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1.
Cardiovasc Interv Ther ; 35(3): 276-282, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31512053

RESUMO

This study aimed to investigate the efficacy of guiding sheath delivery with the crossover approach using a newly customized inner dilator for a 0.018-in. guidewire of the Destination® guiding sheath (Terumo Corporation, Tokyo, Japan) (18-system), compared with that of the conventional-type 0.035-in. guidewires with inner dilators (35-system), and to predict failure of guiding sheath delivery. We conducted a prospective multicenter case series study of the contralateral crossover approach using Destination®, to determine whether the 18-system could be a rescue system in cases in which the conventional 35-system failed. To evaluate the efficacy of the 18-system, we created an in vitro aortoiliac bifurcation model by using a silicone vessel. We enrolled 172 cases consecutively. The initial crossover approach with the 35-system failed in 37 cases (21.5%), and a second attempt with the 18-system was successful in all failed cases. The bifurcation angles in the 35-system failure cases were significantly steeper than those in the 35-system success cases. A receiver operating characteristic curve analysis demonstrated that an aortoiliac bifurcation angle of 68° was the optimal cut-off value for predicting failure of the crossover procedure. Data from the analysis using the silicone vessel model suggested that the 18-system provided superior results, especially in aortoiliac bifurcation angles steeper than 60°, consistent with the in vivo findings. The results of the initial use of the 18-system with the crossover approach suggest that it may be superior to the conventional 35-system, especially in cases of steeper aortoiliac bifurcation angles.


Assuntos
Cateterismo Periférico/instrumentação , Cateterismo Periférico/métodos , Procedimentos Endovasculares/instrumentação , Procedimentos Endovasculares/métodos , Doença Arterial Periférica/cirurgia , Stents , Idoso , Idoso de 80 Anos ou mais , Aorta , Feminino , Artéria Femoral/patologia , Artéria Femoral/cirurgia , Humanos , Artéria Ilíaca , Japão , Masculino , Pessoa de Meia-Idade , Artéria Poplítea/patologia , Artéria Poplítea/cirurgia , Estudos Prospectivos , Resultado do Tratamento
2.
Am J Hypertens ; 19(3): 282-5, 2006 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-16500514

RESUMO

BACKGROUND: Reports indicate that acetazolamide (ACZ) induces the vasodilation of all vessels in animal models, as well as in small and medium kidney vessels in animal models. However, the effect of ACZ on the renal circulation of patients with essential hypertension remains unknown. In this study we examined the effects of a carbonic anhydrase inhibitor, acetazolamide (ACZ), on the renal circulation of patients with essential hypertension. METHODS: We directly infused 1000 mg of ACZ into the main renal arteries of 10 patients with essential hypertension who had undergone cardiac catheterization. We then evaluated the effects of ACZ upon heart rate, renal artery blood pressure (BP), renal artery cross-sectional area, renal Doppler blood flow velocity, renal blood flow (RBF), and renal vascular resistance (RVR). RESULTS: The infusion of ACZ was not associated with any significant changes in heart rate or in systolic or diastolic BP. However, the velocity-time integral was increased by 11.1% +/- 7.2%, from 17.6 +/- 1.8 to 20.0 +/- 3.7 cm (P = .009); RBF was increased by 39% +/- 21%, from 300 +/- 43 to 422 +/- 96 mL/min/m(2) (P = .002); and RVR was reduced by 38% +/- 20% from 24,351 +/- 2,291 to 17,651 +/- 2,731 dynes.sec.cm(-5) (P < .01). In contrast the cross-sectional area of the renal artery did not change. CONCLUSIONS: The results of the present study demonstrated that ACZ has a potent vasodilatory effect on the renal circulation of patients with essential hypertension, leading to an obvious decrease in RVR and an increase in RBF.


Assuntos
Acetazolamida/farmacologia , Inibidores da Anidrase Carbônica/farmacologia , Hipertensão/fisiopatologia , Fluxo Plasmático Renal/efeitos dos fármacos , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
3.
Intern Med ; 41(10): 789-92, 2002 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-12412997

RESUMO

OBJECTIVE: In this study, clinical findings were evaluated in 16 patients with reversible left ventricular dysfunction (RLVD) who showed a clinical picture similar to that of acute myocardial infarction, in addition to akinesis or dyskinesis of the left ventricular apex without showing any abnormalities in the coronary artery. RESULTS: The frequency of RLVD was markedly higher in women than in men in these 16 patients (men:women = 1:7). In addition, these patients showed ECG changes similar to those observed in ischemic heart diseases, such as ST elevation or depression, negative T waves and QT prolongation. However, the serum cardiac markers were only slightly increased, and no specific changes were detected by histological examinations of the heart muscle. CONCLUSION: These patients also showed a clinical picture similar to the stunned myocardium caused by myocardial ischemia. However, the frequency of RLVD was higher in women than in men compared to the frequency of other coronary artery diseases, and there was no severe stenosis in the coronary artery. Moreover, most of these patients showed negative results for the coronary spasm provocation test. Therefore, RLVD may be an atypical ischemic heart disease if it is caused by coronary arteriosclerosis. Since RLVD developed during the course of other diseases or under severe mental stress, autonomic nerves may be involved in the etiology of RLVD. Furthermore, 2 patients who received the coronary spasm provocation test during the acute phase showed positive results. Therefore, other factors that transiently increase the sensitivity of the coronary artery may also be involved in the etiology of RLVD.


Assuntos
Disfunção Ventricular Esquerda/fisiopatologia , Função Ventricular Esquerda/fisiologia , Idoso , Cateterismo Cardíaco , Angiografia Coronária , Eletrocardiografia , Feminino , Humanos , Masculino , Isquemia Miocárdica/fisiopatologia , Disfunção Ventricular Esquerda/diagnóstico por imagem
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