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Vascular Disease Management - ISSN: 1553-8036 - Volume 4 - Issue 3 - May 2007 | |
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| 1Mohan Nandalur, MD 2Bruce Abramowitz, MD, 2Surendra Avula, MD, 2Nausheen Akhter, MD |
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| Abdolreza Agahtehrani, MD and Issam D. Moussa, MD |
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Image Guidance of Percutaneous Coronary and Structural Heart Disease Interventions Using a Computed Tomography and Fluoroscopy Integration
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| 1Joel A. Garcia, MD, 1Marvin H. Eng, MD, 2Onno Wink, PhD, 1S.Y. James Chen, PhD, 1Adam Hansgen, BS, 1John D. Carroll, MD |
Standard angiography (SA) of the coronary vasculature and heart structures is limited by its two-dimensional (2-D) projection of complex three-dimensional (3-D) structures. The use of angiography and fluoroscopy results in imaging artifacts and procedural limitations that makes some interventions difficult. The introduction of 3-D imaging technologies paves the way to a more precise and thorough evaluation of complex structures. Computerized tomographic angiography (CTA) and X-ray based innovative 3-D reconstruction fusion software are major advances in cardiovascular imaging. These imaging techniques provide a 3-D vessel representation and enable the subsequent analysis of 3-D properties with important clinical implications. This review will focus on novel X-ray/CT image fusion techniques that allow for guidance of percutaneous coronary and structural heart disease interventions off- and online.
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The Role of Embolic Protection Devices in Renal Angioplasty and Stenting |
| 1,2Michel Henry, MD, 3Isabelle Henry, MD, 4Christos Klonaris, MD, 5Antonio Polydorou, MD, 6Amanda Polydorou, MD, 1,2Michele Hugel, MD |
Purpose. A renal artery stenosis is frequent and usually caused by atherosclerosis. Renal artery angioplasty and stenting (RAAS) is now the first treatment to be proposed, giving good immediate and long-term results. But one concern is the postprocedural deterioration of the renal function, which may occur in 20–40% of the patients, and therefore limits the immediate benefits of the technique. Atheroembolism seems to play an important role. We postulated that the use of renal embolic protection devices could reduce the risk of renal embolism and avoid deterioration of the renal function. Methods. In 105 hypertensive patients (M:72), mean age: 65.4 ± 11.7 years (22–87) with atherosclerotic renal artery stenosis (18 bilateral), 124 RAAS were performed under protection. Nine patients had solitary kidneys and 38 had renal insufficiency. We used occlusion balloons (n = 46) or filters (n = 78), which allow a continuous flow. We recently experimented with a new filter (FiberNet<
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The Role of Embolic Protection Devices in Renal Angioplasty and Stenting Cont. |
| 1,2Michel Henry, MD, 3Isabelle Henry, MD, 4Christos Klonaris, MD, 5Antonio Polydorou, MD, 6Amanda Polydorou, MD, 1,2Michele Hugel, MD |
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| 1Michael Schlüter, MD, 2John Cosgrave, MD, 1Thilo Tübler, MD, 2Gloria Melzi, MD, 2Antonio Colombo, MD, 1Joachim Schofer, MD |
Objectives. Our goal was to assess the mid-term clinical and angiographic efficacy of rotational atherectomy preceding sirolimus-eluting stent (SES) implantation.
Background. Nondilatable calcified coronary lesions have been excluded from all clinical trials involving the SES. The clinical and angiographic efficacy of rotational atherectomy to enable SES implantation is not known. Methods. We performed rotational atherectomy to enable SES implantation in 44 consecutive patients (34 men; mean [± 1 SD] age 67 ± 9 years). They presented with a total of 47 nondilatable lesions (mean length 22.7 ± 13.7 mm). Results. Rotational atherectomy enabled SES implantation in all cases. The cumulative incidences of target lesion revascularizations and major adverse cardiac events at 7.7 ± 3.0 months were 9.1% (4 patients; 95% confidence interval [CI], 2.5–21.7%) and 11.4% (5 patients; 95% CI, 3.8–24.6%), respectively. Angiographic follow-up obtained from 29 patients (31 l
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