Treatment of multivessel coronary artery disease with sirolimus-eluting stent implantation: immediate and mid-term results.

Objectives: This study evaluated clinical outcome after multivessel stenting with sirolimus-eluting stents (SES) in unselected lesions.

Background: Safety and effectiveness of multivessel SES implantation is currently unknown.

Methods: Major adverse cardiac events (MACE) (death, myocardial infarction [MI], and repeat revascularization) were analyzed at 30 days and at 6 months after multivessel SES implantation.

Insulin-treated diabetes mellitus and predictors of mid-term clinical outcome after percutaneous coronary interventions with stent implantation.

Background: Patients with type II, insulin-dependent diabetes mellitus have a high risk of death and repeat revascularization following successful percutaneous coronary interventions. The predictors of outcome in such patients after coronary stenting have not been clarified.

Methods: We studied 133 consecutive patients with type II, insulin-dependent diabetes mellitus who underwent coronary stenting from November 1992 to May 2001.

Comparison of diamond-like carbon-coated stents versus uncoated stainless steel stents in coronary artery disease.

Stainless steel (SS) and carbon-coated (CC) stents were randomly compared in 347 patients (520 lesions). No differences were observed in in-hospital major adverse cardiac events: 2.8% in the CC group and 4.

Incidence, predictors, in-hospital, and late outcomes of coronary artery perforations.

We sought to determine the incidence of coronary perforations, predisposing factors, and in-hospital and late outcome of patients with coronary perforations. Perforations occurred in 0.84% of treated lesions and more frequently in patients with complex lesions after atheroablative procedures and who underwent intravascular ultrasound guided lumen optimization.

Pharmacological radionuclide ventriculography for detection of myocardial contractile reserve in patients after myocardial infarction: head-to-head comparison of low dose dobutamine and low dose dipyridamole.

Background: Low dose pharmacological stress echocardiography with either dobutamine or dipyridamole infusion has been proposed for recognition of myocardial viability. However, dependence on adequate acoustic window, observer experience, and the mild degree of wall motion changes make the viability assessment by stress echocardiography especially bothersome. The objective of the study was to evaluate the ability of low dose dobutamine and low dose dipyridamole radionuclide ventriculography to detect contractile reserve in patients after myocardial infarction and functional recovery after coronary angioplasty.

Initial experience with a new 8 French-compatible directional atherectomy catheter: immediate and mid-term results.

The purpose of this study was to evaluate the safety and efficacy of the new Fox Hollow atherectomy device (FHT) designed for more efficient and easier plaque removal. The FHT has short rigid section and low-profile cutter mounted on a monorail catheter. The FHT catheter was utilized in 77 patients with 98 lesions.

Modified T-stenting technique with crushing for bifurcation lesions: immediate results and 30-day outcome.

We report a new stenting technique employed in 20 consecutive patients to treat true bifurcation lesions using the Cypher stent (Cordis, Warren, NJ). Both stents are advanced at the site of the bifurcation. The proximal marker of the side-branch stent must be situated in the main branch at a distance of 4-5 mm proximal to the carina of the bifurcation and the main branch stent must cover the bifurcation as well as the protruding segment of the side-branch stent.

Effectiveness of treatment of in-stent restenosis with an 8-French compatible atherectomy catheter.

The study reports the results of directional atherectomy with an 8Fr guiding catheter-compatible atherectomy catheter in a series of 31 in-stent restenotic lesions. This preliminary experience indicates a favorable safety profile, with events limited to non-Q-wave myocardial infarction occurring in 3.6% of patients.

Clinical and angiographic outcome of directional atherectomy followed by stent implantation in de novo lesions located at the ostium of the left anterior descending coronary artery.

Background: Lesions located at the ostium of the left anterior descending coronary artery (LAD) are considered an ideal target for directional atherectomy (DCA), but few data are available about the value of using this strategy before stenting in comparison with stenting alone.

Objectives: To investigate the immediate and mid term clinical and angiographic results of DCA followed by stent implantation for ostial LAD lesions.

Design: Retrospective comparison of the immediate and mid term angiographic and clinical results of a series of 117 consecutive patients with de novo lesions located at the ostium of the LAD.

Beta-radiation therapy for long lesions in native coronary vessels: a matched comparison between de novo and in-stent restenotic lesions.

Objective: The purpose of this study was to evaluate effectiveness and to compare clinical outcome of intracoronary beta-radiation to treat long lesions (>20 mm) in patients with de novo stenosis vs. patients with in-stent restenosis (ISR).

Methods: A matched comparison of 44 patients with 63 de novo lesions and 48 patients with 63 ISR lesions (>20 mm) treated with intracoronary beta-radiation was performed.

Randomized evaluation of polytetrafluoroethylene-covered stent in saphenous vein grafts: the Randomized Evaluation of polytetrafluoroethylene COVERed stent in Saphenous vein grafts (RECOVERS) Trial.

Background: Treatment of lesions located in saphenous vein grafts (SVGs) is associated with increased procedural risk and a high rate of restenosis.

Methods And Results: We conducted a randomized, multicenter trial to evaluate the usefulness of a polytetrafluoroethylene (PTFE)-covered stent compared with a bare stainless steel (SS) stent for prevention of restenosis and major adverse cardiac events (MACE) in patients undergoing SVG treatment. The primary end point was angiographic restenosis at 6 months.

A tortuous distal carotid artery: how to overcome the problem, with the aim of guaranteeing distal protection.

This report describes a case of stent implantation in a right internal carotid artery with severe distal tortuosity, which caused difficulty in advancing a filter protection device. Advancement of the introducing sheath at the level of the carotid bifurcation and exchange for a third-generation distal filter protection device overcame the problem.

Preliminary observations regarding angiographic pattern of restenosis after rapamycin-eluting stent implantation.

Background: Restenosis after implantation of drug-eluting stents (DES) is a rare phenomenon, occurring more frequently peri-stent.

Methods And Results: We evaluated the pattern of restenosis occurring after implantation of DES in unselected lesions. From April 15 to December 6, 2002, we treated 368 patients with 735 lesions by using 841 rapamycin-eluting stents (Cypher, Cordis, a Johnson & Johnson Company).

Sirolimus-eluting stents: a review of experimental and clinical findings.

Sirolimus (rapamycin), a macrolide antibiotic with known potent immunosuppressive properties, acts in the first phase (G1) of the cell cycle, blocking its further progression to the phase of DNA synthesis (S). In experimental models, rapamycin is effective in inhibiting smooth muscle cell proliferation and migration after vessel wall injury with balloon angioplasty. These results lead to the clinical application of sirolimus-eluting stents in 45 patients in Sao Paulo and Rotterdam (FIM Registry) and 238 patients in a randomized, European multicenter trial (RAVEL).

Aortic root and extensive coronary dissections complicating recanalization of chronic right coronary artery occlusion: refraining from stenting may have a favorable outcome!

Aortic root dissection is a rare, potentially life-threatening complication of revascularization procedures. We report a case of recanalization of chronic total occlusion of the right coronary artery. A huge coronary dissection with a false lumen was created using commercially available guidewires during attempts to establish a connection with the distal true vessel lumen.

A new dedicated stent and delivery system for the treatment of bifurcation lesions: preliminary experience.

We report the first clinical experience in eight patients with a new stent and delivery system specifically designed for the treatment of bifurcational lesions. The device (AST SLK-View system) consists of a premounted stent and a delivery system. The stent has a side aperture, which orients toward the ostium of the side branch.

Mechanism of late in-stent restenosis after implantation of a paclitaxel derivate-eluting polymer stent system in humans.

Background: We recently reported delayed angiographic restenosis in 15 patients who received 7-hexanoyltaxol (QP2)-eluting polymer stents (QuaDS) for the treatment of in-stent restenosis. This study presents the histological findings of atherectomy specimens from a subset of these patients receiving implants.

Methods And Results: Between October and December 2001, 5 patients treated with QuaDS-QP2 stents underwent directional coronary atherectomy at 11.

Selection of coronary stents.

In clinical practice, the operator must decide which stent is most appropriate for the patient. This article focuses on the features of stent design that make a specific stent more or less suitable for a particular type of lesion or anatomy: the "average" coronary lesion, the lesion situated on a curve, the ostial lesion, the bifurcational lesion, the lesion located at the left main stem, the calcified lesion, the chronic total occlusion, the small vessel, the saphenous vein graft, acute or threatened vessel closure, and special situations such as coronary aneurysms and perforations.

Carotid artery stenting in the first 100 consecutive patients: results and follow up.

Background: Carotid artery stenting is now used as an alternative to surgical endarterectomy. The availability of cerebral protection systems has expanded the area of application of this procedure.

Objective: To assess the feasibility, safety, and immediate and late clinical outcome in patients undergoing percutaneous carotid interventions.

Results and long-term predictors of adverse clinical events after elective percutaneous interventions on unprotected left main coronary artery.

Background: The safety and efficacy of percutaneous coronary intervention of de novo lesions in unprotected left main coronary arteries remains an unresolved issue.

Methods And Results: We analyzed 67 consecutive patients treated with the following devices: 39 with stents, 12 with rotational atherectomy plus stents, 13 with directional coronary atherectomy plus stents (a total of 64 patients were treated with stents), and 3 patients with directional coronary atherectomy only. The reference vessel size was 3.

In-stent restenosis in small coronary arteries: impact of strut thickness.

Unlabelled: OBJECTIVES; We sought to evaluate whether strut thickness may impact the restenosis rate after stent implantation in small coronary arteries.

Background: Small vessel size (<3.0 mm) is an independent risk factor for the occurrence of in-stent restenosis.

Effective plaque removal with a new 8 French-compatible atherectomy catheter.

The purpose of this study was to evaluate the safety and efficacy of the new 8 Fr guide catheter-compatible Flexicut directional atherectomy device and to compare it with the conventional Atherocath GTO catheter. The 6 Fr Flexicut catheter has a larger cutting window and a titanium nitride-coated cutter to effect more tissue removal as well as treat mildly calcified lesions. A group of 143 lesions in 117 consecutive patients treated with the Flexicut catheter in four centers were compared with a control group of 277 lesions in 212 consecutive patients treated with the GTO device.