Beta-radiation for coronary in-stent restenosis

To determine the feasibility and safety of an intracoronary beta-radiation device in preventing the recurrence of in-stent restenosis (ISR) after successful angioplasty, we studied 37 patients treated with beta-radiation (30-mm strontium-90 source) after angioplasty. The mean reference diameter was 2.9 +/- 0.5 mm, and 62% of lesions were diffuse, including four total occlusions. Beta-radiation was successfully delivered in 36 of 37 (97%) cases. Over the course of 7.1 +/- 4.5 mo follow-up, there were no myocardial infarctions and three deaths: one from preexisting malignancy, one from progressive cardiac failure, and one from sudden cardiac death. Target vessel revascularization (TVR) was performed in seven of 36 (19%) patients. Thirty patients underwent angiography at 6 mo; three (10%) experienced restenosis (diameter stenosis > 50%) at the target site, four (13%) had edge stenoses, and two (7%) had late (> 1 mo) thrombotic occlusions. Beta-radiation for ISR is associated with encouragingly low rates of target lesion restenosis and TVR. Further improvements are needed to solve the limitations of the edge effect and late occlusion.

The Czech National Registry of Occupational Diseases. Ten years of existence

The Czech National Registry of Occupational Diseases was founded in 1991 with the intention of restoring the information system on occupational diseases, which had collapsed in 1990, following deep societal changes brought about by the revolution in 1989. During the ten years of its existence, the Czech National Registry of Occupational Diseases proved to be a reliable information system providing valid data on occupational diseases. The completeness and quality of data stored in the Registry are being controlled by trained personnel. The information is available on-line for competent authorities. This makes it possible to monitor the situation regarding the incidence and the structure of occupational diseases, and to signal arising problems so that effective preventive measures can be taken immediately. Currently, the Registry contains information on approximately 30,000 cases of occupational diseases. A decreasing trend of yearly reported occupational diseases is evident. This fact must be interpreted cautiously. It may reflect the decreasing number of persons working at occupational risk and/or the improvement of hygienic situation at workplaces. However, in addition to these positive changes, the underreporting of occupational diseases in the Czech Republic is highly probable. Workers with an occupational disease feel handicapped at the labor market and seek to avoid the label. Furthermore, effectiveness of the Czech occupational health care system, which is still in the period of restructuring, is far from being perfect.

Mobilization of mercury by DMPS in occupationally exposed workers and in model experiments on rats: evaluation of body burden

The aim of the study was to evaluate the efficacy of DMPS (sodium-2,3-dimercapto-1-propane sulfonate) (Dimaval) administration for mobilizing mercury from the body in occupationally exposed people and experimental animals. Two doses of DMPS were administered at a 24-h interval to: (a) groups of people occupationally exposed to merkury--workers of the chloralkali industry (n = 43), and dentists (n = 12), (b) non-exposed individuals (n = 20), and (c) rats chronically exposed to mercury vapour at the concentration of 0.8 mg/m3 Hg degree (6 h/day, 5 days/week) for 15 weeks. In an out-patient mobilizing test, the urinary excretion of mercury 48 h after the administration of the first dose reached 1513 micrograms in the group of industrial workers, 132.6 micrograms in dentists, and 3.78 micrograms in controls. In rats, two consecutive doses of DMPS decreased kidney content of mercury by about 30% and 50% after oral and intraperitoneal administration, respectively. Kidney mercury burden was calculated on the basis of the data from animal and human studies of the mobilization of mercury via urine after DMPS treatment: 61, 2800 and 28,000 ng/g in controls, dentists and workers, respectively. It was estimated that two doses of DMPS mobilized 17-20% (after oral administration) and 25-30% (after intramuscular administration) of kidney mercury burden, both in the control and exposed subjects.

Double-blind study of the safety of clopidogrel with and without a loading dose in combination with aspirin compared with ticlopidine in combination with aspirin after coronary stenting : the clopidogrel aspirin stent international cooperative study (CLASSICS)

BACKGROUND

Combination therapy with the ADP receptor antagonist ticlopidine plus aspirin has emerged as standard care after coronary stenting. Clopidogrel, a new ADP receptor antagonist, has greater molar potency than ticlopidine and better safety/tolerability.

METHODS AND RESULTS

Patients (n=1020) were randomized after successful stent placement and initiated on a 28-day regimen of either (1) 300-mg clopidogrel loading dose and 325 mg/d aspirin on day 1, followed by 75 mg/d clopidogrel and 325 mg/d aspirin; (2) 75 mg/d clopidogrel and 325 mg/d aspirin; or (3) 250 mg BID ticlopidine and 325 mg/d aspirin. The primary end point consisted of major peripheral or bleeding complications, neutropenia, thrombocytopenia, or early discontinuation of study drug as the result of a noncardiac adverse event during the study-drug treatment period. The primary end point occurred in 9.1% of patients (n=31) in the ticlopidine group and 4.6% of patients (n=31) in the combined clopidogrel group (relative risk 0.50; 95% CI 0.31 to 0.81; P=0.005). Overall rates of major adverse cardiac events (cardiac death, myocardial infarction, target lesion revascularization) were low and comparable between treatment groups (0.9% with ticlopidine, 1.5% with 75 mg/d clopidogrel, 1.2% with the clopidogrel loading dose; P=NS for all comparisons).

CONCLUSIONS

The safety/tolerability of clopidogrel (plus aspirin) is superior to that of ticlopidine (plus aspirin) (P=0.005). The 300-mg loading dose was well tolerated, notably with no increased risk of bleeding. Secondary end point data are consistent with the hypothesis that clopidogrel and ticlopidine have comparable efficacy with regard to cardiac events after successful stenting.

Early and late Q wave regression in the setting of acute myocardial infarction

Abnormal Q waves after a myocardial infarction are not always an indicator of myocardial necrosis. In some cases these Q waves may disappear partially or completely in the evolution of the myocardial infarction. Five cases are described in whom complete Q wave regression and reappearance of R waves in the ECG leads corresponding to the affected area were observed. Q wave regression occurred early (hours) as well as late (months) after the myocardial infarction.

Intraarterial beta irradiation induces smooth muscle cell apoptosis and reduces medial cellularity in a hypercholesterolemic rabbit restenosis model

PURPOSE

Ionizing radiation has been shown to be a powerful inhibitor of neointimal hyperplasia following arterial injury in several animal models of post-percutaneous transluminal coronary angioplasty (post-PTCA) restenosis. This was previously shown to be associated with a reduction in smooth muscle cell (SMC) mitotic activity. This study evaluated the effect of intraarterial beta irradiation on the arterial wall SMC density and apoptosis.

METHODS AND MATERIALS

Twenty-five carotid and 7 iliac arteries of hypercholesterolemic New Zealand white rabbits were injured using the Baumgartner technique. The impact of an 18 Gy beta radiation dose administered after balloon injury was studied and compared to a nonirradiated injured control group. The medial SMC density as well as the percentage of apoptotic cells were determined at 8 days, 21 days, and 6 weeks after injury using an automated computer-based software. Apoptotic cells were identified using in situ end-labeling of fragmented DNA.

RESULTS

The values for medial apoptosis in control vs. irradiated arteries were: 0.014 +/- 0.023 vs. 0.23 +/- 0.28%, p = NS, at 8 days; 0.012 +/- 0.018 vs. 0.07 +/- 0.07%, p = 0.05, at 21 days; and 0 +/- 0 vs. 0.16 +/- 0.11%, p = 0.03, at 6 weeks. The overall incidence of medial apoptotic cells at all time points was 0.01 +/- 0.017 vs. 0.13 +/- 0.14% in controls and irradiated arteries respectively, p = 0.004. Medial SMC density was significantly decreased in irradiated arteries in comparison with controls (p < 0.01 at all time-points).

CONCLUSIONS

Intraarterial beta irradiation stimulates medial SMC apoptosis in balloon-injured arteries. This, together with a decrease in SMC mitotic activity, contributes to a decrease in the arterial wall cellularity.

Massive thromboembolism due to transcatheter ASD closure with ASDOS device

Transcatheter occlusion of atrial septal defects (ASD) is currently being investigated as an attractive alternative to surgical correction. Thromboembolic events are rare in both techniques. However, we report a case of massive systemic embolization and residual left atrial thrombus after secundum ASD transcatheter closure by the ASDOS device (Atrial Septal Defect Occlusion System, Dr. Ing Osypka Corporation, Germany). The patient was successfully treated by femoral embolectomies, surgical removal of the device and closure of the ASD without a patch. No thrombophilia was found on subsequent exploration. Transcatheter ASD closure with the ASDOS device may therefore expose the patient to severe embolic complications. Further evaluation is needed before this technique can be safely recommended.

Acute effects of using a mobile phone on CNS functions

Twenty volunteers participated in two experiments exploring the acute effects of using the mobile phone Motorola GSM 8700 on the functions of the CNS. When speaking (5 minutes reading a text from daily newspapers) the electromagnetic fields from the mobile apparatus did not affect the visual evoked potentials. Also a 6-min exposure did not reveal any effect of electromagnetic fields on the results in two tests (memory and attention) performed while speaking into the mobile. On the other hand the phone call itself strongly influenced the performance in a secondary task applying a test of switching attention which is a good model for driving a car. The response and decision speed were significantly worse. This is a proof that even a slight psychological stress involved in calling while driving can be a great risk.

[High-risk PTCA assisted by the Hemopump 14F: the Geneva experience]

INTRODUCTION

The hemopump is a transvalvular, catheter-mounted, left ventricular assist device, intended for surgical placement via the femoral artery (hemopump 21 Fr. outer diameter). This device has demonstrated its ability to unload the left ventricle, leading to myocardial protection and haemodynamic stabilisation in patients with cardiogenic shock and those undergoing high-risk coronary angioplasty (PTCA). Since 1994, a new hemopump system (14 Fr. in external diameter, flow rates of 1.5-2.2 l/min) has been developed for percutaneous insertion. The aim of this study is to describe the immediate and mid-term results obtained during Hemopump 14 Fr. assisted high-risk PTCA.

PATIENTS

Between September, 1993 and July, 1996, 8 males and 5 female patients (mean age 68.5 +/- 8.6 years) underwent Hemopump 14 Fr. supported high-risk PTCA.

RESULTS

Mean duration of hemopump assistance was 108 +/- 62 min. Hemopump support on maximum speed led to an increase of cardiac index from 2.0 +/- 0.3 to 2.2 +/- 0.5 l/min (p = 0.04) and a decrease of pulmonary wedge pressure from 17 +/- 8 to 14 +/- 8 mm Hg (p = 0.004). LDH increased (463 +/- 305 to 558 +/- 237 u/l-p = 0.05) and the platelet count remained stable (192,840 +/- 60,904 to 190,230 +/- 56,492/mm3). Successful balloon angioplasty was performed in all patients. There was no hospital mortality. Three patients (23%) required blood transfusion. During follow-up, 1 patient (7.7%) developed femoral artery occlusion necessitating surgical repair, and 3 patients (23%) died from cardiac causes 3, 9 and 14 months after the procedure.

CONCLUSIONS

The 14 Fr. Hemopump device may constitute a useful percutaneous mode of haemodynamic support for patients undergoing high-risk PTCA. The haemolysis it causes is mild and not clinically significant, but the hemopump is associated with a significant rate of local vascular complications. Recent improvements in interventional techniques and hardware have decreased the necessity for circulatory assistance during elective PTCA, even for very ill patients. Nevertheless, indications such as cardiogenic shock, the "bridge" period prior to heart transplantation and video-assisted minimally invasive cardiac surgery, or haemodynamic support of the right ventricle are the new applications of the hemopump.

[Treatment of acute myocardial infarction in Switzerland: is emergency PTCA more costly than thrombolysis?]

Confirming earlier studies with a lower number of patients, the Gusto IIb Angioplasty Substudy has shown that in the treatment of acute myocardial infarction emergency PTCA is superior to thrombolysis in reducing the combined clinical endpoints of death, reinfarction and cerebrovascular infarction. The aim of this study was to assess whether, in the Swiss study population of Gusto IIb, emergency PTCA was associated with higher procedural costs than thrombolysis over a median follow-up of 16 months. Therefore, we compared the costs of the initial and the follow-up hospitalisations. There were no differences in clinical characteristics in the Swiss subpopulation compared to the total study population. In a total of 46 patients, PTCA was performed in 22 and thrombolysis with rtPA in 24. During follow-up, 4 patients died, one in the PTCA group and 3 in the thrombolysis group (p = ns). The median total costs of the initial hospitalisation were somewhat higher in the PTCA group than in the group with thrombolysis. During follow-up only 38% of the patients in the PTCA group had to be rehospitalised, compared to 50% in the thrombolysis group. Median total costs within 16 months, therefore, were similar in the two therapeutic groups, but mean total costs per patient were somewhat lower for the PTCA versus the thrombolysis group (p = ns). Based on this comparison of Swiss procedural costs, emergency PTCA should not, in hospitals with the necessary infrastructure, be withheld in the treatment of acute myocardial infarction on the grounds of initially higher procedural costs, especially as the invasive strategy is associated with a more favourable long-term outcome.

Corrective use of the 2.5-mm GFX stent for suboptimal angioplasty results in small coronary arteries

To evaluate the clinical efficacy of endoluminal stenting in the setting of percutaneous intervention for small coronary artery lesions, we reviewed our results on stenting with the 2.5-mm GFX stent (Arterial Vascular Engineering, Santa Rosa, CA) during an 18-month study period. A total of 120 patients with significant coronary artery disease in vessels </=2.6 mm were followed up clinically. Procedural success (defined as angiographic residual stenosis <20% without clinical complications) was obtained in 94% of cases. In-hospital complications were death (1%), non-Q-wave myocardial infarction (5%), and urgent repeat percutaneous intervention because of stent thrombosis (3%). During a mean follow-up of 9.8 months (range, 6-23 months), the following complications were noted: myocardial infarction (1%), clinical need for repeat intervention (13%) requiring repeat percutaneous treatment (12%) and surgical revascularization (1%). In conclusion, transcatheter application of a specifically designed stent for coronary artery disease in small vessels seems safe and efficient with a low incidence of adverse events during follow-up. Cathet. Cardiovasc. Intervent. 48:157-161, 1999.

Neurological and electrophysiological examinations on three groups of workers with different levels of exposure to mercury vapors

The authors performed neurological, visual evoked potentials (VEP) and electroneurography (ENG) examinations on three groups of workers with occupational exposure to mercury vapors (Hg(0)), and on a control group. The exposure of dental professionals (n = 36) was mild, that of chloralkali plant workers (n = 36) was intermediate, and that of workers from mercury works (n = 77) was very high. Symptoms and signs of micromercurialism were observed only in the group with the highest exposure to Hg(0). In comparison with the control group, a shortening of VEP latency and a decrease in amplitude were found in the exposed groups. The VEP changes correlated with Hg(0) excreted in urine after administration of a chelating agent - sodium 2,3-dimercapto-1-propan sulfonate (DMPS). The frequency of abnormal VEP results increased with increasing levels of exposure. ENG changes were observed only in the group with the highest exposure to Hg(0). An isolated decrease of sural nerve conduction velocity was observed in 18% of total workers. In 70% of the cases, this was associated with an abnormality in VEP. The combination of a decrease in sural nerve conduction velocity and an abnormality of VEP seems to be a characteristic pattern of electrophysiological changes in persons exposed to mercury vapors.

A randomized evaluation of early revascularization to treat shock complicating acute myocardial infarction. The (Swiss) Multicenter Trial of Angioplasty for Shock-(S)MASH

AIM

To test whether emergency revascularization improves survival in patients with acute myocardial infarction and shock.

METHODS AND RESULTS

Patients with acute myocardial infarction and early shock were randomized either to undergo emergency angiography, followed immediately by revascularization when indicated, or to receive initial medical management. In five of the nine participating centres, patients with shock but not randomized were entered in a registry. Only 55 patients could be randomized. Of the 32 patients in the invasive group, 30 (94%) underwent early angiography, 27 (84%) PTCA, and one (4%) CABG. Twenty-two (69%) died within 30 days in the invasive group vs 18/23 (78%) in the medically managed group (ns, RR=0.88, 95% confidence interval 0.6-1.2). Among the registry patients, 24/51 were excluded from randomization solely because of patient or physician preference for the invasive approach: 23 (96%) of them underwent emergency angiography, 21 (88%) PTCA, and 12 (50%) died within 30 days. Among the remaining registry patients (n=27) only nine (33%) underwent early angiography, nine (33%) PTCA and 20 (74%) died.

CONCLUSION

We failed to demonstrate that emergency PTCA significantly improves survival in patients with acute myocardial infarction and early cardiogenic shock. Because the study was stopped prematurely, due to an insufficient patient inclusion rate, a clinically meaningful benefit of early reperfusion may have been missed.

Five-year outcome in patients with isolated proximal left anterior descending coronary artery stenosis treated by angioplasty or left internal mammary artery grafting. A prospective trial

BACKGROUND

Percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass surgery (CABG) improve the clinical status of patients with isolated proximal left anterior descending coronary artery stenosis. At 2 years, only additional revascularization was more frequently required after PTCA.

METHODS AND RESULTS

We monitored 134 patients randomized to PTCA (n=68) or CABG (n=66) for </=5 years. End points were death, myocardial infarction, need for additional revascularization, clinical status, and medical treatment. At 5 years, 6 patients (9%) had died in the PTCA group versus 2 (3%) in the CABG group (P=0.12). One patient in each group died of a cardiac cause. Myocardial infarction was more frequent after PTCA (15% versus 4%; P=0.0001), but Q-wave infarction was not (6% in the PTCA group versus 3% in the CABG group; P=0.8). Additional revascularization was required in 38% of patients in the PTCA group versus 9% in the CABG group (P=0.0001). Functional status was comparable, with 6% of patients after PTCA and 3% after CABG in functional class III or IV. Finally, after PTCA or CABG, 62% and 91% of patients, respectively, were free of events (P=0.0001).

CONCLUSIONS

The 5-year prognosis of patients with isolated proximal left anterior descending coronary artery stenosis is good. Both PTCA and CABG improve clinical status, but revascularization was needed more frequently after PTCA. There is an excess incidence of non-Q-wave myocardial infarction in the PTCA group that does not affect the vital or symptomatic outcome.

Catalytic triad of microsomal epoxide hydrolase: replacement of Glu404 with Asp leads to a strongly increased turnover rate

Microsomal epoxide hydrolase (mEH) belongs to the superfamily of alpha/beta-hydrolase fold enzymes. A catalytic triad in the active centre of the enzyme hydrolyses the substrate molecules in a two-step reaction via the intermediate formation of an enzyme-substrate ester. Here we show that the mEH catalytic triad is composed of Asp226, Glu404 and His431. Replacing either of these residues with non-functional amino acids results in a complete loss of activity of the enzyme recombinantly expressed in Saccharomyces cerevisiae. For Glu404 and His431 mutants, their structural integrity was demonstrated by their retained ability to form the substrate ester intermediate, indicating that the lack of enzymic activity is due to an indispensable function of either residue in the hydrolytic step of the enzymic reaction. The role of Asp226 as the catalytic nucleophile driving the formation of the ester intermediate was substantiated by the isolation of a peptide fraction carrying the 14C-labelled substrate after cleavage of the ester intermediate with cyanogen bromide. Sequence analysis revealed that one of the two peptides within this sample harboured Asp226. Surprisingly, the replacement of Glu404 with Asp greatly increased the Vmax of the enzyme with styrene 7,8-oxide (23-fold) and 9, 10-epoxystearic acid (39-fold). The increase in Vmax was paralleled by an increase in Km with both substrates, in line with a selective enhancement of the second, rate-limiting step of the enzymic reaction. Owing to its enhanced catalytic properties, the Glu404-->Asp mutant might represent a versatile tool for the enantioselective bio-organic synthesis of chiral fine chemicals. The question of why all native mEHs analysed so far have a Glu in place of the acidic charge relay residue is discussed.

Transcatheter closure of atrial septal defect and patent foramen ovale with ASDOS device (a multi-institutional European trial)

A clinical trial was conducted to assess the feasibility, safety, and efficacy of the atrial septal defect (ASD) occlusion system for transcatheter closure of secundum ASD and patent foramen ovale (PFO) after episodes of cerebral embolism. Occlusion was attempted in 200 patients aged 1 to 74 years (mean 32). The procedure failed in 26 patients (13%); the device was retrieved through a catheter in 20 and through surgery in 6 patients. Procedure-related complications necessitating surgical removal of the device included device embolization in 2, device entrapment within the Chiari network in 1, frame fracture in 1, and perforation of atrial wall in 2. All 6 patients experienced an uneventful postoperative course. An additional 11 patients (6%) underwent surgical removal of the device during follow-up. There were 163 patients (81%) with an implanted ASD occlusion system at follow-up of from 6 to 36 months (mean 17). Thrombus formation around the device was detected by transesophageal echocardiography in 9 patients 1 to 4 weeks after implantation. One of these patients (who had a coagulation factor XII deficiency) suffered a cerebral thromboembolism. Late atrial wall perforation (5, 6, and 8 months after implantation) occurred in 3 adult patients. Infectious endocarditis developed in 2 adult patients (1%). No late device embolization and no atrioventricular valve injury occurred. An asymptomatic device frame fracture was found in 14% and frame deformity in 4% of all patients during the follow-up period of >230 patient-years. Immediately after closure, a moderate/large residual shunt remained in 8% and a small shunt in 29% of patients. After 1 year, a moderate/large shunt was present in 2% and a small one in 26% of patients. During a total follow-up of 49 patient-years, only 1 of 46 patients with PFO had a transient neurologic event after the closure. The study indicates that patients with centrally situated secundum ASD and those with PFO after cerebral embolism can be treated with this system with a high success rate and an acceptable morbidity.

Differentiation of recent and old cerebral infarcts by diffusion-weighted MRI

We performed MRI, including diffusion-weighted imaging, in 15 patients with recurrent strokes with acute ischaemia and at least one old lesion according to the clinical history and/or CT. Routine MRI showed similar signal intensity changes in both situations. Diffusion-weighted images, however, were positive in all acute or subacute infarcts. The high signal of acutely disturbed diffusion due to intracellular oedema could also be identified in small brain stem lesions. Spatial resolution was increased by applying separate gradients in each axis instead of creating anisotropy-independent trace images.

Randomized evaluation of anticoagulation versus antiplatelet therapy after coronary stent implantation in high-risk patients: the multicenter aspirin and ticlopidine trial after intracoronary stenting (MATTIS)

BACKGROUND

Although the association of ticlopidine and aspirin has been shown to be superior to anti-vitamin K agents and aspirin after coronary stent implantation in low-risk patients, the latter combination has remained an unproven reference regimen for high-risk patients until recently.

METHODS AND RESULTS

We randomized 350 high-risk patients within 6 hours after stent implantation to receive during 30 days either aspirin 250 mg and ticlopidine 500 mg/d (A+T group) or aspirin 250 mg/d and oral anticoagulation (A+OAC group) targeted at an international normalized ratio of 2.5 to 3. The primary composite end point was defined as the occurrence of cardiovascular death, myocardial infarction, or repeated revascularization at 30 days. Patients were eligible if (1) the stent(s) were implanted to treat abrupt closure after PTCA; (2) the angiographic result after implantation was suboptimal; (3) a long segment was stented (>45 mm and/or >/=3 stents); or (4) the largest balloon inflated in the stent had a nominal diameter of </=2.5 mm. The primary cardiac end point was reached for 10 patients (5.6%) in the A+T group and 19 (11%) in the A+OAC group (relative risk [RR], 1. 9; 95% CI, 0.9 to 4.1; P=0.07). Major vascular and bleeding complications were less frequent in the A+T group (3 patients, 1.7%) than in the A+OAC group (12 patients, 6.9%) (RR, 4.1; 95% CI, 1.2 to 14.3; P=0.02).

CONCLUSIONS

High-risk patients should be treated with A+T rather than A+OAC after coronary stenting because the bleeding and vascular complications are significantly reduced and there is a marked trend suggesting a decrease in cardiac events.

Does acute exposure to the electromagnetic field emitted by a mobile phone influence visual evoked potentials? A pilot study

To search for a potential negative influence on the central nervous system (CNS) of the electromagnetic field emitted by a mobile phone, the authors performed a pilot experimental study of the influence of a single short acute exposure to the GSM mobile phone Motorola 8700, using visual evoked potentials (VEP) examination as an electrophysiological marker of CNS dysfunction. The study group consisted of 20 healthy volunteers. The duration of exposure was 5 minutes. The output power of the device was 1.5 W when the antenna was pulled up. Five parameters of VEP were evaluated by means of multifactorial ANOVA. Confounding effects of age, sex, and of the call in itself were taken into consideration. No statistically significant influence of the above-described exposure to the electromagnetic field emitted by the mobile phone on latencies or amplitudes of VEP was observed.

Clinical experience with the percutaneous hemopump during high-risk coronary angioplasty

The percutaneous Hemopump showed beneficial effects during coronary angioplasty in 32 high-risk patients with unloading of the left ventricle during ischemia and maintaining cardiac output with mean aortic pressures of 50 mm Hg in case of cardiac arrest (3 patients). High procedure-related morbidity (occlusion of femoral artery in 2 patients; bleeding with need of transfusion in 4 patients) and mortality (4 of 32 patients) rates demonstrate the need for a very careful selection of patients.