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X Favereau

Publications and source records attributed to X Favereau.

At least 37 records · Page 2Linked to original sources
PubMed1996

Stent implantation in acute myocardial infarction.

Among 138 patients treated with coronary angioplasty during acute myocardial infarction (AMI), 35 (25%) had stent implantation. Mean age was 56 years and 83% were men. Mean onset of chest pain was 6.0 +/- 5.3 hours, and previous thrombolytic therapy was given to 10 patients (29%). Infarct location was anterior in 19 (54%), inferior in 14 (40%), and lateral in 2 patients (6%). Thrombolysis in Myocardial Infarction trial flows 0,1, and 2 were seen in 24 (69%), 6 (17%), and 5 patients (14%), respectively. The culprit vessel was the left anterior descending artery in 18 (51%), right coronary artery in 14 (40%), left circumflex in 2 (6%), and left main coronary artery in 1 patient (3%). Mean vessel diameter was 3.3 +/- 0.3 mm. Indications were: primary in 5 (14%), suboptimal result in 8 (23%), nonocclusive dissection in 14 (40%), and occlusive dissection in 8 patients (23%). Angiographic thrombus after initial angioplasty was present in 12 patients (34%). A total of 46 stents were implanted; mean balloon diameter and pressure were 3.4 +/- 0.4 mm and 15.5 +/- 2.2 atm, respectively. Residual diameter stenosis was 4 +/- 7%. There were 2 deaths; sudden 1, and after elective coronary artery bypass grafting in the other; 2 patients (6%) had groin hematomas. Mean hospitalization was 9.9 +/- 5.0 days. Repeat angiography revealed no stent occlusion. With initial intravenous heparin for 3 to 7 days, all patients received aspirin and ticlopidine for 1 month. Thus, AMI is not a contraindication for stent implantation. The benefits of stenting are a high success rte, low residual diameter stenosis, and low incidence of in-hospital recurrent ischemia. Reduction in restenosis rate in this setting is likely but remains to be determined.

Aged↗
PubMed1996

Evaluation of a new 9F guiding catheter for directional coronary atherectomy.

Large lumen guiding catheters (9.5 to 11 French) are currently required to perform directional atherectomy. These rigid guiding catheters require modifications of usual techniques for manipulation and can induce ostial trauma and peripheral vascular complications. A new type of 9 French guiding catheter (Vista Brite tip, Cordis, Miami, FL) with an inner diameter of 0.098 inch and capable of accomodating atherectomy catheters (SCA-EX) was evaluated. In this preliminary study, 31 consecutive patients were included. Primary success was obtained in 27 (87%); no ostial trauma and only two minor groin hematomas were observed. After exchange with a conventional 10F guiding catheter, because of poor back-up, two of the four failures were successfully treated by DCA. In conclusion, these new 9F guiding catheters provide a useful alternative to currently available guiding catheters for DCA. Nevertheless, new shapes with better back-up are necessary to improve the primary success rate.

Adult↗
PubMed1996

Bail-Out of Stent Jail: Stent Delivery Through Stent Struts.

Stent deployment in a lesion with a large side branch is an example of the potential limitation of intracoronary stents, especially the Palmaz-Schatzª stent with its tubular slotted design. This case study describes a patient in whom a Palmaz-Schatz stent of excessive length covered the origin of a side branch (Òstent jailÓ). Thrombus developed in the jailed branch as well as in the main vessel, causing abrupt vessel closure and impending acute myocardial infarction within one hour after the procedure. This complication was successfully managed by emergency repeat angioplasty and implantation of a Micro Stentª on both branches, i.e. in the main vessel distal to the Palmaz-Schatz stent and in the side branch through the struts of the Palmaz-Schatz stent.

Journal Article↗
PubMed1995

Predictors of short term clinical and angiographic outcome after coronary angioplasty for acute myocardial infarction.

UNLABELLED: Coronary angioplasty is an effective method to achieve myocardial reperfusion in acute myocardial infarction (AMI). We reviewed our experience in 132 patients (pts) who underwent percutaneous transluminal coronary angioplasty (PTCA) of a totally occluded infarct-related artery (IRA) within 24 h after the onset of symptoms (mean delay 10 +/- 7 h), in order to identify the predictors of primary success and of major complications. PTCA was successfully performed in 113 patients (86%). Failure without complications occurred in 12 patients (8.4%); untoward events (death and emergency CABG) occurred in seven patients (5.3%). Pts in the failure group were more likely to have cardiogenic shock (53 vs. 8.8%, P < .0005), longer time to reperfusion (15 +/- 6 vs. 9 +/- 6 h, P < .0005), lower ejection fraction (EF) (42 +/- 16 vs. 54 +/- 12%, P < .0005), multivessel disease (74 vs. 43%, P < .03), and a smaller IRA diameter (2.8 +/- 0.6 vs. 3.1 +/- 0.6 mm, P < .03). Sex, age, previous bypass surgery, previous thrombolytic treatment, IRA, and infarct location were similar in both groups. Absence of cardiogenic shock (P < .0001), decreasing time to reperfusion (P < .005) and increasing EF (P < .02) were independent predictors of successful PTCA. Presence of cardiogenic shock (P < .0001) and decreasing EF (< .05) were independent predictors of untoward events. Repeat angiography was performed 24 h after the procedure in the success group. Angiographic deterioration (stenosis > or = 50% and/or TIMI flow grade < or = 1) was present in 18 pts (16%), among whose 5 pts (4.4%) had re-occlusion of the IRA. Pts with early angiographic deterioration were more likely to have a lower IRA diameter (2.8 +/- 0.5 vs. 3.1 +/- 0.6 mm, P < .02). CONCLUSION: Emergency PTCA is an effective method for establishing reperfusion in AMI. Pts with high-risk baseline characteristics show the highest rate of untoward events, but are the most likely to benefit from aggressive reperfusion therapy.

Adult↗
PubMed1995

Multiple stenting in acute myocardial infarction with double vessel occlusion, complicated with cardiogenic shock.

Stenting of the infarct-related artery during the acute phase of myocardial infarction is a controversial issue. We report a case of primary multiple stent implantation in 2 vessels in a patient with AMI, double vessel total occlusion and cardiogenic shock. No intracoronary thrombotic therapy was given. Stenting provides an optimal angiographic result which may decrease the need for repeat interventions. Primary stenting in AMI deserves further investigation.

Angioplasty, Balloon, Coronary↗
PubMed1995

[Coronary angioplasty during acute myocardial infarction].

BACKGROUND: Percutaneous coronary angioplasty (PTCA) is an effective method to achieve myocardial reperfusion in acute myocardial infarction. In order to identify the predictors of primary success and major complications, we reviewed our experience in 107 patients (pts) who underwent PTCA of a totally occluded infarct-related coronary artery (IRA) within 24 hours (h) after the onset of symptoms. METHODS AND RESULTS: PTCA was successful in 92 pts (86%); PTCA failed without complications in 9 pts (8.4%), major complication (death and urgent coronary artery surgery) occurred in 6 pts (5.6%). Rescue PTCA was performed in 31% of cases and had similar success rate when compared to direct PTCA (85 vs 86%, p = NS). Pts with successful PTCA had repeat angiography 24 h after the procedure. According to primary and 24 h results, pts were divided into 3 groups: primary success with 24 h stable result (Group A: 76 pts, 71%); primary success with 24 h deterioration (Group B: 16 pts, 15%), among which 4 pts showed total reocclusion; primary failure (Group C: 15 pts, 14%). A longer time delay from symptoms onset (p < 0.05), cardiogenic shock (p < 0.001), previous bypass surgery (p < 0.05) were correlated with worse short-term outcome by univariate analysis. When compared to Group A, pts in Group C showed a lower EF (42 +/- 14 vs 51 +/- 16%, p < 0.05). IRA diameter was greater in Group A (3.1 +/- 0.4 mm) when compared to Group B (2.7 +/- 0.4 mm, p < 0.05) and Group C (2.7 +/- 0.5 mm, p < 0.05). Absence of cardiogenic shock (p < 0.001), decreasing time from symptoms onset (p < 0.01) and increasing ejection fraction (EF) (p < 0.05) were independent predictors of primary success by multivariate analysis. Cardiogenic shock (p < 0.001) and decreasing EF (p < 0.05) were independent predictors of major complications. CONCLUSIONS: PTCA of IRA is effective within 24 h from symptoms onset. Procedural failure is infrequent, usually occurring in patients with high-risk baseline characteristics.

Aged↗
PubMed1995

[Multi-instrumental revascularization adjusted to coronary lesions (MIRACLE). Current role of new technologies].

Several new techniques have been developed to get round the limitations of conventional coronary angioplasty. Most entail ablation of the atheromatous plaques by mechanical (atherectomy) or photochemical (laser excimer) means, whilst others (stents) shore up the vascular walls. Their use with conventional coronary balloon angioplasty optimises the results of treatment of complex lesions. This report describes the authors' experience in 1,266 patients (1,668 lesions) treated between January 1992 to December 1993. The new techniques were used in 33% of patients and 30% of lesions (rotational) atherectomy: 20%; stents: 5%; directional atherectomy: 3%; laser excimer: 2%) because of the defavourable angiographic characteristics of the lesions (eccentricity, calcification, bifurcation, length, chronic total occlusion, thrombosis, ostial stenosis, ulceration, saphenous vein graft). The primary success rate was 91% in the whole group (94 to 97% for the patients treated by the new techniques). The global major complication rate was 1.7%. The multi-instrumental revascularization adjusted to the coronary lesions (MIRACLE) gives a high primary success rate in patients with coronary lesions difficult to treat by conventional angioplasty. Randomised trials will be necessary to determine the precise indications of each technique with respect to the morphological characteristics of each lesion.

Aged↗
PubMed1994

Rotational coronary atherectomy with adjunctive balloon angioplasty for the treatment of ostial lesions.

Conventional balloon angioplasty (PTCA) of ostial lesions (OL) is associated with suboptimal results and a higher complication rate. Partial plaque ablation with rotational atherectomy (RA) before PTCA might improve results. This approach was used in 63 patients (pts) (mean age 64 +/- 10 yrs; 44 men, 19 women) with 69 OL. There were 15 aorto-OL and 54 branch-OL. Calcification was more frequent in aorto-OL than in branch-OL (67% vs. 35%, P < 0.05). Mean burr size was 1.8 +/- 0.3 mm. Burr-artery ratio was 0.74 +/- 0.10. Adjunctive PTCA was systematically performed. Procedural success was achieved in 58 pts (92%): 14 aorto-OL (93%) and 50 branch-OL (93%) were successfully treated; major complications occurred in 1 (7%) aorto-OL and 1 (2%) branch-OL. Uncomplicated failure occurred in three cases. Minimal lumen diameter (MLD) increased from 0.69 +/- 0.31 mm before RA to 1.43 +/- 0.28 mm after RA (P < 0.001) and 2.16 +/- 0.29 mm after PTCA (P < 0.001). Diameter stenosis (DS) decreased from 75 +/- 13% before RA to 32 +/- 12% after RA (P < 0.001) and 14 +/- 10% after PTCA (P < 0.001). All successfully treated pts underwent repeat angiography 24 h later and exercise testing or repeat cardiac catheterization > 6 mo later. At 24 h repeat angiography, DS was 17 +/- 15% (P = NS vs. after PTCA); no lesion had a DS > or = 50%. Follow-up coronary angiography was performed in 30 pts (52%) who had abnormal stress testing: 13 pts (43%) showed angiographic restenosis in at least one successfully treated OL. (ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1994

Initial experience with the Europass: a new ultra-low profile monorail balloon catheter.

One of the causes for percutaneous transluminal coronary angioplasty (PTCA) failure is the inability to cross the lesion with the balloon catheter after guidewire positioning. The Europass coronary angioplasty catheter is a monorail Duralyn balloon catheter developed to enhance lesion crossability and to overcome this limitation. This system was evaluated in 50 patients in which target lesions were chronic total coronary occlusions (12 cases) or stenoses that could not be reached or crossed by other new monorail balloon catheters. Overall procedural success was obtained in 49/50 patients (98%), using a single Europass balloon catheter in 46/50 patients (92%), with no in-hospital complications. Its low profile, small distal shaft, and excellent trackability allowed successful angioplasty in cases where other catheters failed. This balloon catheter represents a significant advance in angioplasty technology and can be considered as a first-choice device for a safe and expeditious single-operator procedure.

Aged↗
PubMed1994

[Short-term efficacy of high speed rotational atherectomy with and balloon angioplasty in the treatment of lesions located at the ostium of a coronary branch].

In the treatment of branch-ostial lesions (BOL) balloon angioplasty (PTCA) is associated with suboptimal results and a higher complication rate. Rotational atherectomy (RA) before PTCA might improve results. This approach was used in 37 patients (mean age 62 +/- 10 years; 27 men, 10 women) with 42 BOL. Mean burr size was 1.7 +/- 0.3 mm; burr-artery ratio was 0.75 +/- 0.10. Procedural success was achieved in 39 (93%) BOL; the only major complication was a periprocedural myocardial infarction (CPKMB=58IU/ml). In 2 cases the stenosis was not crossed by the guidewire. Diameter stenosis (DS) decreased from 72 +/- 14% before RA to 30 +/- 12% after RA (p < 0.001) and 15 +/- 10% after PTCA (p < 0.001). All patients with a successful procedure underwent repeat angiography 24 hours DS was 18 +/- 15 (NS versus after PTCA); no lesion had DS > or = 50%. RA with adjunctive PTCA is a safe and effective treatment of BOL, with short-term stable results.

Adult↗
PubMed1994

[Preliminary experience in the treatment of complex stenosis in the aged (> or = 70 years) with high-speed rotational atherotomy followed by conventional PTCA].

Rotational coronary atherectomy with adjunctive balloon angioplasty was performed in 36 patients older than 70 years. Previous myocardial infarction, coronary angioplasty and coronary artery bypass were present in 44%, 11% and 14%, respectively. Thirty-six percent and 33% of patients presented stable and unstable angina pectoris, respectively. Totally, 46 lesions were treated (1,3 lesion/patient). All lesions had complex morphology characteristics: eccentricity (63%), calcification (69%), angulation (44%), length > 10 mm (11%), undilatable rigid lesion with failed PTCA (11%), ostial disease (9%), ulceration (7%). In 39% was present a single-vessel disease, in 44% double-vessel disease and in 17% triple-vessel disease. Five patients received rotational atherectomy on two stenoses in the same vessel, 5 received a two vessels treatment. Procedure was successful in 94% of patients; 2 patients (6%) had major complication (1 urgent coronary artery bypass and 1 acute myocardial infarction) without any death. All patients with successful rotational atherectomy had repeated coronary angiography at 24 hours. No patient showed significant deterioration (stenosis > or = 50%) of the initial result at 24 hours. Rotational atherectomy can be performed in patients over 70 years with complex coronary lesions with a high success rate, low complications and persistence at 24 hours of initial gain. It should be considered as a primary therapeutical option in selected cases with complex coronary lesions in which conventional PTCA can be unsuccessful.

Age Factors↗
PubMed1993

Role of the different percutaneous revascularization techniques in single and multivessel coronary artery disease.

Over the past 16 years coronary angioplasty has become an established therapy for coronary artery disease. Advances in technology and growing operator experience have improved initial success rates, lowered the complications associated with coronary angioplasty and expanded the indications of percutaneous revascularization to include large numbers of patients with complex lesions. The mechanisms of coronary angioplasty include plaque fracture, intimal atherosclerotic flaps, localized medial dissection and stretching of plaque-free segments. The problems and limitations of coronary angioplasty are: unfavourable lesion morphology which may preclude complete revascularization or increase the risk of major complications, "high-risk" patients requiring pharmacological or mechanical support, acute coronary occlusion, and restenosis, the 2 latter problems being related to the very mechanisms of coronary angioplasty. Recently, new interventional devices have been introduced: intracoronary stents, directional coronary atherectomy, rotational atherectomy, transluminal extraction atherectomy, excimer laser coronary angioplasty. A multidevice lesion-specific approach integrated with balloon angioplasty may optimize procedural results in a growing number of patients with complex coronary lesions. However, restenosis occurring within 6 months after successful angioplasty remains the "Achilles' heel" of coronary interventional procedures and erodes the potential advantages angioplasty holds over coronary bypass surgery. These 2 forms of myocardial revascularization are currently compared for the treatment of multivessel disease in randomized trials.

Angioplasty, Balloon, Coronary↗
PubMed1992

Improvement of digital coronary angiography: high resolution processing coupled with a real time functional synchronization procedure.

The use of Digital Subtraction Angiography in coronary applications is restricted by the difficulty in: 1. Obtaining a good resolution of the distal branches. 2. Avoiding, for the purpose of subtraction, the motion artifacts induced by artery and background displacement during the cardiac and respiratory cycles. 3. Preserving the dynamic vascular motion. 4. And storing the digital dynamic information on a permanent support. We used for this study an angiography system, based upon a high resolution 45 MIPS-32 Mbyte image processor, interfaced with a 2.75 Gbyte Winchester drive allowing the real time storage of either 30 frames/s in the 512*512*8 bits matrix or of 7.5 f/s in the 1024*1024*8 bits matrix. To preserve the most important dynamic informations on the basis of the 7.5 f/s maximal storage rate, we developed a synchronization device able to recognize in real time, from chronologic delays derived by using both ECG and Aortic Pressure curves, the functional End-Diastolic (ED) and the End-Systolic (ES) positions, even in the case of heart rates varying during the procedure. The ED and the ES images are stored together with the Mid-Systolic (MS), the 1/3-Diastolic (1/3D) and 2/3-Diastolic (2/3D) images. To establish the validity of this sampling method, which uses a reduced number of frames per cardiac cycle, 7200 coronary injections performed during 450 routine coronary angiographies were compared by two independent observers (A and B), using: first a Digital (D) 5 frames/cycle sequence, and secondly a cine Film (F) 50 frames/s sequence acquired immediately after the corresponding D injection. The D technique resulted in the best image and diagnostic quality, particularly when the F quality was estimated 'fair' or 'poor' by both observers, and in an important reduction on X-Ray doses. The visualisation of the sequential ED, MS, ES, 1/3D and 2/3D frames gives the possibility: 1. of saving the dynamic information, as a regular sample of functional images can be displayed with a cine loop technique. 2. of facilitating cardiac synchronized subtractions. 3. of reducing the amount of frames per cycle, thus allowing an important reduction of X-ray doses and the digital and permanent storage of the most important cardiac cycles.

Angiography, Digital Subtraction↗
PubMed1992

Percutaneous transluminal coronary angioplasty of oversized saphenous coronary bypass grafts: 'hugging balloons' or single peripheral dilatation catheter technique?

The use of angioplasty in patients with previous coronary bypass grafts (CABG) has been described in several reports. CABG diameter often exceeds the size of the available coronary balloon dilatation catheters. Simultaneous inflation of two side-by-side balloons or a peripheral angioplasty catheter have been used to achieve optimal balloon-vessel ratio. We describe our experience with the two-balloon technique (case 1) and with a single peripheral angioplasty balloon (case 2) to dilate oversized CABG.

Aged↗
PubMed1992

[Ambulatory coronary arteriography with 5 French catheters: experience with 604 procedures].

Ambulatory coronary arteriography was carried out in 604 patients, 143 women and 461 men, mean age 53 +/- 14 years. An absolutely stable clinical condition was the main criterion of selection for this investigation and the protocol consisted in day-hospital admission, absence of routine anticoagulation, small calibre (5 French = 1.7 mm diameter) catheters, mobilization 4 hours and discharge 6 hours after the end of the procedure. The percutaneous femoral approach was used in 95% of cases; 56% of patients presented significant single-or multi-vessel coronary artery disease: there were 7 cases of left main coronary artery narrowing; 31 patients required full hospital admission, mainly because of the severity of coronary lesions. Minor complications occurred in 2% of cases.

Adult↗