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A Iñíguez Romo

Publications and source records attributed to A Iñíguez Romo.

14 recordsLinked to original sources
PubMed1999

[The clinical and angiographic evolution of dilated lesions in the proximal segment of the anterior descending coronary artery: stent versus balloon].

INTRODUCTION AND OBJECTIVES: The restenosis rate after coronary balloon angioplasty of lesions located in the proximal segment of the left anterior descending coronary artery is high, having been recommended elective stent implantation in order to improve the outcomes. The aim of this study was to analyze clinical, anatomic and angiographic factors related to the short-term outcome after angioplasty of severe lesions in the proximal segment of the left anterior descending artery, with and without stent implantation. MATERIAL AND METHODS: We study 87 patients with severe stenosis (> or = 70%) of the proximal segment of left anterior descending artery treated successfully with angioplasty. In 54 patients (62%) a conventional balloon was used (group A) and in 33 (38%) a stent was implanted (group B). RESULTS: Mean age of patients was 61.9 +/- 12 years old, 74% were male and angioplasty was performed because of unstable angina in 72%. At the end of the follow-up (mean 6.3 +/- 1.5 months), 21% of patients in group B had angina vs 54% in group A (p = 0.03). Group B patients experienced a lower restenosis rate (30% vs. 50%; p = 0.07) and less repeat angioplasty procedures (33% vs 21%; p = NS) than group A. These results were maintained independently of the vessel diameter (< 3 mm or > or = 3 mm) or when an optimal result (< 25%) after balloon angioplasty was obtained. CONCLUSIONS: In our experience, stenting of lesions located in the proximal segment of the left anterior descending artery appears imply a better short-term clinical, angiographic outcome and a lower restenosis rate than lesions treated with conventional balloon angioplasty, even despite an optimal result after balloon angioplasty or independently of the vessel diameter. Future studies will be necessary to confirm these results.

Aged↗
PubMed1998

[Informed consent in cardiology. The Committee on Informed Consent of the Commission on Professional Matters of the Sociedad Española de Cardiología].

In the last thirty years, the clinical relationship between physicians and patients has been rather modified. There are several factors that have contributed to this change: a) New ways to execute medical practises, specially referred to the development of new techniques; b) Cultural changes in our western society, mainly in the mediterranean area, where there has been progress in the recognition of patients' autonomy to decide about their own lives, health and their own bodies; c) The increasing number of lawsuits, complaints and judgements about the problems that clinical information involves, particularly the informed consent in clinical practise. We consider it necessary to make an extensive and deep discussion from all of the areas in Medicine and Law, to analyze the different ethical and legal parts of the informed consent. For that reason the Spanish Society of Cardiology offers their members a basic document in order to reflect about these facts, developing arguments, justifications and supports. This document has also considered models, conditions to their applicability according to Spanish law, and the experience we have had. Finally, there is a list of diagnostic procedures and interventional practises in cardiology that might be preceded by a written informed consent document. We considered them by the name of Spanish Society of Cardiology recommendations.

Cardiology↗
PubMed1997

[Conventional percutaneous transluminal coronary angioplasty as the form of treatment of complex intra-stent restenosis].

We report the case of a patient with unstable refractory angina due to a coronary narrowing because of in-stent restenosis affecting the first diagonal, first septal and left anterior descending coronary artery. The lesions were successfully dilated with a conventional balloon catheter and a triple guide-wire system was placed through the inter-filaments space of the stent, to protect and recanalize the branch vessels involved. The patient evolved well and was discharged asymptomatic.

Angina, Unstable↗
PubMed1997

[Encapsulated coronary rupture following stent implantation].

We report a case of coronary encapsulated rupture following stent implantation in the distal anastomosis of a saphenous by-pass graft to the left anterior descending coronary artery that evolved well with conservative treatment. The patient did not require pericardiocentesis and was treated with prolonged inflations with low pressure autoperfusion balloon at the rupture point. Pericardial adherences related to a previous coronary surgery probably limited the bleeding process avoiding hemodynamic collapse.

Angioplasty, Balloon, Coronary↗
PubMed1997

[Intracoronary prosthesis (stent): an approach to the analysis of cost-effectiveness].

Stents have emerged as one of the major therapeutic tools for percutaneous intracoronary revascularization procedures. In fact, a stent is implanted in at least 30% of lesions attempted. Their clinical impact is huge because stenting has produced a decrease int the need for emergency surgery to 0.5%, with an incidence of acute myocardial infarction related to angioplasty of 2% and a death rate of < 1% despite unfavourable clinical and anatomical conditions treated. The initial price of stenting was a high frequency of subacute stent thrombosis and peripheral vascular complications, which has been solved. In this context, the cost of stenting procedures increased by more than 30% in relation to the cost of conventional balloon angioplasty. But, the use of new antiplatelet regimes, implantation with high atmospheres and the achievement of a minimal residual narrowing after stenting practically promotes the disappearance of the two major initial problems, making possible a decrease in the restenosis rate to 20% with a parallel reduction of 10% in the need for new revascularization procedures during the first years after stent implantation. This means a reduction in the midterm costs. The incremental rate of cost/effectiveness after stenting in one vessel disease has been estimated as 23,600 dollars/years of adjusted quality of life gained ($/QUALY) ($20-40,000/QALY is acceptable in pharmaeconomic studies). From another point of view, stenting implies 19 QALYS gained at a mean cost of $52,700. The incremental cost of stenting may be more favourable if a reduction of $1,800 in the total cost of stenting procedures could be achieved, or if the stent cost were reduced by at least $700. In Spain, each patient who was event-free during the first year of follow-up would cost 1,674,000 ptas. A 10% reduction of new revascularization procedures x 100 patients would cost 20 million pesetas. Despite the enormous interest of socioeconomic analysis these data only reflect a partial point of view, because of the complexity of evaluating the contribution of new technologies, the true quality of life gained for patients, the societal point of view, or that of the National Health Service. Moreover, we assume that in the current socioeconomic context there are finite resources and a limitless demand.

Coronary Disease↗
PubMed1996

[Percutaneous revascularization with coronary angioplasty in patients with refractory angina].

INTRODUCTION AND OBJECTIVES: Refractory angina, specially when accompanied by electrocardiographic (ECGs) changes, has been associated with a high morbidity and mortality if urgent revascularization is not performed. Percutaneous Transluminal Coronary Angioplasty (PTCA) could be a useful therapeutic alternative in such cases. The aim of this study was to compare the immediate and midterm outcomes of a cohort of high risk patients with refractory angina with or without ECG changes revascularized by PTCA. METHODS: Of 801 consecutive patients who underwent PTCA, we selected 48 patients (49 procedures, 61 lesions), with unstable angina in spite of treatment with nitroglycerin, calcium channel blockers, beta blockers, heparin and aspirin (refractory angina). Twenty-six patients (27 procedures, 37 lesions) had ECG changes (group A), and 22 patients (22 PTCAs, 24 lesions) did not have changes (group B). RESULTS: Mean age of patients was 65 +/- 11 years. The most frequent ECG changes found in group A were T wave inversion (38%) and ST segment depression (34%). The left anterior descending coronary artery was the most frequent dilated vessel (41%). Some new devices (Stent, Rotablator, etc.) were used in 22% vs 25% of lesions in group A and B respectively. Successful dilatation was achieved in 59 (96%) of attempted lesion without statistical differences between group A and B. One patient in each group developed an acute myocardial infarction. Death occurred in 2 patients from group A (one of non-cardiovascular cause). Follow-up was obtained in 33 (94%) of the 35 patients (minimum follow-up > or = 6 months or less if a major event occurred). Mean follow-up time was 16.7 +/- 6 vs 13.4 +/- 6 months in group A and B. During this time, death occurred in 2 patients (6%) both from group B (one non-cardiac); in 9 (27%) patients a repeat PTCA was performed (26% of patients from group A and 28% from B); CABG was performed in 2 (6%) patients (both from group B), and an AMI occurred in 1 patient in each group. Angiographic follow-up was obtained in 73% of patients in group A vs 91% in group B. The restenosis rate was 47% in group A vs 54% in group B. At the end of the first year of follow-up, 93% of patients were alive and 9/10 patients successfully revascularized were asymptomatic or had less severe angina. CONCLUSIONS: At present, PTCA is a safe revascularization method in patients with refractory angina providing a high initial success (95% of cases) and a good mid-term outcome (one year): > 90% survival rate, with improvement in the quality of life in 9/10 patients successfully revascularized, regardless of the presence or absence of ECG changes at the time of PTCA.

Aged↗
PubMed1993

[Percutaneous mitral valvotomy. The experience of the Hospital Universitario San Carlos of Madrid].

Percutaneous mitral valvotomy is an alternative to surgery for the treatment of selected patients with mitral stenosis. With the purpose of reviewing our own experience and to determine the relationship of several variables with procedural success or complications rate, we have analyzed the immediate results of 335 consecutive procedures (90% with the Inoue balloon). Mean age was 51 +/- 12 years, 79% were female, 59% were in atrial fibrillation, 49% in NYHA class > or = III and 34% had mild mitral regurgitation. Mean echocardiographic score was 7.6 +/- 1.9 and up to 25% of patients had a total score > or = 8. Mean mitral valve area (Gorlin) increased from 0.94 +/- 0.2 to 1.87 +/- 0.5 cm2, with increments > or = 50% in mitral area in 88% and a final area > or = 1.5 cm2 in 85% of patients. Patients with an score > 8 obtained smaller mitral areas (1.64 +/- 0.4 vs 1.95 +/- 0.5 cm2. p < 0.01), and a higher percent of suboptimal (< 1.5 cm2) mitral area (22 vs 2%, p < 0.001) than patients with a lower score. Echocardiographic score (p = 0.009), balloon size (p = 0.01) and left atrial diameter (p = 0.04) were identified as independent predictors of a post-procedural mitral area > or = 1.5 cm2. Complications including cardiac tamponade (3 cases), cerebral ischemic events (1 case) and death (1 case) were rare. Mitral regurgitation increased by 2 or more grades in 14%, but regurgitation was severe in only 6% and early mitral surgery was required in 6 (2%) patients. No clinical, anatomical or procedural variables were found to be predictors of a significant increase in mitral regurgitation, a complication which occurred even in valves with a low echocardiographic score. In conclusion, percutaneous mitral valvotomy is a safe and effective procedure for the treatment of selected patients with mitral stenosis. Since complications, even if rare might be serious, the procedure should be performed only in symptomatic patients.

Adult↗
PubMed1992

[The evaluation of the results after coronary angioplasty by intracoronary Doppler and quantitative angiography. The correlation of both methods].

To study the importance of measuring coronary flow reserve immediately after coronary angioplasty we have analysed the results obtained after 28 angioplasties performed in 21 patients. Coronary flow reserve was measured with a 3F intracoronary catheter selectively placed in the dilated artery. Corresponding coronary angiography was analysed with an automatic edge detection program (ARTREK) and visual estimation. Coronary flow reserve increased in 26/27 cases after angioplasty from 2.4 +/- 1.3 to 4.1 +/- 2.7 (p less than 0.001). A correlation was found between minimal luminal area and minimal luminal diameter after coronary angioplasty, and coronary flow reserve (r = 0.46; p less than 0.05 and r = 0.47; p less than 0.05, respectively). The finding of a normal coronary flow reserve (greater than or equal to 3.5), had a 100% specificity but only 56% sensitivity to detect angiographic success (residual stenosis less than 50%). However 47% of patients with angiographic success did not reach normal values of coronary flow reserve. Visual estimation of the stenosis had a good correlation with automatic evaluation but significant scattering was observed at visual levels less than or equal to 25%. Visual assessment underestimated residual stenosis in all but one of the procedures. We conclude that coronary flow reserve is a potentially useful index for assessing the results after angioplasty that may complement coronary angiography. Nonetheless substantial differences between both methods exist in a significant number of cases. The relative merits of both methods, as well as the particular circumstances in which coronary flow reserve should be used, require further studies.

Angioplasty, Balloon, Coronary↗
PubMed1991

[Guided coronary atherectomy: preliminary results].

Coronary atherectomy implies removing atheromatous material from the diseased coronary arterial wall. This technique has emerged as an attractive alternative to conventional percutaneous transluminal coronary angioplasty procedures, in an attempt to diminish both initial procedural failure and restenosis rate. Among different technologies, the Simpson's atherotome provides a means of performing directional (i.e. selective) coronary atherectomy (DCA). This device implements a coaxial catheter which is advanced into the lesion over a steerable guidewire. Its distal tip includes a hollow metallic cylinder with a lateral window. Removal of the material is accomplished by a rotating cutter which can be moved distally, once the device's window has been orientated facing the lesion. We have performed 14 DCA in 14 patients. Mean age was 58 years and 12 patients were male. The technique was indicated for unstable angina (7 patients), stable angina (4 patients) and silent myocardial ischemia (3 patients). Fifteen lesions were attempted (13 original and two with restenosis), located as follows: nine in the left anterior descending coronary artery, three in the right coronary artery and three in the left circumflex artery. Eleven lesions were proximal and four were located in mid coronary segments. Twelve lesions (80%) were eccentric, and five (33%) were irregular. Initial angiographic success (residual stenosis less than 50%) was obtained in all 15 lesions (100%). Pre-DCA stenosis was 84 +/- 5% and post-DCA stenosis was 16 +/- 6%. There was no need for urgent coronary artery by-pass surgery and no patient developed an acute myocardial infarction in relation to the procedure. A 82-year-old woman died after the procedure in cardiogenic shock.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

[Atrial tumor].

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Echocardiography↗