PubMed Health⌕ Search

Biomedical subjects

Iñigo Lozano

Publications and source records attributed to Iñigo Lozano.

At least 19 recordsLinked to original sources
PubMed2007

One-year results of unprotected left main disease treatment with paclitaxel-eluting stents: results of a multicenter registry.

BACKGROUND: Preliminary data suggest that drug-eluting stents might have a role in selected cases of unprotected left main stenosis (ULMS). The purpose of this study was to determine the rates of death, myocardial infarction, and repeated revascularization in a multicenter, prospective series of patients with ULMS treated with paclitaxel-eluting stents. METHODS: A prospective registry was initiated in March 2003 through December 2004 in five tertiary centers including all patients with a significant (>50%) stenosis in ULMS treated with at least one paclitaxel-eluting stent. There were no clinical or angiographic exclusion criteria. Clinical follow-up was obtained at 6 and 12 months. RESULTS: A total of 100 patients were included. Mean age was 67.6 +/- 11.4 years and 36% were diabetics. Distal left main was affected in 53% of patients. Implantation of two stents was required in only 15%. Angiographic success was achieved in all cases. Significant periprocedural CK-MB elevation occurred in 5 patients and there was 1 intraprocedural death. At a median 9 months follow-up, cardiac death occurred in 7%, the majority of which (4%) in patients with ST-elevation myocardial infarction and cardiogenic shock before stent implantation. Only 3 patients (3%) required repeated target-vessel revascularization, all repeated angioplasty procedures. CONCLUSION: Percutaneous treatment of unprotected left main lesions with paclitaxel-eluting stents is associated with acceptable mid-term results in selected patients, with very low rates of repeated revascularization.

Aged↗
PubMed2006

Intimal dehiscence during endovascular treatment of thoracic aortic dissection.

Endovascular treatment of thoracic aortic pathology has become a valuable alternative therapeutic option to open surgery, however complications both during implantation and the postoperative period may occur. In this case report we present an intimal dehiscence during endovascular procedure. Diagnosis was made by transoesophageal echocardiography.

Aortic Dissection↗
PubMed2006

An incidental finding during cardiac catheterization.

Coronary artery obstruction during cardiac catheterization is rare. It is a serious complication and has been reported to occur in 0.15 to 0.5% of cases. Thromboembolism, air embolism and coronary dissection have been described as the most common causes of intraprocedural coronary occlusion. Aortic valve masses can also cause coronary obstruction. We report the case of a young woman with a complication and an incidental finding during angiographic procedure. A surgical treatment was needed.

Adult↗
PubMed2006

[Comparison between theoretical an actual intracoronary stent dimensions in non-complex lesions].

The minimum in-stent lumen diameter is a predictor of restenosis. Stent dimensions provided by manufacturers are derived from in vitro tests. The aim of this study was to compare actual stent dimensions obtained by angiography and intracoronary ultrasound with dimensions that would be expected theoretically for a given inflation pressure in a cohort of 100 non-complex lesions suitable for direct stenting. Significant differences were found between the theoretical diameters and those observed by angiography and ultrasound. The actual-to-theoretical diameter ratio was 0.83 (0.09) when measured using angiography and 0.78 (0.10), using intravascular ultrasound. In lesions without severe calcification, stent dimensions were significantly smaller than indicated by the manufacturer. Nominal figures should not be used as reference values for stent implantation.

Angioplasty, Balloon, Coronary↗
PubMed2006

Should the left main be covered entirely with drug-eluting stents in percutaneous intervention.

Restenosis after percutaneous intervention in the left main coronary artery may present as sudden cardiac death. Although drug-eluting stents have demonstrated promising results, there remains the question about appropriate length of the left main artery to be covered with the stent. We describe a patient who received two drug-eluting stents with the balloon crushing technique in the distal left main coronary artery. Three months later, this patient presented with a new lesion in the segment of the left main artery not covered with stent, but instead at the site where the balloon was inflated in the initial procedure.

Angioplasty, Balloon, Coronary↗
PubMed2005

[Percutaneous treatment of thoracic aorta diseases. A multidisciplinary approach].

INTRODUCTION AND OBJECTIVES: The purpose of this study was to evaluate the experience of a multidisciplinary team in the percutaneous treatment of thoracic aorta disease. PATIENTS AND METHOD: Between December 2001 and January 2004, 15 patients were selected for percutaneous treatment at the Thoracic Aorta Unit of the Hospital Universitario Central de Asturias. The motives for stent implantation were: degenerative aneurysm (n=7), acute dissection (n=4), penetrating atherosclerotic ulcer (n=1), posttraumatic aneurysm (n=2) and postsurgery pseudoaneurysm (n=1). Four procedures were considered emergencies. Another two patients underwent prior surgery of the supra-aortic branches. Previous computed tomographic angiography and arteriography were performed, and in complex cases of dissection, magnetic resonance imaging was used. All stent placement procedures were performed in the hemodynamics laboratory. All patients underwent computed tomographic angiography during follow-up. RESULTS: Stent positioning was technically successful in 14 patients. The mean length of aortic coverage was 230 +/- 110 mm (range 110-440 mm). No intraoperative deaths occurred. There was one in-hospital death. Transient postimplantation syndrome was presented in three patients. Two type I endoleaks, one type II endoleak and one thrombosis of the superior mesenteric artery were found on computed tomographic angiography at one month. One type III endoleak and one type II endoleak were found during subsequent follow-up. CONCLUSIONS: Endovascular stent-grafting is a valid alternative in the treatment of aortic disease in high-risk patients. Coordination between different medical specialties and appropriate selection of patients are needed. Long-term follow-up is necessary to ensure the usefulness and efficacy of the procedure.

Aorta, Thoracic↗
PubMed2005

[Drug-eluting stents in patients with left main coronary lesions who are not candidates for surgical revascularization].

INTRODUCTION AND OBJECTIVES: Surgical revascularization is the treatment of choice in patients with left main coronary artery stenosis. Conventional stents are not a valid alternative because of the rate of restenosis and sudden cardiac death. Drug-eluting stents, which reduce the rate of restenosis, may represent an alternative to cardiac surgery. The objective of this study was to describe the results with drug-eluting stents in patients with left main coronary artery stenosis who were poor candidates for surgical revascularization. PATIENTS AND METHOD: We prospectively followed a consecutive series of patients who were poor candidates for surgical revascularization and were treated with implantation of a drug-eluting stent in the left main coronary artery between May 2002 and April 2004. In-hospital and long-term results were analyzed. Follow-up included angiographic and intravascular ultrasound (IVUS) studies. RESULTS: Forty-two patients (25 men, 59.5%) with a mean age of 70.1 (10.5) years were studied. Fourteen (33%) had diabetes, and 7 (16.7%) had a protected left main coronary artery. The reasons for ruling out surgery were poor distal vessels in 19 (45.2%), previous surgery in 9 (21.4%), age in 6 (14.3%), primary angioplasty in 5 (11.4%), and other reasons in 3 (7.2%). Four patients (9.5%) died before discharge, three of them after primary angioplasty. No in-hospital revascularization procedures were needed. Median follow-up time was 288 days; mean follow-up time was 315 (241) days. Another four patients died after discharge (9.5%) on days 5, 24, 34 and 115. Angioplasty was repeated in one patient, and another was referred for heart transplantation. CONCLUSIONS: Drug-eluting stents represent a valid alternative in patients with left main coronary artery stenosis who are poor candidates for surgical revascularization. Randomized studies with a longer follow-up should be performed to evaluate their benefits in patients eligible for surgery.

Adult↗
PubMed2005

[Direct stenting in saphenous vein grafts. Immediate and long-term results].

INTRODUCTION AND OBJECTIVES: Percutaneous interventions on saphenous vein grafts are associated with a worse outcome than in native vessels, mainly because of the risk of embolization. Direct stenting may diminish aggression to the vessel. This study reports the results of direct stenting in saphenous vein grafts. PATIENTS AND METHOD: We compared 2 cohorts of consecutive patients treated with direct stenting (DS) and stenting with predilatation (PD) in saphenous vein grafts between September 1998 and March 2003. In-hospital and long-term results and predictors of mortality were analyzed. RESULTS: The DS group contained 71 patients with 83 lesions, and the PD group contained 46 patients with 54 lesions. There were no differences in age, risk factors, age of the graft, ejection fraction, stent length, need for postdilatation or number of stents per lesion, although the DS group contained more women (DS=38%, PD=17%, P=.02), and stent diameter was larger (DS=3.59 [0.59] mm, PD=3.21 [0.59] mm, P=.001) in the DS group. Creatine phosphokinase elevation was > or =2-fold in 10% (DS=7%, PD=16%, P=.1). One patient died in the hospital. Median follow-up time was 36.1 months. Survival was 94+/- 2% at 12 months, 87+/-3% at 24 months, 82+/-17% at 36 months, 67+/-8% at 48 months and 58+/-7% at 60 months. Revascularization rate was 14% for the target lesion and 20.5% for the target vessel, with no differences between groups in mortality or revascularization success rate. Predictors of mortality were ejection fraction and smoking habit. CONCLUSIONS: Survival after stenting in saphenous vein grafts is similar with direct and conventional techniques, although there was a tendency toward a lower incidence of myocardial infarction with the former. Although the in-hospital results were favorable, long-term survival was less favorable with both techniques.

Aged↗
PubMed2005

[Cardiac catheterization via the right radial artery with a Judkins left catheter. A prospective study].

Radial artery access improves the patient's well-being, permits earlier ambulation and diminishes vascular complications after cardiac catheterization. Using the same catheter to study the left and right coronary arteries may facilitate the technique. In a cohort of 100 patients we prospectively analyzed the possibility of studying both coronary arteries with a Judkins left 3.5 catheter. The variables studied were percentage of successful access, complications, and procedural time from insertion of the guiding catheter to the end of ventriculography. It was possible to catheterize both coronary arteries with the same catheter in 94 cases (94%) with a procedural time of 16.7 (6.8) min. In 6 patients a JR4 catheter was required, in one of them due to severe spasm of the right coronary artery ostium and due to impossibility to catheterize the ostium in the other 5. There were no cases of severe radial artery spasm.

Aged↗
PubMed2004

Percutaneous intervention over the origin of a saphenous vein graft anastomosed with the St. Jude Medical Symmetry Aortic Connector System.

We describe a percutaneous intervention performed over the proximal anastomoses of an aortocoronary saphenous vein graft that had been attached to the aorta 3 months before with the St. Jude Medical Symmetry Aortic Connector System. Technical aspects of procedure are discussed, and the experience previously reported in the literature related to this issue is reviewed.

Aged↗
PubMed2004

Utility of the fractional flow reserve in the evaluation of angiographically moderate in-stent restenosis.

AIMS: The evaluation of in-stent restenosis (ISR) is usually based on angiographic quantification. This evaluation is sometimes difficult and it has not an accurate clinical correlation. Fractional flow reserve (FFR) measured by intracoronary pressure wire has demonstrated its value in determining the functional repercussion of coronary stenosis. The aim of this study was to evaluate the relation between quantitative angiography-FFR in borderline in-stent restenotic lesions and the accuracy of FFR in deciding the treatment of ISR. METHODS AND RESULTS: Quantitative angiographic values of 65 lesions in 62 patients with angiographically moderate ISR are compared with the FFR value obtained by pressure wire. An FFR value<0.75 was considered significant. Patients with non-revascularized ISR (FFR > or = 0.75) were clinically followed during a year. An FFR value > or = 0.75 was obtained in 41 lesions (63%), 21 of them with stenosis > or = 50%. The co-efficient of correlation between parameters of quantitative angiography and FFR value was <0.5. No events related to the non-treated lesions were observed. CONCLUSIONS: A poor correlation between angiographic quantification and FFR of moderate ISR was found. Conservative management of moderate 40-70% in-stent restenotic lesions with FFR value > or = 0.75 is safe avoiding unnecessary revascularizations based solely on the angiography.

Cohort Studies↗
PubMed2004

[Direct stenting without predilatation: influence of stent diameter on the immediate results].

The influence of stent diameter in a direct stenting technique was analyzed. We retrospectively identified 987 consecutive lesions in 773 patients in whom direct stenting was attempted. Lesions were divided into two groups: group 1, nominal stent diameter 2.5 mm (237 lesions) and group 2, > or =2.75 mm (n=750). Differences between groups were found in age (64.4 [10.4] vs 62.3 [11] P=.009), female sex (33.2% vs 17%; P<.0001), diabetes (44% vs 33.1%; P=.003), tortuosity (5.4% vs 2.5%; P=.034), reference diameter (2.5 [0.3] vs 3.3 [0.6]; P<.0001) and location in distal segments (44.5% vs 29.4%; P<.0001). Primary deployment (85.5% vs 95.5%; P<.0001) and postdilatation success rates (1.9% vs 4.8%; P=.039) were higher in group 2, with no differences in vessel dissection rate (4.7% vs 4.4%; P=.85). Direct stenting with 2.5 mm stents was associated with a lower success rate than larger stents. Vessel tortuosity, angulation, calcification, lesion severity and distal location were also associated with a higher failure rate. The predictive power of our model was 0.87 (95% CI, 0.82-0.92).

Angioplasty, Balloon, Coronary↗
PubMed2004

[Comparison of intracoronary ultrasound expansion parameters in coronary stents implanted with or without balloon predilatation. A randomized intravascular ultrasound study].

INTRODUCTION AND OBJECTIVES: Coronary stenting without balloon predilatation is a safe technique associated with similar clinical results and lower costs, use of contrast and exposure to radiation in comparison to stenting with predilatation. After direct stenting, expansion may be reduced if the stenotic lesion was not predilatated. This study compared a). stent expansion with and without balloon predilatation (direct stenting), observed by intracoronary ultrasound, and b). angiographic results after 6 months and 1 year with the two implantation techniques. PATIENTS AND METHOD: 100 consecutive lesions eligible for direct stenting were randomized to stent implantation with or without balloon predilatation. Only <or=25 mm Multilink Duet/Tri-Star/Tetra or NIR Sox/Elite stents were used. When the angiographic result was considered optimal, an independent operator who had not been involved in the procedure performed an intracoronary ultrasound study. The ultrasound examination was not used in decision making unless there was a potential risk for the patient. Ultrasound parameters of expansion were compared in the two implantation techniques with systematic 6- to 9-month angiographic examinations and 1-year clinical follow-up. RESULTS: There were no clinical or baseline angiographic differences between the two groups. No significant differences were observed in the ultrasound expansion parameters or the rate of clinical events after 12 months of follow-up. Binary angiographic restenosis (23% vs 20%) and late loss index (0.92 [0.81] vs 0.88 [0.60]) did not differ significantly between the predilatation and direct stenting groups. CONCLUSIONS: Direct stenting was not associated with different ultrasound expansion parameters in comparison to the conventional technique. Angiographic restenosis and the rate of long-term clinical events were similar with both techniques.

Angioplasty, Balloon, Coronary↗
PubMed2004

[Short- and medium-term outcomes of percutaneous coronary intervention for unprotected left main coronary artery disease in patients who are poor candidates for surgical revascularization].

INTRODUCTION AND OBJECTIVES: Surgical revascularization is the procedure of choice for unprotected left main coronary artery stenosis, but it may be unsuitable in some patients. We report short- and medium-term outcomes of percutaneous coronary intervention for unprotected left main coronary artery stenosis in a series of patients who were poor candidates for surgery. PATIENTS AND METHOD: Descriptive study of a historic cohort of consecutive patients with unprotected left main coronary artery stenosis who were not candidates for surgery, treated with percutaneous coronary intervention at a single center between April 1999 and December 2003. RESULTS: A total of 83 patients (mean age 72 [9] years) were included. Twenty patients (24%) were in shock on presentation. Surgery was considered unsuitable because of unacceptable surgical risk, poor condition of the distal vessels or comorbid conditions in 61 (73.5%) patients, or acute myocardial infarction in 22 (27%). An intraaortic balloon pump was used in 34 (40%); abciximab in 30 (36%) and stenting in 79 (95%) procedures. The intervention was considered successful in 76 patients (92%). Total in-hospital mortality was 28.9% (55% in patients with acute myocardial infarction and 20% in those without acute myocardial infarction). Median follow-up was 17 months. Average survival was 19.7 (2) months. Eighteen (22%) patients were hospitalized again for a new ischemic event, and 14 (17%) underwent revascularization. In 9 cases (10.8%) a new angioplasty was performed, and in 5 (6.0%) surgical revascularization was necessary. CONCLUSIONS: Percutaneous coronary intervention is an option for revascularization in left main coronary artery stenosis in patients who are poor candidates for surgery, although in-hospital and long-term mortality remain high.

Aged↗
PubMed2003

[Angiographic results of thrombectomy performed with two new devices in lesions with intracoronary thrombus].

INTRODUCTION AND OBJECTIVE: The presence of intracoronary thrombus is associated with less favorable results of percutaneous coronary interventions. In recent years, new devices have been designed to improve the outcome of these procedures when an intracoronary thrombus is present. The results of two new systems of thrombectomy used in a single center are analyzed. METHODS: Prospective observational registry of the use of two thrombectomy devices, X-SIZER (EndiCOR Medical Inc., San Clemente, California, USA) and RESCUE (Boston Scientific Scimed, Inc., Maple Grove, Minnesota, USA), between 1 June 2000 and 15 February 2002. RESULTS. One hundred thirty-nine devices were used in 137 patients (112 RESCUE and 27 X-SIZER). The main indication was primary angioplasty for acute myocardial infarction (80%). In 7 patients (5%), unscheduled thrombectomy was performed for unexpected complications that appeared during the procedure. In 75% of patients, IIb/IIIa inhibitors were given. In 10 cases (7%) the device did not reach the lesion. Complications derived from the use of the device were recorded in 3 cases (2.1%). TIMI flow improved from 1.28 1.1 before thrombectomy to 2.31 1.2 after the procedure. Improvement in the thrombus image was observed in 86%. The intervention was successful in 86%. CONCLUSIONS: Thrombectomy with X-Sizer and Rescue improved the angiographic thrombus image in most cases and was associated to a low complication rate. Its efficacy compared to the conventional technique should be assessed in future trials.

Angioplasty, Balloon, Coronary↗
PubMed2002

[Clinical utilization of the coronary pressure wire].

INTRODUCTION: Earlier studies have established the value of coronary pressure wires for diagnosing and monitoring the treatment of patients with coronary artery disease. In this study we demonstrated their usefulness in the daily clinical practice of a catheterization laboratory. MATERIAL AND METHODS: A retrospective study of the use of pressure wires in our laboratory between October 1998 and November 2000. The pressure wire was inserted whenever the interventional cardiologist considered it to be indicated. In all cases, pressures were recorded with a Waveguide Cardiometrics 0.014 guide (Endosonics) and hyperemia was induced by intracoronary adenosine. RESULTS: Two hundred fifty-three lesions were studied in 190 patients. Indications were functional evaluation of lesions of intermediate severity for 82% (9% intrastent restenoses); guidance of balloon PTCA for 5%; and fulfillment of a research protocol for 13%. Twenty-six percent of lesions considered to be of moderate severity based on angiography were treated as a consequence of the pressures measured by the wire. A decision to begin or continue a procedure was based on wire pressures in 24% and intervention was avoided in 60%. No major complications attributable to the wire were observed. A lesion was dissected in one patient (0.5%) but it was treated without consequences. Twenty pressure wires (11%) failed to work properly during the procedure, fourteen of them (7%) before insertion. The wire could not be advanced across the lesion in one case. CONCLUSIONS: The pressure wire is useful in the daily clinical practice of a catheterization laboratory. Its most common indication is the evaluation of lesions of intermediate or unknown severity, and use is associated with few complications.

Blood Pressure↗