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R Zelman

Publications and source records attributed to R Zelman.

10 recordsLinked to original sources
PubMed2000

Successful non-operative management of right coronary artery perforation during percutaneous coronary intervention in a patient receiving abciximab and aspirin.

We report a case of successful non-operative treatment of coronary artery perforation that occurred during percutaneous transluminal coronary angioplasty. The patient was receiving abciximab, aspirin and heparin. The perforation was recognized immediately and managed by partial reversal of heparin and inflation of a non-compliant balloon at the perforation site. The perforation sealed completely. The patient was discharged asymptomatic the following day.

Abciximab↗
PubMed1995

Intracoronary ultrasound imaging before and after directional coronary atherectomy: in vitro and clinical observations.

The rate of restenosis after directional coronary atherectomy (DCA) is higher than expected. To elucidate why, the current study used intravascular ultrasound (IVUS) imaging to investigate the mechanism of DCA. An in vitro validation study was performed to determine the accuracy of the measurement of plaque removal by IVUS. DCA was performed in eight human atherosclerotic artery segments. The volume of removed plaque was measured by water displacement and was compared with the volume calculated from IVUS images. A clinical study of DCA was performed in 32 lesions. IVUS was performed in 28 lesions after successful DCA. Measurements of lumen dimensions from digital angiograms before and after DCA were compared with observations of lumen and plaque size from the cross-sectional IVUS images. In the in vitro study, the mean plaque volume removed by DCA was 19.9 +/- 8.5 microliters. The calculated estimate of removed plaque volume by IVUS was 18.6 +/- 7.9 microliters and correlated closely with the volume by water displacement (r = 0.92). The calculated volume of plaque removed from histologic sections was 14.3 +/- 6.0 microliters and was linearly correlated with plaque volume by water displacement (r = 0.81). In the clinical study, the angiographic mean minimum lumen diameter increased from 1.0 +/- 0.4 to 2.7 +/- 0.5 mm and the percentage stenosis decreased from 70% to 19% (p < 0.0001). The IVUS images before and after DCA showed that the lumen DCA improved from 2.9 +/- 1.5 to 7.0 +/- 1.5 mm2 (p < 0.0001). In addition the vessel cross-sectional area (CSA) increased from 17.1 +/- 5.9 to 18.7 +/- 5.5 mm2. The atheroma CSA was reduced from 14.2 +/- 5.0 to 11.7 +/- 4.8 mm2. This combined effect of reduction in atheroma CSA and stretching of the outer vessel diameter resulted in an improvement in percentage plaque area stenosis from 83% +/- 7% to 61% +/- 9%. It is concluded that despite a successful angiographic appearance, DCA removed an average of 2.5 mm2 from the atheroma, which corresponds to only 18% of the atheroma CSA. The total lumen CSA increased 4.1 mm2; 61% of the new lumen was created by cutting and removal of plaque, whereas 39% of the new lumen was made by stretching the external wall of the artery. Despite an excellent angiographic result, IVUS imaging reveals that after DCA a significant amount of residual atheroma remains. As in balloon dilatation, a stretching effect is a significant component of DCA.

Aged↗
PubMed1988

Coronary angioplasty: a therapeutic option for symptomatic patients with two and three vessel coronary disease.

Coronary angioplasty is a widely applied revascularization procedure for patients with multivessel coronary artery disease. However, follow-up in this patient subgroup is relatively limited. From 1983 to 1986, coronary angioplasty was performed in 349 and 121 patients with, respectively, two- and three-vessel coronary disease with a primary success rate of 83 and 88%. The in-hospital mortality rate was 2.8% (13 of 470 patients). Complete revascularization was achieved in 128 patients. Among the 397 patients with a successful outcome, 373 (94%) were followed up greater than or equal to 1 year; 79% were free of death, nonfatal myocardial infarction or the need for coronary bypass grafting, and 82% of patients had symptomatic improvement by at least one angina functional class. A second coronary angioplasty procedure was required in 13% of patients. After a mean follow-up period of 27 months, an increased incidence of coronary bypass grafting was noted in patients with incomplete versus complete revascularization (16 versus 7%, p less than 0.05). Among the 222 patients who had repeat cardiac catheterization performed an average of 7 months after angioplasty, 103 were symptomatic; 50% of the 222 patients had at least one vessel with greater than or equal to 50% restenosis and 14% of patients had multiple restenoses. In conclusion, coronary angioplasty can be performed with a high initial success rate and marked symptomatic improvement in patients with multivessel coronary disease. However, in this group's experience, the majority of patients selected for coronary angioplasty with multivessel coronary disease will have incomplete revascularization that can be predicted in the majority of patients before the procedure.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1981

Risk factors for obstructive lung disease.

To assess the role of various risk factors in the pathogenesis of chronic obstructive lung disease (COLD), 163 men and women were followed for approximately 6 yr. Subjects were either community volunteers or relatives of patients with antitrypsin deficiency (PiZ or MZ phenotype). At the onset of the study no subject was receiving medical care for COLD. Covariance analysis revealed that expiratory airflow rates declined excessively in male subjects who had the PiMZ phenotype and reported a family history of lung disease. In subjects with the combination of characteristics, loss of lung function approximated that reported in subjects who have established COLD. In several such subjects, abnormalities have progressed so that they now require treatment. Changes in lung function were less striking in the presence of only 1 or 2 of the 3 risk factors studied. These findings demonstrated that the characteristics of the population being studied can influence the outcome of an investigation. This effect may help account fo the conflicting results of previous investigations designed to assess the role of the PiMZ phenotype in the pathogenesis of COLD.

Adult↗