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Biomedical subjects

S Cattan

Publications and source records attributed to S Cattan.

32 records · Page 2Linked to original sources
PubMed1996

Intracoronary stent implantation without ultrasound guidance and with replacement of conventional anticoagulation by antiplatelet therapy. 30-day clinical outcome of the French Multicenter Registry.

BACKGROUND: Stenting reduces both acute complications of coronary angioplasty and restenosis rates but increases subacute thrombosis rates and hemorrhagic complications when used with coumadin anticoagulation. METHODS AND RESULTS: To simplify postcoronary stenting treatment and to reduce these drawbacks, we evaluated the 1-month outcome of a prospective registry of 2900 patients in whom successful coronary artery stenting was performed without coumadin anticoagulation. Patients received 100 mg/d aspirin and 250 mg/d ticlopidine for 1 month. Low-molecular-weight heparin (LMWH) treatment was progressively reduced in four consecutive stages, from 1-month treatment to none. Event-free outcome at 1 month was achieved in 2816 patients (97.1%). Major stent-related cardiac events were subacute closure in 51 patients (1.8%), including death in 12 (0.5%), acute myocardial infarction in 17 (0.6%), and coronary artery bypass graft surgery in 9 (0.3%). Stent thrombosis was more frequent with balloon size of < 3.0 mm (< or = 2.5 mm, 10%; 3.0 mm, 2.3%; > or = 3.5 mm, 1.0%; P < .001), bail-out situations (6.67% versus 1.38%, P < .001), and patients with unstable angina or acute myocardial infarction (2.2% versus 1.12%, P = .02). Bleeding complications that required transfusion, surgical repair, or both occurred in 55 patients (1.9%). Bleeding complications were related to female gender (4.0% versus 1.51%, P < .001), duration of LMWH treatment (3.83% in phase II/III versus 0.69% in phase IV/V, P < .001), sheath size (6F, 0.52%; 7F, 1.04%; > or = 8F, 4.23%; P < .001), bail-out situations (4.76% versus 1.67%, P < .01), and saphenous graft stenting (4.38% versus 1.75%, P = .04). CONCLUSIONS: These results suggest that poststenting treatment by ticlopidine/aspirin is an effective alternative to coumadin anticoagulation, achieving low rates of subacute closure and bleeding complications. LMWH treatment does not improve subacute reocclusion rates but increases bleeding complications. Furthermore, as bleeding complications were independently related to sheath size, we suggest that stenting with 6F guiding catheters may prevent local complications. Furthermore, the ticlopidine/aspirin combination allows a low-cost stenting strategy without ultrasound assessment of stent deployment and permits short inhospital stay.

Aged↗
PubMed1994

Anomalous course of the left anterior descending coronary artery between the aorta and pulmonary trunk: a rare cause of myocardial ischaemia at rest.

When the left anterior descending coronary artery follows an anomalous course between the aorta and pulmonary artery it can cause myocardial ischaemia or sudden death during exercise in young people. Coronary arteriography in a 27 year old man with angina pectoris at rest showed a left anterior descending coronary artery arising from a common right trunk and running from the aorta to the pulmonary artery. Follow up after revascularisation was uneventful.

Adult↗
PubMed1993

[Chronic obstructions of the left main and right coronary arteries].

The authors report a case of chronic occlusion of the left main coronary associated with occlusion of the second segment of the right coronary artery documented at coronary angiography carried out for effort angina without previous infarction. Myocardial perfusion was preserved mainly by a marginal branch of the right coronary arising immediately before the occluded second segment and by a small branch of the left main coronary artery.

Aged↗
PubMed1989

Inflammatory arteritis with reversible coronary localization in a 70-year-old woman.

Giant cell arteritis with coronary involvement is an uncommon event, often discovered at autopsy after a myocardial infarction. We report the case of a 70-year-old female with unstable angina pectoris persisting despite angioplasty and antianginal treatment, associated with chronically increased erythrocyte sedimentation rate. Temporal artery biopsy was negative but ophthalmic assessment showed sequelae of ischaemic optical neuritis. Response to prednisone therapy was striking, with complete disappearance of angina pectoris, normalization of erythrocyte sedimentation rate and decreased thallium uptake at scintigraphy. This is the first case of giant cell arteritis of the coronary arteries seen after attempted therapy with percutaneous transluminal coronary angioplasty. Such findings justify considering giant cell arteritis each time a case of coronary manifestations with increased erythrocyte sedimentation rate resists medical treatment, or recurs after coronary angioplasty.

Aged↗
PubMed1988

Coronary artery spasm in a transplant patient.

The mechanism of coronary spasm is poorly understood. We report a case of coronary artery spasm in a cardiac transplant patient. Pharmacologic testing indicated denervation of the patient's heart. Therefore coronary artery spasm may occur despite cardiac denervation. This case demonstrates that intact autonomic nervous system and cardiac innervation are not essential for coronary artery spasm.

Adult↗
PubMed1987

[Demonstration of reversible myocardial ischemia in necrotic akinetic areas using endocoronary ECG during angioplasty].

The presence of ischaemic myocardial tissues in necrotic territories and the usefulness of revascularizing these territories are controversial matters. We have determined the existence of this phenomenon by the per-angioplastic intracoronary ECG method, and we have compared the sensitivities of intracoronary ECG and surface ECG. Intracoronary EVG is achieved by using the mobile teflon-coated guide wire of coronary angioplasty as a unipolar epicardial electrode. Being epicardial and localized, the electrode explores a limited area of the myocardium, distal to the artery being dilated and momentarily occluded by the balloon during inflations. The study involved 12 patients (mean age 53.7 years) who presented with the following criteria of admission: transmural myocardial infarction, presence of a Q wave on two leads, akinetic segment at ventriculography and coronary stenosis or occlusion amenable to angioplasty. Patients with collateral circulation between the larger epicardial vessels were excluded. Intracoronary ECG recordings were taken before, during and after inflations. In 9 out of 12 patients the ST segments was elevated by 1.3 mV on average between inflations (S.D. 3.14 mV) and by 4.8 mV (S.D. 3.99 mV) during inflations. These high standard deviations were due to major inter- and intra-individual variations of ST. The difference was significant (p less than 0.05) at variance analysis. No variation of ST was observed in 3 patients. Only one of the 12 patients had elevated ST on both surface ECG and intracoronary ECG tracings. Thus, intracoronary ECG is a sensitive method to evaluate myocardial ischaemia during coronary angioplasty.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

[Methods of evaluating the treatment of unstable angina].

Although unstable angina is an extremely common and often initial manifestation of coronary disease, few controlled studies of its treatment have been carried out. This relative dearth of information is due to the methodological problems raised by the evaluation of unstable angina. Unlike the definition of myocardial infarction, that of unstable angina--i.e. of a population of coronary patients who from time to time are at a high risk of myocardial infarction or death--is neither unequivocal nor easy to standardize. It follows that the patient population ultimately selected for controlled trials is but a small part of all unstable angina patients. The representativeness of patients involved in therapeutic trials is probably approximate. Moreover, the current criteria for assessment of effectiveness are either the clinical signs of angina in the short term or the incidence of myocardial infarction and changes in survival curves in the mid- and long terms. A more precise definition of criteria of inclusion, leading to an homogeneous population, and the development of a simple and reliable method for detecting and quantifying myocardial ischaemia, both being used as intermediate criteria of assessment, would undoubtedly improve the quality of therapeutic trials in unstable angina and, mostly, their applicability to daily therapeutic practice.

Angina Pectoris↗
PubMed1987

[Operative risk in coronary bypass. A multivariate analysis of prognostic factors].

In order to determine the predictors of operative risk in coronary bypass surgery, we have studied 2112 consecutive patients who underwent isolated coronary bypass surgery between January 1979 and September 1984. The overall operative mortality (OM) was 4.4 percent (3.5 percent during the last 3 years). OM increases significantly with age (from O before the age of 30 to 12.3 percent after 70), the functional class (FC) of angina, the FC of dyspnea (NYHA), the creatinine blood level (23.5 percent if greater than 200 mumol/l), the left ventricular end-diastolic pressure and in case of reoperation (16.7 percent), as well as in women (11.6 percent). There is a trend toward higher OM in case of past history of ventricular tachycardia or arterial hypertension, atherosclerotic disease of the lower extremities, left ventricular dysfunction or severe stenosis of the left main coronary artery. OM is not increased in patients with multivessel disease, diabetes or with a past history of myocardial infarction, and is even decreased in obese patients. The variables selected by multivariate analysis were: creatinine blood level, then angina FC, sex, dyspnea FC, age, the absence os obesity, left ventricular dysfunction, the year of surgery and finally reoperation. These results, mainly based on simple clinical variables, should facilitate the therapeutic decisions in borderline indications of coronary bypass surgery.

Aged↗
PubMed1985

[Classification and principles of the use of vasodilators in the treatment of left ventricular insufficiency].

Vasodilators have been widely used in recent years for the treatment of severe left ventricular failure (LVF). However, amongst these drugs, not all have the same therapeutic effects, but they differ from one another in molecular structures, cellular mechanisms, haemodynamic actions and modes of administration. A three tier classification is proposed with the single objective of facilitating the therapeutic choice: mechanism of action: this property distinguishes the alpha-blockers from the beta-2 sympathomimetics, calcium antagonists, angiotensin converting enzyme inhibitors and prostacyclin biosynthesis inducers. Some molecules such as hydralazine, whose mechanism of action remains unclear, cannot be classified in this way; haemodynamic effects: these effects can be used to distinguish vasodilators which act mainly on the venous sector from arterial and mixed vasodilators. The knowledge of the preferential site ol action of these molecules helps to adapt the choice of treatment to the initial haemodynamic profile of each patient; pharmacokinetics: these properties distinguish molecules active only by intravenous administration, better adapted for the treatment of acute LVF in the intensive care unit, from those active orally which can be used for long-term ambulatory therapy of chronic cardiac failure. Trinitrin and its derivatives occupy an intermediate position because of their relatively low bioavailability after oral administration: long-term administration is not always easy and may require special modes of administration (i.e. percutaneous). Vasodilators have been widely used in cardiac failure for about 5 years; the results of some medium term controlled therapeutic trials are now available and confirm the efficacy of these drugs but also define their limitations: variable therapeutic efficacy: the number of responders ranges from 30 to 60 p. 100 according to the molecule used.(ABSTRACT TRUNCATED AT 250 WORDS)

Calcium Channel Blockers↗
PubMed1983

Percutaneous transluminal angioplasty of stenotic lesions in dialysis vascular accesses.

Forty-five stenoses behind arteriovenous fistulas in 35' haemodialysed patients were treated with percutaneous transluminal angioplasty (PTA). Immediate stenoses dilatation results in relation to the AVF type were haemodynamically significant in 40 cases (88%), with poorer results on bovine heterograft stenoses. Dilatation results in relation to the site of the lesion showed haemodynamically efficient angioplasty on stenoses next to the anastomosis (67.5%) but a poor result on distal lesions (4 cases). We observed 4 cases of thrombosis but 2 recovered after treatment, one after local fibrinolytic perfusion one after surgical thrombectomy. Follow-up over a period of one to 18 months (mean 8 months) including angiography and appreciation of the dialysis quality were performed in 30 patients who had a successful dilatation. PTA appears to be a technically feasible and clinically effective method of treating stenoses lying on the venous limb fistula in patients on chronic haemodialysis.

Adult↗
PubMedDate not supplied

[Stenosis of the main trunk of the left coronary artery. Apropos of 54 cases].

In the 54 patients studied coronary arteriography alone showed stenosis of the left main coronary artery (a lesion observed in 5.2 p. 100 of pathological coronary arteriographies), associated with other coronary lesions, 72.2 p. 100 of which involved all three major vessels. Ventriculography was abnormal in 53 p. 100 of the cases, with a less than 45 p. 100 left ventricular ejection fraction in 37.4 p. 100 of them. Nine patients were considered inoperable; 4 of these died during a 40-month follow-up period under medical treatment. Forty-five patients underwent coronary bypass; there were 4 peri-operative deaths (8.9 p. 100), 8 post-operative myocardial infarctions (17.8 p. 100) and one late death (2.2 p. 100). These patients were followed up for a mean period of 26.4 months. All authors who have studied the subject agree that surgery is beneficial: not only does it improve cardiac function, but it also prolongs survival. In spite of the peri-operative risks, surgery must be contemplated in patients with a more than 50 p. 100 stenosis of the left main coronary artery, provided the cardiac vascular bed is accessible to revascularization.

Arteriosclerosis↗