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F Alfonso

Publications and source records attributed to F Alfonso.

At least 37 records · Page 2Linked to original sources
PubMed2001

Acute stent thrombosis visualized by intravascular ultrasound.

Subacute stent thrombosis is currently a rare but feared complication in patients undergoing coronary intervention. Intravascular ultrasound is a useful technique to guide stent implantation. However, its value in patients suffering from acute stent thrombosis has not been described. Herein, we present the intravascular ultrasound findings of a patient experiencing ongoing stent thrombosis and impending vessel closure.

Adult↗
PubMed2000

Initial results and long-term clinical and angiographic outcome of coronary stenting in women.

To assess whether gender influences the results of coronary stenting, 158 consecutive women undergoing coronary stenting were compared with 823 consecutive men. Women had more adverse baseline characteristics, a higher hospital mortality, and were independently associated with procedural failure/complications (relative risk 2.4, 95% confidence interval 1.2 to 4.8); however, the long-term event-free survival and the restenosis rate were not influenced by gender.

Age Factors↗
PubMed2000

Fate of stent-related side branches after coronary intervention in patients with in-stent restenosis.

OBJECTIVES: We sought to assess the fate of stent (ST)-related side branches (SB) after coronary intervention in patients with in-ST restenosis. BACKGROUND: In-ST restenosis constitutes a therapeutic challenge. Although the fate of lesion-related SB after conventional angioplasty or initial coronary stenting is well established, the outcome of ST-related SB in patients with in-ST restenosis undergoing repeat intervention is unknown. METHODS: One hundred consecutive patients (age 61 +/- 11 years, 22 women) undergoing repeat intervention for in-ST restenosis (101 ST) were prospectively studied. Two hundred and twenty-six SB spanned by the ST were identified. The SB size, type, ostium involvement, location within the ST and take-off angle were evaluated. The SB TIMI (Thrombolysis in Myocardial Infarction trial) flow grade was studied in detail before, during, immediately after the procedure, and at late angiography. RESULTS: Occlusion (TIMI flow grade = 0) was produced in 24 (10%) SB, whereas some degree of flow deterioration (> or = 1 TIMI flow grade) was observed in 57 SB (25%). The SB occlusion was associated with non-Q wave myocardial infarction in two patients (both had large and diseased SB). Side-branch occlusion at the time of initial stenting (RR [relative risk] 11.1, 95% CI [confidence interval] 3.5-35.5, p < 0.001), diabetes (RR 3.5, 95% CI 1.1-10.5, p = 0.02), SB ostium involvement (RR 5.0, 95% CI 1.4-17.2, p = 0.004), baseline SB TIMI flow grade <3 (RR 5.5, 95% CI 1.7-18.1, p = 0.005), and restenosis length (RR 1.05 95% CI 1.01-1.11, p = 0.03) were identified as independent predictors of SB occlusion. Late angiography in 19 initially occluded SB revealed that 17 (89%) were patent again. The long-term clinical event-free survival (81% vs. 82% at two years) in patients with and without initial SB occlusion was similar. CONCLUSIONS: Occlusion or flow deterioration of SB spanned by the ST is relatively common during repeat intervention for in-ST restenosis. Several factors (mainly anatomic features) are useful predictors of this event. However, most SB occlusions are clinically silent and frequently reappear at follow-up.

Adult↗
PubMed2000

Stenting the stent: initial results and long-term clinical and angiographic outcome of coronary stenting for patients with in-stent restenosis.

Stent restenosis constitutes a therapeutic challenge affecting an increasing number of patients. Conventional angioplasty and debulking techniques are currently used in these patients. However, the potential role of a second stent implantation in this setting (stenting the stent) remains unknown. Therefore, 65 consecutive patients (12 women, aged 62 +/- 11 years) undergoing stent implantation (42 elective and 23 unplanned) for the treatment of in-stent restenosis (diffuse [> 10 mm] in 39 [60%]) were studied. Angiographic success was obtained in all patients. Three patients developed hospital complications: 1 died from refractory heart failure and 2 suffered non-Q-wave myocardial infarctions. During follow-up (mean 17 +/- 11 months) 1 patient died (noncardiac cause) and only 9 (14%) required target vessel revascularization. Kaplan-Meier event-free survival (freedom from death, myocardial infarction, and target vessel revascularization) at 1 year was 84%. Using Cox analysis, patients with unstable symptoms, a short time to stent restenosis, nonelective stenting, and B2-C lesions tended to have poorer prognosis. After adjustment, nonelective stenting was associated (adjusted RR 2.9, 95% confidence interval [CI] 0.82 to 10.3, p = 0.09) with an adverse clinical outcome. On quantitative angiography (core lab) restenosis was found in 13 of 43 patients (30%) (75% of those eligible). Logistic regression analysis identify restenosis length (adjusted RR 1.43, 95% CI 1.04 to 2.14, p = 0.04), and time to restenosis (adjusted RR 0.67, 95% CI 0.47 to 0.94, p = 0.01) as the only independent predictors of recurrent restenosis. Thus, repeat coronary stenting is a safe and efficacious strategy for the treatment of patients with in-stent restenosis. Both elective and nonelective stenting provide excellent initial results. The long-term clinical and angiographic outcome of these patients is also favorable.

Coronary Angiography↗
PubMed2000

Pressure wire kinking, entanglement, and entrapment during intravascular ultrasound studies: a potentially dangerous complication.

The simultaneous use of intravascular ultrasound catheters and sensor-tipped guidewires is gaining acceptance during coronary interventions as a means to gain further insights on the significance of coronary stenoses. Herein we describe four patients in whom the distal tip of the pressure wire became entrapped during an intravascular ultrasound examination. In the four patients, a localized kinking of the pressure wire initially prevented the removal of the imaging catheter and eventually the wire-catheter assembly had to be retrieved as a unit into the guiding catheter. In one patient, unraveling of the distal part of the pressure wire was noticed. In two patients, a complete loop with further kinking of the pressure wire was induced during the maneuvers performed to withdraw the imaging system. Three patients experienced transient angina. Although in our patients this technical problem was not associated with any clinical sequelae, interventional cardiologists should be aware of the potential complications associated with the combined use of these two intracoronary diagnostic tools.

Cardiac Catheterization↗
PubMed2000

Guidewire-induced coronary pseudostenosis as a source of error during physiological guidance of stent deployment.

Coronary pseudostenoses are a known result of the interaction between tortuous vessels and guidewires and are generally handled by the interventionalist as inocuous side effects of intracoronary instrumentation. The present report demonstrates that pseudostenosis may have hemodynamic relevance and may constitute an important source of error when physiological guidance of percutaneous procedures is performed using sensor-tipped guidewires.

Aged↗
PubMed2000

[The practical clinical guidelines of the Sociedad Española de Cardiología on interventional cardiology: coronary angioplasty and other technics].

Interventional cardiology has had an extraordinary expansion in last years. This clinical guideline is a review of the scientific evidence of the techniques in relation to clinical and anatomic findings. The review includes: 1. Coronary arteriography. 2. Coronary balloon angioplasty. 3. Coronary stents. 4. Other techniques: directional atherectomy, rotational atherectomy, transluminal extraction atherectomy, cutting balloon, laser angioplasty and transmyocardial laser and endovascular radiotherapy. 5. Platelet glycoprotein IIb/IIIa inhibitors. 6. New diagnostic techniques: intravascular ultrasound, coronary angioscopy, Doppler and pressure wire. For the recommendations we have used the classification system: class I, IIa, IIb, III like in the guidelines of the American College of Cardiology and the American Heart Association.

Angioplasty, Balloon, Coronary↗
PubMed2000

[Spanish Registry of the Section of Hemodynamic and Interventional Cardiology Activity for 1999].

The results of the Spanish Registry of Hemodynamic and Interventional Cardiology in 1999 are presented. The activity of 90 centers representing all the cardiac catheterization laboratories in Spain is reported, with 83 centers performing mainly adult cardiac catheterization and 7 centers exclusively carrying out pediatric cardiac catheterization. In 1999, a total of 82,805 diagnostic catheterization procedures, 79% being coronary angiographies (65,234; 1,637 per million inhabitants), were performed, representing a total increase of 11.4% compared to 1998. Compared to 1998, coronary intervention increased by 14.2%, with a total number of 23,010 procedures. The ratio of coronary interventions per million inhabitants was 590. Success rates for coronary interventions (94%) and complications (2.2%) were similar to those registered in previous years, and in 12.4% of the cases IIb-IIIa glycoprotein inhibitors were used. Ten point two per cent of the procedures were performed to treat acute myocardial infarction. Coronary stenting is the main device for coronary intervention. In 1999, coronary stents were used in 17,783 cases (23% increase compared to 1998), representing 77.3% of all coronary revascularization procedures. A total of 22,946 prostheses were implanted, 87% electively and 21.4% as a primary stenting procedure, with a low rate of complications (0.85% subacute closure, 1.95% myocardial infarction and 0.9% mortality). Compared to 1998, both directional coronary atherectomy (52 procedures) and rotational atherectomy (473 procedures) showed a slight decrease.A slight increase (4% compared to 1998) was reported in adult valvuloplasties (525 vs 505)while pediatric interventional procedures increased by 21% (678 vs 557 procedures) compared to 1998. In conclusion, we would like to underline the high degree of laboratory participation in the Registry, and despite the increase in activity, the current rates remain lower than European figures.

Adult↗
PubMed2000

Successful sealing of an angioplasty-related saphenous vein graft rupture with a PTFE-covered stent.

A patient developed severe hemodynamic compromise after saphenous vein graft rupture during high-pressure coronary stent deployment. Immediate balloon inflation followed by implantation of a polytetrafluoroethylene-covered stent solved the problem. The next day, follow-up angiography confirmed persistent sealing of the rupture site. Clinical and angiographic features of vessel rupture during coronary angioplasty as well as several therapeutic options for this complication are discussed.

Aged↗
PubMed1999

Propensity and mechanisms of restenosis in different coronary stent designs: complementary value of the analysis of the luminal gain-loss relationship.

OBJECTIVES: This study sought to investigate the influence of stent design on the long-term angiographic outcome. BACKGROUND: The proportional relationship between vessel injury and late luminal loss in percutaneous revascularization should be best appreciated in coronary stenting, where recoil and shrinkage are theoretically minimal. It is unclear whether all stent designs can counterbalance this reactive loss by achieving a large initial luminal gain (bigger is better). METHODS: In 523 lesions successfully stented, the long-term angiographic results of slotted-tube (n = 331), coil (n = 85), multicellular (n = 70) and self-expandable mesh (n = 37) stent designs were compared using the angiographic gain-loss relationship (GLR). RESULTS: Restenosis rate was 10% for multicellular, 20% for slotted-tube, 46% for coil and 49% for self-expandable designs (p = 0.001). At a difference with other designs, no significant GLR was found in coil stents, suggesting additional mechanisms of luminal loss (i.e., plaque protrusion, stent compression) to neointimal proliferation. Significant differences in late loss between stents were found within each quartile of luminal gain, suggesting a specific role of design in luminal loss. Multivariate analysis identified use of coil and self-expandable stents, vessel size, minimal luminal diameter preintervention, luminal gain and stent length as variables with independent predictive value for several indices of angiographic long-term outcome. CONCLUSIONS: The analysis of GLR: 1) demonstrates that stent design influences late luminal loss; 2) challenges the applicability of the widely accepted "bigger is better" approach to all stent designs; and 3) appears as a valuable tool in assessing long-term stent performance.

Coronary Angiography↗