Giovanni Martini - Academia.edu (original) (raw)
Papers by Giovanni Martini
Catheterization and Cardiovascular Diagnosis, 1998
…A novel technique of coronary bifurcation stenting is reported. A 15 mm Palmaz-Schatz stent is b... more …A novel technique of coronary bifurcation stenting is reported. A 15 mm Palmaz-Schatz stent is bent 180 degrees at its bridge articulation into a V-configuration and mounted on two ballooncatheters linked together by adhesive tape. This unified stent delivery system was used successfully in five cases of porcine coronary bifurcation stenting.
Catheterization and Cardiovascular Diagnosis, 1996
The Wallstent (Schneider, Bulach, Switzerland) is available in different lengths without much com... more The Wallstent (Schneider, Bulach, Switzerland) is available in different lengths without much compromise in flexibility and radial support compared to some other stents. We treated 24 patients (26 vessels) with diffuse coronary lesions or vein graft lesions with intravascular ultrasound-guided peripheral Wallstent implantation. Average balloon pressure during stent optimization was 16.4 +/- 2.7 atm. The stents could be successfully implanted in 24 vessels. Minimal lumen diameter and percent diameter stenosis after stenting were 3.60 +/- 0.62 mm and -8 +/- 13%, respectively. Average stent length was 63.7 +/- 22.7 mm. There was one procedure-related complication. After stenting, all patients were treated only with antiplatelet agents. During 1-month follow-up, there was one subacute stent thrombosis due to incomplete coverage of a distal dissection. These preliminary results show the feasibility of this novel approach in selected lesions.
Mayo Clinic Proceedings, 1997
To analyze the results of implantation of six different intracoronary stents without the use of p... more To analyze the results of implantation of six different intracoronary stents without the use of prolonged anticoagulation. Between Mar. 30, 1993, and Jun. 30, 1995, 889 patients with 1,194 coronary or vein graft lesions underwent implantation of one of six types of stents-Palmaz-Schatz, Gianturco-Roubin, Wiktor, Micro, Cordis, or Wallstent. The patients were classified into seven groups on the basis of the type of stent that was implanted, including one group with combined use of two or more types of stents. Among the 851 patients with successful stent delivery and without major complications, 801 received only antiplatelet therapy, and 50 received a standard anticoagulation regimen. One-month clinical followup data were obtained in all patients, and clinical events were investigated. The mean number of stents was 1.8 per lesion and 2.4 per patient. Procedural success was achieved in 93% of the lesions. The clinical success rate at 1 month was 90%. Intravascular ultrasound assessment was performed in 90% of the lesions. The final minimal luminal cross-sectional area of the stent increased from 6.8 to 7.8 mm2 after intravascular ultrasound-guided optimization. Within 1 month, 16 stent thrombosis events (1.9%) occurred. No significant differences were noted in stent thrombosis rates among the various stent cohorts. Multivariate logistic regression analysis revealed that the final stent minimal luminal diameter measured by intravascular ultrasonography was the only variable associated with stent thrombosis. This study showed that six different stents could possibly be inserted without subsequent anticoagulation if optimal stent expansion and total lesion coverage were achieved.
Catheterization and Cardiovascular Diagnosis, 1997
The new generation quantitative angiographic systems apply the interpolated technique to calculat... more The new generation quantitative angiographic systems apply the interpolated technique to calculate the reference diameter at the site of the stenosis by integrating measurements of the segments proximal and distal to the stenosis. After stent implantation these measurements can be misleading as the treated segment, which is frequently larger than the adjacent not stented segments, is included in the measurements. The consequence is an overestimation of the reference diameter and the residual diameter stenosis. The present study was performed to compare this conventional technique of measurement with a new method which excludes the stented segment for the calculation of the reference diameter. Fifty-two lesions treated with poorly radiopaque stents (56% Palmaz-Schatz, 28% NIR, 10% Gianturco-Roubin, 6% Wallstent) expanded at high pressure (> = or 16 atm) were analyzed according to the conventional and stent excluded method. After stent implantation the reference diameter was 3.39 +/- 0.48 mm with conventional measurements and 3.02 +/- 0.45 mm with the stent excluded method (P < 0.05). The corresponding % diameter stenosis was 13 +/- 9 for the conventional technique and 1 +/- 13 for the stent excluded analysis (P < 0.05). The new approach to quantitative coronary analysis after stenting provides higher accuracy in reference diameter calculations and allows a more appropriate matching of stented segments with adjacent normal segments.
Journal of the American College of Cardiology, 1997
This study evaluated the long-term clinical outcome of successful repeat percutaneous interventio... more This study evaluated the long-term clinical outcome of successful repeat percutaneous intervention after in-stent restenosis. Background. Recurrence of symptoms and angiographic restenosis after stent implantation are observed in 15% to 35% of cases. Repeat percutaneous treatment for in-stent restenosis has been shown to be safe, with high immediate success, but little is known about the long-term clinical outcome. Methods. Clinical follow-up (minimum 9 months) was obtained in a consecutive series of 124 patients (127 vessels) presenting with stent restenosis who were successfully treated with repeat percutaneous intervention. Results. Clinical follow-up was obtained in all 124 patients at a mean [؎SD] of 27.4 ؎ 14.7 months (range 9 to 66); a stress test was available in 88 patients (71%). Recurrence of clinical events occurred in 25 patients (20%) and included death from any cause in 2 patients (2%), target vessel revascularization in 14 (11%), myocardial infarction in 1 (1%) and positive stress test results or recurrence of symptoms (Canadian Cardiovascular Society class I to IV) treated medically in 8 (6%). Cumulative event-free survival at 12 and 24 months was 86.2% and 80.7%, respectively. Significant predictive factors of recurrence of clinical events were repeat intervention in saphenous vein grafts, multivessel disease, low ejection fraction and a < ؊ 3-month interval between stent implantation and repeat intervention. Conclusions. In-stent balloon angioplasty for stent restenosis in native vessels seems to be an effective method in terms of a low long-term clinical event rate. (J Am Coll Cardiol 1997;30:186-92) ©1997 by the American College of Cardiology Coronary stents have been shown to reduce restenosis compared with balloon angioplasty (1,2), but restenosis still occurs in 15% to 35% of cases (1-4). The lowest restenosis rates were observed in focal lesions in large vessels (Ն3.0 mm) (1,2). However, the extension of coronary stent indications to more complex lesions or smaller vessels, or both, produces different, less favorable results (5). The use of local or systemic pharmacologic therapy (6,7), stent coating (8) and radioactive stents (9,10) may decrease the incidence of restenosis, but while awaiting these advances, adequate strategies for repeat treatment need to be investigated. Short-term results of intrastent restenosis treated with balloon angioplasty (11-14); additional stent implantation; rotational, extraction and directional atherectomy; and laser treatment have all been reported to be favorable (15-21), but data regarding the long-term clinical outcome are not available. The purpose of the present study was to evaluate the long-term clinical outcome of repeat percutaneous intervention, mainly balloon angioplasty, for the treatment of in-stent restenosis. Methods Patients. From June 1991 to September 1995, 1,311 consecutive patients underwent intracoronary stenting at our center. Of this cohort, 130 consecutive patients with successful stent implantation returned with angiographic stent restenosis and underwent repeat percutaneous intervention. Patients who had repeat angioplasty for acute or subacute thrombotic stent occlusion within 1 month after stent implantation were not included in this series. In six patients the repeat procedure for in-stent restenosis was unsuccessful (residual diameter stenosis Ͼ30%), and they were excluded from the study. Of these six patients, two (2%) had elective bypass surgery, three (2%) were treated medically, and one (1%) had repeat intervention that was complicated by abrupt vessel closure that led to urgent bypass surgery and subsequent death due to left ventricular failure. Therefore, the study included 124 patients (127 vessels) who had successful percutaneous intervention for in-stent restenosis, and all 124 had clinical follow-up for at least 9 months. Stenting procedure. Before stent implantation in the original lesion, patients were treated with aspirin (325 to 500 mg), and a bolus of 10,000 U of heparin was given after sheath insertion, with repeat boluses of 5,000 U of heparin given as needed to maintain an activated clotting time Ն250 s. Different From the Columbus Clinic,
Journal of the American College of Cardiology, 1995
The Gianturco Roubin (GR) coronary stent has been implanted in 91 lesions in 78 patients. The ind... more The Gianturco Roubin (GR) coronary stent has been implanted in 91 lesions in 78 patients. The indications for stent implantation were 41 elective (45%), 17 chronic total occlusion (19%), 10 acute occlusion (11%), 9 threatened closure (10%), 8 restenosis (9%) and 6 ...
Journal of the American College of Cardiology, 1995
Journal of the American College of Cardiology, 1995
MLD stenosis diameter (mm) (mm) (%) pre procedure 294 ± 0.37 094 ± 0.28 68.7 ± 9.9 pre-dilatation... more MLD stenosis diameter (mm) (mm) (%) pre procedure 294 ± 0.37 094 ± 0.28 68.7 ± 9.9 pre-dilatation 2.91 ± 0.36 159 ± 032 45.9 ± 13.5 post stenting 2.89 ± 0.39 269 ± 0.22 59 ± 10.8 next day In~36) 2.88 ± 032 2.64 ± 0.21 8.0± 8.0 1 mo FlU (n = 35) 291 ± 0.35 2.57 ± 023 11.2± 8.7 3moF/U(n = 41) 2.84 ± 0.32 2.02 ± 0.52 28.9 ± 17.3 6 mo FlU (n = 15) 2.84 ± 0.32
Journal of the American College of Cardiology, 1998
Journal of the American College of Cardiology, 1996
From 9/8/94 to 8/30/95, 85 pts, (55 symptomatic) had 96 carotid artedes treated in an IRB approve... more From 9/8/94 to 8/30/95, 85 pts, (55 symptomatic) had 96 carotid artedes treated in an IRB approved single-center, prospective study evaluating the immediate and long term efficacy of percuteneous carotid PTA end stenting. Symptomatic end asymptomatic pts. with > 60% carotid stenosis were eligible. The protocol required independent neurological evaluation pre-and post-procedure, at 6 weeks and 6 months and carotid angiography at 6 months, Results: Angiographlc success was 99%; 100=/o had successful stem deployment and stem thrombosis was 0%. Doe hundred forty-six stents (120 Johnson & Johnson, Inc., 26 Cook, Inc.) wore deployed for a mean stem to artery ratio of 1.5 (range 1 to 6). Mean stenosls was reduced from 74% .4-14% to 3% :E 16%. There were no major procedural strokes, MIs or deaths. There were 5 (5%) minor (complete recovery within 7 days) procedural strokes and 1 (1%) major in-hospital stroke secondary to atrial fibrillation. There was 1 death secondary to ratro-peritoneal bleeding. Twenty-two pts. have reached the 6 month engiography endpoim with a mean stenosis of 12%-4-16=/o (range-7 to 57°/=) and I case of restenosis. Deformation of the stem ends was noted in 5 pts, and in 1 pt. repeat balloon dilatation was performed. Late neurologic events have not occurred. Two pts. have died in follow-up from non-cerebrovascular causes. Conclusion: Carotid angioplasty and stentiog is associated with a high immediate success rate and a modest complication rate. Angiographic followup to date shows a low incidence of rest:nosis.
Journal of the American College of Cardiology, 1996
253A in 9S%. There were 3 Q-wave infarcts (3%) and 1 death (1%). A non-Q-wave infarct was sustain... more 253A in 9S%. There were 3 Q-wave infarcts (3%) and 1 death (1%). A non-Q-wave infarct was sustained by 610ts (5%) and 1 lot (1%) required emergency bypass surge~'. The pro and final MLO for both groups was 0.72 and 2.75 mm (diameter eten~ls of 76.8 and-11.4%). Patients were discharged on aspirin (ASA) and werfadn 54%, ASA and ti~idine 42%, or ASA, tioiopkiine and low molecular weight hepadn 4"/,,. Mean 18-month follow-up on 7"P/o demonstrated: t:vget lesion retntervention 5%, CABG 3%, stunt thrombosis 0%, death 5%. Conclusion: Stunt deployment for suboptimal RA results or as an adjunct treatment of calcified coronary lesions provides excellent angiographic resuits (-11.4% final etenosis') with few major procedural complications.
Journal of the American College of Cardiology, 1995
The Wiktor coronary stent has been implanted in 82 lesions in 68 patients. The indication for ste... more The Wiktor coronary stent has been implanted in 82 lesions in 68 patients. The indication for stent implantation was 49 elective (57%), 10 threatened closure (12%), 9 SUboptimal PTCA (11%), 7 chronic total occlusion (9%), 4 restenosis (5%), and 3 acute occlusion (4%). ...
Circulation, 1996
Background Previous studies have shown that it is feasible to withhold anticoagulation after a su... more Background Previous studies have shown that it is feasible to withhold anticoagulation after a successful intracoronary stent procedure with a low incidence of stent thrombosis. The importance of specific antiplatelet agents when stenting is performed without anticoagulation is unknown. Methods and Results After successful intravascular ultrasound–guided stenting, 226 patients were randomly assigned to receive either aspirin therapy alone (n=103) or a combination of ticlopidine and short-term aspirin therapy (n=123). Primary angiographic and clinical end points were stent thrombosis, death, myocardial infarction, the need for postprocedure coronary artery bypass surgery or repeated angioplasty, and significant medication side effects requiring termination of the medication within the first month of a successful procedure. At 1 month, the rate of stent thrombosis was 2.9% in the aspirin only group and 0.8% in the ticlopidine-aspirin group ( P =.2). Cumulative major clinical events af...
Acute Cardiac Care, 1998
Coronary stenting (stent implantation) has evolved over the last 5 years with changes in stent de... more Coronary stenting (stent implantation) has evolved over the last 5 years with changes in stent design, stent material and the implantation technique. The use of high-pressure balloon inflation (HP), intravascular ultrasound (IVUS) and appropriate antiplatelet therapy have contributed to the abolishment of the need for subsequent anticoagulation, allowing extended stent applications. We compared results in three groups of patients having stent implantation throughout the period of evolution: group A: no IVUS, no HP, with subsequent anticoagulation treatment (n 3 434); group B: no IVUS, yes HP, without subsequent anticoagulation treatment (n 3 192); and group C: yes IVUS, yes HP, without subsequent anticoagulation treatment (n 3 588). The primary success rates were comparable in all groups. There was a clear change in indications for stenting in groups B and C compared with group A (elective stenting: group A 3 32%; group B 3 66%; group C 3 69%; P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001), in reference vessel size (group A 3 3.22 3 0.37 mm; group B 3 2.92 3 0.56 mm; group C 3 2.98 3 0.57 mm; P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001), and for presence of type B2 and C lesions (group A 3 57%; group B 3 72%; group C 3 74%; P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). The complication rate significantly decreased in group C (group A 3 3.6%; group B 3 4.1%; group C 3 1.2%; P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) and the mean patient hospital stay decreased to 2 days in groups B and C due to the abolition of the need for anticoagulant treatment. The angiographic restenosis rate increased in groups B and C (group A 3 20%; group B 3 34%; group C 3 32%; P…
Catheterization and Cardiovascular Diagnosis, 1996
It is generally believed that the Palmaz-Schatz stent maintains a strong radial force, preventing... more It is generally believed that the Palmaz-Schatz stent maintains a strong radial force, preventing stent recoil. However, the capacity to prevent recoil is largely governed by the hardness or resistance of the lesion. We report two cases of "acute Palmaz-Schatz stent recoil," documented by intravascular ultrasound, and suggest a novel treatment of this unusual problem.
Catheterization and Cardiovascular Diagnosis, 1998
…A novel technique of coronary bifurcation stenting is reported. A 15 mm Palmaz-Schatz stent is b... more …A novel technique of coronary bifurcation stenting is reported. A 15 mm Palmaz-Schatz stent is bent 180 degrees at its bridge articulation into a V-configuration and mounted on two ballooncatheters linked together by adhesive tape. This unified stent delivery system was used successfully in five cases of porcine coronary bifurcation stenting.
Catheterization and Cardiovascular Diagnosis, 1996
The Wallstent (Schneider, Bulach, Switzerland) is available in different lengths without much com... more The Wallstent (Schneider, Bulach, Switzerland) is available in different lengths without much compromise in flexibility and radial support compared to some other stents. We treated 24 patients (26 vessels) with diffuse coronary lesions or vein graft lesions with intravascular ultrasound-guided peripheral Wallstent implantation. Average balloon pressure during stent optimization was 16.4 +/- 2.7 atm. The stents could be successfully implanted in 24 vessels. Minimal lumen diameter and percent diameter stenosis after stenting were 3.60 +/- 0.62 mm and -8 +/- 13%, respectively. Average stent length was 63.7 +/- 22.7 mm. There was one procedure-related complication. After stenting, all patients were treated only with antiplatelet agents. During 1-month follow-up, there was one subacute stent thrombosis due to incomplete coverage of a distal dissection. These preliminary results show the feasibility of this novel approach in selected lesions.
Mayo Clinic Proceedings, 1997
To analyze the results of implantation of six different intracoronary stents without the use of p... more To analyze the results of implantation of six different intracoronary stents without the use of prolonged anticoagulation. Between Mar. 30, 1993, and Jun. 30, 1995, 889 patients with 1,194 coronary or vein graft lesions underwent implantation of one of six types of stents-Palmaz-Schatz, Gianturco-Roubin, Wiktor, Micro, Cordis, or Wallstent. The patients were classified into seven groups on the basis of the type of stent that was implanted, including one group with combined use of two or more types of stents. Among the 851 patients with successful stent delivery and without major complications, 801 received only antiplatelet therapy, and 50 received a standard anticoagulation regimen. One-month clinical followup data were obtained in all patients, and clinical events were investigated. The mean number of stents was 1.8 per lesion and 2.4 per patient. Procedural success was achieved in 93% of the lesions. The clinical success rate at 1 month was 90%. Intravascular ultrasound assessment was performed in 90% of the lesions. The final minimal luminal cross-sectional area of the stent increased from 6.8 to 7.8 mm2 after intravascular ultrasound-guided optimization. Within 1 month, 16 stent thrombosis events (1.9%) occurred. No significant differences were noted in stent thrombosis rates among the various stent cohorts. Multivariate logistic regression analysis revealed that the final stent minimal luminal diameter measured by intravascular ultrasonography was the only variable associated with stent thrombosis. This study showed that six different stents could possibly be inserted without subsequent anticoagulation if optimal stent expansion and total lesion coverage were achieved.
Catheterization and Cardiovascular Diagnosis, 1997
The new generation quantitative angiographic systems apply the interpolated technique to calculat... more The new generation quantitative angiographic systems apply the interpolated technique to calculate the reference diameter at the site of the stenosis by integrating measurements of the segments proximal and distal to the stenosis. After stent implantation these measurements can be misleading as the treated segment, which is frequently larger than the adjacent not stented segments, is included in the measurements. The consequence is an overestimation of the reference diameter and the residual diameter stenosis. The present study was performed to compare this conventional technique of measurement with a new method which excludes the stented segment for the calculation of the reference diameter. Fifty-two lesions treated with poorly radiopaque stents (56% Palmaz-Schatz, 28% NIR, 10% Gianturco-Roubin, 6% Wallstent) expanded at high pressure (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; = or 16 atm) were analyzed according to the conventional and stent excluded method. After stent implantation the reference diameter was 3.39 +/- 0.48 mm with conventional measurements and 3.02 +/- 0.45 mm with the stent excluded method (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). The corresponding % diameter stenosis was 13 +/- 9 for the conventional technique and 1 +/- 13 for the stent excluded analysis (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). The new approach to quantitative coronary analysis after stenting provides higher accuracy in reference diameter calculations and allows a more appropriate matching of stented segments with adjacent normal segments.
Journal of the American College of Cardiology, 1997
This study evaluated the long-term clinical outcome of successful repeat percutaneous interventio... more This study evaluated the long-term clinical outcome of successful repeat percutaneous intervention after in-stent restenosis. Background. Recurrence of symptoms and angiographic restenosis after stent implantation are observed in 15% to 35% of cases. Repeat percutaneous treatment for in-stent restenosis has been shown to be safe, with high immediate success, but little is known about the long-term clinical outcome. Methods. Clinical follow-up (minimum 9 months) was obtained in a consecutive series of 124 patients (127 vessels) presenting with stent restenosis who were successfully treated with repeat percutaneous intervention. Results. Clinical follow-up was obtained in all 124 patients at a mean [؎SD] of 27.4 ؎ 14.7 months (range 9 to 66); a stress test was available in 88 patients (71%). Recurrence of clinical events occurred in 25 patients (20%) and included death from any cause in 2 patients (2%), target vessel revascularization in 14 (11%), myocardial infarction in 1 (1%) and positive stress test results or recurrence of symptoms (Canadian Cardiovascular Society class I to IV) treated medically in 8 (6%). Cumulative event-free survival at 12 and 24 months was 86.2% and 80.7%, respectively. Significant predictive factors of recurrence of clinical events were repeat intervention in saphenous vein grafts, multivessel disease, low ejection fraction and a < ؊ 3-month interval between stent implantation and repeat intervention. Conclusions. In-stent balloon angioplasty for stent restenosis in native vessels seems to be an effective method in terms of a low long-term clinical event rate. (J Am Coll Cardiol 1997;30:186-92) ©1997 by the American College of Cardiology Coronary stents have been shown to reduce restenosis compared with balloon angioplasty (1,2), but restenosis still occurs in 15% to 35% of cases (1-4). The lowest restenosis rates were observed in focal lesions in large vessels (Ն3.0 mm) (1,2). However, the extension of coronary stent indications to more complex lesions or smaller vessels, or both, produces different, less favorable results (5). The use of local or systemic pharmacologic therapy (6,7), stent coating (8) and radioactive stents (9,10) may decrease the incidence of restenosis, but while awaiting these advances, adequate strategies for repeat treatment need to be investigated. Short-term results of intrastent restenosis treated with balloon angioplasty (11-14); additional stent implantation; rotational, extraction and directional atherectomy; and laser treatment have all been reported to be favorable (15-21), but data regarding the long-term clinical outcome are not available. The purpose of the present study was to evaluate the long-term clinical outcome of repeat percutaneous intervention, mainly balloon angioplasty, for the treatment of in-stent restenosis. Methods Patients. From June 1991 to September 1995, 1,311 consecutive patients underwent intracoronary stenting at our center. Of this cohort, 130 consecutive patients with successful stent implantation returned with angiographic stent restenosis and underwent repeat percutaneous intervention. Patients who had repeat angioplasty for acute or subacute thrombotic stent occlusion within 1 month after stent implantation were not included in this series. In six patients the repeat procedure for in-stent restenosis was unsuccessful (residual diameter stenosis Ͼ30%), and they were excluded from the study. Of these six patients, two (2%) had elective bypass surgery, three (2%) were treated medically, and one (1%) had repeat intervention that was complicated by abrupt vessel closure that led to urgent bypass surgery and subsequent death due to left ventricular failure. Therefore, the study included 124 patients (127 vessels) who had successful percutaneous intervention for in-stent restenosis, and all 124 had clinical follow-up for at least 9 months. Stenting procedure. Before stent implantation in the original lesion, patients were treated with aspirin (325 to 500 mg), and a bolus of 10,000 U of heparin was given after sheath insertion, with repeat boluses of 5,000 U of heparin given as needed to maintain an activated clotting time Ն250 s. Different From the Columbus Clinic,
Journal of the American College of Cardiology, 1995
The Gianturco Roubin (GR) coronary stent has been implanted in 91 lesions in 78 patients. The ind... more The Gianturco Roubin (GR) coronary stent has been implanted in 91 lesions in 78 patients. The indications for stent implantation were 41 elective (45%), 17 chronic total occlusion (19%), 10 acute occlusion (11%), 9 threatened closure (10%), 8 restenosis (9%) and 6 ...
Journal of the American College of Cardiology, 1995
Journal of the American College of Cardiology, 1995
MLD stenosis diameter (mm) (mm) (%) pre procedure 294 ± 0.37 094 ± 0.28 68.7 ± 9.9 pre-dilatation... more MLD stenosis diameter (mm) (mm) (%) pre procedure 294 ± 0.37 094 ± 0.28 68.7 ± 9.9 pre-dilatation 2.91 ± 0.36 159 ± 032 45.9 ± 13.5 post stenting 2.89 ± 0.39 269 ± 0.22 59 ± 10.8 next day In~36) 2.88 ± 032 2.64 ± 0.21 8.0± 8.0 1 mo FlU (n = 35) 291 ± 0.35 2.57 ± 023 11.2± 8.7 3moF/U(n = 41) 2.84 ± 0.32 2.02 ± 0.52 28.9 ± 17.3 6 mo FlU (n = 15) 2.84 ± 0.32
Journal of the American College of Cardiology, 1998
Journal of the American College of Cardiology, 1996
From 9/8/94 to 8/30/95, 85 pts, (55 symptomatic) had 96 carotid artedes treated in an IRB approve... more From 9/8/94 to 8/30/95, 85 pts, (55 symptomatic) had 96 carotid artedes treated in an IRB approved single-center, prospective study evaluating the immediate and long term efficacy of percuteneous carotid PTA end stenting. Symptomatic end asymptomatic pts. with > 60% carotid stenosis were eligible. The protocol required independent neurological evaluation pre-and post-procedure, at 6 weeks and 6 months and carotid angiography at 6 months, Results: Angiographlc success was 99%; 100=/o had successful stem deployment and stem thrombosis was 0%. Doe hundred forty-six stents (120 Johnson & Johnson, Inc., 26 Cook, Inc.) wore deployed for a mean stem to artery ratio of 1.5 (range 1 to 6). Mean stenosls was reduced from 74% .4-14% to 3% :E 16%. There were no major procedural strokes, MIs or deaths. There were 5 (5%) minor (complete recovery within 7 days) procedural strokes and 1 (1%) major in-hospital stroke secondary to atrial fibrillation. There was 1 death secondary to ratro-peritoneal bleeding. Twenty-two pts. have reached the 6 month engiography endpoim with a mean stenosis of 12%-4-16=/o (range-7 to 57°/=) and I case of restenosis. Deformation of the stem ends was noted in 5 pts, and in 1 pt. repeat balloon dilatation was performed. Late neurologic events have not occurred. Two pts. have died in follow-up from non-cerebrovascular causes. Conclusion: Carotid angioplasty and stentiog is associated with a high immediate success rate and a modest complication rate. Angiographic followup to date shows a low incidence of rest:nosis.
Journal of the American College of Cardiology, 1996
253A in 9S%. There were 3 Q-wave infarcts (3%) and 1 death (1%). A non-Q-wave infarct was sustain... more 253A in 9S%. There were 3 Q-wave infarcts (3%) and 1 death (1%). A non-Q-wave infarct was sustained by 610ts (5%) and 1 lot (1%) required emergency bypass surge~'. The pro and final MLO for both groups was 0.72 and 2.75 mm (diameter eten~ls of 76.8 and-11.4%). Patients were discharged on aspirin (ASA) and werfadn 54%, ASA and ti~idine 42%, or ASA, tioiopkiine and low molecular weight hepadn 4"/,,. Mean 18-month follow-up on 7"P/o demonstrated: t:vget lesion retntervention 5%, CABG 3%, stunt thrombosis 0%, death 5%. Conclusion: Stunt deployment for suboptimal RA results or as an adjunct treatment of calcified coronary lesions provides excellent angiographic resuits (-11.4% final etenosis') with few major procedural complications.
Journal of the American College of Cardiology, 1995
The Wiktor coronary stent has been implanted in 82 lesions in 68 patients. The indication for ste... more The Wiktor coronary stent has been implanted in 82 lesions in 68 patients. The indication for stent implantation was 49 elective (57%), 10 threatened closure (12%), 9 SUboptimal PTCA (11%), 7 chronic total occlusion (9%), 4 restenosis (5%), and 3 acute occlusion (4%). ...
Circulation, 1996
Background Previous studies have shown that it is feasible to withhold anticoagulation after a su... more Background Previous studies have shown that it is feasible to withhold anticoagulation after a successful intracoronary stent procedure with a low incidence of stent thrombosis. The importance of specific antiplatelet agents when stenting is performed without anticoagulation is unknown. Methods and Results After successful intravascular ultrasound–guided stenting, 226 patients were randomly assigned to receive either aspirin therapy alone (n=103) or a combination of ticlopidine and short-term aspirin therapy (n=123). Primary angiographic and clinical end points were stent thrombosis, death, myocardial infarction, the need for postprocedure coronary artery bypass surgery or repeated angioplasty, and significant medication side effects requiring termination of the medication within the first month of a successful procedure. At 1 month, the rate of stent thrombosis was 2.9% in the aspirin only group and 0.8% in the ticlopidine-aspirin group ( P =.2). Cumulative major clinical events af...
Acute Cardiac Care, 1998
Coronary stenting (stent implantation) has evolved over the last 5 years with changes in stent de... more Coronary stenting (stent implantation) has evolved over the last 5 years with changes in stent design, stent material and the implantation technique. The use of high-pressure balloon inflation (HP), intravascular ultrasound (IVUS) and appropriate antiplatelet therapy have contributed to the abolishment of the need for subsequent anticoagulation, allowing extended stent applications. We compared results in three groups of patients having stent implantation throughout the period of evolution: group A: no IVUS, no HP, with subsequent anticoagulation treatment (n 3 434); group B: no IVUS, yes HP, without subsequent anticoagulation treatment (n 3 192); and group C: yes IVUS, yes HP, without subsequent anticoagulation treatment (n 3 588). The primary success rates were comparable in all groups. There was a clear change in indications for stenting in groups B and C compared with group A (elective stenting: group A 3 32%; group B 3 66%; group C 3 69%; P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001), in reference vessel size (group A 3 3.22 3 0.37 mm; group B 3 2.92 3 0.56 mm; group C 3 2.98 3 0.57 mm; P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001), and for presence of type B2 and C lesions (group A 3 57%; group B 3 72%; group C 3 74%; P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). The complication rate significantly decreased in group C (group A 3 3.6%; group B 3 4.1%; group C 3 1.2%; P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) and the mean patient hospital stay decreased to 2 days in groups B and C due to the abolition of the need for anticoagulant treatment. The angiographic restenosis rate increased in groups B and C (group A 3 20%; group B 3 34%; group C 3 32%; P…
Catheterization and Cardiovascular Diagnosis, 1996
It is generally believed that the Palmaz-Schatz stent maintains a strong radial force, preventing... more It is generally believed that the Palmaz-Schatz stent maintains a strong radial force, preventing stent recoil. However, the capacity to prevent recoil is largely governed by the hardness or resistance of the lesion. We report two cases of "acute Palmaz-Schatz stent recoil," documented by intravascular ultrasound, and suggest a novel treatment of this unusual problem.