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Y C Chuang

Publications and source records attributed to Y C Chuang.

At least 73 records · Page 4Linked to original sources
PubMed1996

Limitations of angiography in the assessment of plaque distribution in coronary artery disease: a systematic study of target lesion eccentricity in 1446 lesions.

BACKGROUND: Plaque distribution (eccentricity) may be a determinant of the success of transcatheter therapy, and certain devices may be better suited to treating severely eccentric lesions than others. However, no study has compared methods for assessing plaque distribution or systematically studied the validity of the angiographic assessment of plaque distribution. METHODS AND RESULTS: We studied 1446 native vessel target lesions in 1349 patients by intravascular ultrasound and coronary angiography. Angiographic and intravascular ultrasound criteria for lesion eccentricity were compared. Angiography showed that 795 of 1446 (55.0%) of target lesions were eccentric. When intravascular ultrasound was used, only 219 lesions (15.1%) had an arc of normal arterial wall within the lesion (equivalent to the pathological definition of lesion eccentricity). When an eccentricity index of >/= 3.0 was used, intravascular ultrasound classified 659 lesions (45.6%) as eccentric. The concordance rates of classification were only 47.7% (versus lesions containing an arc of normal arterial wall) and 53.8% (versus lesions with an ultrasound eccentricity index of >/= 3.0). More eccentric lesions had larger lumen cross-sectional areas, smaller plaque plus media and external elastic membrane cross-sectional areas, and smaller arcs of calcium, suggesting that they may represent less advanced atherosclerotic disease. CONCLUSIONS: There was significant discordance between angiography and ultrasound in assessing plaque distribution. Angiography appeared to detect lesion eccentricity more often than intravascular ultrasound. Furthermore, markedly eccentric lesions, in which there is an arc of normal vessel wall, were uncommon.

Coronary Angiography↗
PubMed1996

Intravascular ultrasound predictors of restenosis after percutaneous transcatheter coronary revascularization.

OBJECTIVES: This study sought to evaluate preintervention and postintervention intravascular ultrasound studies for potential predictors of angiographic restenosis and to use ultrasound predictors of restenosis to enhance our understanding of the pathophysiology of the restenosis disease process. BACKGROUND: Restenosis remains the major limitation of percutaneous transcatheter coronary revascularization. Although its mechanisms remain incompletely understood, numerous studies have identified some of the clinical, anatomic and procedural risk factors for restenosis. Intravascular ultrasound imaging of target lesions before and after catheter-based treatment consistently demonstrates more target lesion calcium, more extensive reference segment atherosclerosis, smaller final lumen dimensions, significant residual plaque burden and a greater degree of tissue trauma than is evident by angiography. METHODS: Intravascular ultrasound studies were performed in 360 nonstented native coronary artery lesions (final diameter stenosis 18 +/- 11%) in 351 patients for whom follow-up angiographic data were available 6.4 +/- 3.6 months later. Hospital charts were reviewed, and qualitative and quantitative coronary angiographic and intravascular ultrasound analyses were performed by independent core laboratories. Four dependent angiographic end points were tested: restenosis as a binary definition (> or = 50% diameter stenosis at follow-up) was the primary end point; follow-up diameter stenosis, late lumen loss and follow-up minimal lumen diameter were the secondary end points. RESULTS: Reference vessel size, the preintervention quantitative coronary angiographic assessment of lesion severity and the postintervention intravascular ultrasound cross-sectional measurements predicted the late angiographic results. In particular, the intravascular ultrasound postintervention cross-sectional narrowing (plaque plus media cross-sectional area divided by external elastic membrane cross-sectional area) predicted the primary end point (restenosis) and two of the three secondary end points (follow-up diameter stenosis and late lumen loss) and was therefore the most consistent predictor of restenosis. CONCLUSIONS: Intravascular ultrasound variables are more powerful and consistent predictors of angiographic restenosis than currently accepted clinical or angiographic risk factors.

Adult↗
PubMed1996

Xanthone derivatives as potential anti-cancer drugs.

Xanthone derivatives have been shown to be potent inhibitors of tumour growth. Oxygenated xanthones and [3-(dialkylamino)-2-hydroxypropoxy]xanthones have been prepared and tested for in-vitro inhibition of human PLC/PRF/5, KB and 212 cells. Structure-activity analysis indicated epoxidation of the hydroxyxanthone increased cytotoxicity against tumour cells but ring-opening of the epoxide group with dialkylamine did not enhance the anti-tumour activity. Further evaluation of three of the most active compounds 2, 6-, 3, 6-, and 3, 5-di(2,3-epoxypropoxy)xanthone (compounds 10a, 11a, and 12a, respectively) in DNA, RNA and protein synthesis of tumour cells showed potent inhibitory activity. The 3,5-di(2,3-epoxypropoxy)xanthone also showed potent inhibitory activity against 212 cells, a Ha-ras oncogene-transformed NIH 3T3 cell line. The results indicated that compounds 10a and 12a are potent anti-tumour agents which not only suppressed cellular DNA, RNA and protein synthesis but also specifically inhibited the Ha-ras oncogene in 212 cells.

3T3 Cells↗
PubMed1996

Increasing antibiotic resistance in clinical isolates of Aeromonas strains in Taiwan.

A total of 234 clinical isolates of Aeromonas, primarily A. hydrophila, were collected for the present study. Most were isolates from blood. By the agar dilution method, more than 90% of the Aeromonas strains were found to be susceptible to moxalactam, ceftazidime, cefepime, aztreonam, imipenem, amikacin, and fluoroquinolones, but they were more resistant to tetracycline, trimethoprim-sulfamethoxazole, some extended-spectrum cephalosporins, and aminoglycosides than strains from the United States and Australia.

Aeromonas↗
PubMed1996

Hemorrhagic fever with renal syndrome: first imported case of hantavirus infection in Taiwan.

A patient infected with hantavirus, with resultant hemorrhagic fever with renal syndrome (HFRS), is reported. The patient was a 38-year-old man, living in Tainan, Taiwan, who had been visiting Mainland China for 3 months when he suddenly developed fever and chills, generalized myalgia, abdominal pain and petechiae on his chest. He sought treatment in Mainland China. His clinical course progressed through febrile, hypotensive, oliguria and polyuria phases. Supportive care included one course of hemodialysis. He returned to Tainan in partial defervescence. Serologic studies undertaken in Taiwan confirmed Hantaan virus infection, with one of the currently identified hantavirus strains. Hospitalization with supportive care produced further clinical improvement. Clinicians should be alert to the possibility of HFRS when examining patients who have been in endemic areas and complain of fever associated with renal dysfunction, hemorrhage or abdominal pain or both.

Adult↗
PubMed1995

Suppression of natural killer cell activity in mouse spleen lymphocytes by several dopamine receptor antagonists.

The effects of dopaminergic receptor inhibitors such as thiothixine (D1/D2), fluphenazine (D1/D2), trifluoperazine (D1/D2), pimozide (D2), flupenthixol (D1/D2), (+/-)-SKF 83566 (D1), and spiperone (D2) on splenic natural killer (NK) cell cytotoxic activities were assessed in vitro using mouse spleen lymphocytes or enriched NK cells. Both the activities of the splenic NK cell cytotoxicity and the effector-target cell conjugation were suppressed by thiothixine, fluphenazine, and trifluoperazine at concentrations from 2.64 to 14.78 microM. In addition, the augmentation of the cytolytic activity of NK cells induced by interferon-alpha or interleukin-2 was antagonized by pretreatment with these neuroleptic compounds. However, neither the splenic NK cell cytotoxicity nor the effector-target cell conjugation were affected by treatment with other neuroleptic compounds such as pimozide, flupenthixol, (+/-)-SKF 83566, and spiperone. Thus, it appears that neuroleptic compounds such as thiothixine, fluphenazine, and trifluoperazine may act through the mechanisms other than a dopaminergic pathway to affect the NK cell-target cell interaction.

2,3,4,5-Tetrahydro-7,8-dihydroxy-1-phenyl-1H-3-ben↗
PubMed1995

Patterns of calcification in coronary artery disease. A statistical analysis of intravascular ultrasound and coronary angiography in 1155 lesions.

BACKGROUND: Target lesion calcium is a marker for significant coronary artery disease and a determinant of the success of transcatheter therapy. METHODS AND RESULTS: Eleven hundred fifty-five native vessel target lesions in 1117 patients were studied by intravascular ultrasound (IVUS) and coronary angiography. The presence, magnitude, location, and distribution of IVUS calcium were analyzed and compared with the detection and classification (none/mild, moderate, and severe) by angiography. Angiography detected calcium in 440 of 1155 lesions (38%): 306 (26%) moderate calcium and 134 (12%) severe. IVUS detected lesion calcium in 841 of 1155 (73%, P < .0001 versus angiography). The mean arc of lesion calcium measured 115 +/- 110 degrees; the mean length measured 3.5 +/- 3.7 mm. Target lesion calcium was only superficial in 48%, only deep in 28%, and both superficial and deep in 24%. The mean arc of superficial calcium measured 85 +/- 108 degrees; the mean length measured 2.4 +/- 3.4 mm. Three hundred seventy-three of 1155 reference segments (32%) contained calcium (P < .0001 compared with lesion site). The mean arc of reference calcium measured 42 +/- 80 degrees; the mean length measured 1.7 +/- 3.6 mm. Only 44 (4%) had reference calcium in the absence of lesion calcium. Angiographic detection and classification of calcium depended on arcs, lengths, location, and distribution of lesion and reference segment calcium. By discriminant analysis, the classification function for predicting angiographic calcium included the arc of target lesion calcium, the arc of superficial calcium, the length of reference segment calcium, and the location of calcium within the lesion. This model correctly predicted the angiographic detection of calcification in 74.4% of lesions and the angiographic classification (none/moderate/severe) of calcium in 62.8% of lesions. CONCLUSIONS: IVUS detected calcium in > 70% of lesions, significantly more often than standard angiography. Although angiography is moderately sensitive for the detection of extensive lesion calcium (sensitivity, 60% and 85% for three- and four-quadrant calcium, respectively), it is less sensitive for the presence of milder degrees.

Calcinosis↗
PubMed1995

Comparison of clinical and angiographic outcomes after saphenous vein graft angioplasty using coronary versus 'biliary' tubular slotted stents.

BACKGROUND: Saphenous vein graft (SVG) angioplasty using 15-mm articulated, tubular slotted stents results in low (0% to 20%) residual diameter stenoses and infrequent (< 5%) major complications. A "biliary" stent design with greater radial compressive strength, enhanced visibility, and more variable sizing (diameter and length) has been approved for noncoronary indications. A comparison of outcomes after coronary versus biliary stent placement in SVG stenoses has not been performed. The purpose of this study was to compare the angiographic and clinical results after SVG angioplasty using these two balloon-expandable, tubular slotted stent designs. METHODS AND RESULTS: During a 3-year period, 231 patients with 305 SVG lesions were treated using Palmaz-Schatz coronary (n = 108) or biliary (n = 123) stents. Cineangiograms were reviewed using qualitative morphological and quantitative angiographic methods. Time-dependent clinical outcome (freedom from death, Q-wave myocardial infarction, or the need for repeat coronary bypass surgery or SVG angioplasty) was assessed using Kaplan-Meier life-table methods. Unstable angina (P < .001) and recent myocardial infarction (P = .001) were present more often in patients undergoing biliary stent versus coronary stent placement. Biliary stent-treated SVG lesions were more frequently de novo (P = .001), ostial in location (P = .002), > or = 10 mm in length (P = .009), thrombus containing (P = .001), and ulcerated (P < .001) than coronary stent-treated SVG lesions. Angiographically, biliary stent-treated lesions had larger reference vessel diameter (3.43 +/- 0.59 mm versus 3.10 +/- 0.64 mm, P < .001), higher balloon-to-artery ratio (1.15 +/- 0.16 mm versus 1.07 +/- 0.19, P = .0001), and lower residual diameter stenosis (6 +/- 17% versus 14 +/- 11% in coronary stent-treated patients; P < .001). Procedural success rates were high (95%), in-hospital major complications were uncommon (< 3%), and follow-up clinical outcomes were favorable (6-month event-free survival approximately 80%) in both groups. CONCLUSIONS: Despite frequent short-term ischemic syndromes and unfavorable lesion characteristics, both biliary and coronary cohorts have similarly favorable short-term procedural results and long-term clinical outcomes. The increased strut thickness of the biliary stent confers greater fluoroscopic visibility and radial compressive strength in exchange for decreased stent flexibility and added technical demand in stent deployment. Extreme caution is recommended with biliary stent placement in the treatment of SVG lesions as clinical results are highly operator dependent.

Aged↗
PubMed1995

Atherosclerosis in angiographically "normal" coronary artery reference segments: an intravascular ultrasound study with clinical correlations.

OBJECTIVES: This study evaluated the magnitude, patterns and clinical correlates of atherosclerosis in angiographically "normal" reference segments in patients undergoing transcatheter therapy for symptomatic coronary artery disease. BACKGROUND: Pathologic studies indicate that the extent of coronary atherosclerosis is underestimated by visual analysis of angiographically normal coronary artery segments. Intravascular ultrasound allows detailed, high quality cross-sectional imaging of the coronary arteries in vivo. METHODS: Intravascular ultrasound was used to study angiographically normal coronary artery reference segments in 884 patients evaluated for transcatheter therapy for symptomatic native coronary artery disease. The reference segment was the most visually normal intravascular ultrasound cross section within 10 mm proximal to the target lesion but distal to any major side branch. Results are presented as mean value +/- 1 SD. RESULTS: Only 60 (6.8%) of 884 angiographically normal reference segments were normal by intravascular ultrasound. Reference segment percent cross-sectional narrowing measured 51 +/- 13% and correlated poorly with the target lesion percent cross-sectional narrowing (r = 0.166, p < 0.0001). Reference segments contained less calcific and dense fibrotic plaque and proportionately more soft plaque elements. Independent predictors of reference segment percent cross-sectional narrowing were male gender, patient age, diabetes mellitus, hypercholesterolemia and presence of multivessel disease. Independent predictors of reference segment calcification were patient age and serum creatinine levels. Reference segment percent cross-sectional narrowing in 723 patients undergoing transcatheter therapy was similar to that in patients studied for diagnostic purposes; however, reference segment arc of calcium was greater in treated patients (43 +/- 81 vs. 25 +/- 57, p = 0.015). Reference segment disease was not an independent predictor of subsequent angiographic restenosis or clinical events within 12 months of follow-up. CONCLUSIONS: Atherosclerosis is ubiquitous in angiographically normal coronary artery reference segments. Reference segment disease parallels the severity of target lesion disease and is associated with many of the conventional risk factors for coronary artery disease. Because of its sensitivity in detecting atherosclerosis in angiographically normal reference segments, intravascular ultrasound should enhance the study of risk factors for atherosclerosis and the results of therapies to control disease progression.

Age Factors↗
PubMed1995

Salmonellosis and mycotic aneurysm of the aorta. A report of 10 cases.

We report a 5 year experience of 10 cases of mycotic aneurysms of the aorta caused by salmonella infection. Of the 10 patients, nine were males and one was female in an age range from 60 to 80 years with a mean of 71 years. The major clinical manifestations were fever, abdominal or back pain, pulsatile abdominal mass and leucocytosis. The diagnosis was based on clinical symptoms and signs and positive blood or tissue cultures. The main confirmatory procedure was computed tomography (CT). Two year survival rate was 20%. Five patients died during hospitalisation, without surgery. Three patients died within 2 months of surgery. The other two patients, treated surgically and by intensive antibiotic therapy, survived. Death resulted usually from recurrent infection and graft leakage. Contrary to previous reports, salmonella mycotic aneurysm is still common in this geographical area and the prognosis is poor.

Aged↗
PubMed1995

Aeromonas bacteremia: review of 59 episodes.

Fifty-nine episodes of bacteremia due to Aeromonas species occurred within a 5-year period in one medical center in southern Taiwan. Underlying diseases in the 58 patients included hepatic cirrhosis (36%) and cancer (24%). Patients with aeromonas bacteremia more often had underlying hepatic cirrhosis than did those with bacteremia due to other gram-negative bacilli. Males (67%) outnumbered females. The cases appeared to cluster in the summer and fall months. Thirty-two percent were polymicrobial infections; often the Aeromonas pathogens were accompanied by other gram-negative bacilli. Aeromonas hydrophila was the most common species isolated (69%). In addition to fever, hypotension and jaundice were the common clinical manifestations of aeromonas sepsis. In cirrhotic patients, spontaneous bacterial peritonitis, altered mental status, and jaundice were most common, and aeromonas bacteremia in such patients was monomicrobial and community-acquired more often than in noncirrhotic patients. In vitro aeromonads were generally susceptible to aminoglycosides, cefuroxime, the third-generation cephalosporins, and quinolones. The overall crude fatality rate was 36%. Predictors of fatal outcome for cirrhotic patients included spontaneous bacterial peritonitis, hypotension on admission, diabetes mellitus, and high Pugh scores.

Adolescent↗
PubMed1995

Gas composition in Clostridium septicum gas gangrene.

Clostridial gas gangrene (myonecrosis) is a rare but catastrophic condition that usually occurs in patients with underlying diseases. This paper reports a fatal case of spontaneous clostridial gas gangrene in a 60-year-old female diabetic patient. The composition of gas samples from the patient's damaged muscle was analyzed. The results showed 5.9% hydrogen, 3.4% carbon dioxide, 74.5% nitrogen and 16.1% oxygen. This gas composition supports the belief that such gas production occurs via glucose fermentation. This is the first time such an analysis has been performed in a clinical case of spontaneous clostridial gas gangrene.

Clostridium↗
PubMed1995

Antimicrobial susceptibility and beta-lactamase production of Moraxella catarrhalis isolates in Taiwan.

Between 1 August 1993 and 31 July 1994, 135 clinical isolates of Moraxella catarrhalis were collected from 12 large medical laboratories in Taiwan. The majority of specimens came from sputum (124 isolates). Other specimens included four isolates from throats, three isolates from wounds or pus, two isolates from eyes, one isolate from blood and one from cerebrospinal fluid. Epidemiologically, M. catarrhalis isolates were found frequently in winter and spring with a peak in February, and only sporadically from April to September. The overall rate of beta-lactamase producing isolates was 98.5% (132/135). All isolates were considered to be ampicillin-resistant, none were found to be resistant to other beta-lactam agents. Among other antimicrobial agents, all isolates were susceptible to chloramphenicol, erythromycin, roxithromycin, ofloxacin and ciprofloxacin, but uniformly resistant to trimethoprim (minimum inhibitory concentration (MIC) > or = 4 micrograms/mL, zone diameter < or = 19 mm). There were 12 isolates (8.8%) resistant to sulfamethoxazole (MIC > or = 32 micrograms/mL, zone diameter < or = 19 mm) and 19 isolates (14.4%) resistant to tetracycline (MIC > or = 16 micrograms/mL, zone diameter < or = 19 mm). The high level of resistance to ampicillin due to beta-lactamase production indicates that this is no longer a reliable agent for the treatment of M. catarrhalis infections. Among the beta-lactam agents tested, amoxicillin + clavulanate and the cephalosporins were active. These agents appear to be reliable first-line therapies when infection with M. catarrhalis is suspected. Misidentification of the species and difficulties in determining susceptibility to ampicillin are still widespread in Taiwanese laboratories. The application of the butyrate hydrolysis test and an appropriate test for beta-lactamase production is necessary for the resolution of these problems.

Adolescent↗
PubMed1994

Clinical significance of distal embolization after transluminal extraction atherectomy in diffusely diseased saphenous vein grafts.

Standard balloon angioplasty of degenerated saphenous vein graft lesions may be complicated by distal embolization, particularly in the presence of intragraft thrombus. Transluminal extraction atherectomy may be useful in this setting because of its ability to remove particulate debris. This study was designed to identify the incidence and prognostic significance of distal embolization after transluminal extraction atherectomy in high-risk saphenous vein graft lesions. To address these issues the clinical course of 65 consecutive patients (86 high-risk saphenous vein graft lesions) was reviewed after extraction atherectomy. Distal embolization occurred in 11 (12.8%) of 86 high-risk lesions. The majority (63.6%) of these episodes occurred after adjunct balloon dilatation following uncomplicated use of the extraction atherectomy catheter. Correlates of distal embolization included patient age and the presence of intragraft thrombus. Major in-hospital complications developed more often in patients with distal embolization (46% vs 2% in those without distal embolization, p < 0.001), resulting in a reduced procedural success rate in this group (55% vs 91%, p = 0.01). We conclude that the risk of distal embolization after saphenous vein graft angioplasty, although potentially reduced, is not eliminated with transluminal extraction atherectomy, particularly in lesions with superimposed thrombus.

Aged↗
PubMed1994

Primary coronary angioplasty in patients with acute myocardial infarction.

In some patients with acute myocardial infarction, thrombolytic therapy may be limited by its failure to reperfuse the occluded artery, by recurrent ischemia (despite initially successful reperfusion), and by major hemorrhagic complications. Primary coronary angioplasty may circumvent these limitations. This article reviews the results of primary angioplasty reported in patients with myocardial infarction and makes recommendations for its use. The review includes pertinent articles found in the English language literature from July 1987 to July 1993 on MEDLINE. Nonrandomized series of primary angioplasty in acute myocardial infarction have demonstrated high procedural success rates (86% to 99%) and infrequent recurrent ischemia (4%). Two randomized trials comparing primary angioplasty and thrombolytic therapy have shown that primary angioplasty results in lower mortality, less recurrent ischemia, shorter length of hospital stay, and improved left ventricular function. Two other randomized studies have shown little benefit from primary angioplasty on myocardial salvage, recurrent ischemia, or ventricular function. One major limitation of primary angioplasty is that it requires 24-hour availability of a catheterization laboratory and experienced surgical personnel. Primary angioplasty may be the preferred approach in patients with extensive myocardial infarction who have immediate (< 120 min) access to a cardiac catheterization laboratory with experienced personnel. Patients having 1) contraindications to thrombolytic therapy, 2) cardiogenic shock, 3) prior coronary bypass surgery, or 4) "stuttering" onset of pain may also benefit from primary angioplasty. Poor candidates for this procedure are those with a small myocardial infarction, those in whom undue delays in access to a cardiac catheterization facility would be expected, or those with complex coronary anatomy, including left main coronary artery disease.

Angioplasty, Balloon, Coronary↗
PubMed1993

Clinical and angiographic outcome after directional coronary atherectomy. A qualitative and quantitative analysis using coronary arteriography and intravascular ultrasound.

To assess clinical and angiographic outcome after directional coronary atherectomy, the clinical course of 306 patients undergoing this procedure was reviewed. Directional atherectomy was successful in 290 (94.8%) procedures; complications developed in 8 (2.6%) patients. After atherectomy, percent diameter stenosis was reduced from 71 +/- 14 to 14 +/- 14% (p < 0.001) and minimal lumen diameter was increased from 0.87 +/- 0.42 to 2.55 +/- 0.57 mm (p < 0.001). In 128 (42%) patients, adjunct balloon angioplasty was performed to treat either complications or a residual stenosis > 30%. Intravascular ultrasound was also performed in 57 patients after directional atherectomy and demonstrated that a significant amount of residual plaque mass remained in lesions with a calcium arc > or = 90 degrees (17 +/- 5 mm2 vs 12 +/- 5 mm2 in lesions without calcium; p = 0.007). During the 11 +/- 6 month follow-up period, 69 (28.3%) patients developed recurrent clinical events (death, 5; Q wave myocardial infarction, 8; coronary bypass surgery, 31; coronary angioplasty, 36). Using a proportional hazards model, independent predictors of late clinical events included diabetes mellitus (relative risk [RR] = 1.95; p < 0.05), unstable angina (RR = 2.78; p < 0.005) and a prior history of restenosis (RR = 2.21; p < 0.01). We conclude that directional atherectomy is associated with high procedural success rates and infrequent complications in selected lesions subsets, although the degree of plaque resection may be limited if extensive calcium is present. Late clinical events develop in some (28%) patients after directional atherectomy, related to certain preprocedural clinical risk factors.

Atherectomy, Coronary↗
PubMed1993

Vascular complications after balloon and new device angioplasty.

BACKGROUND: Despite their potential advantages, new coronary angioplasty devices may be associated with more frequent vascular complications than noted after standard balloon angioplasty, theoretically due to the larger sheaths and prolonged periods of anticoagulation required by some of these devices. This study sought to identify the incidence, predictors, and clinical outcome of vascular complications after new device angioplasty. METHODS AND RESULTS: The clinical course of 1413 patients was reviewed after balloon or new device angioplasty. Vascular complications were defined as formation of a pseudoaneurysm, arteriovenous fistula, retroperitoneal hematoma, or groin hematoma associated with a > 15-point hematocrit drop or the need for surgical repair. Stepwise logistic regression was used to identify independent predictors for vascular complications. Vascular complications developed after 84 (5.9%) procedures; they occurred more frequently after intracoronary stenting (14.0%) and extraction atherectomy (12.5%) than after balloon angioplasty (3.2%) (odds ratios, 4.86; P < .001, and 4.26, P < .05, respectively). Independent predictors of vascular complications included the use of intraprocedural thrombolytic agents (P < .01), intracoronary stenting (P < .005), or extraction atherectomy (P < .05); high maximum creatinine level (P < .005); low nadir platelet count (P < .001); longer periods of excess anticoagulation (P < .05); and the need for repeat coronary angioplasty (P < .005). Vascular complications were not related to the size of the arterial sheath used. CONCLUSIONS: Vascular complications developed more frequently after new device angioplasty than after balloon angioplasty, with the risk for vascular complications directly related to the degree of periprocedural anticoagulation.

Aneurysm, False↗