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PubMed1993

Epithelial reorganization and irregular growth following carbendazim-induced injury of the efferent ductules of the rat testis.

Occlusions of the rat efferent ductules were induced by an oral gavage of carbendazim and the capacity for regeneration or recanalization of the ductules was histologically evaluated between 2 and 70 days post-treatment. At 2 days post-treatment, the efferent ductules were occluded by sloughed materials and showed various degrees of inflammation. Severely damaged epithelium showed few regenerative features at later intervals. On the other hand, epithelia with medium inflammation often exhibited irregular epithelial growth along the luminal contents or the formation of multiple abnormal ductules. These abnormal ductules were formed by migrated and original epithelia at the periphery of the occluded lumen at 16 days post-treatment, indicating attempted recanalization. At later time periods, 32 and 70 days post-treatment, the occluded original lumen was filled in by fibrotic connective tissue and surrounded by a series of abnormal ductules. These abnormal ductules were characterized by cuboidal epithelia, a small luminal diameter, fewer cilitated cells than normal, less developed organelles in the epithelial cells, and basal laminae of irregular thickness. However, there was no evidence that occluded ductules formed patent re-connections via abnormal ductules. The results suggest that occluded efferent ductules have the ability to initiate epithelial regrowth and to form new ductules, but the newly formed ductules are abnormal and are not adequate to recover from azoospermia at least at 70 days post-treatment.

Animals↗

PubMed1988

Evaluation of peritoneal tube grafts in the inferior vena cava of the pig.

A tube graft 2.5 or 5 cm long, was constructed from the peritoneum of the anterior abdominal wall of 12 pigs. It was anastomosed end-to-end as an interposition graft in the infrarenal vena cava. The observation period was 4 months. Three of the six short grafts were venographically patent at 2 weeks, while all the long grafts were occluded. After 4 months two short grafts had recanalized, giving a patency rate of five out of six short grafts. No long grafts recanalized. In three of the patent specimens no clear tissue changes were found with light microscopy, while in the others changes of inflammation and fibrosis were noted. Scanning electron microscopy revealed good 'endothelialization' in two specimens, and partial 'endothelialization' in the others. No dilatation or severe stenosis of the patent grafts was seen. The occluded grafts remained only as a fibrous strand with sutures.

Anastomosis, Surgical↗

PubMed2005

Systematic review of endovenous laser treatment for varicose veins.

BACKGROUND: The safety and effectiveness of endovenous laser treatment (EVLT) for varicose veins are not yet fully evaluated. METHODS: Medical bibliographic databases, the internet and reference lists were searched from January 1966 to September 2004. Only case series were available for inclusion in the review. RESULTS: : Thirteen studies met the inclusion criteria. Self-limiting features, such as pain, ecchymosis, induration and phlebitis, were commonly encountered after treatment. Deep vein thrombosis and incorrect placement of the laser in vessels were uncommon adverse events. No study has yet assessed the effectiveness of laser therapy in comparison to saphenofemoral junction ligation with saphenous vein stripping. Occlusion of the saphenous vein and abolition of venous reflux occurred in 87.9-100 per cent of limbs, with low rates of re-treatment and recanalization. CONCLUSION: From the low-level evidence available it seems that EVLT benefits most patients in the short term, but rates of recanalization, re-treatment, occlusion and reflux may alter with longer follow-up. The lack of such data, in addition to the small numbers of patients in the available studies, demonstrates the need for a randomized clinical trial of EVLT versus conventional surgery.

Adult↗

PubMed2001

Changes in coil morphology following transcatheter coil occlusion of the patent ductus arteriosus using a modified snare technique.

We observed a decrease in length of the Gianturco coils following transcatheter occlusion of the patent ductus arteriosus (PDA). Coil length was measured on chest radiograph within 24 hr of coil placement and compared to the length at the time of follow-up. Echocardiograms were also reviewed for evidence of duct recanalization. Twenty-seven patients met inclusion criteria. The median time to follow-up was 5 months (1--12 months). Twenty-four out of 27 (89%) patients had a decrease in coil length by 1.9 +/- 1.1 mm (P < 0.01). This was an average decrease of 16%. One patient had an increase in length and two patients had no change in coil length. Nineteen out of 27 patients had echocardiograms. Despite the change in coil length, there was no evidence of flow acceleration in the pulmonary artery or descending aorta. No patients had evidence of duct recanalization.

Adolescent↗

PubMed1985

Spontaneous regression of coronary artery obstructions: incidence in 313 consecutive repeat angiograms.

We studied the incidence of reversibility of coronary obstructions in a consecutive series of 313 patients with nonoperated coronary artery disease catheterized twice 3 to 118 (mean 38) months apart. Recanalization was observed in three patients and regression from an initial less than 100% obstruction in six patients. Progression in a different location occurred in six of the nine patients who demonstrated one recanalized or one regressive lesion. We conclude that true regression is an infrequent event in the natural history of medically treated patients with coronary artery disease; moreover, the pathophysiology and clinical relevance of angiographic regression remain poorly defined.

Angina Pectoris↗

PubMedDate not supplied

Intracoronary thrombolysis in evolving isolated right ventricular infarction.

In a 52-year-old man with severe chest pain of 3 hours duration and ST-segment elevation in leads V1 and V2, a nondominant right coronary artery was recanalized by an intracoronary infusion of urokinase. Coronary cineangiography revealed a total occlusion of the nondominant right coronary artery and no significant narrowing of the left coronary artery. Hemodynamic studies during the acute phase of myocardial infarction demonstrated an increase of right atrial mean pressure in association with normal pulmonary capillary wedge pressure. Following the recanalization, chest pain disappeared and hemodynamic alterations were corrected. The purpose of this report is to document a case of isolated right ventricular infarction due to a nondominant right coronary artery occlusion.

Coronary Disease↗

PubMed1990

Experimental argon laser thermal angioplasty as an adjunct to balloon angioplasty in peripheral arteriosclerotic disease.

Laser thermal recanalization has been used clinically as an adjunct to balloon angioplasty in the treatment of peripheral arteriosclerotic disease, with improved initial success rates in total peripheral occlusions and greater 1 yr vessel patency suggested, as compared to balloon angioplasty alone. However, the morphological effects of laser-assisted balloon angioplasty are unknown. Therefore, the goals of the present study were to evaluate 1) the angiographic and histologic effects of laser thermal recanalization followed by balloon angioplasty and 2) the hypothesis that balloon-catheter-induced neointimal fracture could be sealed by subsequent laser thermal angioplasty in an experimental rabbit iliac artery atherosclerotic model. In Group 1 (7 vessels), a 1.5 mm metal capped argon laser fiberoptic was introduced via femoral arteriotomy and 10 W of thermal power was applied to the iliac artery stenosis for 5 sec while maintaining constant back-and-forth motion. Thereafter, balloon angioplasty was performed in the same vessel segment with a 2.5 mm balloon catheter inflated 3 times at 5 atm for 30 sec each. Mean angiographic luminal diameter increased from 1.1 mm to 2.0 mm after both procedures, and mean final post balloon dissection grade was 0.6 on a scale of 0, 1+, and 2+. Perforation occurred once with the laser probe and once with the balloon catheter. Histologic examination of these vessels was characterized by irregular thermal erosions with minimal reactive thrombosis. In Group 2 (10 vessels), the sequence was reversed, with laser thermal angioplasty following balloon dilation. Mean angiographic luminal diameter improved from 1.2 mm to 1.8 mm after both procedures.(ABSTRACT TRUNCATED AT 250 WORDS)

Aortic Dissection↗

PubMed1993

New treatment approach for chronic total occlusions of saphenous vein grafts: thrombolysis and intravascular stents.

Balloon dilation of saphenous vein graft (SVG) occlusions has a lower success rate than angioplasty of native coronary arteries. To improve this outcome, a new therapy for chronic total SVG occlusions was developed. In three aortocoronary bypass graft patients with class III-IV angina and chronic occlusion of the SVGs to the left anterior descending artery (age of occlusions: 2-24 wk, age of graft 1-13 yr), standard recanalization was achieved with a guide wire and intracoronary urokinase infusion (0.5-1.0 million unit bolus followed by 100,000 IU/hr for 11-24 hr; mean infusion time: 19.7 hr). In each patient, a residual focal stenosis (average 82.5%) was successfully dilated and stented (single 4.0 mm Palmaz-Schatz in two patients and a 3.5 mm Strecker stent in the other). All patients had complete relief of symptoms and no sequelae. During a mean 7.7 mon follow-up, 6-mon arteriographic evaluation in two patients showed minimal intra-stent narrowing (26% and 34%). In the Strecker stent patient, the device proved too small for the vein graft, leading to an 89% stent stenosis found on follow-up arteriography at 5 mon. The stent was redilated successfully with a 5% residual narrowing. After urokinase recanalization of chronic total SVG occlusions, intravascular stents may improve the long-term results seen with conventional SVG angioplasty.

Aged↗

PubMed2004

Wireless laser-assisted angioplasty of the superficial femoral artery in patients with critical limb ischemia who have failed conventional percutaneous revascularization.

Percutaneous revascularization has become an effective treatment for patients suffering from chronic critical limb ischemia (CLI) due to chronic atherosclerotic obstructions, including total occlusions. Unlike other vascular beds, total chronic occlusions of the femoropopliteal arteries are frequently found in patients with severe claudication or CLI. As a consequence, patients with long chronic total occlusions of the femoropopliteal arteries are generally not considered optimal candidates for percutaneous revascularization and are frequently referred for surgical revascularization. In the present study, we sought to evaluate the feasibility, safety, and outcome of a modified wireless laser ablation technique to recanalize total occlusions in patients with CLI who had failed conventional percutaneous techniques for limb salvage. Procedural success, complications, actuarial freedom of limb loss, and surgical revascularization were evaluated in 25 patients after a mean follow-up of 13 +/- 8 months. Procedural success was achieved in 21 patients (84%). Actuarial freedom from surgical revascularization or limb loss was 72%. There was one vascular perforation. No deaths or distal embolization occurred. Three patients (12%) required limb amputation during follow-up, whereas four patients (16%) had surgical revascularization in the presence of feasible vascular targets. Limb salvage was achieved in 88% of patients when laser recanalization was combined with surgical revascularization. These results suggest that the use of laser ablation is safe and facilitates angioplasty and stenting in patients with CLI that failed conventional endovascular revascularization. This technique might prevent limb loss in patients with CLI due to femoropopliteal total occlusions, particularly in patients with unsuitable anatomy for surgical revascularization.

Aged↗

PubMed2004

Corrosion of tungsten coils after peripheral vascular embolization therapy: influence on outcome and tungsten load.

The purpose of this study was to evaluate coil corrosion and the long-term outcome after peripheral vascular embolization therapy performed with tungsten coils. We studied 14 patients who received tungsten coils on an average of 26 months prior to follow-up. The protocol included plain radiography and contrast-enhanced magnetic resonance angiography to investigate corrosion of tungsten coils and recanalization of the embolized vessels. Whole blood, hair, and urine tungsten levels were assayed when available. Corrosion of tungsten coils was detected in 9 of 14 patients by plain radiography. No evidence of recanalization of the embolized vessel and no adverse clinical effects of tungsten resorption were detected. Blood levels of tungsten were elevated in 6 of 14 patients and urine levels of tungsten were elevated in all 12 patients tested. Tungsten coil corrosion and elevated tungsten levels in blood, hair, and urine were found in most patients, although no adverse clinical effects of tungsten resorption were detected. Since the overall effect of high tungsten blood levels remains unclear, its use as an implant should be avoided.

Adult↗

PubMed2005

Intracoronary ST segment evolution during primary coronary stenting predicts infarct zone recovery.

In patients with acute myocardial infarction (AMI), early ST segment elevation resolution on ECG predicts myocardial reperfusion and LV recovery. Intracoronary ECG is more sensitive than surface ECG to detect regional ischemia. In patients undergoing primary percutaneous coronary intervention (PCI), we investigated if failed myocardial reperfusion, despite successful infarct vessel recanalization, could be rapidly and easily identified by intracoronary ST segment monitoring from guidewire recording. We recorded intracoronary and standard ECG during primary coronary stenting (PCI) in 50 patients with AMI (59 +/- 11 years; anterior AMI in 66%). All patients had a successful PCI and underwent 2D echocardiography soon after PCI and 6 months later. Following PCI, intracoronary ST resolution >/= 50% from baseline was documented in 39 patients (78%; group A; from 11 +/- 8 to 1 +/- 2 mm) but not in 11 (22%; group B; from 11 +/- 8 to 8 +/- 5 mm). Group A had slightly shorter ischemic time (202 +/- 94 vs. 238 +/- 112 min in B; P = 0.2) and smaller peak CK values (2,752 +/- 2,038 vs. 4,802 +/- 3,671 U/L in B; P = 0.02). After PCI, ST resolution was found on standard ECG in 34 (87%) group A and in 3 (27%) group B patients. At 6-month follow-up, left ventricular ejection fraction was greater in group A (47% +/- 8% vs. 39% +/- 8% in B; P < 0.001) with improved wall motion score index (from 2.2 +/- 0.3 to 1.7 +/- 0.3 in A; from 2.3 +/- 0.4 to 2.1 +/- 0.4 in B; P < 0.001). There were no significant differences between intracoronary and standard ECG for sensitivity (92% vs. 86%) and specificity (62% vs. 57%) to predict improved infarct zone recovery after 6 months. ST elevation resolution on intracoronary recording during PCI predicts infarct zone recovery. Monitoring ST segment evolution by intracoronary ECG allows prompt and inexpensive identification in the catheterization laboratory of those patients without myocardial reperfusion, who may require adjunctive therapeutic interventions after successful infarct vessel recanalization.

Aged↗

PubMed2005

Preliminary experience with the Frontrunner coronary catheter: novel device dedicated to mechanical revascularization of chronic total occlusions.

The novel device Frontrunner coronary catheter (FCC), dedicated to recanalization of chronic total occlusions (CTOs), relies on blunt microdissections inside the plaque, allowing passage of guidewire through the lesion and adjunctive angioplasty. In order to evaluate efficacy and safety of recanalization using the FCC device, we included patients with de novo or restenotic CTOs in a native coronary artery with prior failure using a guidewire or considered unsuitable for guidewire attempt in which the FCC was attempted first. Between October 2000 and June 2003, 50 patients with 50 CTOs were included in the study. Thirty-two patients had prior failure with a mechanical wire. Device and angiographic success were obtained in 25 (50%) occlusions: 53% in lesions with prior guidewire failure and 44% when FCCs were attempted first (P = 0.8). During the first year of experience, angiographic success was 42% (5 occlusions) and in the third year 75% (12 occlusions; P = 0.12). Coronary perforation occurred in nine (18.0%) patients, leading to tamponade in two (4%) patients. Perforations occurred in 5 out of 12 attempted patients during the first year and in 4 out of 38 patients in the following period (41.7% vs. 10.5%; P = 0.04). Serious adverse events occurred in five (10%) patients within 30-day follow-up. Four non-Q-wave myocardial infarctions occurred in hospital (clinical success 42%) and one death 7 days after the index procedure. The use of FCC increases the success to open chronic total occlusions refractory to mechanical guidewires or that were considered unsuitable for an attempt with a guidewire. The risk of coronary perforation due to FCC use is relatively high and it can decrease with experience.

Aged↗

PubMed2006

Paclitaxel-eluting stents for the treatment of chronic total coronary occlusions: a strategy of extensive lesion coverage with drug-eluting stents.

The recanalization of a chronic total coronary occlusion (CTO) is hampered by a high rate of lesion recurrence. The goal of the present study is to assess the effect of paclitaxel-eluting stents in CTOs in a strategy of extensive stent coverage and the optional use of additional bare metal stents (BMSs). In 82 consecutive patients, a CTO (duration > 2 weeks) was successfully recanalized with implantation of one or more Taxus stents. These patients underwent a repeat angiography after 5.0 +/- 1.5 months and were assessed by quantitative angiography. The patients were compared with 82 clinically and lesion-matched patients from a consecutive series of 148 patients with CTOs treated by BMS in the preceding time period. In 21 of the 82 patients, additional lesions in the target artery not directly related to the original occlusion site were treated with BMSs (hybrid approach). The history of diabetes, extent of coronary artery disease, clinical symptoms, and angiographic features were similar in the Taxus and BMS group. Periprocedural adverse events were 3.3% with Taxus and 3.3% with BMS, but 12 months MACE was significantly lower in the group with exclusive use of Taxus (13.3% vs. 56.7%; P < 0.001), mainly due to a lower target lesion revascularization of 10.0% as compared to 53.4% (P < 0.001). There was only one late reocclusion with Taxus (1.7%) as compared to 21.7% with BMS (P < 0.05). However, in the hybrid group, the MACE rate was considerably higher, with 33.3%. Our data of a 80% reduction of target vessel failure as compared to BMS, with a lower risk of late reocclusions without increased acute adverse events, demonstrate the benefit of paclitaxel-eluting stents in CTOs. However, diffuse atherosclerosis in CTOs should be covered completely by the drug-eluting stents.

Aged↗

PubMed2006

A novel approach to chronic total occlusions: the crosser system.

OBJECTIVES: To evaluate safety and efficacy of the CROSSER CTO Recanalization System (CROSSER). BACKGROUND: The CROSSER, a novel device dedicated to recanalization of chronic total occlusions (CTO), relies on a monorail catheter delivering vibrational energy to facilitate the crossing of occluded coronary arteries. METHODS: We included de novo or restenotic occlusions in native coronary arteries with typically unfavorable characteristics and a prior failed guidewire attempt either performed in a previous procedure or just before the usage of the CROSSER. The end points analyzed were technical success (ability to cross or facilitate a guidewire crossing into the true lumen), angiographic success (<20% residual stenosis and TIMI flow grade 3), and clinical success (angiographic success and freedom from major adverse cardiac events at 30 days). RESULTS: Twenty-eight patients (30 lesions) were included. The morphology was blunt in 83.3% and the length of the occlusion was >20 mm in 76.6%. The median age of the CTO was 9 months (range 3-60 months). Technical success was obtained in 19 (63%) occlusions and angiographic success in 16 (53%): 26.3% in lesions with prior procedural failure and 73.7% when CROSSER was attempted after initial guidewire failure. Complications were: one guidewire perforation without consequences and one peri-procedural myocardial infarction (MI). No events occurred within 30-day follow-up after discharge. CONCLUSIONS: In our experience, the CROSSER System is safe and increases the success of opening CTO refractory to guidewires. This novel device may represent an useful adjunct to the armamentarium of the interventional cardiologist.

Aged↗

PubMed1985

Role of coronary spasm in the genesis of myocardial infarction: study of a case treated by isosorbide dinitrate in situ then by transluminal angioplasty.

We report the observation of a 62-year-old patient who was admitted for unstable angina. A prolonged chest pain (more than two hours) with a major electrocardiographic lesion in the posterior leads needed an urgent coronary arteriography in order to attempt a recanalization. Antecedents of arteriopathy of the lower limbs with aortobifemoral bypass required an axillary artery right side approach. A selective right coronary opacification showed complete occlusion at the junction of segments 1 and 2. An intracoronary injection of isosorbide dinitrate relieved a coronary spasm and allowed a complete visualization of the right coronary artery. This appeared to be very atherosclerotic with several severe narrowings, and a subocclusive lesion at the site of the initial occlusion. Percutaneous transluminal coronary angioplasties (PTCA) were performed and led to real 'restructuring' of the right coronary artery. The clinical outcome was excellent without recurrent angina pectoris. An angiographic control performed 6 months after PTCA demonstrated the persistence of the coronary recanalization and an evident improvement of the segmental contractility. This report emphasizes the role of coronary spasm in the genesis of myocardial infarction and shows that PTCA may be performed as a first approach at the acute phase of myocardial infarction; to our knowledge it is the first PTCA performed by an axillary approach at the acute stage of myocardial infarction.

Angina Pectoris, Variant↗

PubMed1987

Thrombolysis of acute total occlusion of the left main coronary artery and long-term survival.

A young woman was admitted with acute anterior myocardial infarction. Emergency coronary angiography showed a total occlusion of the LMCA. Selective infusion of streptokinase recanalized the left main coronary artery (LMCA), the circumflex artery, and the first diagonal, but not the entire left anterior descending artery (LAD). The right coronary artery was dominant and normal. The left-sided congestive heart failure was severe; treatment improved the heart failure and the patient was discharged on Day 25. She was readmitted for control 28 months later: she was only moderately disabled and coronary angiography showed the same occlusion of the LAD; result on ejection fraction (right anterior oblique view 30 degrees) was not significant, but circumflex artery recanalization probably preserved lateral wall contraction. The presence of a normal dominant right coronary artery seems to be a very important factor in contributing to initial survival.

Adult↗

PubMed1988

Preventive effects of batroxobin on experimental canine coronary thrombosis.

The thrombolytic effects of urokinase (UK) and preventive effects of batroxobin, heparin, and aspirin on the recurrence of thrombosis in the coronary artery were studied in 118 anesthetized dogs with severe endothelial denudation and luminal stenosis of the coronary artery. Occlusive thrombi developed in 68 (58%) preparations (dogs), accompanied by a decrease of coronary blood flow and pressure, an electrocardiographic ST elevation, and epicardial cyanosis. An intravenous infusion of 20,000 IU/kg of UK reopened the occluded coronary artery in all 32 preparations with 1-h-old thrombi, in 6 (86%) of 7 preparations with 2-h-old thrombi, and in 5 (83%) of 6 preparations with 3-h-old thrombi. However, recanalization was not observed in preparations with thrombi more than 4-h-old. Occlusion recurred within 6 h after recanalization in 2 (18%) of 18 preparations pretreated with batroxobin (1-2 BU/kg) (p less than .005 vs. control UK group), in 1 (14%) of 7 preparations administered a continuous infusion of 30 U/kg per h of heparin (p less than .05 vs. control UK group), in 4 (57%) of 7 preparations pretreated with 2 mg/kg of aspirin, and in 7 (64%) of 11 preparations not pretreated (control UK group). Complete prevention was observed only in the group administered 2 BU/kg of batroxobin. Histologically, these thrombi closely simulated clinical arterial thrombi. Myocardial hemorrhage and contraction band necrosis were observed in the reperfused hearts. In conclusion, experimental canine coronary thrombi more than 4-h-old were resistant to thrombolytic therapy, and batroxobin and heparin were effective in the prevention of coronary reocclusion.

Animals↗

PubMed1988

Detection of myocardial reperfusion by analysis of serum creatine kinase isoforms.

Serum creatine kinase (CK) MM isoforms were determined by chromatofocusing in 22 patients with acute myocardial infarction undergoing intracoronary thrombolysis. In 13 patients with successful coronary recanalization within 3.6 +/- 1.0 (SD) h after onset, time to peak CK activity occurred 13 +/- 3 h after onset which was significantly shorter (p less than 0.01) than that in 9 patients without coronary recanalization (20 +/- 4 h). The proportion of CK MM-A, the myocardial isoform, in serum in the reperfused group at 6, 10, and 14 h after onset (53 +/- 9, 38 +/- 5, and 27 +/- 4%, respectively) was always significantly lower (p less than 0.01) than that in the nonreperfused group (69 +/- 7, 59 +/- 8, and 43 +/- 4%). During the same period, the proportions of CK MM-B and CK MM-C, the converted isoforms derived intravascularly from MM-A by circulating carboxypeptidase, in the reperfused group were always significantly higher (p less than 0.01) than those in the nonreperfused group. The ratios of MM-A% to MM-B% and MM-A% to MM-C% amplified the differences between the two groups. At 10 h after onset, these ratios clearly differentiated the reperfused and the nonreperfused group at the values of 1.0 (MM-A/MM-B) and 3.0 (MM-A/MM-C) with the diagnostic sensitivity of 85% and 92%, respectively. Thus, myocardial reperfusion was detectable noninvasively by analysis of serum CK MM isoforms during the early stage of acute myocardial infarction.

Aged↗