Comparison of clinical complications, angiographic results, and device usage of coronary angioplasty using low- and high-compliance balloons.
(1997)
Journal - Catheterization and cardiovascular diagnosis (UNITED STATES )
Abstract :
We randomized 800 patients in a prospective study comparing the angiographic results, device usage and in-hospital outcome of balloon angioplasty of primary stenoses of native coronary vessels with low-compliant and highly compliant balloons. The cumulative incidence of prespecified clinical endpoints was 8.0% in both treatment groups. The primary angiographic success rates were 83.9% and 78.9% in the high- and low-compliance group, respectively (P = 0.05). For the lesions dilated with one study balloon only, the quantitative angiographic findings were virtually identical in the two treatment groups. The total number of dissections was slightly but not significantly higher in the lesions treated with a highly compliant balloon. The global usage of angioplasty balloons was similar in both treatment groups. We conclude that, in general, there is no objective reason to prefer one balloon material to another on the basis of its compliance characteristics.
| ISSN : | 0098-6569 |
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| Mesh Heading : | Angioplasty, Transluminal, Percutaneous Coronary Compliance Coronary Disease Equipment Design Equipment Failure Analysis Female Humans Male Prospective Studies Treatment Outcome radiography |
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| Mesh Heading Relevant : | Coronary Angiography instrumentation therapy |
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"Back-squeezing" of the clot: an unusual complication of primary coronary angioplasty.
(1997)
Journal - Catheterization and cardiovascular diagnosis (UNITED STATES )
Abstract :
Distal coronary embolism of thrombotic material is quite common in the setting of primary coronary angioplasty for evolving acute myocardial infarction. Embolization to another coronary artery is, however, much more uncommon. We report on a case in which a large thrombus migrated from the proximal left anterior descending artery (LAD) to the proximal left circumflex artery (CX) during inflation of the dilatation balloon. The putative mechanism was retrograde expulsion of the thrombus by the deploying balloon.
| ISSN : | 0098-6569 |
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| Mesh Heading : | Aged Angioplasty, Transluminal, Percutaneous Coronary Fatal Outcome Humans Male Myocardial Infarction Pressure therapy |
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| Mesh Heading Relevant : | Coronary Thrombosis adverse effects |
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In vivo comparison of different quantitative edge detection systems used for measuring coronary arterial diameters.
(1995)
Journal - Catheterization and cardiovascular diagnosis (UNITED STATES )
Abstract :
Three different systems for quantitative coronary analysis [Cardiovascular Measurement System (CMS); Polytron 1000; Angiographic Workstation (AWOS)] were compared in 109 patients before and after coronary angioplasty and at follow-up coronary angiography. Correlation coefficients were low and 95% limits of agreement were wide. In general, CMS exhibited a tendency to yield lower values for very small diameters and higher values for larger vessels. The acute gain in minimal luminal diameter was considerably smaller when assessed by AWOS as compared to Polytron (0.52 vs. 0.71 mm, P < .0001) and to CMS (0.52 vs. 0.75 mm, P < .0001). Long-term gain was much larger when assessed by Polytron as compared to AWOS (18.8 vs. 11.5%, P < .001) and it was almost double for CMS as compared to AWOS (20.7 vs. 11.5%, P < .0001). In conclusion, in the individual patient very different results can be obtained when different QCA systems are used, and systematic differences between the systems are encountered.
| ISSN : | 0098-6569 |
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| Mesh Heading : | Algorithms Analysis of Variance Angioplasty, Transluminal, Percutaneous Coronary Coronary Angiography Coronary Disease Coronary Vessels Humans Sensitivity and Specificity physiology |
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| Mesh Heading Relevant : | Technology Assessment, Biomedical instrumentation instrumentation diagnosis pathology |
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Limited value of exercise testing in the detection of silent restenosis after successful coronary angioplasty.
(1995)
Journal - American heart journal (UNITED STATES )
Abstract :
We studied the diagnostic value of exercise electrocardiographic (ECG) testing in 191 patients who were completely asymptomatic 6 months after a successful percutaneous transluminal coronary angioplasty procedure. With > 70%- and > 50%-diameter stenosis at follow-up as restenosis criteria, the sensitivities of exercise ECG testing were 29% and 21%; the specificities 89% and 91%; the positive predictive values 20% and 52%; the negative predictive values 93% and 70%; the accuracies 83% and 68%; and the risk ratios 2.8 and 1.7, for prevalences of 9% and 33%, respectively. There were no significant differences in the diagnostic value of exercise ECG testing between men and women, patients receiving or not receiving beta-blocking agents, and the presence or absence of pathologic Q waves. Significant differences in systolic blood pressure and the rate-pressure product at peak exercise were found between patients with and without restenosis. For individual patients, however, no practical conclusions can be drawn from these values. In conclusion, the diagnostic value of exercise ECG testing for silent restenosis is low, and supplementation with other techniques seems to be warranted.
| ISSN : | 0002-8703 |
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| Mesh Heading : | Adult Aged Coronary Angiography Coronary Disease Female Follow-Up Studies Humans Male Middle Aged Recurrence Sensitivity and Specificity physiopathology therapy |
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| Mesh Heading Relevant : | Angioplasty, Transluminal, Percutaneous Coronary Electrocardiography Exercise Test diagnosis |
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Discrepancy between visual estimation and computer-assisted measurement of lesion severity before and after coronary angioplasty.
(1994)
Journal - Catheterization and cardiovascular diagnosis (UNITED STATES )
Abstract :
One hundred fourteen coronary stenoses were quantified before and after percutaneous transluminal coronary angioplasty (PTCA) using a semi-automated digital system. The values obtained were considered as standard for comparison with visual estimation by the PTCA operator as well as by independent consensus-reading. The measured percent stenosis was 62.7 +/- 13.7% before and 27.7 +/- 12.4% after angioplasty. Before PTCA, the operator consistently overestimated stenosis severity (87.8 +/- 8.5%, P < 0.0001) and consensus-reading reduced but did not eliminate this overestimation (78.0 +/- 12.3%, P < 0.05). The error in visual estimation was inversely correlated with the measured degree of stenosis: coefficients were -0.79 (P < 0.0001) and -0.51 (P < 0.0001) for operator and consensus-readers, respectively. After PTCA, the operator underestimated the residual stenosis (21.2 +/- 9.9%, P < 0.0001) but there was no systematic bias by consensus-reading (29.4 +/- 12.0%, NS). Again the error in visual estimation was inversely correlated with the measured degree of residual stenosis: coefficients were -0.76 (P < 0.0001) and -0.58 (P < 0.0001) for operator and consensus-reading, respectively. In conclusion, the operator overestimates lesion severity before and underestimates moderate residual stenoses after PTCA, a problem only partially corrected by independent consensus-readers.
| ISSN : | 0098-6569 |
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| Mesh Heading : | Coronary Angiography Coronary Disease Coronary Vessels Diagnostic Errors Humans Observer Variation epidemiology therapy |
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| Mesh Heading Relevant : | Angioplasty, Transluminal, Percutaneous Coronary Image Processing, Computer-Assisted methods radiography pathology |
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Intra- and interobserver variability of a fast on-line quantitative coronary angiographic system.
(1994)
Journal - International journal of cardiac imaging (UNITED STATES )
Abstract :
To evaluate intra- and interobserver variability of an on-line quantitative coronary angiographic system, 2 independent observers measured 166 primary lesions excluding total occlusions before and after coronary angioplasty. Each observer repeated his measurement 3 times at 14 days interval. The average percent diameter stenosis results obtained by observer 1 and 2 were almost identical, before (62.2% +/- 12.0% and 62.6% +/- 11.4%, NS) and after (27.1% +/- 12.0% and 26.9% +/- 11.3%, NS) angioplasty. Variability was expressed as 95% limits of agreement (mean difference +/- 2 x SD). The intra-observer variability of observer 1 ranged from -6.6% to 6.6% before angioplasty and from -9.6% to 9.6% after angioplasty. The corresponding limits of observer 2 were -8.0% to 7.5% and -8.3% to 8.5%, respectively. The interobserver variability ranged from -10.4% to 9.6% before versus -12.5% to 13.1% after angioplasty. This variability was not influenced by vessel size. The widening of the limits observed after angioplasty was largely due to an increased variability in the measurements of the absolute minimal luminal diameter but not of the reference segment. We conclude that the intra- and interobserver variability of measurements obtained with an on-line quantitative angiographic system used for guiding coronary interventions is acceptable and without systematic bias in any direction for a wide range of primary coronary stenoses. However, the variability increases when images are acquired immediately after angioplasty.
| ISSN : | 0167-9899 |
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| Mesh Heading : | Angioplasty, Transluminal, Percutaneous Coronary Belgium Coronary Angiography Humans Observer Variation epidemiology |
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| Mesh Heading Relevant : | Online Systems methods methods |
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Angiotensin-converting enzyme inhibition with fosinopril sodium in the prevention of restenosis after coronary angioplasty.
(1994)
Journal - Circulation (UNITED STATES )
Abstract :
BACKGROUND: Several angiotensin-converting enzyme inhibitors have antiproliferative effects in a rat model after carotid artery balloon injury. METHODS AND RESULTS: We conducted a randomized, double-blind, placebo-controlled trial to assess the effect of fosinopril, a novel angiotensin-converting enzyme inhibitor, in restenosis prevention after percutaneous transluminal coronary angioplasty (PTCA). Patients received fosinopril or matched placebo 10 mg at least 18 hours before PTCA, 20 mg at least 4 hours before PTCA, and 40 mg daily for 6 months. In addition, all patients received aspirin. Coronary angiograms before PTCA and immediately after PTCA as well as at 6-month follow-up were quantitatively analyzed. A total of 509 patients were recruited. The final per-protocol population consisted of 153 fosinopril-treated and 151 placebo-treated patients. Restenosis rates according to the National Heart, Lung, and Blood Institute criterion 4 (loss of > or = 50% of the initial gain [primary end point]) were 45.7% and 40.7% in the fosinopril and control groups, respectively (not significant). The respective mean differences in minimal coronary luminal diameter between post-PTCA and follow-up angiograms were -0.59 +/- 0.71 mm and -0.51 +/- 0.67 mm (not significant). Clinical events during the 6-month follow-up period, analyzed on an on-treatment basis, were ranked according to the most serious event. The respective numbers in the fosinopril and the control groups were for death, 0 and 0; myocardial infarction, 0 and 0; coronary artery bypass graft surgery, 1 and 3; repeat PTCA, 35 and 35; recurrent signs of ischemia necessitating early repeat coronary angiography and managed medically, 6 and 7; and none of the above, 111 and 106. All these differences were significant. CONCLUSIONS: Administration of fosinopril in a dose of 40 mg daily during 6 months after PTCA does not prevent restenosis and has no effect on overall clinical outcome.
| ISSN : | 0009-7322 |
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| Mesh Heading : | Aspirin Coronary Angiography Coronary Disease Double-Blind Method Female Follow-Up Studies Fosinopril Humans Male Middle Aged Recurrence Time Factors therapeutic use epidemiology prevention & control administration & dosage |
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| Mesh Heading Relevant : | Angioplasty, Transluminal, Percutaneous Coronary therapy therapeutic use |
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Isolated single coronary artery: a review of 50,000 consecutive coronary angiographies.
(1993)
Journal - European heart journal (ENGLAND )
Abstract :
Single coronary artery is a rare congenital anomaly of the coronary arteries where only one coronary artery arises from the aortic trunk by a single coronary ostium, supplying the entire heart. A database consisting of the angiographic reports of 50,000 consecutive coronary angiographies performed in adult patients in the University Hospital of Leuven between March 1973 and August 1991 was searched for the diagnosis of single coronary artery. All films concerned were reviewed and classified according to their anatomical type. Thirty-three cases of single coronary artery were retrieved, yielding an incidence of 0.066%. Patient characteristics and clinical data are described, with a discussion on the pathological importance of this finding.
| ISSN : | 0195-668X |
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| Mesh Heading : | Adult Aged Coronary Angiography Coronary Vessel Anomalies Female Humans Incidence Male Middle Aged Retrospective Studies classification epidemiology |
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| Mesh Heading Relevant : | radiography |
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Long term effects of nisoldipine on the progression of coronary atherosclerosis and the occurrence of clinical events: the NICOLE study
(2003)
Journal - Heart
Abstract :
Background: Earlier angiographic studies have suggested that calcium antagonists may prevent the formation of new coronary lesions and the progression of minimal lesions. Conversely, a meta-analysis suggested that these drugs may increase cardiovascular mortality and morbidity in patients with coronary heart disease.Objective: To investigate whether nisoldipine retards the progression of coronary atherosclerosis or reduces the occurrence of clinical events.Design and setting: The NICOLE study (NIsoldipine in COronary artery disease in LEuven) is a single centre, randomised, double blind, placebo controlled trial with coronary angiography at baseline, six months, and three years of follow up.Patients: 826 patients who had undergone successful coronary angioplasty were randomised to nisoldipine 40 mg once daily or placebo. The intention to treat and per protocol population consisted of 819 and 578 patients, respectively.Results: In the per protocol population, 625 of the nisoldipine treated and 655 of the placebo treated patients (NS) showed angiographic progression in at least one coronary arterial segment, defined as an increase in diameter stenosis of = 13%. The average minimum luminal diameter of the non-dilated lesions decreased by 0.163 mm and 0.167 mm in the nisoldipine and placebo groups, respectively (NS). The respective numbers of new lesions detected were 7 and 13 (NS). In the intention to treat population, the rates of death, stroke, and acute myocardial infarction were similar in both treatment groups. However, nisoldipine use was associated with fewer revascularisation procedures and thus the percentage of patients with any clinical event was lower (44.6% v 52.6%, p = 0.02).Conclusions: Nisoldipine has no demonstrable effect on the angiographic progression of coronary atherosclerosis or the risk of major cardiovascular events but its use is associated with fewer revascularisation procedures.
| ISSN : | 1355-6037 |
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| Keywords : | nisoldipine,atherosclerosis,angiography,revascularisation |
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