Search results for "Convent"

A Complex Combination of Microvascular and Macrovascular Diseases

2016

When FFR is larger than 0.80, a PCI is not justified. Transient microvascular dysfunction may, however, be associated with impaired hyperemia and falsely negative FFR. This case also emphasizes the dynamic nature of microvascular disease, and provides an example of both “typical” syndrome X and “less conventional” syndrome slow flow associated with increased peripheral resistances (see Chap. 35).

Multiple Lesions, Multiple Measures

2016

This case describes the assessment of FFR in the case of tandem intermediate lesions in the proximal and mid LAD. Hyperemia was induced with intravenous (IV) infusion of Adenosine, which allows pullback measurements. First, with the wire placed distal in the vessel, FFR provides information on whether the sum of the two stenoses causes ischemia. Thereafter, during pullback, the most severe stenosis can be identified as the most relevant pressure drop. Finally, a re-evaluation of FFR is important after PCI: after the first stenosis is treated, the degree of hyperemia achievable will be larger, thus unmasking the relevance of the second one.

Minimally invasive mitral valve surgery: State-of-the-art and our experience

2015

The minimally invasive approach is becoming the standard-of-care for surgery of the mitral valve. As any less invasive strategy, it entails an increased surgical complexity. Standard-of-care mitral repair using the totally videoscopic approach is indeed reproducible; however, few specific data on patients with complex mitral valve disease are available in the published literature. The purpose of the present paper is to provide an overview of the current state-of-the-art in minimally invasive cardiac surgery, and a summary of recent evidence on the topic, with particular regard to the surgical techniques and comparisons with conventional surgery. The experience of the GVM Care and Research n…

The IMPACTOR-CTO Trial

2018

Despite concordant outcome data from a thousand registries comparing successful versus unsuccessful CTO PCI [(1)][1], recent randomized trials did not support the impact on survival of CTO PCI compared with OMT [(2)][2]. In contrast, more certainty exists about its importance in improving QoL [(2)][

Möglichkeiten und Grenzen der Spiral-CT bei der Untersuchung von Nierenbeckenkarzinomen

1994

PURPOSE To assess the value of spiral CT in comparison to conventional CT in the staging of renal pelvic carcinoma. PATIENTS AND METHODS 35 patients with renal pelvic carcinoma underwent preoperative CT; conventional technique (n = 21) and spiral CT (n = 14) with the reconstruction of thin sections were compared. RESULTS Non-invasive or minimal invasive tumours (TA, T1, T2) could not be differentiated with either technique. Small, flat tumours (TA) or multicentric tumours may be missed, even if spiral scanning is applied. The separation of local tumour growth from infiltration is significantly improved by spiral CT (12 of 12 patients instead of 18 out of 21 patients with the conventional te…

Impact of admission hyperglycemia on one-year mortality in non-diabetic patients admitted for rescue PCI

2013

0197: Angiographically visible distal embolization is not linked with culprit lesion but with clinical characteristics

2016

Despite the recent improvements in percutaneous coronary intervention (PCI), angiographically visible distal embolization (AVDE) complicates 6 to 18% of ST elevation myocardial infarction (STEMI) treated with PCI, and is associated with poor clinical outcomes. Culprit lesion characteristics have been proved to be the main predictive factor of AVDE. But data regarding clinical characteristics predicting AVDE are lacking. We aimed to identify predictors of AVDE complicating PCI in STEMI management. 769 consecutive patients admitted for STEMI who underwent PCI were included. Clinical, angiographic and therapeutics characteristics were assessed for each patien. AVDE was defined as an abrupt ves…

1-Year Outcomes of FFRCT-Guided Care in Patients With Suspected Coronary Disease

2016

Abstract Background Coronary computed tomographic angiography (CTA) plus estimation of fractional flow reserve using CTA (FFR CT ) safely and effectively guides initial care over 90 days in patients with stable chest pain. Longer-term outcomes are unknown. Objectives The study sought to determine the 1-year clinical, economic, and quality-of-life (QOL) outcomes of using FFR CT instead of usual care. Methods Consecutive patients with stable, new onset chest pain were managed by either usual testing (n = 287) or CTA (n = 297) with selective FFR CT (submitted in 201, analyzed in 177); 581 of 584 (99.5%) completed 1-year follow-up. Endpoints were adjudicated major adverse cardiac events (MACE) …

Drug-Eluting Stent for Left Main Coronary Artery Disease

2012

Objectives The aim of this study was to compare, in a large all-comers registry, major adverse cardiac and cerebrovascular events (MACCE) after percutaneous coronary intervention (PCI) with first-generation drug-eluting stents (DES) versus coronary artery bypass grafting (CABG) in unprotected left main coronary artery (ULMCA) stenosis. Background Percutaneous coronary intervention with DES implantation in ULMCA has been shown to be a feasible and safe approach at midterm clinical follow-up. Methods All consecutive patients with ULMCA stenosis treated by PCI with DES versus CABG were analyzed in this multinational registry. A propensity score analysis was performed to adjust for baseline dif…

Highlights and essentials from the first "experts-live" course of the EuroCTO club

2010

Chronic total occlusions (CTOs) are frequently encountered during diagnostic coronary catheterisation. However, there is still confusion regarding the indication for percutaneous coronary intervention (PCI) in this lesion subset, mainly because it is cumbersome and the prognostic impact of revascularisation in these patients remains unclear. Many studies have now shown the long term clinical benefits after CTO PCI1-3; still, with procedural complexity, high radiation exposure to both the patient and the operator, high costs and lower procedural success rates, most patients with CTO are managed medically or referred for bypass graft surgery – regardless of the severity of symptoms and extent…