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Biomedical subjects

M E Sipperly

Publications and source records attributed to M E Sipperly.

9 recordsLinked to original sources
PubMed1991

Salvage of branch vessels during bifurcation lesion angioplasty: acute and long-term follow-up.

To evaluate angiographic success, frequency of branch vessel loss and salvage, and long-term outcome, we studied the early and late outcomes of 56 consecutive patients who underwent PTCA of bifurcation lesions, which involved the left anterior descending or left circumflex coronary artery, with stenoses greater than 70% in both the parent and an involved branch vessel. In 35 patients (63%), the PTCA strategy was attempted dilation of both the main vessel and the involved branch vessels using predominantly a double-wire, sequential balloon technique; in 21 (27%) the PTCA attempt was confined to the main vessel alone. Transient angiographic occlusion of the branch vessel occurred in 32% of patients in whom dilation of both vessels was attempted, and in 38% in whom the main vessel alone was dilated (p = NS); 91% of the occluded branch vessels were the salvaged when sequential angioplasty of both vessels had been initially planned, compared to only 38% when the initial strategy had been dilation of the main vessel alone (p less than .05). Predischarge exercise testing showed residual ischemia in 6% of patients who had both vessels successfully dilated, versus 37% in those in whom dilatation was confined to the main vessels (p less than .01). Clinical restenosis, defined as late (greater than 6 weeks) recurrence of angina or a positive exercise test, occurred in 42% of patients who had both vessels successfully dilated. Thus although bifurcation lesion angioplasty frequently results in transient branch vessel loss, these branches can usually be salvaged using a double-wire technique but tend to have a higher late restenosis than conventional single vessel PTCA.

Angioplasty, Balloon, Coronary↗
PubMed1991

The NACI Registry: an instrument for the evaluation of new approaches to coronary intervention. The NACI Investigators.

The New Approaches to Coronary Intervention (NACI) Registry was developed to collect in-depth data about patients whose coronary artery lesions are being treated with new interventional techniques such as atherectomy, stents, and laser devices. The NACI Registry database distinguishes among several possible "modes" for device use, such as preparatory, planned definitive, and bailout use. Common definitions are used for data collection across all devices, and device-specific forms are used to record procedural details. NACI's unique modular form design facilitates thorough data collection, even for the most complex treatment scenarios. The database structure allows for data analysis at the patient, procedure, lesion, and device levels, as required to perform in-depth analyses of the immediate and long-term success of new devices. Once adequate knowledge of basic device performance has been collected, the Registry structure can also allow expeditious planning and performance of randomized trials comparing a new device to conventional PTCA.

Angioplasty, Balloon, Coronary↗
PubMed1990

Effects of two types of fish oil supplements on serum lipids and plasma phospholipid fatty acids in coronary artery disease.

Fish oil has consistently been shown to lower triglyceride levels, but its effects on low-density lipoprotein (LDL) cholesterol remain controversial. The current study compares the long-term effects of 2 different fish oil preparations (ethyl ester and triglyceride) versus olive oil in patients with coronary artery disease. Eighty-nine subjects were randomly assigned to receive capsules containing 6 g/day (triglyceride group) or 7 g/day (ethyl ester group) of n-3 fatty acids, or capsules containing 12 g/day of olive oil for 6 months. Mean triglyceride levels decreased by 28% in the ester and 32% in the triglyceride fish oil groups (p less than 0.05 for both). LDL cholesterol levels increased by 3% (difference not significant) in the ester and 12% (p less than 0.05) in the triglyceride fish oil groups; in hypertriglyceridemic subjects the increase was 23% (p less than 0.01) and 14% (difference not significant), respectively. Plasma phospholipid fatty acid analysis showed a fivefold increase in eicosapentaenoic acid levels in both fish oil groups (p less than 0.001), and a long-term decrease in arachidonic acid levels (p less than 0.001). Achieved eicosapentaenoic acid level correlated with the degree of increase in LDL cholesterol (r = 0.38, p less than 0.05). These data suggest that fish oil administration is associated with an increase in LDL cholesterol levels in a diverse group of patients with coronary artery disease; this change appears to be correlated with n-3 fatty acid absorption. The impact of this increase in LDL is unknown, but should be considered as potentially adverse.

Coronary Disease↗
PubMed1989

Randomised trial of fish oil for prevention of restenosis after coronary angioplasty.

To examine the potential role of fish oil supplementation in the prevention of restenosis after coronary angioplasty (PTCA), a randomised double-blind trial was conducted in 204 patients. The treatment group received 6 g/day of n-3 fatty acids, beginning 5.4 (SD 3.2) days before PTCA, and continuing for 6 months; the control group received olive oil placebo. Compliance was assessed by pill count and plasma levels of eicosapentaenoic acid (EPA). Restenosis was identified by symptoms and exercise testing and confirmed by angiography. PTCA was successful in 186 patients (93%). The incidence of angiographic restenosis was 34% in the fish oil group and 23% in the control group (relative risk 1.7, 95% CI 0.9-3.4). The lack of benefit of fish oil was not influenced by length of pretreatment, compliance with study medication, or the concentrations of plasma EPA achieved.

Angioplasty, Balloon↗
PubMed1989

Expanding role of coronary angioplasty: current implications, limitations, and nursing considerations.

In the mid-1960s, Dotter and Judkins first suggested that insertion of a rigid dilator into an occluded artery might reestablish blood flow. However, their envisioned extension of transluminal recanalization techniques to smaller artery stenoses, including those of the coronary arteries, which had previously required vascular surgery for correction, was not realized until many years later. In the late 1970s, Gruentzig overcame initial technical hurdles and performed the first coronary balloon angioplasty. Since then, percutaneous transluminal coronary angioplasty has been progressively refined and now constitutes a major medical intervention in the treatment of coronary disease. This article is a review of the current indications and limitations of complex angioplasty.

Angina, Unstable↗
PubMed1988

Initial success and long-term follow-up of percutaneous transluminal coronary angioplasty in chronic total occlusions versus conventional stenoses.

Coronary angioplasty was attempted in 1,074 consecutive patients, including 169 patients with total (100%) occlusion (group 1), 102 patients with functional total (99%) occlusion (group 2) and 711 patients with conventional (70 to 95%) stenoses (group 3). After exclusion of 92 patients with acute myocardial infarction, the mean age of the patients was 57 +/- 12 years, including 727 men (74%) and 255 women (26%). Although there were no differences between groups with respect to anginal symptoms or extent of coronary artery disease, the primary success rate (by lesion) varied according to lesion severity, and was 63%, 78% and 90% for groups 1, 2 and 3, respectively (p less than 0.001). Only 3 patients (1%) with chronic coronary artery occlusion (groups 1 and 2) required emergency surgery because of side-branch occlusion in 2 patients and guidewire fracture in 1 patient, whereas emergency surgery was required in 14 patients (2%) in group 3. Long-term follow-up averaging 19 +/- 11 months was available for 95% of patients. Although the combined likelihood of death or nonfatal myocardial infarction was below 6% for each group at 2 years (difference not significant), the likelihood of death, nonfatal infarction, coronary bypass surgery or repeat percutaneous transluminal coronary angioplasty was higher (41%) in group 1 than in groups 2 (28%) or 3 (28%) (p less than 0.001). Thus, coronary angioplasty can be performed safely and effectively in patients with chronic total occlusion, although neither the primary success rate nor the long-term follow-up are as favorable as in patients with conventional stenoses.

Angioplasty, Balloon↗
PubMed1988

Predictors, therapeutic options and long-term outcome of abrupt reclosure.

To ascertain the clinical and procedural factors that relate to the occurrence and management of abrupt reclosure, data on 1,160 consecutive patients who underwent coronary angioplasty between December 1981 and December 1986 were analyzed. Abrupt reclosure occurred in 54 patients (4.7%), developing during the dilatation procedure in 43 patients (80%) and delayed by 11 +/- 2 hours after the procedure in 11 patients (20%). Patients were divided into 3 groups based on subsequent management: (1) 22 patients (40%) in whom the involved vessel was reopened by additional dilatation, (2) 14 patients (26%) in whom the involved vessel was not reopened but the patient was treated medically, and (3) 18 patients (33%) in whom abrupt reclosure was managed by emergency bypass surgery, yielding an overall emergency surgery rate of 1.6%. Patients whose abrupt reclosure was reopened were more likely to have luminal thrombus (54 vs 28%) and less likely to have extensive local dissection after dilatation (14 vs 61%; p less than 0.025) than patients undergoing emergency surgery. Patients treated medically despite continued vessel occlusion were more likely to have collateral blood flow to the occluded zone (54 vs 11%, p less than 0.01) than patients undergoing surgery. While 10 of 18 patients (56%) undergoing emergency surgery sustained a myocardial infarction, all patient subgroups appeared to do well during long-term follow-up.

Angioplasty, Balloon↗
PubMedDate not supplied

Marine lipids and coronary angioplasty. Benefit or risk.

More than 10 years ago Dyerberg and Bang first reported a lower incidence of coronary disease in the Greenland Eskimos. This finding was attributed to their diet, which was rich in fat from whale, fish, and seals. Further analysis revealed that the Eskimos had lower levels of plasma cholesterol and triglyceride and high plasma concentrations of certain polyunsaturated fatty acids. The fatty acids, eicosapentaenoic acid and docosahexaenoic acid, are part of the omega-3 fatty acid family. The effects of these fatty acids on serum cholesterol and platelet function have been the basis of extensive investigation. Most recently, studies have been conducted on the effect of omega-3 fatty acids on patients undergoing coronary angioplasty to determine if omega-3 fatty acid's effect on platelet function might decrease the high restenosis after coronary angioplasty. However, the results of these trials remain controversial. This article presents an overview of marine lipid research and its role in the treatment of coronary disease.

Angioplasty, Balloon, Coronary↗