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Biomedical subjects

R R Heuser

Publications and source records attributed to R R Heuser.

At least 19 recordsLinked to original sources
PubMed2001

Initial experience and safety in the treatment of chronic total occlusions with fiberoptic guidance technology: optical coherent reflectometry.

Percutaneous treatment of chronic total coronary occlusions has been limited by procedural complications such as vessel injury or perforation. Optimizing visualization in the vessel with optical coherent reflectometry and a forward-looking fiberoptic guidance technology may improve the safety and efficacy of percutaneous treatment of these lesions.

Arterial Occlusive Diseases↗
PubMed2001

Intracoronary autologous blood to seal a coronary perforation.

BACKGROUND: Coronary artery perforation is a rare but serious complication of percutaneous coronary interventions. CASE REPORT: We report on the treatment of a coronary perforation during percutaneous transluminal coronary angioplasty (PTCA) of the left anterior descending (LAD) coronary artery in a patient suffering from post infarction angina complicated by cardiogenic shock. The perforation was treated successfully with intracoronary administration of the patient's own blood. CONCLUSION: This new technique may be used as adjunctive therapy to prolonged balloon inflation, coronary stenting, coronary microcoil and gelfoam embolization in the treatment of severe and hemodynamically compromising perforations.

Angioplasty, Balloon, Coronary↗
PubMed2001

Chronic total occlusions: experience with fiber-optic guidance technology--optical coherence reflectometry.

Chronic total occlusions are difficult to treat and continue to challenge the interventional cardiologist. The primary difficulty is safely crossing the total occlusion with a guidewire before any revascularization can begin. One of the main reasons conventional and newer guidewires have not proven effective is simply the lack of visualization to safely steer the guidewire across the occlusion. This limitation can be overcome with new technology using a "forward-looking" fiber-optic guidance. The Safe-Steer TO (Total Occlusion) Crossing System is a new guidance system that uses optical coherence reflectometry to steer a guidewire through total occlusions. Optical coherence reflectometry uses algorithms to determine tissue types (plaque vs arterial wall) by measuring the intensity of the reflection of near-infrared light. The authors' clinical experience with the Safe-Steer System has met considerable success. With their initial 28 patients (7 women, 21 men) with known chronic total occlusions and confirmed ischemia, the primary success rate for the crossing the occlusion was 86% (24/28 cases). The average occluded lesion length was 41.1 +/- 30.8 mm. Our initial clinical experience demonstrates that the optical guidewire is a viable technology in the treatment of chronic total occlusions.

Adult↗
PubMed2001

Peripheral vascular disease: perspectives on aortoiliac, renal, and femoral treatments using catheter-based techniques.

The percutaneous treatment of peripheral vascular disease has advanced over the past two decades and is fast becoming the preferred treatment of choice. Stents have positively altered the clinical outcomes in peripheral revascularizations. Anatomic variability is an important factor in determining if the patient is an ideal percutaneous interventional candidate. Future technological developments in percutaneous interventions will help include new patients with peripheral vascular disease previously considered nonideal percutaneous candidates.

Aorta↗
PubMed1999

Low- versus high-dose recombinant urokinase for the treatment of chronic saphenous vein graft occlusion.

Recanalization of a totally occluded saphenous vein graft (SVG) using commercially available urokinase from human kidney cells has been shown to be effective, but the duration of infusion and complications such as allergic reactions, bleeding events, and non-Q-wave myocardial infarction have limited its acceptance. Recently, genetic engineering has allowed the synthesis of recombinant urokinase (r-UK). Patients with an occluded SVG from 37 centers were randomized to receive a 6-hour infusion of either low-dose (125,000 IU/hour) or high-dose (350,000 IU/hour) r-UK followed by up to a maximum of 18 hours of r-UK (125,000 IU/hour) via a subselective catheter directly into the occluded vein graft. The primary study end point was final preintervention achievement of Thrombolysis In Myocardial Infarction (TIMI) flow > or = 2 using core angiographic analysis. One hundred seven patients were randomized and 98 received the study drug (low dose 52 patients, high dose 46 patients). TIMI flow > or = 2 after completion of the study drug was higher in the high-dose group (51% vs 24%, p = 0.019). This difference narrowed, but a trend was still evident on the final angiogram after adjunctive mechanical intervention (72% vs 58%, p = 0.254). Bleeding complications were frequent; severe or life-threatening bleeding occurred in 12% of patients on the low dose and 11% of patients on the high dose (p = NS), including 2 intracerebral bleeds, both of which were fatal with 1 in each group. Thus, in patients with an occluded SVG, a randomized trial of direct low-dose versus high-dose r-UK infusion demonstrated increased recanalization rates (TIMI flow > or = 2) in the high-dose arm. Percutaneous revascularization of SVG with r-UK can be accomplished with acceptable success rates, but complications are frequent.

Adult↗
PubMed1998

Fracture of coronary guidewire during rotational atherectomy with coronary perforation and tamponade.

We present the case of a calcified right coronary artery lesion with a 90-degree exit angle. Attempts at rotational atherectomy led to wire transection and vessel wall perforation necessitating emergent pericardiocentesis and bypass surgery. We review the literature on complications of rotational atherectomy and the management of coronary perforations and retained guidewire fragments.

Atherectomy, Coronary↗