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Arno Buecker - One of the best experts on this subject based on the ideXlab platform.
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Percutaneous endovascular tissue sampling of endoluminal tumors using Directional Atherectomy
European Radiology, 2019Co-Authors: Alexander Massmann, Roland Seidel, Arno Buecker, Günther K. Schneider, Peter FriesAbstract:Objectives To evaluate technical feasibility and safety of endovascular tumor specimen sampling using an escalating endovascular biopsy strategy using a Directional Atherectomy device compared with forceps biopsy and catheter aspiration. Materials and methods Between 2013 and 2017, a cohort of ten consecutive patients (6 male; median age 56, range 39–73 years) was referred for sampling of endovascular masses. Localizations included the abdominal aorta ( n = 4), left brachiocephalic vein ( n = 2), inferior vena cava ( n = 1), and left pulmonary artery ( n = 3). For each individual mass, all three endovascular tissue sampling approaches were applied including catheter-based aspiration, straight two-jaw biopsy forceps, and Directional Atherectomy during a single session. Results Aspiration and forceps biopsy did not provide sufficient material for histological analyses. In contrast, technical success for endovascular tumor sampling using Directional Atherectomy was 100%. After two Atherectomy passages, sufficient material was available for each vessel region allowing histologic diagnosis, which revealed sarcoma and chronic inflammation for masses in the aorta, angiosarcoma for brachiocephalic vein, hepatocellular carcinoma for inferior vena cava, and angiosarcoma for pulmonary artery. In case of a histologically benign diagnosis, no malignant tumor proliferation was obvious on follow-up imaging studies after 3 months and 1 year. Thus, the rate of false-negative results was considered 0%. No procedure-associated complications, e.g., vessel perforation, were recorded. Conclusion Preliminary results in a limited number of patients proved Directional Atherectomy beneficial as a safe and feasible technique for endoluminal tissue sampling of vascular masses. Additional large-scale studies are necessary and worthy for further evaluation in clinical practice. Key Points • Endovascular masses pose a challenge to appropriate clinical management. • Off-label Directional Atherectomy proved to be a safe and feasible technique for endoluminal tissue sampling of vascular masses. Furthermore, Directional Atherectomy was superior to aspiration or forceps biopsy in our small study cohort. • Directional Atherectomy may represent the last or only option for tissue probing as a prerequisite for further treatment decisions.
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Percutaneous endovascular tissue sampling of endoluminal tumors using Directional Atherectomy
European Radiology, 2019Co-Authors: Alexander Massmann, Roland Seidel, Günther Schneider, Arno Buecker, Peter FriesAbstract:Objectives To evaluate technical feasibility and safety of endovascular tumor specimen sampling using an escalating endovascular biopsy strategy using a Directional Atherectomy device compared with forceps biopsy and catheter aspiration.
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Percutaneous endovascular tissue sampling of endoluminal tumors using Directional Atherectomy.
European radiology, 2019Co-Authors: Alexander Massmann, Roland Seidel, Günther Schneider, Arno Buecker, Peter FriesAbstract:To evaluate technical feasibility and safety of endovascular tumor specimen sampling using an escalating endovascular biopsy strategy using a Directional Atherectomy device compared with forceps biopsy and catheter aspiration. Between 2013 and 2017, a cohort of ten consecutive patients (6 male; median age 56, range 39–73 years) was referred for sampling of endovascular masses. Localizations included the abdominal aorta (n = 4), left brachiocephalic vein (n = 2), inferior vena cava (n = 1), and left pulmonary artery (n = 3). For each individual mass, all three endovascular tissue sampling approaches were applied including catheter-based aspiration, straight two-jaw biopsy forceps, and Directional Atherectomy during a single session. Aspiration and forceps biopsy did not provide sufficient material for histological analyses. In contrast, technical success for endovascular tumor sampling using Directional Atherectomy was 100%. After two Atherectomy passages, sufficient material was available for each vessel region allowing histologic diagnosis, which revealed sarcoma and chronic inflammation for masses in the aorta, angiosarcoma for brachiocephalic vein, hepatocellular carcinoma for inferior vena cava, and angiosarcoma for pulmonary artery. In case of a histologically benign diagnosis, no malignant tumor proliferation was obvious on follow-up imaging studies after 3 months and 1 year. Thus, the rate of false-negative results was considered 0%. No procedure-associated complications, e.g., vessel perforation, were recorded. Preliminary results in a limited number of patients proved Directional Atherectomy beneficial as a safe and feasible technique for endoluminal tissue sampling of vascular masses. Additional large-scale studies are necessary and worthy for further evaluation in clinical practice. • Endovascular masses pose a challenge to appropriate clinical management. • Off-label Directional Atherectomy proved to be a safe and feasible technique for endoluminal tissue sampling of vascular masses. Furthermore, Directional Atherectomy was superior to aspiration or forceps biopsy in our small study cohort. • Directional Atherectomy may represent the last or only option for tissue probing as a prerequisite for further treatment decisions.
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Three-Year Results After Directional Atherectomy of Calcified Stenotic Lesions of the Superficial Femoral Artery
Cardiovascular and interventional radiology, 2014Co-Authors: Peter Minko, Arno Buecker, S. Jaeger, Marcus KatohAbstract:Objective To investigate the 3-year outcome of patients with peripheral arterial disease (PAD) and heavily calcified stenotic lesions of the superficial femoral artery after Directional Atherectomy.
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Mechanical Recanalization of Subacute Vessel Occlusion in Peripheral Arterial Disease with a Directional Atherectomy Catheter
CardioVascular and Interventional Radiology, 2012Co-Authors: Alexander Massmann, Marcus Katoh, Roushanak Shayesteh-kheslat, Arno BueckerAbstract:Purpose To retrospectively examine the technical feasibility and safety of Directional Atherectomy for treatment of subacute infrainguinal arterial vessel occlusions. Methods Five patients (one woman, four men, age range 51–81 years) with peripheral arterial disease who experienced sudden worsening of their peripheral arterial disease–related symptoms during the last 2–6 weeks underwent digital subtraction angiography, which revealed vessel occlusion in native popliteal artery ( n = 4) and in-stent occlusion of the superficial femoral artery ( n = 1). Subsequently, all patients were treated by Atherectomy with the SilverHawk (ev3 Endovascular, USA) device. Results The mean diameter of treated vessels was 5.1 ± 1.0 mm. The length of the occlusion ranged 2–14 cm. The primary technical success rate was 100%. One patient experienced a reocclusion during hospitalization due to heparin-induced thrombocytopenia. There were no further periprocedural complications, in particular no peripheral embolizations, until hospital discharge or during the follow-up period of 1 year. Conclusion The recanalization of infrainguinal arterial vessel occlusions by Atherectomy with the SilverHawk device is technically feasible and safe. In our limited retrospective study, it was associated with a high technical success rate and a low procedure-related complication rate.
Alexander Massmann - One of the best experts on this subject based on the ideXlab platform.
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Percutaneous endovascular tissue sampling of endoluminal tumors using Directional Atherectomy
European Radiology, 2019Co-Authors: Alexander Massmann, Roland Seidel, Arno Buecker, Günther K. Schneider, Peter FriesAbstract:Objectives To evaluate technical feasibility and safety of endovascular tumor specimen sampling using an escalating endovascular biopsy strategy using a Directional Atherectomy device compared with forceps biopsy and catheter aspiration. Materials and methods Between 2013 and 2017, a cohort of ten consecutive patients (6 male; median age 56, range 39–73 years) was referred for sampling of endovascular masses. Localizations included the abdominal aorta ( n = 4), left brachiocephalic vein ( n = 2), inferior vena cava ( n = 1), and left pulmonary artery ( n = 3). For each individual mass, all three endovascular tissue sampling approaches were applied including catheter-based aspiration, straight two-jaw biopsy forceps, and Directional Atherectomy during a single session. Results Aspiration and forceps biopsy did not provide sufficient material for histological analyses. In contrast, technical success for endovascular tumor sampling using Directional Atherectomy was 100%. After two Atherectomy passages, sufficient material was available for each vessel region allowing histologic diagnosis, which revealed sarcoma and chronic inflammation for masses in the aorta, angiosarcoma for brachiocephalic vein, hepatocellular carcinoma for inferior vena cava, and angiosarcoma for pulmonary artery. In case of a histologically benign diagnosis, no malignant tumor proliferation was obvious on follow-up imaging studies after 3 months and 1 year. Thus, the rate of false-negative results was considered 0%. No procedure-associated complications, e.g., vessel perforation, were recorded. Conclusion Preliminary results in a limited number of patients proved Directional Atherectomy beneficial as a safe and feasible technique for endoluminal tissue sampling of vascular masses. Additional large-scale studies are necessary and worthy for further evaluation in clinical practice. Key Points • Endovascular masses pose a challenge to appropriate clinical management. • Off-label Directional Atherectomy proved to be a safe and feasible technique for endoluminal tissue sampling of vascular masses. Furthermore, Directional Atherectomy was superior to aspiration or forceps biopsy in our small study cohort. • Directional Atherectomy may represent the last or only option for tissue probing as a prerequisite for further treatment decisions.
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Percutaneous endovascular tissue sampling of endoluminal tumors using Directional Atherectomy
European Radiology, 2019Co-Authors: Alexander Massmann, Roland Seidel, Günther Schneider, Arno Buecker, Peter FriesAbstract:Objectives To evaluate technical feasibility and safety of endovascular tumor specimen sampling using an escalating endovascular biopsy strategy using a Directional Atherectomy device compared with forceps biopsy and catheter aspiration.
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Percutaneous endovascular tissue sampling of endoluminal tumors using Directional Atherectomy.
European radiology, 2019Co-Authors: Alexander Massmann, Roland Seidel, Günther Schneider, Arno Buecker, Peter FriesAbstract:To evaluate technical feasibility and safety of endovascular tumor specimen sampling using an escalating endovascular biopsy strategy using a Directional Atherectomy device compared with forceps biopsy and catheter aspiration. Between 2013 and 2017, a cohort of ten consecutive patients (6 male; median age 56, range 39–73 years) was referred for sampling of endovascular masses. Localizations included the abdominal aorta (n = 4), left brachiocephalic vein (n = 2), inferior vena cava (n = 1), and left pulmonary artery (n = 3). For each individual mass, all three endovascular tissue sampling approaches were applied including catheter-based aspiration, straight two-jaw biopsy forceps, and Directional Atherectomy during a single session. Aspiration and forceps biopsy did not provide sufficient material for histological analyses. In contrast, technical success for endovascular tumor sampling using Directional Atherectomy was 100%. After two Atherectomy passages, sufficient material was available for each vessel region allowing histologic diagnosis, which revealed sarcoma and chronic inflammation for masses in the aorta, angiosarcoma for brachiocephalic vein, hepatocellular carcinoma for inferior vena cava, and angiosarcoma for pulmonary artery. In case of a histologically benign diagnosis, no malignant tumor proliferation was obvious on follow-up imaging studies after 3 months and 1 year. Thus, the rate of false-negative results was considered 0%. No procedure-associated complications, e.g., vessel perforation, were recorded. Preliminary results in a limited number of patients proved Directional Atherectomy beneficial as a safe and feasible technique for endoluminal tissue sampling of vascular masses. Additional large-scale studies are necessary and worthy for further evaluation in clinical practice. • Endovascular masses pose a challenge to appropriate clinical management. • Off-label Directional Atherectomy proved to be a safe and feasible technique for endoluminal tissue sampling of vascular masses. Furthermore, Directional Atherectomy was superior to aspiration or forceps biopsy in our small study cohort. • Directional Atherectomy may represent the last or only option for tissue probing as a prerequisite for further treatment decisions.
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Mechanical Recanalization of Subacute Vessel Occlusion in Peripheral Arterial Disease with a Directional Atherectomy Catheter
CardioVascular and Interventional Radiology, 2012Co-Authors: Alexander Massmann, Marcus Katoh, Roushanak Shayesteh-kheslat, Arno BueckerAbstract:Purpose To retrospectively examine the technical feasibility and safety of Directional Atherectomy for treatment of subacute infrainguinal arterial vessel occlusions. Methods Five patients (one woman, four men, age range 51–81 years) with peripheral arterial disease who experienced sudden worsening of their peripheral arterial disease–related symptoms during the last 2–6 weeks underwent digital subtraction angiography, which revealed vessel occlusion in native popliteal artery ( n = 4) and in-stent occlusion of the superficial femoral artery ( n = 1). Subsequently, all patients were treated by Atherectomy with the SilverHawk (ev3 Endovascular, USA) device. Results The mean diameter of treated vessels was 5.1 ± 1.0 mm. The length of the occlusion ranged 2–14 cm. The primary technical success rate was 100%. One patient experienced a reocclusion during hospitalization due to heparin-induced thrombocytopenia. There were no further periprocedural complications, in particular no peripheral embolizations, until hospital discharge or during the follow-up period of 1 year. Conclusion The recanalization of infrainguinal arterial vessel occlusions by Atherectomy with the SilverHawk device is technically feasible and safe. In our limited retrospective study, it was associated with a high technical success rate and a low procedure-related complication rate.
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Mechanical Recanalization of Subacute Vessel Occlusion in Peripheral Arterial Disease with a Directional Atherectomy Catheter
CardioVascular and Interventional Radiology, 2012Co-Authors: Alexander Massmann, Marcus Katoh, Roushanak Shayesteh-kheslat, Arno BueckerAbstract:To retrospectively examine the technical feasibility and safety of Directional Atherectomy for treatment of subacute infrainguinal arterial vessel occlusions. Five patients (one woman, four men, age range 51–81 years) with peripheral arterial disease who experienced sudden worsening of their peripheral arterial disease–related symptoms during the last 2–6 weeks underwent digital subtraction angiography, which revealed vessel occlusion in native popliteal artery (n = 4) and in-stent occlusion of the superficial femoral artery (n = 1). Subsequently, all patients were treated by Atherectomy with the SilverHawk (ev3 Endovascular, USA) device. The mean diameter of treated vessels was 5.1 ± 1.0 mm. The length of the occlusion ranged 2–14 cm. The primary technical success rate was 100%. One patient experienced a reocclusion during hospitalization due to heparin-induced thrombocytopenia. There were no further periprocedural complications, in particular no peripheral embolizations, until hospital discharge or during the follow-up period of 1 year. The recanalization of infrainguinal arterial vessel occlusions by Atherectomy with the SilverHawk device is technically feasible and safe. In our limited retrospective study, it was associated with a high technical success rate and a low procedure-related complication rate.
Peter Fries - One of the best experts on this subject based on the ideXlab platform.
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Percutaneous endovascular tissue sampling of endoluminal tumors using Directional Atherectomy
European Radiology, 2019Co-Authors: Alexander Massmann, Roland Seidel, Arno Buecker, Günther K. Schneider, Peter FriesAbstract:Objectives To evaluate technical feasibility and safety of endovascular tumor specimen sampling using an escalating endovascular biopsy strategy using a Directional Atherectomy device compared with forceps biopsy and catheter aspiration. Materials and methods Between 2013 and 2017, a cohort of ten consecutive patients (6 male; median age 56, range 39–73 years) was referred for sampling of endovascular masses. Localizations included the abdominal aorta ( n = 4), left brachiocephalic vein ( n = 2), inferior vena cava ( n = 1), and left pulmonary artery ( n = 3). For each individual mass, all three endovascular tissue sampling approaches were applied including catheter-based aspiration, straight two-jaw biopsy forceps, and Directional Atherectomy during a single session. Results Aspiration and forceps biopsy did not provide sufficient material for histological analyses. In contrast, technical success for endovascular tumor sampling using Directional Atherectomy was 100%. After two Atherectomy passages, sufficient material was available for each vessel region allowing histologic diagnosis, which revealed sarcoma and chronic inflammation for masses in the aorta, angiosarcoma for brachiocephalic vein, hepatocellular carcinoma for inferior vena cava, and angiosarcoma for pulmonary artery. In case of a histologically benign diagnosis, no malignant tumor proliferation was obvious on follow-up imaging studies after 3 months and 1 year. Thus, the rate of false-negative results was considered 0%. No procedure-associated complications, e.g., vessel perforation, were recorded. Conclusion Preliminary results in a limited number of patients proved Directional Atherectomy beneficial as a safe and feasible technique for endoluminal tissue sampling of vascular masses. Additional large-scale studies are necessary and worthy for further evaluation in clinical practice. Key Points • Endovascular masses pose a challenge to appropriate clinical management. • Off-label Directional Atherectomy proved to be a safe and feasible technique for endoluminal tissue sampling of vascular masses. Furthermore, Directional Atherectomy was superior to aspiration or forceps biopsy in our small study cohort. • Directional Atherectomy may represent the last or only option for tissue probing as a prerequisite for further treatment decisions.
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Percutaneous endovascular tissue sampling of endoluminal tumors using Directional Atherectomy
European Radiology, 2019Co-Authors: Alexander Massmann, Roland Seidel, Günther Schneider, Arno Buecker, Peter FriesAbstract:Objectives To evaluate technical feasibility and safety of endovascular tumor specimen sampling using an escalating endovascular biopsy strategy using a Directional Atherectomy device compared with forceps biopsy and catheter aspiration.
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Percutaneous endovascular tissue sampling of endoluminal tumors using Directional Atherectomy.
European radiology, 2019Co-Authors: Alexander Massmann, Roland Seidel, Günther Schneider, Arno Buecker, Peter FriesAbstract:To evaluate technical feasibility and safety of endovascular tumor specimen sampling using an escalating endovascular biopsy strategy using a Directional Atherectomy device compared with forceps biopsy and catheter aspiration. Between 2013 and 2017, a cohort of ten consecutive patients (6 male; median age 56, range 39–73 years) was referred for sampling of endovascular masses. Localizations included the abdominal aorta (n = 4), left brachiocephalic vein (n = 2), inferior vena cava (n = 1), and left pulmonary artery (n = 3). For each individual mass, all three endovascular tissue sampling approaches were applied including catheter-based aspiration, straight two-jaw biopsy forceps, and Directional Atherectomy during a single session. Aspiration and forceps biopsy did not provide sufficient material for histological analyses. In contrast, technical success for endovascular tumor sampling using Directional Atherectomy was 100%. After two Atherectomy passages, sufficient material was available for each vessel region allowing histologic diagnosis, which revealed sarcoma and chronic inflammation for masses in the aorta, angiosarcoma for brachiocephalic vein, hepatocellular carcinoma for inferior vena cava, and angiosarcoma for pulmonary artery. In case of a histologically benign diagnosis, no malignant tumor proliferation was obvious on follow-up imaging studies after 3 months and 1 year. Thus, the rate of false-negative results was considered 0%. No procedure-associated complications, e.g., vessel perforation, were recorded. Preliminary results in a limited number of patients proved Directional Atherectomy beneficial as a safe and feasible technique for endoluminal tissue sampling of vascular masses. Additional large-scale studies are necessary and worthy for further evaluation in clinical practice. • Endovascular masses pose a challenge to appropriate clinical management. • Off-label Directional Atherectomy proved to be a safe and feasible technique for endoluminal tissue sampling of vascular masses. Furthermore, Directional Atherectomy was superior to aspiration or forceps biopsy in our small study cohort. • Directional Atherectomy may represent the last or only option for tissue probing as a prerequisite for further treatment decisions.
Donald S Baim - One of the best experts on this subject based on the ideXlab platform.
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Effect of prior coronary restenosis on the risk of subsequent restenosis after stent placement or Directional Atherectomy
The American journal of cardiology, 1994Co-Authors: Mauro Moscucci, Richard E Kuntz, Joseph P. Carrozza, Robert N. Piana, Aaron D. Kugelmass, Cynthia Senerchia, Donald S BaimAbstract:Abstract Lesions that have developed restenosis after a prior intervention may be more likely to develop restenosis after subsequent percutaneous interventions. To determine if this is an independent effect, the clinical characteristics and immediate angiographic outcomes of 179 prior restenosis lesions were compared with those of 254 primary lesions after stenting or Directional Atherectomy. Six-month angiographic follow-up was obtained for 79% of successfully treated lesions. Univariable and muttivariable logistic regression was used to determine how binary restenosis (defined as $ -50% diameter stenosis at follow-up) was influenced by postprocedure luminal diameter, left anterior descending artery location, diabetes mellitus, as well as prior restenosis. At 6-month follow-up, prior restenosis lesions had a significantly smaller late diameter (1.77 vs 2.18 mm, p
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lesion to lesion independence of restenosis after treatment by conventional angioplasty stenting or Directional Atherectomy validation of lesion based restenosis analysis
Circulation, 1993Co-Authors: Charles Michael Gibson, Richard E Kuntz, Masakiyo Nobuyoshi, Bernard Rosner, Donald S BaimAbstract:BACKGROUND Since many restenosis trials include patients in whom more than one lesion is treated, analysis of the angiographic data on a "per lesion" basis might be confounded by potential correlations of restenosis among multiple treated lesions within each patient. The goals of this study were: 1) to determine whether there was any correlation in the rate of restenosis among multiple lesions that underwent conventional angioplasty, stenting, or Directional Atherectomy within the same patient and 2) to determine whether lesions treated in a multilesion intervention experience a different magnitude of restenosis than lesions undergoing single-lesion procedures. METHODS AND RESULTS Of 441 patients treated by Palmaz-Schatz stenting (n = 114), Directional Atherectomy (n = 100), or conventional balloon angioplasty (n = 227), 67 underwent multilesion procedures involving treatment of 146 lesions. A general linear model with intraclass correlation (GLIMIC) was used to calculate the coefficient of correlation (rho) of the change in the measured minimum luminal diameter (late loss) from the time of the initial procedure to 6-month angiogram among the multiple lesions within the same patient for all 441 patients. This showed no correlation among multiple lesions within the same patient for the late loss in minimum luminal diameter (rho = -0.12 [95% CI: -0.40, 0.12]), among lesions in the same vessel (rho = 0.14 [95% CI: -0.34, 0.62]), or among different vessels (rho = -0.18 [95% CI: -0.52, 0.16]), suggesting that the magnitude of late loss is independent among multiple lesions within the same patient. There was no difference (p = 0.96) between the observed incidence of zero-, one-, and two-vessel restenosis (> or = 50% diameter stenosis at follow-up) for patients with multiple-lesion treatment and that predicted assuming lesion-to-lesion independence. Similarly, there was no difference in late loss or in the overall binary restenosis rate when single-lesion procedures were compared with multilesion procedures. Multivariable analysis of the late loss in lumen diameter (which adjusted for the effects of the acute result and the device used) demonstrated no independent effect (p = 0.20) of single-lesion versus multilesion status. CONCLUSIONS Luminal encroachment appears to occur at independent rates among multiple lesions treated in a single patient. The observed incidence of restenosis for patients with multiple treated lesions is accurately predicted assuming independent probabilities of restenosis. Lesion-based analysis, even when including multiple treated lesions within the same patient, is thus valid for evaluating conventional angioplasty, stenting, or Directional Atherectomy.
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generalized model of restenosis after conventional balloon angioplasty stenting and Directional Atherectomy
Journal of the American College of Cardiology, 1993Co-Authors: Richard E Kuntz, Michael C Gibson, Masakiyo Nobuyoshi, Donald S BaimAbstract:Objectives. This study was designed to extend the results of a quantitative model originally developed for restenosis after stenting or Atherectomy to include restenosis after conventional balloon angioplasty. Background. We have previously described a continuous regression model that explains late (6-month) lumen narrowing as the difference between the immediate gain and the subsequent normally distributed late loss in lumen diameter after Palmaz-Schatz stenting or Directional Atherectomy. Methods. Lumen diameter was measured immediately before and after coronary intervention on 524 consecutive lesions including those treated by Palmaz-Schatz stenting (102), Directional Atherectomy (134) and conventional balloon angioplasty (288). Of these lesions, 475 (91%) underwent follow-up angiography 3 to 6 months after treatment. The immediate increase in lumen diameter produced by the intervention (immediate gain) and the subsequent reduction in lumen diameter between the time of Intervention to follow-up angiography (late loss) were examined. Association between demographic or angiographic variables and continuous measures of restenosis (late lumen diameter or late percent stenosis) was tested with linear regression techniques; a traditional binary measure of restenosis (late diameter stenosis ≥50%) was evaluated with logistic regression analysis. Results. Regression models relating late lumen diameter to the immediate lumen result were successfully fitted to all segisests studied. According to these models, three indexes of restenosis (late lumen diameter, late percent stenosis and binary restenosis) were found to depend solely on the immediate humen diameter after the procedure and the immediate residual percent stenosis, but noton the specific intervention used. Moreover, the late loss in lumen diameter was round to vary directly with the immedite gain provided by an intervention, and the “loss mdsx” (a measure that corrects for differences in immediate gain) was uniform among all) three intaterventions. Conclusions. The quantitative model originally developed for restenosis after stenting or athererectomy may thus be generalized to include conventional balloon anagioplasty. It shows that the apparent differences in restenosis among the three intervreations studied are due solely to differences in the immediate result provided and notto differences in the behavior ef subsequent late loss. Moreover, although the late loss in lumen diameter was found to correlate with differences in the immediate gain provided by an intervention, the “loss index” (a measure that corrects for differences in acute gain) was uniform across all three interventions. It is thus the immediate result (and not the procedure used to obtain that result) that determines late outcome after coronary intervention.
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Lesion-to-lesion independence of restenosis after treatment by conventional angioplasty, stenting, or Directional Atherectomy. Validation of lesion-based restenosis analysis.
Circulation, 1993Co-Authors: Charles Michael Gibson, Richard E Kuntz, Masakiyo Nobuyoshi, Bernard Rosner, Donald S BaimAbstract:BACKGROUNDSince many restenosis trials include patients in whom more than one lesion is treated, analysis of the angiographic data on a "per lesion" basis might be confounded by potential correlations of restenosis among multiple treated lesions within each patient. The goals of this study were: 1) to determine whether there was any correlation in the rate of restenosis among multiple lesions that underwent conventional angioplasty, stenting, or Directional Atherectomy within the same patient and 2) to determine whether lesions treated in a multilesion intervention experience a different magnitude of restenosis than lesions undergoing single-lesion procedures.METHODS AND RESULTSOf 441 patients treated by Palmaz-Schatz stenting (n = 114), Directional Atherectomy (n = 100), or conventional balloon angioplasty (n = 227), 67 underwent multilesion procedures involving treatment of 146 lesions. A general linear model with intraclass correlation (GLIMIC) was used to calculate the coefficient of correlation (rho)...
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Acute and long-term outcome of narrowed saphenous venous grafts treated by endoluminal stenting and Directional Atherectomy
The American journal of cardiology, 1992Co-Authors: Richard M. Pomerantz, Richard E Kuntz, Joseph P. Carrozza, Robert F. Fishman, Michael K. Mansour, Stuart J. Schnitt, Robert D. Safian, Donald S BaimAbstract:Abstract Angioplasty of the narrowed saphenous vein bypass grafts remains a difficult challenge. Over a 37-month period at this institution, 119 of 176 interventions (68%) on saphenous vein grafts (average age 8.3 years from bypass surgery to graft intervention) were performed using either Directional coronary Atherectomy (n = 35) or Palmaz-Schatz intracoronary stents (n = 84), representing 37% of all stents and 15% of all atherectomies during the study period, respectively. Of the 57 saphenous vein graft lesions treated with conventional balloon angioplasty during this period, 49 (86%) had 1 or more contraindications to stenting or Directional Atherectomy (thrombus, total occlusion, reference vessel The acute success rate was 99% for stents (1 failure to dilate) and 94% for Directional Atherectomy (2 failures to cross the lesion with the Atherectomy device). Lumen diameter increased from 0.9 to 3.6 mm (reference vessel 3.6) for stents, and from 0.9 to 3.5 mm (reference 3.8) for Atherectomy (for all comparisons, p = not significant), with no major complications (abrupt or subabrupt closure, emergent coronary bypass surgery, death, or Q-wave myocardial infarctions). During the same time period 50 of 57 vein grafts (88%) rejected for stenting or Atherectomy were dilated successfully by conventional balloon angioplasty, with 3 patients (5%) requiring emergent coronary bypass surgery. Angiographic follow-up was available for 50 of 64 eligible patients (78%). Restenosis (defined as ≥50% stenosis at 6-month angiographic follow-up) was present in 13 of 50 lesions (26%, [95% confidence interval: 14%, 38%]), including 8 of 32 stented lesions (25%) and 5 of 18 Atherectomy lesions (28%) (p = not significant). These data suggest that saphenous vein bypass graft stenoses may be treated safely and effectively using Palmaz-Schatz stenting or Directional Atherectomy, with short- and long-term results that may be better than those traditionally expected with conventional balloon angioplasty.
Robert D. Safian - One of the best experts on this subject based on the ideXlab platform.
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influence of vessel selection on the observed restenosis rate after endoluminal stenting or Directional Atherectomy
American Journal of Cardiology, 1992Co-Authors: Richard E Kuntz, Robert D. Safian, Tomoaki Hinohara, Gregory C RobertsonAbstract:In comparing the restenosis rates among different interventions, 1 potential confounder might be the differences in the vessels treated, as dictated by the technical limitations of particular devices. The purpose of this study was to use current "acute gain-late loss" analysis to examine what influence vessel selection has on the restenosis rates seen after coronary stenting or Directional Atherectomy. The minimal luminal diameter of native coronary lesions was measured before and immediately after intervention in 102 single Palmaz-Schatz stents and 347 atherectomies, 367 (82%) of which had repeat angiographic measurement 6 months after intervention. Atherectomy-treated lesions had a higher proportion of left anterior descending to right coronary arteries (68 vs 24%) compared with stents (31 vs 54%), p 50% diameter stenosis) and continuous (late percent stenosis) definitions.(ABSTRACT TRUNCATED AT 250 WORDS)
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Acute and long-term outcome of narrowed saphenous venous grafts treated by endoluminal stenting and Directional Atherectomy
The American journal of cardiology, 1992Co-Authors: Richard M. Pomerantz, Richard E Kuntz, Joseph P. Carrozza, Robert F. Fishman, Michael K. Mansour, Stuart J. Schnitt, Robert D. Safian, Donald S BaimAbstract:Abstract Angioplasty of the narrowed saphenous vein bypass grafts remains a difficult challenge. Over a 37-month period at this institution, 119 of 176 interventions (68%) on saphenous vein grafts (average age 8.3 years from bypass surgery to graft intervention) were performed using either Directional coronary Atherectomy (n = 35) or Palmaz-Schatz intracoronary stents (n = 84), representing 37% of all stents and 15% of all atherectomies during the study period, respectively. Of the 57 saphenous vein graft lesions treated with conventional balloon angioplasty during this period, 49 (86%) had 1 or more contraindications to stenting or Directional Atherectomy (thrombus, total occlusion, reference vessel The acute success rate was 99% for stents (1 failure to dilate) and 94% for Directional Atherectomy (2 failures to cross the lesion with the Atherectomy device). Lumen diameter increased from 0.9 to 3.6 mm (reference vessel 3.6) for stents, and from 0.9 to 3.5 mm (reference 3.8) for Atherectomy (for all comparisons, p = not significant), with no major complications (abrupt or subabrupt closure, emergent coronary bypass surgery, death, or Q-wave myocardial infarctions). During the same time period 50 of 57 vein grafts (88%) rejected for stenting or Atherectomy were dilated successfully by conventional balloon angioplasty, with 3 patients (5%) requiring emergent coronary bypass surgery. Angiographic follow-up was available for 50 of 64 eligible patients (78%). Restenosis (defined as ≥50% stenosis at 6-month angiographic follow-up) was present in 13 of 50 lesions (26%, [95% confidence interval: 14%, 38%]), including 8 of 32 stented lesions (25%) and 5 of 18 Atherectomy lesions (28%) (p = not significant). These data suggest that saphenous vein bypass graft stenoses may be treated safely and effectively using Palmaz-Schatz stenting or Directional Atherectomy, with short- and long-term results that may be better than those traditionally expected with conventional balloon angioplasty.