onset of Kawasaki disease), significant left ventricular dysfunction was observed in the posterior or inferior wall in all patients. In the right coronary arteries, giant aneurysms (> or = 8 mm in diameter) were angiographically detected in two patients, localized stenosis (> or = 95%) in one, and recanalization in four. In a recent angiographic study, the left ventricular dysfunction had normalized in all seven patients. Recanalization was observed, even in two patients with giant aneurysms and in one with localized stenosis. Collateral circulation was detected in five patients in this study. Abnormal deep Q waves on ECG were detected in only one patient, and no abnormal findings on ECG were seen in the remaining six. Upon 201TI myocardial scintigraphy, no reduction of 201TI uptake was observed in any of the seven patients at the site of the abnormal wall motion on the first angiography. CONCLUSIONS: The regional left ventricular dysfunction in the seven patients may have been induced by severe acute ischemia due to a transient right coronary obstruction or by severe chronic ischemia due to coronary lesions. Eventually, left ventricular wall motion normalized after an improvement in the blood flow supply as a result of early recanalization and development of collateral circulation.

Adolescent↗
PubMedDate not supplied

[Peripheral and coronary angioscopy: its correlation with endovascular procedures].

The efficacy of any method of transluminal angioplasty has been evaluated with angiography, this can show the major anatomic results. Angioscopy can detect by direct observation, the induced changes in the vessel wall morphology after the recanalization method. We studied 5 coronary arteries and 9 peripheral arteries with total occlusion in 7, and the other 7 with more than 75% of obstruction. All of them were evaluated with angiography and angioscopy, before and after the transluminal angioplasty. Eleven of the arteries were treated by transluminal ultrasound angioplasty, we obtained recanalization in 90% of them, in 6 (55%) of this we found angioscopic evidence of dissection in variable degrees. Two cases were treated only with balloon angioplasty, and the angioscopy image was of dissection too. In the only case of laser angioplasty we observed dark brown coloration in the treated lesion suggesting carbonization changes. The initial angiography analysis did not suggest the presence of complication of the atheroma plaque. However in 21% of the cases the angioscopy inspection demonstrated and hemorrhagic dye of the endothelium, and thrombosis in situ in 29%. We no found correlation in angiography and angioscopy aspect in 25% of the cases. Some of the endothelial alterations that can not be detectable by angiography, can be demonstrated by angioscopy, this changes could improve the appreciation of any recanalization method results, that could suggest its possible immediate and late complications.

Angioplasty, Balloon↗