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L F Satler

Publications and source records attributed to L F Satler.

At least 145 records · Page 8Linked to original sources
PubMed1996

Mechanisms and immediate and long-term results of adjunct directional coronary atherectomy after rotational atherectomy.

OBJECTIVES: The purpose of this study was to confirm the mechanisms and the immediate and long-term results of rotational atherectomy and adjunct directional coronary atherectomy. BACKGROUND: Rotational atherectomy is best suited for treating calcific stenoses, but the ability of rotational atherectomy alone to optimize lumen dimensions in large vessels is limited; this is only partly improved by adjunct balloon angioplasty. METHODS: We treated 165 lesions in 163 patients by use of rotational atherectomy and adjunct directional coronary atherectomy. Quantitative angiography and intravascular ultrasound were used for lesion analysis. A matched comparison with 208 lesions treated with rotational atherectomy and adjunct coronary angioplasty was performed. Patients were then followed up for at least 9 months, and target-lesion revascularization was assessed. RESULTS: In the 61 lesions imaged sequentially, lumen area increased from 1.7 +/- 0.8 (mean +/- 1 SD) to 3.9 +/- 1.1 mm(2) after rotational atherectomy, owing to a decrease in plaque plus media area from 16.8 +/- 5.0 to 15.2 +/- 5.2 mm(2) (both p < 0.0001). After adjunct directional coronary atherectomy, lumen area increased even more to 6.7 +/- 2.0 mm(2) (vs. 5.1 +/- 1.4 mm(2) after adjunct coronary angioplasty, p < 0.0001) as a result of both vessel expansion (18.8 +/ 5.3 to 20.8 +/- 5.7 mm(2)) and additional plaque removal (to 14.1 +/- 5.0 mm(2), all p < 0.0001). The total arcs of calcium decreased from 207 +/- 107 degrees to 166 +/- 93 degrees after rotational atherectomy and to 145 +/- 87 degrees after directional coronary atherectomy. Overall, procedural success was 96%, and final diameter stenosis was 15 +/- 17%. Target-lesion revascularization was 23%. The only independent predictor of target-lesion revascularization was a larger overall atherectomy index (84% vs. 59%, p = 0.048). CONCLUSIONS: There is a synergistic relationship between rotational atherectomy and directional coronary atherectomy in the treatment of calcific lesions. The immediate results show a high procedural success--lumen dimensions were larger and late target-lesion revascularization was lower in lesions treated with rotational atherectomy and directional coronary atherectomy than in those treated with rotational atherectomy and adjunct balloon angioplasty.

Aged↗
PubMed1996

Effect of rotational atherectomy in noncalcified atherosclerotic plaque: a volumetric intravascular ultrasound study.

OBJECTIVES: This study used pre-rotational and post-rotational atherectomy volumetric intravascular ultrasound analysis to determine whether rotational atherectomy causes ablation of non-calcified atherosclerotic plaque. BACKGROUND: Rotational atherectomy is currently the preferred treatment for heavily calcified coronary lesions. However, the mechanism of lumen enlargement in noncalcified lesions has not been studied in detail. Intravascular ultrasound allows detailed, cross-sectional imaging of the coronary arteries in vivo. The normal coronary artery wall, the major components of the atherosclerotic plaque and the quantitative changes in vessel, lumen and plaque cross-sectional areas and volumes that occur as a result of the atherosclerotic disease process and during transcatheter therapy can be studied in a manner otherwise not possible. METHODS: Eighteen noncalcified native vessel lesions in 18 patients were imaged before and after rotational atherectomy using intravascular ultrasound systems incorporating motorized transducer pullback through a stationary imaging sheath. External elastic membrane, lumen and plaque plus media cross-sectional areas were measured every 1 mm of lesion length (for a total of 10 image slices), and external elastic membrane, lumen and plaque plus media volumes were calculated using Simpson's rule. RESULTS: After rotational atherectomy, the minimal lumen cross-sectional area increased from 1.37 +/- 0.50 to 2.99 +/- 0.60 mm2 (mean value +/- 1 SD, p < 0.0001). Lumen volume increased from 23.2 +/- 9.0 to 38.0 +/- 8.0 mm3 (p < 0.0001) as a result of a decrease in plaque plus media volume (from 102.2 +/- 50.9 to 85.8 +/- 47.7 mm3, p < 0.0001), with no change in total vessel (external elastic membrane) volume (125.3 +/- 54.2 to 123.8 +/- 52.9 mm3, p = 0.119). CONCLUSIONS: Rotational atherectomy effectively ablates noncalcified plaque in non-calcium-containing lesions.

Atherectomy, Coronary↗
PubMed1996

Safety and efficacy of elective stent implantation following rotational atherectomy in large calcified coronary arteries.

Rotational atherectomy is an effective transcatheter therapy for calcified coronary lesions. In large (> 3-mm) calcified coronary arteries, stent implantation following rotational atherectomy may further improve acute and especially, long-term benefit. To determine the safety and efficacy of this device synergy approach, we studied 24 consecutive patients undergoing this procedure electively in native coronary arteries. Procedural success was achieved in 100% without any major ischemic complications. There was also no incidence of subacute thrombosis or cardiac event during 30-day follow-up period. Thus, we conclude that elective stent implantation following rotational atherectomy in large, calcified coronary arteries is safe and results in excellent clinical benefit up to 30 days.

Aged↗
PubMed1996

An overview of US coronary stent trials.

Since the introduction of coronary stent procedures in the US there has been a determined effort to understand appropriate clinical applications better through the use of carefully designed prospective clinical trials. These studies fall into the general categories of efficacy studies, pharmacology, studies, intravascular ultrasound studies, adjuvant stent therapy studies, stent versus stent studies and new stent registries. Most of the pivotal clinical trials have been randomized controlled studies, but there have also been several carefully performed registry analyses which have provided useful insights. There are ample data to support the use of stents for abrupt and threatened closure syndrome. STRESS (the STent REStenosis Study) helped to establish the 'anti-restenosis' efficacy of elective Palmaz-Schatz coronary stent placement in native coronary arteries, although secondary complications (subacute stent thrombosis, bleeding and vascular events) were disturbing owing to excessive systemic anticoagulation regimens. Subsequent studies, often using intravascular ultrasound guidance, have clearly indicated that optimal stent implantation requiring post-stent high-pressure dilatations combined with aggressive antiplatelet therapy (aspirin plus ticlopidine) provides the best early and late clinical outcomes. Many of these observations have now been extended to other lesion subsets including saphenous vein grafts. In the future, stent adjuvant therapies will be carefully evaluated, including pharmacological agents, intravascular irradiation, and pre-stent atheroablation. Finally, interstent comparisons of randomized clinical trials are ongoing and there are several new stent registries which will help to extend the frontiers of clinical applications and operator technique.

Angioplasty, Balloon, Coronary↗
PubMed1995

Patterns of calcification in coronary artery disease. A statistical analysis of intravascular ultrasound and coronary angiography in 1155 lesions.

BACKGROUND: Target lesion calcium is a marker for significant coronary artery disease and a determinant of the success of transcatheter therapy. METHODS AND RESULTS: Eleven hundred fifty-five native vessel target lesions in 1117 patients were studied by intravascular ultrasound (IVUS) and coronary angiography. The presence, magnitude, location, and distribution of IVUS calcium were analyzed and compared with the detection and classification (none/mild, moderate, and severe) by angiography. Angiography detected calcium in 440 of 1155 lesions (38%): 306 (26%) moderate calcium and 134 (12%) severe. IVUS detected lesion calcium in 841 of 1155 (73%, P < .0001 versus angiography). The mean arc of lesion calcium measured 115 +/- 110 degrees; the mean length measured 3.5 +/- 3.7 mm. Target lesion calcium was only superficial in 48%, only deep in 28%, and both superficial and deep in 24%. The mean arc of superficial calcium measured 85 +/- 108 degrees; the mean length measured 2.4 +/- 3.4 mm. Three hundred seventy-three of 1155 reference segments (32%) contained calcium (P < .0001 compared with lesion site). The mean arc of reference calcium measured 42 +/- 80 degrees; the mean length measured 1.7 +/- 3.6 mm. Only 44 (4%) had reference calcium in the absence of lesion calcium. Angiographic detection and classification of calcium depended on arcs, lengths, location, and distribution of lesion and reference segment calcium. By discriminant analysis, the classification function for predicting angiographic calcium included the arc of target lesion calcium, the arc of superficial calcium, the length of reference segment calcium, and the location of calcium within the lesion. This model correctly predicted the angiographic detection of calcification in 74.4% of lesions and the angiographic classification (none/moderate/severe) of calcium in 62.8% of lesions. CONCLUSIONS: IVUS detected calcium in > 70% of lesions, significantly more often than standard angiography. Although angiography is moderately sensitive for the detection of extensive lesion calcium (sensitivity, 60% and 85% for three- and four-quadrant calcium, respectively), it is less sensitive for the presence of milder degrees.

Calcinosis↗