Biomedical subjects

R L Feldman

Publications and source records attributed to R L Feldman.

147 records · Page 9Linked to original sources

PubMedDate not supplied

Randomized comparison of over-the-wire and fixed-wire balloon devices for coronary angioplasty.

One hundred and fifteen consecutive patients undergoing coronary angioplasty (PTCA) were randomized to low profile over-the-wire (OTW, e.g., Mini, Sulp II) or fixed-wire (FW, e.g., Ace, Orion, Probe) PTCA balloon wire devices. Overall success, ability to begin and finish with the same balloon device, fluoroscopy time, physician time, and amount of contrast media used were prospectively assessed. Overall final success rate was excellent regardless of which type of system was used first (OTW 92%; FW 96%). In 6 patients no wire would cross, in another, the stenosis would not dilate despite high pressure ( greater than 18 atm). When an OTW device was used first, it was initially successful in 69% of patients and was changed with success to a second OTW balloon in 4 (cumulative 76%). An OTW balloon was changed to FW in 11 patients (success 9 patients, 82%). This was because of inability to cross with balloon of the OTW system after a steerable wire had crossed in 9 of the patients. When a FW device was used first, it was initially successful in 89%. A change to another FW device led to success in 4 additional patients (cumulative 96%). In no patient was a FW changed to an OTW device. Thus, a FW device was more likely to be successful (either 54 of 56 patients initially randomized to FW, or 63 of 67 total patient number in whom a FW device was used) than an OTW device (45 of 59 patients) p less than .05.(ABSTRACT TRUNCATED AT 250 WORDS)

Angioplasty, Balloon, Coronary↗

PubMedDate not supplied

Coronary angioplasty in patients who were considered poor bypass surgery candidates.

In most patients who undergo coronary angioplasty (PTCA), coronary bypass surgery (CABG) is an alternative. Patients with severe symptoms secondary to coronary disease, amenable to PTCA, but who are poor CABG candidates are commonly seen. From April 1988 to December 1989 PTCA was performed in 751 patients. Patients with evolving infarction (47) were excluded. Of the remaining 704, 605 were considered candidates for CABG and they were compared to the 99 patients not felt to be candidates for CABG. The objective of this report was to compare these 2 patient groups. These salvage PTCA patients were older, had a higher incidence of heart failure, more prior CABG, higher left ventricular end-diastolic pressure and lower ejection fraction (all p less than 0.01). PTCA had a high success rate per lesion in both groups (96% CABG candidates vs. 95% salvage patients), but there were more patients whose culprit lesion could not be dilated in the salvage group (14% vs. 7%, p less than 0.02). Severe complications including Q wave infarction (2% vs. .3%) and in-hospital death (7% vs. 0.2%) were more common in salvage patients. As planned, emergency CABG was not performed on any salvage PTCA patient but on 2.6% of the other patients. Patients who may benefit from PTCA but were not felt to be operable made up 13% of our PTCA experience. PTCA can be performed in these patients but risks were increased.

Age Factors↗

PubMedDate not supplied

Clinical and angiographic experience with intraoperative transluminal balloon-catheter dilatation and coronary artery bypass graft surgery.

Between April, 1980 and October, 1983, 40 patients with chronic stable angina pectoris underwent intraoperative transluminal balloon-catheter dilatation and coronary artery bypass graft (CABG) surgery. The main indication for this combined procedure was diffuse symptomatic coronary artery disease with at least one coronary artery having two or more areas of narrowing. Intraoperative dilatation was performed upon 42 coronary arteries involving 57 narrowed arterial segments where dilatation was attempted. The balloon-tipped catheter could not be passed through two stenotic sites. There was no documented perforation but unrecognized intimal injury was observed in two patients at postoperative catheterization. There was one perioperative myocardial infarction, one operative death and 97% early relief of angina pectoris. In 25 distal arterial narrowings that were studied angiographically in the early postoperative period (mean 10 days), 15 (60%) were unchanged, 2 (8%) were worse and 8 (32%) were improved compared to the preoperative angiogram. Patients with discrete narrowings did better than those who had balloon dilatation for diffuse narrowings; 49% of the former as compared to 17% of the latter had angiographic evidence for improvement. During the follow-up period (mean 30 months), three patients developed recurrent angina pectoris and one died of congestive heart failure. Thirteen distal arterial narrowings were studied angiographically late postoperatively (mean 12 months). In these 13 areas, 6 (46%) were unchanged, 3 (23%) were worse and 4 (31%) were improved compared to preoperative angiograms. Additionally, 10 arterial narrowings were observed angiographically, both early and late postoperatively. Nine of these serially observed segments remained unchanged while one became worse.(ABSTRACT TRUNCATED AT 250 WORDS)

Angina Pectoris↗