Lawrence A Garcia

St. Elizabeth's Medical Center, Boston, Massachusetts, United States

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Publications (21)63.78 Total impact

  • Jaime Ghitelman, Lawrence A Garcia
    The Journal of invasive cardiology 05/2010; 22(5):240-1. · 1.57 Impact Factor
  • Jaime Ghitelman, Lawrence A Garcia
    The Journal of invasive cardiology 04/2010; 22(4):179-80. · 1.57 Impact Factor
  • Christopher Lawson, Lawrence A Garcia
    The Journal of invasive cardiology 06/2009; 21(5):214-5. · 1.57 Impact Factor
  • Lawrence A Garcia, Sean P Lyden
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    ABSTRACT: Compared to conventional percutaneous transluminal angioplasty (PTA) and stent implantation for arterial occlusive diseases, atherectomy offers the theoretical advantages of eliminating stretch injury on arterial walls and reducing the, rate of restenosis. Historically, however, neither rotational nor directional atherectomy, whether used alone or with adjunctive PTA, has shown any significant long-term benefit over PTA alone in the coronary or peripheral arteries. However, the SilverHawk Plaque Excision System has produced positive results in single-center prospective registries of patients with femoropopliteal and infrainguinal lesions, with reduced adjunctive PTA, minimal adjunctive stenting, and competitive 6-month and 12-month patency rates. In the observational nonrandomized TALON (Treating Peripherals with SilverHawk: Outcomes Collection) registry, freedom from target lesion revascularization was 80% for 87 patients at 12 months. Questions remaining for further research with this device include more accurate determination of an event rate for distal embolization, the appropriate use of distal protection, the value of and appropriate circumstances for adjunctive angioplasty, and definitive patency and clinical outcomes. Other atherectomy devices are discussed.
    Journal of Endovascular Therapy 05/2009; 16(2 Suppl 2):II105-15. · 2.70 Impact Factor
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    ABSTRACT: Optimal management of patients with asymptomatic critical carotid artery stenoses prior to coronary artery bypass grafting (CABG) has no clear consensus. Further, optimal timing for surgical coronary revascularization has not been defined after or with any carotid revascularization. We reviewed the data from 2002 to 2007, of all patients in our institution who underwent carotid artery stenting (CAS) for critical carotid artery stenoses, prior to CABG. Twenty patients with critical carotid disease were referred for preoperative carotid intervention prior to CABG. Carotid duplex demonstrated evidence of critical stenoses in all patients. Patients were serially assessed by a stroke neurologist before and after the procedure (immediately, at 24 hr, at 48 hr, immediately following CABG, and at 30 days). We evaluated initial procedural success as well as freedom from periprocedure stroke. Prior to undergoing CABG, 20 patients had stents placed in a single carotid artery for unilateral asymptomatic critical carotid artery stenoses. All the procedures, except one, were performed with distal embolic protection. Patients received aspirin and clopidogrel. There were no strokes or deaths up to a mean follow up of 486 days. The mean time from CAS to CABG performed in the same hospital admission was 6.4 days. Transfusion rates were not excessive despite dual antiplatelet therapy. In a real-world setting, endovascular extracranial CAS for asymptomatic carotid artery stenosis by experienced operators, prior to CABG was safe and permitted early coronary revascularization without increased risk of strokes or death in this high-risk cardiovascular patient population.
    Catheterization and Cardiovascular Interventions 11/2008; 73(2):139-42. · 2.51 Impact Factor
  • Yuri B Pride, Michael C Nguyen, Lawrence A Garcia
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    ABSTRACT: We describe a case of a 51-year-old female who was incidentally noted to have a renal artery aneurysm on computed tomography (CT). The aneurysm was not seen on an abdominal CT performed 4 years prior, so the patient underwent successful percutaneous coil embolization. The indications for repair of such aneurysms are unknown, and there are a myriad of surgical and percutaneous management options. Because of the increase in abdominal imaging, the incidence of renal artery aneurysms is likely to rise. We describe the case and review the literature surrounding the epidemiology, outcome and management of renal artery aneurysms.
    The Journal of invasive cardiology 10/2008; 20(9):470-2. · 1.57 Impact Factor
  • Amjad Almahameed, Lawrence A Garcia
    The Journal of invasive cardiology 08/2008; 20(7):333-4. · 1.57 Impact Factor
  • Michael C Nguyen, Lawrence A Garcia
    The Journal of invasive cardiology 06/2008; 20(6):277-8. · 1.57 Impact Factor
  • Troy A Bunting, Lawrence A Garcia
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    ABSTRACT: Atherectomy is experiencing increased interest from endovascular specialists as a therapeutic treatment in the peripheral arteries. Long studied in the coronary vasculature, atherectomy has several theoretical advantages that make it uniquely suited for the peripheral circulation. In particular, infra-inguinal peripheral arterial disease experiences physiologic stresses and forces that have made traditional percutaneous coronary treatments such as angioplasty and stenting not as successful. Restenosis has been a major problem for angioplasty and stenting alone. The SilverHawk atherectomy device has favorable short-term data but important longer-term data are limited and need further study. Laser atherectomy also has favorable applications in niche patients but the number of studies is limited. Unfortunately, athero-ablative technologies for peripheral arterial disease require more definitive objective data regarding 12-month and longer-term outcomes in order to obtain widespread scientific acceptance.
    Journal of Interventional Cardiology 01/2008; 20(6):417-24. · 1.50 Impact Factor
  • Source
    Yuri B Pride, Duane S Pinto, Lawrence A Garcia
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    ABSTRACT: Chronic upper limb ischemia is uncommon, and is most often secondary to subclavian artery stenosis. Percutaneous intervention for subclavian stenosis usually includes balloon angioplasty and stent implantation. Brachial artery stenosis is even more scarce and accounts for approximately 12% of symptomatic upper extremity ischemia. Because it is rare, the optimal treatment strategy for brachial artery stenosis remains uncertain. We describe a case of chronic brachial artery ischemia due to atherosclerotic disease treated with the SilverHawk plaque excision system and review the available data regarding its use.
    Vascular Medicine 09/2007; 12(3):207-10. · 1.62 Impact Factor
  • Troy A Bunting, Lawrence A Garcia
    The Journal of invasive cardiology 06/2007; 19(5):215-6. · 1.57 Impact Factor
  • Lawrence A Garcia, Joseph P Carrozza
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    ABSTRACT: Catheter-derived pressure gradient (CPG) measurements across vascular lesions are used to determine the hemodynamic significance of a stenosis prior to peripheral vascular intervention. We tested the hypothesis that CPGs overestimate the true translesion gradient during hemodynamic interrogation. We evaluated 20 lesions (iliac, subclavian, or renal) in 16 patients undergoing angiography for peripheral vascular disease. Mean arterial pressure gradients were measured across each lesion using a 4- or 5-Fr fluid-filled catheter and compared to gradients measured with a 0.014'' pressure wire (PWG). In all lesions, the CPG was higher than the PWG (28.3 +/- 4.5 mmHg vs 11.6 +/- 1.8 mmHg; P < 0.05). Both CPG and PWG correlated with diameter stenosis (CPG = 0.78 [DS]- 29; r(2)= 0.44; P < 0.05 and PWG = 0.30 [DS]- 10.5; r(2)= 0.43; P < 0.05), but the CPG overestimated the pressure gradient compared with the PWG. Peripheral arterial vascular lesion pressure gradients assessed with large diameter catheters consistently overestimate the actual PG. Although both CPG and PWG correlated with anatomic stenosis, the overestimation of the physiologic significance of these lesions may lead to inappropriate intervention. Use of a pressure wire for hemodynamic interrogation may be a better tool for assessment of the hemodynamic significance of a peripheral vascular lesion.
    Journal of Interventional Cardiology 03/2007; 20(1):63-5. · 1.50 Impact Factor
  • Lawrence A Garcia
    The Journal of invasive cardiology 08/2006; 18(7):322-3. · 1.57 Impact Factor
  • Lawrence A Garcia, Joseph P Carrozza
    The Journal of invasive cardiology 08/2006; 18(7):339-40. · 1.57 Impact Factor
  • Journal of Endovascular Therapy 03/2006; 13 Suppl 2:II60-71. · 2.70 Impact Factor
  • Source
    Lawrence A Garcia
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    ABSTRACT: Peripheral arterial disease (PAD), a major cause of disability, loss of work, and lifestyle changes in the United States, is defined as obstruction of blood flow into an arterial tree excluding the intracranial or coronary circulations. PAD is mostly silent in its early stages, but when lesion obstruction exceeds 50%, it may cause intermittent claudication with ambulation. Further disease progression typically leads to rest pain or frank tissue loss. However, some patients may remain asymptomatic with severe disease because of extensive collateralization in the lower extremity. Estimates of the prevalence of intermittent claudication vary by population, from 0.6% to nearly 10%; the rate increases dramatically with age. Approximately 20% to 25% of patients will require revascularization, while fewer than 5% will progress to critical limb ischemia. Limb loss, although rare, is associated with severe disability and an overall poor prognosis, with 30% to 40% mortality in the first 24 months after limb loss. As with coronary artery disease, the most common cause of symptomatic obstruction in the peripheral arterial tree is atherosclerosis, a systemic inflammatory process in which cholesterol-laden plaque builds up in the artery and eventually blocks the lumen. Typical risk factors include age, gender, diabetes, tobacco abuse, hypertension, and hyperlipidemia.
    Journal of Endovascular Therapy 03/2006; 13 Suppl 2:II3-9. · 2.70 Impact Factor
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    ABSTRACT: Although several prospective studies have examined the safety and efficacy of stent placement for femoropopliteal arterial disease, the current cost of these procedures is unknown. To estimate and compare hospital costs associated with conventional balloon angioplasty (percutaneous transluminal angioplasty [PTA]) and stent placement for patients with symptomatic peripheral arterial disease, the authors performed a prospective economic evaluation in conjunction with the Intracoil Femoropopliteal Stent Trial (VascuCoil). Between May 1997 and December 1999, 266 patients with stenotic or occluded superficial femoral or popliteal arteries were prospectively randomized to treatment with the IntraCoil stent or PTA. Detailed resource use and cost data for each patient's initial revascularization procedure and ensuing hospitalization were collected and analyzed on an intention-to-treat basis. Compared with conventional balloon angioplasty, stent placement did not improve clinical outcomes but increased procedure duration, equipment costs, and physician services. As a result, initial hospital costs were approximately 3,500 dollars higher for patients randomized to the IntraCoil stent, compared with PTA (8,435 dollars vs 4,980 dollars; P < .001). As performed in the VascuCoil trial, primary stent placement for femoropopliteal disease did not improve clinical outcomes but increased initial treatment costs by more than 3,000 dollars. Because there were no substantial differences in subsequent clinical outcomes between the two treatments, it is unlikely that these increased initial costs would be offset by savings in follow-up costs. These findings suggest that a strategy of routine stent implantation for patients undergoing femoropopliteal PTA is not optimal on economic grounds and that PTA with provisional stent implantation is preferred.
    Journal of Vascular and Interventional Radiology 10/2004; 15(10):1065-9. · 2.00 Impact Factor
  • Lawrence A Garcia, Joseph P Carrozza
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    ABSTRACT: Atherosclerotic coronary lesions complicated with obstructing thrombus are associated with an increased rate of acute complications and poorer long-term patency after percutaneous balloon angioplasty. Saphenous vein graft (SVG) percutaneous coronary intervention (PCI) has remained a daunting task given the friable nature of the large plaque burdens and unpredictable issues of embolization and no-reflow. These events are associated with increased morbidity including myocardial infarction and death. Today, in both native and autologous SVG lesions, mechanical thrombectomy has become a primary tool for removal of clot prior to PCI. Some studies have shown that mechanical thrombectomy prior to PCI is safe and effective to reduce poor outcomes with PCI in patients with acute coronary syndromes complicated by thrombus in both vein grafts and native coronary arteries.
    The Journal of invasive cardiology 05/2004; 16(5 Suppl):3S-8S; quiz 8S-9S. · 1.57 Impact Factor
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    ABSTRACT: Stent thrombosis (ST) is a rare but devastating complication of coronary stent implantation, occurring in 0.5% to 1.9% of patients with bare metal stents. The incidence of ST with drug-eluting stents is less well studied, particularly among patients outside of clinical trials. The aim of this study was to evaluate the incidence and potential risk factors for ST in patients receiving sirolimus-eluting stents (SES) in the "real world" after commercial release in the United States in April 2003. All 652 patients who underwent SES implantation (776 lesions treated) at our institution between April and October 2003 were followed up prospectively after the procedure (median follow-up 100 days). During that period, 7 patients (1.1%, 95% CI 0.4% to 2.2%) developed ST within a range of 2 to 13 days, and 1 patient had an ST-elevation myocardial infarction on day 39 with evidence of thrombus within the SES at angiography. Patients with an ST had significantly smaller final nominal balloon diameters (2.75 versus 3.00 mm, P=0.04), and in 4 (57%) of the 7 patients with ST versus 1.7% of patients without ST (P<0.001), antiplatelet therapy had been discontinued after the procedure. Among the ST patients, 1 died and 5 had myocardial infarctions. In this single-center experience, the incidence of ST after SES implantation was approximately 1%, which is within the expected range of bare metal stents. The discontinuation of antiplatelet therapy was strongly associated with the development of ST in this patient population.
    Circulation 04/2004; 109(16):1930-2. · 15.20 Impact Factor
  • Source
    Lawrence A Garcia, Joseph P Carrozza
    Journal of the American College of Cardiology 06/2003; 41(9):1493-5. · 14.09 Impact Factor

Publication Stats

301 Citations
1 Download
1k Views
63.78 Total Impact Points

Institutions

  • 2009–2010
    • St. Elizabeth's Medical Center
      Boston, Massachusetts, United States
  • 2008
    • Harvard Medical School
      Boston, Massachusetts, United States
  • 2002–2008
    • Beth Israel Deaconess Medical Center
      • • Division of Cardiovascular Medicine
      • • Department of Medicine
      Boston, MA, United States