ABSTRACT
Catheter balloon angioplasty is a well accepted form of nonsurgical treatment of acutely and chronically obstructed coronary artery vessels. It is also the centerpiece for various new intervention techniques. Their morphologic effect on the site of obstruction has been termed "remodeling." Part V of this six-part series focuses on remodeling effects of balloon angioplasty on obstructed young (< or = 1 year) and old (> 1 year) saphenous vein bypass grafts.
Subject(s)
Angioplasty, Balloon, Coronary , Graft Occlusion, Vascular/therapy , Saphenous Vein/pathology , Arteriosclerosis/pathology , Arteriosclerosis/therapy , Atherectomy , Coronary Artery Bypass , Coronary Disease/pathology , Coronary Disease/therapy , Graft Occlusion, Vascular/pathology , Humans , Recurrence , Saphenous Vein/transplantation , StentsABSTRACT
The late angiographic outcome of the Gianturco-Roubin intracoronary stent has not been well defined. To investigate serial changes within the stent, we studied 23 patients (15 men and 8 women, median age 63) who had late angiographic follow-up ( > 1 year) after undergoing Gianturco-Roubin stenting for angioplasty-associated acute or threatened native coronary artery closure. Coronary angiography before and after stenting, at 6-month follow-up, and at late return was analyzed with quantitative coronary angiography. The median time from stent deployment to late angiographic follow-up was 27 months. As expected, stenting significantly increased the median minimal lumen diameter (MLD) acutely from 1.0 to 2.46 mm. Median percent diameter stenosis decreased from 66% to 18%. Although at 6 months there was a significant loss of the acute gain (median MLD decreased from 2.46 to 1.9 mm), with a corresponding increase in percent stenosis from 18% to 31%, late angiography demonstrated lesion regression, median MLD increasing from 1.9 to 2.15 mm (p = 0.004), and percent stenosis decreasing from 31% to 21% (p = 0.0026). No patient had a significant decline in minimal lesion diameter, and 5 patients had a > 50% increase in MLD at late follow-up. Linear regression analysis of 6-month MLD and late lumen gain suggested that lesions with the greatest regression were those with the lowest lumen diameters at 6-month angiography. Late angiographic analysis demonstrated significant lesion regression within the Gianturco-Roubin stent, which was sometimes dramatic. In suggesting that coronary arteriography at 6 months may underestimate the late angiographic benefit of intracoronary stenting, these data have important clinical implications, and imply that patients with a stable clinical course and angiographic stent restenosis may often be followed rather than routinely redilated.
Subject(s)
Coronary Disease/therapy , Coronary Vessels , Stents , Angioplasty, Balloon, Coronary , Constriction, Pathologic/diagnostic imaging , Constriction, Pathologic/therapy , Coronary Angiography , Coronary Disease/diagnostic imaging , Female , Follow-Up Studies , Humans , Linear Models , Male , Middle Aged , RecurrenceABSTRACT
This article demonstrates a method for evaluating the predictive validity of nursing home pre-admission screens (PAS) by using measures of predictive validity adapted from the field of epidemiology. Our approach estimates how well as PAS performs in identifying the "who but for" population of the Medicaid home and community-based services waiver programs for the frail elderly. The methodology's usefulness in screen revision is also illustrated.
Subject(s)
Eligibility Determination/statistics & numerical data , Geriatric Assessment , Homes for the Aged/statistics & numerical data , Medicaid/statistics & numerical data , Nursing Homes/statistics & numerical data , Activities of Daily Living , Aged , Connecticut , Eligibility Determination/standards , Epidemiologic Methods , Female , Forecasting , Frail Elderly , Homes for the Aged/economics , Humans , Male , Nursing Homes/economics , Reproducibility of Results , United StatesABSTRACT
In the last 15 years, intense interest has focused on various interventional pharmacologic and mechanical forms of therapy for the treatment of atherosclerosis coronary artery disease. Many techniques and devices (dilating balloons, perfusion catheters, thermal probes and balloons, lasers, atherectomy devices, stents, intravascular ultrasound) have been used or are under study for future use. Many of these techniques and devices require an understanding of histologic and pathologic features of the coronary arteries and diseases which affect them. This article reviews selective areas of anatomy, histology, and pathology relevant to the use of various new interventional techniques. Part IV of this review will focus on congenital coronary artery anomalies, myocardial bridges, coronary aneurysm, emboli, and dissection and clinical implications regarding echocardiographic imaging techniques.
Subject(s)
Coronary Disease/diagnosis , Coronary Vessels/anatomy & histology , Coronary Vessels/pathology , Coronary Aneurysm/diagnosis , Coronary Vessel Anomalies/diagnosis , Echocardiography , HumansABSTRACT
In the last 15 years, intense interest has focused on various interventional, pharmacologic, and mechanical forms of therapy for the treatment of atherosclerotic coronary artery disease. Many techniques and devices (dilating balloons, perfusion catheters, thermal probes and balloons, lasers, atherectomy devices, stents, intravascular ultrasound) have been used or are under study for future use. Many of these techniques and devices require an understanding of histologic and pathologic features of the coronary arteries and diseases which affect them. This article reviews selective areas of anatomy, histology, and pathology relevant to the use of various new interventional techniques. Part III of this four-part review focuses on eccentric and concentric plaques, formation of coronary thrombus, and status of the "infarct artery" after mechanical and pharmacologic forms of acute reperfusion therapy.
Subject(s)
Coronary Artery Disease/pathology , Coronary Vessels/pathology , Diagnostic Imaging/instrumentation , Radiography, Interventional/instrumentation , Angioplasty, Balloon, Coronary/instrumentation , Coronary Artery Disease/therapy , Humans , Myocardial Infarction/pathology , Myocardial Infarction/therapy , Thrombolytic Therapy/instrumentationABSTRACT
In the last 15 years, intense interest has focused on various interventional, pharmacologic, and mechanical forms of therapy for the treatment of atherosclerotic coronary artery disease. Many techniques and devices (dilating balloons, perfusion catheters, thermal probes and balloons, lasers, atherectomy devices, stents, intravascular ultrasound) have been used or are under study for future use. Many of these techniques and devices require an understanding of histologic and pathologic features of the coronary arteries and diseases which affect them. This article reviews selective areas of anatomy, histology, and pathology relevant to the use of various new interventional techniques. Part II of this four-part review will focus on aging changes seen in the epicardial coronary arteries and will review selected features of atherosclerotic plaque, including fissure and topography.
Subject(s)
Angioplasty, Balloon, Coronary/instrumentation , Cardiac Catheterization/instrumentation , Coronary Artery Disease/therapy , Coronary Vessels/pathology , Radiography, Interventional/instrumentation , Coronary Artery Disease/pathology , Endothelium, Vascular/pathology , HumansABSTRACT
In the last 15 years, intense interest has focused on various interventional pharmacologic and mechanical forms of therapy for the treatment of atherosclerosis coronary artery disease. Many techniques and devices (dilating balloons, perfusion catheters, thermal probes and balloons, lasers, atherectomy devices, stents, intravascular ultrasound) have been used or are under study for future use. Many of these techniques and devices require an understanding of histologic and pathologic features of the coronary arteries and diseases which affect them. This article reviews selective areas of anatomy, histology, and pathology relevant to the use of various new interventional techniques. Part I of this review will focus on anatomic aspects of the epicardial coronary artery system, coronary arterial distribution, myocardial supply, and histologic features of the normal coronary artery.
Subject(s)
Angioplasty, Balloon, Coronary , Coronary Vessels/pathology , Diagnostic Imaging , Myocardial Infarction/pathology , Coronary Circulation/physiology , HumansABSTRACT
This review describes 23 patients with aortic valve stenosis who underwent balloon valvuloplasty during life and had subsequent valve tissue examined at the time of aortic valve replacement or at necropsy. Of 23 stenotic aortic valves, 17 were examined within 30 days (early) after balloon dilation. Of these 94% had nonrheumatic (nonfused commissures) etiologies for the aortic stenosis. Of the 6 valves examined after 30 days (late) (restenosis), mechanisms of restenosis involve refusion of split commissures and probable elastic recoil. Clinical prediction of the aortic stenosis etiology prior to balloon valvuloplasty may help predict short- and long-term success of the dilation procedure.
Subject(s)
Aortic Valve Stenosis/pathology , Catheterization/standards , Adult , Age Factors , Aged , Aged, 80 and over , Aortic Valve Stenosis/etiology , Aortic Valve Stenosis/therapy , Female , Humans , Male , Middle Aged , Predictive Value of Tests , RecurrenceABSTRACT
During the last several years, dilating balloons have been applied in the treatment of stenotic cardiac valves. This interest has recently been extended to stenotic porcine bioprosthetic valves. Part I of this review discusses the pathologic processes responsible for degeneration of porcine prostheses: intrinsic calcification (mineralization), cuspal tears and perforations, and cuspal thrombosis (non-infective). These changes form the basis of applied balloon valvuloplasty techniques.