[Deformation of a coronary stent as a sequela of resuscitation]. / Deformation eines koronaren Stents als Reanimationsfolge.

We report a case of LAD-stent deformation by extracorporeal cardiopulmonary resuscitation (CPR) shortly after stent implantation. To our knowledge, this is the first reported case. During an emergency PTCA, stents were implanted into the RCA and LAD. Patency was proven by angiography before the patient left the cardiac laboratory. Thirty minutes later the patient underwent CPR because of ventricular fibrillation. The patient died in cardiogenic shock. Postmortem examination showed a distinctly deformed LAD-stent. The case proves the possibility of a deformation of a coronary stent by resuscitation.

[Quality assurance in PTCA]. / Qualitätssicherung bei der PTCA.

The special need for quality assurance in PTCA results from increasing numbers of procedures, which are due to the prevalence of disease, high primary success rates, progressive simplicity of the basic procedure, but guaranteed financing in Germany. Quality assurance programs first have to take into account the procedural quality, which includes preparation, performance, result, and also overall appropriateness (the indication) of PTCA, and secondly, the structural quality, including personnel, organization, cardiac laboratory facilities and technical equipment. In spite of numerous publications addressing special issues relating to PTCA, these items have been largely neglected in research, and it is uncertain which parameters and methods are meaningful for the improvement of clinical quality and effectiveness. Two examples for general and for internal quality control are demonstrated. In a first extensive quality assurance project of the ALKK study group, all PTCA procedures of a complete group of hospitals are prospectively registered on an intention-to-treat basis, data are controlled by visiting monitors, and appropriateness is examined in a representative sample of procedures by evaluating complete patient files. As an example for an internal quality control system a software program (CLAIM, cardiac laboratory angiography investigation management) is presented. The program yields clinical data but also investigator-related parameters such as fluoroscopy time, investigation time, contrast use, balloon consumption, etc.(ABSTRACT TRUNCATED AT 250 WORDS)

[Coronary stent implantation: infection and abscess with fatal outcome]. / Koronare Stentimplantation: Infektion und Abszedierung mit letalem Ausgang.

We report a case of coronary stent-implantation using a Palmaz-Schatz-stent in the right coronary artery (RCA) of a 66-year old woman. Coronary stenting was performed following local dissection and high-grade stenosis after PTCA. Following stent thrombosis re-PTCA was successful, but within 4 weeks progressive reduction of the patient's general condition, plus leucocytosis, subfebril temperatures, and a pericardial effusion occurred. Transesophageal echocardiography documented a perivascular myocardial abscess near the RCA stent; puncture demonstrated pericardial empyema. Emergency cardiac operation was done with segmental resection of the destructed RCA, stent explantation, and CABG to the peripheral RCA, but the patient died. To our knowledge, this is the first case of stent infection reported in the international literature. Transesophageal echocardiography was very helpful in diagnosing this fatal complication of coronary stenting.

[Endoscopic pseudocysto-gastric drainage involving the stomach after Billroth II operation]. / Endoskopische pseudozysto-gastrale Drainage in einem Magen nach Billroth-II-Operation.

A 45 years old female patient developed a large pseudocyst after an acute pancreatitis in 1987. In 1982 gastric resection with Billroth's anastomosis was performed. The patient underwent surgical internal and percutaneous external drainage in 1988, which both resulted unsuccessfully. The current admission was due to a complete occlusion of the gastric anastomosis, induced by a recurrent pseudocyst of 9.2 x 7.3 cm in diameter. Endoscopically guided pseudocysto-gastric drainage by means of electrocauterization was successful with nearly complete evacuation.

[Acute and intermediate clinical and angiography results after coronary stent implantation]. / Akute und mittelfristige klinische und angiographische Ergebnisse nach koronarer Stentimplantation.

The value of stenting in emergency situations in interventional angioplasty procedures is widely accepted. Stenting remains controversial as a therapeutic method for use beyond the acute phase, as the results reported in the acute phase are characterized by a wide range. This study reports the implantation results of Palmaz-Schatz stents in 64 cases mostly for failed PTCA. Stents were mounted on Monorail-PVC-balloon catheters. The acute success rate was 96.8%. In two cases with stent misplacement CABG was performed within 48 h. No lethal events occurred in the acute phase. Stent thrombosis has only been seen in four cases (6.5%) so far under subtle monitoring of the anticoagulant regime. Restenosis rate (definition: NHLBI-4) according to serial angiography 6 and 12 weeks after implantation was 4.25% at 6 weeks, with a cumulative rate of 19.4% up to 12 weeks. All recurrences eligible for PTCA have been successfully redilated. A high extracardiac complication rate--predominantly groin hematoma--is the main disadvantage of the procedure. Surgical repair was necessary in 11.4% up to 6 weeks after implantation. Surprisingly high was also the incidence of hematuria, also in 11.4%, in the phase of high anticoagulation. In conclusion, stenting is an effective therapeutic method to avoid emergency CABG and elective CABG in most cases of failed PTCA.