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1.
Mov Ecol ; 10(1): 47, 2022 Nov 10.
Article in English | MEDLINE | ID: mdl-36357952

ABSTRACT

Reintroduced animals-especially those raised in captivity-are faced with the unique challenge of navigating a wholly unfamiliar environment, and often make erratic or extensive movements after release. Naïveté to the reintroduction landscape can be costly, e.g., through increased energy expenditure, greater exposure to predation, and reduced opportunities to forage. Integration with an extant population may provide opportunities for social information transfer. However, in the absence of interactions with residents, it is unclear how individual and social learning may affect an animal's ability to track resources in an unfamiliar landscape. We use integrated step selection functions (iSSFs) to address these knowledge gaps, by evaluating the extent to which environmental factors, individual experience (time since release), and social information-sharing (group size) influence movement decisions by scimitar-horned oryx (Oryx dammah) reintroduced into their native range for the first time in ca. 30 years. We found that both experience and social factors influenced the habitat selection and movement behavior of reintroduced oryx. Of four candidate iSSFs, the model that included environmental, experience, and group size variables performed best in both dry and wet periods. Statistically significant interaction terms between environmental variables and experience were generally larger than similar terms for group size, indicating that experience may affect habitat selection by reintroduced oryx more strongly than social factors. These findings may inform the management of recovering wildlife populations, update widely-held expectations about how released ungulates acclimate to novel landscapes, and demonstrate the utility of long-term monitoring of reintroduced populations.

2.
Mov Ecol ; 10(1): 6, 2022 Feb 05.
Article in English | MEDLINE | ID: mdl-35123584

ABSTRACT

CONTEXT: Asian elephant numbers are declining across much of their range driven largely by serious threats from land use change resulting in habitat loss and fragmentation. Myanmar, holding critical range for the species, is undergoing major developments due to recent sociopolitical changes. To effectively manage and conserve the remaining populations of endangered elephants in the country, it is crucial to understand their ranging behavior. OBJECTIVES: Our objectives were to (1) estimate the sizes of dry, wet, and annual ranges of wild elephants in Myanmar; and quantify the relationship between dry season (the period when human-elephant interactions are the most likely to occur) range size and configurations of agriculture and natural vegetation within the range, and (2) evaluate how percentage of agriculture within dry core range (50% AKDE range) of elephants relates to their daily distance traveled. METHODS: We used autocorrelated kernel density estimator (AKDE) based on a continuous-time movement modeling (ctmm) framework to estimate dry season (26 ranges from 22 different individuals), wet season (12 ranges from 10 different individuals), and annual range sizes (8 individuals), and reported the 95%, 50% AKDE, and 95% Minimum Convex Polygon (MCP) range sizes. We assessed how landscape characteristics influenced range size based on a broad array of 48 landscape metrics characterizing aspects of vegetation, water, and human features and their juxtaposition in the study areas. To identify the most relevant landscape metrics and simplify our candidate set of informative metrics, we relied on exploratory factor analysis and Spearman's rank correlation coefficient. Based on this analysis we adopted a final set of metrics into our regression analysis. In a multiple regression framework, we developed candidate models to explain the variation in AKDE dry season range sizes based on the previously identified, salient metrics of landscape composition. RESULTS: Elephant dry season ranges were highly variable averaging 792.0 km2 and 184.2 km2 for the 95% and 50% AKDE home ranges, respectively. We found both the shape and spatial configuration of agriculture and natural vegetation patches within an individual elephant's range play a significant role in determining the size of its range. We also found that elephants are moving more (larger energy expenditure) in ranges with higher percentages of agricultural area. CONCLUSION: Our results provide baseline information on elephant spatial requirements and the factors affecting them in Myanmar. This information is important for advancing future land use planning that takes into account space-use requirements for elephants. Failing to do so may further endanger already declining elephant populations in Myanmar and across the species' range.

3.
Ecol Appl ; 28(4): 1003-1010, 2018 06.
Article in English | MEDLINE | ID: mdl-29450936

ABSTRACT

Home-range estimation is an important application of animal tracking data that is frequently complicated by autocorrelation, sampling irregularity, and small effective sample sizes. We introduce a novel, optimal weighting method that accounts for temporal sampling bias in autocorrelated tracking data. This method corrects for irregular and missing data, such that oversampled times are downweighted and undersampled times are upweighted to minimize error in the home-range estimate. We also introduce computationally efficient algorithms that make this method feasible with large data sets. Generally speaking, there are three situations where weight optimization improves the accuracy of home-range estimates: with marine data, where the sampling schedule is highly irregular, with duty cycled data, where the sampling schedule changes during the observation period, and when a small number of home-range crossings are observed, making the beginning and end times more independent and informative than the intermediate times. Using both simulated data and empirical examples including reef manta ray, Mongolian gazelle, and African buffalo, optimal weighting is shown to reduce the error and increase the spatial resolution of home-range estimates. With a conveniently packaged and computationally efficient software implementation, this method broadens the array of data sets with which accurate space-use assessments can be made.


Subject(s)
Ecology/methods , Algorithms , Animal Distribution , Animals , Buffaloes , Female , Movement , Skates, Fish
4.
Ecology ; 97(3): 576-82, 2016 Mar.
Article in English | MEDLINE | ID: mdl-27197385

ABSTRACT

An animal's trajectory is a fundamental object of interest in movement ecology, as it directly informs a range of topics from resource selection to energy expenditure and behavioral states. Optimally inferring the mostly unobserved movement path and its dynamics from a limited sample of telemetry observations is a key unsolved problem, however. The field of geostatistics has focused significant attention on a mathematically analogous problem that has a statistically optimal solution coined after its inventor, Krige. Kriging revolutionized geostatistics and is now the gold standard for interpolating between a limited number of autocorrelated spatial point observations. Here we translate Kriging for use with animal movement data. Our Kriging formalism encompasses previous methods to estimate animal's trajectories--the Brownian bridge and continuous-time correlated random walk library--as special cases, informs users as to when these previous methods are appropriate, and provides a more general method when they are not. We demonstrate the capabilities of Kriging on a case study with Mongolian gazelles where, compared to the Brownian bridge, Kriging with a more optimal model was 10% more precise in interpolating locations and 500% more precise in estimating occurrence areas.


Subject(s)
Antelopes/physiology , Models, Biological , Motor Activity/physiology , Animals , Telemetry
5.
Ecology ; 96(5): 1182-8, 2015 May.
Article in English | MEDLINE | ID: mdl-26236833

ABSTRACT

Quantifying animals' home ranges is a key problem in ecology and has important conservation and wildlife management applications. Kernel density estimation (KDE) is a workhorse technique for range delineation problems that is both statistically efficient and nonparametric. KDE assumes that the data are independent and identically distributed (IID). However, animal tracking data, which are routinely used as inputs to KDEs, are inherently autocorrelated and violate this key assumption. As we demonstrate, using realistically autocorrelated data in conventional KDEs results in grossly underestimated home ranges. We further show that the performance of conventional KDEs actually degrades as data quality improves, because autocorrelation strength increases as movement paths become more finely resolved. To remedy these flaws with the traditional KDE method, we derive an autocorrelated KDE (AKDE) from first principles to use autocorrelated data, making it perfectly suited for movement data sets. We illustrate the vastly improved performance of AKDE using analytical arguments, relocation data from Mongolian gazelles, and simulations based upon the gazelle's observed movement process. By yielding better minimum area estimates for threatened wildlife populations, we believe that future widespread use of AKDE will have significant impact on ecology and conservation biology.


Subject(s)
Animal Distribution/physiology , Homing Behavior/physiology , Models, Biological , Animals , Antelopes/physiology , Computer Simulation , Data Interpretation, Statistical , Ecosystem , Models, Statistical , Movement
6.
Environ Monit Assess ; 74(2): 141-66, 2002 Mar.
Article in English | MEDLINE | ID: mdl-11878640

ABSTRACT

Landscape structure in a forest mosaic changes with spatial scale (i.e. spatial extent) and thresholds may occur where structure changes markedly. Forest management alters landscape structure and may affect the intensity and location of thresholds. Our purpose was to examine landscape structure at different scales to determine thresholds where landscape structure changes markedly in managed forest mosaics of the Appalachian Mountains in the eastern United States. We also investigated how logging influences landscape structure and whether these management activities change threshold values. Using threshold and autocorrelation analyses, we found that thresholds in landscape indices exist at 400, 500, and 800 m intervals from the outer edge of management units in our study region. For landscape indices that consider all landcover categories, such as dominance and contagion, landscape structure and thresholds did not change after logging occurred. Measurements for these overall landscape indices were strongly influenced by midsuccessional deciduous forest, the most common landcover category in the landscape. When restricting analyses for mean patch size and percent cover to individual forest types, thresholds for early-successional forests changed after logging. However, logging changed the landscape structure at small spatial scale, but did not alter the structure of the entire forest mosaic. Previous forest management may already have increased the heterogeneity of the landscape beyond the point where additional small cuts alter the overall structure of the forest. Because measurements for landscape indices yield very different results at different spatial scales, it is important first to identify thresholds in order to determine the appropriate scales for landscape ecological studies. We found that threshold and autocorrelation analyses were simple but powerful tools for the detection of appropriate scales in the managed forest mosaic under study.


Subject(s)
Environmental Monitoring , Forestry , Trees , Population Dynamics , United States
7.
Lancet ; 355(9222): 2199-203, 2000 Jun 24.
Article in English | MEDLINE | ID: mdl-10881893

ABSTRACT

BACKGROUND: Whether routine implantation of coronary stents is the best strategy to treat flow-limiting coronary stenoses is unclear. An alternative approach is to do balloon angioplasty and provisionally use stents only to treat suboptimum results. We did a multicentre trial to compare the outcomes of patients treated with these strategies. METHODS: We randomly assigned 479 patients undergoing single-vessel coronary angioplasty routine stent implantation or initial balloon angioplasty and provisional stenting. We followed up patients for 6 months to determine the composite rate of death, myocardial infarction, cardiac surgery, and target-vessel revascularisation. RESULTS: Stents were implanted in 227 (98.7%) of the patients assigned routine stenting. 93 (37%) patients assigned balloon angioplasty had at least one stent placed because of suboptimum angioplasty results. At 6 months the composite endpoint was significantly lower in the routine stent strategy (14 events, 6.1%) than with the strategy of balloon angioplasty with provisional stenting (37 events, 14.9%, p=0.003). The cost of the initial revascularisation procedure was higher than when a routine stent strategy was used (US$389 vs $339, p<0.001) but at 6 months, average per-patient hospital costs did not differ ($10,206 vs $10,490). Bootstrap replication of 6-month cost data showed continued economic benefit of the routine stent strategy. INTERPRETATION: Routine stent implantation leads to better acute and long-term clinical outcomes at a cost similar to that of initial balloon angioplasty with provisional stenting.


Subject(s)
Angioplasty, Balloon, Coronary , Coronary Disease/therapy , Stents , Adult , Aged , Aged, 80 and over , Angioplasty, Balloon, Coronary/economics , Cardiac Surgical Procedures , Chi-Square Distribution , Female , Follow-Up Studies , Health Care Costs , Hospital Costs , Humans , Male , Middle Aged , Myocardial Infarction/etiology , Proportional Hazards Models , Quality of Life , Retreatment , Stents/economics , Survival Rate , Treatment Outcome
8.
Circulation ; 76(4): 792-801, 1987 Oct.
Article in English | MEDLINE | ID: mdl-2958172

ABSTRACT

The transstenotic pressure gradient recorded during coronary angioplasty (PTCA) reflects the dynamic relationship that exists between coronary blood flow and the effective cross-sectional area of the arterial lumen. An apparent relationship between the dynamic behavior of the pressure gradient and subsequent acute vessel closure was observed in our catheterization laboratory. We therefore examined the usefulness of the pressure gradient trend in predicting acute complications after 463 attempted PTCA procedures. Two pressure gradient trend patterns were identified: (1) a rising trend pattern identified by an increasing pressure gradient in the interval after deflation of the angioplasty, and (2) a stable trend pattern identified by a constant or decreasing pressure gradient. The incidence of acute vessel closure (17% vs 4%, p = .0001), emergency CABG (5.6% versus 1%, p less than .05), and myocardial infarction (13% versus 2%, p less than .0001) after the PTCA procedure was significantly higher among patients with rising trend patterns when compared with patients with stable trend patterns. Multivariate analysis identified independent predictors for an acute closure event as rising trend pattern (p less than .001), post-PTCA gradient (p less than .05), and post-PTCA percent diameter stenosis (p less than .02). Independent predictors for emergency coronary artery bypass grafting and myocardial infarction were post-PTCA gradient (p less than .001) and a rising trend pattern (odds ratio = 2.91, p less than .001), respectively. The dynamic behavior of the gradient trend provides additional useful information about the results of dilatation.(ABSTRACT TRUNCATED AT 250 WORDS)


Subject(s)
Angioplasty, Balloon/adverse effects , Coronary Disease/therapy , Coronary Vessels/physiopathology , Acute Disease , Aged , Coronary Angiography , Coronary Disease/diagnostic imaging , Coronary Disease/physiopathology , Female , Humans , Male , Middle Aged , Myocardial Infarction/etiology , Pressure , Prognosis , Risk Factors
9.
J Am Coll Cardiol ; 9(6): 1214-8, 1987 Jun.
Article in English | MEDLINE | ID: mdl-2953771

ABSTRACT

Over a 5 year period at three centers, 53 patients underwent percutaneous transluminal angioplasty of a right coronary artery ostial stenosis. The procedure was successful in 42 patients (79%) and unsuccessful in 11, of whom 5 (9.4%) required emergency coronary artery bypass grafting because of abrupt closure. The right coronary ostial lesion had distinctive technical requirements to achieve success, including high pressure balloon inflation (10 +/- 4 atm) and the need for unconventional right coronary guide catheters. Technical factors that account for increased difficulty in these patients include: problems with guide catheter impaction and ostial trauma; inability to inflate the balloon with adequate guide catheter support; and need for increased intracoronary manipulation. The stenoses were quite discrete (4 +/- 5 mm) and calcified in the majority (40) of the 53 patients. Long-term follow-up (mean 12.5 months, range 4 to 60) of these patients demonstrated clinical recurrence of angina in 20 patients (48%) and angiographically proved restenosis in 16 (38%). Repeat coronary angioplasty was successful in three of six patients for relief of symptoms for over 6 months. In conclusion, angioplasty of the right coronary ostial lesion compared with nonostial dilation leads to a suboptimal early success rate; an apparent high risk of emergency bypass surgery; and a high restenosis rate. Careful assessment of the patient with this lesion and improved technology appear to be warranted.


Subject(s)
Angioplasty, Balloon/standards , Coronary Disease/therapy , Angiography , Angioplasty, Balloon/adverse effects , Clinical Trials as Topic , Coronary Artery Bypass , Coronary Disease/diagnostic imaging , Coronary Disease/surgery , Follow-Up Studies , Humans , Recurrence
10.
Am Heart J ; 113(1): 37-48, 1987 Jan.
Article in English | MEDLINE | ID: mdl-3799440

ABSTRACT

Intracoronary delivery of argon laser energy was studied in eight anesthetized mongrel dogs. A No. 4.5 French single lumen catheter, with steerable guidewire and an optical fiber, was introduced through a Judkins-type femoral-coronary guiding catheter into three left anterior descending and eight left circumflex coronary arteries. A total of 65 laser energy exposures were made coaxially at 24 sites in the 11 arteries. At five sites, angiographically evident arterial perforation occurred with the first laser exposure, while at seven sites multiple laser exposures were made without angiographically evident perforation. All eight dogs remained hemodynamically stable, and were electively killed 5 +/- 1 hours following the procedure. Sections of myocardium from territories supplied by treated arteries demonstrated minimal or no pathology in 10 cases, while one territory had a small zone of early myocardial necrosis. This study suggests that standard coronary artery catheterization techniques can be used to introduce and position a steerable guidewire and an optical fiber in canine coronary arteries. Laser energy can repeatedly be delivered coaxially. Short-term deleterious effects may be reduced or eliminated, and exposure of blood elements to argon laser energy does not appear to create debris.


Subject(s)
Cardiac Catheterization/methods , Lasers/adverse effects , Animals , Coronary Vessels/injuries , Coronary Vessels/pathology , Dogs , Heart Injuries/etiology , Male
12.
J Am Coll Cardiol ; 8(6): 1271-6, 1986 Dec.
Article in English | MEDLINE | ID: mdl-2946740

ABSTRACT

This double-blind, randomized study evaluated the effect of nifedipine on restenosis after coronary angioplasty. Two hundred forty-one patients with dilation of 271 coronary sites were randomized at the time of hospital discharge to receive nifedipine, 10 mg (123 patients), or placebo (118 patients) four times daily for 6 months. No patient was known to have coronary artery spasm. The mean duration of therapy was 4.4 +/- 2 (mean +/- SD) months for nifedipine and 4.3 +/- 2 months for placebo. A restudy angiogram was available in 100 patients (81%) in the nifedipine group and 98 patients (83%) in the placebo group. A recurrent coronary stenosis was noted in 28% of patients in the nifedipine group and in 29.5% of those in the placebo group (p = NS). The mean diameter stenosis was 36.4 +/- 23% for the nifedipine group and 36.7 +/- 23% for the placebo group (p = NS). By pill count, 78% of patients receiving nifedipine and 82% of those receiving placebo complied with the study drug regimen. Coronary stenosis recurred in 33% of patients in the placebo group and in 29% of patients in the nifedipine group who complied with the regimen and had angiograms (p = NS). In conclusion, the study did not demonstrate a significant beneficial effect of nifedipine on the incidence of recurrent stenosis after successful percutaneous transluminal coronary angioplasty.


Subject(s)
Angioplasty, Balloon , Coronary Disease/therapy , Nifedipine/therapeutic use , Adult , Aged , Coronary Disease/prevention & control , Humans , Middle Aged , Nifedipine/administration & dosage , Nifedipine/adverse effects , Patient Compliance , Recurrence , Time Factors
14.
Circulation ; 73(6): 1223-30, 1986 Jun.
Article in English | MEDLINE | ID: mdl-2938848

ABSTRACT

Obstruction to blood flow is accompanied by a pressure gradient across the obstructed site. In certain clinical settings, magnitude of pressure gradient has been used to judge severity of obstruction, and gradient reduction to judge success of an interventional procedure. In percutaneous transluminal coronary angioplasty (PTCA) the relationships between transstenotic pressure gradient, diameter stenosis, and lesion length are imprecisely known. We therefore examined 4263 sets of measurements in patients who underwent PTCA on single, discrete coronary arterial lesions. Multivariate regression analysis demonstrated that pressure gradient was artifactually elevated by about 12 mm Hg at low values of diameter stenosis but increased by the 4th power of stenosis as expected from fluid dynamics models. Pressure gradient was dampened and relatively constant at values of diameter stenosis of 60% or higher, probably because of total or near-total occlusion of the artery. Lesion length was not found to influence pressure gradient. Reductions in diameter stenosis (delta D) and pressure gradient (delta G) were related nonlinearly, with delta D proportional to the square root of delta G, suggesting that a reduction in gradient is directly proportional to an increase in cross-sectional area of the stenosis. The predictive value of final post-PTCA pressure gradients was found: a final gradient of 15 mm Hg or less predicted a final post-PTCA diameter stenosis of 30% or less, with 75% sensitivity and 29% specificity (p less than .01). The results of this study suggest that (1) pressure gradient as currently measured during PTCA is related to diameter stenosis but not to lesion length (2) reductions in pressure gradient and diameter stenosis are nonlinearly related.(ABSTRACT TRUNCATED AT 250 WORDS)


Subject(s)
Angioplasty, Balloon , Arterial Occlusive Diseases/physiopathology , Blood Pressure , Coronary Disease/physiopathology , Arterial Occlusive Diseases/diagnostic imaging , Arterial Occlusive Diseases/therapy , Coronary Angiography , Coronary Disease/diagnostic imaging , Coronary Disease/therapy , Coronary Vessels/physiopathology , Humans , Postoperative Period , Regression Analysis
15.
Am Heart J ; 111(6): 1065-72, 1986 Jun.
Article in English | MEDLINE | ID: mdl-3716979

ABSTRACT

Imprecision in guiding and positioning is a recurring problem with fiberoptic delivery of laser energy (E) in small arteries. Manipulation can produce mechanical perforation of the vessel, and noncoaxial alignment can result in thermal perforation at relatively low laser energy levels. A No. 4.5 French single-lumen catheter was designed to accommodate both a steerable guidewire and an optical fiber. It was passed, under fluoroscopic control, into the abdominal aorta in 18 atherosclerotic rabbits. Argon laser energy was delivered coaxially at three sites in each of 14 rabbits (total = 42 sites); four rabbits were controls. Laser power levels (1 to 6 W) and exposure times (20 to 60 seconds) were varied. Energy level in joules (J) was calculated for each exposure. Saline flush at 25 ml/min was delivered through the catheter during laser exposures. Angiographic or microscopic evidence of vessel perforation was observed at 10 sites (E = 174 +/- 108 J). Another six sites exhibited microscopic laser effect only, without evidence of vessel perforation (E = 155 +/- 91 J). The remaining 26 sites exhibited no effects of laser energy (E = 117 +/- 92 J). No angiographically visible perforation occurred with E less than 120 J. This study suggests that a fiberoptic catheter with steerable guidewire allows safer intravascular manipulation of optical fibers, improves coaxial alignment in the arterial lumen, and may permit substantial laser energy delivery into atherosclerotic arteries.


Subject(s)
Aortic Diseases/surgery , Arteriosclerosis/surgery , Laser Therapy , Animals , Aorta/pathology , Aortography , Catheterization/methods , Cineangiography , Diet, Atherogenic , Disease Models, Animal , Endothelium/pathology , Fiber Optic Technology , Optical Fibers , Rabbits , Time Factors
17.
Circulation ; 73(4): 710-7, 1986 Apr.
Article in English | MEDLINE | ID: mdl-2936532

ABSTRACT

To determine risk factors for restenosis, we studied 998 patients who underwent elective coronary angioplasty (PTCA) to native coronary arteries between July 1980 and July 1984. Restenosis, defined as a luminal narrowing of greater than 50% at follow-up, was present in 302 patients (30.2%). Univariate analysis of 29 factors revealed seven factors related to restenosis: vessel dilated (circumflex coronary artery 18%, right coronary artery 27%, left anterior descending artery 34%; p less than .01), final gradient of 15 mm Hg or less compared with greater than 15 mm Hg (27% vs 38%, p less than .01), duration of angina greater than 2 months compared with angina of shorter duration (27% vs 35%, p = .01), post-PTCA stenosis of 30% or less compared with 31% to 50% (28% vs 36%, p less than .025), stable vs unstable angina (26% vs 34%, p less than .05), presence vs absence of intimal dissection (26% vs 32%, p = .07), and female gender vs male gender (25% vs 32%, p = .08). Multivariate analysis revealed five factors independently related to increased risk of restenosis in the following order of importance: PTCA in the left anterior descending artery, absence of intimal dissection immediately after PTCA, final gradient greater than 15 mm Hg, a large residual stenosis after PTCA, and unstable angina. Restenosis after PTCA is a multifactorial problem. The hemodynamic and angiographic result at the time of PTCA significantly influences long-term outcome, but additional measures aimed at reducing the rate of recurrence of atherosclerotic plaque are required.


Subject(s)
Coronary Disease/therapy , Adult , Aged , Angioplasty, Balloon , Constriction, Pathologic/etiology , Female , Humans , Male , Middle Aged , Risk
19.
Circulation ; 72(5): 1044-52, 1985 Nov.
Article in English | MEDLINE | ID: mdl-2931211

ABSTRACT

We prospectively recorded all in-hospital complications of the first 3500 consecutive patients to undergo elective coronary angioplasty (PTCA) at Emory University Hospitals from July 14, 1980, to August 28, 1984, by three operators. PTCA was attempted in a total of 3933 lesions, with a primary success rate of 91%. Multiple-lesion PTCA was performed in 401 patients, and PTCA of saphenous vein grafts was attempted in 172. No complications were recorded in 3116 (89%) cases, isolated minor complications occurred in 241 (6.9%), and major complications (emergency surgery, myocardial infarction, death) were observed in 145 (4.1%). Emergency coronary artery bypass graft surgery (CABG) was performed in 96 patients (2.7%), with a myocardial infarction rate of 49% (47/96), a Q wave infarction rate of 23% (22/96), and an emergency surgery mortality rate of 2% (2/96). Hospital discharge occurred within 2 weeks of attempted PTCA in 91% (87/96) of patients undergoing emergency CABG. The overall myocardial infarction rate was 2.6% (94/3500). There were two nonsurgical deaths, giving a total mortality rate of 0.1% (4/3500). Univariate and multivariate analysis of 3099 patients undergoing single-lesion PTCA identified five preprocedure predictors of a major complication: multivessel coronary disease, lesion eccentricity, presence of calcium in the lesion, female gender, and lesion length. Unstable angina, duration of angina, lesion severity, previous CABG, and vein graft dilatation were not associated with an increased incidence of major complications. The strongest predictor of a major complication was the procedural appearance of an intimal dissection. Intimal dissection was evident in 894/3099 (29%) patients.(ABSTRACT TRUNCATED AT 250 WORDS)


Subject(s)
Angioplasty, Balloon/mortality , Coronary Disease/therapy , Coronary Artery Bypass , Female , Hospitals , Humans , Male , Middle Aged , Postoperative Complications
20.
Am J Cardiol ; 56(12): 712-7, 1985 Nov 01.
Article in English | MEDLINE | ID: mdl-2932902

ABSTRACT

Three distinct periods in catheter design have been identified since the advent of percutaneous transluminal coronary angioplasty (PTCA) in 1977. In the first period PTCA was performed using a double-lumen balloon catheter that had a fixed, flexible guidewire at the tip. In the second period, an independent, steerable guidewire and the steerable catheter system were used. In the third period, low-profile catheters were introduced. A total of 2,969 patients who had single-vessel PTCA of a native coronary artery was separated into groups according to the period during which PTCA was performed. Introduction of the steerable catheter system was accompanied by improvement in primary success rate in PTCA attempts on the right coronary artery (78% vs 88%, p less than 0.005). Introduction of the low-profile catheter was accompanied by improved primary success in PTCA attempts on the left anterior descending coronary artery (LAD) (90% vs 94%, p less than 0.005). The percentage of PTCA attempts on the LAD decreased over the 3 periods (70% to 60% to 56%), while the percentage of attempts on the left circumflex artery increased (7% to 12% to 16%). Before steerable and low-profile catheters were used, there were significant differences in ability to reach and cross stenoses among the 3 major coronary arteries. These differences no longer exist. These results indicate that technical improvements and operator experience have made stenoses in all 3 major coronary arteries equally accessible to dilatation catheters and that primary success rates and reasons for failure in these arteries are now similar.


Subject(s)
Angioplasty, Balloon , Coronary Disease/therapy , Angiography , Angioplasty, Balloon/methods , Cardiac Catheterization , Coronary Disease/diagnostic imaging , Humans
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