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E Eeckhout

Publications and source records attributed to E Eeckhout.

At least 55 records · Page 3Linked to original sources
PubMed1995

Can early closure and restenosis after endoluminal stenting be predicted from clinical, procedural, and angiographic variables at the time of intervention?

OBJECTIVES: To develop a statistical model to assess the risk of early closure and restenosis on the basis of the information available at the time of stent implantation. DESIGN: An exploratory forward, stepwise multivariate logistic regression for each adverse event and multivariate polychotomous analysis for both events. SETTING: Tertiary referral centre for interventional treatment of coronary artery disease. PATIENTS: 243 consecutive, successful stenting procedures between 1986 and 1993 with the Wallstent, the Palmaz-Schatz and Wiktor stents with analysis of clinical, procedural, and angiographic variables. MEAN OUTCOME MEASURES: Early closure was defined as angiographically documented stent thrombosis within the first 3 weeks after implantation and restenosis according to the 50% reference diameter reduction criterion. RESULTS: Overall early closure and restenosis rates were 14.4% (35/243) and 19.2% (40/208, for a 97% repeat angiography rate). The statistical model predicted a worse outcome for male patients, with less restenosis in female patients. The only risk factor in female patients was the presence of collaterals to the target lesion. For male patients the following risk factors for closure and restenosis were retained: multiple stent implantation during the same session, the presence of collaterals to the target lesion, stenting of the left anterior descending artery or of the left circumflex artery, and bailout stenting. Only bailout stenting implied a decreased restenosis risk. CONCLUSIONS: Clinical, procedural and angiographic variables increase the risk for early closure and restenosis after endoluminal stenting. The prediction models described above need to be validated prospectively.

Angina Pectoris↗
PubMed1995

Major dissection during coronary angioplasty: outcome using prolonged balloon inflation versus coronary stenting.

BACKGROUND: Abrupt or threatened closure is the major acute complication following conventional coronary angioplasty with a persistent incidence of 2% to 10%. OBJECTIVES: In order to evaluate the safety and efficacy of endoluminal stenting and autoperfusion balloon angioplasty in the setting of abrupt or threatened closure following coronary angioplasty, the short- and long-term clinical and angiographic follow-up of respectively 45 and 51 patients treated by either method were compared. METHODS: From August 1986 through August 1992, consecutive patients treated by either endoluminal stenting or autoperfusion balloon angioplasty for abrupt closure following coronary angioplasty, were entered into an observational trial that requested clinical follow-up and repeat angiography at 6 months. RESULTS: Except for vessel localization, baseline clinical, angiographic and procedural characteristics were comparable. The in-hospital clinical and angiographic outcome was similar (p = 0.85) with 69% event-free patients in both treatment groups. The postprocedural minimal luminal diameter was larger following stenting: 2.67 +/- 0.76mm versus 2.07 +/- 0.70mm (autoperfusion balloon) (p = 0.0002). At follow-up, there were less events in the stent group: 11% versus 34% for the autoperfusion balloon angioplasty group, (p = 0.03). Restenosis rates were 5% (2/37 patients, stent) versus 27% (11/41 patients, autoperfusion balloon) (p = 0.02). CONCLUSIONS: Autoperfusion balloon angioplasty and endoluminal stenting are effective and safe therapeutic options for abrupt or threatened closure following coronary angioplasty with a comparable short-term clinical and angiographic outcome. However, during follow-up, more complications occur following autoperfusion balloon angioplasty. This is explained by a higher restenosis rate in this treatment group.

Adult↗
PubMed1995

[Balloon angioplasty for restenosis of coronary endoprostheses].

Between March 1991 and June 1994, the authors treated restenosis (> or = 50%) of coronary endoprostheses in 17 men aged 39 to 72 years by balloon angioplasty. The stents had been implanted for de novo stenosis in 14 patients, restenosis in 1 patient and for acute occlusion in 2 patients. The vessels treated were the left anterior descending artery (1 case), the left circumflex artery (2 cases), the right coronary artery (7 cases) and venous bypass grafts (7 cases). The endoprostheses used were 5 Wallstents in 4 patients, 13 Wiktor stents in 11 patients and 2 Palmaz-Schatz in 2 patients. Clinically, the patients with restenosis presented with class II angina (6 patients), class III (8 patients) and class IV (3 patients) of the Canadian Cardiovascular Society Classification. Conventional balloon angioplasty was performed 17 months (range: 3 to 87 months) after stent implantation and resulted in immediate clinical and angiographic success (residual stenosis < or = 50% on quantitative analysis) in all patients. In particular, there were no dissections. The minimal lumenal diameter (MLD) and percentage stenosis changed from 1.04 mm (range: 0.87 to 1.20) and 72% (range: 68 to 76) respectively before stent implantation to 2.83 mm (range: 2.46 to 3.20) and 23% (range: 20 to 27) after stent implantation. Restenosis resulted in a MLD and percentage stenosis of 0.89 mm (range: 0.77 to 1.01) and 73% (range: 69 to 78) respectively. After angioplasty of the stent, they returned to 2.68 mm (range: 2.29 to 3.06) and 27% (range: 23 to 30) respectively. The patients were not anticoagulated after angioplasty.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Coronary angioplasty versus left internal mammary artery grafting for isolated proximal left anterior descending artery stenosis.

Coronary artery bypass grafting (CABG) and percutaneous transluminal coronary angioplasty (PTCA) are more effective than medical treatment for the management of ischaemic heart disease. However, patients with single-vessel involvement have been excluded from prospective comparisons of the two methods. We have carried out such a comparison in patients with isolated proximal left anterior descending artery stenosis, conserved left ventricular function, and documented ischaemia. Eligible patients presenting to a single centre were randomly assigned PTCA (68 patients) or left internal mammary grafting (66). The procedures were technically feasible in all cases. The incidence of in-hospital complications was 2% (perioperative myocardial infarction) for CABG and 3% (emergency CABG for acute closure) for PTCA. Clinical and functional status improved similarly in both groups. However, patients in the PTCA group took more antianginal drugs. At median follow-up of 2.5 years, 86% of CABG-treated and 43% of PTCA-treated patients were free from adverse events (p < 0.01; relative risk 2.0 [95% CI 1.7-2.3]). The adverse events that explain this difference were restenosis (32%) requiring subsequent surgical (16%) or percutaneous (15%) revascularisation (1% had medical therapy). Rates of cardiac death and myocardial infarction did not differ between the groups. Both CABG and PTCA improve the clinical status of symptomatic patients with single-vessel coronary artery disease. If patient and physician accept the risk of restenosis and reintervention associated with PTCA, this procedure remains a suitable option and a simpler initial alternative to CABG.

Angioplasty, Balloon, Coronary↗
PubMed1994

Stent shortening and elongation: pitfalls with the Wiktor coronary endoprosthesis.

This report demonstrates two specific complications that occurred during implantation of a Wiktor (Medtronic, Inc., Minneapolis, MN) coronary stent: stent shortening and elongation were observed and attributed to the unique coil structure of the device. Major cardiac events occurred during follow-up as a consequence of this stent deformation. Therefore, semiurgent bypass surgery should be considered to treat this complication.

Aged↗
PubMed1994

Endoluminal stenting of narrowed saphenous vein grafts: long-term clinical and angiographic follow-up.

From April 1986 through April 1993, 58 intracoronary stents (41 Wall and 17 Wiktor stents) were implanted for the treatment of saphenous vein graft stenosis in 40 symptomatic patients. The indication was a primary stenosis in 44 and restenosis in 14 procedures. In-hospital complications were subacute stent thrombosis (2%), myocardial infarction (2%), and emergency coronary artery bypass grafting (CABG) (2%). Complications during a mean follow-up period of 42+/-27 months were restenosis (35% by patient, 33% by lesion), myocardial infarction (12%), late bypass grafting (12%), and death (7%). On quantitative coronary angiographic analysis, the mean minimal luminal diameter (and its confidence interval) increased from 1.3 mm (1.1-1.5 mm, preprocedure) to 2.9 mm (2.7-3.1 mm, postprocedure) and 2.2 mm (2.0-2.5 mm, 6 months follow-up, 95% angiographic follow-up). Progression of the underlying coronary artery disease and restenosis were the main reasons for a continual decline of the proportion without cardiac event on a Kaplan-Meier estimate. Restenosis occurred in one-third of cases beyond the first 6 months of follow-up. A relative risk ratio analysis for restenosis, performed on 14 variables, disclosed an increased risk for the following variables: (1) stenting of the proximal, distal or anastomosis part of the vein graft (relative risk 2.41, confidence interval: 1.28-3.59), (2) the implantation of stents < 4.5 mm (2.59, 1.18-4.00), and (3) stenting of a redo-CABG vein graft (2.37, 1.17-3.58). Saphenous vein graft stenting seems to be characterized by excellent immediate clinical and angiographic results; in particular, stent thrombosis is rare.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Complications and follow-up after intracoronary stenting: critical analysis of a 6-year single-center experience.

From April 1986 through April 1992, 123 patients received 153 intracoronary stents (131 Medinvent, 13 Palmaz-Schatz, 9 Wiktor) during 131 procedures. The indication was bail-out treatment in 39, restenosis in 59 native coronary arteries, and stenosis or restenosis in 33 vein grafts. Stent-related events were studied during the in-hospital stay and on follow-up and included closure, stent restenosis, myocardial infarction, death, and the need for coronary bypass surgery. A Kaplan-Meier estimate extended to 6 years showed different short- and long-term outcomes for the distinct treatment groups (p < 0.05): right coronary artery stenting (more particularly, stenting for restenosis after angioplasty) had the lowest and vein graft stenting had the highest stent-related complication rate. The complication rate was similar (p > 0.25) (1) in the case of multiple nontandem stent implantation during the same procedure; (2) for the different endoprosthesis sizes; and (3) during the different procedural years. In native coronary arteries, restenosis after angioplasty of the right coronary artery could be a preferential indication for coronary artery stenting. Despite a favorable short-term outcome, vein graft stenting has a high incidence of events on long-term follow-up, mainly because of late restenosis. Multiple nontandem stenting during the same procedure is not associated with a higher incidence of complications, in particular, the restenosis rate is not appreciably higher. Finally, only a minor benefit for the learning curve is apparent from this single-center experience with continual unchanged postprocedural management.

Adult↗
PubMed1994

Coronary angioplasty in octogenarians: immediate and long-term results and comparison with a younger population.

The safety and efficacy of percutaneous transluminal coronary angioplasty (PTCA) was examined in a group of 91 octogenarians during 133 consecutive procedures and compared to the younger part of our PTCA population (3,443 procedures) during an 8-year study period. Most octogenarians presented with refractory or unstable angina pectoris and multivessel involvement, but had normal left ventricular function. The angiographic success rate was 84%. Technical failure was observed in 12% of cases and complications in 14%. Two early procedure related deaths were observed. Restenosis was estimated at 24%. The proportion surviving and the proportion without cardiac event estimated by the Kaplan-Meier method at 2 years were 0.89 and 0.60, respectively. In comparison to the younger population, the immediate angiographic success was lower as a result of a higher incidence of technical failure (P less than 0.05). Otherwise, no difference in terms of restenosis or overall related complication rate was noted (P greater than 0.1). It is concluded that PTCA is an efficient and safe therapeutic option for octogenarians with severe or refractory angina pectoris. Technical failure is more frequently observed than in younger patients and explains a lower immediate angiographic success. Nevertheless, at 2-years follow-up, a large majority of patients are alive and asymptomatic.

Age Factors↗
PubMed1993

Initial experience with a new balloon-on-a-wire catheter: the Bijou.

This paper presents our initial experience with a new low-profile balloon "on-a-wire" catheter, the Bijou. The concept of this balloon is to provide an additional side lumen with the advantages of (1) the ability to measure pressure gradient, (2) the possibility of drug infusion, and (3) the ability to advance a steerable guidewire through this side lumen. The balloon has been tested in 15 patients; 14 underwent an elective procedure for stable angina pectoris (with 2 cases of restenosis) and one an emergency angioplasty in a case of acute myocardial infarction. The stenosis was located on the left anterior descending artery in 11 procedures, on the right in 3, on a marginal branch in 2, on the circumflex and a saphenous vein graft in 1. All stenoses could be dilated successfully (residual stenosis < 25%). The transstenotic pressure gradient felt from 49 +/- 13 mmHg to 7 +/- 4 mm Hg after angioplasty. Except for an uncomplicated dissection in 3 patients, no other complication was noted. With this new catheter, the double-lumen configuration adds the advantages of an "over-the-wire" to an "on-a-wire" system.

Aged↗
PubMed1993

Retrieval of a migrated coronary stent by means of an alligator forceps catheter.

Stent migration and embolization are well-known complications of intracoronary stenting with balloon-mounted stents. During an elective stenting procedure of a proximal right coronary artery stenosis, a 3.5 mm Wiktor stent (Medtronic Inc., Minneapolis) was displaced from its delivery balloon. The guiding catheter and the delivery system were withdrawn, leaving the stent around a 3 m 0.014 inch High Torque floppy guidewire (ACS, Santa Clara, CA) in the abdominal aorta. An 40 cm 5F Alligator Forceps catheter (Cook OB/Gyn., Spencer, IN), introduced through a cut-off 8F coronary guiding catheter, allowed improved torque control of the retrieval catheter and a safe and successful withdrawal of the stent through the arterial introducer sheet.

Angina Pectoris↗
PubMed1993

Coronary artery rupture during transluminal coronary recanalization and angioplasty in a case of acute myocardial infarction and shock.

Percutaneous transluminal coronary angioplasty (PTCA) is a widely performed and effective therapy for coronary artery disease. Evolution of the dilatation instruments during the last decade has led to an increased success rate of PTCA and to the development of newer techniques such as recanalization of totally occluded coronary arteries. We report a case of coronary artery recanalization complicated by fatal coronary artery rupture.

Aged↗
PubMed1993

Semiquantitative analysis of cerebral blood flow by means of 99Tcm-HMPAO SPECT in individuals before and after a high altitude Himalayan expedition.

Nine members of the 'Belgian Tibet Expedition 1991' underwent a 99Tcm-hexamethylpropyleneamine oxime (HMPAO) brain single photon emission computed tomographic study before and after their stay at high altitude. Cerebral and cerebellar activity were analysed in three circumference profiles, representing the lower, middle and upper transaxial sections of the brain. The count value of each volume element (VE) was normalized to the maximum cerebellar value. In order to compare individual regional cerebral blood flow (rCBF) before and after the expedition, the relative differences in rCBF were calculated for each VE as: rel delta (%) = 100 x (value after expedition - value before expedition)/value before expedition. In 4/9 cases regional rel delta values were negative in most cortical regions; in 3/9 individuals nonsignificant changes were found and 2/9 climbers showed a positive rel delta value in most cortical regions. For the group as a whole there was (1) a mean decrease of 1.7% in global cortical CBF and (2) a significantly (P < 0.01) diminished rCBF was observed in both temporal and the left frontotemporal areas.

Adult↗
PubMed1990

The reduction of the leprosy endemicity in northeastern Zaire 1975/1989.

The leprosy endemy in Uele, North Eastern region of Zaire has declined considerably since the 1950's, particularly since 1975. The hypothesis is advanced that the most important causal factor has been the distribution of dapsone for many years, through a vertical programme. The gradual increase of dapsone resistance has been taken care of by the introduction of combined, multidrug therapy in the 1980's. The cost per patient detected and treated rises in inverse proportion to the decline in endemy; therefore, the time has come for the integration of a leprosy control in the primary health care strategy. However, central specialized teams financed by voluntary organisations should be maintained to assure training of personnel, to give advice in diagnosis, prevention and treatment of complications, to provide drugs and to assist in rehabilitation.

Dapsone↗
PubMed1990

Detection of late potentials on the averaged QRS signal recorded at rest and during a standardized stress test after acute myocardial infarction.

The high-amplification signal-averaged ECG (SAECG) allows the detection and analysis of late potentials (LP), which are related to a higher risk of severe ventricular arrhythmias in patients with myocardial disease and coronary artery disease. Because of excessive noise, this technique is usually performed at rest and occasionally immediately after interruption of exercise. Until now, however, it has not been used during exercise. The authors relate in this paper the method and results of the SAECG recorded at rest and during a standard stress test on 30 patients with a recent first myocardial infarction (day 10-14), in good condition, without ECG evidence of significant residual ischemia or bundle branch block. The SAECG was recorded during the steady state of a standardized stress test when a heart rate (HR) corresponding to 80% of the maximal HR was reached during a first test. Three patients had three criteria for LP, three others had two criteria, and two had only one. It has been impossible to analyze the SAECG during exercise because of excessive noise. One patient out of 30 in our study, 21 subjects had normal SAECG at rest and during exercise. None of the 6 patients with more than 1 abnormal criterion at rest became normal during the stress test despite a decrease of the duration criteria in all and an increase of the amplitude (root mean square) the terminal 40 ms (RMS40), as opposed to the 2 patients with just one positive criterion at rest (RMS 40 less than 25 muV) who became normal during exercise.(ABSTRACT TRUNCATED AT 250 WORDS)

Arrhythmias, Cardiac↗
PubMed1990

[The evaluation of an anti-leprosy program in Uélés (1975-1989)].

Foperda, who took over and continued the work initiated in 1924 by the Congo Red Cross, is responsible for the programme of fight against leprosy in the Ueles region (Zaire). Important results have been obtained since 1975 in the framework of a specialised medical service. These results are exposed and discussed herebelow. The evolution of the endemic leprosy in the region under survey allows to contemplate new trends for the pursuit of the programme in the coming years (controlled integration within polyvalent health services).

Democratic Republic of the Congo↗
PubMed1989

Monitoring of bone mineral content in patients on regular hemodialysis.

Bone mineral content (BMC) was measured at the lumbar spine region by means of dual photon absorptiometry over a 3-year period in 20 patients on regular hemodialysis (RHD). Baseline mean BMC at the start of the monitoring was significantly decreased to 82.64% of predicted value (p less than 0.05). During a 3-year follow-up mean BMC rose significantly to 90.61% (p less than 0.05). Six patients received vitamin D supplements. Analysis of the data showed that rise of BMC was similar whether vitamin D was given or not. Our data suggest that (1) RHD inhibits bone loss at the lumbar spine level that occurred mainly before active uremia treatment and (2) the increment of BMC observed in this study can be attributed to the different site of measurement, the inaccuracy of the measurements by interference with soft tissue calcifications and the dialysis conditions.

Biomarkers↗