P W Radke

Royal Brompton and Harefield NHS Foundation Trust, Harefield, England, United Kingdom

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Publications (27)140.67 Total impact

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    ABSTRACT: To compare acute and follow up clinical and angiographic results after treatment of in-stent restenosis (ISR) by sirolimus eluting stents (SES) with results obtained after intracoronary radiation therapy (IRT). Matched pair analysis. 62 consecutive ISR lesions (< 30 mm lesion length, reference diameter < 3.5 mm) in 62 patients were treated with SES. From a database of 174 lesions (n = 141 patients) treated for ISR by intracoronary beta radiation, 62 lesions (62 patients) were pair matched with the SES group for diabetes mellitus, lesion length, vessel size, and pattern of ISR. Six month angiographic and 12 month clinical follow up results were obtained. Baseline clinical and angiographic characteristics were similar between the groups (not significant). SES implantation resulted in significantly lower postprocedural in-lesion diameter stenosis than did IRT (mean (SD) 14.2 (9.5)% v 21.1 (10.6)%, p = 0.001), significantly higher minimum lumen diameter at follow up (1.91 (0.58) v 1.55 (0.72) mm, p = 0.005), and a higher net gain (1.16 (0.55) v 0.77 (0.70) mm, p = 0.002). Angiographic binary in-lesion restenosis rate at six months was 11% in the SES group and 29% in the IRT group (p = 0.046). In 16 ISR lesions SES were used after failed IRT and in 46 lesions for first time ISR. In-lesion late loss was higher after use of SES for failed IRT than after use of SES for first time ISR (0.61 (0.67) mm v 0.24 (0.41) mm, p = 0.018). In a multivariate analysis prior failed IRT was the only independent predictor for recurrent restenosis after SES for ISR (p = 0.052, odds ratio 5.8). Six patients (10%) in the SES group and 17 patients (27%) in the IRT group underwent target lesion revascularisation during the 12 months of follow up (p = 0.022). In this non-randomised matched cohort SES achieved acute and follow up results superior to IRT for treatment of ISR even if cases of failed IRT are included. Failed IRT is a predictor of impaired SES effectiveness.
    Heart (British Cardiac Society) 12/2005; 91(12):1584-9. · 5.01 Impact Factor
  • P W Radke, A Kaiser, C Frost, U Sigwart
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    ABSTRACT: To evaluate the clinical outcome after treatment of coronary in-stent restenosis. For identification of the relevant literature a specific search strategy was conducted and explicit inclusion criteria were defined to avoid selection bias. Based on the selected literature, a systematic review using descriptive statistics and meta-analysis methods regarding the outcome after treatment of coronary in-stent restenosis was performed. The proportion of patients experiencing a major adverse cardiac event (MACE) as defined by death, myocardial infarction, and target lesion revascularization was the main outcome measure. A total of 1304 citations were identified. Among these, 28 studies (six different treatment modalities) including a total of 3012 patients met the inclusion criteria and were incorporated into this analysis. The estimated average probability of experiencing a major cardiac adverse event after treatment for in-stent restenosis with a follow-up period of 9+/-4 months was 30.0% (25.0-34.9%, 95% confidence interval) with strong evidence for heterogeneity between study specific results (P=0.0001). The clinical outcome was not significantly different between treatment modalities. After adjustment for confounding factors (i.e. lesion length), however, patients undergoing intracoronary radiation showed an estimated advantage of 16.9% (-37.7+/-4.0%, 95% confidence interval) in MACE free survival, as compared to balloon angioplasty. The post-interventional diameter stenosis was the only independent predictor for the long-term outcome after treatment of in-stent restenosis. Treatment of in-stent restenosis is associated with an overall 30% rate of major adverse cardiac events. Currently, repeat angioplasty is the treatment option of choice, especially when a sufficient acute procedural result can be achieved. Intracoronary radiation should be considered in cases with therapy refractory forms of diffuse in-stent restenosis.
    European Heart Journal 03/2003; 24(3):266-73. · 14.72 Impact Factor
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    ABSTRACT: Restenosis after coronary stent implantation remains the major limitation of this treatment modality. At present, re-dilatation is considered the therapeutic option of choice for focal lesions, however, long restenotic lesions (>10 mm) do not respond favourably. Despite the emerging concept of intracoronary radiation, encouraging acute procedural results are also reported for different debulking techniques (Excimer laser angioplasty, directional coronary atherectomy, and rotational atherectomy, or rotablation). Rotablation has been studied most extensively with acute and long- term results published in a total of more than 850 patients. Experimental and first clinical data indicate favourable results for the rotablator as compared to balloon angioplasty alone for the treatment of in-stent restenosis. Data from the first 2 randomized clinical trials (ROSTER-, and ARTIST-trial) have now been published with conflicting results: The european multicenter ARTIST-trial including 300 patients could not prove a benefit for the rotablator as compared to re-dilatation in patients with diffuse stent restenosis. On the contrary, the monocenter ROSTER-trial, which has been presented as an abstract until today, suggests a clinical benefit of patients treated by the rotablator if they were studied with intracoronary ultrasound prior to randomization. Currently, rotablation for the treatment of restenosis cannot be considered as the first line treatment modality in patients with in-stent restenosis. As a result of unsatisfying angiographic and clinical long-term results by the use of a variety of treatment modalities in diffuse stent restenosis, prevention of this iatrogenic entity has become mandatory.
    Minerva cardioangiologica 10/2002; 50(5):555-63. · 0.43 Impact Factor
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    ABSTRACT: Gastric PCO2 measured by balloon tonometry can estimate the adequacy of splanchnic perfusion. However, enteral feeding and gastric content can interfere with gastric PCO2 assessment. Tonometry in other sites of the body could avoid these problems. We therefore tested the hypothesis that oesophageal air tonometry would give results similar to gastric tonometry. We studied 20 consecutive patients (mean age 68 (SD 9) [range 49-81] yr, 18 males, SAPS II score 55 (SD 18), ICU mortality 55%) with circulatory disorders during mechanical ventilation in the intensive care unit. Tonometer probes were placed via the nose, one into the stomach and the other in the oesophagus. PCO2 was measured with two automated gas analysers, at admission and 30 min, 1, 2, 3, 32, 40, and 48 h thereafter. One hundred and forty-eight paired measurements were obtained. Gastric PCO2 was greater than oesophageal PCO2 on admission (7.19 (1.43) vs 5.89 (0.73) kPa, P < 0.01) and subsequently. Differences between the measures correlated (r = 0.67) with the mean absolute value, indicating that overestimation increased as gastric PCO2 increased. Oesophageal PCO2 is less than gastric PCO2, and the difference is greater when gastric PCO2 levels are greater. Air tonometry may not measure regional PCO2 levels in the oesophagus satisfactorily. Other methods and sites for carbon dioxide tonometry should be examined.
    BJA British Journal of Anaesthesia 08/2002; 89(2):237-41. · 4.24 Impact Factor
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    P W Radke, U Sigwart
    The Lancet 10/2001; 358(9283):757; author reply 758-9. · 39.21 Impact Factor
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    ABSTRACT: Restenosis remains the major limitation of coronary stent implantation, especially in diffuse forms of in-stent restenosis. In this study, rotablation (RA) with adjunct angioplasty of in-stent restenosis was performed in 84 patients. Clinical follow-up and control angiography were obtained 6-month postprocedure. The rate of recurrent restenosis after rotablation for in-stent restenosis at 6-month angiographic follow-up was 45%, resulting in a rate of major adverse cardiac events of 35%. At 3-year follow-up, the cumulative event-free survival rate was 57% for the entire population. The only predictor of MACE at 3-year clinical follow-up by multivariate logistic regression analysis was in-stent lesion length. RA for the treatment of diffuse in-stent restenosis is thereby characterized by high procedural success rates and recurrent angiographic restenosis in 45% of patients with diffuse lesions. Major adverse cardiac events occur most likely within the first 6 months postprocedure. Three years after rotablation of in-stent restenosis, 43% of patients had experienced at least one major adverse cardiac event. Cathet Cardiovasc Intervent 2001;53:334-340.
    Catheterization and Cardiovascular Interventions 08/2001; 53(3):334-40. · 2.51 Impact Factor
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    ABSTRACT: Experimental and clinical data support an infectious cause of atherosclerosis and thereby coronary artery disease. This study was intended to assess the prevalence and possible clinical associations of the presence of cytomegalovirus DNA within coronary samples from patients undergoing coronary artery bypass grafting. A coronary thrombendatherectomy was performed in 53 patients with advanced coronary artery disease. Two samples of each atheroma were used for further analysis and pathogen detection. In 30% of patients with advanced coronary artery disease cytomegalovirus DNA was detected in coronary samples as assessed by highly sensitive PCR methods. The occurrence of the virus within the vessels was characterized by an inhomogeneous distribution pattern. Due to an increased proportion of restenotic lesions and a higher degree of calcification in cytomegalovirus-positive lesions, a causative association between the virus presence and mechanisms of restenosis post angioplasty is further supported. Antiviral pharmacological interventions to prevent restenosis in high-risk patients, however, seem not to be justified by the data currently available.
    Medizinische Klinik 04/2001; 96(3):129-34. · 0.34 Impact Factor
  • The Journal of invasive cardiology 03/2001; 13(2):141-2; discussion 158-70. · 1.57 Impact Factor
  • P W Radke, P Hanrath, J vom Dahl
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    ABSTRACT: Restenosis after coronary stent implantation remains one of the major limitations of this treatment modality. At present, redilatation is considered the therapeutic option of choice for focal lesions; however, long restenotic lesions (> 10 mm) do not respond favourably. Despite the emerging concept of intracoronary radiation, encouraging acute procedural results are also reported for different debulking techniques (excimer laser angioplasty, directional coronary atherectomy, and rotational atherectomy, or rotablation). Rotablation has been studied most extensively with acute and long-term results published in a total of 500 patients. Experimental and first clinical data indicate favourable results for the rotablator as compared to balloon angioplasty alone for the treatment of in-stent restenosis. Data from the first two randomised clinical trials (ROSTER and A.R.T.I.S.T. trials) have now been published in abstract form, with conflicting results: whereas the monocenter ROSTER trial suggests a clinical benefit to patients treated by the rotablator, the multicenter A.R.T.I.S.T. trial including nearly 300 patients could not prove a benefit for the rotablator as compared to re-dilatation in patients with diffuse stent restenosis. Currently, rotablation for the treatment of restenosis can not be considered as the first line treatment modality in patients with stent restenosis. As a result of unsatisfying angiographic and clinical long-term results by the use of a variety of treatment modalities in diffuse stent restenosis, prevention of this iatrogenic entity will become mandatory.
    Zeitschrift für Kardiologie 03/2001; 90(3):161-9. · 0.97 Impact Factor
  • P. W. Radke, P. Hanrath, J. vom Dahl
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    ABSTRACT: Die Restenosierung nach koronarer Stentimplantation stellt weiterhin ein bedeutendes Problem in der interventionellen Kardiologie dar. Derzeit gilt die erneute Dilatation (Re-Dilatation) bei fokaler und kurzstreckiger Stent-Restenose als Verfahren der Wahl, die Behandlung langstreckiger Formen der Stent-Restenose (>10mm) bleibt jedoch trotz Verwendung unterschiedlicher Techniken aufgrund unbefriedigender Langzeit-Ergebnisse problematisch. Neben der intrakoronaren Strahlentherapie (Brachytherapie), bei der die potentiell limitierenden Phänomene der Randstenosierung („Candy-Wrapper”) und der „späten” Thrombose noch nicht abschließend geklärt sind, sind derzeit vor allem Gewebe-ablative Verfahren (Excimer Laser-Angioplastie, direktionale koronare Atherektomie, Rotations-Atherektomie) Gegenstand zahlreicher klinischer Studien.    Für die Rotations-Atherektomie (Rotablation) liegt mit fast 500 behandelten Patienten das umfangreichste Datenmaterial vor. Tierexperimentelle Untersuchungen und erste vergleichende klinische Studien konnten Vorteile dieses Therapieverfahrens gegenüber der alleinigen Re-Dilatation aufzeigen. Die einzigen bisher in Abstractform veröffentlichten randomisierten Untersuchungen, die ROSTER- und die A.R.T.I.S.T.-Studie, erbrachten jedoch konträre Ergebnisse. Während der monozentrische ROSTER-Trial einen klinischen Vorteil der Patienten aufzeigen konnte, die mit Rotablation therapiert wurden, ergab die multizentrische A.R.T.I.S.T.-Studie bei fast 300 Patienten in den angiographischen und klinischen Endpunkten keinen Vorteil für die Rotablation.    Das Verfahren der Rotablation mit adjuvanter Angioplastie kann daher noch nicht als etabliertes Verfahren in der Therapie der Stent-Restenose angesehen werden. Aufgrund der weitgehend unbefriedigenden Ergebnisse in der Therapie der diffusen Stent-Restenose unter Verwendung verschiedener Verfahren und den noch nicht gänzlich verstandenen Nebeneffekten der Brachytherapie kommt der Prävention der Stent-Restenose in Zukunft besondere Bedeutung zu. Restenosis after coronary stent implantation remains one of the major limitations of this treatment modality. At present, re-dilatation is considered the therapeutic option of choice for focal lesions; however, long restenotic lesions (>10mm) do not respond favourably. Despite the emerging concept of intracoronary radiation, encouraging acute procedural results are also reported for different debulking techniques (excimer laser angioplasty, directional coronary atherectomy, and rotational atherectomy, or rotablation).     Rotablation has been studied most extensively with acute and long-term results published in a total of 500 patients. Experimental and first clinical data indicate favourable results for the rotablator as compared to balloon angioplasty alone for the treatment of in-stent restenosis. Data from the first two randomised clinical trials (ROSTER and A.R.T.I.S.T. trials) have now been published in abstract form, with conflicting results: whereas the monocenter ROSTER trial suggests a clinical benefit to patients treated by the rotablator, the multicenter A.R.T.I.S.T. trial including nearly 300 patients could not prove a benefit for the rotablator as compared to re-dilatation in patients with diffuse stent restenosis.    Currently, rotablation for the treatment of restenosis can not be considered as the first line treatment modality in patients with stent restenosis. As a result of unsatisfying angiographic and clinical long-term results by the use of a variety of treatment modalities in diffuse stent restenosis, prevention of this iatrogenic entity will become mandatory. Schlüsselwörter–Stent-Restenose–Therapie–Rotations-AtherektomieKey words Stent restenosis–treatment–rotational atherectomy
    Zeitschrift für Kardiologie 01/2001; 90(3):161-169. · 0.97 Impact Factor
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    ABSTRACT: In-stent restenosis (ISR) is still a growing problem in interventional cardiology due to the increasing number of stent implantations. Various treatment modalities are available at present. As a non ablative strategy balloon angioplasty is the strategy of choice for focal ISR, while ablative techniques such as directional coronary atherectomy, Excimer laser coronary angioplasty and rotational atherectomy are used preferentially in diffuse restenosis processes. These debulking techniques are optimized by peri-interventional use of intravascular ultrasound and adjunctive balloon angioplasty. Study data comparing different interventional approaches, usually with adjunct balloon angioplasty, have not proven an optimal treatment modality for ISR yet.
    Seminars in interventional cardiology: SIIC 01/2001; 5(4):199-208.
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    ABSTRACT: To evaluate the use of the Sequential Organ Failure Assessment (SOFA) score, the total maximum SOFA (TMS) score, and a derived variable, the deltaSOFA (TMS score minus total SOFA score on day 1) in medical, cardiovascular patients as a means for describing the incidence and severity of organ dysfunction and the prognostic value regarding outcome. Prospective, clinical study. Medical intensive care unit in a university hospital. A total of 303 consecutive patients were included (216 men, 87 women; mean age 62 +/- 12.6 years; SAPS II 26.2 +/- 12.7). They were evaluated 24 h after admission and thereafter every 24 h until ICU discharge or death between November 1997 and March 1998. Readmissions and patients with an ICU stay shorter than 12 h were excluded. Survival status at hospital discharge, incidence of organ dysfunction/failure. Collection of clinical and demographic data and raw data for the computation of the SOFA score every 24 h until ICU discharge. Length of ICU stay was 3.7 +/- 4.7 days. ICU mortality was 8.3% and hospital mortality 14.5%. Nonsurvivors had a higher total SOFA score on day 1 (5.9 +/- 3.7 vs. 1.9 +/- 2.3, p < 0.001) and thereafter until day 8. High SOFA scores for any organ system and increasing number of organ failures (SOFA score > or = 3) were associated with increased mortality. Cardiovascular and neurological systems (day 1) were related to outcome and cardiovascular and respiratory systems, and admission from another ICU to length of ICU stay. TMS score was higher in nonsurvivors (1.76 +/- 2.55 vs. 0.58 +/- 1.39, p < 0.01), and deltaSOFA/total SOFA on day 1 was independently related to outcome. The area under the receiver-operating characteristic curve was 0.86 for TMS, 0.82 for SOFA on day 1, and 0.77 for SAPS II. The SOFA, TMS, and deltaSOFA scores provide the clinician with important information on degree and progression of organ dysfunction in medical, cardiovascular patients. On day 1 both SOFA score and TMS score had a better prognostic value than SAPS II score. The model is closely related to outcome and identifies patients who are at increased risk for prolonged ICU stay.
    Intensive Care Medicine 09/2000; 26(8):1037-45. · 5.54 Impact Factor
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    ABSTRACT: New Zealand obese (NZO) mice exhibit a polygenic obesity associated with hyperinsulinaemia and hyperglycaemia. Here we show that the strain presents additional features of a metabolic syndrome, i.e. elevated blood pressure, serum cholesterol and serum triglyceride levels. A back-cross model of NZO mice with the lean Swiss Jackson Laboratory (SJL) strain was established in order to investigate further the correlation between hypertension, obesity, serum insulin and hyperglycaemia. Systolic blood pressure was significantly elevated at 6 weeks of age and appeared to parallel the weight gain of the animals. Serum insulin levels, presumably reflecting insulin resistance, and systolic blood pressure values were significantly correlated with the body mass index (r2 = 0.707 and 0.486, respectively) in the back-cross mice. In contrast, blood pressure was only weakly correlated with serum insulin (r2 = 0.288) in non-diabetic mice, and was independent of serum insulin levels in diabetic animals. The data are consistent with the concept that hypertension and insulin resistance are a characteristic consequence of the genetic constellation leading to obesity in the NZO strain, and that these traits reflect related mechanisms. It appears unlikely, however, that hypertension is a direct consequence of hyperinsulinaemia.
    European Journal of Clinical Investigation 04/2000; 30(3):195-202. · 3.37 Impact Factor
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    ABSTRACT: Objective: To evaluate the use of the Sequential Organ Failure Assessment (SOFA) score, the total maximum SOFA (TMS) score, and a derived variable, the ΔSOFA (TMS score minus total SOFA score on day 1) in medical, cardiovascular patients as a means for describing the incidence and severity of organ dysfunction and the prognostic value regarding outcome. Design: Prospective, clinical study. Setting: Medical intensive care unit in a university hospital. Patients: A total of 303 consecutive patients were included (216 men, 87 women; mean age 62 12.6 years; SAPS II 26.2 12.7). They were evaluated 24 h after admission and thereafter every 24 h until ICU discharge or death between November 1997 and March 1998. Readmissions and patients with an ICU stay shorter than 12 h were excluded. Main outcome measure: Survival status at hospital discharge, incidence of organ dysfunction/failure. Interventions: Collection of clinical and demographic data and raw data for the computation of the SOFA score every 24 h until ICU discharge. Measurements and main results: Length of ICU stay was 3.7 4.7 days. ICU mortality was 8.3 % and hospital mortality 14.5 %. Nonsurvivors had a higher total SOFA score on day 1 (5.9 3.7 vs. 1.9 2.3, p < 0.001) and thereafter until day 8. High SOFA scores for any organ system and increasing number of organ failures (SOFA score ≥ 3) were associated with increased mortality. Cardiovascular and neurological systems (day 1) were related to outcome and cardiovascular and respiratory systems, and admission from another ICU to length of ICU stay. TMS score was higher in nonsurvivors (1.76 2.55 vs. 0.58 1.39, p < 0.01), and ΔSOFA/total SOFA on day 1 was independently related to outcome. The area under the receiver-operating characteristic curve was 0.86 for TMS, 0.82 for SOFA on day 1, and 0.77 for SAPS II. Conclusions: The SOFA, TMS, and ΔSOFA scores provide the clinician with important information on degree and progression of organ dysfunction in medical, cardiovascular patients. On day 1 both SOFA score and TMS score had a better prognostic value than SAPS II score. The model is closely related to outcome and identifies patients who are at increased risk for prolonged ICU stay.
    Intensive Care Medicine 01/2000; 26(8):1037-1045. · 5.54 Impact Factor
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    ABSTRACT: This case report describes the therapeutic dissolution of an intracoronary thrombus in a patient with ectatic coronary arteries post-myocardial infarction by prolonged intravenous glycoprotein (GP) IIb/IIIa antagonist administration. The report emphasizes the potential thrombotic complications in patients with ectatic coronary arteries and the beneficial use of GP IIb/IIIa receptor antagonists as direct thrombolytic agents even in partially organized thrombus formation. In addition to the well-documented effects of GP IIb/IIIa blockade in the scenario of percutaneous interventions, unstable angina, and non-Q wave infarction, the use of this new class of drugs in acute myocardial infarction seems to be promising and might also be considered in the setting of persistent thrombotic material within the coronary vasculature.
    The Journal of invasive cardiology 12/1999; 11(11):679-81. · 1.57 Impact Factor
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    ABSTRACT: BACKGROUND: Congenital origin of the left coronary artery from the pulmonary artery (ALCAPA) results in chronically dysfunctional myocardium with the partial ability to recover after revascularization. We attempted to establish an ALCAPA syndrome in anesthetized pigs for 24 hours and to compare it with stunned and infarcted myocardium. METHODS AND RESULTS: In group 1 (n = 12), a bypass graft was interposed between the pulmonary artery and the left anterior descending coronary artery (LAD). Reduction of flow in the LAD with gradual increases in flow from the pulmonary artery resulted in an incremental reduction of segment shortening (8.9 +/- 5.3% at 24 hours vs 26.6 +/- 10% at baseline, P <.005). In group 3 (n = 5), 2 cycles of 10-minute LAD occlusion resulted in decreased segment shortening with slow recovery (at 24 hours 18.7 +/- 1.3% vs 24.2 +/- 4% at baseline, segment shortening with slow recovery (at 24 hours 18.7 +/- 1.3% vs 24.2 +/- 4% at baseline, P <.05). In group 3 (n = 6), 1-hour LAD occlusion reduced segment shortening at 24 hours to 4.7 +/- 5.2% (P <.005 vs baseline). Histological analysis of the LAD territory revealed severe degeneration, myolysis, and alteration of the chromatin structure in group 1 comparable to ischemic cell death in group 3, whereas control areas and the LAD area in group 2 showed only minor structural alterations. Infarct size/risk area, as measured by tetrazolium staining, was 49.8 +/- 11.2% in group 1, 9.3 +/- 8.1% in group 2 (P <.005), and 60.3 +/- 9% in group 3. CONCLUSION: Hypoxic myocardial hypoperfusion from the pulmonary artery results in myocardial necrosis in anesthetized pigs. These findings are in contrast to the concept of myocardial hibernation in the ALCAPA syndrome because in this model, hypoxic hypoperfusion failed to induce adaptation to preserve myocardial structure.
    Journal of Cardiovascular Pharmacology and Therapeutics 10/1999; 4(4):235-247. · 3.07 Impact Factor
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    ABSTRACT: This quantitative angiographic and intravascular ultrasound study determined the mechanisms of acute lumen enlargement and recurrent restenosis after rotational atherectomy (RA) with adjunct percutaneous transluminal coronary angioplasty in the treatment of diffuse in-stent restenosis (ISR). In-stent restenosis remains a significant clinical problem for which optimal treatment is under debate. Rotational atherectomy has become an alternative therapeutic approach for the treatment of diffuse ISR based on the concept of "tissue-debulking." Rotational atherectomy with adjunct angioplasty of ISR was used in 45 patients with diffuse lesions. Quantitative coronary angiographic (QCA) analysis and sequential intravascular ultrasound (IVUS) measurements were performed in all patients. Forty patients (89%) underwent angiographic six-month follow-up. Rotational atherectomy lead to a decrease in maximal area of stenosis from 80+/-32% before intervention to 54+/-21% after RA (p < 0.0001) as a result of a significant decrease in intimal hyperplasia cross-sectional area (CSA). The minimal lumen diameter after RA remained 15+/-4% smaller than the burr diameter used, indicating acute neointimal recoil. Additional angioplasty led to a further decrease in area of stenosis to 38+/-12% due to a significant increase in stent CSA. At six-month angiographic follow-up, recurrent restenosis rate was 45%. Lesion and stent length, preinterventional diameter stenosis and amount of acute neointimal recoil were associated with a higher rate of recurrent restenosis. Rotational atherectomy of ISR leads to acute lumen gain by effective plaque removal. Adjunct angioplasty results in additional lumen gain by further stent expansion and tissue extrusion. Stent and lesion length, severity of ISR and acute neointimal recoil are predictors of recurrent restenosis.
    Journal of the American College of Cardiology 08/1999; 34(1):33-9. · 14.09 Impact Factor
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    ABSTRACT: This study evaluated the effect of the glycoprotein IIb/IIIa (GPIIb/IIIa) antagonist abciximab on myocardial hypoperfusion during percutaneous transluminal rotational atherectomy (PTRA). PTRA may cause transient ischemia and periprocedural myocardial injury. A platelet-dependent risk of non-Q-wave infarctions after directional atherectomy has been described. The role of platelets for the incidence and severity of myocardial hypoperfusion during PTRA is unknown. Seventy-five consecutive patients with complex lesions were studied using resting Tc-99m sestamibi single-photon emission computed tomography prior to PTRA, during, and 2 days after the procedure. The last 30 patients received periprocedural abciximab (group A) and their results were compared to the remaining 45 patients (group B). For semiquantitative analysis, myocardial perfusion in 24 left ventricular regions was expressed as percentage of maximal sestamibi uptake. Baseline characteristics did not differ between the groups. Transient perfusion defects were observed in 39/45 (87%) patients of group B, but only in 10/30 (33%) patients of group A (p < 0.001). Perfusion was significantly reduced during PTRA in 3.3 +/- 2.5 regions in group B compared to 1.4 +/- 2.5 regions in group A (p < 0.01). Perfusion in the region with maximal reduction during PTRA in groups B and A was 76 +/- 15% and 76 +/- 15% at baseline, decreased to 56 +/- 16% (p < 0.001) and 67 +/- 14%, respectively, during PTRA (p < 0.01 A vs. B), and returned to 76 +/- 15% and 80 +/- 13%, respectively, after PTRA. Nine patients in group B (20%) and two patients in group A (7%) had mild creatine kinase and/or troponin t elevations (p = 0.18). Patients with elevated enzymes had larger perfusion defects than did patients without myocardial injury (4.2 +/- 2.7 vs. 2.3 +/- 2.5 regions, p < 0.05). These data indicate that GPIIb/IIIa blockade reduces incidence, extent and severity of transient hypoperfusion during PTRA. Thus, platelet aggregation may play an important role for PTRA-induced hypoperfusion.
    Journal of the American College of Cardiology 04/1999; 33(4):998-1004. · 14.09 Impact Factor
  • P W Radke, J vom Dahl, H G Klues
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    ABSTRACT: In-stent restenosis has become a significant problem for interventional cardiologists. Due to different pathogenic causes it remains unclear whether a uniform therapeutic regimen is appropriate. Redilatation has predominantly been used for the treatment of instent restenosis, however, in long and diffuse restenotic stents, long-term results are reported to be poor. Therefore, tissue-debulking techniques may have beneficial effects in complex cases of in-stent restenosis. The therapeutic benefit of intracoronary radiation, local drug delivery or gene transfer has not been evaluated so far. Therefore, prevention of the iatrogenic entity in-stent restenosis has become more important.
    Medizinische Klinik 03/1999; 94(2):88-92. · 0.34 Impact Factor
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    ABSTRACT: Due to the widespread use of stents in complex coronary lesions, stent restenosis represents an increasing problem, for which optimal treatment is under debate. "Debulking" of in-stent neointimal tissue using percutaneous transluminal rotational atherectomy (PTRA) offers an alternative approach to tissue compression and extrusion achieved by balloon angioplasty. One hundred patients (70 men, aged 58 +/- 11 years) with a first in-stent restenosis underwent PTRA using an incremental burr size approach followed by adjunctive angioplasty. The average lesion length by quantitative angiography was 21 +/- 8 mm (range 5 to 68) including 22 patients with a length > or = 40 mm. Twenty-nine patients had complete stent occlusions with a lesion length of 44 +/- 23 mm. Baseline diameter stenosis measured 78 +/- 17%, was reduced to 32 +/- 9% after PTRA, and further reduced to 21 +/- 10% after adjunctive angioplasty. Primary PTRA was successful in 97 of 100 patients. Clinical success was 97%, whereas 2 patients developed non-Q-wave infarctions without clinical sequelae. Clinical follow-up was available for all patients at 5 +/- 4 months without any cardiac event. Angiography in 72 patients revealed restenosis in 49%, with necessary target lesion reintervention in 35%. The incidence of rerestenosis correlated with the length of the primarily stented segment and the length of a first in-stent restenosis. Thus, PTRA offers an alternative approach to treat diffuse in-stent restenosis. Neointimal debulking of stenosed stents can be achieved effectively and safely. PTRA resulted in an acceptable recurrent restenosis rate in short and modestly diffuse lesion, whereas the restenosis rate in very long lesions remains high despite debulking.
    The American Journal of Cardiology 03/1999; 83(6):862-7. · 3.21 Impact Factor

Publication Stats

340 Citations
140.67 Total Impact Points

Institutions

  • 2003
    • Royal Brompton and Harefield NHS Foundation Trust
      Harefield, England, United Kingdom
  • 1997–2002
    • RWTH Aachen University
      • Institute of Medical Statistics
      Aachen, North Rhine-Westphalia, Germany
  • 2001
    • The Heart Lung Center
      Londinium, England, United Kingdom
    • Imperial College London
      Londinium, England, United Kingdom
  • 1999–2001
    • University Hospital RWTH Aachen
      • Department of Neurology
      Aachen, North Rhine-Westphalia, Germany