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11/2011; , ISBN: 978-953-307-286-9
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ABSTRACT: Although the advancement of the equipment and the presence of innovative techniques, percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) continues to be affected by lower procedural success in comparison with non occluded vessel PCI.
We describe a new technique for the treatment of coronary CTO which utilizes a new generation of polymeric wires.
From March 2009 to June 2010 different strategies were adopted as "bail out" after an initial attempt failed in 117 consecutive CTO lesions. Among these, conventional strategies (CS) such as parallel wire, sub-intimal tracking and re-entry (STAR), microchannel technique, intracoronary ultrasound guided revascularization and anchor balloon, were used in 75 cases (64.1%), while in the remaining a new technique, the "mini-STAR," was used (39.9%). Although no substantial differences were observed regarding the distribution of clinical features and angiographic lesions characteristics between the populations, mini-STAR was able to achieve a higher rate of procedural success in comparison with other CS (97.6% vs. 52%, P < 0.001) with lower contrast agent use (442 ± 259 cm(3) vs. 561 ± 243 cm(3), P = 0.01) and shorter procedural and fluoroscopy times (122 ± 61 vs. 157 ± 74 min, P = 0.009 and 60 ± 31 min vs. 75 ± 38 min, P = 0.03, respectively). No differences were observed in term of peri-procedural complications such as procedural myocardial infarction, coronary perforations, and contrast-induced nephropathy between mini-STAR and CS.
The mini-STAR technique is a promising strategy for the treatment of CTO lesions, achieving a high procedural success rate and low occurrence of procedural adverse events.
Catheterization and Cardiovascular Interventions 09/2011; 79(1):30-40. · 2.29 Impact Factor
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Giampaolo Niccoli,
Andrea Leo,
Simona Giubilato,
Nicola Cosentino, Alfredo Ruggero Galassi,
Silvia Minelli,
Italo Porto,
Antonio Maria Leone,
Francesco Burzotta,
Carlo Trani,
Filippo Crea
International journal of cardiology 06/2011; 150(3):351-4. · 7.08 Impact Factor
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ABSTRACT: Trifurcation lesions, which are mostly observed in distal left main (LM), represent a technical challenge for interventional cardiologists. We sought to determine the feasibility and long-term clinical outcome of drug eluting stent (DES) implantation in patients with LM coronary trifurcation lesions.
All patients with clinically significant de novo LM trifurcation lesions, who refused coronary artery bypass surgery and were considered eligible for percutaneous coronary intervention (PCI), were consecutively enrolled in this study from November 2005 to February 2007. Eleven patients (65+/-9 years, 91% men) met all the inclusion criteria and underwent LM trifurcation stenting with DES. Angiographic success was 100%. Clinical follow-up in all patients and angiographic follow-up in 91% of patients was available at 32+/-7 and 8+/-2 months, respectively. The primary endpoint, defined as the composite of cardiac death or acute myocardial infarction, occurred in one patient (9%). No cases of stent thrombosis were recorded. Three patients (27%), experienced a clinically-driven target lesion revascularisation (TLR).
PCI with DES implantation in patients with LM trifurcation seems feasible and safe, with acceptable TLR rates. Large scale multicentre registries are warranted to reliably address clinical outcome of this subset of patients.
EuroIntervention: journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology 09/2009; 5(4):432-7. · 3.29 Impact Factor
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Alessandra Sanfilippo,
Miriam Cumbo,
Anna Maria Caggegi,
Sergio Monaco,
Rita Bucalo,
Cettina Ruperto,
Claudia Tamburino,
Gian Paolo Ussia, Alfredo Ruggero Galassi,
Piera Capranzano,
Davide Capodanno,
Corrado Tamburino
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ABSTRACT: We sought to evaluate the impact on long-term clinical outcomes of different types of drug-eluting stents (DES) in elderly patients.
Elderly patients constitute a fast-growing portion of cardiovascular patients, however, they are not adequately represented in clinical trials. Moreover, few data comparing different type of DES in elderly patients are available.
From a total of 2,330 consecutive patients treated at our institution with DES, we selected 207 elderly patients (> or = 75 years of age) who underwent, from May 2002 to December 2006, sirolimus-eluting stent (SES group, 116 patients [pts], 56%) or paclitaxel-eluting stent (PES group, 91 pts, 43.9%) implantation. We evaluated the 24-month incidence of major adverse cardiac events (MACE).
Higher rates of hypertension (78.4% vs. 90.1%; p = 0.01), diabetes (37.9 vs. 45.1; p = 0.01) and previous coronary artery bypass grafts (10.3% vs. 19.4%; p = 0.04) in the PES group were observed, whereas in the SES group, there were more smokers (26.6% vs. 12.1%; p = 0.007) and a higher incidence of previous myocardial infarction (MI) (50% vs. 35.2%; p = 0.02). Procedural success and in-hospital MACE were similar in both groups. At follow up, there was a higher incidence of MACE (22.4% vs. 10.9%; p = 0.04) and target lesion revascularization (7.1% vs. 3.0%; p = 0.02) in the SES group compared to the PES group. The incidence of cardiac death and MI were comparable between the two groups, as well as the rate of stent thrombosis. After adjustment for clinical and angiographic characteristics, no significant differences in outcomes were observed between SES and PES.
In this real-word experience, no significant differences were found in the safety and efficacy profiles between SES and PES use in elderly patients.
The Journal of invasive cardiology 08/2009; 21(7):330-3. · 1.84 Impact Factor
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ABSTRACT: Percutaneous closure of the left atrial appendage (LAA) is a novel alternative for the treatment of patients with atrial fibrillation (AF) and with a high risk of stroke who are not eligible for long-term anticoagulation therapy. The aim of this study was to asses the safety, feasibility, and long-term efficacy of this procedure.
From July 2004 to June 2007, 20 patients (13 male, mean age 69 +/- 8 years) with non-valvular AF (NV-AF) underwent LAA percutaneous closure using the PLAATO system, implanted through a transeptal access. All patients had contraindications to anticoagulant therapy and were at high risk for cardioembolic stroke (mean CHADS(2) score 3 +/- 1.2). A trans-thoracic echocardiogram was performed at 1, 3, and every 6 months after the procedure, whereas a trans-oesophageal echocardiogram (TOE) was scheduled at 6 months. After 24 months, a phone interview was obtained.
All procedures were successfully performed in 18 patients. In two patients, LAA closure was not feasible for the presence of a multilobed LAA. Two patients underwent percutaneous closure of patent foramen ovale in the same session. In one patient, the procedure was complicated by cardiac perforation with pericardial effusion, treated with pericardiocentesis. At a mean follow up of 40 +/- 10 months, no embolic events occurred. One patient died, after 36 months, for gastric cancer. TOE examination showed the complete exclusion of the LAA in all patients.
Percutaneous closure of LAA is safe and efficacious to prevent stroke in patients with NV-AF at high risk for cardioembolic events, with contraindications to anticoagulant therapy.
Catheterization and Cardiovascular Interventions 05/2009; 74(2):217-22. · 2.29 Impact Factor
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ABSTRACT: We sought to evaluate clinical and angiographic outcomes of percutaneous coronary intervention (PCI) in patients receiving both bare-metal stents (BMS) and drug-eluting stents (DES).
Few data are available about the safety and efficacy of the practice namely called "hybrid PCI".
One hundred and eighty-six patients, 502 de novo lesions, received during PCI both BMS (n = 266) and DES (316), with a mean of 3.1 +/- 1.2 stents/patient. Cumulative major adverse cardiac events were analyzed at 24 +/- 22 months.
Clinical follow up was carried out in 100% of eligible patients. Angiographic follow up at 8.6 +/- 4.4 months was achieved in 70.4% of patients, 71.6% of stents and 72.5% of lesions. Binary restenosis was 12.9% vs. 20.6% (p = 0.034) in DES vs. BMS, respectively; late loss was significantly higher in BMS than in DES (0.67 +/- 0.73 vs. 0.35 +/- 0.71 mm; p < 0.001). DES showed less lumen loss and binary restenosis rates than BMS in B2/C lesions (p < 0.001 and 0.007, respectively), while any significant difference was detected in A/B1 lesions (p = 0.27 and 0.76, respectively).
The simultaneous use of DES and BMS is safe and provides similar results for the 2 stents only in simple lesions. In complex lesions, BMS offer restenosis and a target lesion revascularization rates significantly higher than with DES.
The Journal of invasive cardiology 04/2009; 21(4):145-50. · 1.84 Impact Factor
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Corrado Tamburino,
Maria Elena Di Salvo,
Davide Capodanno,
Piera Capranzano,
Rosario Parisi,
Francesca Mirabella,
Francesco Scardaci,
Gianpaolo Ussia, Alfredo Ruggero Galassi,
Damiana Fiscella,
Roxana Mehran,
George Dangas
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ABSTRACT: We sought to evaluate the safety and performance of the Janus Tacrolimus-Eluting stent (TES) in an unselected population of patients, without application of restrictive clinical or angiographic criteria.
Continued attention to the safety, efficacy, and deliverability of first-generation drug eluting stents has led to the development of new antiproliferative agents with alternative stent platforms and different drug carrier vehicles.
The TEST (Tacrolimus Eluting STent) registry is a prospective, nonrandomized single-center registry in which 140 consecutive patients who underwent single- or multi-vessel percutaneous coronary intervention between February 2005 and August 2005 were enrolled.
The composite rate of major adverse cardiac events (MACE) at 22 months clinical follow-up was 40.9%. The rate of mortality, myocardial infarction, and target lesion revascularization (TLR) were 5.5%, 11%, and 31.5%, respectively. Angiographic follow-up at 8 months was achieved in 74% of patients; binary restenosis occurred in 39.4% of lesions. Most restenosis lesions (94.6%) had a diffuse pattern, while focal restenosis was observed in 5.4% of cases. Definite or probable stent thrombosis was observed in 2.4% of patients.
The present prospective, nonrandomized, TEST registry indicated high MACE and restenosis rates, and thereby rather discouraging long-term outcomes with use of the Janus TES in an unselected "real world" population of patients who underwent single- or multi-vessel percutaneous coronary intervention.
Catheterization and Cardiovascular Interventions 11/2008; 73(2):243-8. · 2.29 Impact Factor
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Corrado Tamburino,
Saverio Ciriminna,
Rossella Barbagallo, Alfredo Ruggero Galassi,
Gianpaolo Ussia,
Piera Capranzano,
Francesco Tagliareni,
Salvatore Tolaro,
Antonino Nicosia,
Amerigo Stabile,
Rosario Grassi,
Antonio Fiscella,
Aldo Patti,
Giovanni Saccone
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ABSTRACT: This is a multicentre, open label, prospective non-randomized registry, with 9-month angiographic follow-up, conducted to evaluate the safety and effectiveness of drug-eluting stents (DES) when used in high restenosis risk patients from the real world.
From June 2004 to February 2005, a total of 1622 consecutive patients were enrolled to the Sicilian DES Registry, according to specific inclusion criteria. Both paclitaxel-eluting and sirolimus-eluting stents were used. The analysis was performed on 1472 patients because 150 patients were excluded from the study. The primary endpoint was to evaluate the rate of major adverse cardiac events (MACE) within 9 months after DES implantation. Major adverse cardiac events were defined as cardiac death, non-Q-wave or Q-wave myocardial infarction (MI) and target vessel revascularization (TVR). The secondary endpoints were procedural success, angiographic binary restenosis and stent thrombosis within 9 months post-procedure.
Patients were more frequently male; 472 (32.1%) were diabetics, of whom 130 (27.5%) were treated with insulin. Mean ejection fraction of the left ventricle was 51.5 +/- 8.7%. Multivessel disease was found and treated in 627 patients (42.6%). A total of 2439 lesions were treated with DES. Final angiographic success was achieved in 2422 (99.3%) lesions. Procedural success was achieved in 1422 (96.6%) patients. The 9-month cumulative incidence of MACE was 7.3% with 0.8% of cardiac deaths, 0.8% non-fatal MI, 7.9% TVR. Binary restenosis was observed in 101 patients (8.3%). Stent thrombosis was documented in 11 patients (0.8%).
Drug-eluting stents appear to be safe and associated with a low incidence of MACE at 9-month follow-up, even in patients selected for their complexity.
Journal of Cardiovascular Medicine 03/2008; 9(2):161-8. · 1.51 Impact Factor
