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V Trehan

Publications and source records attributed to V Trehan.

27 records · Page 2Linked to original sources
PubMedDate not supplied

Procedural outcome and follow-up results of balloon angioplasty versus new device interventions for treatment of true bifurcation stenoses.

Strategies for dilatation of bifurcation stenoses have continued to evolve over the past several years. However, there is limited experience on the efficacy of various nonballoon interventional devices and their results in comparison with balloon angioplasty. We, therefore, analysed our data in 72 patients of coronary artery disease with true bifurcation stenoses with balloon angioplasty or new device interventions (NDI). All patients underwent dilatation of both the primary vessel and side branch ostial stenosis. Balloon angioplasty using double guidewire with sequential or simultaneous (kissing balloon) balloon inflation in the two vessels was performed in 42 patients. Thirty patients underwent NDI, using directional coronary atherectomy (DCA) in 12, rotablation in 6 and elective coronary stents in 12 patients. There were no significant differences in the baseline clinical and angiographic variables between patients in the two groups. While the preprocedural luminal diameter stenosis was similar, the residual stenosis was significantly less, both in the primary vessel and side branch, after NDI compared to balloon angioplasty. The procedure was successful in 96.6 percent patients treated with NDI and 83.3 percent with balloon angioplasty (p < 0.01) with relief of obstruction in both branches without any major complications. Freedom from subsequent coronary events in the form of angina, myocardial infarction, PTCA, bypass graft surgery of death was significantly more, both at 6 months (92% versus 65.6%, p < 0.001) and 12 months (81.8% versus 53.1%, p < 0.001) in the group of patients treated with NDI compared to balloon angioplasty. It is, therefore, concluded that NDI including DCA, rotablation and elective stenting are associated with higher rate of success, lesser complications and better event-free survival in comparison to balloon angioplasty for treatment of true bifurcation stenoses.

Adult↗
PubMedDate not supplied

Immediate and six-month outcome of self-expanding Wallstent for long lesions in native coronary arteries.

Between April and December 1996, 50 less-shortening Wallstents were deployed in the native coronary arteries of 44 patients, with lesions more than 20 mm long and minimum vessel diameter of at least 3.0 mm. There were 39 males and 5 females with an age range of 35-77 years. The majority (70.4%) had multivessel disease (MVD). The target vessel was LAD for 17 (34%), RCA 23 (46%) and LCx-OM for 10 (20%) stents. All lesions were type C, according to the ACC/AHA Task Force Classification. The length of the lesions ranged from 21-60 mm (mean: 31 +/- 8). The stent selection was based upon oversizing by 1.5-2.0 mm compared to the minimum vessel diameter, and covering approximately 4-5 mm of the apparently normal vessel on either side of the target lesion. The stent was deployed successfully without any major complications, including myocardial infarction, emergency coronary artery bypass grafting (CABG) and death in 43 out of 44 (97.7%) patients. One patient in whom there was failure to reach the target site with stent, developed non-Q wave inferior myocardial infarction. Post-discharge, two patients reported to have died within one month after the procedure. The event-free survival, defined as the absence of angina, myocardial infarction, need for revascularisation or death was 93.2 percent at 30 days and 84 percent at 6 months following stent implantation. From our data, it is concluded that (i) the delivery of the new, less-shortening, self-expanding Wallstent at the target site was possible in almost all the cases; (ii) clinical success with < 30 percent residual diameter stenosis could be achieved in approximately 98 percent of cases, and (iii) there was an impressive event-free survival of 84 percent at 6 months of follow-up. The occurrence of 2 deaths during the first 30 days, however, necessitates close supervision for possible subacute stent thrombosis. The results of angiography after six months would help to define the true incidence of restenosis.

Adult↗
PubMedDate not supplied

Transcatheter coil occlusion of persistent ductus arteriosus using detachable steel coils: short-term results.

Twenty patients underwent transcatheter occlusion of persistent ductus arteriosus (PDA), 1.5-5.5 mm in diameter, with detachable steel coils. A coil having a diameter at least twice that of the narrowest ductal diameter was used. Procedural success was achieved in all, using a single coil in 14 and multiple coils in the remaining 6. At follow-up after 2-12 (6.7 +/- 2.8) months, continuous murmur persisted in only one patient, while 4 (20%) patients had residual shunt on Doppler colour-flow imaging. There was no instance of coil embolisation, thromboembolism, intravascular haemolysis, local vascular complication or sepsis. Transcatheter occlusion of PDA with detachable coils is a safe, technically easy and cost-effective method with the added advantage of feasibility in small children.

Adolescent↗
PubMedDate not supplied

Elective coronary stenting after recanalization for chronic total occlusion: clinical and angiographic follow-up results.

Percutaneous transluminal coronary angioplasty (PTCA) for chronic totally occluded coronary arteries is associated with a significant residual stenosis and a high incidence of restenosis. Between March 1995 to February 1997, recanalization of chronic total occlusion (CTO) was attempted in 95 patients, of whom 79 (83.1%) were dilated successfully using balloon angioplasty, rotablation or both. Forty two patients underwent elective stent implantation to evaluate the influence of stenting on immediate results and clinical as well as angiographic outcome on long-term follow-up. There were 39 males and 3 females, with a mean age of 51 +/- 8 years. The majority (69.1%) had multivessel disease. The target vessel was LAD in 25 (58.1%), RCA in 12 (27.9%), LCx-OM in 5 (11.6%) and ramus in 1 (2.3%). After recanalization and adequate predilatation, various types of stents were deployed successfully at the target site in all patients, using high pressure intrastent balloon dilatation. The luminal diameter stenosis reduced to 47 +/- 15 percent after balloon angioplasty and < 10 percent in all, after stent implantation. There were no in-hospital major complications, including subacute stent thrombosis, myocardial infarction, need for emergency bypass graft surgery or death. The follow-up data is available in 36 patients, ranging from 1-22 months (mean: 7.4 +/- 4.7; median: 6). Of these, 32 (88.8%) were free of angina at their last visit, 3 (8.3%) required target lesion revascularization and 2 patients died, one at 3 weeks and the other at 6 months after the procedure. The event-free survival, estimated by the Kaplan-Meier survival curve was 97.3, 82.8 and 77.25 percent at one, 6, and 12 months, respectively after stenting. Out of 29 eligible patients, 20 underwent repeat coronary angiography after 6 months, which revealed restenosis in 5 (25%). In conclusion, our study shows that elective coronary stenting following successful recanalization of chronic total occlusion produces an excellent immediate result and reduces the recurrence of angina, target lesion revascularization and angiographic restenosis on long-term follow-up.

Angioplasty, Balloon, Coronary↗
PubMedDate not supplied

Immediate and follow-up clinical outcome after multivessel coronary stenting.

Seventy-two out of 656 patients treated by coronary stenting between January 1995 to May 1997 underwent elective multivessel stenting as a strategy for nonsurgical revascularization in patients with two-vessel (n = 37) and three-vessel (n = 35) disease. Their age ranged from 35 to 77 years (mean: 53.6 +/- 9.2) and the majority (77.8%) were males. The patients were included if the target vessel was more than 2.7 mm in diameter and subserved a moderate to large area of viable myocardium, provided the target lesion was considered approachable by stent. In all, 160 stents were deployed in 146 vessels with a mean of 2.2 stents per patient. The procedure was performed on all the target lesions in one stage in 51(70.8%) and two stages in 21(29.2%) patients. Two-vessel stenting was done in all except 2 patients who received stents in all the three major arteries. Successful deployment of the stent was achieved at the target site in all patients without any major in-hospital complications including subacute stent thrombosis, myocardial infarction (MI), emergency bypass graft surgery (CABG) or death. Clinical follow-up was available in 66(91.6%) patients at a mean of 7.8 +/- 5.5 months. The actuarial survival rates were 98.6, 96.7 and 94.6 percent, respectively at one, 3 and 6 to 12 months after the procedure with an event-free survival (absence of death, MI, recurrence of angina or any revascularization) of 98.5 percent at one, 93 percent at 3, 83.2 percent at 6 and 68.4 percent at 12 months. Only 15(22.7%) patients developed any event and target lesion revascularization was required in 8(12%) patients. In conclusion, multivessel stenting in patients with two- and three-vessel coronary disease is feasible, safe and effective in preventing major in-hospital complications as well as reducing the recurrence of clinical events and need for revascularization on follow-up.

Adult↗
PubMedDate not supplied

Elective stenting of unprotected left main coronary artery ostial stenoses: short- and mid-term results.

Elective stenting as a primary strategy for non-surgical revascularisation was performed in five patients with symptomatic unprotected left main coronary artery ostial stenoses. Their ages ranged from 24 to 57 years (mean: 44.6 +/- 14.4 years). Left ventricular ejection fraction ranged from 35 to 55 percent. All patients underwent successful stenting for left main ostial stenoses using a disarticulated 7 mm Palmaz-Schatz stent. Luminal diameter stenosis reduced from 74 +/- 10.8 to 10 +/- 7.2 percent after the procedure. One patient developed recurrence of angina on the 7th day due to marked recoil of the left main coronary artery with possible thrombosis, requiring immediate coronary artery bypass graft surgery without any sequelae. Remaining four patients were asymptomatic over a mean follow-up of 54 +/- 36 weeks (range: 25-96) and none developed angiographic restenosis at six months. Our preliminary observations therefore suggest that primary stenting is a feasible alternative to bypass graft surgery in patients with unprotected left main coronary artery ostial stenoses.

Adult↗