Interventional Cardiology Department Research Articles

A large-scale multicentre study in Belgium of dose area product values and effective doses in interventional cardiology using contemporary X-ray equipment

In this paper, a large-scale multicentre patient dose study performed in eight Belgian interventional cardiology departments is presented. Effective dose (E) was calculated based on a detailed dose-area product (DAP)-registration during each procedure and by using conversion coefficients generated by the Monte Carlo-based computer program PCXMC. Conversion coefficients were found to be 0.177 mSv Gycm(-2) for systems that do not use any additional copper filtration in cineradiography and 0.207 mSv Gycm(-2) for systems that use additional copper filtration in cineradiography. Mean E values of 9.6 and 15.3 mSv for diagnostic and therapeutic procedures, respectively, were obtained. DAP distributions were investigated in order to derive dose reference levels: 71 and 106 Gycm2 for diagnostic and therapeutic procedures, respectively, are proposed. Significant differences were observed in DAP distributions taking into account whether additional copper filtration was used in the cineradiography mode. Apart from the skin, the organs most at risk are lungs and heart. The probability of fatal cancer for the studied population amounted to 1.1x10(-4) and 2.1x10(-4) for diagnostic and therapeutic procedures, respectively, for the age distribution of the patients considered in this multicentre study.

The SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery (SYNTAX) study: Design, rationale, and run-in phase

Changes in the treatment of coronary artery disease both surgically and percutaneously have rendered the major randomized trials historical. Furthermore, the restrictive criteria of previous trials excluded most patients treated in daily practice. Although coronary surgery is still considered the current, evidence-based, gold-standard treatment of left main (LM) and 3-vessel coronary disease, the added benefit of drug-eluting stents has further expanded the use of percutaneous coronary intervention (PCI) beyond less complex populations in daily practice. The 1500-patient, prospective, multicenter, multinational (European and North American), randomized SYNTAX study with nested registries will enroll "all-comers." Consecutive patients with de novo 3-vessel disease (3VD) and/or LM disease will be screened for eligibility by the Heart Team (composed of an interventionalist, a cardiac surgeon, and the study coordinator) at each site and then allocated to either (1) the randomized cohort, if comparable revascularization can be achieved by either PCI or coronary artery bypass surgery (CABG), or (2) to one of the nested registries for CABG-ineligible patients (PCI registry) or for PCI-ineligible patients (CABG registry). Randomized patients will be stratified based on LM disease and diabetes by site. The primary end point for the randomized comparison is noninferiority of major adverse cardiac and cerebral events between the 2 groups at 1 year. To adequately project the expected enrollment rate per site, a run-in phase was mandated for each site interested in participating in the trial. Both cardiothoracic and interventional cardiology departments within the same institution were asked to complete a questionnaire regarding their frequency of treatment of LM and 3VD over a retrospective 3-month period. By replacing most traditional inclusion and exclusion criteria with the real-world decision between the cardiothoracic surgeon and the interventionalist, this study will define the roles of CABG and PCI using drug-eluting stents in the contemporary management of LM and 3VD. Results of the run-in phase were used by the steering committee to determine eligibility and to project enrollment for each site.

Implementation of Guidelines Improves the Standard of Care

The purpose of this study was to determine whether implementation of recent guidelines improves in-hospital mortality from acute ST-elevation myocardial infarction (STEMI) in a metropolitan area. We organized a network that consisted of the Viennese Ambulance Systems, which is responsible for diagnosis and triage of patients with acute STEMI, and 5 high-volume interventional cardiology departments to expand the performance of primary percutaneous catheter intervention (PPCI) and to use the fastest available reperfusion strategy in STEMI of short duration (2 to 3 hours from onset of symptoms), either PPCI or thrombolytic therapy (TT; prehospital or in-hospital), respectively. Implementation of guidelines resulted in increased numbers of patients receiving 1 of the 2 reperfusion strategies (from 66% to 86.6%). Accordingly, the proportion of patients not receiving reperfusion therapy dropped from 34% to 13.4%, respectively. PPCI usage increased from 16% to almost 60%, whereas the use of TT decreased from 50.5% to 26.7% in the participating centers. As a consequence, in-hospital mortality decreased from 16% before establishment of the network to 9.5%, including patients not receiving reperfusion therapy. Whereas PPCI and TT demonstrated comparable in-hospital mortality rates when initiated within 2 to 3 hours from onset of symptoms, PPCI was more effective in acute STEMI of >3 but <12 hours' duration. Implementation of recent guidelines for the treatment of acute STEMI by the organization of a cooperating network within a large metropolitan area was associated with a significant improvement in clinical outcomes.

Comparison of a CCD and a flat-panel digital system in an Interventional Cardiology Laboratory

We evaluated the performances of angiographic units equipped with a flat-panel (FP) detector and image intensifier (II) charge-coupled device (CCD) in the Interventional Cardiology (IC) Department. Entrance dose rate and dose per image, along with the dose at the II level were measured using 2 mm copper sheets to simulate a patient. Image quality (IQ) was evaluated using a phantom. Doses increased with fluoroscopy level changing from low to high. FP presented higher doses than CCD. Periodic measurements showed differences of up to 35%. Low mode IQ did not significantly differ from normal and high mode for both systems. Low fluoroscopy mode was decided to be used routinely. Both X-ray systems performed within international recommendations for conventional systems with the exception of higher cine radiation doses and II dose rates, stressing the fact that more studies are required to investigate whether dose levels should be adjusted.

111 Vertebral artery angioplasty and stenting: a preliminary report of an interventional cardiology, radiology and surgical department. Do we have to treat vertebral stenosis?

111 Vertebral artery angioplasty and stenting: a preliminary report of an interventional cardiology, radiology and surgical department. Do we have to treat vertebral stenosis?

3580 Carotid angioplasty and stenting: a preliminary report of an haemodynamic interventional cardiology department

3580 Carotid angioplasty and stenting: a preliminary report of an haemodynamic interventional cardiology department

High shear stress after successful balloon angioplasty is associated with restenosis and target lesion revascularization Attila Thury, Glenn van Langenhove, Stephane G. Carlier, Mariano Albertal, Ken Kozuma, Evelyn Regar, Jolanda J. Wentzel, Rob Krams, Cornelis J. Slager, Jan J. Piek, Patrick W. Serruys. Department of Interventional Cardiology, Thoraxcenter, Rotterdam, The Netherlands, Laboratory of Hemodynamics, Thoraxcenter, Rotterdam, The Netherlands

High shear stress after successful balloon angioplasty is associated with restenosis and target lesion revascularization Attila Thury, Glenn van Langenhove, Stephane G. Carlier, Mariano Albertal, Ken Kozuma, Evelyn Regar, Jolanda J. Wentzel, Rob Krams, Cornelis J. Slager, Jan J. Piek, Patrick W. Serruys. Department of Interventional Cardiology, Thoraxcenter, Rotterdam, The Netherlands, Laboratory of Hemodynamics, Thoraxcenter, Rotterdam, The Netherlands

Novel method for in vivo calculation of absolute shear stress at any location of a stented human coronary artery Attila Thury, Jolanda J. Wentzel, Elbert H. Janssen, Rob Krams, Jan A. Oomen, Johan C. H. Schuurbiers, Jurgen M. R. Ligthart, Patrick W. Serruys, Cornelis J. Slager. Department of Interventional Cardiology, Thoraxcenter, Rotterdam, The Netherlands, Laboratory of Hemodynamics, Thoraxcenter, Rotterdam, The

Novel method for in vivo calculation of absolute shear stress at any location of a stented human coronary artery Attila Thury, Jolanda J. Wentzel, Elbert H. Janssen, Rob Krams, Jan A. Oomen, Johan C. H. Schuurbiers, Jurgen M. R. Ligthart, Patrick W. Serruys, Cornelis J. Slager. Department of Interventional Cardiology, Thoraxcenter, Rotterdam, The Netherlands, Laboratory of Hemodynamics, Thoraxcenter, Rotterdam, The

Endovascular brachytherapy in coronary arteries: the Rotterdam experience

Purpose: The use of endovascular coronary brachytherapy to prevent restenosis following percutaneous transluminal coronary angioplasty (PTCA) began in April 1997 at the Department of Interventional Cardiology of the Thoraxcenter at the University Hospital of Rotterdam. This article reviews the more than 250 patients that have been treated so far. Methods and Materials: The Beta-Cath™ System (Novoste), a manual, hydraulic afterloader with 12 90Sr seeds, was used in the Beta Energy Restenosis Trial (BERT-1.5, n=31), for compassionate use ( n=25), in the Beta-Cath System trial ( n=27) and in the Beta Radiation in Europe (BRIE, n=14). Since the Beta-Cath™ System has been commercialized in Europe, 57 patients have been treated and registered in RENO (Registry Novoste). In the Proliferation Reduction with Vascular Energy Trial (PREVENT), 37 patients were randomized using the Guidant-Nucletron remote control afterloader with a 32P source wire and a centering catheter. Radioactive 32P coated stents have been implanted in 102 patients. In the Isostent Restenosis Intervention Study 1 (IRIS 1), 26 patients received a stent with an activity of 0.75–1.5 μCi, and in the IRIS 2 (European 32P dose response trial), 40 patients were treated with an activity of 6–12 μCi. In two consecutive pilot trials, radioactive stents with non-radioactive ends (cold-end stents) and with ends containing higher levels of activity (hot-end stents) were implanted in 21 and 17 patients, respectively. Results: In the BERT-1.5 trial, the radiation dose, prescribed at 2 mm from the source train (non-centered), was 12 Gy (10 patients), 14 Gy (10 patients) and 16 Gy (11 patients). At 6-month follow-up, 8 out of 28 (29%) patients developed restenosis. The target lesion revascularization rate (TLR) was 7 out of 30 (23%) at 6 months and 8 out of 30 (27%) at 1 year. Two patients presented with late thrombosis in the first year. For compassionate use patients, a restenosis rate (RR) of 53% was observed. In the PREVENT trial, 34 of 37 patients underwent an angiographic 6-month follow-up. The doses prescribed at 0.5 mm depth into the vessel wall were 0 Gy (8), 28 Gy (9), 35 Gy (11) and 42 Gy (8). TLR was 14% in the irradiated patients and 25% in the placebo group. One patient developed late thrombosis. In the IRIS 1 trial, 23 patients showed an RR of 17% (in-stent). In the IRIS 2 trial, in-stent restenosis was not seen in 36 patients at 6-month follow-up. However, a high RR (44%) was observed at the stent edges. Conclusions: The integration of vascular brachytherapy in the catheterization laboratory is feasible and the different treatment techniques that are used are safe. Problems, such as edge restenosis and late thrombotic occlusion, have been identified as limiting factors of this technique. Solutions have been suggested and will be tested in future trials.

Frontiers in interventional cardiology.

n more than 20 years since the first percutaneous coronary revascularization procedures, the field of interventional cardiology has proliferated beyond all expectations. Now more than 1 million procedures are performed worldwide each year. Stenting has revolutionized the field, which previously relied on balloon dilatation in the majority of patients. With 50% of patients now undergoing stent implantation, the groundwork is laid for further important advances. In this article, we discuss the 4 most important new advances in the field of interventional cardiology: platelet inhibition, prevention of restenosis, stent evolution, and angiogenesis.

Lesiones vasculares yatrogénicas tras cateterismo cardíaco

The increase in vascular complications after cardiac catheterizations is rising due to the increase in the total number of these procedures. The purpose of this report is to determine the incidence of this complication and to identify the variables which are related to the presence of vascular complications which required surgical repair. Retrospective review of the 3,723 cardiac catheterizations made by the interventional cardiology department during a period between June 1992 to August 1996. Thirty two vascular complications were detected (0.9%), which required surgical reparation. There was no statistical difference in age, sex, presence of vascular risk factors, cardiac indication for catheterization and vascular approach between those patients who had a vascular complication and those who did not. The presence of obesity [RR: 2.5, IC 95% (1.2-5)], use of catheter sheath, superior or equal to 8F [RR: 0.3, IC 95% (0.14-0.62)] and use of systemic anticoagulation [RR: 4.8, IC 95% (2.1-10.8)], increase the risk of vascular complications. Two patients died (6.2%) due to cardiac complications and there were minor complications in 23% after surgical repair. Vascular complications after cardiac catheterization continue to be a significant problem. There are several variables which influence the presentation of vascular complications. Continued surveillance of cardiac catheterization complications is necessary to minimize problems and improve results.

Stenting and balloon rupture

Catheterization and Cardiovascular DiagnosisVolume 39, Issue 2 p. 214-214 Letter to the Editor Stenting and balloon rupture John P. Antonellis MD, Corresponding Author John P. Antonellis MD Evangellsmos General Hospital, Hemodynamic and Interventional Cardiology Department, Athens, GreeceEvangellsmos General Hospital, Hemodynamic and Interventional Cardiology Department, Athens, GreeceSearch for more papers by this author John P. Antonellis MD, Corresponding Author John P. Antonellis MD Evangellsmos General Hospital, Hemodynamic and Interventional Cardiology Department, Athens, GreeceEvangellsmos General Hospital, Hemodynamic and Interventional Cardiology Department, Athens, GreeceSearch for more papers by this author First published: October 1996 https://doi.org/10.1002/(SICI)1097-0304(199610)39:2<214::AID-CCD25>3.0.CO;2-FCitations: 1AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume39, Issue2October 1996Pages 214-214 SCAI Member Sign in RelatedInformation

Heparin-coated Palmaz-Schatz stents in human coronary arteries: Early outcome of the benestent-II pilot study: P.W. Serruys, H. Emanuelsson, W. Van der Giessen, A.C. Lunn, F. Kiemeney, C. Macaya, W. Rutsch, G. Heyndrickx, H. Suryapranala, V. Legrand, J.J. Goy, P. Materne, H. Bonnier, M.-C. Morice, J. Fajadet, J. Belardi, A. Colombo, E. Garcia, P. Ruygrok, et al. Department of Interventional Cardiology,

Heparin-coated Palmaz-Schatz stents in human coronary arteries: Early outcome of the benestent-II pilot study: P.W. Serruys, H. Emanuelsson, W. Van der Giessen, A.C. Lunn, F. Kiemeney, C. Macaya, W. Rutsch, G. Heyndrickx, H. Suryapranala, V. Legrand, J.J. Goy, P. Materne, H. Bonnier, M.-C. Morice, J. Fajadet, J. Belardi, A. Colombo, E. Garcia, P. Ruygrok, et al. Department of Interventional Cardiology,