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Successful sealing of post-interventional coronary aneurysm with coated stent and late recurrence—Follow-up with combined imaging—A case report. Int J Angiol 2011. [DOI: 10.1007/s00547-004-1070-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Härle T, Reimers J, Hertting K, Kuck KH. Successful trapping of an organized thrombus in a coronary artery aneurysm in myocardial infarction: case report and literature review. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2008; 9:52-5. [PMID: 18206639 DOI: 10.1016/j.carrev.2007.08.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2007] [Revised: 08/26/2007] [Accepted: 08/30/2007] [Indexed: 10/22/2022]
Abstract
A 44-year-old female presented with acute inferior myocardial infarction. Emergency coronary angiography showed an aneurysm of the proximal right coronary artery and an occlusion of the vessel downstream due to a huge organized thrombus. Mechanical fragmentation, glycoprotein IIb/IIIa antagonist, and intracoronary thrombolysis were all tested without success. Finally, the aneurysm was covered with a standard bare metal stent in order to trap the thrombus between the stent and the vessel wall and at least partially in the aneurysm. The strategy was successful, and after 1 week, the blood flow in the right coronary artery was normal; however, the aneurysm remained. After 6 months, there was significant in-stent restenosis of the proximal and mid segments of the right coronary artery but no evidence of the aneurysm. The restenosis was treated with two drug-eluting stents, leading to an excellent result after a further 6 months. The patient was free of symptoms and the left ventricular ejection fraction was within the normal range.
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Affiliation(s)
- Tobias Härle
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.
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4
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Kucher T, Brener B, Marak M, Parsonnet V. Endovascular Delivery of Vein Segments With Valves Versus Direct Anastomosis. J Endovasc Ther 2005; 12:366-70. [PMID: 15943513 DOI: 10.1583/05-1531.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To demonstrate an experimental model designed to allow placement of a vein segment containing a valve into a femoral vein without the need for anastomoses or surgical incision on the target limbs. METHODS Segments of jugular veins containing valves were harvested bilaterally from 7 female dogs weighing 30 to 40 kg. One of the vein segments was then interposed into one femoral vein, using a standard surgical end-to-end anastomosis. Another segment was loaded into a self-expanding nitinol stent, everted, and secured outside of the stent. This vein-coated stent was then deployed from the jugular approach into the opposite common femoral vein. The endpoint of the study was thrombosis of one of the veins segments or patency at 120 days. The function of the valves was tested prior to completion of the study by instilling dye under incremental pressures and recording the pressure necessary to cause reflux. Light microscopy and electron microscopy were utilized to evaluate structure of the valves at study endpoint. RESULTS Both grafts in one dog occluded during the second week after surgery. Anastomotic and vein-stented sites remained patent in the remaining 6 animals for 120 days. Retrograde phlebography demonstrated valve competency bilaterally in all cases. The reflux pressures on the stented side averaged 70 mmHg while the transplanted vein segment averaged 55 mmHg. Light microscopy and electron microscopy showed intact vein valve structure in all segments at the completion of the study. CONCLUSIONS This experimental work demonstrates that endovascular delivery of a native canine vein containing a competent valve is feasible and effective.
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Affiliation(s)
- Taras Kucher
- Department of Surgery, Newark Beth Israel Hospital, Newark, New Jersey 07112, USA.
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Aqel RA, Zoghbi GJ, Iskandrian A. Spontaneous coronary artery dissection, aneurysms, and pseudoaneurysms: a review. Echocardiography 2004; 21:175-82. [PMID: 14961799 DOI: 10.1111/j.0742-2822.2004.03050.x] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Spontaneous coronary artery dissection is a rare cause of myocardial ischemia and sudden death. Coronary aneurysms and pseudoaneurysms, which may occur after percutaneous coronary interventions, rarely occur spontaneously. We review the pertinent medical literature and describe the intravascular findings of spontaneous coronary artery dissection, aneurysms, and pseudoaneurysms.
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Affiliation(s)
- Raed A Aqel
- Birmingham's Veterans Affairs Medical Center, Division of Cardiovascular Disease, Alabama 35233, USA.
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Gaspar J, Vonderwalde C, Eid-Lidt G. Treatment of coronary artery aneurysms by percutaneous sealing with bovine-pericardium-covered stents. INTERNATIONAL JOURNAL OF CARDIOVASCULAR INTERVENTIONS 2003; 2:241-246. [PMID: 12623575 DOI: 10.1080/acc.2.4.241.246] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The clinical significance of coronary artery aneurysms is briefly discussed. Until recently, surgical excision was the only treatment available. Single-case reports have documented aneurysm exclusion with vein-covered stents using 10 or 11 F. guiding catheters. This paper reports four patients with coronary artery aneurysms which were successfully excluded with the use of a novel pericardium-covered stent which is less invasive and shortens procedure time compared with the use of an autologous vein-grated stent and can be deployed using 8 F. or 9 F. guiding catheters. Short-term (five- to eight-month) clinical follow-up has been event-free in all patients, and in three patients six-month follow-up angiography has shown insignificant luminal loss.
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Affiliation(s)
- Jorge Gaspar
- Department of Interventional Cardiology, Instituto Nacional de Cardiología, Mexico City, Mexico
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Gercken U, Lansky AJ, Buellesfeld L, Desai K, Badereldin M, Mueller R, Selbach G, Leon MB, Grube E. Results of the Jostent coronary stent graft implantation in various clinical settings: procedural and follow-up results. Catheter Cardiovasc Interv 2002; 56:353-60. [PMID: 12112888 DOI: 10.1002/ccd.10223] [Citation(s) in RCA: 126] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The Jostent coronary stent graft (CSG) is composed of a PTFE layer sandwiched between two stainless steel stents, initially introduced for the treatment of coronary perforations and aneurysms with excellent results. By providing a mechanical barrier, this stent design also may be beneficial in the treatment of complex ulcerated lesions and in-stent restenosis by preventing debris protrusion and neointimal proliferation through the stent struts. To evaluate the safety and efficacy of this stent graft, we implanted 78 CSGs in 70 patients for a broad range of indications, including coronary perforations, aneurysms, degenerated saphenous vein grafts, complex lesions, and in-stent restenosis. The primary angiographic success rate (95.9%) was high, and using intravascular ultrasound (IVUS) guidance during stent implantation and high inflation pressures (19.3 +/- 3.2 atm), stent expansion with optimal symmetry was achieved in 94.7%. One limitation of the Jostent CSG was the side-branch occlusion rate (18.6%) and the resulting non-Q-wave infarction rate in seven cases (mean CK elevation, 238 U/l), acute Q-wave MI in two cases, and transient ventricular fibrillation in one patient after occlusion of the proximal RCA side branch without further complications. Subacute stent thrombosis occurred in four cases (5.7%) 7 to 70 days after stent implantation, despite using combined antiplatelet therapy with aspirin (ASA), ticlopidine, and/or clopidogrel for 30 days. Angiographic follow-up was available in 56 patients (80.0%) after a mean of 159 +/- 49 days, and follow-up IVUS was available in 38 cases. The overall restenosis rate (> 50% diameter stenosis) was 31.6% manifest primarily as edge restenosis (29.8% stent edge vs. 8.8% stent center; P < 0.001). IVUS examinations showed a minimal late lumen loss of 0.4 +/- 2.2 mm(2) within the center of the stent graft vs. 3.2 +/- 2.3 mm(2) at the stent edges (P < 0.001). The restenosis rate in the prespecified subgroups was 33.3% for saphenous vein grafts (2/6 lesions), 30.0% in complex lesions (6/20 lesions), and 38.5% (10/26 lesions) for the treatment of in-stent restenosis. Implantation of the Jostent CSG is feasible and safe, even in complex lesion subsets, and is associated with high primary success rates provided major side branches are avoided. The use of this stent may require an extended time course of antiplatelet therapy. Frequent focal stent edge renarrowing influences the overall restenosis rate. However, in treatment of complex in-stent restenosis and vein graft lesions, stent grafts may offer benefit over conventional therapies. Covered stents such as the JoMed coronary stent graft may become essential for bailout treatment of coronary perforations.
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Affiliation(s)
- Ulrich Gercken
- Department of Cardiology and Angiology, Heart-Center, Siegburg, Siegburg, Germany
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Dixon SR, Skelding KA, Frumin HI, O'Neill WW. Occlusion of a saphenous vein graft aneurysm with a vein-covered stent. J Interv Cardiol 2002; 15:201-4. [PMID: 12141145 DOI: 10.1111/j.1540-8183.2002.tb01057.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
A 67-year-old man was admitted with unstable angina, 15 years after saphenous vein graft bypass surgery. Cardiac catheterization demonstrated a large saccular aneurysm arising from the proximal segment of the vein graft to the obtuse marginal artery. Intravascular ultrasound revealed the opening of the aneurysm that measured 15 mm in length. The aneurysm was successfully occluded by deployment of a vein-covered stent.
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Affiliation(s)
- Simon R Dixon
- Division of Cardiology, William Beaumont Hospital, 3601 West 13 Mile Rd., Royal Oak, MI 48073, USA
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Fukutomi T, Suzuki T, Popma JJ, Hosokawa H, Yokoya K, Inada T, Hayase M, Kondo H, Ito S, Suzuki S, Itoh M. Early and late clinical outcomes following coronary perforation in patients undergoing percutaneous coronary intervention. Circ J 2002; 66:349-56. [PMID: 11954948 DOI: 10.1253/circj.66.349] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Coronary perforation is a rare but serious complication that occurs during percutaneous coronary intervention (PCI). This study examines the frequency of coronary perforation during PCI, evaluates the management strategies used to treat perforations, and describes the long-term prognosis of patients who have developed coronary perforation during PCI. Coronary perforations were found in 69 (0.93%) of 7,443 consecutive PCI procedures, occurring more often after use of a new device (0.86%) than after use of balloon angioplasty (0.41%) (p<0.05). Coronary perforation was attributable solely to the coronary guidewire in 27 (0.36%) cases. Coronary perforations were divided into 2 types: (1) Those with epicardial staining without ajet of contrast extravasation (type I, n=51), and (2) those with a jet of contrast extravasation (type II, n= 18). Patients with type I and type II perforations were managed by observation only (35% and 0%, respectively), reversal of anticoagulation (57% and 94%), pericardiocentesis and drainage (27% and 61%), and prolonged perfusion balloon angioplasty (16% and 100%). Two patients with type II perforations required emergency coronary artery bypass surgery. There were no in-hospital deaths. Late pseudoaneurysms developed in 18 (28.6%) patients during the 13.4 +/- 11.3 months' follow-up period, and were more common in patients with type II perforations (72.2% vs 11.1% with type I perforations; p<0.001). During the follow-up period, no patient had evidence of coronary rupture. The results suggest that coronary perforation is uncommon after PCI, and can be managed without cardiac surgery in the majority of cases. Late pseudoaneurysms developed in some patients, particularly in patients with type II perforations, but there were no late consequences of coronary perforation after PCI.
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Affiliation(s)
- Tatsuya Fukutomi
- The First Department of Internal Medicine, Nagoya City University Medical School, Nagoya, Aichi, Japan.
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Briguori C, Sarais C, Sivieri G, Takagi T, Di Mario C, Colombo A. Polytetrafluoroethylene-covered stent and coronary artery aneurysms. Catheter Cardiovasc Interv 2002; 55:326-30. [PMID: 11870936 DOI: 10.1002/ccd.10063] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Angiographically detected coronary aneurysms (i.e., coronary segment greater then 1.5 times the normal artery) have an incidence of 0.3%-4.9% among patients undergoing coronary angiography and have been reported after an intervention procedure with a frequency of 2%-10%. The indication for treatment and the best modality still need to be defined. Some authors reported the successful treatment of coronary aneurysms with the polytetrafluoroethylene (PTFE)-covered stent implantation, supporting the role of this strategy. In our institution, from September 1997 to December 1999 eight PTFE-covered stents were implanted to treat seven coronary aneurysms in seven patients. All aneurysms were successfully treated by the PTFE-covered stent. In one case, there was the necessity of an additional PTFE stent to cover the aneurysm completely. In no case did the loss of stent occur. No in-hospital MACE occurred. At 35 +/- 8 (21-44) months, six patients were symptom-free. Angiographic follow-up was performed in all patients at 10 +/- 6 months. Restenosis occurred in one patient (14%) who had repeat percutaneous coronary interventions. This preliminary experience suggests that PTFE-covered stent may be useful in the treatment of coronary artery aneurysms.
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Affiliation(s)
- Carlo Briguori
- Laboratory of Interventional Cardiology, Vita-Salute University School of Medicine, San Raffaele Hospital, Milan, Italy
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Stefanadis C, Toutouzas K, Tsiamis E, Toutouzas P. New stent design for autologous venous graft-covered stent preparation: first human application for sealing of a coronary aneurysm. Catheter Cardiovasc Interv 2002; 55:222-7. [PMID: 11835652 DOI: 10.1002/ccd.10087] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In this case report, we present the first clinical application of a new stent design for autologous venous graft-covered stent preparation. This stent consists of a main body, resembling the configuration of conventional stents, and two connecting arms at the edges of the stent for the stabilization of the venous graft on the external surface of the stent. This new stent design was applied in a patient with an aneurysm in a stented segment in the right coronary artery. The immediate and long-term angiographic evaluation after the covered stent implantation showed complete sealing of the aneurysm without restenosis.
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Affiliation(s)
- Christodoulos Stefanadis
- Department of Cardiology, Athens Medical School, 9 Tepeleniou Street, 15452 Paleo Psychico, Athens, Greece.
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Kereiakes DJ, Broderick TM, Howard WL, Anderson LC, Weber M, Mitts DL. Successful long-term therapy following saphenous vein-covered stent deployment for atherosclerotic coronary aneurysm. Catheter Cardiovasc Interv 2002; 55:100-4. [PMID: 11793504 DOI: 10.1002/ccd.10064] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
We describe a case of atherosclerotic aneurysm involving the left main coronary artery in a patient with prior coronary artery bypass surgery. A saphenous vein-covered stent was used to seal the aneurysm in conjunction with conventional stenting of an associated native vessel coronary stenosis. Focal late restenosis involving the stent graft was successfully treated with repeat angioplasty and brachytherapy. Autologous vein-covered stent deployment should be considered in the treatment of symptomatic or progressively enlarging coronary aneurysms.
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Affiliation(s)
- Dean J Kereiakes
- The Lindner Center for Research and Education, Ohio Heart Health Center, Cincinnati, Ohio 45219, USA.
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Pineda GE, Khanal S, Mandawat M, Wilkin J. Large atherosclerotic left main coronary aneurysm--a case report and review of the literature. Angiology 2001; 52:501-4. [PMID: 11515991 DOI: 10.1177/000331970105200710] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Coronary artery aneurysm (CAA) is a rare disorder, characterized by an abnormal dilatation of a localized portion of the coronary artery. It is usually diagnosed incidentally by coronary angiography. Over 50% of coronary artery aneurysms are of atherosclerotic origin. The natural history of coronary aneurysms is not well understood. Their presence is not always considered to be an operative indication; rather, the severity of the associated coronary artery disease (CAD) is what dictates a surgical approach. In the absence of obstructive CAD, the definitive treatment for this condition is unclear. The authors present the case of an isolated saccular left main coronary aneurysm with no associated flow-limiting CAD. The patient was treated medically with antiplatelet and anticoagulant medication with no adverse events at 3, 6, 9, and 12 months of follow-up.
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Affiliation(s)
- G E Pineda
- Cardiovascular Division, Augusta VA Medical Center, Medical College of Georgia, 30912, USA
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15
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Abstract
Coronary aneurysms in adults are rare. Surgical treatment is often concomitant to treating obstructing coronary lesions. However, the ideal treatment strategy is poorly defined. We present a case of successful treatment of a large coronary artery aneurysm with a reverse saphenous interposition vein graft. This modality offers important benefits over other current surgical and percutaneous techniques and should be considered as an option for patients requiring treatment for coronary aneurysms.
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Affiliation(s)
- M S Firstenberg
- Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Ohio 44195, USA
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Abstract
We report three cases of coronary angioplasty using the IntraTherapeutics Intrastent biliary stent. We describe a technique utilizing routine coronary angioplasty equipment including 8 Fr guiding catheters and 0.014" guidewires. This technique can be easily performed in large-diameter coronary arteries.
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Affiliation(s)
- M Agirbasli
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Crawford Long Hospital, the Carlyle Fraser Heart Center, Atlanta, GA 30365, USA
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Stefanadis C, Toutouzas K, Tsiamis E, Vlachopoulos C, Kallikazaros I, Stratos C, Vavuranakis M, Toutouzas P. Stents covered by autologous venous grafts: feasibility and immediate and long-term results. Am Heart J 2000; 139:437-45. [PMID: 10689258 DOI: 10.1016/s0002-8703(00)90087-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Previous experimental studies with a new covered stent, the autologous venous graft-covered stent (AVGCS), have shown favorable results. The aim of this study was to evaluate the feasibility and safety of this new technique in human coronary arteries and to compare the long-term outcome with uncovered stents. METHODS AND RESULTS A venous graft was removed from an upper limb. A conventional stent then was covered by the venous graft. Fifty-eight AVGCS were implanted in 56 patients, including 16 patients with acute coronary syndromes (ACS). Additionally, in 114 patients, 138 uncovered stents were implanted, serving as a control group, including 38 patients with ACS. The procedure was successful in all patients. Stent thrombosis was observed in 3 patients in the control group and in 1 patient with an AVGCS. There was a trend for the minimal luminal diameter to be greater in the AVGCS group at follow-up (P =.07), and statistical significance was observed in patients with ACS (P <.01). The target vessel revascularization and the restenosis rates were similar between the 2 groups. In patients with ACS, the restenosis rate was less (P <.04) and there was a trend for target vessel revascularization to be less in covered stents (P =.09). The event-free survival rate at 4 years was 85% in the AVGCS group versus 81% in the control group (P = not significant); in ACS it was 94% versus 78%, respectively (P = not significant). Stents covered by thicker venous grafts were associated with improved clinical outcome. CONCLUSIONS Stents covered by autologous venous grafts may be safely prepared without complications. This technique may prove to be a useful means, especially in patients with ACS.
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Affiliation(s)
- C Stefanadis
- Department of Cardiology, Hippokration Hospital, University of Athens, Greece.
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STÖRGER HANS, HAASE JÜRGEN. Polytetrafluoroethylene-Covered Stents: Indications, Advantages, and Limitations. J Interv Cardiol 1999. [DOI: 10.1111/j.1540-8183.1999.tb00674.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Antonellis IP, Patsilinakos SP, Pamboukas CA, Kranidis AJ, Prappa E, Filippatos G, Margaris NG, Siaterli M, Tavernarakis AG, Rokas SG. Sealing of coronary artery aneurysm by using a new stent graft. Catheter Cardiovasc Interv 1999; 48:96-9. [PMID: 10467081 DOI: 10.1002/(sici)1522-726x(199909)48:1<96::aid-ccd20>3.0.co;2-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Coronary stenting has begun to play an increasingly important role in the management of coronary artery aneurysms. A case of successful and complete sealing of a coronary aneurysm by using a new stent graft is described. Further studies in a large patient population are required to confirm the safety and efficacy of this method. Cathet. Cardiovasc. Intervent. 48:96-99, 1999.
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Affiliation(s)
- I P Antonellis
- Invasive Cardiology Unit, Evangelismos Hospital, Athens, Greece
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von Birgelen C, Haude M, Herrmann J, Altmann C, Klinkhart W, Welge D, Wieneke H, Baumgart D, Sack S, Erbel R. Early clinical experience with the implantation of a novel synthetic coronary stent graft. Catheter Cardiovasc Interv 1999; 47:496-503. [PMID: 10470484 DOI: 10.1002/(sici)1522-726x(199908)47:4<496::aid-ccd22>3.0.co;2-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Coating stents with autologous venous grafts has been suggested to prevent problems associated with conventional stenting, but the need for surgical vessel harvest hampered broad application. A novel synthetic coronary stent graft (CSG) overcomes this limitation by a synthetic membrane, fixed between two thin metallic stents. We successfully implanted 21 CSGs in 18 patients for treatment of acute coronary rupture, thrombus-containing lesions, and lesions with plaque rupture or adjacent pseudoaneurysm. Substantial residual angiographic diameter stenoses were seen in seven CSGs (25% +/- 10% vs. 8% +/- 6%; P < 0.01), which were implanted with relatively small balloon catheters (balloon-to-artery ratio 1.00 +/- 0.09 vs. 1.24 +/- 0.18; P = 0.01) and required postdilatation. Overall, the largest balloon catheter applied measured 4.0 +/- 0.7 mm (balloon-to-artery ratio 1.21 +/- 0.20) and the inflation pressure was 16 +/- 3 atm. Final intravascular ultrasound imaging demonstrated adequate and symmetrical expansion of the CSG (> or = 85% +/- 15% of the reference lumen). Elective implantation was associated with two small non-Q-wave myocardial infarctions, resulting from unavoidable occlusions of side branches. Thus, implantation of CSG is feasible and safe. Adequate expansion can be achieved by the use of relatively large low-compliant balloon catheters inflated with high pressure.
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Affiliation(s)
- C von Birgelen
- Department of Cardiology, University Hospital Essen, Germany.
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21
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Schöbel WA, Voelker W, Haase KK, Karsch KR. Occurrence of a saccular pseudoaneurysm formation two weeks after perforation of the left anterior descending coronary artery during balloon angioplasty in acute myocardial infarction. Catheter Cardiovasc Interv 1999; 47:341-6. [PMID: 10402295 DOI: 10.1002/(sici)1522-726x(199907)47:3<341::aid-ccd22>3.0.co;2-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
We describe the occurrence of a localized saccular pseudoaneurysm in a 69-year-old patient 2 weeks after perforation of the left anterior descending coronary artery during balloon angioplasty in acute myocardial infarction. The therapy of perforations requires prolonged balloon inflations, perfusion balloons, covered stents, or surgery. Coronary peudoaneurysm formations are rare; their therapy requires covered stents or surgery. Cathet. Cardiovasc. Intervent. 47:341-346, 1999.
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Affiliation(s)
- W A Schöbel
- Department of Cardiology, University of Tübingen, Tübingen, Germany.
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22
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Abstract
One month after a successful angioplasty, one of our patients developed a new aneurysm in the right coronary artery (RCA). The aneurysm was characterized as a pseudoaneurysm by the use of intravascular ultrasound (IVUS). A stenosis that was not well seen by angiography was better depicted by IVUS. Both the pseudoaneurysm and the stenosis were successfully treated with a second angioplasty and stenting with a covered stent. Delayed development of pseudoaneurysms after dissection is an uncommon, but possible complication after angioplasty. In this case IVUS was useful for accurate characterization of the aneurysm. The use of covered stents may become a clinically useful method for treating coronary pseudoaneurysms.
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Affiliation(s)
- E Lell
- Division of Cardiology, Robert-Bosch-Hospital, Stuttgart, Germany
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23
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Heuser RR, Woodfield S, Lopez A. Obliteration of a coronary artery aneurysm with a PTFE-covered stent: endoluminal graft for coronary disease revisited. Catheter Cardiovasc Interv 1999; 46:113-6. [PMID: 10348581 DOI: 10.1002/(sici)1522-726x(199901)46:1<113::aid-ccd28>3.0.co;2-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
This is the first reported use of the JOSTENT stent graft for aneurysm disease in native coronaries. Consideration can be given to using this polytetrafluoroethylene (PTFE)-covered stent in situations such as dissections and restenosis in saphenous vein grafts or in long native coronary arteries without side branches, though further investigation is warranted.
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Affiliation(s)
- R R Heuser
- Phoenix Heart Center, Arizona 85016, USA.
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24
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HAUSDORF GERD. Future Uses of Stents. J Interv Cardiol 1998. [DOI: 10.1111/j.1540-8183.1998.tb00149.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Abstract
A 67-year-old patient developed a third restenosis with coronary artery aneurysm of the left anterior descending artery after two previous percutaneous transluminal coronary angioplasty (PTCA) procedures and one previous combined excimer-laser/balloon angioplasty. The stenosis was successfully dilated by conventional balloon technique and the aneurysm was excluded by implantation of a Palmaz-Schatz stent. Follow-up examination after 6 months revealed normal coronary artery perfusion without restenosis, whereas the aneurysm remained occluded. This case demonstrates, that stenting of a coronary artery aneurysm may be a successful method for a permanent occlusion.
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Affiliation(s)
- M G Hennersdorf
- Medical Clinic and Policlinic B, Department of Cardiology, Pneumology and Angiology, Heinrich-Heine-University, Düsseldorf, Germany.
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26
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Gruberg L, Roguin A, Beyar R. Percutaneous closure of a coronary aneurysm with a vein-coated stent. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1998; 43:308-10. [PMID: 9535370 DOI: 10.1002/(sici)1097-0304(199803)43:3<308::aid-ccd14>3.0.co;2-h] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Coronary artery aneurysm is a rare but recognized complication following percutaneous intervention. We report the formation of such an aneurysm after recanalization with Excimer laser wire of a chronic totally occluded left anterior descending coronary artery and stent implantation and its subsequent treatment using an autologous vein graft-coated stent.
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Affiliation(s)
- L Gruberg
- Division of Invasive Cardiology, Heart Institute, Rambam Medical Center, Haifa, Israel
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27
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Stefanadis C, Toutouzas K, Tsiamis E, Vlachopoulos C, Kallikazaros I, Stratos C, Toutouzas P. Total reconstruction of a diseased saphenous vein graft by means of conventional and autologous tissue-coated stents. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1998; 43:318-21. [PMID: 9535373 DOI: 10.1002/(sici)1097-0304(199803)43:3<318::aid-ccd17>3.0.co;2-h] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This is the first report of a total reconstruction of a diseased saphenous vein graft, with thrombus-containing lesion and multiple stenoses, by the implantation of arterial graft- and venous graft-coated stents, and of conventional stents. The procedure was successful without any complications, and follow-up angiography after 6 months revealed patency of the vessel.
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Affiliation(s)
- C Stefanadis
- Department of Cardiology, University of Athens, Greece
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28
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Kitzis I, Kornowski R, Miller HI. Delayed development of a pseudoaneurysm in the left circumflex artery following angioplasty and stent placement, treated with intravascular ultrasound-guided stenting. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1997; 42:51-3. [PMID: 9286541 DOI: 10.1002/(sici)1097-0304(199709)42:1<51::aid-ccd15>3.0.co;2-p] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Three months following satisfactory angioplasty and stent placement, a patient developed restenosis and a pseudoaneurysm of a coronary artery segment proximal to the previously stented area. The restenosis and the pseudoaneurysm were successfully treated with intravascular ultrasound-guided primary stenting. The delay in the appearance of the pseudoaneurysm attests to the chronic nature of the lesion.
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Affiliation(s)
- I Kitzis
- Department of Cardiology, Tel-Aviv Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Israel
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29
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Rodríguez O, Baim DS. Coronary aneurysms after catheter interventions: an exception to "bigger is better". CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1997; 41:411-2. [PMID: 9258485 DOI: 10.1002/(sici)1097-0304(199708)41:4<411::aid-ccd14>3.0.co;2-o] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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30
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Stefanadis C, Tsiamis E, Vlachopoulos C, Toutouzas K, Giatrakos N, Tsioufis C, Diamantopoulos L, Toutouzas P. Arterial autologous graft-stent for treatment of coronary artery disease: a new technique. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1997; 40:302-7. [PMID: 9062730 DOI: 10.1002/(sici)1097-0304(199703)40:3<302::aid-ccd20>3.0.co;2-p] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The radial artery has been used as a free bypass graft with excellent results. An autologous vein graft-coated stent, a novel type of stent developed at our institution, has been applied successfully under both experimental and clinical conditions. To extend the spectrum of biological linings for coated stents, we used an arterial graft. We describe the first application of the radial artery as an autologous coating for a conventional stent to be used in treatment of coronary artery disease.
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Affiliation(s)
- C Stefanadis
- Department of Cardiology, Hippokration Hospital, University of Athens, Greece
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31
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Stefanadis C, Tsiamis E, Vlachopoulos C, Toutouzas K, Stratos C, Kallikazaros I, Vavuranakis M, Toutouzas P. Autologous vein graft-coated stents for the treatment of thrombus-containing coronary artery lesions. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1997; 40:217-22. [PMID: 9047072 DOI: 10.1002/(sici)1097-0304(199702)40:2<217::aid-ccd25>3.0.co;2-m] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Recent studies have shown that stents may have a potential role in the treatment of thrombus-containing lesions. We report on the application of an autologous vein graft-coated stent (AVGCS) as the primary therapeutic modality for acute myocardial infarction in 10 patients. AVGCS delivery and deployment were successful and uneventful. Mean minimal lumen diameter and TIMI trial flow grade increased significantly (from 0.04 +/- 0.09 mm pre-AVGCS to 3.02 +/- 0.32 mm post-AVGCS, and from 10 patients with flow grade 0-1 pre-AVGCS to 10 patients with flow grade 3 post-AVGCS, respectively). Ten-day angiogram revealed maintenance of the immediate results. Nine patients had a negative exercise stress test 2 mo post-AVGCS, and at a mean follow-up of 30 +/- 7 weeks, all 9 were symptom-free. One patient, 3 wk after implantation and while being hospitalized for hypovolemic shock, developed recurrent infarction. These favorable preliminary outcomes suggest that AVGCS may play a useful role in the treatment of thrombus-containing lesions.
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Affiliation(s)
- C Stefanadis
- Department of Cardiology, Hippokration Hospital, University of Athens, Greece
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