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T Ischinger

Publications and source records attributed to T Ischinger.

31 records · Page 2Linked to original sources
PubMed1984

Experience with a technique for coronary angioplasty of bifurcational lesions.

To decrease the risk of iatrogenic side branch occlusion during coronary angioplasty of bifurcational lesions, we evaluated a technique in which two over-the-wire dilatation systems are positioned within the stenosed coronary artery and the side branch in jeopardy. The technique was used in eight patients undergoing angioplasty for a lesion in the left anterior descending or circumflex artery located near a large side branch. Successful dilatation of the major vessel lesion was achieved in all eight patients, and dilatation within the side branch was successful in all three patients whose lesion involved the side branch ostium. In one patient, dilatation within the major vessel led to partial closure of the side branch and the prepositioned guide wire facilitated prompt dilatation of the iatrogenic closure. There were no complications associated with use of the additional dilatation system. The technique appears to provide an efficacious method to perform safe coronary angioplasty in selected patients with bifurcational lesions.

Adult↗
PubMed1984

Higher balloon dilatation pressure in coronary angioplasty.

The advent of improved balloon catheters for percutaneous transluminal coronary angioplasty (PTCA) in 1981 extended the theoretic pressure range available for dilatation from 7 atm to 13 atm. The impact of higher dilatation pressure on results of PTCA was studied. The last 100 consecutive patients treated exclusively with the old balloon type (low-pressure group) were compared to the first 100 consecutive patients treated exclusively with the new balloon type (high-pressure group). There was no difference in age, sex, artery distribution, initial degree of stenosis, and initial pressure gradient between the two groups. The mean peak pressure applied was 7.0 +/- 1.6 atm in the low-pressure group and 8.5 +/- 2.1 atm in the high-pressure group (p less than 0.001). The average balloon diameter used and the number and duration of balloon fillings were similar in both groups. Primary success, complications, and residual degree of stenosis were not different in the two groups. The residual pressure gradient, however, was significantly lower in the high-pressure group (11 +/- 7 mm Hg) than in the low-pressure group (16 +/- 10 mm Hg) (p less than 0.01). This indicates a better immediate hemodynamic result without increased risk. It is concluded that it is safe to perform PTCA with the new balloon types allowing for higher pressures. The increment in average pressure used for dilatation, which occurred incidentally, improved the average hemodynamic outcome. This may influence recurrence rate and deserves further investigation by randomized trials.

Angioplasty, Balloon↗
PubMed1984

The occurrence of angiographically detected intracoronary thrombus in patients with unstable angina pectoris.

To examine the role of intracoronary thrombus (ICT) in unstable angina, we reviewed the coronary arteriograms of 83 patients with unstable angina (group I) and 37 patients with stable angina (group II) for angiographic evidence of ICT. Group I and group II patients were similar with respect to mean age, presence of single and multiple vessel disease, and past history of myocardial infarction. Group I patients had no ECG or creatine kinase enzyme evidence of acute myocardial infarction. The angiographic criteria for ICT included an intracoronary filling defect, intraluminal staining, and total coronary artery occlusion with convex dye outline. ICT was found in 10 of 83 patients in group I (12.0%) vs 0 of 37 patients in group II (p less than 0.05). These findings suggest that in some patients coronary artery thrombosis plays an important role in the pathogenesis of unstable angina.

Angina Pectoris↗
PubMed1984

Repeat coronary angioplasty.

The potential of repeat percutaneous transluminal coronary angioplasty as a mode of therapy for recurrence of stenosis after initially successful angioplasty was examined on the basis of data on all 514 patients with successful angioplasty at Emory University before April 1982. Recurrence was found in 171 (33%) of the 514 patients. Repeat angioplasty was attempted in 95 patients with a significantly higher primary success rate (97 versus 85%, p less than 0.001) and a lower complication rate (8 versus 15%, p less than 0.10) than those of initial angioplasty. Follow-up documentation was available in all 92 patients with successful repeat angioplasty. A second recurrence of stenosis was found in 26% (24 of 92). A third angioplasty was performed in seven patients; six procedures were successful and there have been no recurrences of stenosis. Repeat coronary angioplasty provides a means to treat recurrence of stenosis. It proved to be very successful and safe and yielded good long-term results. It also increased the percent of patients with documented lasting success after angioplasty from 63 to 78%.

Angioplasty, Balloon↗
PubMed1983

Percutaneous transluminal coronary angioplasty in patients with prior coronary bypass surgery.

To improve symptomatic status and avoid reoperation, 122 initial and 7 repeat percutaneous transluminal coronary angioplasty procedures were performed in 116 patients with disabling angina pectoris at a mean of 26.8 months (range 2 to 132) after coronary bypass surgery. Marked angiographic improvement (greater than 30% reduction in diameter stenosis) was obtained in 107 (88%) of the 122 initial procedures and in all 7 repetitions. Mean stenosis was reduced from 78 +/- 13% (mean +/- standard deviation) to 25 +/- 13% (p less than 0.0001) and mean pressure gradient from 49 +/- 15 to 11 +/- 8 mm Hg (p less than 0.0001). Complications were: emergency surgery (three patients), Q wave infarction (one patient), myocardial infarction by enzyme criteria only (four patients) and non-occluding coronary dissection (one patient). There were no neurologic or peripheral vascular complications and no early deaths. One late death occurred 14 months after an unsuccessful but uncomplicated angioplasty procedure. At a mean follow-up of 8.3 months, 88 patients (76%) were free of angina or in improved condition. In patients followed up for at least 6 months, evidence of restenosis occurred in 9 (53%) of 17 saphenous veins, 1 (50%) of 2 proximal graft anastomoses, 4 (18%) of 22 distal graft anastomoses and 5 (14%) of 37 native coronary arteries. When coronary anatomy is suitable, percutaneous transluminal angioplasty is an attractive alternative to reoperation in symptomatic patients with prior coronary bypass surgery.

Adult↗
PubMed1983

Does length or eccentricity of coronary stenoses influence the outcome of transluminal dilatation?

In 526 patients undergoing a first percutaneous transluminal coronary angioplasty (PTCA) of a single native vessel, we studied the influence of length and eccentricity of the lesion on complications and primary success. Long stenoses (greater than or equal to 5 mm, n = 153) did not differ from short stenoses (less than or equal to 4 mm, n = 265) in terms of overall complications or gain in lumen diameter and distal pressure. Eccentric stenoses (n = 155) showed a lower rate of primary success than concentric stenoses (n = 338) (80% vs 89%, p less than 0.05). Inability to cross the stenosis was the main reason for failure. Stenoses that were long and eccentric (n = 51) had the highest incidence of complications (24%) and stenoses that were short and concentric (n = 177) the lowest (12%, p less than 0.05). However, the average outcome expressed by gain in lumen diameter and distal pressure was equal in both groups and is obviously more dependent on technical factors than on anatomy. Nevertheless, length and, particularly, eccentricity of a lesion constitute risk factors for PTCA. They may be overcome by technical skill and sophisticated equipment, such as steerable catheters.

Adult↗
PubMed1983

Should coronary arteries with less than 60% diameter stenosis be treated by angioplasty?

We evaluated all patients receiving percutaneous transluminal coronary angioplasty (PTCA) in the past year for mild stenosis (60% or less diameter narrowing, n = 64, group 1) and compared them with a random sample of 330 patients with greater than 60% stenosis (n = 66, group 2) treated during the same year. The degree of coronary stenosis before PTCA was 52 +/- 7% (mean +/- SD) in group 1 and 79 +/- 11% in group 2. The primary success rate was 90% (58 of 64 patients) in group 1 vs 86% (57 of 66 patients) in group 2. The incidence of complications requiring coronary surgery after PTCA failed was similar in both groups (3 of 64 in group 1, 4 of 66 in group 2), but there were four occurrences of myocardial infarction in group 1 and none in group 2 (p less than .05). Recurrence of stenosis was judged on the basis of objective data, 76% of which were angiographic data, in 97% of the patients with primary success. At a mean interval of 5 months with a mean follow-up period of 7 months, 17 of 58 patients (29%) with primary success in group 1 and 24 of 57 patients (42%) in group 2 developed restenosis. In group 1, restenosis was markedly more severe (73 +/- 15%) than initial stenosis (p less than .005), which was not the case in group 2. In conclusion, PTCA in mild stenosis has favorable primary and long-term results, yet carries the risk of myocardial infarction and emergency operation and may, in some cases, even accelerate the disease process.

Adult↗
PubMed1983

Acute occlusion after percutaneous transluminal coronary angioplasty--a new approach.

Between July 1980 and November 1982, there were 935 coronary angioplasties attempted at Emory University Hospital. Of these patients, 20 developed acute occlusion. Of these 20, 19 presented within 3 hr of surgery or within 3 hr after stopping a continuous heparin infusion. Five patients required emergency surgery, but in 15 nitrates, nifedipine, and/or repeat angioplasty reopened the artery and the patient could be stabilized on continuous infusions of heparin and nitroglycerin. In only one case was an occluding thrombus evident on angiographic examination. The mechanism of acute occlusion is unknown, but coronary artery spasm may play a role.

Acute Disease↗
PubMed1983

[Positive inotropic effects of doxaminol in congestive heart failure].

The hemodynamic effects of doxaminol, a new, orally applicable beta-agonist, chemically dissimilar to catecholamines, were studied in comparison to those of dobutamine by means of thermodilution. After single-dose application of doxaminol in cases of congestive heart failure, cardiac output and stroke volume increased, heart rate increased slightly, pulmonary and systemic arterial pressure remained constant, and peripheral vascular resistance decreased. No arrhythmias appeared, but one patient suffered an attack of angina.

Aged↗
PubMedDate not supplied

Differential effect of Photofrin II on growth of human smooth muscle cells from nonatherosclerotic arteries and atheromatous plaques in vitro.

The effect of dihematoporphyrin-ester or -ether (DHE), a photosensitizing porphyrin with different amounts of aggregates, on the growth of cultured smooth muscle cells obtained from nonatherosclerotic arteries and from atheromatous plaques (primary stenosing and restenosing lesions) was examined without photoactivation of the drug. Clinically relevant DHE concentrations ranging from 0.1 to 25 micrograms/ml were used. In all proliferation studies with cells of second and third passage (approximately 10 cumulative population doublings in vitro), the growth rates decreased in a dose-dependent manner. Smooth muscle cells from atherosclerotic lesions were significantly more sensitive than smooth muscle cells from normal arteries. Cells derived from restenosing lesions retained their increased sensitivity even after eight passages in culture (approximately 20 cumulative population doublings). Cell size measurements showed that the decreased proliferative activity mainly occurred in smooth muscle cell subpopulations consisting of small cells. A cytotoxic effect of DHE was observed at concentrations above 5 micrograms/ml, causing cytoplasmic protrusions, vacuoles, and even complete cell lysis. At a DHE concentration of 5 micrograms/ml, the number of viable cells was 73% +/- 14% (means +/- SD) for smooth muscle cells from nonatherosclerotic arterial media and only 38% +/- 11% (means +/- SD) for smooth muscle cells from atherosclerotic plaques. In all experiments, no significant difference in response to DHE treatment was observed between cells from primary stenosing and restenosing lesions, suggesting a specific mechanism for plaque-derived cells causing an increased sensitivity in comparison to smooth muscle cells from nonatherosclerotic arteries. The pronounced sensitivity of plaque cells against DHE treatment suggests that this drug--even without photoactivation--is potentially valuable in vivo as a therapeutic approach to vascular stenoses.

Arteriosclerosis↗