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31.
Nadim M. Zacca Neal S. Kleiman Arsenio R. Rodriguez Jacques Heibig David Warth Scott Harris Steven T. Minor Albert E. Raizner 《Catheterization and cardiovascular interventions》1992,26(2):92-97
Previous clinical use of the Rotablator(TM) In coronary artery disease has involved a sequential increase in burr sizes up to 2 mm in diameter and has often utilized balloon adjunct to achieve an optimal result. We report our experience and describe our technique using a single, large burr (2.25, 2.5, or 2.75 mm diameter) without balloon assistance. The burr size was selected to approximate 70–90 percent of the apparent normal lumen diameter. Thirty-one patients with 36 lesions of complex morphology (eccentric, irregular, calcified, ulcerated, at bends, at bifurcations, completely occluded, as well as balloon failures) were successfully treated with the Rotablator(TM). Results were assessed by computerized quantitative angiography. The percent diameter stenosis (mean ± SD) for the group was reduced from 69.8 ± 11.3% to 30.9 ± 10% (p < 0.001). The mean absolute diameter stenosis increased from 0.9 ± 0.3 mm to 2.2 ± 0.3 mm (p < 0.001). Angiographically visible dissections were seen in 4 patients and were uncomplicated in 2. One patient had a non-Q-wave myocardial infarction. A fourth patient had a presumed acute occlusion 36 hr after the procedure, necessitating emergency bypass surgery, but without Q waves on the electrocardiogram or wall-motion abnormalities on the echocar-diogram. Nitroglycerin was infused through the Rotablator(TM) catheter and has considerably lowered the degree and frequency of spasm. No other acute complications occurred. The mean procedure time using a single burr was shorter than when multiple burrs were used: 56.5 vs. 97.3 min, respectively (p < 0.05). The use of a single, large-size Rotablator(TM) burr is an effective method of treating complex coronary stenoses without balloon assistance and has an encouragingly low complication rate and short procedure time. © 1992 Wiley-Liss, Inc. 相似文献
32.
Marwan H. Saab Douglas C. Smith Paul K. Aka Robert W. Brownlee J. David Killeen 《Cardiovascular and interventional radiology》1992,15(4):211-216
Percutaneous transluminal balloon angioplasty (PTA) was performed in 17 tibial arteries with an average cross-sectional area
stenosis of 92% (range 75–99%) in 13 patients (14 limbs) for limb salvage. In 4 of 14 lower extremities, PTA of femoropopliteal
arteries was also performed. Technical success with 50% or less residual stenosis was achieved in all 17 tibial vessels. At
approximately 2 months after PTA, clinical improvement had occurred in 10 of 14 limbs; no patient was made worse. Most recent
follow-up (mean 19 months, range 8–34 months) revealed continued satisfactory clinical success with no further vascular intervention
in 9 of these 10 limbs (one patient died). Short segmental stenoses, residual stenoses less than 40% following PTA, and absence
of diabetes or gangrene appear to be predictors of favorable clinical outcomes. Our results suggest that PTA of focal tibial
stenosis is an effective and safe treatment modality in properly selected patients and that wider use of PTA may be justified. 相似文献
33.
1985~1993年对43例脑血管病及脑肿瘤患者应用介入神经放射治疗方法进行了51次治疗,包括外伤性颈内动脉海绵窦瘘的球囊栓塞治疗8例;脑、脊髓血管畸形的栓塞治疗17例;各种脑肿瘤术前栓塞7例;经皮穿刺血管内成型治疗脑供血动脉狭窄3例和脑胶质瘤超选择化疗8例,效果良好,介入神经放射治疗已成为重要的临床治疗手段,是某些脑血管疾病的首选治疗方法。 相似文献
34.
Emad Dean Nukta Bernhard Meier Philip Urban Thierry Muller Pierre A. Dorsaz Josiane Favre 《Catheterization and cardiovascular interventions》1992,25(4):272-277
The Magnum system, initially designed for coronary angioplasty (PTCA) of chronic total occlusion, consists of a balloon catheter and a solid steel 0.021 inch (0.53 mm) steerable and removable wire with a soft and moldable distal portion, tipped with a 1 mm olive. To evaluate its performance in routine PTCA, 200 unselected consecutive patients were randomized to two equal groups, i.e., group Magnum (100 patients, 115 vessels) and group Standard (100 patients, 118 vessels) including 18 and 21 patients with chronic total occlusions, respectively. Randomization was performed by the sealed envelope system in the catheterization laboratory and crossover of system was imposed if it was not possible to place a balloon correctly within 20 min of fluoroscopy time. There were no significant differences between groups concerning clinical and angiographic baseline characteristics, size of initial balloons (3.0±0.3 mm in both groups), fluoroscopy time to cross the lesion with the wire (Magnum: 4±5, Standard: 5±6 min), total fluoroscopy time (Magnum: 11 ± 9, Standard: 12±12 min), and need for crossover (Magnum: 10%, Standard: 16%). Success rates per lesion were comparable with 90% in group Magnum and 84% in group Standard, as were the complications with one inhospital death in group Standard, occurring three weeks after PTCA and stent implantation. There was no emergency operation. Six patients per group had myocardial infarction of whom two in group Magnum and one in group Standard developed a Q-wave. The following variables were significantly in favor of the Magnum system compared with the Standard system: success rate in nontotal lesions (97% versus 90%) crossover success in total occlusions (0 vs. 33%), fluoroscopy time to cross the lesion with the balloon once the wire was in place (1 ± 2 vs. 2 ± 4 min), and use of a single versus 1.2±0.5 wires per lesion. The only advantage of the Standard systems was the more common use of 7 French guiding catheters (Magnum: 40%, Standard: 53%, p = 0.09). The Magnum system compares favorably with standard systems for routine PTCA. The robust design of the Magnum wire does not impair ease of placement and safety but saves material and facilitates balloon advancement across the lesion. 相似文献
35.
Bošnjaković Petar Ivković Tomislav Ilić Miodrag Aracki Snežana 《Cardiovascular and interventional radiology》1992,15(4):217-220
Flexible tantalum stents (Strecker) were used as an adjunct to percutaneous transluminal angioplasty (PTA) in the treatment
of stenotic arterial or venous limbs of Brescia-Cimino hemodialysis fistulas. The diagnostic procedure was performed using
retrograde fistulography. After PTA with unsatisfactory results, stents were placed in 5 patients with significant residual
stenoses and poor fistula function. Within the mean follow-up period of 6.4 months (range 3–10 months) all fistulas were functioning.
We conclude that Strecker stent is useful in the treatment of stenotic hemodialysis arteriovenous fistulas as an adjunct to
PTA. 相似文献
36.
37.
Bruce E. Lewis Colin Sumida Ming H. Hwang Henry S. Loeb 《Catheterization and cardiovascular interventions》1992,26(4):295-299
Four selected cases of emergent IABP insertion in PV patients are presented. After angiographic documentation of critical iliac stenosis, conservative peripheral angioplasty was performed prior to IABP insertion. No patient experienced a peripheral ischemic event associated with IABP use. © 1992 Wiley-Liss, Inc. 相似文献
38.
The primary objective of revascularization procedures in the posterior circulation is the prevention of vertebrobasilar ischemic stroke. Specific anatomical and neurophysiologic characteristics such as posterior communicating artery size affect the susceptibility to ischemia. Current indications for revascularization include symptomatic vertebrobasilar ischemia refractory to medical therapy and ischemia caused by parent vessel occlusion as treatment for complex aneurysms. Treatment options include endovascular angioplasty and stenting, surgical endarterectomy, arterial reimplantation, extracranial-to-intracranial anastomosis, and indirect bypasses. Pretreatment studies including cerebral blood flow measurements with assessment of hemodynamic reserve can affect treatment decisions. Careful blood pressure regulation, neurophysiologic monitoring, and neuroprotective measures such as mild brain hypothermia can help minimize the risks of intervention. Microscope, microinstruments and intraoperative Doppler are routinely used. The superficial temporal artery, occipital artery, and external carotid artery can be used to augment blood flow to the superior cerebellar artery, posterior cerebral artery, posterior inferior cerebellar artery, or anterior inferior cerebellar artery. Interposition venous or arterial grafts can be used to increase length. Several published series report improvement or relief of symptoms in 60 to 100% of patients with a reduction of risk of future stroke and low complication rates. 相似文献
39.
用经皮经腔动脉成形术(PTA)治疗锁骨下动脉狭窄或闭锁24例,用血管旁路术治疗14例。结果:2种治疗方法的近期通畅率相似,2年通畅率分别为66.7%和72.7%。提示:PTA和血管旁路术均是治疗锁骨下动脉狭窄或闭锁的有效方法 相似文献
40.
A case of bacterial endocarditis following percutaneous angiography and angioplasty of a subclavian artery stenosis is described. Septic complications following angiography and angioplasty, and the role of prophylactic antibiotics are discussed. 相似文献