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Y Guérin

Publications and source records attributed to Y Guérin.

At least 37 records · Page 2Linked to original sources
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

Rotational atherectomy with adjunctive balloon angioplasty versus conventional percutaneous transluminal coronary angioplasty in type B2 lesions: results of a randomized study.

A randomized pilot study was performed comparing conventional balloon angioplasty (percutaneous transluminal coronary angioplasty [PTCA] group) and rotational atherectomy (RA) with a medium size burr (50% to 70% burr/artery ratio) with systematic adjunctive balloon angioplasty (RA group) in type B2 stenosis. A total of 64 patients were included. Primary success was 93.7% in the RA group and 87.5% in the PTCA group (p = NS). Technical failure with no complication occurred once in each group. Acute complications occurred in three patients in the PTCA group and in one in the RA group. Angiographic restenosis rates were similar (RA group: 39%, PTCA group: 42%, p = NS) with a follow-up rate of 93%. In type B2 lesions, when compared with conventional angioplasty, RA with systematic balloon angioplasty does not seem to increase procedural success, and the restenosis rate remains comparable. However, these results must be confirmed in a larger series of patients.

Aged↗
PubMed1996

[Coronary artery stenting without antivitamin K. Results after a month].

This paper reports experience with a new antithrombotic agent prescribed to reduce the incidence of subacute occlusions during the first month after coronary stenting. Therefore, a powerful association of platelet antiaggregant agents was tested. From December 1992 to October 1994, coronary stenting was successfully achieved in 1,294 patients (1,118 men, average age 60.5 +/- 10 years) who were then treated with the association of ticlopidine 0.25 g/day and aspirin 0.10 g/day for one month. This was covered with anticoagulation with a low molecular weight heparin for a variable period (one month, two weeks, then one week), according to the different phases of the study protocol. In all, 1487 stents were successfully implanted (1,330 Palmaz Schatz; 63 Cook; 80 Wictor; 13 AVE and 1 Strecker) in 1,326 vessels (520 left anterior descending, 208 left circumflex, 475 right coronary, 16 left main coronary arteries and 107 venous grafts) using balloon catheters of 2.5 mm to 5 mm diameter for average 3.45 +/- 0.4 mm). Major complications in the first month included 9 deaths (0.7%), 22 occlusions (1.7%): 14 myocardial infarcts (1%) and 11 aorto-coronary bypass procedures (0.85%). There were 136 local haematomas or false aneurysms (10.5%), 42 of which (3.25%) required blood transfusion or surgical repair. This multicenter trial of a protocol associating platelet antiaggregant agents and low molecular weight heparin for one month showed a low incidence of subocclusion after coronary stenting (1.7 +/= 2.5%) and should enable interventional cardiologists to widen the indications for coronary stenting.

Adult↗
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

[Autoimmune asthenospermia induced by an epididymal protein, ovine prealbumin (oPES)].

The motility of ejaculated spermatozoa (% of progressive spermatozoa) has been evaluated visually on 26 adult rams. Half the animals were immunized with a secretory epididymal protein (prealbumin epididymal-specific (PES) ovine) injected according to immunizing protocols (Freund or Hunter adjuvant) intraperitoneally or intradermally (Freund or Hunter adjuvant) or intramuscularly (Hunter adjuvant or PES only). The other animals received the same product without the protein (controls). The product resulted in a strong asthenospermia which parallels the transient presence of anti-PES antibodies in the seminal plasma. A study with 64 ewes showed that the fertility of 10 immunized rams that had recovered sufficient forward motility to ensure fertilization, did not differ from that of control rams.

Animals↗
PubMed1995

[Restenosis: physiopathology, treatments and prevention].

Despite fifteen years of extensive research, we still do not know how to predict or prevent restenosis. Angioplasty induces lesions in the intima, media and sometimes adventitia, resulting in a cicatricial process comprising proliferation and migration of smooth muscle cells towards the intima and secretion of extracellular matrix, leading to the formation of a neointima. Since angioplasty is associated with the simultaneous development of neointimal hyperplasia and restenosis, a cause and a effect relationship has therefore been proposed between neointimal hyperplasia and restenosis. All the restenosis prevention strategies based on inhibition of smooth muscle cell proliferation, which successfully limited restenosis in animal models have failed in man, due to the hazardous extrapolations from experimental models which are very different from the atheromatous lesions observed in man, rather than to the use of animal models in general. It is reasonable to wonder whether we have not selected the wrong target: is smooth muscle cell proliferation really responsible for restenosis? Experimental results supported by histological and ultrasonographic data in man, show that the cicatricial process which induces restenosis consists of constrictive remodelling, which decreases the perimeter of the external elastic lamina and the lumen. The use of stents appears to be the primary strategy designed to limit restenosis and prevent constrictive remodelling in man, even if it stimulates neointimal hyperplasia. Progress in the understanding of the mechanisms of postangioplasty remodelling open new perspectives in the prevention of restenosis.

Angioplasty, Balloon, Coronary↗
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

[Multiple pulmonary coronary fistulae. Apropos of a case].

Coronary-pulmonary fistula is a rare congenital anomaly. It is usually detected fortuitously in adulthood during a coronary angiography carried out to assess signs of myocardial ischemia. Multiple coronary fistulae are still more rare. Coronary angiography evaluates the lesions and indicates the most appropriate treatment. The congenital lesions are frequently combined with atheromatous lesions. The case described is that of a double fistula in a 61-year old man which was revealed by angina; the stenoses and occlusions which accompanied the fistulae lead to a discussion of their atheromatous nature and the nature of the pathological link between them: is this fortuitous or are they a progressive complication? Treatment involves both exclusion of the fistulae and coronary revascularization.

Arterio-Arterial Fistula↗
PubMed1993

[Coronary angioplasty combining rotational atherectomy and balloon dilatation. Results in 67 complex stenoses].

The treatment of complex coronary stenoses by conventional angioplasty is limited by a relatively low angiographic success rate, associated with a high risk of major complications. The role of new angioplasty techniques in the treatment of these lesions has not yet been determined. The aim of this prospective study was to evaluate the systematic association of rotational atherectomy (Rotablator) with balloon angioplasty on coronary stenoses characterised by at least 2 type B criteria of the ACC/AHA classification (type B2 lesions). The procedures was begun with rotational ablation with a medium-sized burr (50 to 70% of the reference diameter of the artery) and completed systematically by balloon angioplasty (balloon/artery ratio = 1), using the lowest possible inflation pressures for successful dilatation. This technique was used in 61 patients who had 67 coronary stenoses with a primary success rate (residual stenosis < 50% and no major complications) of 93.4% (57 patients). One emergency coronary bypass procedure was necessary and another patient developed transmural infarction on the 3rd day after the procedure. There were two technical failures (3.3%). The mean inflation pressure of the balloon was 4.1 +/- 1.2 atmospheres. There were no fatalities. During atherectomy, transient conduction defects were observed in 4 patients (6.6%): severe hypotension in 2 patients (3.3%) and complete spasm in 3 stenoses (4.5%). A significant increase in cardiac enzyme levels was observed in 4 patients (6.6%). The authors conclude that rotational atherectomy with a medium-sized burr, followed by systematic low pressure balloon dilatation allows treatment of certain complex coronary stenoses with a high primary success rate and few major complications.(ABSTRACT TRUNCATED AT 250 WORDS)

Angioplasty, Balloon, Coronary↗
PubMed1992

[Stenosis of the common trunk of the left coronary artery: an unusual complication of percutaneous coronary angioplasty].

The recurrence of angina-type pain within a few months of successful coronary angioplasty usually indicative of a diagnosis of coronary re-stenosis. A control coronary artery angiograph sometimes eliminates this diagnosis by detecting a fresh coronary stenosis. The authors report a case of a tight stenosis of the left major coronary trunk a few months after angioplasty of the circumflex artery. The onset of a stenosis of this type leads to the discussion of the possible role of a traumatic lesion of the wall of the major trunk by the catheter-guide.

Adult↗
PubMed1992

[Spasm of the left main coronary artery resistant to intracoronary vasodilators. Apropos of a case].

Coronary spasm is essentially and angiographic diagnosis. Catheter-induced spasm is frequent during coronary angiography and usually regresses after the administration of intracoronary vasodilators. The authors report a case of coronary spasm with subocclusion of the left main coronary artery: the coronary narrowing remained significant after intracoronary vasodilator therapy, suggesting an organic component. The spasm was relieved only after a prolonged intravenous infusion of isosorbide dinitrate.

Angina Pectoris, Variant↗
PubMed1991

[Retrograde dissection of the common trunk of the left coronary vessel during angioplasty of left anterior descending coronary artery. Apropos of 2 cases].

Acute dissection of the left main coronary artery during coronary angiography or angioplasty is a rare but well known complication; it is attributed to a mechanical trauma caused by the tip of the catheter guide wire. The authors present two cases of dissection at the site of coronary angioplasty with a retrograde extension to the left main stem requiring emergency coronary surgery.

Aged↗
PubMed1990

[Father-male offspring transmission of seasonal variations in testicular diameter and percentage of abnormal sperm in the Ile-de-France ram. 1. Male offspring born in February].

An experiment was conducted on the Ile-de-France (IF) breed to determine if the more or less important sensitivity of the ram to photoperiodism came under genetic control. Five base breed unrelated rams (greater than or equal to 4 yr old), were chosen for this study: 2 good (I and II), 2 bad (III and IV), and an intermediate sire (V). Ram I, which died a few years before the experiment began, was selected on both the low amplitude of its sperm production during a 6-month period of artificial lighting and the very high fertilizing capacity of its sperm in spring. Rams II to V were controlled for 12 (percentage of morphologically abnormal spermatozoa, AM) or 14 (maximum antero-posterior scrotal diameter of both testes, DT) consecutive months. Following this period of control, seasonal variation in rams was assessed as follows: low (ram II), high (rams III and IV) and intermediate (ram V) seasonal variation rams. Breeding (artificial insemination) of these 5 rams to IF ewes resulted in 18 male offspring born in February and distributed as follows: rams I to III: 4 male offspring/ram (families 1 to 3, F1 to F3), rams IV and V: 3 male offspring/ram (families 4 and 5, F4 and F5). The 18 animals were controlled once a week (DT and AM) from 8, 5 to 46 months of age (7 periods, P1 to P7). Regarding DT, mean DT was higher in F1 and F2 than those of the whole population (WP) (represented by a discontinuous line of ordinate 5.0 in Graph 3), but F2 was closer to this population than F1. On the other hand, they were lower in the rams of F3 and F4. Differences between F3 or F4 and WP were lower in autumn than in spring. All families showed significant differences during the experimental periods except at P7 for pairs 3-5 and 4-5. Distances between F1, F2, F3 were always different (P less than 0.01 or P less than 0.001), whatever the size of the population (n = 3 or 4). Weekly F5 values varied in an opposite way to those of F3 and F4: increase in spring and decrease in autumn. Regarding AM, families did not differ as much as in DT (graph 4). Weekly variations in AM were also stronger. However, mean AM was almost always lower in F1 males and somewhat higher in F3 males to that of WP.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗