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Patrick W Serruys - One of the best experts on this subject based on the ideXlab platform.
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2016Co-Authors: Martin J C Van Gemert, Jan J. Piek, George K. David, Jan G.p. Tijssen, Sipke Strikwerda, William K Redekop, Patrick W Serruys, Kong I Lie, Pim J De Feyter, Jacques JAbstract:lesions: subanalysis of a randomised trial or balloon Angioplasty for complex coronary Clinical events following excimer laser angioplast
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randomized comparison of primary stenting and provisional balloon Angioplasty guided by flow velocity measurement
Circulation, 2000Co-Authors: Patrick W Serruys, Jan J. Piek, Bernard De Bruyne, Stephane Carlier, Jose Eduardo Moraes Rego Sousa, Toshiya Muramatsu, Chris J Vrints, Peter Probst, Ricardo Seabragomes, Ian SimpsonAbstract:Background—Coronary stenting improves outcomes compared with balloon Angioplasty, but it is costly and may have other disadvantages. Limiting stent use to patients with a suboptimal result after Angioplasty (provisional Angioplasty) may be as effective and less expensive. Methods and Results—To analyze the cost-effectiveness of provisional Angioplasty, patients scheduled for single-vessel Angioplasty were first randomized to receive primary stenting (97 patients) or balloon Angioplasty guided by Doppler flow velocity and angiography (523 patients). Patients in the latter group were further randomized after optimization to either additional stenting or termination of the procedure to further investigate what is “optimal.” An optimal result was defined as a flow reserve .2.5 and a diameter stenosis ,36%. Bailout stenting was needed in 129 patients (25%) who were randomized to balloon Angioplasty, and an optimal result was obtained in 184 of the 523 patients (35%). There was no significant difference in event-free survival at 1 year between primary stenting (86.6%) and provisional Angioplasty (85.6%). Costs after 1 year were significantly higher for provisional Angioplasty (EUR 6573 versus EUR 5885; P50.014). Results after the second randomization showed that stenting was also more effective after optimal balloon Angioplasty (1-year event free survival, 93.5% versus 84.1%; P50.066). Conclusions—After 1 year of follow-up, provisional Angioplasty was more expensive and without clinical benefit. The beneficial value of stenting is not limited to patients with a suboptimal result after balloon Angioplasty. (Circulation. 2000;102:2930-2937.)
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a comparison of systematic stenting and conventional balloon Angioplasty during primary percutaneous transluminal coronary Angioplasty for acute myocardial infarction
Journal of the American College of Cardiology, 2000Co-Authors: Luc Maillard, Patrick W Serruys, Philippe Raynaud, Martial Hamon, J P Monassier, Khalife Khalife, Philippe Gabriel Steg, Farzin Beygui, Jeanleon Guermonprez, Christian SpauldingAbstract:Abstract OBJECTIVES In a multicenter, randomized trial, systematic stenting using the Wiktor stent was compared to conventional balloon Angioplasty with provisional stenting for the treatment of acute myocardial infarction (AMI). BACKGROUND Primary Angioplasty in AMI is limited by in-hospital recurrent ischemia and a high restenosis rate. METHODS A total of 211 patients with AMI RESULTS Angiographic success (Thrombolysis in Myocardial Infarction [TIMI] flow grade 3 and residual diameter stenosis CONCLUSIONS In the setting of primary Angioplasty for AMI, as compared with a strategy of conventional balloon Angioplasty, systematic stenting using the Wiktor stent results in lower rates of angiographic restenosis.
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coronary artery stenting compared with balloon Angioplasty for restenosis after initial balloon Angioplasty restenosis stent study group
The New England Journal of Medicine, 1998Co-Authors: Raimund Erbel, Patrick W Serruys, Peter Probst, Michael Haude, Hans Wilhelm Hopp, D Franzen, H J Rupprecht, Bernd Heublein, Wolfgang Rutsch, Peter De JaegereAbstract:Background Intracoronary stenting reduces the rate of restenosis after Angioplasty in patients with new coronary lesions. We conducted a prospective, randomized, multicenter study to determine whether intracoronary stenting, as compared with standard balloon Angioplasty, reduces the recurrence of luminal narrowing in restenotic lesions. Methods A total of 383 patients who had undergone at least one balloon Angioplasty and who had clinical and angiographic evidence of restenosis after the procedure were randomly assigned to undergo standard balloon Angioplasty (192 patients) or intracoronary stenting with a Palmaz–Schatz stent (191 patients). The primary end point was angiographic evidence of restenosis (defined as stenosis of more than 50 percent of the luminal diameter) at six months. The secondary end points were death, Q-wave myocardial infarction, bypass surgery, and revascularization of the target vessel. Results The rate of restenosis was significantly higher in the Angioplasty group than in the ste...
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efficacy of beta radiation in prevention of post Angioplasty restenosis an interim report from the beta energy restenosis trial
Herz, 1998Co-Authors: David Meerkin, Patrick W Serruys, Raoul Bonan, Ian Crocker, Andre Arsenault, Prakash Chougule, V L M A Coen, David O Williams, Spencer B KingAbstract:Restenosis remains a major limitation of corortary Angioplasty in spite of major advances in techniques and tech- nology. Recent studies have demonstrated that ionizing radiation may limit the degree of this problem. Gamma radia- tion has been shown to be effective in reducing in stent reste- nosis in humans, and beta radiatio~ following encouraging results in animals has been shown to be feasible in humans. The objective of this study was to assess the feasibility of a 5 F non-centered catheter to deliver beta radiation emitting seeds to the lesion site post angioptasty and its effect on restenosis. Following successful Angioplasty, patients were randomized to treatment with 12.14 or 16 Gy at the Angioplasty site. This was delivered with a 5 t" non-centered catheter. Twelve beta radiation emittfi~g seeds (g~ were delivered to an ama
Ole-alexander Breithardt - One of the best experts on this subject based on the ideXlab platform.
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a randomized multicenter single blinded trial comparing paclitaxel coated balloon Angioplasty with plain balloon Angioplasty in drug eluting stent restenosis the pepcad des study
Journal of the American College of Cardiology, 2012Co-Authors: Harald Rittger, Anilm Sinha, Marc Ohlow, Andreas Brugger, Volkhard Kurowski, Matthias Waliszewski, Ralf Birkemeyer, Johannes Brachmann, Holger Thiele, Ole-alexander BreithardtAbstract:Objectives This study sought to define the impact of paclitaxel-coated balloon Angioplasty for treatment of drug-eluting stent restenosis compared with uncoated balloon Angioplasty alone. Background Drug-coated balloon Angioplasty is associated with favorable results for treatment of bare-metal stent restenosis. Methods In this prospective, single-blind, multicenter, randomized trial, the authors randomly assigned 110 patients with drug-eluting stent restenoses located in a native coronary artery to paclitaxel-coated balloon Angioplasty or uncoated balloon Angioplasty. Dual antiplatelet therapy was prescribed for 6 months. Angiographic follow-up was scheduled at 6 months. The primary endpoint was late lumen loss. The secondary clinical endpoint was a composite of cardiac death, myocardial infarction attributed to the target vessel, or target lesion revascularization. Results There was no difference in patient baseline characteristics or procedural results. Angiographic follow-up rate was 91%. Treatment with paclitaxel-coated balloon was superior to balloon Angioplasty alone with a late loss of 0.43 ± 0.61 mm versus 1.03 ± 0.77 mm (p Conclusions Paclitaxel-coated balloon Angioplasty is superior to balloon Angioplasty alone for treatment of drug-eluting stent restenosis. (PEPCAD DES–Treatment of DES-In-Stent Restenosis With SeQuent® Please Paclitaxel Eluting PTCA Catheter [PEPCAD-DES]; NCT00998439 )
Felix Zijlstra - One of the best experts on this subject based on the ideXlab platform.
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randomized comparison of coronary stenting with balloon Angioplasty in selected patients with acute myocardial infarction
Circulation, 1998Co-Authors: H Suryapranata, A Vant W J Hof, J C A Hoorntje, M J De Boer, Felix ZijlstraAbstract:Background—Although the benefits of primary Angioplasty in acute myocardial infarction have been demonstrated, several areas for improvement remain. Therefore, a prospective randomized trial comparing primary stenting with balloon Angioplasty in patients with acute myocardial infarction was conducted. Methods and Results—Patients with acute myocardial infarction were randomly assigned to undergo either primary stenting (n=112) or balloon Angioplasty (n=115). The clinical end points were death, recurrent infarction, subsequent bypass surgery, or repeat Angioplasty of the infarct-related vessel. The overall mortality rate at 6 months was 2%. Recurrent infarction occurred in 8 patients (7%) after balloon Angioplasty and in 1 (1%) after stenting (P=0.036). Subsequent target-vessel revascularization was necessary in 19 (17%) and 4 (4%) patients, respectively (P=0.0016). The cardiac event-free survival rate in the stent group was significantly higher than in the balloon Angioplasty group (95% versus 80%; P=0.01...
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comparison of primary coronary Angioplasty and intravenous thrombolytic therapy for acute myocardial infarction a quantitative review
JAMA, 1997Co-Authors: W D Weaver, Raymond J Gibbons, Cindy L Grines, Eulogio Garcia, R J Simes, Amadeo Betriu, Felix Zijlstra, Liliana Grinfeld, E RibeiroAbstract:Objective. —To provide a quantitative review of the treatment effects of primary coronary Angioplasty vs intravenous thrombolysis for acute myocardial infarction. Data Sources. —Ten randomized trials were identified through computerized bibliographic search of MEDLINE from January 1985 through March 1996 and by queries of principal investigators. Study Selection. —Single-center and multicenter randomized trials comparing primary Angioplasty with intravenous thrombolytic therapy among 2606 patients were included. Four trials compared Angioplasty with streptokinase, 3 compared Angioplasty with a 3- to 4-hour infusion of tissue-type plasminogen activator, and 3 compared Angioplasty with "accelerated" administration of tissue-type plasminogen activator over 90 minutes. Data Extraction. —Each investigator provided definitions and exact data for outcome events. Odds ratios (ORs), 95% confidence intervals (CIs), and Pvalues were calculated using exact tests for categorical data. Data Synthesis. —Mortality at 30 days or less was 4.4% for the 1290 patients treated with primary Angioplasty compared with 6.5% for the 1316 patients treated with thrombolysis (34% reduction; OR, 0.66; 95% CI, 0.46-0.94;P=.02). The effect was similar among thrombolytic regimens, and no subgroup demonstrated a significant reduction in death. The rates of death or nonfatal reinfarction were 7.2% for Angioplasty and 11.9% for thrombolytic therapy (OR, 0.58; 95% CI, 0.44-0.76;P Conclusions. —Based on outcomes at hospital discharge or 30 days, primary Angioplasty appears to be superior to thrombolytic therapy for treatment of patients with acute myocardial infarction, with the proviso that success rates for Angioplasty are as good as those achieved in these trials. Data evaluating longer-term outcomes, operator experience, and time delay before treatment are needed before primary Angioplasty can be universally recommended as the preferred treatment.
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angiographic findings and catheterization laboratory events in patients with primary coronary Angioplasty or streptokinase therapy for acute myocardial infarction
European Heart Journal, 1995Co-Authors: Johan H C Reiber, J C A Hoorntje, H Suryapranata, Felix ZijlstraAbstract:Background : The purpose of this study was to evaluate catheterization laboratory events and angiographic findings in patients randomly assigned to undergo primary coronary Angioplasty or to receive intravenous streptokinase for acute myocardial infarction. Methods: We analysed angiographic data in 301 patients with acute myocardial infarction, randomly assigned to undergo primary coronary Angioplasty without antecedent thrombolytic therapy or to receive intravenous streptokinase therapy. Follow-up coronary angiography was preferably performed after 3 months. AII angiograms were analysed with a quantitative coronary analysis system. Results: Of the 152 patients assigned to Angioplasty treatment, 140 underwent this procedure with a success rate of 97%. The residual diameter stenosis of the infarct-related vessel immediately after Angioplasty was 27 ± 15% and there were major events in 14% of the patients in the catheterization laboratory. At follow-up angiography after a mean interval of 92 days in the Angioplasty assigned patients, a diameter stenosis of 35 ± 22% was observed in this group. The restenosis rate was 28% and the reocclusion rate 5%. A Thrombolysis in Myocardial Infarction (TIMI) grade 2 flow immediately after Angioplasty was predictive for reocclusion at follow-up (P= θ0.001). In the streptokinase assigned patients (149) the infarct-related vessel was patent at follow-up angiography after a mean of 22 days in 66% of the patients with a mean residual diameter stenosis of 77 ± 20%. Conclusion: Primary coronary Angioplasty is a highly effective and safe reperfusion modality for patients with acute myocardial infarction. However, TIMI grade 2 flow through the infarct-related vessel immediately after Angioplasty is a predictor of reocclusion.
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immediate coronary Angioplasty versus intravenous streptokinase in acute myocardial infarction left ventricular ejection fraction hospital mortality and reinfarction
Journal of the American College of Cardiology, 1994Co-Authors: Menkojan De Boer, Jan C A Hoorntje, Jan Paul Ottervanger, Stoffer Reiffers, Harry Suryapranata, Felix ZijlstraAbstract:Abstract Objectives . The purpose of the present study was to compare intravenous Streptokinase therapy with immediate coronary Angioplasty without antecedent thrombolytic therapy with regard to left ventricular function and hospital mortality and reinfarction. Background . Despite the widespread use of intravenous thrombolytic therapy and immediate percutaneous transluminal coronary Angioplasty, these two strategies to treat patients with an acute myocardial infarction have only recently been compared in randomized trials. Coronary Angioplasty has been shown to result In a higher patency rate of the Infant-related coronary artery, with a less severe residual stenotic lesion, compared with streptokinase therapy, but whether this more favorable coronary anatomy results in clinical benefit remair to be established. Methods . We studied 301 patients with acute myocardial infarction randomly assigned to undergo immediate coronary Angioplasty without antecedent thrombolytic therapy or to receive intravenous streptokinase therapy. Before discharge left ventricular ejection fraction was measured by radionuclide scanning. Results . The in-hospital mortality rate in the streptokinase group was 7% (11 of 149 patients) compared with 2% (3 of 152 patients) in the Angioplasty group (p = 0.024). In the streptokinase group recurrent myocardial infarction occurred in 15 patients (10%) versus in 2 (1%) in the Angioplasty group (p Conclusions . These findings indicate that immediate coronary Angioplasty without antecedent thrombolytic therapy results in better left ventricular function and lower risk of death and recurrent myocardial infarction than treatment with intravenous streptokinase.
Sadayoshi Ito - One of the best experts on this subject based on the ideXlab platform.
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kidney enlargement effect of Angioplasty for nonatherosclerotic renovascular disease reversibility of ischemic kidney
Hypertension Research, 2020Co-Authors: Tomoyuki Iwasaki, Eikan Mishima, Takehiro Suzuki, Koichi Kikuchi, Takafumi Toyohara, Kazumasa Seiji, Kei Takase, Mariko Miyazaki, Hideo Harigae, Sadayoshi ItoAbstract:Renal artery stenosis causes kidney ischemia, reducing the size of the affected kidney, which eventually results in atrophy. Although renal atrophy is considered irreversible, resolution of the ischemia occasionally restores kidney size when the cause is renal artery stenosis. Angioplasty is effective in patients with nonatherosclerotic renovascular diseases (non-ARVDs). Nevertheless, renal enlargement after Angioplasty has not been fully examined. We conducted a retrospective study to examine this phenomenon in non-ARVD patients. Ten patients with a <100-mm pole-to-pole length of the poststenotic kidney were treated with Angioplasty. Data were collected up to 12 months after Angioplasty. The mean age was 28 years; the estimated glomerular filtration rate was 92 ± 7 mL/min/1.73 m2 (mean ± SEM); blood pressure was 150/99 mmHg; 80% were women; and fibromuscular dysplasia was present in 90% of the patients. All patients had hypertension. The lengths of the poststenotic and contralateral kidney before Angioplasty were 91 ± 1 and 111 ± 3 mm, respectively. After Angioplasty, the length of the poststenotic kidney gradually increased during the 3 months after treatment (+5.4 mm) and that of the contralateral kidney decreased over the same time course (-3.7 mm). Enlargement was also found in the moderate atrophy subgroup (length < 92 mm), and it was greater in the <30 years old group. In a noteworthy case, renal size in the poststenotic kidney recovered from 87 to 102 mm after Angioplasty. Our findings demonstrated that reduced renal size can be reversed after optimal Angioplasty in non-ARVD patients, especially young patients, suggesting reversibility of the ischemic kidney.
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selection of patients for Angioplasty for treatment of atherosclerotic renovascular disease predicting responsive patients
American Journal of Hypertension, 2020Co-Authors: Eikan Mishima, Takehiro Suzuki, Sadayoshi ItoAbstract:Atherosclerotic renal artery stenosis (ARAS) can cause secondary hypertension, progressive decline in renal function, and cardiac complications. Recent randomized controlled trials including the Cardiovascular Outcomes in Renal Atherosclerotic Lesions study have not reported the benefit of renal artery stenting compared with medical therapy alone to improve renal function or reduce cardiovascular and renal events in the enrolled patients with ARAS. However, observational evidence indicating the benefits of Angioplasty in the selected high-risk patients with ARAS has been increasing. Thus, the timely correction of stenosis through Angioplasty may have a beneficial effect in selected patients. However, optimal patient selection for Angioplasty has been debated and can be challenging at times. Clinicians must identify the responsive patients who would benefit from Angioplasty through risk stratification and the prediction of outcomes. Efforts have been made for the determination of predictors that can identify the subgroups of patients who would benefit from Angioplasty. Lower age, more severe stenosis, preserved renal perfusion, and absence of diabetes or generalized atherosclerosis have been reported as the predictors for the improvement of hypertension after Angioplasty. Global renal ischemia, rapidly declining renal function over 6-12 months, progressive shrinkage of the affected kidney, lower resistive index, and lower levels of albuminuria have been reported as predictors of improved or preserved renal function after Angioplasty. This review discusses the identification of ARAS patients who will potentially respond well to Angioplasty.
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cutting balloon Angioplasty of resistant renal artery stenosis caused by fibromuscular dysplasia
Journal of Vascular Surgery, 2005Co-Authors: Masayuki Tanemoto, Takaaki Abe, Tatsuji Chaki, Fumitoshi Satoh, Tadashi Ishibashi, Sadayoshi ItoAbstract:Balloon Angioplasty is an established intervention to treat renovascular hypertension. Conventional balloon Angioplasty is usually effective in cases of renovascular hypertension caused by fibromuscular dysplasia. In the present report, we describe two cases of renovascular hypertension caused by fibromuscular dysplasia in which stenotic lesions were resistant to conventional balloon Angioplasty but were successfully managed by a cutting balloon. After cutting balloon Angioplasty, systemic blood pressure was normalized in both patients, without the use of antihypertensive agents. Angioplasty by using a cutting balloon is a new therapeutic choice against renal artery stenosis that is resistant to dilation by a conventional balloon.
David P Faxon - One of the best experts on this subject based on the ideXlab platform.
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restenosis reocclusion and adverse cardiovascular events after successful balloon Angioplasty of occluded versus nonoccluded coronary arteries results from the multicenter american research trial with cilazapril after Angioplasty to prevent translumi
Journal of the American College of Cardiology, 1996Co-Authors: Peter B Berger, Patrick W Serruys, David R. Holmes, Magnus E Ohman, Mary Ann Ohanesian, Joseph G Murphy, Robert S Schwartz, David P FaxonAbstract:Objectives. This study sought to compare the frequency of restenosis, reocclusion and adverse cardiovascular events after Angioplasty of occluded versus nonoccluded coronary arteries. Background. Angioplasty of chronically occluded coronary arteries is believed to be associated with a higher frequency of restenosis and reocclusion than Angioplasty of subtotal stenoses. Whether this leads to adverse cardiovascular events is unknown. Methods. The Multicenter American Research Trial With Cilazapril After Angioplasty to Prevent Restenosis (MARCATOR) was a placebo-controlled trial with angiographic follow-up to determine the effect of the angiotensin-converting enzyme inhibitor cilazapril on the frequency of restenosis. In this trial, restenosis was defined as 1) angiographic reduction of minimal lumen diameter ≥0.72 mm between Angioplasty and the follow-up visit; and 2) >50% diameter stenosis on the follow-up angiogram. We identified 139 patients with successful Angioplasty of a coronary occlusion (Group 1) and compared the frequency of restenosis, reocclusion and adverse cardiovascular events with that in 1,295 patients with successful Angioplasty of a subtotal stenosis (Group 2). Results. Restenosis occurred in 36 patients with occluded arteries (29%) versus 264 with nonoccluded arteries (23%, p = 0.177) by definition 1 and in 62 patients with occluded arteries (49%) versus 478 with nonoccluded arteries (42%, p = 0.119) by definition 2. Occlusion was present in 24 Group 1 patients (19%) compared with 74 Group 2 patients (7%) (p Conclusions. The frequency of restenosis was slightly but not significantly greater after successful Angioplasty of an occluded artery than after Angioplasty of a subtotal stenosis. Although reocclusion was more frequent, occurring in 19% of patients, the net clinical benefit of Angioplasty in such patients was similar to that in patients with subtotal stenoses over the 6-month follow-up period.
