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Antonio Colombo - One of the best experts on this subject based on the ideXlab platform.
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a randomized multicenter study comparing a paclitaxel drug eluting balloon with a paclitaxel eluting stent in small coronary vessels the bello balloon elution and late loss optimization study
Journal of the American College of Cardiology, 2012Co-Authors: Azeem Latib, Antonio Colombo, Patrizia Presbitero, Alberto Cremonesi, Fausto Castriota, Antonio Micari, Francesco De Felice, Alfredo Marchese, Maurizio Tespili, Gregory A SguegliaAbstract:Objectives The aim of this study was to evaluate the efficacy of drug-eluting balloons (DEB) compared with paclitaxel-eluting stents (PES) for the reduction of restenosis in small vessels. Background DEB have been shown to be effective in the treatment of coronary in-stent restenosis, but data are limited regarding their efficacy in de novo disease. Methods BELLO (Balloon Elution and Late Loss Optimization) is a prospective, multicenter trial that randomized 182 patients with lesions located in small vessels (Reference Diameter Results Baseline characteristics were well matched, except for a smaller vessel size in the DEB group (2.15 ± 0.27 mm vs. 2.25 ± 0.24 mm; p = 0.003). The majority (89%) of lesions involved vessels with a Diameter Conclusions Treatment of small-vessel disease with a paclitaxel DEB was associated with less angiographic late loss and similar rates of restenosis and revascularization as a PES. (Balloon Elution and Late Loss Optimization [BELLO]; Study NCT01086579 )
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Provisional stenting in small vessels
International Journal of Cardiovascular Interventions, 2009Co-Authors: Flavio Airoldi, Carlo Di Mario, Remo Albiero, Takuro Takagi, Goran Stankovic, Antonio ColomboAbstract:Based on the currently available data, the strategy of routine stent placement in unselected lesions located in small coronary arteries provides good immediate results but is still associated with a high incidence of in-stent restenosis. Randomized trials comparing elective stenting with balloon angioplasty have not provided the demonstration that routine stenting is the best strategy for percutaneous intervention in coronary arteries with a Reference Diameter smaller than 2.75-3.0 mm. This paper describes the rationale for provisional stenting in this clinical setting and reviews the role of quantitative coronary angiography, intracoronary ultrasound and intracoronary Doppler measurements in the identification of lesions that would benefit from adjunctive stent placement after balloon angioplasty and in guiding stent implantation.
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Discrepancy between angiography and intravascular ultrasound when analysing small coronary arteries
European Heart Journal, 2002Co-Authors: C. Briguori, Jonathan M. Tobis, T. Nishida, Marco Vaghetti, Remo Albiero, C. Di Mario, Antonio ColomboAbstract:Aims A small Reference Diameter may be the consequence of high plaque burden and diffuse disease. The Reference vessel Diameter in small coronary arteries may vary according to the method of measurement used. We endeavoured to confirm the difference between data from examinations conducted using angiography with that revealed by intravascular ultrasound. Methods and Results Between March 1993 and October 1999, 344 consecutive patients with 419 lesions in small vessels (2·75 mm, Small group) and 953 patients with 1161 lesions in large vessels (Large group) underwent intravascular ultrasound-guided percutaneous transluminal angioplasty in our Institution. The mean difference between the intravascular ultrasound and the angiographic Reference Diameter (IVUS-Angio) was 1·30·5 mm in the Small group and 1·00·6 mm in the Large group (P
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New approach to quantitative angiographic assessment after stent implantation.
Catheterization and Cardiovascular Diagnosis, 1997Co-Authors: Bernhard Reimers, Johan H. C. Reiber, Carlo Di Mario, Lucia Di Francesco, Issam Moussa, Simonetta Blengino, Giovanni Martini, Antonio ColomboAbstract:The new generation quantitative angiographic systems apply the interpolated technique to calculate the Reference Diameter at the site of the stenosis by integrating measurements of the segments proximal and distal to the stenosis. After stent implantation these measurements can be misleading as the treated segment, which is frequently larger than the adjacent not stented segments, is included in the measurements. The consequence is an overestimation of the Reference Diameter and the residual Diameter stenosis. The present study was performed to compare this conventional technique of measurement with a new method which excludes the stented segment for the calculation of the Reference Diameter. Fifty-two lesions treated with poorly radiopaque stents (56% Palmaz-Schatz, 28% NIR, 10% Gianturco-Roubin, 6% Wallstent) expanded at high pressure (> = or 16 atm) were analyzed according to the conventional and stent excluded method. After stent implantation the Reference Diameter was 3.39 +/- 0.48 mm with conventional measurements and 3.02 +/- 0.45 mm with the stent excluded method (P < 0.05). The corresponding % Diameter stenosis was 13 +/- 9 for the conventional technique and 1 +/- 13 for the stent excluded analysis (P < 0.05). The new approach to quantitative coronary analysis after stenting provides higher accuracy in Reference Diameter calculations and allows a more appropriate matching of stented segments with adjacent normal segments.
Raul Moreno - One of the best experts on this subject based on the ideXlab platform.
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randomized comparison of sirolimus eluting stent versus standard stent for percutaneous coronary revascularization in diabetic patients the diabetes and sirolimus eluting stent diabetes trial
Circulation, 2005Co-Authors: Manel Sabaté, Javier Goicolea, Pilar Jimenezquevedo, Dominick J Angiolillo, Joan Antoni Gomezhospital, Fernando Alfonso, Rosana Hernandezantolin, Camino Banuelos, Javier Escaned, Raul MorenoAbstract:Background— Outcomes after percutaneous coronary interventions in diabetic patients are shadowed by the increased rate of recurrence compared with nondiabetic patients. Methods and Results— We conducted a multicenter, randomized trial to demonstrate the efficacy of sirolimus-eluting stents compared with standard stents to prevent restenosis in diabetic patients with de novo lesions in native coronary arteries. The primary end point of the trial was in-segment late lumen loss as assessed by quantitative coronary angiography at 9-month follow-up. The trial was stratified by diabetes treatment status. One hundred sixty patients were randomized to sirolimus-eluting stents (80 patients; 111 lesions) or standard stent implantation (80 patients; 110 lesions). On average, Reference Diameter was 2.34±0.6 mm, lesion length was 15.0±8 mm, and 13.1% of lesions were chronic total occlusions. In-segment late lumen loss was reduced from 0.47±0.5 mm for standard stents to 0.06±0.4 mm for sirolimus stents (P<0.001). Targe...
Manel Sabaté - One of the best experts on this subject based on the ideXlab platform.
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Fractional Flow Reserve in Diabetics: Does It Have an Expiry Date?
Revista Espanola De Cardiologia, 2008Co-Authors: Manel SabatéAbstract:Assessing the clinical importance of intermediate coronary stenosis, defined as a luminal obstruction of 40% to 70%, is a challenge for the interventional cardiologist. Coronary angiography correlates poorly with the functional importance of epicardial coronary disease, especially in patients with stenosis at the threshold of significance. Post-mortem studies have demonstrated that the coronary lumen area only decreases when atherosclerotic plaque values are above 40%. This event is due to the vessel undergoing positive remodeling during the atherosclerotic process. 1 Another potential source of error lies in the actual methodology used in calculating the severity of coronary stenosis. Thus, the percentage of stenosis is normally calculated as the ratio between the minimum luminal Diameter at the site of obstruction and a Reference Diameter considered “normal,” that is, without disease. 2 Obviously, in the case of diffuse disease, it is very difficult to establish a disease-free Reference Diameter, which can lead to underestimating the degree of coronary obstruction. Other sources of error are stenosis in tortuous arteries, in bifurcations, with overlapping branches, or highly focal “diaphragm-like” stenosis. This is compounded by the not inconsiderable degree of variation between observers in the qualitative calculation of the degree of obstruction. The calculation of the fractional flow reserve (FFR) has helped to resolve many of these limitations. The FFR is defined as the ratio between the peak coronary flow in the stenotic artery and the peak coronary flow in the same vessel in the theoretical absence of obstruction. 3,4 This should be calculated during maximum arteriolar vasodilation, which establishes the minimum myocardial resistance in the area under study. This is usually achieved by the
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randomized comparison of sirolimus eluting stent versus standard stent for percutaneous coronary revascularization in diabetic patients the diabetes and sirolimus eluting stent diabetes trial
Circulation, 2005Co-Authors: Manel Sabaté, Javier Goicolea, Pilar Jimenezquevedo, Dominick J Angiolillo, Joan Antoni Gomezhospital, Fernando Alfonso, Rosana Hernandezantolin, Camino Banuelos, Javier Escaned, Raul MorenoAbstract:Background— Outcomes after percutaneous coronary interventions in diabetic patients are shadowed by the increased rate of recurrence compared with nondiabetic patients. Methods and Results— We conducted a multicenter, randomized trial to demonstrate the efficacy of sirolimus-eluting stents compared with standard stents to prevent restenosis in diabetic patients with de novo lesions in native coronary arteries. The primary end point of the trial was in-segment late lumen loss as assessed by quantitative coronary angiography at 9-month follow-up. The trial was stratified by diabetes treatment status. One hundred sixty patients were randomized to sirolimus-eluting stents (80 patients; 111 lesions) or standard stent implantation (80 patients; 110 lesions). On average, Reference Diameter was 2.34±0.6 mm, lesion length was 15.0±8 mm, and 13.1% of lesions were chronic total occlusions. In-segment late lumen loss was reduced from 0.47±0.5 mm for standard stents to 0.06±0.4 mm for sirolimus stents (P<0.001). Targe...
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The ESSEX (European Scimed Stent Experience) study
Catheterization and Cardiovascular Interventions, 2000Co-Authors: I. Patrick Kay, Manel Sabaté, Glenn Van Langenhove, Guy R. Heyndrickx, Gilles Grollier, Harry Suyrapranata, Jan C.a. Hoorntje, Wim J. Van Der Giessen, Marie-angèle Morel, Clemens DiscoAbstract:The aim of the study was to assess the safety and feasibility of implantation of the Scimed Radius stent. Secondary objectives were to assess the result of stent placement by quantitative coronary angiography (QCA) and intravascular ultrasound (IVUS). The ESSEX study was a prospective, multicenter, observational study in which candidates for a single elective stent implantation, in a de novo or restenotic lesion, Reference Diameter 2.75-4.00 mm and target lesion 12 atm) as a determinant of clinical, QCA, and IVUS outcomes suggested no benefit or detrimental effect from optimization with high-pressure balloon inflation. Implantation of the self-expanding Radius stent is safe and efficacious. Based on registry data, clinical, angiographic, and IVUS, data comparable with modern balloon-expandable stents were obtained.
Akira Yamashina - One of the best experts on this subject based on the ideXlab platform.
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Assessment of optimum stent deployment by stent boost imaging: comparison with intravascular ultrasound
Heart and Vessels, 2013Co-Authors: Nobuhiro Tanaka, Jacques J. Koolen, Nico H. J. Pijls, Kees-joost Botman, Herman R. Michels, Bart R. G. Brueren, Kathinka Peels, Naohisa Shindo, Jun Yamashita, Akira YamashinaAbstract:Stent boost (SB) imaging is an enhancement of the radiologic edge of the stent by digital management of regular X-ray images. The purpose of the present study was to validate SB imaging by comparison with the anatomical standard using intravascular ultrasound (IVUS). We investigated SB and IVUS after stent implantation in 68 arteries in 60 patients. Based on those findings, we added high-pressure dilatation in four patients and another stent implantation in four patients. We defined the SB criteria for adequate stent deployment as: complete stent expansion, stent minimum Diameter ≥70% of Reference Diameter, and stent minimum Diameter ≥2.0 mm; and IVUS criteria for adequate stent deployment as: minimal stent area ≥5.0 mm^2. If the Reference vessel was
Gregory A Sgueglia - One of the best experts on this subject based on the ideXlab platform.
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a randomized multicenter study comparing a paclitaxel drug eluting balloon with a paclitaxel eluting stent in small coronary vessels the bello balloon elution and late loss optimization study
Journal of the American College of Cardiology, 2012Co-Authors: Azeem Latib, Antonio Colombo, Patrizia Presbitero, Alberto Cremonesi, Fausto Castriota, Antonio Micari, Francesco De Felice, Alfredo Marchese, Maurizio Tespili, Gregory A SguegliaAbstract:Objectives The aim of this study was to evaluate the efficacy of drug-eluting balloons (DEB) compared with paclitaxel-eluting stents (PES) for the reduction of restenosis in small vessels. Background DEB have been shown to be effective in the treatment of coronary in-stent restenosis, but data are limited regarding their efficacy in de novo disease. Methods BELLO (Balloon Elution and Late Loss Optimization) is a prospective, multicenter trial that randomized 182 patients with lesions located in small vessels (Reference Diameter Results Baseline characteristics were well matched, except for a smaller vessel size in the DEB group (2.15 ± 0.27 mm vs. 2.25 ± 0.24 mm; p = 0.003). The majority (89%) of lesions involved vessels with a Diameter Conclusions Treatment of small-vessel disease with a paclitaxel DEB was associated with less angiographic late loss and similar rates of restenosis and revascularization as a PES. (Balloon Elution and Late Loss Optimization [BELLO]; Study NCT01086579 )