Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 15 de 15
Filtrar
1.
Catheter Cardiovasc Interv ; 79(6): 921-6, 2012 May 01.
Artículo en Inglés | MEDLINE | ID: mdl-21542122

RESUMEN

BACKGROUND: Pharmacokinetic data suggests that the intravenous form of n-acetylcysteine (NAC) may be more effective than the oral formulation in preventing contrast induced nephropathy (CIN). NAC owing to its anti-oxidant properties might be beneficial for patients with acute coronary syndromes (ACS) who are at increased risk for CIN. The aim of this prospective randomized, single-center, double-blind, placebo controlled trial (NCT00939913) was to assess the effect of high-dose intravenous NAC on CIN in ACS patients undergoing coronary angiography and/or percutaneous coronary intervention (PCI). METHODS: We randomized 398 ACS patients scheduled for diagnostic angiography ± PCI to an intravenous regimen of high-dose NAC (1,200 mg bolus followed by 200 mg/hr for 24 hr; n = 206) or placebo (n = 192). The primary end-point was incidence of CIN defined as an increase in serum creatinine concentration ≥ 25% above the baseline level within 72 hr of the administration of intravenous contrast. RESULTS: There was no difference found for the primary end point with CIN in 16% of the NAC group and in 13% of the placebo group (p = 0.40). Change in serum cystatin-C, a sensitive marker for renal function, was 0.046 ± 0.204 in the NAC group and 0.002 ± 0.260 in the control group (p = 0.07). CONCLUSION: In ACS patients undergoing angiography ± PCI, high-dose intravenous NAC failed to reduce the incidence of CIN.


Asunto(s)
Acetilcisteína/administración & dosificación , Síndrome Coronario Agudo/diagnóstico por imagen , Angioplastia Coronaria con Balón , Antioxidantes/administración & dosificación , Medios de Contraste/efectos adversos , Angiografía Coronaria/efectos adversos , Enfermedades Renales/prevención & control , Síndrome Coronario Agudo/terapia , Anciano , Biomarcadores/sangre , Distribución de Chi-Cuadrado , Creatinina/sangre , Cistatina C/sangre , Método Doble Ciego , Femenino , Humanos , Infusiones Intravenosas , Enfermedades Renales/sangre , Enfermedades Renales/inducido químicamente , Enfermedades Renales/diagnóstico , Masculino , Persona de Mediana Edad , Nueva Orleans , Placebos , Estudios Prospectivos , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento
2.
Catheter Cardiovasc Interv ; 80(1): 121-7, 2012 Jul 01.
Artículo en Inglés | MEDLINE | ID: mdl-22120976

RESUMEN

BACKGROUND: Current "best" medical therapy with anti-platelet and/or anti-thrombotic agents for symptomatic atherosclerotic intracranial (IC) disease is associated with high recurrence. IC catheter-based therapy (CBT) using balloon angioplasty with or without stent placement is an option for patients who have failed medical therapy. We sought to examine the outcomes of CBT for patients with symptomatic IC arterial disease managed by experienced interventional cardiologists. METHODS: We retrospectively studied 89 consecutive symptomatic patients with 99 significant (≥70% diameter) IC arterial stenoses who underwent CBT. CBT was performed by experienced interventional cardiologists with the consultative support of a neurovascular team. The primary endpoint was stroke and vascular death. RESULTS: Procedure success was achieved in 96/99 (97%) lesions and percent diameter stenosis was reduced from 91% ± 7.5% preprocedure to 19% ± 15% postprocedure (P < 0.001). The rate of in-hospital periprocedural stroke and all death was 3%. The primary endpoint of stroke and vascular death rate at 1 year was 5.7% (5/88) and at 2 years was 13.5% (11/81). The 2-year all-cause mortality was 11.3% (10/88). CONCLUSIONS: For patients with symptomatic IC arterial stenosis who have failed medical therapy or are considered very high risk for stroke, CBT performed by experienced interventional cardiologists is safe and offers both high procedural success rates and excellent clinical outcomes at 1 year. CBT is an attractive option for this high-risk patient population considering the expected 12-15% rate of recurrent stroke at 1 year.


Asunto(s)
Angioplastia de Balón , Infarto de la Arteria Cerebral Media/terapia , Arteriosclerosis Intracraneal/terapia , Anciano , Angioplastia de Balón/efectos adversos , Angioplastia de Balón/instrumentación , Angioplastia de Balón/mortalidad , Angiografía Cerebral , Supervivencia sin Enfermedad , Femenino , Mortalidad Hospitalaria , Humanos , Infarto de la Arteria Cerebral Media/complicaciones , Infarto de la Arteria Cerebral Media/diagnóstico por imagen , Infarto de la Arteria Cerebral Media/mortalidad , Arteriosclerosis Intracraneal/complicaciones , Arteriosclerosis Intracraneal/diagnóstico por imagen , Arteriosclerosis Intracraneal/mortalidad , Ataque Isquémico Transitorio/etiología , Ataque Isquémico Transitorio/mortalidad , Ataque Isquémico Transitorio/prevención & control , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Nueva Orleans , Recurrencia , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Stents , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/mortalidad , Accidente Cerebrovascular/prevención & control , Factores de Tiempo , Resultado del Tratamiento
3.
Vasc Med ; 16(5): 354-9, 2011 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-22003001

RESUMEN

Clinically evident and subclinical peri-procedural bleeding following interventional therapies are associated with adverse cardiovascular outcomes. The risk factors for clinically evident bleeding have been well described. Despite the well-documented association of adverse outcomes for patients with a subclinical peri-procedural hemoglobin drop, the clinical predictors have not yet been defined. We identified 1176 consecutive patients with a subclinical drop in hemoglobin (fall of ≥ 1 g/dl in patients without clinical bleeding) following percutaneous coronary interventions (PCI) and peripheral vascular interventions (PVI). Multivariate logistic regression analysis was performed. A subclinical peri-procedural hemoglobin drop ≥ 1 g/dl was identified in 41% (400/972) of PCI and in 49% (213/435) of PVI. More than one access site predicted a higher risk of a subclinical drop in hemoglobin in both groups. A body mass index ≥ 30 predicted a lower risk of a subclinical drop in hemoglobin in both groups. For PCI, creatinine clearance < 60 ml/min was associated with a higher risk of a subclinical drop in hemoglobin. In conclusion, clinically silent peri-procedural hemoglobin fall ≥ 1 g/dl is common in patients undergoing both coronary and peripheral percutaneous intervention. Predictors identified in our study will need prospective validation.


Asunto(s)
Angioplastia Coronaria con Balón/efectos adversos , Enfermedad de la Arteria Coronaria/terapia , Hemoglobinas/metabolismo , Enfermedad Arterial Periférica/terapia , Hemorragia Posoperatoria/etiología , Anciano , Índice de Masa Corporal , Estudios de Cohortes , Enfermedad de la Arteria Coronaria/sangre , Creatinina/metabolismo , Femenino , Humanos , Fallo Renal Crónico/metabolismo , Masculino , Persona de Mediana Edad , Enfermedad Arterial Periférica/sangre , Hemorragia Posoperatoria/sangre , Estudios Retrospectivos , Factores de Riesgo
4.
Vasc Med ; 16(2): 109-12, 2011 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-21511673

RESUMEN

The objective of this paper is to describe outcomes of endovascular therapy in patients with symptomatic common femoral artery (CFA) lesions. Symptomatic atherosclerotic disease of the common femoral artery is an uncommon clinical entity, and there is no consensus regarding the suitability of catheter-based therapy. We reviewed the records of 26 consecutive patients treated with catheter-based therapy for symptomatic CFA lesions between 1994 and 2009. Angiographic success and procedure success were obtained in all vessels and in all patients. At 1 year, 100% (16/16) of the claudication patients and 70% (7/10) of the critical limb ischemia (CLI) patients maintained clinical success. The ankle- brachial index (ABI) significantly improved from a baseline of 0.47 ± 0.18 to 0.77 ± 0.18 (p < 0.001) after the procedure. At their most recent clinic visit (31 months ± 14 months), clinical success was maintained in 100% of the claudication patients and in 70% (7/10) of the CLI patients. During the follow-up period, femoral vascular access for an unrelated procedure was obtained through the CFA stent. In conclusion, patients with symptomatic CFA atherosclerotic disease obtained excellent clinical outcomes with angioplasty with stenting. We found that angioplasty with stenting of the CFA did not preclude future CFA vascular access. Our data suggest that catheter-based therapies should be considered as an option to open surgery in selected patients with symptomatic CFA disease.


Asunto(s)
Aterectomía/métodos , Aterosclerosis/terapia , Arteria Femoral , Anciano , Anciano de 80 o más Años , Angiografía , Índice Tobillo Braquial , Aterosclerosis/diagnóstico por imagen , Aterosclerosis/fisiopatología , Catéteres de Permanencia , Supervivencia sin Enfermedad , Femenino , Humanos , Claudicación Intermitente/terapia , Isquemia/terapia , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Stents
5.
Catheter Cardiovasc Interv ; 73(5): 692-8, 2009 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-19198006

RESUMEN

OBJECTIVES: To report the technical success and clinical outcomes of catheter-based therapy (CBT) for acute ischemic stroke in patients ineligible for intravenous thrombolysis. BACKGROUND: Acute ischemic stroke is common but undertreated. CBT for acute ischemic stroke is a therapeutic option in selected patients who are not candidates for intravenous thrombolysis. METHODS: Consecutive stroke patients who were ineligible for intravenous thrombolysis and underwent CBT were identified by retrospective chart review. Demographic information, National Institutes of Health Stroke Scale (NIHSS), procedural characteristics, and clinical outcomes during hospitalization and at 90 days follow up were collected. Experienced interventional cardiologists with the consultative support of stroke neurologists were on call for acute strokes. RESULTS: A total of 33 acute ischemic stroke patients underwent emergency cerebral angiography, with 26 patients undergoing CBT. Successful "culprit" artery recanalization was achieved in 23 (88%) of the 26 patients. In-hospital adverse events occurred in 4 (15%) patients, with intracerebral hemorrhage (ICH) (12%) representing the most common adverse event. The baseline NIHSS for patients who underwent intervention was 16.5 +/- 9.9 (median 16) and improved significantly to 9.9 +/- 8.7 (median 9) (P < 0.001) at hospital discharge. A modified Rankin score of two or less (indicating mild disability) was achieved in half (n = 13) of the CBT treated patients. All cause mortality at 90 days was 8% (2/26). CONCLUSIONS: In selected patients, CBT provided by qualified interventional cardiologists supported by stroke neurologists, offers a safe and effective option for patients with acute stroke who are not eligible for intravenous thrombolysis.


Asunto(s)
Angioplastia de Balón , Isquemia Encefálica/complicaciones , Cardiología/métodos , Angiografía Cerebral , Radiografía Intervencional , Radiología Intervencionista/métodos , Accidente Cerebrovascular/terapia , Anciano , Angioplastia de Balón/efectos adversos , Angioplastia de Balón/instrumentación , Isquemia Encefálica/diagnóstico por imagen , Isquemia Encefálica/mortalidad , Isquemia Encefálica/terapia , Conducta Cooperativa , Evaluación de la Discapacidad , Embolectomía , Femenino , Humanos , Hemorragias Intracraneales/etiología , Hemorragias Intracraneales/mortalidad , Masculino , Persona de Mediana Edad , Neurología , Grupo de Atención al Paciente , Admisión y Programación de Personal , Derivación y Consulta , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Stents , Accidente Cerebrovascular/diagnóstico por imagen , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/mortalidad , Terapia Trombolítica/efectos adversos , Factores de Tiempo , Resultado del Tratamiento
6.
Catheter Cardiovasc Interv ; 71(5): 701-5, 2008 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-18360868

RESUMEN

OBJECTIVE: We investigated whether repeat renal artery stent placement compared with treatment with balloon angioplasty alone results in better patency in patients presenting with renal artery in-stent restenosis (ISR). BACKGROUND: Although stent placement for renal artery stenosis has been demonstrated to be superior to balloon angioplasty for "de novo" renal artery lesions, the optimal therapy for ISR remains unclear. METHODS: Between January 1997 and August 2006, 34 consecutive patients (41 renal arteries) with ISR were treated at the discretion of the operator with balloon angioplasty or repeat stent placement. Quantitative angiography was performed before and immediately after intervention and at follow-up. Angiographic follow-up was obtained for clinical indications in 75% of lesions and routine noninvasive follow-up imaging was obtained in 95% of lesions. RESULTS: Repeat renal artery stent placement demonstrated improved patency compared with balloon angioplasty alone with a 58% reduction in recurrent ISR (29.4% vs. 71.4%, P = 0.02) and a 30% reduction in follow-up diameter stenosis (41% vs. 58.2%, P = 0.03). The repeat stent group also had better secondary patency (P = 0.05) and a greater freedom from repeat ISR (P = 0.01) when compared with balloon angioplasty alone. There was a trend favoring repeat stent placement for cumulative freedom from target vessel revascularization (TVR) (P = 0.08). CONCLUSIONS: Repeat stent placement appears to result in superior patency compared with balloon angioplasty alone for the treatment of renal ISR.


Asunto(s)
Angioplastia de Balón/efectos adversos , Obstrucción de la Arteria Renal/terapia , Stents , Grado de Desobstrucción Vascular , Anciano , Angioplastia de Balón/instrumentación , Femenino , Estudios de Seguimiento , Humanos , Masculino , Metales , Persona de Mediana Edad , Diseño de Prótesis , Radiografía , Obstrucción de la Arteria Renal/diagnóstico por imagen , Obstrucción de la Arteria Renal/fisiopatología , Proyectos de Investigación , Estudios Retrospectivos , Medición de Riesgo , Prevención Secundaria , Factores de Tiempo , Resultado del Tratamiento
7.
Catheter Cardiovasc Interv ; 72(3): 303-308, 2008 Sep 01.
Artículo en Inglés | MEDLINE | ID: mdl-18726941

RESUMEN

BACKGROUND: Carotid artery stent (CAS) placement is an alternative to carotid endarterectomy (CEA) for stroke prevention. Clinical adoption of CAS depends on its safety and efficacy compared to CEA. There are conflicting reports in the literature regarding the safety of CAS in the elderly. To address these safety concerns, we report our single-center 13-year CAS experience in very elderly (> or =80 years of age) patients. METHODS: Between 1994 and 2007, 816 CAS procedures were performed at the Ochsner Clinic Foundation. Very elderly patients, those > or =80 years of age, accounted for 126 (15%) of all CAS procedures. Independent neurologic examination was performed before and after the CAS procedure. RESULTS: The average patient age was 82.9 +/- 2.9 years. Almost one-half (44%) were women and 40% were symptomatic from their carotid stenoses. One-third of the elderly patients met anatomic criteria for high surgical risk as their indication for CAS. The procedural success rate was 100% with embolic protection devices used in 50%. The 30-day major adverse coronary or cerebral events (MACCE) rate was 2.7% (n = 3) with all events occurring in the symptomatic patient group [death = 0.9% (n = 1), myocardial infarction = 0%, major (disabling) stroke = 0.9% (n = 1), and minor stroke = 0.9% (n = 1)]. CONCLUSION: Elderly patients, > or =80 years of age, may undergo successful CAS with a very low adverse event rate as determined by an independent neurological examination. We believe that careful case selection and experienced operators were keys to our success.


Asunto(s)
Angioplastia de Balón , Estenosis Carotídea/terapia , Stents , Accidente Cerebrovascular/prevención & control , Factores de Edad , Anciano de 80 o más Años , Angioplastia de Balón/efectos adversos , Angioplastia de Balón/instrumentación , Angioplastia de Balón/mortalidad , Estenosis Carotídea/mortalidad , Estenosis Carotídea/patología , Competencia Clínica , Endarterectomía Carotidea/efectos adversos , Femenino , Humanos , Masculino , Infarto del Miocardio/etiología , Infarto del Miocardio/mortalidad , Selección de Paciente , Estudios Retrospectivos , Medición de Riesgo , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/mortalidad , Factores de Tiempo , Resultado del Tratamiento
8.
Circulation ; 107(13): 1722-4, 2003 Apr 08.
Artículo en Inglés | MEDLINE | ID: mdl-12665483

RESUMEN

BACKGROUND: Sirolimus-coated stents are a promising new therapy for restenosis. We treated a select group of patients at especially high risk for restenosis with oral sirolimus. METHODS AND RESULTS: Patients were treated with an oral sirolimus-loading dose of 6 mg after coronary angioplasty, followed by 2 mg/d for 4 weeks. Serum electrolytes, lipid profile, renal panel, and complete blood cell count were measured at 1, 3, and 5 weeks after drug initiation. Oral sirolimus was prescribed to 22 patients who had a total of 28 lesions and were at high risk for restenosis. Of the 22 study patients, 11 (50%) discontinued oral sirolimus early because of side effects or laboratory abnormalities. Hypertriglyceridemia and leukopenia were the most frequent adverse events, occurring in 3 patients each. All adverse drug effects were reversible after discontinuation. Follow-up was obtained in 100% of patients at a mean of 9.9+/-1.8 months, ranging from 6.5 to 11.8 months. Target lesion revascularization (TLR) occurred in 15 of 28 lesions (53.6%) and 13 of 22 patients (59.1%). There was no difference in TLR for patients receiving a complete course of sirolimus (n=8; 72.7%) compared with patients who terminated treatment prematurely (n=5; 45.5%; P=NS). Clinically driven repeat cardiac catheterization was obtained in 15 (68.2%) patients; restenosis (>50% diameter stenosis at follow-up) was present in 13 (86.7%). CONCLUSIONS: Oral sirolimus does not appear to provide benefit to patients with recalcitrant restenosis. Adverse drug effects are frequent, underscoring the importance of local drug delivery to achieve high tissue concentrations without systemic adverse drug effects.


Asunto(s)
Reestenosis Coronaria/prevención & control , Sirolimus/administración & dosificación , Administración Oral , Angioplastia Coronaria con Balón , Reestenosis Coronaria/diagnóstico , Reestenosis Coronaria/radioterapia , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Sirolimus/efectos adversos , Sirolimus/uso terapéutico , Stents/efectos adversos , Insuficiencia del Tratamiento
9.
Circulation ; 105(23): 2737-40, 2002 Jun 11.
Artículo en Inglés | MEDLINE | ID: mdl-12057987

RESUMEN

BACKGROUND: Several clinical trials indicate that intracoronary radiation is safe and effective for treatment of restenotic coronary arteries. We previously reported 6-month and 3-year clinical and angiographic follow-up demonstrating significant decreases in target lesion revascularization (TLR) and angiographic restenosis after gamma radiation of restenotic lesions. The objective of this study was to document the clinical outcome 5 years after treatment of restenotic coronary arteries with catheter-based iridium-192 (192Ir). METHODS AND RESULTS: A double-blind, randomized trail compared 192Ir to placebo sources in patients with restenosis after coronary angioplasty. Over a 9-month period, 55 patients were enrolled; 26 were randomized to 192Ir and 29 to placebo. At 5-year follow-up, TLR was significantly lower in the 192Ir group (23.1% versus 48.3%; P=0.05). There were 2 TLRs between years 3 and 5 in patients in the 192Ir group and none in patients in the placebo group. The 5-year event-free survival rate (freedom from death, myocardial infarction, or TLR) was greater in 192Ir-treated patients (61.5% versus 34.5%; P=0.02). CONCLUSIONS: Despite apparent mitigation of efficacy over time, there remains a significant reduction in TLR at 5 years and an improvement in event-free survival in patients treated with intracoronary 192Ir. The early clinical benefits after intracoronary gamma radiation with 192Ir seem durable at 5-year clinical follow-up.


Asunto(s)
Braquiterapia , Reestenosis Coronaria/radioterapia , Anciano , Cateterismo Cardíaco , Angiografía Coronaria , Circulación Coronaria , Reestenosis Coronaria/sangre , Reestenosis Coronaria/diagnóstico , Supervivencia sin Enfermedad , Método Doble Ciego , Femenino , Estudios de Seguimiento , Rayos gamma , Humanos , Radioisótopos de Iridio/administración & dosificación , Radioisótopos de Iridio/uso terapéutico , Masculino , Neovascularización Patológica , Stents/efectos adversos , Resultado del Tratamiento
10.
J Invasive Cardiol ; 24(5): 229-30, 2012 May.
Artículo en Inglés | MEDLINE | ID: mdl-22562918

RESUMEN

Percutaneous left ventricular assist device (pLVAD) utilization is increasing as the potential applications expand. We report a case of high-risk balloon aortic valvuloplasty and percutaneous coronary intervention using the Impella 2.5 pLVAD in a patient with severely depressed left ventricular function as a bridge to heart transplantation.


Asunto(s)
Angioplastia Coronaria con Balón/instrumentación , Estenosis de la Válvula Aórtica/terapia , Insuficiencia Cardíaca/terapia , Trasplante de Corazón , Corazón Auxiliar , Angioplastia Coronaria con Balón/métodos , Estenosis Coronaria/terapia , Insuficiencia Cardíaca/cirugía , Humanos , Masculino , Persona de Mediana Edad , Stents , Disfunción Ventricular Izquierda/terapia
11.
J Am Coll Cardiol ; 55(6): 538-42, 2010 Feb 09.
Artículo en Inglés | MEDLINE | ID: mdl-20152558

RESUMEN

OBJECTIVES: The aim of this study was to demonstrate the safety and long-term durability of catheter-based therapy for symptomatic vertebral artery stenosis (VAS). BACKGROUND: Symptomatic VAS carries with it a 5-year 30% to 35% risk of stroke. The 2-year mortality approaches 30% for medically managed strokes involving the posterior circulation. Surgical bypass is rarely performed, due to high morbidity and mortality. Endovascular revascularization with primary stenting offers an attractive treatment option for these patients. METHODS: One-hundred five consecutive symptomatic patients (112 arteries, 71% male) underwent stent placement for extracranial (91%) and intracranial (9%) VAS from 1995 to 2006. Fifty-seven patients (54%) had bilateral VAS, 71 patients (68%) had concomitant carotid disease, and 43 patients (41%) had a prior stroke. RESULTS: Procedural and clinical success was achieved in 105 (100%) and 95 (90.5%) patients, respectively. One-year follow-up was obtained in 87 (82.9%) patients, of which 69 patients (79.3%) remained symptom-free. At 1 year, 6 patients (5.7%) had died and 5 patients (5%) had a posterior circulation stroke. Target vessel revascularization occurred in 7.4% at 1 year. At a median follow-up of 29.1 months (interquartile range 12.8 to 50.9 months), 13.1% underwent target vessel revascularization, 71.4% were alive, and 70.5% remained symptom-free. CONCLUSIONS: In experienced hands, stenting for symptomatic VAS can be accomplished with a very high success rate (100%), with few periprocedural complications, and is associated with durable symptom resolution in the majority (approximately 80%) of patients. We conclude that endovascular stenting of vertebral artery atherosclerotic disease is safe and effective compared with surgical controls and should be considered first-line therapy for this disease.


Asunto(s)
Angioplastia/métodos , Insuficiencia Vertebrobasilar/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Angioplastia/efectos adversos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Stents
12.
Ochsner J ; 9(4): 220-6, 2009.
Artículo en Inglés | MEDLINE | ID: mdl-21603447

RESUMEN

It is estimated that as many as 1,000,000 people in the United States have chronic symptomatic coronary artery disease (often referred to as refractory angina) that is recalcitrant to medical therapy and unamenable to conventional revascularization procedures. Patients have reproducible lifestyle-limiting symptoms of chest pain, shortness of breath, and easy fatigability. Several new therapies are available to treat this difficult patient population, including newer drugs, enhanced external counterpulsation, transmyocardial revascularization, and cell-based therapies. This article reviews the current state of the art for treatment of refractory angina.

13.
J Interv Cardiol ; 18(1): 27-31, 2005 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-15788051

RESUMEN

BACKGROUND: The short-term clinical impact of intramyocardial gene transfer (GT) of the angiogenic protein vascular endothelial growth factor-2 (VEGF-2) has been previously reported to significantly reduce Canadian Cardiovascular Society (CCS) angina class and to prolong exercise treadmill test (ETT) time. We describe the safety and long-term events (>1 year) in consecutive, nonrandomized, patients who received intramyocardial VEGF-2. METHODS: Thirty patients with intractable CCS class III or IV angina and no options for revascularization underwent direct intramyocardial GT of VEGF-2 naked DNA via limited thoracotomy at total doses of 0.2, 0.8, or 2.0 mg. Patients were followed for clinical events after 1 year by hospital records, follow-up visits or telephone contact. Due to one perioperative death, 29 patients were followed. RESULTS: At a mean follow-up of 751 +/- 102.5 days (range 459-959) there were four deaths (13.8%), five myocardial infarctions (MIs) (17.2%), and seven revascularization procedures (24.1%). There were 15 hospitalizations in 12 patients. At the end of the follow-up period no patient (0%) had CCS class IV angina, 3 patients (11.5%) had class III angina, and 23 (88.5%) had class I to II angina. There were two new diagnoses of cancer. CONCLUSION: Transthoracic intramyocardial injection of VEGF-2 is associated with an improvement of symptoms of angina in the majority of patients beyond the first year of treatment. Major clinical events such as death, MI, and repeat revascularization are uncommon during the first year but more frequent after 1 year at a rate consistent with the severity of underlying disease in this population with advanced atherosclerosis. The majority of events were the result of progression of disease in areas of the heart remote from the site of GT. A large randomized trial is planned to determine the efficacy of intramyocardial VEGF-2 injections in inoperable patients.


Asunto(s)
Angina de Pecho/terapia , Técnicas de Transferencia de Gen , Factores de Crecimiento Endotelial Vascular/genética , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores de Tiempo , Resultado del Tratamiento
14.
Catheter Cardiovasc Interv ; 60(1): 41-4, 2003 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-12929102

RESUMEN

Transplant vasculopathy significantly limits the survival of cardiac transplant patients and occurs in 50% of patients by 5 years posttransplant. We report our experience with six cardiac transplant patients who underwent intracoronary brachytherapy for in-stent restenosis. At four centers, six patients underwent intracoronary radiation for in-stent restenosis. All patients received extended antiplatelet therapy with clopidogrel and aspirin. Follow-up angiography was performed in all patients. Two of the six patients underwent subsequent target lesion revascularization. Patient 1 presented with total occlusion of her radiated lesion. She had a complex procedure requiring stenting for a dissection after the radiation dwell. Patient 2 had high-grade restenosis following brachytherapy. Patient 3 had a 50% restenotic lesion. Patients 4, 5, and 6 had follow-up angiography that showed no evidence of restenosis. There are few good options to treated accelerated transplant vasculopathy. Radiation therapy may be a viable option in this difficult patient population.


Asunto(s)
Braquiterapia , Reestenosis Coronaria/terapia , Trasplante de Corazón , Stents , Ticlopidina/análogos & derivados , Abciximab , Adulto , Anciano , Anticuerpos Monoclonales/uso terapéutico , Arterias/patología , Arterias/efectos de la radiación , Arterias/cirugía , Aspirina/uso terapéutico , Implantación de Prótesis Vascular , California , Clopidogrel , Angiografía Coronaria , Reestenosis Coronaria/diagnóstico , Reestenosis Coronaria/radioterapia , Vasos Coronarios/patología , Vasos Coronarios/efectos de la radiación , Vasos Coronarios/cirugía , Femenino , Estudios de Seguimiento , Humanos , Fragmentos Fab de Inmunoglobulinas/uso terapéutico , Masculino , Persona de Mediana Edad , Inhibidores de Agregación Plaquetaria/uso terapéutico , Reoperación , Ticlopidina/uso terapéutico , Resultado del Tratamiento
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA