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Ivan P Casserly

Publications and source records attributed to Ivan P Casserly.

At least 19 recordsLinked to original sources
PubMed2006

Simultaneous multivessel acute drug-eluting stent thrombosis.

Stent thrombosis (ST) in the era of bare metal stents (BMS) using high-pressure stent deployment and combined anti-platelet therapy is an uncommon but feared complication. There is concern for an elevated risk of stent thrombosis (ST) with drug-eluting stents (DES). We describe a case of simultaneous multivessel drug-eluting stent thrombosis 8 h after deployment of paclitaxel-eluting stents in the right coronary (RCA) and left anterior descending (LAD) arteries.

Coronary Thrombosis↗
PubMed2006

Evaluating the optimal activated clotting time during carotid artery stenting.

Carotid artery stenting is an alternative to carotid endarterectomy for patients at high risk for surgery for carotid artery stenosis. Although unfractionated heparin is routinely used, there are no published data evaluating the optimal activated clotting time during carotid stenting. In a retrospective analysis of 605 patients who underwent carotid stenting using unfractionated heparin at the Cleveland Clinic Foundation, the optimal peak procedural activated clotting time associated with the lowest combined incidence of death, stroke, or myocardial infarction was 250 to 299 seconds.

Aged↗
PubMed2006

The optimal revascularization strategy for multivessel coronary artery disease: the debate continues.

Mortality rates were lower among patients with multivessel coronary artery disease who underwent coronary artery bypass grafting (CABG) than among similar patients who underwent percutaneous coronary intervention (PCI) in an analysis of data from New York State registries (N Engl J Med 2005; 352:2174-2183). This finding appears to run counter to the results of randomized controlled trials, which found both procedures equivalent with regard to mortality. What are we to believe?

Angioplasty, Balloon, Coronary↗
PubMed2005

Predictors of revascularization method and long-term outcome of percutaneous coronary intervention or repeat coronary bypass surgery in patients with multivessel coronary disease and previous coronary bypass surgery.

AIMS: The optimal revascularization strategy in patients with symptomatic multivessel coronary artery disease (CAD) and previous coronary artery bypass grafting (CABG) remains unknown. METHODS AND RESULTS: We evaluated all patients with previous CABG undergoing isolated, non-emergency multivessel revascularization between 1 January 1995 and 31 December 2000. The analysis concentrated on the independent predictors of the revascularization method, as well as on long-term mortality and its predictors, after calculating a propensity score for the method of revascularization. There were 2191 patients (1487 with reoperation and 704 with percutaneous coronary intervention, PCI) in the study. The most important factors in choosing reoperation were presence of more diseased or occluded grafts, previous infarction, lower ejection fraction (EF), longer interval from first CABG, and more total occlusions of native arteries, as well as absence of a patent mammary graft. The distribution of the propensity score was skewed towards the two extremes. At 5 years, the unadjusted cumulative survival was 79.5% for CABG and 75.3% for PCI, P=0.008. After adjustment for the propensity score for PCI vs. CABG, PCI was associated with a hazard ratio of 1.47 (0.94-2.28), P=0.09. The most powerful predictors of mortality were higher age and lower EF. CONCLUSION: The choice of the revascularization method in patients with previous CABG is dictated mostly by anatomical considerations and less by clinical characteristics. In contrast, clinical characteristics predominantly affect long-term outcome, whereas the method of revascularization has a limited effect. A randomized clinical trial addressing this important segment of the population with ischaemic heart disease is warranted.

Age Distribution↗
PubMed2005

Slow-flow phenomenon during carotid artery intervention with embolic protection devices: predictors and clinical outcome.

OBJECTIVES: The purpose of this research was to define the predictors of the "slow-reflow" phenomenon during carotid artery intervention with filter-type embolic protection devices (EPDs) and to determine its prognostic significance. BACKGROUND: During carotid artery intervention using filter-type EPDs, we have observed cases in which there is angiographic evidence of a significant reduction in antegrade flow in the internal carotid artery proximal to the filter device, termed "slow-flow." The predictors of this phenomenon and its prognostic significance are unknown. METHODS: Using a single-center prospective carotid intervention registry, patients with slow-flow were compared to patients with normal flow during carotid intervention with respect to clinical, procedural, and lesion characteristics, and the 30-day incidence of death and stroke. RESULTS: A total of 414 patients underwent 453 carotid artery interventions using EPDs. Slow-flow occurred in 42 patients (10.1%) undergoing 42 carotid interventions (9.3%), and most commonly occurred after post-stent balloon dilatation (71.4%). Multivariate logistic regression analysis identified the following predictors of slow-flow: recent history (<6 months) of stroke or transient ischemic attack (odds ratio [OR] 2.8, 95% confidence interval [CI] 1.4 to 5.6, p = 0.004), increased stent diameter (OR 1.4, 95% CI 1.02 to 1.94, p = 0.044), and increased patient age (OR 1.05, 95% CI 1.01 to 1.09, p = 0.025). Among patients with slow-flow, the 30-day incidence of stroke or death was 9.5% compared to 2.9% in patients with normal flow (chi-square = 4.73, p = 0.03). This difference was driven by the disparity in the 30-day incidence of stroke (9.5% vs. 1.7%). CONCLUSIONS: Slow-flow during carotid intervention with EPDs is a frequent event that is associated with an excess risk of periprocedural stroke. The association of the phenomenon with clinically symptomatic carotid lesions and use of larger stent diameters suggests that embolization of vulnerable plaque elements may play a pathogenic role.

Aged↗
PubMed2005

Advances in percutaneous valvular intervention.

We are entering a new era in the percutaneous treatment of valvular heart disease. Novel techniques and devices have given rise to the possible treatment of a range of valvular heart diseases that previously necessitated surgical therapies, including aortic stenosis, pulmonary regurgitation and mitral regurgitation. Despite the enormous potential of these percutaneous therapies, enthusiasm needs to be balanced by an understanding of the challenges that need to be overcome before such therapies can be widely embraced. This review provides a critical assessment of the status of the major developments in percutaneous valvular intervention to date, and provides the authors' perspective on the current role and future potential of these techniques.

Angioplasty, Balloon, Coronary↗
PubMed2004

Propensity analysis of long-term survival after surgical or percutaneous revascularization in patients with multivessel coronary artery disease and high-risk features.

BACKGROUND: Although most randomized clinical trials have suggested that long-term survival rates after percutaneous coronary intervention (PCI) or surgical multivessel coronary revascularization (CABG) are equivalent, some post hoc analyses in high-risk groups and adjustment for severity of coronary disease have suggested higher mortality after PCI. METHODS AND RESULTS: We studied 6033 consecutive patients who underwent revascularization in the late 1990s. PCI was performed in 872 patients; 5161 underwent CABG. Half the patients had significant left ventricular dysfunction or diabetes. Propensity analysis to predict the probability of undergoing PCI according to 22 variables and their interactions was used. The C-statistic for this model was 0.90, indicating excellent discrimination between treatments. There were 931 deaths during 5 years of follow-up. The 1- and 5-year unadjusted mortality rates were 5% and 16% for PCI and 4% and 14% for CABG (unadjusted hazard ratio, 1.13; 95% CI, 1.0 to 1.4; P=0.07). PCI was associated with an increased risk of death (propensity-adjusted hazard ratio, 2.3; 95% CI, 1.9 to 2.9; P<0.0001). This difference was observed across all categories of propensity for PCI and in patients with diabetes or left ventricular dysfunction. Other independent predictors of mortality (P< or =0.01 for all) were renal dysfunction, age, diabetes mellitus, chronic lung disease, peripheral vascular disease, left main trunk stenosis, and extent of coronary disease (Duke angiographic score). CONCLUSIONS: In patients with multivessel coronary artery disease and many high-risk characteristics, CABG was associated with better survival than PCI after adjustment for risk profile.

Aged↗
PubMed2004

Point-of-care ecarin clotting time versus activated clotting time in correlation with bivalirudin concentration.

INTRODUCTION: A thrombin inhibitor management (TIM) point-of-care test based upon the ecarin clotting time (ECT) has been developed. The ECT has been suggested to more accurately reflect the anti-coagulant effect of direct thrombin inhibitors compared with the activated clotting time (ACT). We sought to examine the correlation of the TIM-ECT test with bivalirudin concentration in patients undergoing percutaneous coronary intervention (PCI), and to compare the performance of this test with the current standard (i.e., ACT). MATERIALS AND METHODS: In a multicenter study, blood samples were obtained at six pre-defined time-points in 170 consecutive patients undergoing PCI using bivalirudin. For each sample, the TIM-ECT (citrated and non-citrated), ACT, and bivalirudin concentration was determined. RESULTS: Considering samples from all time-points (n=784), the correlations of TIM-ECT citrated, TIM-ECT non-citrated, and ACT with bivalirudin concentration were 0.96, 0.93, and 0.90, respectively. For samples collected at therapeutic levels of bivalirudin (n=353), the correlations of TIM-ECT citrated, TIM-ECT non-citrated, and ACT with bivalirudin concentration were lower, and showed a greater disparity between methods, with correlation coefficients of 0.75, 0.59, and 0.37, respectively. Prediction models based on the measured bivalirudin concentration were developed for TIM-ECT and ACT, and the coefficients of determination (r(2)) of actual versus predicted TIM-ECT and ACT were 0.91 and 0.81, respectively. CONCLUSIONS: In this PCI population, the TIM-ECT point-of-care test and ACT demonstrated a strong correlation with bivalirudin concentration. The TIM-ECT test had a higher correlation with bivalirudin concentration at therapeutic levels of the drug, and for individual samples appears to more consistently reflect the bivalirudin concentration compared with the ACT.

Aged↗
PubMed2003

Intracardiac echocardiography during transcatheter interventions for congenital heart disease.

Although transesophageal echocardiography is often used for guidance during transcatheter interventions, few data exist regarding the use of the newer modality of intracardiac echocardiography. This brief report summarizes our single center experience using intracardiac echocardiographic guidance during transcatheter interventional procedures for congenital heart disease.

Adolescent↗
PubMed2003

Effect of abciximab versus tirofiban on activated clotting time during percutaneous intervention and its relation to clinical outcomes--observations from the TARGET trial.

Previous evidence suggests that the monoclonal antibody abciximab may have a more potent anticoagulant effect than small-molecule glycoprotein (GP) IIb/IIIa inhibitors. We prospectively reviewed collected heparin dose, activated clotting time (ACT), and corresponding clinical outcome data from The Do Tirofiban and ReoPro Give Similar Efficacy Outcome Trial (TARGET), a direct comparison of tirofiban versus abciximab in patients who underwent percutaneous intervention. Of the 4,809 patients enrolled in the trial, 3,739 patients (78%) had an ACT measured after the administration of GP IIb/IIIa and heparin (peak procedural ACT); this formed the population for the present study. Mean total heparin dose was 75 +/- 32 and 76 +/- 31 U/kg in the tirofiban and abciximab groups, respectively. The resultant mean peak ACTs were 296 +/- 91 and 299 +/- 89 seconds (p = 0.09). In a subset of patients with both baseline ACT (before any heparin or GP IIb/IIIa therapy) and peak procedural ACT measurements, the difference in ACT between these time points was 80 +/- 97 vs 82 +/- 101 seconds (p = 0.44) for the tirofiban and abciximab groups, respectively. After adjusting for patients' weight, weight-adjusted heparin dose, and method of ACT measurement in a multiple linear regression analysis, the type of GP IIb/IIIa inhibitor was not predictive of the peak ACT (p = 0.24). When stratified by ACT quartile, no statistically significant difference in bleeding or ischemic end points between the tirofiban and abciximab cohorts was observed. In this large contemporary percutaneous coronary intervention trial, there was no observed difference in the anticoagulant effect of tirofiban and abciximab, as measured by the ACT, or in the incidence of bleeding or ischemic complications in each ACT quartile.

Abciximab↗
PubMed2003

Transcatheter closure of recurrent postmyocardial infarction ventricular septal defects utilizing the Amplatzer postinfarction VSD device: a case series.

The initial therapy for postmyocardial infarction ventricular septal defects is surgical repair of the defect. Unfortunately, a significant number of patients develop recurrent ventricular septal defects (VSDs) following operative repair. Transcatheter closure offers an alternative to reoperation in these critically ill patients. We present a series of four patients in whom recurrent ventricular septal defects were closed using an Amplatzer VSD device.

Aged↗
PubMed2003

Endovascular brachytherapy for treatment of bilateral renal artery in-stent restenosis.

Percutaneous transluminal angioplasty of renal artery stenosis is an attractive alternative to surgical therapy. However, even with endovascular stenting, the overall rate of restenosis is 21%. While brachytherapy for coronary in-stent restenosis has proven efficacy, its use for renal artery in-stent restenosis has not been formally evaluated. We report a case of bilateral in-stent renal artery restenosis treated with endovascular brachytherapy.

Aged↗
PubMed2003

Aortocoronary dissection complicating a percutaneous coronary intervention.

Aortocoronary dissection complicating diagnostic angiography or percutaneous coronary intervention is a rare occurrence. We present a case of aortocoronary dissection complicating a right coronary artery intervention. After closing the entry port with intracoronary stenting, the patient was managed conservatively. Serial computed tomography scans demonstrated spontaneous resolution of the dissection.

Angioplasty, Balloon, Coronary↗
PubMed2002

Relationship between residual atheroma burden and neointimal growth in patients undergoing stenting: analysis of the atherectomy before MULTI-LINK improves lumen gain and clinical outcomes trial intravascular ultrasound substudy.

OBJECTIVES: The objective of this study was to examine the relationship between quantitative volumetric and cross-sectional measures of residual atheroma burden and neointimal growth after coronary stenting. BACKGROUND: Previous intravascular ultrasound (IVUS) studies have demonstrated a correlation between residual atheroma burden and neointimal growth after coronary stenting. However, postmortem studies contradict this finding. METHODS: The study population included 34 patients who underwent IVUS six to eight months after stent placement, including 26 patients who underwent IVUS immediately after stent placement and at six to eight months follow-up. Using manual planimetry, the lumen cross-sectional area (LA), stent cross-sectional area (SA) and external elastic membrane cross-sectional area (EEM) were measured at 1-mm intervals after the procedure and at follow-up. Percent neointimal area (NA) and atheroma area (AA) were calculated as: percent neointimal area = ([SA - LA]/SA) x 100; percent AA = ([EEM - SA]/EEM) x 100 in the entire cross section and in individual quadrants. Postinterventional atheroma volume and neointimal volume at follow-up were calculated using Simpsons's rule. RESULTS: In pooled analyses using all cross sections and cross-sectional quadrants, there was a weak correlation between percent AA and NA (r = 0.11 and 0.12, respectively). Analysis in individual patients demonstrated no significant relationship between total or quadrant measurements of percent AA and NA (p = 0.47 and 0.4, respectively). No relationship between atheroma volume postintervention and neointimal volume at follow-up was observed (r = 0.1, p = 0.62). CONCLUSIONS: This study failed to demonstrate a clinically significant relationship between quantitative volumetric and cross-sectional measures of residual atheroma burden and subsequent neointimal growth.

Adult↗
PubMed2002

Impact of nonmeasurable borders and variation in cross-section counts on intravascular ultrasound measurement of atherosclerotic plaque volume.

The inability to measure borders and variation in the number of 1-mm cross sections acquired from an identical length of vessel in serial intravascular ultrasound (IVUS) pullbacks represents potential errors in calculating volumes by IVUS. In a clinical IVUS trial, the percentage of nonmeasurable lumen and external elastic membrane borders, and the percent variation in the number of 1-mm cross sections acquired from an identical vessel length at 2 separate time points, were determined. A statistical model that simulated the effect of varying the percentage of the total number of cross sections in a pullback (i.e., sample fraction) was developed using SAS software. Mean and maximum errors for calculation of atheroma volume for each sample fraction were determined. The mean percentage of nonmeasurable lumen and external elastic membrane borders in an individual patient was 8.4 +/- 8.4% and 17.4 +/- 18.4%, respectively. Mean variation in the number of 1-mm cross sections acquired in serial studies was 5.6 +/- 6.2%. A decrease in sample fraction from 95% to 50% was associated with a linear increase in the mean and maximum errors in atheroma volume, from 2.0 +/- 0.9% and 5.9 +/- 3.0%, to 7.1 +/- 2.8% and 23.4 +/- 10.3%, respectively. Thus, nonmeasurable borders and variation in the number of 1-mm cross sections acquired from an identical length of vessel in serial studies are real considerations in clinical IVUS trials. However, given the reported incidence of these considerations in this clinical trial, our statistical model suggests that the impact of each of these considerations on atheroma volume calculation is small.

Coronary Artery Disease↗
PubMed2002

Paradoxical embolization of a fractured guidewire: successful retrieval from left atrium using a snare device.

In adults, paradoxical embolization of catheters or guidewire fragments related to central venous catheterization is a rare phenomenon. Reports of successful percutaneous retrieval of foreign bodies from the left atrium is also rare. We describe the successful percutaneous retrieval of a fractured guidewire that had undergone paradoxical embolization to the left atrium in an adult patient.

Device Removal↗