Operator volume and outcomes of primary angioplasty for acute myocardial infarction in a single high-volume centre.

Objective: The guidelines for the management of ST-elevation myocardial infarction (STEMI) state the minimum operator volume for percutaneous coronary interventions (PCIs), without strong evidence of a relationship between operator volume and outcomes of primary angioplasty, at variance with elective practice. We sought to investigate the effect of operator volume on primary PCI for STEMI.

Methods: Three hundred and thirty-one consecutive STEMI patients were treated over 19 months with primary PCI in a high-volume centre without on-site cardiac surgery.

Ad hoc transradial coronary angioplasty strategy: experience and results in a single centre.

Background: The combination of diagnostic and angioplasty as a single procedure is becoming common practice in many institutions, but the feasibility of this strategy performed with the transradial approach in a large group of patients has not been evaluated. This study was performed to explore the feasibility, safety and cost-effectiveness of the transradial approach as a single procedure for diagnostic angiography and angioplasty, including stent implantation.

Methods: From February 1999 and November 2000 the percutaneous transradial approach was attempted in 800 patients with functional radial arch attested using Allen's test.

[Primary angioplasty in acute myocardial infarction: experience and results in the first 1,000 consecutive patients].

Background: One of the biggest debates in modern cardiology regards the relative merit of primary percutaneous transluminal coronary angioplasty (PTCA) versus thrombolysis for the treatment of acute myocardial infarction with persistent ST-segment elevation. After the excellent results with primary PTCA in trials and meta-analyses, the next question is whether such results might be duplicated in "real world" conditions.

Methods: Between January 1995 and April 2003, 1000 consecutive patients with acute myocardial infarction, out of 2272 (44%) with ST-segment elevation admitted to the coronary care unit at the Cardiology Department of the S.

Transradial approach for renal percutaneous transluminal angioplasty and stenting: a feasibility pilot study.

Background: Stent implantation of renal stenosis (RS) has been reported on extensively; this technique is perceived as superior to balloon angioplasty alone and less invasive than surgical revascularization. With the development of new accessories and stents, we can now improve and optimize procedural and clinical results. In this pilot study, we tested an alternative minimally invasive approach for renal stenting: the transradial artery catheterization (TAC) and a 6 French (Fr) system for stenting.

[Acute myocardial infarction during labor: report of a case and review of the literature].

Acute myocardial infarction in pregnancy is a rare condition with substantial risk of maternal and fetal death. There is very little information about the use in this setting of percutaneous coronary interventional therapy. Together with literature review on this topic, we present the case of a 33-year-old 39-week pregnant woman who sustained during labor an acute transmural anterior myocardial infarction.

Acute and mid-term results of phosphorylcholine-coated stents in primary coronary stenting for acute myocardial infarction.

The aim of this pilot study was to evaluate the safety and efficacy of the BiodivYsio phosphorylcholine-coated stent in the primary treatment of acute myocardial infarction. The BiodivYsio stent (Biocompatible) is a balloon-expandable stent, laser etched from a 316 L stainless steel tube. This device is coated with phosphorylcholine, a synthetic, hemocompatible phospholipid polymer that has been shown in experimental studies to reduce platelet and protein adhesion to the surface of the metal.

Hypothesis and development of a minimally invasive approach for percutaneous transmyocardial revascularization with holmium laser.

Background: Percutaneous transluminal myocardial revascularization (PTMR) is a new procedure to improve perfusion of the ventricular wall for patients with intractable angina and untreatable by surgery or conventional catheter-based intervention. Actually PTMR requires femoral approach to utilize 8F-9F system device. We now report the feasibility study of PTMR using a laser delivered through a novel Eclipse system and new 6F and 7F guiding catheters that allow to perform PTMR even in patients with peripheral vascular disease and particularly suitable for alternative small vascular access.

Italian BiodivYsio open registry (BiodivYsio PC-coated stent): study of clinical outcomes of the implant of a PC-coated coronary stent.

Unlabelled: Rapid technological developments have made new materials available for percutaneous coronary intervention procedures. The coronary stent in particular has undergone progressive structural improvements leading to the recent availability of a third generation of stents, namely, coated stents. The rapid evolution of the stent has often made its evaluation problematical, since trials are frequently confined to small groups of patients in single centers.

Transcatheter mechanical thrombus aspiration for stent thrombosis.

Currently, in-stent thrombosis is a rare but serious clinical event. The mechanical or pharmacological approach has not totally solved this problem. In this report we describe the treatment of in-stent thrombosis with a new device for mechanical thrombus aspiration.

Percutaneous transmyocardial revascularization with holmium laser in patients with refractory angina: a pilot feasibility study.

Background: Percutaneous transluminal myocardial revascularization (PTMR) is a new procedure to improve perfusion of the ventricular wall for patients with intractable angina that is untreatable by surgery or conventional catheter-based intervention. PTMR allows the creation of myocardial channels through the controlled delivery of holmium laser energy from the ventricular chamber. Preliminary studies in animals and human subject have yielded promising results.

[Primary angioplasty in acute myocardial infarct with or without a stent implant: the experience and results at 6 months in the first 200 patients].

Background: Although it is superior to thrombolysis, primary PTCA does have some limitations, both in hospital (recurrent ischemia and reinfarction due to reocclusion of the infarct-related artery) and at the six-month follow-up (high rate of late restenosis). Coronary stenting is a promising way of solving some of these problems, even if its use in patients with acute myocardial infarction could prove to be controversial because of intracoronary thrombus. In this study, we propose two procedural strategies in the treatment of the infarct-related artery (IRA): the search for optimal angiographic results after PTCA ("stent-like result"--SLR--with residual stenosis < or = 20%--no dissection--TIMI III flow) or intracoronary stenting when SLR was not obtained after a second inflation.

Transradial approach for coronary procedures: initial experience and results.

Background: Due to the recent miniaturization of angioplasty equipment, the transradial approach has gained favor as an alternative catheterization method for coronary procedures. The purpose of this study was to assess the practical clinical application of this method.

Methods: Between June 1997 and February 1998, one operator (MG) attempted the percutaneous transradial approach in 185 consecutive unselected patients with functional radial arch attested using Allen's test.

Transcatheter management of cardiac and pericardial metastatic involvement.

We performed percutaneous balloon pericardiotomy and pulmonary valvuloplasty in a woman affected with cardiac and pericardial involvement from a primary pulmonary adenocarcinoma. Pericardial window was indicated for a recurrent, symptomatic, pericardial effusion. Valvular stenosis was severe and related to metastatic infiltration of cardiac tissue.

[Non-cardiac transcatheter intervention: operative possibilities in a hemodynamics laboratory].

Introduction: New possibilities for transcatheter treatment of the cardiovascular system are guaranteed with the improvement of materials and the availability of new devices. Nevertheless, a rationalization of the potential activity in this sector seems to be necessary, and it could arise through the presence of Catheterization Laboratories "open" to diagnostic procedures and therapy that are not confined to the coronary system. This clinical study reports the experiences and results of our work in this field.

"Functional myocardial bridging" and "hyperkinetic state": a rare association as a cause of acute myocardial infarction.

An 82-year-old female was admitted to the catheterization laboratory for investigation of acute antero-lateral myocardial infarction with evidence of severe left ventricular dysfunction. Angiographically, she was found to have normal coronary arteries, with the exception of the presence of myocardial bridging in the left anterior descending coronary artery. This was recognized as a "functional" variation of anatomical bridging, in which a systolic coronary compression is caused by abnormal muscular septal hypertrophy.

[Coronary stenting for treatment of intimal dissection and occlusive thrombosis during primary PTCA in acute myocardial infarction].

Coronary angioplasty during acute coronary syndrome, and particularly in MI, continues to involve a greater risk of acute and subacute occlusion. Stenting for acute or threatened vessel closure has a high initial success rate and reduces the need for emergency bypass surgery. Nevertheless, under these conditions intracoronary thrombus actually appears to be a relative contraindication to stent implantation.

[Clinical experience with the use of implantable vascular systems in advanced heart failure].

Background: Patients with end-stage cardiomyopathy frequently require acute or chronic infusional treatments and long hospitalization. Availability of a simple and safe vascular access is a true necessity for these patients, especially in case of inotropic or diuretic outpatient treatment. In this study we have evaluated the usefulness and the applicability of implantable vascular access in the management of end-stage cardiomyopathy.

Percutaneous balloon pericardiotomy for malignant pericardial tamponade.

Recurrent pericardial effusion or tamponade can complicate malignant disease. The medical approach with pharmacologic agents has a high recurrence rate. Balloon pericardiotomy (BP) may provide a less invasive alternative to surgery.

Balloon expandable stent implantation after iatrogenic arterial dissection of the left subclavian artery.

A patient undergoing attempted angioplasty of a left internal mammary artery graft to left anterior descending coronary artery developed an iatrogenic dissection of the left subclavian artery, with symptoms of left arm claudication. A balloon expandable stent was inserted with an excellent angiographic result. The patient has remained free of symptoms or signs of decreased arm flow, with a patent subclavian artery demonstrated on angiography 8 months later.

[The use of myoglobin for the early diagnosis of reperfusion in acute myocardial infarct].

Myoglobin (Mb) is an intracardiac protein known to be rapidly released after onset of reperfusion. The new automated latex-enhanced nephelometric immunoassay is an interesting fast alternative to the other methods. Therefore we sought to assess the accuracy of rapid rise of Mb concentration to predict the success of reperfusion.

Coronary stenting: single institution experience with the initial 100 cases using the Palmaz-Schatz stent.

We studied 100 patients who had coronary implantation of Palmaz-Schatz stents in our institution from November 1989 until March 1991. A total of 126 standard and 6 short stents were implanted. The patients' mean age was 58 +/- 5 years, and 97 were males.

Coronary stenting with a balloon-expandable stent after the recanalization of chronic total occlusions.

To diminish the restenosis rate after successful recanalization of chronic total coronary occlusion, we have implanted the Palmaz-Schatz stent in 6 patients. All procedures were successfully done without major complications. The angiographic follow-up at 6 months showed restenosis in one asymptomatic patient who had had 2 stents implanted.