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Michael S Lee,
Seung-Jung Park,
David E Kandzari,
Ajay J Kirtane, William F Fearon,
Emmanouil S Brilakis,
Paul Vermeersch,
Young-Hak Kim,
Ron Waksman,
Julinda Mehilli,
Laura Mauri,
Gregg W Stone
11/2011; 4(11):1250-1. · 1.07 Impact Factor
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Michael S Lee,
Seung-Jung Park,
David E Kandzari,
Ajay J Kirtane, William F Fearon,
Emmanouil S Brilakis,
Paul Vermeersch,
Young-Hak Kim,
Ron Waksman,
Julinda Mehilli,
Laura Mauri,
Gregg W Stone
[show abstract]
[hide abstract]
ABSTRACT: Saphenous vein grafts are commonly used conduits for surgical revascularization of coronary arteries but are associated with poor long-term patency rates. Percutaneous revascularization of saphenous vein grafts is associated with worse clinical outcomes including higher rates of in-stent restenosis, target vessel revascularization, myocardial infarction, and death compared with percutaneous coronary intervention of native coronary arteries. Use of embolic protection devices is a Class I indication according to the American College of Cardiology/American Heart Association guidelines to decrease the risk of distal embolization, no-reflow, and periprocedural myocardial infarction. Nonetheless, these devices are underused in clinical practice. Various pharmacological agents are available that may also reduce the risk of or mitigate the consequences of no-reflow. Covered stents do not decrease the rates of periprocedural myocardial infarction and restenosis. Most available evidence supports treatment with drug-eluting stents in this high-risk lesion subset to reduce angiographic and clinical restenosis, although large, randomized trials comparing drug-eluting stents and bare-metal stents are needed.
08/2011; 4(8):831-43. · 1.07 Impact Factor
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Michael S Lee,
Tae Yang, William F Fearon,
Michael Ho,
Giuseppe Tarantini,
Jola Xhaxho,
Gino Gerosa,
Mark Weston,
Ashkan Ehdaie,
Leroy Rabbani,
Ajay J Kirtane
[show abstract]
[hide abstract]
ABSTRACT: The present study evaluated the safety and efficacy of percutaneous coronary intervention (PCI) of the unprotected left main coronary artery (ULMCA) for the treatment of cardiac allograft vasculopathy (CAV) in consecutive unselected patients with orthotopic heart transplantation (OHT). PCI in patients with OHT and develop CAV has been associated with greater restenosis rates compared to PCI in patients with native coronary artery disease. A paucity of short- and long-term data is available from patients with OHT who have undergone PCI for ULMCA disease. The present retrospective, multicenter, international registry included 21 patients with OHT and CAV who underwent ULMCA PCI from 1997 to 2009. Angiographic success was achieved in all patients. Drug-eluting stents were used in 14 of the 21 patients. No major adverse cardiac events or repeat OHT occurred within the first 30 days. At a mean follow-up of 4.9 ± 3.2 years, 3 patients (14%) had died, myocardial infarction had occurred in 1 patient (5%), and target lesion revascularization had been required in 4 patients (19%). Follow-up angiography was performed in 16 patients (76%), and restenosis was observed in 4 (19%). No stent thrombosis of the ULMCA was observed. One patient (5%) underwent coronary artery bypass grafting, and 5 patients (24%) underwent repeat OHT. In conclusion, the results of our study have shown ULMCA PCI to be safe and reasonably effective in patients with OHT and represents a viable treatment strategy for CAV in these patients.
The American journal of cardiology 10/2010; 106(8):1086-9. · 3.58 Impact Factor
