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Biomedical subjects

J Hollman

Publications and source records attributed to J Hollman.

At least 37 records · Page 2Linked to original sources
PubMed1988

Balloon inflation following injection of contrast material through the distal lumen of the USCI balloon catheter.

We report on four patients in whom we observed inflation of the balloon following injection of contrast material into the distal lumen during percutaneous transluminal coronary angioplasty. This is a rare technical problem. However, inadvertent balloon inflation may cause transient occlusion of the proximal coronary artery and in one case was associated with acute occlusion of a vessel that had been dilated. Management involves prompt deflation of the balloon.

Adult↗
PubMed1988

The limited impact of percutaneous coronary artery angioplasty on bypass surgery.

Although percutaneous transluminal coronary angioplasty has been used successfully now for 10 years, coronary bypass surgery volumes have not diminished greatly. This paper examines the anatomic limitations of percutaneous transluminal coronary angioplasty. Using complete revascularization criteria, angioplasty could be used in only 38% of patients undergoing coronary bypass surgery at the Cleveland Clinic in 1981. The principal anatomic reason for rejecting patients for percutaneous transluminal coronary angioplasty was chronic total occlusion in a vessel suitable for bypass surgery. Angioplasty could be used more frequently in one- and two-vessel bypass patients than in patients receiving more grafts. Percutaneous transluminal coronary angioplasty is currently limited more by its inability to more completely revascularize advanced coronary artery disease than it is from the technical aspects of crossing or dilating stenoses.

Angioplasty, Balloon↗
PubMed1988

Mechanisms of vessel injury during percutaneous transluminal angioplasty of saphenous vein bypass grafts and coronary arteries.

Three patients were studied in whom percutaneous transluminal angioplasty (PTA) was attempted in stenotic saphenous vein bypass grafts. In two cases, large splits were present in the thick fibrotic intima of the vein grafts, accompanied by rupture of atherosclerotic plaques or hemorrhage into atherosclerotic plaques. Both cases required emergency coronary artery bypass surgery. In the third case, a vein graft failed to dilate after multiple attempts. Only small splits were present in that fibrotic intima. Two other patients were studied in whom coronary artery PTA was attempted. In both cases, laceration of a nonatherosclerotic segment of the artery occurred. Combined with our previous report, these observations indicate that PTA results in lacerations of atherosclerotic plaques, fibrotic intima, and otherwise normal vessel walls and that laceration is the mechanism of both successful dilation and serious complications.

Angioplasty, Balloon↗
PubMed1987

Frequency, management and follow-up of patients with acute coronary occlusions after percutaneous transluminal coronary angioplasty.

Angiograms from 1,500 consecutive patients undergoing percutaneous transluminal coronary angioplasty (PTCA) at the Cleveland Clinic were reviewed to determine the frequency of acute coronary occlusion after successful PTCA. Thirty-two patients (2%) had acute coronary occlusions. Of these, 27 (84%) presented within 6 hours. Compared with control group, only the presence of eccentric lesions (72% vs 24%) and intimal tears (78% vs 34%) was more predominant in the group with acute occlusion. Redilation was attempted in 31 patients and was successful in 27 (87%). Nine of these patients eventually required coronary bypass surgery and 18 were discharged and followed for 11 to 34 months (mean 18). Thus, redilation is a safe and effective approach to manage patients in whom coronary occlusion develops after PTCA.

Acute Disease↗
PubMed1987

Laboratory test results as predictors of recurrent coronary artery stenosis following angioplasty.

A retrospective study has been conducted to examine the potential value of a battery of selected clinical laboratory tests as predictors of recurrent coronary artery stenosis following angioplasty. Data from 443 patients (including 325 men and 118 women) who had undergone coronary angioplasty were analyzed. Total men, total women, aspirin-treated men, and aspirin-treated women received separate statistical treatment. The only statistically significant difference in mean laboratory values between success (no recurrent stenosis) and recurrence groups was for serum cholesterol in aspirin-treated women, where the recurrence group showed a higher value than the success group. Multiple logistic regression showed a statistically significant association between elevated mean cholesterol and low mean hemoglobin concentration and recurrence in the female aspirin-treated group. Although only a small number of the laboratory test results fell outside normal laboratory reference ranges, we noted that for some tests, patients with extreme values predominantly developed recurrent stenosis while for certain other tests they were mainly successful. For example, seven of eight male diabetics with plasma glucose concentrations above 9.4 mmol/L (170 mg/dL) developed recurrence, while recurrent stenosis did not occur in any of six men with a bleeding time greater than twice normal. The results of these studies do not support the hypothesis that lipoprotein, coagulation, and platelet factors influence the development of recurrent stenosis in the majority of patients, although abnormalities in certain of these parameters may contribute to the process in specific cases.

Aged↗
PubMed1986

Effect of nifedipine on recurrent stenosis after percutaneous transluminal coronary angioplasty.

This double-blind, randomized study evaluated the effect of nifedipine on restenosis after coronary angioplasty. Two hundred forty-one patients with dilation of 271 coronary sites were randomized at the time of hospital discharge to receive nifedipine, 10 mg (123 patients), or placebo (118 patients) four times daily for 6 months. No patient was known to have coronary artery spasm. The mean duration of therapy was 4.4 +/- 2 (mean +/- SD) months for nifedipine and 4.3 +/- 2 months for placebo. A restudy angiogram was available in 100 patients (81%) in the nifedipine group and 98 patients (83%) in the placebo group. A recurrent coronary stenosis was noted in 28% of patients in the nifedipine group and in 29.5% of those in the placebo group (p = NS). The mean diameter stenosis was 36.4 +/- 23% for the nifedipine group and 36.7 +/- 23% for the placebo group (p = NS). By pill count, 78% of patients receiving nifedipine and 82% of those receiving placebo complied with the study drug regimen. Coronary stenosis recurred in 33% of patients in the placebo group and in 29% of patients in the nifedipine group who complied with the regimen and had angiograms (p = NS). In conclusion, the study did not demonstrate a significant beneficial effect of nifedipine on the incidence of recurrent stenosis after successful percutaneous transluminal coronary angioplasty.

Adult↗
PubMed1986

Restenosis after successful coronary angioplasty in patients with single-vessel disease.

To determine risk factors for restenosis, we studied 998 patients who underwent elective coronary angioplasty (PTCA) to native coronary arteries between July 1980 and July 1984. Restenosis, defined as a luminal narrowing of greater than 50% at follow-up, was present in 302 patients (30.2%). Univariate analysis of 29 factors revealed seven factors related to restenosis: vessel dilated (circumflex coronary artery 18%, right coronary artery 27%, left anterior descending artery 34%; p less than .01), final gradient of 15 mm Hg or less compared with greater than 15 mm Hg (27% vs 38%, p less than .01), duration of angina greater than 2 months compared with angina of shorter duration (27% vs 35%, p = .01), post-PTCA stenosis of 30% or less compared with 31% to 50% (28% vs 36%, p less than .025), stable vs unstable angina (26% vs 34%, p less than .05), presence vs absence of intimal dissection (26% vs 32%, p = .07), and female gender vs male gender (25% vs 32%, p = .08). Multivariate analysis revealed five factors independently related to increased risk of restenosis in the following order of importance: PTCA in the left anterior descending artery, absence of intimal dissection immediately after PTCA, final gradient greater than 15 mm Hg, a large residual stenosis after PTCA, and unstable angina. Restenosis after PTCA is a multifactorial problem. The hemodynamic and angiographic result at the time of PTCA significantly influences long-term outcome, but additional measures aimed at reducing the rate of recurrence of atherosclerotic plaque are required.

Adult↗
PubMed1986

Balloon rupture during coronary angioplasty.

Out of a total of 1,500 percutaneous coronary angioplasties (PTCA), 55 (3.6%) were associated with balloon rupture. Lesion calcification was noticed in 7 of these 55 patients (12.7%). Balloon rupture occurred at a mean pressure of 10.7 atmospheres. All balloons were retrieved without difficulty. Intimal tears were noted in 18 (32.7%) cases. Three patients required bypass surgery. In 29 patients restudied angiographically, the restenosis rate was 38%. Balloon rupture during PTCA does not seem to be associated with detrimental consequences.

Adult↗
PubMed1985

Percutaneous transluminal coronary angioplasty after previous coronary artery bypass surgery.

To improve symptomatic status and avoid repeat coronary artery bypass graft surgery (CABG), 115 lesions were approached for transluminal coronary angioplasty (PTCA) in 94 patients (82 men, 12 women) with angina pectoris and prior CABG at a mean of 60 months (range 4 to 192) after CABG. Fifteen patients were in Canadian Cardiovascular Society functional class I, 32 were in class II, 31 were in class III, and 16 were in class IV. Patients were 37 to 76 years old (mean 57). PTCA was successful (at least a 40% reduction in stenosis diameter and improvement in symptomatic status) in 83 patients (88%) and 103 (90%) lesions. Mean stenosis was reduced from 80 +/- 14% to 20 +/- 16% (mean +/- standard deviation) and mean pressure gradient from 41 +/- 7 mm Hg to 14 +/- 6 mm Hg. Seven patients had lesions that could not be crossed for technical reasons and these patients underwent non-emergency CABG. Four patients required emergency CABG after PTCA; 1 patient subsequently died and 2 survived acute myocardial infarction. One patient had a femoral artery laceration, which required surgical repair. At a mean follow-up of 8 +/- 4 months, 63 patients (76%) with initially successful results were free of angina or in improved condition. Of the remaining 20 patients, 18 consented to repeat coronary angiography. Four patients did not have restenosis. Of the 14 patients with documented restenosis, 5 underwent successful repeat PTCA, 5 had repeat CABG, and 4 were treated medically. Thus, when coronary anatomy is suitable, PTCA is an effective alternative to reoperation in symptomatic patients with prior CABG.

Adult↗
PubMed1985

Intimal proliferation of smooth muscle cells as an explanation for recurrent coronary artery stenosis after percutaneous transluminal coronary angioplasty.

The pathologic changes in the coronary arteries of three patients who died 5, 17 and 62 days, respectively, after percutaneous transluminal coronary angioplasty were studied. Changes in the vessel wall seen early after angioplasty included focal denudation of the endothelium, splits in the intima extending to and along the inner aspect of the media, focal intimal necrosis and adventitial hemorrhage. Extensive medial dissections were seen in the coronary arteries of the two patients who died 5 and 17 days after coronary angioplasty. Fibrin was deposited on the surface of the intima, within intimal cracks and in areas of intimal and medial necrosis. Focal proliferation of smooth muscle cells was prominent on neointimal surfaces of the coronary artery from the patient who died 17 days after angioplasty. The previously dilated coronary segment from the patient who died 62 days after angioplasty was stenosed by an extensive recent proliferation of smooth muscle cells that were distributed over the entire circumference of the intimal surface as well as within gaps in the old atherosclerotic plaques. This type of intimal proliferation would appear to be responsible for the recurrent coronary artery stenosis that develops in some patients after coronary angioplasty.

Adult↗
PubMed1985

Digital subtraction fluoroscopy: a new method of detecting coronary calcifications with improved sensitivity for the prediction of coronary disease.

The association between calcification of the coronary arteries and coronary artery narrowing is well established. However, fluoroscopic visualization of coronary calcifications has been insufficiently sensitive to be useful as a screening test. Since digitization of radiographic images permits the subtraction of noncardiac structures from moving cardiac structures, such subtraction might increase the sensitivity of coronary fluoroscopy. To determine whether coronary calcifications were better visualized with digital subtraction fluoroscopy than with conventional fluoroscopy, we taped diseased human coronary arteries to a pulsating water balloon inside the thorax of a dog cadaver and studied this model with both fluoroscopic techniques. Calcific atherosclerotic plaques were more easily identified with digital subtraction fluoroscopy than with conventional fluoroscopy. We tested the method clinically by submitting 191 subjects without history or electrocardiographic evidence of previous myocardial infarction who were referred for coronary arteriography to both fluoroscopic studies. For at least one, at least two, and three calcified coronary arteries, digital fluoroscopy was more sensitive (92%, 66%, and 40%) than conventional fluoroscopy (63%, 21%, and 2%) (all p less than .001) for the prediction of significant coronary obstructions (greater than 50%). Although digital fluoroscopy was less specific than conventional fluoroscopy (digital: 65%, 89%, and 97%; conventional: 81%, 98%, and 100%) (all but last, p less than .01), receiver operating curve analysis revealed a significantly larger area under the curve, indicating higher accuracy for the digital technique (p = .03). Digital subtraction fluoroscopy was more accurate in younger than in older patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Angiography↗