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ABSTRACT: Drug-eluting stent (DES) underexpansion has been reported as an independent factor for restenosis and thrombosis; therefore, adequate plaque modification prior to DES implantation is the key of calcified lesion treatment.
Consecutive patients with severely calcified lesions undergoing rotational atherectomy (RA) followed by balloon dilatation before DES implantation were analyzed. Patients were divided into two groups based on the balloon type before stent implantation: the cutting balloon (ROTACUT group) and the plain balloon (control group).
Twenty-five patients with 26 calcified lesions were identified: 10 patients (10 lesions) were included in the ROTACUT group and 15 patients (16 lesions) in the control group. There were statistically no differences in the final burr size (1.65 ± 0.21 mm vs 1.67 ± 0.22 mm; P=.803), the maximum (max) balloon diameter before stent implantation (2.85 ± 0.34 mm vs 2.72 ± 0.42 mm; P=.411), the max final balloon diameter (3.30 ± 0.33 mm vs 3.28 ± 0.44 mm; P=.908), and the max final balloon inflation pressure (15.3 ± 3.0 atm vs 16.4 ± 5.5 atm; P=.501). Final minimum stent cross-sectional area (CSA) was significantly larger in the ROTACUT group compared to the control group (6.80 ± 1.27 mm² vs 5.38 ± 1.89 mm²; P=.048).
RA followed by cutting balloon plaque modification for DES implantation in severely calcified lesions appears to be more efficacious including significantly larger final stent CSA.
The Journal of invasive cardiology 05/2012; 24(5):191-5. · 1.84 Impact Factor
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ABSTRACT: We report a case of excessive axial plaque redistribution leading to luminal narrowing at the reference segment confirmed by serial intravascular ultrasound during coronary stent implantation.
Cardiovascular revascularization medicine: including molecular interventions 01/2012; 13(2):144-6.
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ABSTRACT: It remains unclear whether patients with chronic heart failure (CHF) and advanced left ventricular (LV) dysfunction on β-blocker therapy benefit from exercise training (ET).
We studied 45 CHF patients with advanced LV dysfunction [ejection fraction (LVEF) < 25%] and impaired exercise tolerance [normalized peak oxygen uptake (PVO₂) < 70%] receiving a β-blocker: 33 patients participated in a cardiac rehabilitation program with ET (ET group) and 12 did not (inactive control group). Exercise capacity, LV dimension and plasma B-type natriuretic peptide (BNP) were assessed before and after a 3-month study period. At baseline, both groups had markedly reduced LVEF (ET group 18 ± 4% vs. Control group 18 ± 5%, NS) and impaired exercise capacity (normalized PVO₂ 51 ± 10% vs. 55 ± 9%, NS). Although one patient in the ET group withdrew from the program due to worsening CHF, no serious cardiac events occurred during the ET sessions. After 3 months, the ET group (n = 24) had significantly improved PVO₂ by 16 ± 15% (1,005 ± 295 to 1,167 ± 397ml/min, P < 0.001), while the PVO₂ of the control group was unchanged. LV end-diastolic dimension decreased in both groups to a similar extent, but plasma BNP was significantly decreased only in the ET group (432 to 214 pg/ml, P < 0.05).
The data indicate that in CHF patients with advanced LV dysfunction on β-blocker therapy, ET successfully improves exercise capacity and BNP without adversely affecting LV remodeling or causing serious cardiac complications.
Circulation Journal 06/2011; 75(7):1649-55. · 3.77 Impact Factor
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EuroIntervention: journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology 04/2011; 6(9):1131-6. · 3.29 Impact Factor
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09/2010; 3(9):986-7. · 1.07 Impact Factor
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Cosmo Godino,
Guido Parodi, Shinichi Furuichi,
Azeem Latib,
Rossella Barbagallo,
Omer Goktekin,
Michela Cera,
Ralf Mueller,
Corrado Tamburino,
Eberhard Grube,
Carlo Di Mario,
Bernard Reimers,
Alaide Chieffo,
David Antoniucci,
Antonio Colombo,
Giuseppe M Sangiorgi
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ABSTRACT: Limited data are available on the long-term outcome following PCI with paclitaxel-eluting stent (PES) implantation in patients with unprotected left main coronary artery (LMCA). The objective of this study was to evaluate "real world" long-term outcome following paclitaxel-eluting stent (PES) implantation for unprotected LMCA disease in patients enrolled in the TRUE registry.
From March 2003 to October 2004, 93 consecutive patients (81.7% male) underwent PCI for unprotected LMCA disease. Surveillance angiography was performed at 6.8+/-3.3 months follow-up. The target lesion involved the distal LMCA in 68 (73.1%) patients. Double stenting techniques were performed in 46 (67.6%) distal LMCA, of these 50% were stented using the Crush technique. Clinical follow-up was complete in all patients with 85.8% angiographic follow-up rate. In-segment restenosis occurred in 16 (20.3%) patients and was focal in 72.4% of cases and significantly higher in patients with distal LMCA (36.8% vs. 13.6%, p<0.04). At a median follow-up of 1,450 days (IQR 1281-1595), the overall incidence of MACE was 35.5% and the TLR rate was 25.8% and significantly higher in patients with bifurcation stenting (32.3% vs. 8%, p<0.02). The estimated cardiac survival rate at one and four years was 96.7% and 93.3%, respectively. Total mortality rate was 14.1% and cardiac was 6.5%. There was one (1.1%) definite stent thrombosis (ST) and one (1.1%) probable ST.
Treatment of unprotected LMCA disease with PES, after four years follow-up, appears to be safe and effective with a low rate of cardiac mortality and overall risk of ST. The need for target lesion revascularisation in 25.8% of patients highlights the need for more effective PCI especially in patients with distal LMCA disease.
EuroIntervention: journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology 04/2010; 5(8):906-16. · 3.29 Impact Factor
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04/2010; 3(4):457-8. · 1.07 Impact Factor
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ABSTRACT: Little information is available on the outcome after rotational atherectomy (RA) followed by drug-eluting stent (DES) implantation in calcified coronary lesions. The aim of this study was to evaluate the outcome of patients with severe lesion calcification undergoing RA followed by implantation of DES.
Ninety-five patients with 96 de novo severely calcified lesions were included. Twenty-nine patients (30.5%) had diabetes mellitus and seven patients (7.4%) had chronic renal failure. The total stent length per lesion was 48.4+/-24.9 mm. Procedural success rate was 95.8%. The incidence of cumulative major adverse cardiac events, defined as death, myocardial infarction (MI) and target vessel revascularisation (TVR), was 15.8% at the mean follow-up period of 14.7 months (range 6.0-57.7). Death occurred in four patients (4.2%). Non Q-wave MI occurred in 3 patients (3.2%) and Q-wave MI occurred in two patients (2.1%). The rate of target lesion revascularisation (TLR) was 9.5%. The rate of TVR was 11.6%. Two definite (2.1%) and 2 possible (2.1%) stent thromboses were observed.
RA followed by DES implantation in severely calcified coronary lesions appears to be feasible including high rate of procedural success and low-incidence of TLR considering this complex lesion subset.
EuroIntervention: journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology 09/2009; 5(3):370-4. · 3.29 Impact Factor
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ABSTRACT: This report describes a retrograde wiring technique, using intravascular ultrasound, for a blunt chronic total occlusion with a side branch at the site of occlusion of which the operator has difficulty of awareness of the proper re-entry point with the retrograde wire angiographically.
Catheterization and Cardiovascular Interventions 07/2009; 75(2):214-21. · 2.29 Impact Factor
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Cosmo Godino, Shinichi Furuichi,
Azeem Latib,
Nuccia Morici,
Alaide Chieffo,
Enrico Romagnoli,
Corrado Tamburino,
Rossella Barbagallo,
Michela Cera,
David Antoniucci,
Omer Goktekin,
Carlo Di Mario,
Bernard Reimers,
Eberhard Grube,
Flavio Airoldi,
Giuseppe M Sangiorgi,
Antonio Colombo
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ABSTRACT: Several randomized trials have shown that sirolimus-eluting stents and paclitaxel-eluting stents (PES) are effective in reducing restenosis in respect to bare-metal stents, including the subset of small vessels. The objective of this study was to evaluate "real world" angiographic and clinical outcomes of a large series of patients enrolled in the TRUE registry and treated with PES for both small vessel and very small vessel lesions. A consecutive series of 675 patients (926 lesions) with reference vessel diameter <2.75 mm measured by quantitative coronary angiography analysis were analyzed. The primary end point was the rate of angiographic in-stent restenosis and 1-year major adverse cardiac events. In this study 390 lesions were identified as small vessel (reference vessel diameter >or=2.25 and <2.75 mm) and 536 lesions as very small vessel (reference vessel diameter <2.25 mm). Overall in-stent restenosis was 15.5% (n = 96). Compared with small vessel, the very small vessel lesions had more in-stent restenosis (21.7% vs 11.4%, p <0.001) and in-segment restenosis (29.3% vs 22.5%, p = 0.055). The majority of the restenotic lesions (n = 125) were focal (57%, n = 71). At 1 year, cardiac death was 1.6% (n = 11), acute myocardial infarction 0.5% (n = 4.), and the target lesion revascularization 12.8% (n = 86). Cumulative major adverse cardiac events rate was 17.3% (n = 119). The rate of definite and probable stent thrombosis was 0.9% (n = 8). In conclusion, in comparison with historical bare-metal stent controls, this large series of small vessel lesions treated with PES confirms previous results reporting the efficacy of PES in small vessels. The rate of subacute and late stent thrombosis was low in this subgroup of patients.
The American journal of cardiology 10/2008; 102(8):1002-8. · 3.58 Impact Factor
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EuroIntervention: journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology 09/2008; 4(2):297. · 3.29 Impact Factor
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ABSTRACT: This report describes a technique for percutaneous coronary intervention in an ostial lesion with difficult take-off utilising an 8F guiding catheter and a 5F 125 cm-long diagnostic catheter followed by buddy wire placement.
Catheterization and Cardiovascular Interventions 01/2008; 70(7):979-82. · 2.29 Impact Factor
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ABSTRACT: This report describes a wiring technique for a blunt chronic total occlusion with a side branch at the site of occlusion for which the operator has difficulty of awareness of the proper entry point angiographically.
Catheterization and Cardiovascular Interventions 12/2007; 70(6):856-9. · 2.29 Impact Factor
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ABSTRACT: This report describes a technique for bailout stenting in treating coronary bifurcation lesion when the side branch (SB) is compromised after stent implantation in the main branch (MB) and there are difficulties to negotiate the guidewire from the MB into the true lumen of a dissection of the SB.
Catheterization and Cardiovascular Interventions 12/2007; 70(5):708-12. · 2.29 Impact Factor
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ABSTRACT: A 25-year-old semiprofessional soccer player was referred to our hospital because of intermittent claudication of the right leg. He had right limb trauma while playing soccer, and a selfexpandable stent was implanted for the occluded femoropopliteal artery. One month later, he complained of acute recurrence of claudication. Angiography revealed an occlusion of the stent due to cross-sectional stent squeeze and partial fracture. The occlusion was successfully revascularized with additional stenting. The patient was asymptomatic at 5-month follow up. Early self-expandable stent squeeze is quite rare. The forces exerted in the popliteal artery while playing soccer may have caused this phenomenon.
The Journal of invasive cardiology 11/2007; 19(10):E300-2. · 1.84 Impact Factor
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ABSTRACT: Exercise training (ET) is an emerging therapy for chronic heart failure, but the baseline patient characteristics for predicting cardiac events (CEs) during the course of ET remain unknown.
Of the 111 stable heart failure patients who participated in a 3-month ET program, 6 withdrew from the program for cardiac reasons and 9 had transient interruptions in the program because of CEs. The baseline clinical characteristics of these 15 patients (CE group) and the remaining 96 patients (No-CE group) were compared. Compared with the No-CE group, the CE group had a significantly higher prevalence of pacemaker/implantable cardioverter-defibrillators, larger left ventricular end-diastolic diameter (LVEDDs), lower peak oxygen uptake, greater ventilation drive, and higher plasma brain natriuretic peptide concentration at baseline. Multivariate logistic regression analysis showed that a larger LVEDD was a significant predictor of the occurrence of a transient interruption to or permanent withdrawal from the ET program because of CEs. Receiver operating characteristic curve analysis demonstrated that an LVEDD > or = 65 mm had a sensitivity of 93% and specificity of 48% in predicting CEs.
Patients with a large LVEDD (> or = 65 mm) at baseline should be monitored carefully during the course of an ET program.
Circulation Journal 08/2007; 71(7):1035-9. · 3.77 Impact Factor
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ABSTRACT: Slow flow or no-reflow is a serious complication during percutaneous coronary intervention (PCI), but little is known about the risk factors. A 64-year-old man underwent coronary angiography and PCI for stable angina. Pre-interventional intravascular ultrasound demonstrated an ultrasound attenuated coronary plaque, as a long eccentric bulky plaque with a marked decrease of the back echo without calcification. Since the lesion was highly eccentric in the large left anterior descending artery, directional coronary atherectomy (DCA) and subsequent stent implantation were planned. Serious no-reflow occurred after DCA. The DCA specimen suggested that the lipid-laden atheromatous gruel could attenuate the ultrasound reflection and cause distal embolization, resulting in no-reflow during PCI. The presence of ultrasound attenuated coronary plaque is a predictor of slow flow or no-reflow in PCI, indicating that distal protection devices may be required during the procedure.
Journal of Cardiology 05/2007; 49(4):193-7. · 1.28 Impact Factor
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ABSTRACT: There is no specific study evaluating the outcome of DES implantation in trifurcation lesions.
To evaluate the mid-term clinical and angiographic outcome of drug-eluting stent (DES) implantation in trifurcation lesions.
All complications and major adverse cardiac events, including cardiac death, Q-wave myocardial infarction (MI), target lesion revascularization (TLR), and target vessel revascularization (TVR) were recorded in-hospital and during clinical follow up.
A total of 15 consecutive patients undergoing percutaneous coronary intervention with DES in de novo trifurcation lesions were identified. Lesions were located as follows: 13 (86.7%) at the distal left main coronary artery (LMCA) comprising the left anterior descending artery (LAD), the left circumflex artery (LCX) and an intermediate branch; 1 between the LAD, diagonal, and septal branches; and 1 between the LCX, obtuse marginal and posterior lateral branches. Stenting was performed in all 3 branches in 8 patients, in 2 branches in 6 patients, and in 1 branch in 1 patient. The mean follow-up period was 19.0 +/- 8.3 months. TLR occurred in 3 patients (20%) with LMCA lesions. TVR occurred in 6 patients (40%). Of those, 3 were due to TLR, while the other 3 for progression of nontarget lesions. No deaths, Q-wave MIs or stent thromboses were recorded.
Most trifurcation lesions were found in the distal LMCA. DES implantation in trifurcation lesions can be performed with a low incidence of death, Q-wave MI or stent thrombosis.
The Journal of invasive cardiology 04/2007; 19(4):157-62. · 1.84 Impact Factor
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ABSTRACT: We explored the stimulus for B-type natriuretic peptide (BNP) secretion in the clinical setting of heart failure (HF).
Increasingly, plasma BNP levels are being incorporated into the clinical assessment and management of systolic heart failure (SHF) as well as diastolic heart failure (DHF). However, heterogeneity in BNP levels among individuals with HF can cause some confusion in interpreting results.
In 160 consecutive patients presenting with HF, we measured plasma BNP levels and performed echocardiography and cardiac catheterization. Systolic and diastolic meridional wall stress was calculated from echocardiographic and hemodynamic data.
Although plasma BNP had a significant correlation (r2 = 0.296 [p < 0.001]) with left ventricular end-diastolic pressure (EDP) as previously reported, the correlation between plasma BNP and end-diastolic wall stress (EDWS) (r2 = 0.887 [p < 0.001]) was more robust. In a subanalysis of 62 patients with DHF, a similar result was obtained (r2 = 0.143 for EDP and r2 = 0.704 for EDWS). In a comparison between SHF and DHF, the BNP level was significantly higher in SHF (p < 0.001). Although EDP did not show any difference, EDWS was significantly higher in SHF than in DHF (p < 0.001).
The present study shows that plasma BNP levels reflect left ventricular EDWS more than any other parameter previously reported, not only in patients with SHF, but also in patients with DHF. The relationship of left ventricular EDWS to plasma BNP may provide a better fundamental understanding of the interindividual heterogeneity in BNP levels and their clinical utility in the diagnosis and management of HF.
Journal of the American College of Cardiology 02/2006; 47(4):742-8. · 14.16 Impact Factor
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ABSTRACT: There have not been previous reports of patients undergoing percutaneous coronary intervention (PCI) using a gadolinium chelate.
A 74-year-old woman, who had a history of anaphylactic shock 4 times in response to iodinated contrast media despite preprocedural intravenous administration of hydrocortisone, was hospitalized because of unstable angina refractory to intensive medical treatment. Fully considering the risks of iodinated agents, digital subtraction coronary angiography and PCI were performed using gadopentetate dimeglumine without any side effects or complications.
Gadolinium chelates can be an alternative contrast media during PCI in particular patients with contraindications to iodinated media.
Circulation Journal 11/2004; 68(10):972-3. · 3.77 Impact Factor
