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ABSTRACT: Aortic dissection is a recognized, though rare complication of percutaneous revascularization procedures. We report a case of an extensive type A dissection that occurred during an attempt to recanalize a chronic total occlusion of a right coronary artery. The patient was treated conservatively and was followed for 36 months, during which he remained well. We conclude that, even though surgery remains the preferred option, conservative management could also be considered in certain patients.
The Journal of invasive cardiology 07/2000; 12(6):320-3. · 1.84 Impact Factor
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The Journal of invasive cardiology 04/1999; 11(3):135-7. · 1.84 Impact Factor
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G J Karrillon,
M C Morice,
E Benveniste,
P Bunouf,
P Aubry,
S Cattan,
B Chevalier,
P Commeau,
A Cribier,
C Eiferman, [......],
T Lefevre,
B Livarek,
Y Louvard,
J Marco,
S Makowski,
J P Monassier,
J M Pernes,
P Rioux,
C Spaulding,
G Zemour
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ABSTRACT: Stenting reduces both acute complications of coronary angioplasty and restenosis rates but increases subacute thrombosis rates and hemorrhagic complications when used with coumadin anticoagulation.
To simplify postcoronary stenting treatment and to reduce these drawbacks, we evaluated the 1-month outcome of a prospective registry of 2900 patients in whom successful coronary artery stenting was performed without coumadin anticoagulation. Patients received 100 mg/d aspirin and 250 mg/d ticlopidine for 1 month. Low-molecular-weight heparin (LMWH) treatment was progressively reduced in four consecutive stages, from 1-month treatment to none. Event-free outcome at 1 month was achieved in 2816 patients (97.1%). Major stent-related cardiac events were subacute closure in 51 patients (1.8%), including death in 12 (0.5%), acute myocardial infarction in 17 (0.6%), and coronary artery bypass graft surgery in 9 (0.3%). Stent thrombosis was more frequent with balloon size of < 3.0 mm (< or = 2.5 mm, 10%; 3.0 mm, 2.3%; > or = 3.5 mm, 1.0%; P < .001), bail-out situations (6.67% versus 1.38%, P < .001), and patients with unstable angina or acute myocardial infarction (2.2% versus 1.12%, P = .02). Bleeding complications that required transfusion, surgical repair, or both occurred in 55 patients (1.9%). Bleeding complications were related to female gender (4.0% versus 1.51%, P < .001), duration of LMWH treatment (3.83% in phase II/III versus 0.69% in phase IV/V, P < .001), sheath size (6F, 0.52%; 7F, 1.04%; > or = 8F, 4.23%; P < .001), bail-out situations (4.76% versus 1.67%, P < .01), and saphenous graft stenting (4.38% versus 1.75%, P = .04).
These results suggest that poststenting treatment by ticlopidine/aspirin is an effective alternative to coumadin anticoagulation, achieving low rates of subacute closure and bleeding complications. LMWH treatment does not improve subacute reocclusion rates but increases bleeding complications. Furthermore, as bleeding complications were independently related to sheath size, we suggest that stenting with 6F guiding catheters may prevent local complications. Furthermore, the ticlopidine/aspirin combination allows a low-cost stenting strategy without ultrasound assessment of stent deployment and permits short inhospital stay.
Circulation 10/1996; 94(7):1519-27. · 14.74 Impact Factor
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ABSTRACT: Percutaneous coronary angioplasty (PTCA) is an effective method to achieve myocardial reperfusion in acute myocardial infarction. In order to identify the predictors of primary success and major complications, we reviewed our experience in 107 patients (pts) who underwent PTCA of a totally occluded infarct-related coronary artery (IRA) within 24 hours (h) after the onset of symptoms.
PTCA was successful in 92 pts (86%); PTCA failed without complications in 9 pts (8.4%), major complication (death and urgent coronary artery surgery) occurred in 6 pts (5.6%). Rescue PTCA was performed in 31% of cases and had similar success rate when compared to direct PTCA (85 vs 86%, p = NS). Pts with successful PTCA had repeat angiography 24 h after the procedure. According to primary and 24 h results, pts were divided into 3 groups: primary success with 24 h stable result (Group A: 76 pts, 71%); primary success with 24 h deterioration (Group B: 16 pts, 15%), among which 4 pts showed total reocclusion; primary failure (Group C: 15 pts, 14%). A longer time delay from symptoms onset (p < 0.05), cardiogenic shock (p < 0.001), previous bypass surgery (p < 0.05) were correlated with worse short-term outcome by univariate analysis. When compared to Group A, pts in Group C showed a lower EF (42 +/- 14 vs 51 +/- 16%, p < 0.05). IRA diameter was greater in Group A (3.1 +/- 0.4 mm) when compared to Group B (2.7 +/- 0.4 mm, p < 0.05) and Group C (2.7 +/- 0.5 mm, p < 0.05). Absence of cardiogenic shock (p < 0.001), decreasing time from symptoms onset (p < 0.01) and increasing ejection fraction (EF) (p < 0.05) were independent predictors of primary success by multivariate analysis. Cardiogenic shock (p < 0.001) and decreasing EF (p < 0.05) were independent predictors of major complications.
PTCA of IRA is effective within 24 h from symptoms onset. Procedural failure is infrequent, usually occurring in patients with high-risk baseline characteristics.
Giornale italiano di cardiologia 05/1995; 25(5):591-7.
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ABSTRACT: Rotational coronary atherectomy with adjunctive balloon angioplasty was performed in 36 patients older than 70 years. Previous myocardial infarction, coronary angioplasty and coronary artery bypass were present in 44%, 11% and 14%, respectively. Thirty-six percent and 33% of patients presented stable and unstable angina pectoris, respectively. Totally, 46 lesions were treated (1,3 lesion/patient). All lesions had complex morphology characteristics: eccentricity (63%), calcification (69%), angulation (44%), length > 10 mm (11%), undilatable rigid lesion with failed PTCA (11%), ostial disease (9%), ulceration (7%). In 39% was present a single-vessel disease, in 44% double-vessel disease and in 17% triple-vessel disease. Five patients received rotational atherectomy on two stenoses in the same vessel, 5 received a two vessels treatment. Procedure was successful in 94% of patients; 2 patients (6%) had major complication (1 urgent coronary artery bypass and 1 acute myocardial infarction) without any death. All patients with successful rotational atherectomy had repeated coronary angiography at 24 hours. No patient showed significant deterioration (stenosis > or = 50%) of the initial result at 24 hours. Rotational atherectomy can be performed in patients over 70 years with complex coronary lesions with a high success rate, low complications and persistence at 24 hours of initial gain. It should be considered as a primary therapeutical option in selected cases with complex coronary lesions in which conventional PTCA can be unsuccessful.
Giornale italiano di cardiologia 06/1994; 24(6):701-5.
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Contraception, fertilité, sexualité 11/1992; 20(10):936-41.
