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1.
Am J Cardiol ; 97(1): 21-5, 2006 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-16377277

RESUMO

The intracoronary changes that occur after brachytherapy for in-stent restenosis (ISR) have yet to be fully established. The purpose of this study in patients who had ISR was to examine the serial angioscopic changes in intracoronary lesions that occurred after brachytherapy. Forty-four patients who had ISR (49 lesions) underwent balloon angioplasty (n = 34) or directional atherectomy (n = 15), followed by intracoronary brachytherapy using a beta-emitting phosphorus-32 source wire. Angioscopic investigations were performed 3 and 9 months after brachytherapy. Uncovered stents were detected in 63.3% of lesions at 3 months. A significant decrease (p = 0.028) in this prevalence occurred over the next 6 months, with 36% of lesions having uncovered stents at 9 months. At 3 months, 33% of the lesions had visible erosion or ulceration and superficial thrombus. The prevalence of these characteristics was decreased at 9 months, although 17% of the lesions were still ulcerated or eroded at that time. Protruding thrombus was not observed in any lesion at 3 and 9 months. In conclusion, uncovered stents and intimal erosions or ulcerations were still present 9 months after brachytherapy in 36% and 17% of lesions, respectively. These results suggest that the healing process was not completed 9 months after brachytherapy in approximately 33% of lesions.


Assuntos
Angioscopia , Braquiterapia , Reestenose Coronária/terapia , Stents , Idoso , Angioplastia com Balão , Aterectomia Coronária , Doença da Artéria Coronariana/patologia , Trombose Coronária/patologia , Feminino , Seguimentos , Humanos , Masculino , Radioisótopos de Fósforo , Túnica Íntima/patologia
2.
Int J Cardiovasc Intervent ; 6(3-4): 119-27, 2004.
Artigo em Inglês | MEDLINE | ID: mdl-16146904

RESUMO

BACKGROUND: Percutaneous coronary intervention (PCI) has been increasingly applied to unprotected left main coronary artery (LMCA) lesions, with varied procedural success and clinical outcomes. However, the effect of PCI on left ventricular performance is still unclear, and there are no clinical studies assessing factors that influence left ventricular ejection fraction (LVEF) in these cases. METHODS: Between April 1986 and August 2002, de novo PCI was performed for unprotected LMCA stenoses in 199 patients. Close clinical and angiographic follow-up were conducted after the procedure. RESULTS: One hundred eighty patients survived over six months and analysis of paired left ventriculography was possible in 175 patients. Improvement in LVEF was observed in the entire population (52.9 +/- 15.7% to 56.1 +/- 14.3%, p = 0.048). The LVEF change was 6.7 +/- 9.5% (p < 0.01) in group with baseline LVEF < or = 50% and 0.7 +/- 6.7 % (p = NS) in group with LVEF > 50%. There was significant intergroup difference (p < 0.001). Patients with baseline diameter stenosis > or = 60% had an improvement of 5.3 +/- 8.3% (p < 0.05) whereas those with stenosis < 60% had no improvement (2.0 +/- 8.4%, p = NS). CK-MB elevation > or = 3 times normal after PCI had a significant inverse association with improvement in LVEF (p < 0.05). Multivariate analysis revealed baseline LVEF < or = 50% was the only independent predictor of improvement in LVEF (standard estimate = 3.509, 95% CI: 2.164-4.854, p < 0.001). CONCLUSIONS: Successful PCI procedure is associated with significant improvement in LVEF, especially in patients with depressed left ventricular function.


Assuntos
Angioplastia Coronária com Balão , Aterectomia Coronária , Estenose Coronária/terapia , Recuperação de Função Fisiológica/fisiologia , Volume Sistólico/fisiologia , Função Ventricular Esquerda/fisiologia , Idoso , Estenose Coronária/mortalidade , Estenose Coronária/fisiopatologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Stents , Taxa de Sobrevida , Resultado do Tratamento
3.
Am J Cardiol ; 92(8): 936-40, 2003 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-14556869

RESUMO

Stent implantation in unprotected left main coronary artery (LMCA) bifurcation lesions may improve procedural and late clinical outcomes. However, concerns regarding stent-related complications, such as stent jail, subacute thrombosis, and in-stent restenosis remain. Optimal debulking by directional coronary atherectomy (DCA) with intravascular ultrasound (IVUS) guidance may be effective in this complex lesion subset, but this strategy has not yet been established. Our objective was to evaluate the safety and efficacy of IVUS-guided DCA for unprotected LMCA stenoses with distal bifurcation involvement. A total of 67 consecutive patients were included in this study and procedural success was achieved in all cases. Two cardiac deaths (2.9%) were noted and 3 patients (4.5%) underwent repeat angioplasty during hospitalization. There was no Q-wave myocardial infarction or emergency bypass surgery. Non-Q-wave myocardial infarction (creatine kinase-MB >3 times normal) occurred in 13.4% of patients. Stent implantation was necessary in 17 cases (25.4%) to achieve an optimal result. IVUS showed an improved lumen cross-sectional area and a low plaque burden in the LMCA after intervention. All-cause mortality, angiographic restenosis, and the target lesion revascularization rates at 6 months were 7.4%, 23.8%, and 20.0%, respectively. With IVUS guidance, aggressive DCA can be performed safely in unprotected LMCA bifurcation lesions, and optimal angiographic and IVUS results can be achieved with low residual plaque burden, which leads to a low restenosis rate. Optimal lesion debulking by DCA does not necessarily need adjunctive stenting in this specific anatomic subset.


Assuntos
Aterectomia Coronária/métodos , Estenose Coronária/cirurgia , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/cirurgia , Ultrassonografia de Intervenção , Idoso , Idoso de 80 Anos ou mais , Transfusão de Sangue/estatística & dados numéricos , Estimulação Cardíaca Artificial/estatística & dados numéricos , Reestenose Coronária/epidemiologia , Reestenose Coronária/etiologia , Vasos Coronários/patologia , Complicações do Diabetes , Feminino , Humanos , Balão Intra-Aórtico/estatística & dados numéricos , Masculino , Infarto do Miocárdio/etiologia , Reoperação , Fatores de Risco , Stents , Resultado do Tratamento
4.
Int J Cardiovasc Intervent ; 5(3): 132-6, 2003.
Artigo em Inglês | MEDLINE | ID: mdl-12959729

RESUMO

BACKGROUND: Although some studies have documented the six-month angiographic outcomes of percutaneous coronary intervention (PCI) with new devices for unprotected left main trunk disease (ULMTD), a long-term angiographic analysis is mandatory to evaluate the safety and effectiveness of this procedure. This study aims to assess a long-term (one year or more) angiographic analysis after PCI for this lesion. METHODS: PCI was performed for 225 ULMTD with de novo or restenotic lesions. There were 19 deaths and 12 repeat PCIs during the hospital stay. The remaining 194 lesions were followed, and 126 lesions showed no angiographic restenosis or target lesion revascularization within six months. Finally, long-term quantitative angiographic follow-up was completed in 78 lesions (mean 2.4 years, maximum 7.5 years after PCI). RESULTS: Minimal lumen diameter increased significantly from 2.46 +/- 0.59 mm to 2.72 +/- 0.65 mm (p < 0.0001) and percent diameter stenosis decreased significantly from 26 +/- 14% to 19 +/- 14% (p < 0.0001) between the six-month and the long-term follow-ups. No additional restenosis or new lesions were found at long-term follow-up, and significant lesion regression was ascertained in each procedure (directional coronary atherectomy, p < 0.005; ballooning, p < 0.005; stenting, p < 0.05). CONCLUSIONS: These findings support the safety and effectiveness of PCI for ULMTD during the long-term period.


Assuntos
Angioplastia Coronária com Balão/efeitos adversos , Reestenose Coronária/diagnóstico por imagem , Reestenose Coronária/terapia , Estenose Coronária/diagnóstico por imagem , Estenose Coronária/terapia , Complicações Pós-Operatórias , Adulto , Idoso , Idoso de 80 Anos ou mais , Angiografia Coronária , Reestenose Coronária/etiologia , Estenose Coronária/complicações , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Resultado do Tratamento
5.
Catheter Cardiovasc Interv ; 59(4): 482-8, 2003 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-12891613

RESUMO

To get superior guiding catheter support, we tried a new method called the anchor technique. By inflating a balloon in a nontarget vessel and holding its shaft with backward force while advancing another balloon, the anchor effect for the guiding catheter could be obtained and it appeared to be helpful for a balloon or a stent to cross the target lesion.


Assuntos
Angioplastia Coronária com Balão/métodos , Cateterismo Cardíaco/métodos , Estenose Coronária/terapia , Idoso , Feminino , Humanos , Masculino
6.
Int J Cardiovasc Intervent ; 5(1): 13-6, 2003.
Artigo em Inglês | MEDLINE | ID: mdl-12623560

RESUMO

Despite technical and mechanical improvement in coronary stents the incidence of restenosis caused by in-stent neointimal hyperplasia remains high. Oral administration of numerous pharmacological agents has failed to reduce restenosis after coronary stenting in humans, possibly owing to insufficient local drug concentration. Therefore, drug-eluting stents were developed as a vehicle for local drug administration. The authors developed a new drug-eluting polymer stent that is made of poly-l-lactic acid polymer mixed with tranilast, an anti-allergic drug that inhibits the migration and proliferation of vascular smooth muscle cells induced by platelet-derived growth factor and transforming growth factor->1. Polymer stents might be superior to polymer-coated metallic stents as local drug delivery stents in terms of biodegradation and the amount of loaded drug. Drug-mixed polymer stents can be loaded with a larger amount of drug than can drug-coated metallic stents because the polymer stent struts can contain the drug. Clinical application is required to assess the safety and efficacy of drug-eluting polymer stents against stent restenosis.


Assuntos
Implantes Absorvíveis , Anti-Inflamatórios não Esteroides/administração & dosagem , Inibidores da Agregação Plaquetária/administração & dosagem , Poliésteres , Stents , ortoaminobenzoatos/administração & dosagem , Animais , Sistemas de Liberação de Medicamentos , Humanos , Suínos
7.
Catheter Cardiovasc Interv ; 56(1): 40-5, 2002 May.
Artigo em Inglês | MEDLINE | ID: mdl-11979532

RESUMO

We compared the outcome of the self-expanding Radius stent and the balloon-expandable Multilink stent serially by angiography and intravascular ultrasound. Successful stent deployment was achieved in 66 lesions of 56 stable angina patients (34 lesions with Radius stents and 32 lesions with Multilink stents). At follow-up, there were no significant differences in minimal lumen diameter or percent diameter stenosis between the groups, nor in restenosis rates, although the Radius stent group rate was slightly lower (23.5% vs. 31.3%). In the Radius stent group, stent cross-sectional area (CSA) increased gradually after implantation until the 6-month follow-up (8.37 +/- 1.83 to 10.16 +/- 2.59 mm(2); n = 15), giving a larger CSA (P = 0.03) than the Multilink stent group, which decreased (9.00 +/- 2.05 to 8.27 +/- 2.15 mm(2); n = 17). The lumen CSA was also slightly larger (6.82 +/- 3.06 vs. 5.84 +/- 1.85 mm(2); P = 0.29) in the Radius stent group. These findings indicated that the Radius stent enlarged progressively after implantation, which might be useful for prevention of restenosis.


Assuntos
Angioplastia Coronária com Balão , Estenose Coronária/terapia , Procedimentos Cirúrgicos Eletivos , Rádio (Anatomia)/cirurgia , Stents , Idoso , Implante de Prótese Vascular , Angiografia Coronária , Reestenose Coronária/etiologia , Reestenose Coronária/terapia , Estenose Coronária/complicações , Estenose Coronária/mortalidade , Progressão da Doença , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Rádio (Anatomia)/diagnóstico por imagem , Reoperação , Fatores de Risco , Análise de Sobrevida , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia de Intervenção
8.
Curr Interv Cardiol Rep ; 3(1): 10-17, 2001 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-11177716

RESUMO

To overcome several problems of conventional metallic stents, there have been many attempts to manufacture stents made of biodegradable materials. Although some studies have noted various degrees of inflammatory responses after biodegradable stent implantation, stents made of poly-l-lactic acid (PLLA) showed high biocompatibility with minimal inflammatory response and neointimal formation in porcine coronary arteries. Therefore, PLLA materials are more likely to cover the specific need for human coronary arteries in terms of biodegradation period and scaffolding ability over 6 months. A clinical study of PLLA self-expanding stent implantation is underway in Japan. The initial and 6-month results are favorable and suggest the feasibility, safety, and efficacy of the PLLA biodegradable stent in humans. However, long-term follow-up with larger numbers of patients will be required to validate the long-term efficacy of PLLA stents.

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