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David A Halon

Publications and source records attributed to David A Halon.

23 records · Page 2Linked to original sources
PubMed2003

Preliminary experiences using X-sizer catheter for mechanical thrombectomy of thrombus-containing lesions during acute coronary syndromes.

Thrombus-containing lesions are frequently observed in patients with acute coronary syndromes. These lesions are prone to increased procedural risks, including distal embolization and abrupt closure of the vessel. This preliminary report evaluates if thrombus removal using a new X-Sizer catheter could reduce thrombotic burden and optimize angioplasty results. Thrombectomy was attempted with the X-Sizer catheter in 11 patients (age, 59 +/- 10 years) undergoing coronary angioplasty with angiographic evidence of intracoronary thrombus. The device uses a helix cutter contained in a 4.5 or 5.5 Fr catheter tip connected to a closed vacuum aspiration system. Procedural outcomes using detailed angiographic analysis and clinical data were obtained from all treated patients. Seven patients (64%) had acute or recent myocardial infarction and four patients (36%) presented with unstable angina. The culprit lesion was located in right coronary, left anterior, vein graft, and circumflex-marginal in five, three, two, and one patient, respectively. The mean proximal reference diameter was 3.37 +/- 0.39 mm and % diameter stenosis was 90% +/- 15% prior to thrombectomy and decreased to 72% +/- 16% afterward and was 9% +/- 10% at the end of the procedure. The TIMI flow increased from 0.8 +/- 1.0 to 2.1 +/- 0.9 following thrombectomy and the final TIMI grade was 2.9 +/- 0.3. Stents were used in 9 of 11 patients. Procedural success was achieved in 10 of 11 patients (91%). No evidence of stent thrombosis was noted among treated patients in hospital and at 30-day follow-up. In this preliminary series of patients with angiographic evidence of thrombus, the use of X-Sizer thrombectomy seems to be feasible and relatively safe, permitting thrombus removal and improved intracoronary flow.

Aged↗
PubMed2003

Perceived patient comprehension in acute and chronic cardiovascular clinical trials.

An anonymous patient perception comprehension and satisfaction questionnaire was sent to 438 patients 1-3 months after they had participated in a clinical cardiovascular trial to examine the level of patient comprehension as perceived by the patient. We compared perceived comprehension in acute (acute myocardial infarction) and chronic (outpatient heart failure) clinical trials. Partially or fully completed questionnaires were received from 220 patients (70 chronic, 150 acute). The findings were similar in the 2 patient groups. Perceived full comprehension (understood most or all) of the trial was reported by 18 (27%) of chronic and 40 (31%) of 129 acute patients, while almost 20% of both groups reported little or no understanding of the trial. The level of comprehension was related to the recollected duration of explanation (p = 0.003 chronic, p < 0.001 acute). Perceived comprehension was not related to the personnel explaining the study (physician or nurse) or to whether the explanation as recollected was oral or written. However, in both acute and chronic patients, the majority (51% chronic; 63% acute) preferentially recalled the oral rather than written explanation of the trial. The very similar findings in the acute and chronic situation suggest that perceived understanding reflects human nature and willingness to be involved in medical issues. Considerable effort should be directed to improve the duration of explanation (particularly oral), if we are to achieve our goal of true informed consent in clinical cardiovascular trials.

Cardiovascular Diseases↗
PubMed2002

Myocardial perfusion abnormalities early (12-24 h) after coronary stenting or balloon angioplasty: implications regarding pathophysiology and late clinical outcome.

OBJECTIVE: We prospectively examined the prevalence of reversible perfusion defects on very early (12-24 h) thallium-201 single photon emission computed tomography (SPECT) scintigraphy after angiographically successful percutaneous coronary intervention (PCI) by stenting and/or stand-alone balloon angioplasty and the predictive value of these defects for late target lesion revascularization (TLR). PATIENTS AND METHODS: 83 consecutive patients undergoing PCI for 88 lesions (38 balloon angioplasties, 50 stents) underwent very early (12-24 h) SPECT thallium-201 scintigraphy at rest and following administration of 0.7 mg/kg intravenous dipyridamole after PCI. Univariate and multivariate clinical, procedural and scintigraphic correlates of target lesion revascularization during long-term follow-up were examined. RESULTS: Coronary stenting achieved a larger immediate post-PCI minimal luminal dimension (2.7 +/- 0.4 vs. 2.1 +/- 0.4 mm, p < 0.001) and less residual stenosis (4 +/- 12 vs. 19 +/- 11%, p < 0.001) than stand-alone balloon angioplasty. Nonetheless, early reversible perfusion defects were similarly present in the territory supplied by 36% of stented lesions and 32% of lesions treated by balloon angioplasty (NS). Of 81 lesions (76 patients) available for long-term clinical follow-up, TLR was performed in 11% of the stent group and 14% of the balloon angioplasty group (NS). By multivariate logistic regression analysis, diabetes mellitus was the only predictor of late TLR (p < 0.05). The type of intervention (balloon or stent) predicted neither early perfusion defects nor late TLR. CONCLUSIONS: Early 201-thallium SPECT scintigraphy was abnormal in a third of patients treated by stand-alone balloon angioplasty or by stent placement. The very early SPECT scintigraphic findings did not differentiate between balloon and stent and did not predict late TLR.

Adult↗
PubMed2002

Burden of late repeat hospitalization in patients undergoing angioplasty or bypass surgery. A long-term (13 years) report from the Lady Davis Carmel Medical Center registry.

We investigated the incidence and determinants of early and late repeat hospitalization for cardiac causes in 378 patients following myocardial revascularization [199 coronary balloon angioplasty (PTCA), 179 coronary bypass surgery (CABG)] in a single cardiovascular center and followed for a median period of 13 years. Data were available for repeat rehospitalization in 91% and for mortality in all. Patients in the upper quartile for repeat hospitalization (>or=4 rehospitalizations) were defined as having multiple repeat hospitalizations. In the PTCA cohort, the rehospitalization rate was high (48%) in the first year, partly due to restenosis and to a group of patients who underwent planned repeat angiography, and then 15-26% annually. In the surgical cohort, annual repeat hospitalization was 8-12% during the first 4 years, but increased to a level similar to that in PTCA patients (19-26%) in the second half of the follow-up period. Independent predictors of multiple (>or=4) repeat hospitalizations included systemic hypertension (odds ratio 2.4, 95% CI 1.4-4.0), incomplete revascularization (odds ratio 2.0, 95% CI 1.1-3.4) and less extensive (<3 vessels) disease at the time of the index procedure (odds ratio 2.0, 95% CI 1.1-3.4). Predictors of repeat hospitalization were different from those of mortality (diabetes mellitus, 3-vessel disease). Late repeat hospitalizations after myocardial revascularization impose a considerable burden on the patient and the health care system, and represent an issue which should be better addressed.

Adult↗